THE MINUTES OF THE INAUGURAL MEETING OF
THE BRITISH COLUMBIA - WEST COAST TRAVEL MEDICINE SOCIETY
HELD AT THE PLAZA 500 HOTEL, VANCOUVER ON THURSDAY 24TH JANUARY 2002
Minutes in Final Form to be Accepted at Next BCTMS/WCTMS Meeting
Present:
Dr. Darin Cherniwchan (Fraser Valley Travel Clinic)
Barb Cherniwchan, lawyer
Anna Langan, office manager (The Travel Clinic)
Dr. Ming Jung (Global Vaccination & Travel Clinic)
Yvonne Kwok (Global)
Carol May, RN (International Travel Health & Vaccination Centre)
Heather East, RN (International TH&VC)
Dr. David Patrick (BCCDC)
Karen Pielak (BCCDC)
Dr. Rusung Tan (TMVC)
Dr. Laurie Dusik (The Travel Clinic, TMVC, NSH Travel Clinic, SFH Travel Clinic)
Dr. Caroline Penn (TMVC & SFU)
Ray Christopherson, CFO (TMVC)
Marie Wingen, Nurse Manager (TMVC-Vancouver)
Louise Williams, RN (TMVC-Vancouver)
Dr. Anna Banerji, Post-Travel ID (TMVC)
Dr. Wayne Ghesquiere (Nova Travel Clinic – Victoria)
Andrea Derban, RN (NSH Travel Clinic)
Marion Guenther, RN (NSH Travel Clinic)
Brenda Ramshaw, RN (Nanaimo Public Health Travel Clinic)
Francine Lewis, RN (Nanaimo Public Health Travel Clinic)
Dr. Jim Hayward (Lynn Valley Medical & Travel Clinic)
Sally Livingstone, RN (Capilano College)
Dr. Zia Fahim (TMVC- Surrey)
Danielle Morin, RN (TMVC-Vancouver)
Dr. Mike Mamacos (On-Site Immunizations)
Dr. Kathy Kelly (Mynn Valley Medical & Travel Clinic)
Dr. John Farley (Downtown Infectious Disease Clinic & Ocean Walk Medical)
Peter Reid, Wyeth-Ayerst
Sonja Sandberg, GSK
Andrea Walters, GSK
Viviane Lavigne, Aventis Pasteur
Joan Rousseau, Aventis Pasteur
Apologies:
Dr. Stan Karon (Mariner’s Clinic)
Dr. Suni Boraston (The Travel Clinic)
Judy Tobias (The Travel Clinic)
Paulina Pike, RN (CRD Travel Clinic – Victoria)
Laura Moore-Dempsey, Merck Frosst
Dr. Paul Assad (International Travel Health & Vaccination Centre)
Dr. Paul Zickler (International Travel Health & Vaccination Centre)
Jeanette McCart, RN (Victoria Travel & Immunization Services)
David McCaig, Association for Canadian Travel Agents/BC/Yukon Division
Canadian Institute of Travel Counsellors (CITC) – National Org.
Jan Preece, Wyeth-Ayerst
1. Introductions and Welcome
The meeting began at 6:15 with a buffet supper. Dr Darin Cherniwchan welcomed everyone to the inaugural meeting of the BCTMS. He thanked the hotel for the excellent meal and and expressed thanks to all those in attendance for their interest in establishing a Society of Travel Medicine in B.C.
Dr. Darin Cherniwchan acknowledged the presence of both public and private health clinics represented by physicians and nurses from Greater Vancouver, North Shore, Nanaimo, and the Fraser Valley. There were also representatives from several Pharmaceutical Companies. Special thanks were expressed to Joan Rousseau and Vivian Lavigne from Aventis Pasteur for their help in organizing the evening.
Two planning meetings had been held prior to the meeting and the following people had been instrumental in planning the agenda for the evening.
Darrin Cherniwchan
Marie Wingen
Ray Christopherson
Paul Assad
Laurie Dusik
Barb Chernwichan
Joan Rousseau
Caroline Penn
Ming Jung
Yvonne Kwok
2. Why a BC Travel Medicine Society? – Joan Rousseau – Aventis Pasteur
Joan referred us to the Survey of Travel Medicine Clinics carried out in the Fall of 2001 All private and public travel medicine clinics were surveyed to assess the current status and anticipated future needs of Travel Medicine Specialists and to explore the need for a Provincial Travel Health Association. A copy of the survey results had been circulated[1]
Joan received 44 responses (100%), 60% from public clinics and 40% from the private sector, and 90% of the Yellow Fever centers. The responses indicated the following areas of concern
1) Access to Resources
2) Education
3) Standardization of Travel Medicine Practice
4) Funding
5) Vaccine Issues
The forming of a Provincial Travel Medicine Association has been defined by many as a tool to accomplish the needs described in the survey.
The major foreseeable barriers are seen to be time (it is a voluntary association) and geographic distances.
3. Funding Issues
Dr David Patrick (BC Centre for Disease Control)
The question was put to the group as to whether there was any interest in exploring the possibility of obtaining travel related vaccines from one vendor and distributing these to Travel Medicine Specialists at a discount price.
Discussion followed around the following:
Ø if the tender for specific vaccines was given to one company would this limit the competition?
Ø What would be the cost of administering such a program and would there be any real savings to the group?
Ø Which vaccines would be included?
Ø Would the vaccines be available only to Travel Medicine Specialists or to General Practitioners as well?
Ø With the government cutting funds for Health Care are they likely to undertake a program to subsidize Travel Medicine?
It was agreed that the group would be surveyed for feedback and a subcommittee would be formed to discuss this issue and report back to David Patrick.
Andrea Derban (North Shore Health – Co-ordinator of travel medicine)
Andrea spoke about the concern re funding for the public clinics. North Shore Health holds 3-5 clinics per week and they have 2 sessional physicians. It is an ongoing fight to keep program going. It is the only public health program offered to all ages to prevent the spread of infectious diseases in those returning from other countries.
Another concern is the consistency in the practice of travel medicine. With little funding for staff to attend meetings, and to access resources it is difficult to communicate with other Travel Medicine Specialists. There is a need for information and education.
Anna Langan (The Travel Clinic – Vancouver Coastal Authority)
Anna reported that in 1997 they applied to the Ministry of Health for funding to act as the Centre of Excellence for Travel Medicine in BC and were turned down. There remains a great need for funding for public health travel programs.
Laurie works in both public and private health clinics. Funding is always an issue. In Lower Mainland we have access to other clinics whereas smaller communities do not have this resource and the nurses feel isolated and require support, funding and education. One purpose of the Society would be to help nurses in small communities with networking, websites, mentorship programs, seminars, talks and teleconferencing.
Ru Tan (TVMC- Vancouver BC)
Ru spoke about the private sector experience. Every clinic is different. TVMC is run by committee. Last year TVMC’s clinics saw a total of15,000 patients. TVMC make their money from Consultation fees to pay staff. There is a continuing need for private travel medicine clinics, travelers are better served and other clinics are not seen as competition but partnership. There is a developing acceptance of private clinics by the public health sector.
Wayne Ghesquiere raised the question as to why Public Health Travel Clinics do not charge a fee to help with funding issues. Brenda Ramshaw from Nanaimo Public Health responded by saying that while they do not charge a consult fee they charge more for vaccines. Also need to factor in that nurses wages and buildings are subsidized by the government.
6. "Why Re-invent the Wheel? The Alberta Experience
We can look to the AATHP (Alberta Association of Travel Health Professionals) for guidance. The AATHP was set up 6 years ago with funding from the Industry.
They currently have a membership fee of $100.00 - $80.00 goes to the annual conference costs and $20 to the administration of the society. An executive of approx. 12 members exists with an annual rotation of about 3 to maintain consistency and avoid burn-out, given the voluntariness of the positions. At least one physician serves on each committee (majority of members are nurses). Other provinces can join the society but members must be Alberta resident to sit on Executive. The AATHP uses teleconferencing to network with members and has worked to produce a brochure for raising awareness of travel clinics with physicians.They do not have a web site yet but are considering this. In Alberta, a Manual of Standardization of care including malaria advice has been developed and updated on an annual basis. This has not been done by the AATHP but rather the Capital Health Region.
7. "Passion with a Purpose"
Dr. Darin Cherniwchan
Darin commented that it was obvious from the meeting thus far that there is a lot of passion around the topic of Travel Medicine. It was therefore important to assess the needs and expectations of the society and to establish a plan of action. He stressed the need to move slowly towards the goals of the Society as they were established.
Several purposes for the Society had already been identified:
a) Access to resources. A website had already been established at www.BCTMS.ca and members would be encouraged to access the website for meeting minutes, information etc. Travel Medicine is constantly changing and it is of utmost importance that Travel Medicine providers have up to the minute information to be able to give current and appropriate advice to travelers. This information is easily gathered and dispersed via the internet and email.
b) Standardization of Care. Consistency of information and advice had been identified as a primary purpose of the Society. The production of a Travel Medicine Manual offering information on standard advice and recommendations could be developed and circulated to members. There would be a one time purchase fee and then annual update fee
c) I.S.T.M. exam in New York 2003
Darrin referred us to the memorandum from Travel Medicine News Share[2] This exam acknowledges a level of comprehension required to practice travel medicine. It was suggested that those interested in taking the exam should form a group to give everyone an opportunity to share information and case studies.
d) Press Releases
Within the next week or so a press release would be issued to Newspapers and Medical Journals to advertise the British Columbia Travel Medicine Society.
e) Society Executive
Those interested in serving on the Executive Committee should inform Darin Cherniwchan. A confidential ballot will then be mailed out to all members of the Society. Representatives from the private and public sectors will be elected to serve on the Executive Committee
Barb Cherniwchan then spoke about the Incorporation of the Society[3]
The charter documents are being finalized. These incorporate the name of the society, the constitution or purpose of the society and the by laws of the society.
a) The name of the Society.
The name British Columbia Travel Medicine Society has been reserved with the Registrar of Companies and consent needs to be obtained from the provincial government and the College of Physicians and Surgeons.
b) Purposes of the Society
1. To promote healthy and safe travel by providing travelers with quality pre and post travel care, by increasing public awareness and by fostering co-operation among all Travel Medicine Specialists.
2. To facilitate quality pre-travel counseling and vaccination services and the proper and effective treatment of post travel illness.
It was stressed that there were lots of "other" players in travel medicine and we can all benefit from liaising with these people to facilitate comprehensive care. To ensure that consistent advice is offered across B.C. CATMAT has defined a travel medicine consult and has issued guidelines for the practice of Travel Medicine. [4] One purpose of the society could be to produce standardized patient information leaflets and handouts.
Ming Jung suggested that VFR and migrational health issues should be incorporated into the purpose of BCTMS and Barb agreed to do this.
c) Membership and voting
The membership will be divided into voting and non-voting members.
a) British Columbia travel medicine providers (Class A voting members)
b) Senior Administrators of travel clinics located in BC (Class B voting members)
c) All other persons are eligible for non-voting membership
d) Membership Fees
It has been suggested that membership fees be $100 for voting and $50 for non voting members. It is hoped to obtain funding from Manufacturers and the fees would go towards the costs of running the society (start up costs, web page set up etc). As the number of members is unknown and the costs are unknown it is anticipated that excess fees can be deducted from next years fees or put towards the running of a Conference. Ray Christopherson had volunteered to be Society Treasurer.
Final and complete charter documents will be circulated to members via email when available.
9. Health Canada's requirement for Freezer Alarms
Joan Rousseau brought the meetings attention to Health Canada's requirement for freezer alarms for the storage of Yellow Fever. From 1st July 2002 Yellow Fever centres are required to have their freezer alarmed for -30 to +5 C. The reason given by Health Canada for the necessity for freezer alarms was to provide an added level of cold chain national security management " given their mandated responsibility via WHO. Cold Chain management has been cited as a “hot” issue in the HC YF-Centre evaluation done in 2000. There are currently 31 designated Yellow Fever centres in BC (12 public and 19 private)
Discussion followed regarding the necessity of the alarm and the criteria for "spoiled " vaccine. Vivian Lavigne told the meeting that Christine Labelle from Health Canada would be meeting with Aventis in Toronto in March at which time she hoped to clarify the reasoning and criteria further.
Joan had surveyed a few Alarm companies and while prices vary, the anticipated cost would be $700 for the installation of the alarm and $30 per month for monitoring fee approximately. Pricing may vary throughout the province.
Joan also told the meeting that single dose Yellow Fever would be available at the end of February/02.
10. Closing of the Meeting
Darin Cherniwchan closed the meeting at 9.10 pm encouraging those present to submit membership fees before they left in order to become a "Charter Member" of the society.
[1] BC Travel Clinic Needs Assessment Survey Fall 2001
[2] Certificate of Knowledge in Travel Medicine Examination Update – Dec 2001
[3] Memorandum from Barbara Cherniwchan to BCTMS members re the Incorporation of the Society
[4] Canada Communicable Disease Report Dec 1999 “Guidelines for the Practice of Travel Medicine