Community Mailboxes Come to Selkirk

For those who have read my blog, I mostly talk about health care issues from a personal perspective.  In between our frequent medical adventures, speaking engagements, and volunteer activities I actually have a job.  Apparently I still need to pay the bills.

My job is actually a lot of fun.  I get to travel a bit and see the country.  I work with a great group of people who are dedicated and provide me with a lot of support.  For the past 5 years I have been one of the project managers working on upgrading Canada Post's infrastructure.  A $2 B investment.  Last year I had the privilege of joining the team that is bringing Community Mailboxes to nearly 5 millions customers across Canada.  Up until now most of my work has been behind the scenes and much of our work would go undetected by our customers.  The Community Mailbox (CMB) Project is the complete opposite.  It effects how customers get their mail and is very visible to most Canadians.

This fall our CMB project comes to Selkirk.  We "Go Live" on October 26.  Selkirk is a mere ten minutes from my home.  These are my neighbours.

Recent Installation of A Community Mailbox in Selkirk, MB

It has been fun working close to home.  A couple of weeks ago I joined one of our delivery services officers and did some inspections of the sites that are being installed in Selkirk.  It was really nice to get out of the office and do some "real" work.  We had a chance encounter with two of our customers who were out for a walk on a beautiful fall day.  Two of our seniors who were very interested in what we were doing.  As many are well aware, there are many people who are concerned about the loss of door to door delivery. The reaction from these two ladies was typical of the response we get.  The first lady was upset with us.  She explained how inconvenient the new boxes would be.  She went on to state how it was so easy for her now to just stick her hand out the door on a cold day and grab her mail.  She didn't need to get out of her pyjamas or even go outside.  It was so easy.  What she said is exactly true.  Door to door delivery is very convenient.  We understand, for some this change is less than ideal.  Without getting much of a reaction from us, the first lady walked away and i didn't get the impression she was very pleased with us.  The second lady had a much different response.  She was asking how the new boxes worked, and inquired when she might be getting her keys etc.  We showed her the new mailbox and briefly explained how she would get her mail.  She also asked about parcels.  We also showed her the parcel compartment and the process she would need to extract parcels from the box.  She seemed very curious and very intrigued.  We could tell she was kind of excited about something new.  It was very positive response.  So in our chance encounter we had one "for" and one "against".  Very typical of what we see.

I think many people who are against the changes we are proposing do not realize the phenomenal cost of delivering mail door to door.  Is it a service we (as Canada Post) would like to continue and maintain a very proud tradition.  Is it possible to continue? Absolutely.  Is it feasible?  Definitely not.  I do not want to get into the financial models or data that shows how costly door to door delivery is.  If you are interested, there are some good papers on the topic published by the Conference Board of Canada and the Macdonald-Laurier Institute.  No one argues that ending door to door delivery and implementing CMBs will save Canada Post millions of dollars.  Taxpayer dollars that can be spent on roads, health care, and many other worth while programs.  For those who think taxpayers should subsidize Canada Post I would propose that we agree to disagree.

For my neighbours in Selkirk; I hope the transition goes very smoothly.  There is a great team of folks in our call centre who are willing to answer your questions and a great deployment team who will ensure everything transitions smoothly.  One comment we hear over and over again is that this may be a great opportunity to go to your CMB, pick up your mail, and say "hi" to your neighbours.

Donald Lepp
Project Manager, Canada Post
CPC 2.0 - CMB Project

Do We Get Better Health Care? ...Yes we do.

This has been another fun filled week of working the health care system.  To explain all of the events that have happened in the last couple of days I have to back up a few months.

On May 20th we had a scheduled visit to the Emergency Room at Children's Hospital in Winnipeg.  To make a long story short we ended up waiting 5 hours for what ended up being a simple injection.  To say we were ticked off is an understatement.  The lack of communication and pure incompetence of a broken health care system was on full display.  It was a case study in silo mentality where various players in the system failed to coordinate a fairly simple task.  As a project manager this drove me nuts.

As I tweeted some of the events of that morning, the Health Critic for the Progressive Conservative Party, Myrna Driedger, picked up on some of my tweets.  She discussed a few details of our experience; as scheduled appointments to Manitoba's ERs have been a long standing issue as these numbers have increased despite numerous promises from our provincial NDP government to curtail the practice.  She invited me to come to question period where she brought the issue of scheduled visits to our health minister Sharon Blady.

As I was referred to (by name) in question period I drew immediate attention from the Health Minister's staff.  I was immediately contacted.  I had a very pleasant conversation with one of the Minister's assistants.  They asked if they could investigate the issue on our behalf.  I agreed, but later had second thoughts.  I contacted the Minister's office later that week and decided this was something I wanted to tackle on my own.  I know many people at Children's Hospital and I am a parent rep on the Child Health Quality Committee (CHQC).  With Russell's Doctors I had at my disposal all of the people I needed to investigate this issue on my own.  This was going to be fun!

Russell's Cardiologist is great and she did a ton of work on my behalf.  We were able to identify several problems, that we encountered that morning, and we rectified them.  I think there were several people who learned something as a result.  I prepared a brief report for the CHQC and got some mixed responses but overall it was a good discussion.  As promised, I sent a copy of my report and a history of our experiences in health care to the Minister of Health.   I received an response from the Minister last week.  I would comment on the content of the letter from the Minister but I am not accustomed to providing gratuitous profane outbursts.

This brings me to the events of this week.  Early Tuesday morning Russell woke us up and was obviously in some significant discomfort.  He was reaching for his belly and was writhing on the floor.  There wasn't any discussion, we were off for another adventure in the Children's Emergency Room.

Russell examining Jake the Giraffe:
Waiting for an ER Doc to yell at me for letting
my son play with expensive hospital equipment

Unlike our visit in May, we waited for absolutely nothing.  We arrived at about 5 am.   We were taken into treatment room almost immediately.  We saw a Doctor with about 15 minutes.  This was awesome.  Seeing how much discomfort Russell was in, they got an IV in him very quickly.  They were able to take blood and gave him some much needed morphine.  That settled the boy done very nicely.  After a few more questions and discussion we were off to get chest x rays and an abdominal x ray.  This visit was totally unlike our experience in May.  The situation we consistently run into when we talk to the staff is the fact Russell has a heart transplant and he gets special attention.  He is complex and everyone starts to pay attention when he rolls into any clinic or ER.  This was certainly the case on this trip.  Our initial ER Doctor has seen us before.  He remembered us.  After shift change we met our new Doctor.  She happened to be the Doctor who was on service when Russell crashed in Emerg 7 years ago.  A point I reminded her about.  Our new nurse also popped in to do vitals and check in with us.  She also spent a shift with us on one of our previous visits to the Emerg.  At about this time the unit manager showed up.  I know her from our CHQC.  Do you see a pattern?  What is the old American Express commercial tagline "Membership Has Its Privileges."

Our entire experience on Tuesday was positive.  Good communication.  We knew what was going on and what the game plan was.  When we waited we knew why we were waiting and what we were waiting for.  When the Drs were guessing; they admitted it and explained why.  Textbook care.  The interesting part came when we were planning on leaving the ER.  The Doctors arranged for Russell to keep his IV in place and we planned to do an IV dose of antibiotic the next day.  We were planning for a scheduled visit to the Emergency Room for the next day.  I couldn't help but laugh.  This was exactly the issue that brought me to the Manitoba Legislature and received media attention in May.  I was committing an unpardonable sin in the ER.  A scheduled visit.

My fear on coming back to Emerg this morning was that instruction were not passed on to the staff who were on service when we came in.  If we got triaged that would be a disaster.  By policy we should go through the triage process.  We were circumventing the rules.  When we arrived this morning i got a little bit of resistance until one of our nurses recognized us and brought us right into a treatment room.  We talked to the Dr on service, got the IV treatment, and left the hospital in less than 90 minutes.  We were likely in and out before many patients would have been seen by a Doctor.  We are going back tomorrow morning for another IV dose.

So why did this trip work out so much better than our trip in May.  Very simple.  It wasn't busy.  5:00 AM is a great time to go to an ER.  Also. from beginning to end the ER was in charge of this trip.  There was very limited interaction with other specialties.  When any hospital department has control over resources to get a job done they will do fine.  It is when you get numerous specialties and departments involved it all breaks down.  This is certainly the case when we deal with Cardiology.  Our appointments their go so smoothly because they control the whole process internally.  Hospital organizations do not play well with each other. The other major component to a successful trip was us.  At a basic level we know how the hospital works.  We know where to find things.  We know some of the terminology.  We also know that we can't leave things to chance.  We ask questions.  Add all of these factors together and you get a very efficient trip to the ER.  It doesn't happen often so we are enjoying the moment.  It is experiences like that convinces me that we can do so much better and do it more consistently.

So, my questions is; Do we get preferential treatment in the hospital?  Yes and No.  There are things we don't have control over and hospitals are huge.  We don't have connections everywhere.  Where we have a huge advantage is that we are able to converse and communicate very differently with staff who know us because we have credibility with them.  Relationships that we have taken great care to cultivate.  Even when we had our messy trip to Emergency in May our experience was made a lot less horrific because we had people we could phone (and complain to).  I'm able to text our cardiologist and get answers to question in mere minutes.  Not many people have our level of access.  In that sense we have a huge advantage.  It is that level of access that probably saved Russell's life 7 years ago.

That is what frightens me.  Not everyone can advocate for themselves.  If you haven't been in a hospital in 30 years it is like being in a foreign country where you don't speak the language.  In addition,  we have trusted care providers who actively advocate on our behalf.  We are very fortunate and...yes...probably a little spoiled.  I don't know where we would be without the resources we have.  Does everyone have access to these resources.  Definitely Not.








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Where It All Started: Chapter 1 in a Patient Story

Sept 11, 2001 is a date everyone will remember.  For many of us who watched video of two airplanes hitting the twin towers we saw the world change in front of our eyes.  We were bystanders to that tragedy. For those who were in New York and had friends and families killed in those attacks the experience was so much more personal.  I have no idea what that would have been like to experience.  I am also sure that each person who experienced that day (first hand) has personal feelings and memories of that day that are unique to each individual.  It is impossible to truly know what it is like to go through something like that unless you are there.

This is the struggle I have every time I try to share our story of what happened on the evening of Oct 2, 2008, but like those who experienced 9/11 our lives were forever changed and we will never be the same again.

The post written below was writedn seven years ago, a few days after we arrived at the Stollery Children’s Hospital. As I re-read this I realize how many more details and experiences I omitted.  Perhaps someday I will re-visit those horrific hours and put them down on paper.  

When I talk about patient experience or the role of the caregiver.  This is what I am talking about.

Posted Oct 9, 2008 12:23am

The events leading up to our “trip” to Edmonton began with a trip to our pediatrician on Wednesday for Russell’s 2 month boosters. Everything went off with no real excitement. That night Russell had a normal feed but promptly threw everything up. Obviously he was not feeling well, perhaps some reaction to the shots.

In the morning (Thursday), Russell had a normal feed and everything seemed to be going well. During the day, he was a little fussy about eating. This continued during the afternoon. Late in the afternoon, Susan began to get concerned as he had not been eating well all day and she noticed a yellow tinge to him. When I got home from work, I tried to feed him as well but he was not interested. At this point in time, we were getting more concerned as he had this yellow colour, was not eating, and was quite lethargic. He had very little energy. We made a few calls and contacted one of the cardiologists who was on call. He suggested that we head to Emergency, as it would just be a good idea for someone to check his vitals and have a look at him. If it was not cardiac related and just a “kid-thing” they would just send us home and that would be the end of it.

We arrived at Emergency around 10:30 PM on Thursday. As expected, when we arrived Russell was nice and pink and looking quite great. We were feeling a little silly for being there, but we told our story to the triage nurse and they found us a treatment room. A resident gave Russell a quick once-over and didn’t seem too concerned (We always have trouble reading Doctor body language). We waited in the treatment room for some time. Russell seemed OK but yet not himself. Periodically a nurse would check on us while we waited for the Doctor on duty to give Russell a look. During one of these visits Russell turned white as a ghost and the nurse observed his sudden change. She quickly called for the resident who was close by and she observed the sudden changes as well. Russell let out a cry that we had never heard before and it was obvious to us that he was in some form of distress. Susan and the nurse settled Russell down and got him comfortable but you could tell everyone was on edge and the ER Doctor was summoned. A quick exam by the ER Doctor and Cardiology was paged for a consult. Dion from the Variety Heart Clinic (Pediatric Cardiologist) was at Emergency very quickly and immediately was concerned about Russell’s condition. He did an Ultrasound which confirmed that Russell’s heart was functioning at an even lower level than at Russell’s last visit to the clinic. He relayed the concern to us and stated that he was in bad shape and that they wanted to get Russell to the ICU as soon as possible.

From this point, things got very bad; very quickly. At about 2:00 or 2:30 AM Russell was being transported down the hallway toward the elevator to take him to ICU when he “seized” or “lost consciousness.” I will always remember the nurse tapping Russell on his chest and calling to him by name trying to get him to regain consciousness. He was immediately whisked into a treatment room and we were asked to wait in one of the family rooms. For the next hour and a half...we waited. At about 5:00 we were allowed to see Russell. The ICU team had begun the process of stabilizing him but at this point he was certainly not stable.
At this point, he was brought upstairs to the Paediatric Intensive Care Unit (PICU). We waited a little while longer until we were brought into his room in PICU. I will always remember the ICU Doctor, standing at the threshold of Russell’s room, arms crossed, and looking totally focused. She directed her ICU team with conductor-like precision. In the midst of all of the activity she took the time to explain all of the efforts being performed to stabilize Russell. The waiting continued. The next few hours involved adjusting medications to get Russell’s vital signs to stable parameters. We did not know how much better Russell would get as we did not know what caused the “episode”. Did his heart give out? Was it something else? We didn’t know.

After we brought Russell into Children's Emergency;
He crashed in the Hallway and was immediately
whisked away to the resuscitation room.
The next time we saw him he looked like this

The next few hours we waited and we began to make some plans to stay at the hospital as we knew we would be there for some time. Things were starting to stabilize but with conversations with the cardiologist we knew plans were in the works to find Russell a bed in Edmonton. We had no idea how long this process may take. We were informed that if Russell’s heart had really given out that Edmonton had capability to provide mechanical assistance to Russell’s heart to help it pump. This would require surgery in addition to a heart transplant that now seemed inevitable.

During the mid-morning we decided to start getting prepared for an extended hospital stay. I went home to get an overnight bag prepared for Susan, so that she could stay with Russell in the hospital. After I went home, Susan tried to get some sleep in a room provided by the hospital. After Susan fell asleep she got a phone call shortly before lunch from the Variety Heart Clinic. She was informed that there was a bed available in Edmonton and that Russell was scheduled to fly out at 1:30 that afternoon via Air Ambulance and that we were to fly out later that afternoon. Susan immediately called me to let me know that we were packing for a little more than an overnight stay. In fact, we were told to be prepared to stay until we got a transplant. To say we were a little shocked was a bit if an understatement.

This began a flurry of activity that found us on a plane heading for Edmonton at 6:00PM that evening and after a layover in Calgary we found ourselves in the PICU at Stollery Children’s Hospital at the University of Alberta Hospital.

At about 10:00PM we saw Russell and saw that he was stable and survived his journey well. After 41 hours with no sleep, we found ourselves in Edmonton with no clear plan and no idea when we might return home. We had a very sick little boy with a failing heart and a daughter 800 miles away. At this point we wished each other a Happy 16th Anniversary and we went to our hotel and went to sleep. The journey had just begun.

Seven years later we are still very much on that journey.  Our life is consumed by health related issues and trying to manage day to day life with some very unique challenges.  I wish we had an ending to this story but I guess that is something to be thankful for.  The pages of our future have you to be written.  It should be interesting.