Mt. Waddington Health Network

1. Mt. Waddington Health Network Presentation to the Vancouver Island Health Authority

2. Overview Introduction to Mt. Waddington Health network Mt. Waddington Health Indicators Health Network Achievements Health Network Activities Health Network Future Planning opportunities

3. Thank you for supporting us Ongoing Recognition of Mt. Waddington as highest priority area for the Health Authority Continuing collaboration with us to address health issues Providing necessary resources to support the Health Network We want to Thank VIHA for the support given over the last couple of years by Grant Hollett and Sia Zabaras of Planning, The Mt. Waddington Implementation Services Team especially Arlene Trustham, and Sandra Waarne our facilitator. Last year when we presented we hoped that you would recognize our work and continue to support us to move forward to address our health issues. You have done that very thing. Assisting Mt. Waddington to develop its transportation system and Providing necessary resources to support the Health Network� Activities have made our achievements possible We hope you will support us in the future as we move forwardWe want to Thank VIHA for the support given over the last couple of years by Grant Hollett and Sia Zabaras of Planning, The Mt. Waddington Implementation Services Team especially Arlene Trustham, and Sandra Waarne our facilitator. Last year when we presented we hoped that you would recognize our work and continue to support us to move forward to address our health issues. You have done that very thing. Assisting Mt. Waddington to develop its transportation system and Providing necessary resources to support the Health Network� Activities have made our achievements possible We hope you will support us in the future as we move forward

4. Mt. Waddington Region Just a reminder of the Georgraphic size and diversity of Mt. Waddington The future economy lies in the natural beauty which Mt. Waddington can still be proud of ;as well as ,The forests, the fish, and the resources yet to be developed. Incidentally, Mount Waddington (at 13,176 ft ) is the highest mountain in BC that is totally within the BC boundary. Our people are its greatest resource of course. This you will discover One important issues this brings to mind is that if you look at the distances: if you can look at the number of diagnostic services that are being provided to Mt. Waddington residents in Courtenay and Campbell river and think about the numbers of people and the cost to get Mt. Waddington residents down for those procedures: a lot of money, time, and inconvenience could be saved by having a better envelope of diagnostic services located in Mt. Waddington. Just a reminder of the Georgraphic size and diversity of Mt. Waddington The future economy lies in the natural beauty which Mt. Waddington can still be proud of ;as well as ,The forests, the fish, and the resources yet to be developed. Incidentally, Mount Waddington (at 13,176 ft ) is the highest mountain in BC that is totally within the BC boundary. Our people are its greatest resource of course. This you will discover One important issues this brings to mind is that if you look at the distances: if you can look at the number of diagnostic services that are being provided to Mt. Waddington residents in Courtenay and Campbell river and think about the numbers of people and the cost to get Mt. Waddington residents down for those procedures: a lot of money, time, and inconvenience could be saved by having a better envelope of diagnostic services located in Mt. Waddington.

5. Geographic Characteristics Huge geography (1/3 of island by area) Dispersed population/very low density 10 First Nations communities 4 municipalities and 4 electoral areas We�ve talked about the size of MWRD � its interesting to note that Campbell River is the centre of the Island, yet is considered a north Island Community. Most of the population is located within the four municipalities of Alert Bay, Port Alice, Port Hardy & Port McNeill. These communities are approximately 50km apart (Alert Bay is closer but travel via a ferry is as daunting and as time consuming as the alpine-type drive from Port Alice to other municipalities). The four largest reserves are close to Alert Bay, Port Hardy and Coal Harbour but there are small First Nations and other small communities in electoral areas scattered throughout Mount Waddington. We�ve talked about the size of MWRD � its interesting to note that Campbell River is the centre of the Island, yet is considered a north Island Community. Most of the population is located within the four municipalities of Alert Bay, Port Alice, Port Hardy & Port McNeill. These communities are approximately 50km apart (Alert Bay is closer but travel via a ferry is as daunting and as time consuming as the alpine-type drive from Port Alice to other municipalities). The four largest reserves are close to Alert Bay, Port Hardy and Coal Harbour but there are small First Nations and other small communities in electoral areas scattered throughout Mount Waddington.

6. Demographics 2005 population estimate: 14,056 4.3% growth by 2010 (14,654) Very young population � Average age: 35 vs. 42 for Health Authority 74% under age 50 Significant Aboriginal Population (at least 20%, probably higher) Interesting that the population has only decreased slightly in the past census figures, in spite of some decrease in major industries of fishing, logging & mining. This decrease has been dramatic (closure of a large mine in P. Hardy meant a loss of close to 1,000 jobs and the pulp mill in P. Alice, while now going again has fewer employees. In addition, wild salmon has not been available to harvest.) Since we had a dramatic decrease, where did the corresponding dramatic increase occur? Some gains have been made in the mining of aggregates, fish farming, tourism & retirement destinations, but the major increase has been in the population of the First Nations. I remember that 35 years ago the population was around 14,000 and the First Nations represented on 12% of the total� so we�re close to doubling that. It is still a long way from the historical high when the Alert Bay / Fort Rupert areas boasted of a population of 25,000� but that�s another story. The estimate is that growth will continue at a modest rate in the tourism & on-reserve developments. The opening of the north coast trail next year and continued recognition by active retirees of what this area has to offer will also contribute to the areas growth. Again, a very young population coupled with scattered communities with a high % of First Nations gives challenges here that don�t exist down Island to the same degree.Interesting that the population has only decreased slightly in the past census figures, in spite of some decrease in major industries of fishing, logging & mining. This decrease has been dramatic (closure of a large mine in P. Hardy meant a loss of close to 1,000 jobs and the pulp mill in P. Alice, while now going again has fewer employees. In addition, wild salmon has not been available to harvest.) Since we had a dramatic decrease, where did the corresponding dramatic increase occur? Some gains have been made in the mining of aggregates, fish farming, tourism & retirement destinations, but the major increase has been in the population of the First Nations. I remember that 35 years ago the population was around 14,000 and the First Nations represented on 12% of the total� so we�re close to doubling that. It is still a long way from the historical high when the Alert Bay / Fort Rupert areas boasted of a population of 25,000� but that�s another story. The estimate is that growth will continue at a modest rate in the tourism & on-reserve developments. The opening of the north coast trail next year and continued recognition by active retirees of what this area has to offer will also contribute to the areas growth. Again, a very young population coupled with scattered communities with a high % of First Nations gives challenges here that don�t exist down Island to the same degree.

7. Mt. Waddington Health Network exists to� Participate in decisions related to & impacting on health in Mt. Waddington � Provide community input to action which improves the health of our citizens. Being the furthest away from the centre of VIHA operations, this remoteness ( both in distance and community make-up), the communities banded together to have a common voice on health issues. We are working, blue-collar communities that get involved and are used to working collaboratively. The recognition by society that the health of a community is not just the number of nurses, doctors or available beds, but that health is influenced by other factors like education, income, lifestyle etc. So more and more members of the community have recognized the need for involvement. This Health Network provides the vehicle on which all may board, determine ways of improving the health of our communities and recommend to others (primarily VIHA & MWRHD) the action required.to achieve those improvements. We are involved� we are contribution. . Being the furthest away from the centre of VIHA operations, this remoteness ( both in distance and community make-up), the communities banded together to have a common voice on health issues. We are working, blue-collar communities that get involved and are used to working collaboratively. The recognition by society that the health of a community is not just the number of nurses, doctors or available beds, but that health is influenced by other factors like education, income, lifestyle etc. So more and more members of the community have recognized the need for involvement. This Health Network provides the vehicle on which all may board, determine ways of improving the health of our communities and recommend to others (primarily VIHA & MWRHD) the action required.to achieve those improvements. We are involved� we are contribution. .

8. Mt. Waddington Health Network is� A mechanism for organizations (e.g. VIHA) to have ongoing relationships with the broader community regarding health. A grassroots movement. It has an open membership - any person or organization can participate. Supportive of broadening understanding of the determinants of health. I believe that VIHA has an opportunity to work more closely with the Mt. Waddington resident then ever before. We are willing to Help you with your Rural remote strategy . We can be a sounding Board for you. We know the wants and needs of our local communities. We are involved. Wouldn�t it be great for VIHA if all areas had local groups such as our Health Network that could get all the players together, reach a consensus and make a recommendation on a health issue. We travel to different communities for our Health Network meetings so that more people can be involved and contribute The Mt. Waddington Regional Hospital District has asked us to give recommendation on their Capital expenditures. Again, the broadening of the definition of �Health� has increased the numbers within each community that consider health within their bailiwick, so the grass roots are growing like weeds! I believe that VIHA has an opportunity to work more closely with the Mt. Waddington resident then ever before. We are willing to Help you with your Rural remote strategy . We can be a sounding Board for you. We know the wants and needs of our local communities. We are involved. Wouldn�t it be great for VIHA if all areas had local groups such as our Health Network that could get all the players together, reach a consensus and make a recommendation on a health issue. We travel to different communities for our Health Network meetings so that more people can be involved and contribute The Mt. Waddington Regional Hospital District has asked us to give recommendation on their Capital expenditures. Again, the broadening of the definition of �Health� has increased the numbers within each community that consider health within their bailiwick, so the grass roots are growing like weeds!

9. Mt. Waddington Health Network membership includes� Citizens First Nations and Aboriginal citizens Municipalities Education Community agencies Youth Seniors/Elders Mt. Waddington Regional District Vancouver Island Health Authority This slide more definitively shows the make-up of the Health Network. Membership is open to all and attendance has participants from all the above that come from diverse communities. This slide more definitively shows the make-up of the Health Network. Membership is open to all and attendance has participants from all the above that come from diverse communities.

10. Self explanatory, although there may be other players who are not identified. Self explanatory, although there may be other players who are not identified.

11. Health Network Firsts� We are the first community to have a formal relationship with VIHA. We have a history of knowing how to participate in & make decisions concerning health of North Island residents. We have shown the work that can be accomplished by a Health network Think we have made these two points loud and clear. Yes, we want to be first and yes we know that there is a vital role for groups such as ours to perform.Think we have made these two points loud and clear. Yes, we want to be first and yes we know that there is a vital role for groups such as ours to perform.

12. Mt. Waddington Health Network Steering Committee The Health Network is supported by a Steering Committee that: provides the communication, logistical, & executive leadership functions; and is a subset of the members of the Health Network and reflects its constituents. Meets monthly to receive input from the community and to move the issues forward to a positive outcome. The steering committee is a group that are elected by the general membership at an open meeting. We have an Aboriginal and Non-Aboriginal Co-Chair. We are Georgia Cook and Alyson Hagan-Johnson the task of the steering committee is to: gather the concerns of the general membership, determine the action required; and develop a plan that will (when endorsed by the membership) form a recommendation to the appropriate agency. There is a fair amount of work and complexity.The steering committee is a group that are elected by the general membership at an open meeting. We have an Aboriginal and Non-Aboriginal Co-Chair. We are Georgia Cook and Alyson Hagan-Johnson the task of the steering committee is to: gather the concerns of the general membership, determine the action required; and develop a plan that will (when endorsed by the membership) form a recommendation to the appropriate agency. There is a fair amount of work and complexity.

13. The four most likely to be in communication with are shown, but not limited to (e.g. school district may have some common issues). This is how we workThe four most likely to be in communication with are shown, but not limited to (e.g. school district may have some common issues). This is how we work

14. Mt. Waddington Health Status Here is some of the latest information on Mt. Waddington Health Status indicators Mt. Waddington Risk Factors These Indicators direct the Health networks focus We want to Thank Dr. Charmaine Enns our Medical Health Officer and Mike Pennock From the VIHA Public and Population Health Observatory for this data. Sandra Waarne will review this with you.We want to Thank Dr. Charmaine Enns our Medical Health Officer and Mike Pennock From the VIHA Public and Population Health Observatory for this data. Sandra Waarne will review this with you.

15. Premature Mortality Life expectancy in Mount Waddington is 2.5 years less than the BC average One of the lowest levels in the province High rates of premature mortality from both natural and external causes. Particularly high in smoking-related, alcohol related and suicide. Among natural causes the area is particularly high in ischemic heart disease (not charted)Life expectancy in Mount Waddington is 2.5 years less than the BC average One of the lowest levels in the province High rates of premature mortality from both natural and external causes. Particularly high in smoking-related, alcohol related and suicide. Among natural causes the area is particularly high in ischemic heart disease (not charted)

16. Child Health High rates of teen pregnancy, infant mortality, maternal smoking and childhood respiratory (Infant mortality rates have fallen) Near normal rates of low birth rate and preterm Preschool physical development ( the percentage of children rated by their kindergarten teacher as having problems with fine motor skills, preparedness for school, washroom skills and handedness) are close to the provincial average.High rates of teen pregnancy, infant mortality, maternal smoking and childhood respiratory (Infant mortality rates have fallen) Near normal rates of low birth rate and preterm Preschool physical development ( the percentage of children rated by their kindergarten teacher as having problems with fine motor skills, preparedness for school, washroom skills and handedness) are close to the provincial average.

17. Infant Mortality is Decreasing

18. Healthy Development Very high rates of family violence and youth crime High rate of children on social assistance (risk factor for p[physical and emotional problems) Early development skills related to emotional development and social development were near normal in 2005/2006. This was a marked improvement from three years earlier.Very high rates of family violence and youth crime High rate of children on social assistance (risk factor for p[physical and emotional problems) Early development skills related to emotional development and social development were near normal in 2005/2006. This was a marked improvement from three years earlier.

19. Education Education is a critical determinant of health A number of issues, across the life cycle, identified in the profile- Preschool language skill problems Lower scores on standardized testing in grades 4 and 7 Higher drop out rates High rates of adults wit less than a highschool educationEducation is a critical determinant of health A number of issues, across the life cycle, identified in the profile- Preschool language skill problems Lower scores on standardized testing in grades 4 and 7 Higher drop out rates High rates of adults wit less than a highschool education

20. Economic Security On the positive side, Family incomes were slightly above the provincial average Prevalence of low incomes among families was well below the provincial average Housing costs were low However, Employment Insurance dependency was high and dependence on provincial income assistance programs was relatively high Problems with housing quality On the positive side, Family incomes were slightly above the provincial average Prevalence of low incomes among families was well below the provincial average Housing costs were low However, Employment Insurance dependency was high and dependence on provincial income assistance programs was relatively high Problems with housing quality

21. BC Wellness Survey 1 Survey conducted through the Provincial Health Services Authority in 2005 Mount Waddington chosen as location by VIHA Sample of 741 split into two 336 in Port Hardy/Port McNeil 405 in rest of Mount Waddington This is very important data because it informs us of our Health risksThis is very important data because it informs us of our Health risks

22. Risk Factors: Body Weight Mount Waddington residents more likely to be overweight and obese than the BC average � Port Hardy and Port McNeil 24% higher Rest of Mt Waddington 44% higher� Does not appear to be due to lower levels of physical activity. Comparative data for Mt Waddington is hard to find but the data that exists suggests there is a relatively high level of physical activity The problem of overweight and obesity appears to be more related to diet. You May be aware that Cormorant Island Had a research study using a traditional Aboriginal diet to help people lose weight last year. This was very successful for many people. It really raised the important of diet in obesity and Diabetes in the the community.You May be aware that Cormorant Island Had a research study using a traditional Aboriginal diet to help people lose weight last year. This was very successful for many people. It really raised the important of diet in obesity and Diabetes in the the community.

23. Obesity rates are falling

24. Risk Factors: Smoking Mount Waddington has a high rate of smoking, relative to rest of the province- Port Hardy/Port McNeil 30% are current smokers Rest of Mount Waddington 27% are current smokers BC 18% are current smokers The rate of Prenatal a maternal smoking is a real concern when you think of the affect on babies and the cost of cigarettes.The rate of Prenatal a maternal smoking is a real concern when you think of the affect on babies and the cost of cigarettes.

25. Smoking rates are falling

26. Exposure to ETS is Decreasing in the Home

27. Risk Factors: Alcohol High mortality reflects past behaviour High rates of problem-drinking in North Health Services Delivery Area which includes Mt. Waddington Average rates of problem drinking in Mt. Waddington The age of alcohol use is an issue cited in the McCreary Study The incidence of Binge drinking is high The Youth Wellness Committee is wanted to address this.The age of alcohol use is an issue cited in the McCreary Study The incidence of Binge drinking is high The Youth Wellness Committee is wanted to address this.

28. Heavy Drinking is Still High

29. Conclusions Mount Waddington has significant health problems � premature mortality, child health, mental health and addictions Risk factors Family violence Poor education performance EI dependency Housing quality Smoking and obesity (diet-related) The Mt. Waddington Health Network focuses on these significant health Problems. Our risk factors are effected by the Social Determinant of health in our areaThe Mt. Waddington Health Network focuses on these significant health Problems. Our risk factors are effected by the Social Determinant of health in our area

30. The Health Network Goals Reduce/eliminate health status inequity Meet or exceed British Columbia health status rates Focus on the health risks that affect: Child Health and Youth Health Addiction and Mental Health Seniors / Elders Health This page shows our targets. The Steering committee has just completed a day long session on Networks, their Benefits, Where we are as a Network and where we should go in the future. We are ready and moving forward.This page shows our targets. The Steering committee has just completed a day long session on Networks, their Benefits, Where we are as a Network and where we should go in the future. We are ready and moving forward.

31. Achievements� Ongoing Health network meetings This is the 7th Health Network Meeting Held in 6 different communities & reserves Membership over 120 Steering Committee is committed and meets monthly Provided information on Mt. Waddington Health issues at each meeting

32. More Achievements� The Mt. Waddington Bus System and the Volunteer Transportation Network July 2nd , The system was launched It is a 12 hour , 5 day week service. One of the buses is here today The Regional district of Mt. Waddington manages the system North Island Community Services Operates the system BC Transit runs the system and will provide funding in 2010 Has a Regional operating committee of stakeholders and participating communities and reserves The first problem identified by the Network was the lack of transportation. We had no bus service.This impacted on the ability of those in other communities (within Mount Waddington) to attend to a health related matter. Since similar medical services are not available in all of the areas this proposal was developed by a subcommittee of the Network and recommended to the Regional District of Mount Waddington.During the past year a group of dedicated people, worked very hard, overcoming a number of logistic and political obstacles. The transportation system is managed by a committee lead by the Mt. Waddington Regional district which meets monthly to deal with any issues necessary. The committee is comprised of The Regional District, BCTransit, VIHA, & Representatives of the stakeholder communities including 3 first Nations Bands. The region will look forward to demonstrated improvements in the receiving of services� particularly to those in poorer circumstances who either have no wheels or are not able to drive. We believe that this will be the first of many other success stories.The first problem identified by the Network was the lack of transportation. We had no bus service.This impacted on the ability of those in other communities (within Mount Waddington) to attend to a health related matter. Since similar medical services are not available in all of the areas this proposal was developed by a subcommittee of the Network and recommended to the Regional District of Mount Waddington.During the past year a group of dedicated people, worked very hard, overcoming a number of logistic and political obstacles. The transportation system is managed by a committee lead by the Mt. Waddington Regional district which meets monthly to deal with any issues necessary. The committee is comprised of The Regional District, BCTransit, VIHA, & Representatives of the stakeholder communities including 3 first Nations Bands. The region will look forward to demonstrated improvements in the receiving of services� particularly to those in poorer circumstances who either have no wheels or are not able to drive. We believe that this will be the first of many other success stories.

33. More Achievements� Developed Partnership with BC Healthy Living Alliance Funding for the Community Community Development Leader, Sharon Gordon More programming to come This partnership has provided funding for : a network capacity and planning workshop held August 27, and funding for the development of a Mt. Waddington Youth Council. We are also supporting and working with the new half time community development leader funded by the Healthy Living Alliance for Mt. Waddington This partnership has provided funding for : a network capacity and planning workshop held August 27, and funding for the development of a Mt. Waddington Youth Council. We are also supporting and working with the new half time community development leader funded by the Healthy Living Alliance for Mt. Waddington

34. Health Network Activities� We listen to the Health Concerns of the community We act to make the concerns known and plan with stakeholders action for improvements within the health system and within the community. We track action on issues until we get results We have been developing partnerships with community service providers also. The north Island Circle is here today to meet with us . This group began a number of years before the health network and represents the health and social services providers in Mt. Waddington. Please use this opportunity to discuss issues with those representing services here today. We have been developing partnerships with community service providers also. The north Island Circle is here today to meet with us . This group began a number of years before the health network and represents the health and social services providers in Mt. Waddington. Please use this opportunity to discuss issues with those representing services here today.

35. Tracking Our Activities� Please review the tracking handout which gives the status of our activities There are a number of Issues which we need to continue to addressed

36. Future Planning� Partnership with VIHA Planning around a rural services strategy. Development of a Seniors Advisory group Planned Brief on Cross-Trained Imaging and laboratory Technicians Providing recommendations on capital projects to Regional Hospital District At our workshop we agreed to participate with VIHA on looking at what are the necessary services we need and where they should be provided. Over the past year we have discovered the amount and variety of the issues that seniors are dealing with. The Health Network at its April meeting recommended that we develop a seniors advisory committee to deal with their issues as well as the contentious seniors housing needs. The Regional Hospital district has asked the Steering committee to review capital planning expenditures requested by VIHA. We are planning a meeting with the Mt. Waddington Health services Managers in the near future.At our workshop we agreed to participate with VIHA on looking at what are the necessary services we need and where they should be provided. Over the past year we have discovered the amount and variety of the issues that seniors are dealing with. The Health Network at its April meeting recommended that we develop a seniors advisory committee to deal with their issues as well as the contentious seniors housing needs. The Regional Hospital district has asked the Steering committee to review capital planning expenditures requested by VIHA. We are planning a meeting with the Mt. Waddington Health services Managers in the near future.

37. More Future Planning� Participation in Evaluation Research relating the outcomes of the Health Network Participation with Community Futures on a Community development education Proposal Develop a sustainability plan for Mt. Waddington Health Network Both Ron Lindstrom from the UBC specialist on Networks and VIHA planning is interested in assisting the Network to build its capacity around evaluation. The continued partnerships with other organization is very beneficial We are interested in the feasibility of a Mt. Waddington Health Foundation.Both Ron Lindstrom from the UBC specialist on Networks and VIHA planning is interested in assisting the Network to build its capacity around evaluation. The continued partnerships with other organization is very beneficial We are interested in the feasibility of a Mt. Waddington Health Foundation.

38. What we want from VIHA Strengthen our rural health services by: Sustaining a base of core functions that work for Mt. Waddington (Integrated Services Team): Focus on Health Promotion/Disease Prevention; Maintain our 5 local facilities as required to meet needs of our communities; More appropriate and coordinated access to specialized services elsewhere. Continue our good relationship Continue to provide support for the unique needs of Mt. Waddington We ask that our rural health services be strengthened and a core base of services sustained (this is the work that is underway with the VIHA Integrated Services Team). Core services need to be honed to address our distinct problems with emphasis on prevention. We need to maintain our facilities as required as they are very important to the health of the whole of Mount Waddington. With travel times between each problematic, closure of any one would put additional health risks in place; each facility does provide care to satellite communities that are scattered around them. Industrial type accidents are prevalent in our blue collar communities. We recognize that our facilities will never have cat scans, have highly skilled specialists or do brain surgery but they are the focal point to all the services provided. They are also a cornerstone to the recruitment of workers and retirees to the north island. Specialized hospital care or treatment should be available down island with improvements made in the acceptance and discharge procedures. Our seniors have limited access to long term care beds and the need to provide additional beds is critical. Lets get on with it.The capital expenditure to construct assisted living units is seen as unaffordable, but supported living units in each community should be put in place as soon as possible.The ball is in our court. Finally, we want to continue our recognized relationship with VIHA and want VIHA to continue to provide support for the unique needs of Mt Waddington.We ask that our rural health services be strengthened and a core base of services sustained (this is the work that is underway with the VIHA Integrated Services Team). Core services need to be honed to address our distinct problems with emphasis on prevention. We need to maintain our facilities as required as they are very important to the health of the whole of Mount Waddington. With travel times between each problematic, closure of any one would put additional health risks in place; each facility does provide care to satellite communities that are scattered around them. Industrial type accidents are prevalent in our blue collar communities. We recognize that our facilities will never have cat scans, have highly skilled specialists or do brain surgery but they are the focal point to all the services provided. They are also a cornerstone to the recruitment of workers and retirees to the north island. Specialized hospital care or treatment should be available down island with improvements made in the acceptance and discharge procedures. Our seniors have limited access to long term care beds and the need to provide additional beds is critical. Lets get on with it.The capital expenditure to construct assisted living units is seen as unaffordable, but supported living units in each community should be put in place as soon as possible.The ball is in our court. Finally, we want to continue our recognized relationship with VIHA and want VIHA to continue to provide support for the unique needs of Mt Waddington.

39. What we want from VIHA� Finish the Authority wide discharge plan so it meets the needs of Rural People Take seriously the differences between rural and Urban and,with the Rural Services strategy provide more equitable services based on our unique rural and remote needs Don�t forget to get us our 11 care beds Rural People are getting stranded without money, clothes and transportation on discharge from facilities. We look forward to the follow through on what was presented to the VIHA Quality Council. Rural needs are absolutely different and people don�t take it into consideration. We know you are working hard to move on building our multilevel care bedsRural People are getting stranded without money, clothes and transportation on discharge from facilities. We look forward to the follow through on what was presented to the VIHA Quality Council. Rural needs are absolutely different and people don�t take it into consideration. We know you are working hard to move on building our multilevel care beds

40. Questions and Discussion Thank you for the opportunity to share our story so far. We look forward to continuing our partnership with VIHA - as we strive to improve the health & well-being of Mt. Waddington citizens. It has been my job to talk and your job to listen. I hope we finished at the same time. Any questions or comments?It has been my job to talk and your job to listen. I hope we finished at the same time. Any questions or comments?