UBC Learning Centre: Centre for Excellence in Indigenous Health webinar on March 28th introduced a new video The Edge of Care that follows the story of community leaders, elders, artists, knowledge keepers, and physicians as they work together to deliver equitable health care to the most remote and rural communities in BC.

The film, The Edge of Care, available at https://www.youtube.com/watch?v=0YYMNtnBkis was created by the Educational Technology (EdTech) team from UBC’s Faculty of Medicine in partnership with the Rural Coordination Centre of BC (RCCbc). It showcases two communities—Bella Bella and Takla—that use Real-Time Virtual Support (RTVS). It features rural physicians, Indigenous community members, leaders, elders, knowledge keepers, artists, medical trainees and RTVS physicians.

A focus of the film is the impact that Real-Time Virtual Support (RTVS) peer pathways have had on remote communities and the rural providers that serve them.

In the webinar, Dr. Amy Sawchuck and Dr. Keeve de Villiers talked about the work of the Rural Coordination Centre of BC (RCCbc) the Maternity and Babies Advice Line (MaBAL) program, part of the Real-Time Virtual Support (RTVS) suite of peer support pathways. Family physicians with expertise in obstetrics are available 24/7 to support rural providers with maternity, newborn or women’s health issues. The service provides a safety net and peace of mind for rural providers and the communities they serve and is featured in the film.

RTVS offers free clinical support for physicians, residents, nurse practitioners, nurses, midwives, and in some cases first responders, in rural, remote and First Nations communities in BC. MaBAL is one of three 24/7 RTVS pathways for healthcare providers for healthcare collaboration in rural and remote communities in BC, providing urgent and non-urgent support for pre-conception, prenatal, antenatal, intrapartum and postpartum presentations for parents and newborns.

Support includes:

·      Reviewing a case

·      Helping to navigate the healthcare system including patient transport

·      Providing collaborative support

·      Infant nutrition help

·      Interpreting test results

·      Running through simulation scenarios

·      Other situations as needed by rural providers

The RCCbc Rural Obstetrical & Maternity Sustainability Program (ROAM-SP) works with rural communities to strengthen their peer, facility and regional networks and enhance rural maternity care services and provide local plans to address specific needs of their maternity care providers.

The film is presented by Dr. John Pawlovich. A graduate of UBC’s medical program and clinical professor in the department of family practice, Dr. Pawlovich, MD’94 is the Rural Doctors’ UBC Chair in Rural Health. Also the medical director for Carrier Sekani Family Services, he provides medical care to several Indigenous communities, including Takla Landing, located approximately 400 km north of Prince George.

Dr. Pawlovich describes the work of RCCbc in collaboration with the remote, rural community of Takla. Takla only got electricity and running water in the 1980’s and until quite recently did not have internet connection and relied on radio phone contact with external medical supports. The road is a forest service road, needing a truck and radio, and can take hours. Small planes land by sight. Bad weather can cut the village off. The community has been significantly affected by residential schools and intergenerational trauma.

Historically, the interface between health care providers and community members has been fragmented and intermittent. Over the past ten years, RCCbc has worked with the community to provide continuity of care and build long-term relationships. RTVS provides 24/7 direct physician-to-physician support. Local physicians talk about how significant the specialized support can be as they deal with emergency situations.

A community member comments on the ease of adaptation to using audio-visual services fitting well with their traditional ways of learning and interacting, citing how their elderly mother felt comfortable talking with a doctor on-screen, and stayed relaxed because the person they were interacting with was not physically present in the room with them.

A local mother who grew up in the community, but had left to bring up her children, has now moved back to the community because she feels comfortable that she and her children have the health supports they need. A local doctor talks about the support she has received through MaBAL in the delivery room and the value of being able to talk through and be prepared for potential issues in real time, and a community member expresses the excitement of being able to welcome a baby directly into the community at birth.

Dr. Pawlowich talks about how he and his peers from RCCbc, along with their medical students, make a practice to come into communities and engage in community social and cultural activities. The unstructured, in-person connections build familiarilty and trust between physicians and community members to improve the effectiveness of their online interactions.