Queen Elizabeth Scholar: Insights from Chloe Gao

– [James] Alright, hello
everyone and welcome to the McMaster Health Forum. I’m James and I want to thank you for joining us here today for our third webinars from our QE
Scholars for this term. We have one more after this. It’ll be next week on
Wednesday at three o’clock. So an agenda for today’s webinars. I will provide you a quick little summary of the McMaster Health Forum. I will give you quick little rundown of our current Queen Elizabeth
Scholarship programme, a summary of our new Queen
Elizabeth Scholarship programme and then I’ll introduce you to our two presenters, Chloe and Sabrina. Chloe went to Australia
and Sabrina went to Malawi in the summer of 2018. So McMaster Health Forum is a leading hub for improving health outcomes through collective problem solving. We aim to harness information,
convene stakeholders, and prepare action-oriented leaders and act as an agent of change by empowering stakeholders. The Queen Elizabeth Scholarship Programme is run by a partnership between
the Rideau Hall Foundation, Community Foundations of Canada, Universities Canada and
individual Canadian universities. The purpose of the
programme is to activate a dynamic community of
young global leaders across the Commonwealth
to create lasting impacts both at home and abroad through
cross-cultural exchanges encompassing international
education, discovery and inquiry, and professional experiences. The version of the Queen
Elizabeth Scholarship programme that’s offered here at
McMaster Health Forum is called the Strengthening
Health Systems. Our scholars will
contribute to strengthening health systems and
become part of our large and growing network of
health system leaders. This programme, from
which our two scholars who will be presenting
today is ending this year, but we have been awarded a
new scholarship programme. We are one of 20 Canadian institutions to be awarded a new Queen
Elizabeth Scholarship programme. It’ll run from 2018 to the end of 2021. This new programme is called
the Queen Elizabeth Scholarship programme in Strengthening
Health and Social Systems. There are mainly it’s
mainly the same programme with a few differences,
so I’ll just highlight those differences now. First of all, the location of
the internships has changed. The old programme we
could only send students to Commonwealth countries
or involve students from Commonwealth countries. Now we can all expand that to include low and middle income countries. Because of this, our
partners have changed. We have the same partners that we had in our previous programme but
we’ve added two new partners, one in Columbia and one in Lebanon. The focus of our internships
have slightly changed. We have expanded beyond health systems and are now also including social systems and because of this, the
eligible McMaster programmes have changed slightly. All of the same undergraduate
and graduate programmes are eligible. We have added now the Arts
and Science undergraduate programme as an eligible programme and the number of
opportunities has changed. In our old programme, we hosted
or sent abroad 61 students. In this new programme,
we will only be sending or hosting 24 students,
so cut by about a third. With that said, here is our the scholars from our previous or current, now ending, Queen Elizabeth Scholarship programme. Our first cohort, which
is on the screen now, primarily went away or visited us in 2016. Our second cohort, which was quite large. 22 students primarily went
away or visited us in 2017. And our third cohort,
which is also quite large. 25 students, of which
our presenters are part of this cohort, these
students primarily went away or visited us in 2018. As we record this webinar
here in the fall of 2018, we have five students currently abroad. With that said, our first
presenter today is Chloe Gao. Chloe is an undergraduate student in the bachelor of
health sciences programme specialising in child health. She’s developed an interest in
supporting evidence-informed policymaking and service user engagement in health care reform. Through her internship,
Chloe hoped to gain further insights into the
process by which research evidence can be translated
into the implementation of regulatory policies which are conducive to improved population health outcomes. So with that, please let
me introduce you to Chloe. – [Chloe] Thank you James
for the introduction. Before I go in to my presentation, I just wanted to do something
called land acknowledgement, which I noticed was a custom in Australia. So my very simplified explanation is that this acknowledgement
essentially serves to recognise the original
inhabitants of the land where a certain gathering takes place and although saying these
words don’t in any way remedy past events, they
do spread an awareness of indigenous presence,
ownership, and land rights in every day life. So, in keeping with this,
I’d like to acknowledge the traditional territory
of the Haudenosaunee and Anishinaabes peoples and
I’d like to pay my respects to their elders past, present, and future. I’d also like to acknoledge
the traditional inhabitants of the land on which I
completed my internship in Sydney and that’s the Gadigal
people of the Eura nation. So I’m very thankful for the opportunity to live, work, and learn on these lands. So here’s just a brief overview of what I’ll be talking about today. I start off by introducing
the Sax Institute, which is where my internship took place. I’ll then explain the historical context behind each of the three main projects that I undertook at Sax. I’ll then give a high level summary of the projects I completed
during my internship as well as its relevance and impact to health system strengthening. And finally, I’ll end things off by highlighting some of my
favourite personal experiences of my trip and of my entire life so far and share some of my future plans which QES has undoubtedly shaped. So it all started when I got on a plane to the other side of the world,
as all good stories start. I was really looking
forward to the opportunity to learn about and contribute
to health system strengthening work with the Sax Institute and I was also super
excited to immerse myself in Australia’s outdoor lifestyle and huge distance running culture, which is one of the main reasons why I chose to complete my
internship in Sydney specifically and the picture on the left,
don’t be fooled by the smile. I actually started
crying immediately after that picture was taken ’cause it hit me that I’d be leaving for three months, but I’m glad that my parents
pushed me out the gate because it was the best
thing ever, so yes. So now just moving on
to a brief introduction of the Sax Institute. So it’s a not for profit organisation that aims to bridge the
gap between researchers and health decision makers. So its mission sounds very similar to that of the McMaster health forums. So the institute is comprised
of several divisions and I’ve listed some of them above and each of them pursue
a different line of work, but are united under this common goal of supporting the use of research evidence and the development and implementation of policies, programmes, and services. So during my internship,
I was mainly based in the knowledge exchange team but I also contributed to
some work with the SEARCH team and SEARCH, by the way,
stands for the Study of Environment on Aboriginal Resilience and Child Health. So before I start talking
about the specific work that I was involved in, I
just wanted to give you all an overview of the historical context around which my projects were centred. So Aboriginal and Torres
Strait Islander people are the first inhabitants of Australia and are one of the
oldest surviving cultures in the world, which really
speaks to the richness and depth of its cultural history. But if we look at Australia’s
past with openness and honesty, it really
reveals that the colonisation of Australia by European settlers has led to this concept
called Stolen Generations. So where many indigenous children were forcibly removed from their families after colonialistic government
policies were implemented. So the generations removed
under these policies became known as the Stolen generations and this removal broke important cultural, spiritual, and family
ties because children were essentially placed in these institutions or with white families where neglect, cultural shaming, and other forms of abuse were pervasive and it’s
really important to note that the damaging effects of this removal extend far beyond the individual child who was directly removed. So the trauma experienced
by these children impacted their families,
their community dynamics, and their future relationships
with their own families. So its effects have been
deemed to be intergenerational in nature and this idea
of Stolen Generations has left its legacy of
intergenerational trauma and loss on the lives of Aboriginal and Torres Strait Islander people and which is evidenced
by the large disparity that exists several
quality of life indicators such as health, education,
employment, and housing. And because most of the people- Well, I guess all of the people
watching my presentation, are likely Canadian, this
history closely mirrors Canada’s residential school system, which was established by government to forcibly assimilate indigenous children into the dominant Euro-Canadian culture and has also caused much
intergenerational harm in present time health
and social inequities. So now that I’ve outlined
the historical context of my work, I’m gonna talk
about the specific projects that I was involved in
at the Sax Institute. So during the course of my internship, I assisted with projects with both the knowledge exchange
team, so those are two Rapid Evidence Scans
that addressed different depressing health issues
and I also assisted with a community feedback
report with the SEARCH team and this was for an Aboriginal
community controlled health service and I’ll
definitely go into more detail about these projects as
my presentation goes on. So just starting off
with the work I completed with the knowledge exchange team. So before I talk about
the rapid evidence scans that I helped to write, I just wanted to give you all a definition
of what a rapid evidence scan actually is because it
definitely wasn’t a part of my common language when
I first started working at the Sax Institute. So a rapid evidence scan. It’s a concise summary
of evidence that aims to answer a specific policy question presented in a policy friendly format. So it’s very similar to the
rapid response programme here at the McMaster health forum. So when a requester, which
are often decision makers across government and
non government agencies. So when they commission a review from the Sax Institute, there
are a few preliminary steps before the actual writing can take place and one very important preliminary step is the knowledge brokering session, which is essentially an in-person meeting with a representative
from the requesting agency and the knowledge broker with experience in both the research world
and the policy making world. And this knowledge broker
is then responsible for clarifying the relevant policy issues and translating them into
resarchable questions that researchers can easily work with. And although the research
part of the process doesn’t typically occur in house, just as an aside, but
Sax usually commissions external researchers
to take on the writing after they themselves
facilitate the knowledge brokering session, the
knowledge exchange team actually received two rapid requests during my internship
where time constraints meant that all the work
would be conducted in house so I had the opportunity to
be involved in the process. So the first rapid evidence scan that I was involved in
examined diabetes programmes for Aboriginal people. So in Australia, it’s
known that Aboriginal and Torres Strait
Islander people experience disproportionately high levels of diabetes compared to their non
indigenous counterparts. And here are just some statistics illustrating that fact and you can see that the percentage of
people reporting diabetes is significantly higher
across all age groups for the Aboriginal and Torres
Strait Islander population. So because of this health gap, the Aboriginal Chronic
Conditions Network Executive at the Agency for Clinical
Innovation, or ACI, which is a statutory health organisation in New South Wales. So they identified
diabetes as a priority area for improving health
outcomes for this population. So after convening a
knowledge brokering session with a representative
from ACCN, this specific review question surfaced. So what initiatives for diabetes care that have a focus on
Aboriginal populations have been implemented in Australia? So, to answer this review question, systematic searches were conducted, which generated various papers and reports describing a range of
programmes implemented for Aboriginal and Torres
Strait Islander people diagnosed with diabetes in Australia. So I’m not gonna walk through
all the findings in detail, but some of the most common
programme target areas included educational interventions, which encouraged people with diabetes to make lifestyle and dietary changes, screening interventions to
promote early identification, treatment approaches,
self management support, case management and care coordination to support continuity of
the services received, which is especially
important because diabetes is a chronic condition, and foot care and care addressing other
physical complications associated with diabetes. So some programme features that
were deemed to be important by service users and
service providers alike across the literature,
include holistic, integrated, and culturally competent care, as well as involving Aboriginal Health Workers in the design and delivery of care, which also improves the
cultural competence of care. So the second rapid evidence scan that I was involved in explored
transfer of care programmes for Aboriginal people. So Aboriginal people in
Australia face higher rates of hospital admissions as
well as chronic illnesses that lead to these hospital admissions compared to non Aboriginal Australians. And again, just some statistics
illustrating that fact. You can see that it’s significantly higher amongst Aboriginal and
Torres Strait Islander people across all jurisdictions in
terms of hospital admissions. So since transfer of
care initiatives aimed to streamline transitions
between acute care settings, such as hospitals, back
to primary care settings, such as GPs and community based clinics, the ACCN similarly identified this as a priority area to
improve health outcomes for Aboriginal people. So another review question then surfaced based on this health issue. So what promising transfer
of care initiatives with a focus on Aboriginal populations, have been implemented in Australia? So once again, I’m not gonna walk through all the findings in close detail, but just a brief overview. We identified several papers and reports that explored transfer of care initiatives tailored towards Aboriginal
populations in Australia. So it’s important to know at this point that only one of the
papers that we identified actually explored a
transfer of care initiative from an acute care setting
to a primary care setting explicitly, whereas the majority of the papers actually
focused on care pathways, which is different
because it’s more complex and it involves several providers across several different care locations within a single treatment
plan for one person. But we chose to include
these papers as well even though they didn’t explicitly
address a review question because mechanisms to
support transfer of care were mentioned, so this
information was very important for us to capture as well. Finally, one paper identified the question of early intervention to
prevent premature self discharge or discharge against professional advice. So in this paper, it was found that improving cultural
safety would reduce premature self discharge and this in turn, obviously, is conducive to
successful transfer of care. So across the papers, several barriers of facilitators were also identified. So barriers included system complexity, so having long care pathways
involving multiple providers across several care
locations was definitely an identified barrier, so, as well, unclear care pathways that
are not consistently promoted to healthcare providers,
inadequately trained and coordinated workforce where providers are not or do not have a good
understanding of their own as well as others’ roles
and responsibilities and interestingly
enough, in our synthesis, it was found that practitioners
were often unaware of best practises and
of the types and number of visits required in a
patient’s care pathway, which obviously serves as
a barrier to facilitating that transfer of care, and finally, limited resources were
often cited as a barrier because it makes it difficult to train and tyre enough employees
who can oversee services and patients and ensure that
this care is continuous. So moving on to the
more positive findings, so several facilitators
were also identified. So having local referral pathways, so this would be keeping
within the care pathway in close geographical
proximity to one another was identified as an enabler and finally, involving
Aboriginal health workers in care was also
identified as a facilitator for this question as well. Okay. So ultimately, these
two rapid evidence scans addressed the question of what’s out there and what’s effective in
terms of diabetes programmes and transfer of care
initiatives for Aboriginal and Torres Strait islander populations. So these syntheses of
research can then be used by the ACCN to inform the
design of new programmes or modify or scale up current programmes that are promising. So that’s it with the
work that I completed with the knowledge exchange team. I’m gonna move on to the SEARCH project but before I talk about that project, I just wanted to give you
all a brief background of what SEARCH actually is. So SEARCH, like I previously mentioned, stands for the Study of
Environment on Aboriginal Resilience and Child
Health and it’s Australia’s largest long term study of
the heath and well being of urban Aboriginal children and it essentially helps to address a large gap in Aboriginal health research, which the fact that while 57%
of the Aboriginal population lives in urban areas, it’s
estimated that only 10% of Aboriginal health
research focuses on the needs of this population and
even less on childhood, which is where health
inequity often begins. And this is because the majority of Aboriginal health research is actually directed towards people living in rural and remote regions so there’s a common misconception there that that’s where the majority of the Aboriginal population lies, but it’s actually in urban
areas where that happens. So working as part of SEARCH, are four Aboriginal Community
Controlled Health Services, which are basically primary
health care services initiated and operated by the
local Aboriginal community to deliver holistic and culturally
appropriate health care. So this type of partnership research that SEARCH essentially models strives to engage Aboriginal people as equal partners and leaders and ensures that the findings generated will be relevant to the unique needs of the Aboriginal communities
involved in the work. So with this in mind, I worked on a plain language
community feedback report for the Tharawal Aboriginal Corporation, which is one of SEARCH’s
four partnering ACCHSs. So this report summarised
all the study findings thus far which pertained to the social and emotional wellbeing of
urban Aboriginal children and it was actually one of many summaries of SEARCH data and local feedback that are provided to
ACCHSs on a regular basis to seek their input and
streamline the development of new programmes and this constant and open communication of research findings back
into the community controlled health services helps to support
the sustained partnerships between Aboriginal
communities and researchers and these reports also help to ensure that ACCHSs can effectively understand and use the data to improve health, advocate for increased funding
of evidence based services and direct future research priorities and this really demonstrates the value of partnership research
where Aboriginal leadership and building community
capacity to use and understand data in an established
partnership like this can drive such meaningful improvements and health outcomes for the populations involved in this work. So now that I’m done with
the work that I completed during my internship, I’m gonna
move on to the more personal experiences of my trip. So in hindsight, I realised that the value of partnerships became
apparent during the hours I wasn’t in an office as well, which is actually a lot of hours if you think about it because
if you’re only working from nine to four, you have 17 hours left in the day to do whatever you want. So that’s just like a bonus of oh I guess like the 24 hours in a day. Like, you would have it
regardless, but I mean I just wanted to put it out there. So for me, I love distance running. I’ve been involved with the sport for a few different ways
for half my life now but never have I been able to use it as a way to find companionship,
comfort, and familiarity in a country where I
came in knowing no one. I connected with a lot of the city runners during the week and they showed me around and we hung out, but I
think the most exciting personal experience was meeting the huge ultra running community up in the Blue Mountains,
and for those who haven’t heard of this sport or
maybe aren’t too familiar with it, it’s basically like
these honest, low profile, very authentic people who
train for and run races that are longer than the
traditional marathon distance, so you have your 50 kilometres,
your 100 kilometres, 100 milers, just a few of
the more common distances. So it was definitely like a
unique and magnetising space where I felt like a lot
of things were possible and I ended up really bonding with this one family that loved to run and during the weekends,
I’d just stay over on the mountains with them and they lived in one of two houses on Mount Victoria and we just ran a race at
the mountain running group, so these are just some of the loveliest and most warm hearted people I met in Australia and by the way, the lady in the pink t-shirt, she’s on like I guess like the bottom
right photo over there, she’s 68 years old and she’s training for a 50 kilometre mountain run, so I believe that it is never too late to chase after something
that you’re passionate about in life. Okay, just my two cents on that issue. So yeah, the mountain running family and they call themselves the
Clampett clan, by the way, and they called me Chloe Clampett and then they like
unofficially adopted me, so yeah, I was like fine with that and that’s like the title of the slide. But we’d often go camping before the races ’cause they were held in these remote but I guess like just
some of the most beautiful places I’ve ever seen in my life and I saw lots of wild kangaroo, wild wombats, and a
wild opossum down there and you can see that it’s like well, this was the opossum
stealing our garbage at three a.m. and hijacking a wombat hole and I wanted to stay up even later just to see if like the wombat would come out and seek revenge, but I fell asleep, so, but yeah, I mean. I’m just like truly grateful
for these wonderful people who were so willing to help and share their playground with me
when I was feeling scared and a little bit vulnerable,
so going forward, I’ll always remember what it feels like to be helped out in that
way and I will always strive to be that way for other people. Next slide. Yeah, so besides running, I also practised sand dune quad biking in Port Stevens and I don’t even my G2 yet,
so this was a huge step up. This was like practising . So surfing at Bondi Beach,
which is a lot harder than it looks by the way,
but it was like still a lot of fun and I also
helped a fellow QE scholar by the name of Fanny practise
her photography skills by being her dance model and here’s me practising various tricks
across several locations in New South Wales and
Gold Coast in Queensland. So yeah, that’s it. So what’s next in Chloe Gao’s world. So my goals. Okay so these are just some lighthearted or I guess like my life goals, so not too lighthearted. Apply the personal and
professional experiences I’ve gained through QES to my life back in Canada and see how I can work towards addressing similar health and social inequities more locally. I’m also working on
integrating my Child Health educational background with my interest in the field of health
systems and health policy. I’m not too sure exactly
how that looks yet, but I’m workin’ on it and last but certainly not least,
just like my Clampett clan who were just happy and present and would just keep running and running like nothing was stopping them, I want to run long,
run free, and run happy towards all my goals in life so yeah, that’s it for my future. And finally, just a few very
important acknowledgements here for all the people who made this possible. First I want to thank
the McMaster Health Forum and especially James McKinley over there for all their support and
guidance over the years and for helping me grow into the person that I am today. Next I wanted to thank the
Queen Elizabeth Scholarship programme because I
wouldn’t have been able to experience any of this
without their willingness to invest in youth. And finally, I want to
thank the Sax Institute for hosting me. And yup, that’s it. (applause)

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