A publication for Staff and Physicians of IH
Dr. Halpenny introduces “Every person matters.”
Preparing for the 2015 Employee Engagement Survey.
Thanks to dedicated staff, collaboration, and CSI-like science.
Unique video series supports nurse practitioner integration.
Dietetic interns come home to further their learning.
The choice is yours.
Helping residents live life to the fullest.
Featuring LPN Lee-Ann Seidler and South Okanagan General Hospital.
The many communities that make up where we live, work, and play.
Snapshots of our staff in action and trending health & wellness videos.
Meet KGH’s newest dietetic interns. Story p. 10.
The @InteriorHealth magazine is a monthly publication created by the Communications Department of Interior Health. Past issues of @InteriorHealth can be found on our website under About Us/Media Centre/Publications & Newsletters. If you have story ideas for future issues, please e-mail: IHAcommunications@interiorhealth.ca Deadline for submissions to the April 2015 @InteriorHealth magazine is March 11. Editors: Amanda Fisher, Breanna Pickett Designers: Breanna Pickett, Kara Visinski, Tracy Watson IH Communications Contributors: Lisa Braman, Lesley Coates, Susan Duncan, Patrick Gall, Karl Hardt, Megan Kavanagh, Breanna Pickett, Erin Toews, Tracy Watson
Every person matters
I would like to use my message in this month’s @IH to share news about a topic that will resonate with all employees because it’s about you, as well as everyone you interact with as you go about your work each day.
Every person matters.
CEO, Dr. Robert Halpenny
At Interior Health, we want to set new standards of excellence in the delivery of health services in B.C. and to also promote healthy lifestyles and provide needed health services in a timely, caring, and efficient manner. To achieve this, we are guided by the following strategic goals: Goal 1 Goal 2 Goal 3
Goal 4
The articles featured in the @IH newsletter are great examples of how we’re achieving our goals … and realizing our vision and mission.
This is a concept that has come out of focus groups held across the organization in 2014 where we were looking for input into our strategic direction. Managers, staff, and physicians provided valuable feedback and voiced a desire to see “Every person matters” as an overarching model for patient/ resident/client care and staff /physician/ volunteer engagement – for it to be the culture of Interior Health.
the people we care for, and everyone we interact with. For that reason, it has been added as the centre point of our IH Strategy Map, tying our four IH goals together with a “people” element that speaks to inclusiveness. It encompasses patients, clients, and residents, as well as our staff and physicians, and all the other individuals and organizations we interact with on a day-to-day basis. “Every person matters” is also the new tagline that we are introducing for Interior Health, to replace “For your whole life”, and you will start to see it paired with our logo and in many of the materials we produce for internal and external audiences.
In the last several months, the Senior Executive Team, the Board of Directors, our leadership teams, and physician leaders have been involved in “Every person matters” discussions. In all cases, it has been embraced as an opportunity to strengthen our engagement efforts and develop a stronger, visibly caring culture. There is also support for seeing it put into practice in a variety of ways, but with a specific emphasis on a grassroots momentum for this culture change. “Every person matters” underpins everything we do and is truly an extension of our organizational values – Quality, Integrity, Respect, and Trust. We want it to be the guide for our actions and behaviours overall and the foundation for how we treat one another,
I know there are many areas of IH where this very concept is already “the way of being”, so I would like to see that grow and spread and be the “the way we are” across the organization as a whole. It’s a choice we can each make individually to have a positive impact collectively. I’m in!
L
ater this year, Interior Health employees will be asked to complete an Employee Engagement Survey. In preparation, we want to know what each of the 12 questions means to you, and how it relates to your level of employee engagement.
The question to discuss throughout March is:
Q11: In the last six months,
someone has talked to me about my progress. Each employee excels in at least one area. Research shows that too often, managers focus on areas that need improvement instead of areas of excellence when, in fact, great gains are made by building on talent, instead of trying to improve weaknesses. When both manager and employee identify a task at which the employee truly excels, they can work together to create a development plan that supports the individual’s full learning potential, positioning the employee to make his or her greatest contribution to the organization. When a manager is regularly checking in with an employee about progress and development, the employee feels more engaged, is more likely to plan on staying with the company, and is more than twice as likely to recommend the company to others as a great place to work.
contributions progress
potential
excellence
With this explanation in mind, share your thoughts with us! Does your manager encourage you in areas that you excel? Do you feel as though you work to your full potential? Please send your feedback to YourOpinionsCount. In last month’s @IH, we discussed the following question: Q10. I have a best friend at work. The complete list of responses is posted on the Engagement web page.
Dr. Sue Pollock, Medical Health Officer and Lori Hiscoe, Operations Manager – Communicable Disease Unit, review the genomic data used to confirm the end of the TB outbreak.
Written by: Lesley Coates, Public Health Communications Officer
I
always thought that declaring an outbreak over sounded like a dramatic event, perhaps involving a gavel, maybe a megaphone or even a town crier.
On Jan. 29, I was present when Dr. Sue Pollock, Medical Health Officer declared the six-year Central Okanagan TB (tuberculosis) outbreak over. Although it wasn’t quite as dramatic as I had envisioned, I knew I was part of an important moment made possible by dedicated staff, collaboration, and what I can only describe as CSI-like science. Dr. Robert Parker, Medical Health Officer, recalls the early days of the outbreak. “Prior to 2008, we did see a few TB cases each year, but we didn’t really see active, ongoing TB transmission. However, in late May 2008, when we identified TB in an individual staying at a local shelter, we knew we had a high-risk situation. Additional case finding confirmed we had active TB transmission occurring and we knew that we were probably facing a multi-year outbreak.” The outbreak occurred primarily among homeless populations in the Kelowna area with a small number of linked cases identified in the communities of Penticton and Salmon Arm. During the course of the outbreak, 52 active TB cases were identified and approximately 2,400 contacts were exposed to infectious TB.
Above: Staff at KGH received hands-on TB skin test training during the outbreak. Right: Street nurses and outreach workers played an essential role in connecting with hard-to-reach clients.
Dr. Pollock, who led the Outbreak Management Team for the last three years, emphasizes that many factors contribute to these kinds of outbreaks. “Outbreaks among the homeless are strongly related to social determinants of health and disparities in employment, income, safe housing, and access to health care. They typically last several years and require a tremendous amount of resources and community coordination to bring under control.”
Decision-support tools were implemented. We provided additional training and fit testing for the use of N95 respirators, and our TB screening programs were ramped up for staff working in higher-risk departments.” Managing the TB outbreak also involved a CSI-like science called genomics. Now, if you are wondering what genomics are, believe me, you are not alone. On paper it looks like a boring and meaningless spreadsheet of numbers, letters, and colours. But you can’t help but get excited about it if you are fortunate enough to hear the very enthusiastic Dr. Jennifer Gardy, Senior Scientist at the BC Centre for Disease Control (BCCDC), talk about what it all means.
The outbreak was challenging to manage. Those most at risk were often transient and had little interaction with health-care providers. To overcome this, medical health officers and the Communicable Disease Unit worked closely Dr. Gardy, a genomics whiz, used DNA from the TB with community outreach services including street nurses, bacteria and other data collected by nurses during the shelters, and community agencies. outbreak to identify cases that were connected to the outbreak and to better understand how the outbreak Through these partnerships, street-savvy outreach workers spread from person to person. Her most recent analysis in used their connections to reach hard-to-locate clients January 2015 confirmed there was no evidence of ongoing and regular screening and symptom checks were offered transmission – the outbreak was indeed over. I n locations where the clients felt safe and comfortable. On Jan. 29 as I watched Dr. Pollock declare the Sharon Cook, Kelowna General Hospital (KGH) Health outbreak over and listened to reflections on the people, Service Administrator, notes the outbreak also had a partnerships, and events of the last six years, two things significant impact on acute services. struck me. The first – managing and ending a six-year TB outbreak is no easy task. I hope all those involved are very “A TB outbreak in the community meant we would see proud of their innovation, perseverance, and dedication. more TB patients in our hospital, so we needed to take The second – our medical health officers really do need a additional measures to reduce the risk to patients and gavel. staff. Our older negative-pressure isolation rooms at KGH were upgraded to meet new Infection Prevention and For more information and resources on TB, visit the BCCDC Control and Workplace Health and Safety guidelines. website > Tuberculosis.
(L-R) Dana Jones, Nurse Practitioner; Donna Mendel, Interior Health Regional Practice Leader; and Nelly Oelke, UBCO Assistant Professor, School of Nursing.
Lights. Camera. Action!
N
urse practitioners play a vital role in supporting the health needs of our patients and, since 2005, they have steadily been integrated throughout our health region. Bringing a new health-care provider into a complex, established health-care system has generated excitement, presented learning opportunities, and created questions along the way.
“We are seeing some repeating themes emerge around NP integration,” says Donna Mendel, Regional Practice Leader, Professional Practice Office. “The public, administrators, physicians, specialists, nurses, and members of Allied Health want to know how NPs fit into existing teams, how they work independently, and how they collaborate with physicians.” In 2012, at the Interior Health Rural Health Services Research Conference, some of these themes were brought forward. Conference participants discussed how they could use research as a means of supporting the collaboration between NPs and the multi-disciplinary health-care teams within Interior Health, particularly in primary health care. From these conversations, an exciting collaborative research project sparked between the School of Nursing at the University of British Columbia, Okanagan (UBCO), and Interior Health’s Professional Practice Office. Over the last 18 months, research activities included a detailed literature review, interviews, and stakeholder workshops resulting in a number of recommendations to clarify the role of NPs and promote their integration within the health-care system. “The results of our research led us to developing a series of three informational videos about NPs, how they work
within the health-care team, and the impact they have on the health-care system,” says Donna. Sharing the results of a research project through video is in itself unique and, in this case, the NP videos can also be used to raise awareness and increase understanding for patients, families, health-care providers, physicians, and administrators about the role of the NP. “We are thrilled with the outcome of this research study,” says Nelly Oelke, Assistant Professor for the School of Nursing at UBCO. “It has prompted discussions and action in NP integration, strengthened partnerships between researchers and decision-makers, and will provide the foundation for future research.” The NP
videos are located on the IH YouTube channel and consider the following questions: What is the role of a nurse practitioner? How are nurse practitioners integrated in the health-care team? What impacts do nurse practitioners bring to health-care systems?
An online photo album depicting “the making-of” the NP videos is posted on the UBCO Facebook page. Donna knows these videos are just one step to further NP integration, but it’s a step in the right direction. “Our hope is these videos will be shared across our health authority and throughout B.C. to educate all health-care professionals who work with NPs, and to increase understanding of the collaborative role NPs play in health care.”
Photos taken during filming of a three-part video series that highlights the role of nurse practitioners in our health-care system. Above left, Nurse Practitioner Dana Jones. Above right, Dr. Guy Fradet (L) and Nurse Practitioner Wayne Senner receive direction from the videographer.
Nurse practitioners work in partnership with physicians and other health-care professionals to provide quality care to people of all ages, families, groups and communities. NPs are registered nurses with additional education at the Master’s level and are qualified to diagnose and treat illnesses; order tests; prescribe medications; and manage, monitor and review chronic health conditions. Within Interior Health, there are currently 40 NPs working in a variety of settings including: caring for the elderly in residential care; partnering in care with First Nations communities; providing primary care in a number of rural communities; and caring for patients in the cardiac and thoracic programs.
Dietitian internship program offers students experience in their own backyard
W
hen Allison Verigin and Heather Gregory completed their fourth year in UBC’s dietetics degree program, they knew exactly where they wanted to apply for their one-year internship.
“Interior Health was the first choice for both of us,” says Heather, with Allison nodding in agreement. Today, they are Kelowna General Hospital’s two newest dietetic interns. Both Allison and Heather were born and raised in the small community of Castlegar, situated in the southeast corner of B.C. They also graduated together from Stanley Humphries Secondary School before heading down to Vancouver to enter into the dietetics degree program.
The internship combines school work with hands-on clinical experience. It also pairs students with dietitian preceptors in different areas of practice and provides them with shortterm placements at facilities throughout Interior Health. “We take two students here in Kelowna and two in Kamloops,” says Lisa Koski, Professional Practice Lead Dietitian and coordinator of the Dietetic Internship Program in Kelowna. “It’s a really great program from start to finish,” says Lisa. “The education of health professionals adds value to the region as a whole and, more importantly, the clinicians working with the interns benefit from teaching and mentoring students: it’s a win-win!” Lisa and her Kamloops counterpart, Dawn Benwell, say many dietetic interns are hired in the health authority where they complete their internship. Recruitment and retention of staff is a big initiative across all of IH internship programs. One of last year’s dietetic internship students, Haeli Draper, is now working in Kelowna for IH. She was offered employment upon completion of her internship and Allison and Heather hope to follow in her footsteps. “We’d both like to stay and work in the area,” says Heather. “I think I’d like to stay in Kelowna and gain some experience and then possibly one day look at returning to Castlegar.” Allison agrees that she, too, will consider returning to a smaller community, not necessarily Castlegar, but possibly somewhere in the Kootenay region.
Kelowna General Hospital’s two dietetic interns Allison Verigin and Heather Gregory on either side of Lisa Koski, Professional Practice Lead Dietitian and coordinator of the Dietetic Internship Program.
“We both still have family in Castlegar and on top of that we both still really enjoy what the B.C. Interior has to offer in terms of skiing, biking, outdoor recreating … etcetera,” says Allison. “So, it was a really easy choice for us to make when we were asked where we wanted to apply for our internship.” Interior Health partnered with the UBC Dietetics Faculty in 2007 to offer a complete internship program within the region. At present, UBC offers students placements in all health authorities across the province.
For now, the two classmates have another four months left in their internship, and are looking forward to the opportunities and experiences that await. “So far, we’ve done placements at many different sites across IH,” says Allison. “I was in Grand Forks for a week. It was nice to be so close to home and working in a professional capacity.” Once their internships are complete, the two have one last challenge ahead. As a requirement, they must pass their Canadian Dietetic Registration Exam in B.C. to certify with the College of Dietitians of British Columbia. On behalf of IH, we wish Allison and Heather the best of luck.
H
IV, once considered a death sentence, is now a manageable medical condition. Early diagnosis and advances in treatment allow those infected with HIV to live long, healthy, and productive lives.
Unfortunately, despite advances in treatment, we continue to see deaths and severe illness due to HIV infection. The most common reason for this … a late diagnosis.
“When HIV infection is diagnosed early it can be managed like any other chronic infectious disease, with effective medication and regular medical follow-up.” In order to promote testing and earlier diagnoses, the Province recently released B.C. HIV testing guidelines. The guidelines recommend that HIV testing become part of the regular tests offered to all adults in the province.
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An early HIV diagnosis makes all the difference when it
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“An early HIV diagnosis makes all the difference when it comes to treatment outcomes and preventing the spread of HIV to others,” says Dr. Trevor Corneil, Medical Health Officer Physician Lead for the STOP HIV Program.
comes to treatment outcomes and preventing the spread of HIV to others
All HIV testing in B.C is confidential. Until recently there were two testing options that would allow you to determine how much personal information is shared when getting tested. You could get an HIV test using your name and contact information (nominal testing) or you could get a non-nominal test using a pseudonym (false name) or your initials. “Public health practitioners have been working hard to raise awareness about advances in HIV treatment, to reduce HIV stigma, and to normalize testing and we are definitely making strides,” adds Dr. Corneil. “At the same time, we know there are people out there who are reluctant to get an HIV test due to confidentiality concerns and we need to meet these people on their own terms.” Now a third option – anonymous testing – is available in the Interior Health region through the BC Centre for Disease Control (BCCDC) Anonymous Testing Pilot Project. When a person gets an anonymous HIV test, there is no collection of identifiable information. Anonymous HIV testing links test results to the person being tested using a code known only to them. All testing, recording, and reporting of results are made under the code. The person tested is then responsible for following up to get their results by providing their code. “Research in other sites that now offer anonymous testing tells us that it works. People are getting tested earlier and the vast majority return for their results,” says Dr. Corneil. “Testing for HIV is an obvious first step when engaging people in care, providing HIV treatment, and reducing the risk of transmission to others.” The anonymous testing pilot project has launched at various sites in the Lower Mainland and continues to expand to other testing sites around the province. BCCDC will be conducting a thorough evaluation of the anonymous HIV testing project with the results of the evaluation determining whether to offer anonymous HIV testing on an ongoing basis. For more information on HIV testing, visit My Health is Sexy.
Above: Jenna Ziegler, Health Outreach Nurse, discusses HIV testing with Dr. Trevor Corneil, Medical Health Officer. Right: (L-R) Jenna Ziegler, Nicola Shanks, and Kim Bucek are part of the IHwide Health Outreach Team. The team provides free and confidential HIV testing including the anonymous testing option.
Marg Kosa (at end of boat, waving) and Irma Baker (middle right) take Cottonwoods residents for a day on the patio boat.
ome puttered in their gardens. Others travelled around the world. Still more painted for relaxation or indulged in a mean hand of cards. People who now live in residential care facilities did all this and more before they entered long-term care. While no longer being able to live independently, many still enjoy participating in leisure activities that enhance their quality of life – thanks to recreation teams across Interior Health.
Leanne observes the Central Okanagan recreation team in action every day and is always impressed by their creativity and enthusiasm. The team includes recreation therapists Jenelle Leclair, Sharie Fehr, Carmen Cocarell, and Trevor Besse at Cottonwoods Care Centre, Darcy Jong at Brookhaven Care Centre, Lori Pell at Central Okanagan Hospice House, Jen Schellenberger at David Lloyd Jones Home, and Jane Rasmussen at Three Links Manor, as well as their larger recreation teams.
Recreation teams organize indoor and outdoor activities and outings that nurture residents’ interests, such as woodworking, cooking, baking, music, creative arts therapy, church services, exercise programs, pampering time, and scenic drives.
“Recreation teams in our Interior Health homes take their cues from residents and their families about what they are interested in – either something they did before they entered care or something they’ve always wanted to try,” says Leanne.
“It can be as simple as a game of Cribbage or Bingo,” says Leanne Brager, Assistant Manager for Central Functions, including the recreation team at Cottonwoods Care Centre.
For instance, Roy, who lives at Brookhaven Care Centre, was able to indulge his passion for sailing by going on sailing outings with recreation therapist Darcy.
Top left: Roy’s passion for sailing hasn’t stalled since he’s been at Brookhaven Care Centre. He attends outings with recreation therapist Darcy Jong. Top right: At Cottonwoods Care Centre, Carolyn Ward helps residents enjoy Canada Day. Bottom left: Olivia Massegnan leads residents in song at Cottonwoods’ Resident Talent Show in November. Bottom right: Residents like Brent enjoy dabbling in artwork.
“Recreational activities help to enhance a person’s quality of life,” says Leanne. “They improve physical, social and cognitive abilities. They also build confidence, increase independence and strengthen interpersonal skills as well as enrich life through growth and development.” Sometimes, they just make someone smile. In February, to help celebrate Recreation Month, the Leisure Department at David Lloyd Jones Home surveyed residents about their favourite programs. Their answers were as varied as the residents themselves. In fact, in February alone, David Lloyd Jones Home offered more than 35 types of recreational events, many of which occurred at least once per week. Ernie became emotional as he spoke about regular visits to Orchard Park Mall. He says when the bus arrives at the mall and he spots his wife Thelma waiting for him, “it’s almost too good to be true!” These trips allow Ernie and Thelma to get out together and enjoy a restaurant meal
or a picnic luncheon. Larry says he never wants to stop learning, so he particularly enjoys the cognitive programs, such as crossword puzzles or discussions on current events. He says every time he attends one of the discussion groups, it makes him think and wish to learn more. And long-time resident Clara says she loves the “Armchair Travel” program. The presentations about different cultures or countries through food, maps, and pictures allow her to re-live the years she spent travelling with her husband. “Recreation programming in Interior Health exemplifies Patient-Family-Centered-Care,” says Vanda Urban, Residential Health Service Administrator for the Central Okanagan. “It allows the resident to make choices about how they wish to spend their leisure time.” Read more about what IH’s Recreation Staff does in the Interior Health Resident and Family Handbook.
Lee-Ann Seidler, LPN @IH: How long have you lived in Oliver? Forever (laughs). @IH: How long have you worked at the South Okanagan General Hospital (SOGH)? In 1979, I graduated from Selkirk College in Nelson. That same year, I started working casually at SOGH. It was a brand new facility. I worked here for approximately eight years as an LPN, then I started working in acute care and have been here ever since. @IH: How has SOGH changed over the past 35 years? When I first started at SOGH, we were a 45-bed hospital, not including our long-term care facility, McKinney Place. We did surgeries two to three days a week, we delivered babies, pediatrics, cardiac, ED … we were a bunch of everything all rolled into one. Now, we’re an 18-bed hospital with a capacity of 25. We do daycare procedures and still have our ED, we do cardiac to detox to psychiatrics to rehab. Being a small rural hospital, our ward cares for a variety of patients and their needs. It’s really changed over the 35 years I’ve been here. @IH: What are some of the “big events” that stand out for Lee-Ann out for a walk with her dog Scout in Oliver. you over the 35 years you’ve been there? Well, in 1999 the SOGH was chosen as the pilot project for LPN’s going full scope. So, in 1999 all the nurses, both in acute and at Mckinney Place, upgraded their pharmacology course and started giving medications and taking full patient loads. That was a big thing for us. Then, around that same time, we were also the pilot project for electronic charting. Both were big learning curves and both happened at the same time. It was a crazy sort of time, but we all went through it and we all survived. Another big event was having our former charge nurse, Gayle Duteil, become BCNU’s new president this past year. @IH: What’s special about SOGH that you perhaps wouldn’t find at another hospital? Because we’re a small hospital, we’re very personal. We sing happy birthday to staff and patients, we give hugs to patients we’ve cared for over a long period of time, and we all wish them well. It’s a real homey sort of feeling here. @IH: What advice would you give young nurses starting at SOGH? Whenever I take on a nurse under preceptor training I always emphasize kindness. The patient might not be feeling good, they might have come in under a very duress situation, and they might not be on their best behaviour or the kindest or politest … but if you always show them kindness, then you will eventually get it in return. Also, don’t take your work home with you! @IH: What would you say is the best part of working at SOGH? My co-workers and the fact that it’s a small hospital, I like that about it best. Everybody is like family here. We care for everyone and make sure we always take care of each other.
South Okanagan General Hospital, Oliver
82,000
Meals served to patients
4,160
2,665
Meals on Wheels prepared
737
Lab exams per day
Gathered from 2013-2014 data
18
Pounds of bananas ordered
Acute-care beds
15,428
Unscheduled emergency department visits
45
Years old
Kamloops Submitted by: Jennifer Maier
Kalamalka Lake Submitted by: Tye Kober
West Chilcotin Submitted by: Tammy Thielman
Coldwater River, Merritt Submitted by: Patricia Zumino
Williams Lake Submitted by: Russell Chartier
Where We Live & Work ... A Spotlight on Our Communities Covering over 215,000 square kilometres, Interior Health is diverse in nature and composed of vibrant urban centres and unique rural communities. Photos are submitted by employees and posted to the InsideNet. Select photos are featured in @IH. Submit your photos of the beautiful places that make up IH: InsideNetWebmaster@interiorhealth.ca
(L-R) Royal Inland Hospital Foundation chief executive officer Heidi Coleman cuts the ribbon with philanthropist Guy Mercier and wife Kam Khunkhun, Health Minister Terry Lake, RIH Evening Auxiliary president Jenny Quince and Dr. Anders Ganstal, RIH Emergency Department Physician Lead, during an event to mark the completion of a renovation to the Trauma Room in the RIH Emergency Department on Feb. 27. The renovation was completed thanks to donations from the Foundation, with help from Mr. Mercier and the Auxiliary.
Dr. Guy Fradet (L) and Carol Laberge recently accepted their 2015 Quality Award from the BC Patient Safety and Quality Council for Leadership in Quality. The award was presented to them by council chair Doug Cochrane in Vancouver during the Health Talks event. The award also came with $2,500, which will go towards cardiac nursing education.
February was a busy month at the Community Health & Services Centre (CHSC) construction site in downtown Kelowna. The last of the existing services that had been running underground through the site have been either removed or relocated. As they were being removed, excavation work was able to begin for the foundation. Feb. 24 saw the first concrete poured on site, however this was not part of the foundation structure, but rather a “mud slab� to provide a solid surface on which to build the formwork for the concrete foundation. For more info on this project, visit the dedicated CHSC TeamSite.
The campaign by St. John Ambulance, dubbed The Chokeables, sees the actors play objects that could cause babies to choke — a small princess toy, a chewed-up pen lid, a jelly baby, and a peanut. Learn more at St. John Ambulance, www.sja.ca.
Dr. Mike Evans explores what works and what doesn't work when thinking about quitting smoking. Learn more at Centre for Addiction and Mental Health, www.camh.ca.
Would you know when someone is having a stroke? Recognizing the signs and acting quickly could mean the difference between life and death, or between a full recovery and lasting disability. Learn more at The Heart & Stroke Foundation, www.heartandstroke.ca.