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Rural And Remote Health - Flying Those In Need To Services

INTRODUCTION by Alison Stirling

In past OHPE Bulletin features we have discussed 'accessibility' and 'equity' issues in relation to multiple barriers, such as poverty, language, race, culture and sexual orientation that groups of people experience. But Access to Health Services is also a geographic issue, a determinant of health for people who are living in underserviced, rural, northern and remote areas. As equal access to health services is a key part of the Canada Health Act, most provinces have put in place various programs to bring people to medical care services, or medical care to communities. Examples include the Underserviced Area Program and the Northern Health Travel Grant Program in Ontario. But, despite such efforts, access to health care by residents in rural, northern and more remote areas can still be problematic and is a frequently expressed concern.

In May and June 2000, a series of news stories emerged about possible discrimination against northern Ontario residents, in accessing cancer care services, in comparison to southern Ontario residents. The Ministry of Health and Long Term Care gave Cancer Care Ontario a special allocation of $155 million to their budget to cover 100% of the costs of travel, accommodation and food for southern Ontario cancer patients who have to travel from their communities for cancer care in Thunder Bay, in Sudbury, in Detroit, or in Buffalo. Northern cancer patients, who regularly have to travel far from home for cancer treatment, can only get a small portion of their travel covered--nothing for accommodation, nothing for food. When a group of northerners who claim they are victims of "health care apartheid," launched a class action suit in June 2000 to recoup some of their thousands of expenses for travelling to health services - the news stories and petitions from municipalities and politicians brought attention to the issues of access to health services and the availability of supports.* (article by Lisa Priest in June 17, 2000 The Globe and Mail, "Northern Ontario cancer patients face 'discrimination.'")

Our feature today comes from the only Canadian charitable, non-profit organization offering air travel help to people in isolated areas to reach needed health services. The author of this timely and fascinating piece, is Malak Sidky, Manager of Flight Programs at Hope Air. Malak has more than 10 years of experience as a health care professional. She has worked at a national children's charity (SAFE KIDS Canada), in pediatric hospitals and with health associations.

For more information on Hope Air, read further, or contact them directly at: 416-222-6335 or toll-free at 1-877-346 -HOPE (4673) or by email at

A. Hope Air - "Flying those in need to medical care"

Throughout Canada, rationalization of the healthcare system is challenging the realities of providing medical diagnosis and treatment for many Canadians, particularly those in rural and remote communities. It is with respect to improving and increasing access to needed health services that Hope Air exists.

Hope Air is a national charity dedicated to serving Canadians in financial need by providing free air transportation to recognized facilities for medical care not available in the patient's home community. Since 1986, Hope Air (formerly Mission Air Transportation Network) has been assisting patients from every province, representing every age group and illness category, in reaching necessary medical care. The program is provided by using empty and/or donated seats on commercial and corporate aircraft and through Hope Air's innovative Volunteer Pilot Program. In fiscal 1998-99, Hope Air arranged almost 3,100 free flights, valued at more than $1,500,000. In 1998/99, Hope Air arranged 902 flights for residents of Ontario, notably from communities like Sault Ste. Marie, Timmins, Thunder Bay, Sudbury and other Northern Ontario communities. Hope Air also provides 24-hour back up for the Province of Ontario's organ retrieval program.

B. Acting on Determinants of Health

Hope Air's program addresses not only the practical issue of one's ability to reach appropriate medical care, but also considers the economic and social conditions which make it necessary for a patient or family to approach Hope Air for assistance. Part of our mandate is to relieve the stress of illness coupled with financial hardship - stress that can only add to the challenges faced by these Canadians. Our goal is to get these people to medical care, enabling them to return to their home communities with improved health, a positive attitude and an improved quality of life and well-being.

C. The People Who Use Hope Air Services

Our clients come from communities across Canada, from Happy Valley, Newfoundland to Nanaimo, British Colombia. They share the need to travel far from home for necessary medical care and the inability to afford the high cost of a flight. But each story is unique and compelling.

A recent case comes to mind. The Smiths (not their real name) live in Thunder Bay with their three year old son, Adam, who has renal failure. Because there is no pediatric nephrologist in Thunder Bay, Adam must travel to London, Ontario to receive specialized care. This past year, they have needed to travel to London ten times. Dad's salary as a logger is insufficient to support the family's frequent trips to London. Making the 12-15 hour trip by car is not a viable option, as the long car ride would be very difficult and stressful for a child already at risk and the family car is not reliable. Having exhausted the resources of government travel grants and assistance from the Kidney Foundation, the Smiths were referred to Hope Air. Because of the generosity of Air Canada, one of Hope Air's sponsors, we were able to arrange flights for Adam and his Dad. This is Hope Air's only mandate - to fly those in need to medical care.

D. Selection Criteria for Services

Generally, the criteria for using our services include:

- Being a Canadian citizen or landed immigrant

- Demonstrating financial need

- Having a scheduled appointment for recognized medical treatment

Hope Air is not an air ambulance service. Patients must be able to board the aircraft with a minimum of aid, sit in a regular airplane seat and must not require medical attention on board the aircraft. Requests for an escort are accommodated whenever possible if the escort is required for medical reasons. Requests need to be made at least 14 days prior to the departure date. Hope Air may arrange up to 3 return trips in one calendar year.

Once Hope Air confirms the eligibility criteria, we make arrangements for the flight. After the flight, we contact the patient and administer a patient satisfaction survey. All survey results are entered into an Access database and analysed periodically to ensure we are providing high quality service.

E. Accessing Cancer Diagnosis and Care Services

Hope Air has always had a special relationship with the Canadian Cancer Society - indeed, 40% of those we assist are cancer patients who must travel for necessary diagnosis and treatment. As of June 1, 2000, Hope Air began a formal partnership with the Canadian Breast Cancer Foundation (CBCF), managing points awarded to the Foundation to assist breast cancer patients traveling from their local communities for medical care. This CBCF partnership sets an example for the possibility of Hope Air supporting special treatment programs associated with other diseases.

For more information about Hope Air, feel free to browse our web site at or call us at 416-222-6335. Fax: (416) 222-6930

Hope Air

Procter & Gamble Building 4711 Yonge Street

Toronto, Ontario. M2N 6K8


F. Key Resources:

1. PatientLink Aeromedical Inc. - This is a private air ambulance service operating internationally. They will fly Hope Air patients for free if there are spare seats on their planes. They can be reached at 1-888-546-5247 or at

2. Angels of Flight Canada - Private company operating out of Peterborough. They provide non-emergency land services (e.g. patient transfers) throughout Ontario. They employ paramedics & nurses. They also work with commercial airlines and contract out planes to provide air ambulance services world-wide. For further information, call 1-800-563-7686 or check out their web site at

3. Canadian Cancer Society's Cancer Information Service (CIS) provides information about free lodging and ground transportation for cancer patients requiring medical treatment across Canada. The CIS can be reached at 1-888-939-3333 or at

4. Hope Air volunteers can provide information on affordable lodging and ground transportation for any patient requiring medical treatment across Canada. The toll free number is 1-877-346-4673.

5. The Kidney Foundation - provides last resort financial assistance to kidney patients. They have a Northern Issues Task Force to develop recommendations on access to health care. They can be reached at 1-800-414-3484.

6. Northern Health Programs & Planning Branch. This is a branch of the Ontario Ministry of Health that provides financial assistance for ground transportation from the city hall of the city where the patient lives to the city hall in the treatment city. They can be reached at 1-705-670-7280.

7. Canadian Owners and Pilots Association. This organization, based in Ottawa, is the recognized voice of general aviation in Canada. They have a monthly journal (circulation: 18,000) called Canadian Flight. Hope Air publishes frequent articles in the journal and is linked to their web site