Better Connected: How Low-orbit Satellite Internet Can Pave Way for Health Equity

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Technology has allowed rural healthcare providers to improve patient care in their communities—but there are still gaps because of a lack of infrastructure.  

Real-Time Virtual Support (RTVS), which can incorporate Point-of-Care Ultrasound (POCUS) virtually, among other services made possible by fast internet connections, have been important tools for rural providers in the past few years, especially since the start of the COVID-19 pandemic.  

But not all communities are created equal when it comes to having the infrastructure needed to make the best use of this technology. 

Slow internet speeds, or patchy connectivity, mean many nursing stations can’t do video calls, so virtual physicians and specialists are patched in over the phone—and that could mean not having the full picture of what’s needed to provide the best care. 

Meanwhile, rural healthcare providers and patients who are connected to RTVS virtual physicians and other virtual specialists via Zoom are feeling the benefits. 

So what can be done? 

Dr. Stefan Du Toit, a general practitioner in Valemount, says low-orbit satellite internet has the potential to make a big impact on rural healthcare.  

Dr. Du Toit has been one of the first in his community to order and set up StarLink, the service operated by tech billionaire, Elon Musk. Though the dish is being used in his own home, he says it’s something he’d love to see rolled out in rural healthcare.  

“SpaceX Starlink Broadband Satellite Deployment over Earth” by jurvetson is licensed with CC BY 2.0. To view a copy of this license, visit

The advantage of satellite internet, especially in a place like British Columbia, which has very challenging geography, is that it doesn’t require a huge investment in infrastructure, such as cabling or cell towers.  

With low-orbit satellite service, only a dish and a monthly fee is required. And unlike traditional satellite internet, low-orbit satellite internet doesn’t have speed issues.  

With traditional satellite internet, which has been available since the late 1990s, data must travel up to the satellite and back (about 72,000 km). This round trip occurs twice for each query you make and adds about a second delay or more to the total time your device takes to communicate with a website or host server. It means it’s not practical to do real-time video calls, like the ones used for RTVS.  

In contrast, low-orbit satellites are roughly 1150 km (about 2300 km round trip) from the surface, making latency issues almost non-existent.  

Dr. Du Toit says having fast, reliable internet was key to improving patient care in rural areas.  

For example, when doctors in Valemount are on call, they’re also covering the nearby community of McBride. So if a patient turns up in McBride, the doctors need to make a decision on the patient’s treatment, such as whether a transfer is needed, what lab work to order, or what medications are needed.  

“Before we had fast internet, we had to do those calls [to nurses in McBride] by telephone. You couldn’t evaluate the patients, even look at them, you’d just have to base your decisions on what you heard. Over the years, we got used to that. But when we got video calls, you’re able to see a wound, see their clinical picture, you could make decisions with more confidence. As the bandwidth increased, and as these things became available, things improved even more,” he says.  

But this type of connection is not available in every community.   

Dave Harris, the technical lead for RTVS, says people living in rural areas with poor internet connectivity essentially become have-nots simply because of where they live.  Harris has been involved in RTVS since the beginning and has long been a proponent of using technology to increase health equity.  He’s excited about the potential of StarLink and other low-orbit satellite providers to give rural patients and providers a better life.  

“We really, for the first time, have the opportunity to bridge this gap.” 

“To put in one cell tower and all infrastructure to support it is at least $200,000 for a tower, plus all the money that’s needed to maintain it. Companies look at that and it doesn’t make economic sense to them or their shareholders.” 

And while governments can subsidize this infrastructure, there still needs to be someone with technical expertise to bring the service into homes, he says. 

“With Starlink, it’s just a satellite dish, and anyone can put it on their home and then they pay a monthly fee and that’s it.” 

Both Harris and Dr. Du Toit can also see an even more exciting opportunity with low-orbit satellite internet.  

“If you have a town with 200 people, you might only need four StarLink dishes to serve the whole community. There’s enough bandwidth there that, if you create a mesh network (essentially creating a wifi zone spanning hundreds of meters using a series of repeaters), the whole community can be connected,” Harris says.  

The cost? Likely something in the realm of a $20,000 one-time set up cost for the whole community, plus the monthly fees, according to Harris.  

Fast internet is making a difference for health equity in places where it’s available. The way that rural providers can bring ultrasound and RTVS into clinics and hospitals is a game-changer.  

Dr. Du Toit says: “I get very passionate and excited about these things because I’ve been a GP for 25 years, so it’s only been in the past five years that we’ve been able to bring a specialist into the room using RTVS. I’ve never had that privilege and it’s huge. I think, for retention of doctors in rural areas and for helping new doctors adjust to being doctors, it’s key. It really decreases your stress levels by 90% just to know you have someone available immediately who can help.”  

Having the virtual specialist in the room is also a great help to the wider community. 

Dr. Du Toit adds: “Some of these cases I’ve been dealing with, we’d have transferred in the past because we would not have felt comfortable with them. But now you can have a specialist walk you through a situation and manage the case with you. After managing the case you have a wealth of experience. You can read books and go to university, but the way that you really learn and retain that information is to do it yourself. So now, there are more situations that we are comfortable with. And that’s because of the technology that we have.”

Better Connected: How Low-orbit Satellite Internet Can Pave Way for Health Equity

Shaping the Future of Care Closer to Home for Older Adults – October 12, 13 and 15, 2021

Older people should be free to choose to age in place – meaning people should be supported to live safely and independently at home or in the community, for as long as they wish and are able. But what does this look like in Canada?  And how do we work together to achieve it?

There are many innovations and models of care across the country that empower people to have independence, choice, and opportunities to improve their quality of life. HEC is bringing together people to have a conversation to identify what matters and promote excellence in care for older adults within home care.

We want to hear from those who are providing care to older adults in the home and community, those who are receiving care in the home and community, and family and caregivers.

To participate, join one of our focus groups and share your experiences, insights, and big (and small) ideas to help shape the future of care closer to home for older adults.

Virtual focus groups will be held on October 12, 14 and 15, 2021 and run for approximately 60 to 90 minutes. There is no preparation time required.

Click here to register

COVID-19: learning as an interdependent world

Published:September 25, 2021DOI:

[Excerpt] There were some grounds for hope that the COVID-19 pandemic would be under control by now. Huge scientific advances have been made in our understanding of COVID-19, as well as its countermeasures. Countries have had 18 months to understand which policies work, and to develop strategies accordingly. Yet the pandemic is at a dangerous and shifting stage. Almost 10 000 deaths are reported globally every day. National responses to COVID-19 range from the complete lifting of restrictions in Denmark, to new state-wide lockdowns in Australia, and a growing political and public health crisis in the USA. In the UK, the number of infections is rising again, putting unsustainable pressure on the health service. Health workers are exhausted. The response to WHO’s call for global solidarity to combat COVID-19 has been derisory. The pandemic remains a global emergency.The handling of the pandemic is becoming increasingly politicised, with many public health decisions informed by partisan division instead of science. The conflation of the two is damaging public trust in both governments and scientists. For example, vaccine hesitancy has become a major issue in the USA due to the unprecedented political polarisation that has affected virtually all aspects of the US pandemic response. There is a sharp geopolitical contrast in vaccine uptake, with polls showing vaccine acceptance of 52·8% in Democrat counties versus 39·9% in Republican counties. This situation is no longer a debate about a public health crisis. In France, Italy, and the USA, the discussion has evolved into a division over the touchstones of democracy: freedom of individual choice versus the power of governments attempting to safeguard citizens. US President Joe Biden, in attempts to combat vaccine hesitancy, has imposed the most dramatic vaccine mandates to date. The US paradox shows how a scientific superpower can be plunged into chaos.

COVID-19 continues to spread globally. The current hot spots are the USA, Brazil, and India, followed by the UK, Turkey, Philippines, and Russia. As vaccine roll-out advances, many high-income countries have lifted most restrictions, often without considering lessons learnt from other countries. For instance, Israel, the first country to vaccinate most of its population, jumped at lifting all restrictions by June, 2021, when hospital admissions and deaths were substantially reduced. However, Israel is seeing a sharp rise in COVID-19 cases caused by the delta (B.1.617.2) variant. The Israeli experience shows the continual need to monitor vaccine protection; the importance of identification and understanding of variants of concern; and the fact that vaccines are not wholly effective at stopping the transmission of the virus, but are very effective at protecting against disease. Scientists themselves remain divided on the best approach to vaccination programmes and there are notable differences between countries, specifically around the roll-out of booster vaccination and the vaccination of children. The authors of a recent Viewpoint in The Lancet argue that, although many high-income countries are beginning to offer booster vaccination, evidence of the need for boosters in the general population is still lacking.Global vaccination is the best approach to ending the pandemic, but equitable delivery of COVID-19 vaccines remains painfully slow. More than 5·7 billion vaccine doses have been administered globally, but only 2% of those have been in Africa. Such vaccine inequality is not only unjust, but it undermines global health security and economic recovery. COVAX has indisputably helped to deliver vaccines more widely and more quickly than otherwise would have occurred—in 6 months, 240 million doses have been delivered to 139 countries—but this is not enough. COVAX has inherent shortcomings and is well short of the goal of distributing 2 billion doses (20% of the world population) by the end of 2021.


A Study of Family Councils in Nursing Homes

Linda CoxCurryPhD, RNCharlesWalkerPhD, RNMildred O.HogstelPhD, RN, BCMary BethWalkerMS, RN

Families can remain actively involved in the care of their residents by participating in a Family Council within the nursing home (NH).

A Family Council is an independent, self-determining group of NH residents’ families and friends and often includes a nursing facility liaison. 

Problem: Less than half of NHs has an active council. 

Purpose: To determine the presence, characteristics, and impact of Family Councils. 

Method: A descriptive study was conducted. Mailed surveys to NH administrators and personal interviews of Family Council members were included in this study.

The survey was mailed to administrators in all 60 licensed NHs in a metropolitan county in the southwestern United States. 

Results: Sixteen NH administrators responded, with 12 (75%) of the 16 reporting the presence of an active Family Council. Three administrators provided the name of a member of their facility’s Family Council who were interviewed by telephone. Both the survey and personal interview results supported the positive effect of active Family Councils to provide mutual support, empower its members, and advocate change to improve the residents’ quality of life.


Family Councils

Recommendations to Improve Emergency Preparedness, Response and Recovery for Older Adults Across Canada

Closing the Gaps:
Advancing Emergency Preparedness, Response and Recovery for Older Adults

29 Evidence-Informed Expert Recommendations to Improve Emergency Preparedness, Response and Recovery for Older Adults Across Canada


[Excerpts] Report Development Contributors

In January 2019, the Canadian Red Cross in partnership with the National Institute on Ageing reviewed the latest evidence and expert opinions to inform the development of recommendations for governments, organizations and individuals to improve emergency preparedness, response and recovery for older adults.

Executive Summary [Excerpts]

Older adults consistently experience the greatest proportion of casualties during and after emergencies in Canada, and internationally, when compared to younger age groups.

In the 2017 wildfires in British Columbia and floods in Quebec, older adults were impacted the hardest due to their greater levels of vulnerability, while poorly coordinated protocols left them more vulnerable due to delays in initiating evacuation procedures

More recently, 97% of Canada’s first 10,000 COVID-19 deaths have occurred in older Canadians 60 years of age and older, with the greatest proportion of deaths occurring in long-term care and retirement homes.

Several research studies have demonstrated that these poor outcomes are linked to physiological age-related changes, such as impairments to sensory, cognitive and mobility disabilities; access and functional needs; social isolation and lack of access to familial and other social supports; having limited financial resources; and insufficient policies and procedures.
Furthermore, interruption to the timely provision of routine medical care is recognized as a likely contributor to mortality and morbidity associated medical complications during emergencies, especially in the immediate months following major natural disasters. The high proportion of deaths that also seem to occur in older adult congregate living settings is further indicative of fundamental issues that will need to be addressed in these settings as well.

There is a clear need to better support emergency preparedness for older Canadians living at home in the community or in congregate settings. In order to improve preparedness and response to emergencies, Canada needs greater consideration and adoption of evidence-informed, uniform
and collaborative emergency management interventions. These efforts will require improved resources and capacity to meet the emergency needs of all older adults, regardless of the variety of circumstances and settings in which they may be living.

In order to achieve a collaborative approach to improving emergency management nation-wide, the recommendations are categorized across six relevant emergency management domains:

1. Individuals and unpaid caregivers;
2. Community-based services and programs;
3. Health care professionals and emergency response personnel;
4. Care institutions and organizations; 5. Legislation and policy; and
6. Research.

The intention of these recommendations is to provide interventions that can bridge the existing gaps in emergency preparedness, response and recovery, and facilitate better outcomes for older adults across Canada.

The intention of these recommendations is to provide interventions that can bridge the existing gaps in emergency preparedness, response and recovery, and facilitate better outcomes for older adults across Canada.

A sample of recommendations:
Recommendation 2.1: Access should be increased to tailored community-based programs that educate older adults and their unpaid caregivers about emergencies that could affect their region and how best to prepare for and respond to them. Volunteer representatives of older Canadians and their unpaid caregivers should be recruited and involved in training material development and implementation, to ensure their voices and perspectives are reflected.

Recommendation 2.2: Programs that provide disaster relief and/or essential community services, such as Meals on Wheels, and daily living assistance for older people (financial, medical, personal care, food and transportation) should receive emergency preparedness training and education as well as develop and adhere to plans and protocols related to responding adequately to the needs of their clients during emergencies. Volunteer representatives of older Canadians and their unpaid caregivers should be recruited and involved in training material development and implementation, to ensure their voices and perspectives are reflected.

Recommendation 2.3: Community-based programs that provide in-home health and personal care for older adults should integrate strategies that minimize unnecessary personal contact and leverage resources (e.g. personal protective equipment such as gowns, masks, gloves, hand sanitizer etc.) in their emergency preparedness plans and protocols.

Recommendation 4.3: Care institutions and other organizations should strive to develop comprehensive emergency plans that include effective response strategies for protecting older adults against infectious disease outbreaks and reflect evidence-based standards supported by organizations such as Infection Prevention and Control Canada (IPAC).

Recommendation 5.3: All provinces and territories should support the creation of a national licensure process or program for nurses, physicians, allied health professionals and other emergency medical service personnel to allow them to provide voluntary emergency medical support across provincial/territorial boundaries during declared states of emergency.
Recommendation 5.4: All provincial and territorial governments should support legislative requirements that mandate congregate living settings for older persons (e.g. nursing homes, assisted living facilities and retirement homes) to regularly update and report their emergency plans that outline actions and contingencies to take in case of emergencies.

All provinces and territories should work towards standardizing requirements for emergency plans in congregate living settings in accordance with the priorities outlined in the 2019 Emergency Management Strategy for Canada and ensure that their emergency plans for congregate living settings are aligned with directives outlined in their provincial/territorial pandemic and emergency plans.

Recommendation 5.5: All provinces and territories should adopt a standardized approach to promoting collaborations between local pharmaceutical prescribers and dispensers (i.e. community pharmacists), physicians and nurse practitioners, to ensure an adequate supply of prescription medications are dispensed to persons with chronic health conditions prior to and during an emergency. This approach should also outline the need for collaboration between pharmaceutical providers, hospitals and relief agencies to ensure an adequate supply of prescription medications are available at hospitals, relief and evacuation shelters.

Click to Download CRC WhitePaper EN.pdf

Emergency Preparedness

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UBC Graduate Certificate in Primary Health Care

The part-time Graduate Certificate in Primary Health Care was developed to support working health care professionals for the transformation to patient-centred, team-based care. Navigate the complexities of interprofessional teams, integrate and apply your skills in context, and lead change in your organization.

Registration for the program is open until November 15.

 > Apply for the January 2022 cohort

Health care in BC is undergoing a radical transformation. Recognizing the need for consistent, community-based care, the BC Government has a mandate to implement a model that will see primary health care delivered by interprofessional teams.

The UBC Graduate Certificate in Primary Health Care was developed by the UBC Faculty of Medicine to support and prepare health care professionals for this transformation. It’s an opportunity to build your skills and apply the principles of team-based care, contribute meaningfully to an interprofessional team and lead change in your organization.

Navigate the complexities of team-based care

Understand and apply key concepts, benefits and challenges of team-based primary health care. Build on existing patient-centered care principles as you start to transform your own practice.

Incorporate your skills to collaborate in an interprofessional team

Refine your understanding and discover what it means to practise effectively on a collaborative, interprofessional team. Explore team dynamics, culture, communication, conflict and ethics.

Integrate and apply your skills in your context

Understand how to deliver primary health care in urban, rural and remote communities. Examine team-based care within Indigenous, mental health and addictions, maternity, sexual health and ageing population contexts.

Program Highlights

Interactive Delivery

Delivered part-time, primarily online

Interactive courses are offered online over 18 months, and include six days of face-to-face intensives. Apply and integrate what you learn in your workplace as you progress through the program.

Led by Practitioners

Led by senior faculty & leading practitioners

The UBC Faculty of Medicine is a recognized leader in the science and practice of medicine. Benefit from a program designed, developed and taught by senior faculty and instructors, and expert clinicians.

Learn with Peers

An interactive learning experience that mirrors real teams

Engage, share experiences and practise skills with a cohort of professionals from a broad range of disciplines and backgrounds. Learn how to work as a virtual team, and build a community of practice and network of peers.

Explore the Program, click on:

Primary Health Care in Perspective

patient talking to doctor primary health care

The shift to team-based primary health care in BC

The concept of team-based primary health care has been around for decades. Here in BC, the Provincial Government is embracing this model of care. Find out what this shift means for patients and our health care system, and access a list of resources.

Read More