Warren Brock

Communications Manager

Centre for Chronic Disease Prevention and Management, Southern Medical Program
Office: Reichwald Health Sciences Centre
Phone: 250.807.8601
Email: warren.brock@ubc.ca


 

The Southern Medical Program is excited to welcome our new and current students back to class for the fall term. Meet some of our students and hear about what they are most looking forward to for the new school year.

Name: Lisa Renaud
Hometown: Born in Maple Ridge, spent some time in Lillooet and then Kelowna
Year in Program: 3

What inspired you to pursue medicine?
In short, it provides an opportunity to help people. Additionally, I enjoyed science growing up and medicine certainly meets my interests.

Why did you choose UBC?
By studying at UBC I was able to stay close to my family. Plus, the skiing is fantastic in Kelowna.

What are you most looking forward to for the coming school year?
We started clerkship this past June and it has been fantastic so far. I am looking forward to rotating through many more specialties that I have not been exposed to before.

What’s top on your bucket list?
Multi-day kayak trip through Gwaii Haanas.


Name: Raja Choudhary
Hometown: Grand Forks
Year in Program: 1

What inspired you to pursue medicine?
Growing up in a rural town, I saw the health care disparities that our communities faced. My friends and family had a hard time traveling long distances to see doctors. I want to take my love for science and health and apply that to my future career as a doctor while helping rural communities gain the proper health care facilities they deserve.

Why did you choose UBC?
UBC’s distributed sites help students stay close with their friends and family while they make their way through the challenging experience that is medical school. This opportunity gives me the chance to become a doctor while staying true to my roots. Having the support of my loved ones while serving in and close to where I grew up made UBC’s medical program the best choice for me.

What are you most looking forward to for the coming school year?
I’m looking forward to meeting everyone in the program and getting started with my journey through medical school! Along with school, I’m hoping to get involved with the community and join some of the different clubs that UBC Medicine has to offer. I’m excited to be moving back to the interior after spending the last few years in Vancouver pursing my undergraduate degree.

What’s top on your bucket list?
Trying out the best restaurants in the Kelowna area!


Name: Stephanie McCann
Hometown: Kelowna
Year in Program: 2

What inspired you to pursue medicine?
As I went through life and discovered what I was interested in, I came to realize fairly early on that medicine was a combination of all the things I wanted most in a career. I enjoy continuously learning, having the ability to educate and support people, and challenging myself, so I feel like medicine is the perfect blend of all of the above. On top of this, my father is a physician and being able to hear about all his interesting stories and the satisfaction he gets from helping people always made being a physician stay at the top of my list. I’m happy I decided to stick with my gut as my first year of medicine was absolutely incredible and I truly feel like I’m in the right place.

Why did you choose UBC?
I’ve lived in Kelowna my entire life and have never found a good enough reason to want to go anywhere else. The Okanagan is beautiful, and I love the hot summers by the lake just as much as I love skiing in the winter. Being around my family and friends is a huge bonus, and I knew I would enjoy pursuing medicine here as much as I enjoyed my undergrad at UBCO. I also really liked the idea of attending a smaller distributed site where you really get to know everyone, and the friends I’ve made over the past year have definitely made me feel like I made the right choice.

What are you most looking forward to for the coming school year?
I was thankful that we were able to experience a lot of hands-on learning last year, so I think spending more time getting clinical experience will be great. There is so much variety available in terms of physician careers, so I’m looking forward to hopefully getting more exposure to all medicine has to offer (and, of course, getting to see all my classmates again)!

What’s top on your bucket list?
For this year, I definitely want to hit more ski resorts when I have the time. I have a water bottle that I’ve decided to cover in stickers from different mountains (and I currently only have two), so I’m getting out on the slopes whenever I can! I’d also eventually like to become fluent in another language, so keeping up on my Duolingo streak will be very important to me.


Name: Brandon Hayashi
Hometown: Kamloops
Year in Program: 2

What inspired you to pursue medicine?
I’ve always been interested in science and medicine, and growing up, I always wanted a career where I could help others. My most formative and inspirational experience that swayed me towards medicine was my time in social work! Throughout my science degree, I was a social worker. I did a variety of jobs: I found housing for street-entrenched individuals, provided harm reduction supplies, conducted street outreach, reversed overdoses, and when possible, provided counselling services. As a member of an interdisciplinary healthcare team working with nurses, doctors, and other social workers, I witnessed the importance of collaboration and the impact this has on a single patient. Having seen several sides to this dynamic, I want to be the type of physician that can champion teamwork and provide an adaptive and holistic approach to healthcare.

Why did you choose UBC?
I chose UBC as much as they chose me! I was planning on picking UBC no matter what! I grew up in the Okanagan so having the privilege of pursuing my dream in Kelowna close to my friends, family, and mentors really means a lot. I also have the opportunity to return to my hometown for my clinical rotations, which is incredible!

What are you most looking forward to for the coming school year?
I am incredibly excited about everything! New friends, going into school with a better handle on the curriculum, the opportunity to do more hands-on skills, all of it! I am especially interested in learning how to make healthcare more accessible to marginalized populations through advocacy and incorporating that into my own approach.

What’s top on your bucket list?
I’m a pretty simple guy! I don’t have a lot of activity-centric things on my bucket list. Ideally, I want to give everything back to my community. I want to be a community psychiatrist that, through his practice, prevented a lot of adverse health outcomes. I want to liaise between various social nonprofits to provide care to those who need it most. I want to have a scholarship in my name so I can perpetuate youth potential. At the end of the day, I don’t want to just kick the bucket; I want to do a kickflip over it.


Name: Brett Rouault
Hometown: St. Albert and Vernon
Year in Program: 4

What inspired you to pursue medicine?
Growing up I loved all my science classes, especially the courses about the human body. Going through university this strange affliction continued, and I also began to learn the many benefits that you get from a career in which you serve others. Medicine was therefore a natural choice.

Why did you choose UBC?
UBC was kind enough to accept my application after my 5th attempt at applying! Despite the initial challenges I was very honored to accept a position at the University of British Columbia in my new adopted province. Being accepted to the Southern Medical Program in Kelowna has allowed be to still be around for my family, which I something I value greatly.

What are you most looking forward to for the coming school year?
During our 4th year of study, we do a variety of electives throughout the province, compared to our 3rd year where our learning is localized at one site (mine was in Kamloops). I am looking forward to learning with the large variety of people and preceptors that the many different locales in British Columbia have to offer. Each location I visit and each patient I see is another learning opportunity to help me become a better physician in the future.

What’s top on your bucket list?
I hope to build a remote cabin near a lake somewhere in BC at some point in my life.

Dr. Daryl Wile

Name:  Dr. Daryl Wile
Clinical Faculty Rank:
Clinical Assistant Professor, UBC Department of Medicine
Community:
Okanagan
Teaches:
Foundations of Medical Practice, Clinical Skills, FLEX, Clerkship, Postgraduate Training

What’s your best approach to providing an engaging and positive teaching session?
I love to teach with analogy as a way to build relationships with other knowledge. Clinical cases also provide a great structure if time is taken to get to know the patients, as their stories will reinforce the memory of important concepts and findings.

How have learners benefited your practice?
When I am working with learners I refresh my knowledge of what is new in the field. The biggest benefit though is the boost of enthusiasm it brings to practice. For me, it’s energizing and refreshing to get people interested in neurology.

How has teaching impacted your well-being or approach to the work day?
Being a well-rounded person with balance in life is a fundamental part of becoming a good doctor. Meeting students and residents who are amazing people in their lives outside of medicine is a great reminder of this. For me, teaching provides balance for the pressure of clinical work and helps create a refreshing and sustainable practice. I have found connecting with other faculty, staff and students has countered the remoteness and isolation that has waxed and waned through the course of the pandemic.

Click here to learn more about teaching opportunities with the SMP.

Southern Medical Program (SMP) students Connor De Melo and Eden Dubchak are this year’s recipients of the Reichwald Family Foundation Awards. Both students, who recently entered their third year of studies, are recognized for their excellence in academics, leadership, and community service.

Connor De Melo

De Melo grew up in Kelowna and completed a BSc in Microbiology at UBC Okanagan. De Melo has served as part of the MD Student Outreach Ambassador Program and as Year 1 Social Vice-President. He has also volunteered and supported numerous community organization including CRIS Adaptive Adventures. As part of the Flexible and Enhance Learning course, De Melo is working on a Parkinson’s Disease research project looking to improve treatment and fall prevention for patients.

“I am incredibly grateful to have received this award and would like to express my appreciation to the faculty and the Reichwald family for all of their support,” says De Melo. “It makes a significant impact financially for me and my family at this time and we are very thankful.”

Eden Dubchak

Originally from Vancouver, Dubchak completed a BSc in Behavioural Neuroscience at UBC. He has served in several leadership roles including the Vice-President Academic and helped advocate for academic needs of his classmates. Dubchak has also greatly supported student research with the Interdisciplinary Student Health Conference and Neuroscience Undergraduate Research Conference and prospective medical students through the MD Student Outreach Ambassador Program

“I feel very fortunate and honoured to have been chosen for this award,” says Dubchak. “I would like to extend my sincere gratitude to the Reichwald family for their generosity and their continued support of medical students like myself, and I look forward to serving the community in the future.”

The new Black Student MD Admissions Pathway will help address the underrepresentation of Black physicians in British Columbia (B.C.)

“The goal of the pathway is to remove barriers that hinder the professional and academic success of Black students, creating a community within and beyond UBC where Black MD students can see representation that reflects them within higher medical education and the healthcare system,” says Donneil McNab, the Faculty of Medicine Black Student Initiatives Manager.

In this newly created role, McNab hopes to inspire and encourage more Black students to study medicine in B.C., while also supporting them throughout their academic careers.

“The program will provide holistic and multifaceted support for students, and include touchpoints before, during and after their time with us at UBC,” she says. “It will be an honour to have that level of involvement in the student life cycle of Black MD students and the chance to create positive change for students.”

“Graduating more Black physicians is absolutely pivotal as we strive to eliminate racism and discrimination in the healthcare system, and make health care more responsive to the needs and experiences of Black people and other underrepresented communities while improving health outcomes for all British Columbians,” says Dr. Roger Wong, Vice-Dean, Education.

The new pathway reflects the Faculty of Medicine’s contract with society and commitment to educating, developing and mentoring diverse future health care practitioners — as outlined in its Building the Future: 2021-2026 Strategic Plan. The pathway also aligns with the recommendations within the UBC President’s Task Force on Anti-Racism and Inclusive Excellence report.

“This pathway is the foundational step that the Faculty of Medicine is taking to help increase the representation of Black students within the MD program,” says Dr. Wong. “We recognize that this is just the beginning and more needs to be done, such as increasing the recruitment of Black mentors and role models. The Faculty remains committed to working collaboratively with various stakeholders to achieve this.”

Created in collaboration with various stakeholders in Black medical education across Canada, the pathway also draws on the successes of, and lessons from, the Faculty of Medicine’s Indigenous MD Admissions Pathway.

James Andrew

“Thanks to our reputation for recruiting and supporting Indigenous medical students, applications and admissions have increased fivefold over the past two decades,” says James Andrew, Faculty of Medicine Indigenous Student Initiatives Manager.

The Faculty of Medicine envisions similar outcomes for the Black Student MD Admissions Pathway while recognizing that the urgent work of anti-racism and meaningful, system-wide change requires engaged, long-term support from UBC, government and health institutions across the province.

Dr. Shahin Shirzad

“To effect change of this magnitude, we need to support Black leadership and expertise at all levels of the health care system,” says Dr. Shahin Shirzad, Assistant Dean, Admissions, MD Undergraduate Program. “This begins with education: ensuring accessibility to medical education for our Black community and providing an environment with opportunities and resources so all students can realize their potential.”

To this end, the Faculty of Medicine is committed to creating mentorship and ambassadorial opportunities as well as increasing access to academic, financial and well-being services to ensure Black students and students from other underrepresented groups succeed and thrive.

“As someone who has experienced racial inequity in healthcare, I think [the pathway] is a potential game-changer,” McNab says. “The beauty of the Black Student MD Admissions pathway is that it will benefit all students as they will have more opportunities to learn from and with a more diverse group of peers, which only makes for more culturally aware physicians.”

For more information, visit the Black Student MD Admissions Pathway page on the MD Undergraduate Program website.

Each year, Southern Medical Program (SMP) students recognize faculty and staff from across the Interior Health region for their outstanding contributions to medical education. The nomination and selection process for the annual awards program is completed solely by SMP students. Congratulations to our 2022 recipients.

Year 1 Southern Medical Program Excellence Award
Wendy Milligen
Program Coordinator, Years 1 & 2
Year 2 Southern Medical Program Excellence Award
Dr. Cara Wall
Director, Faculty Development
Year 3 Southern Medical Program Excellence Award – Kamloops
Dr. Cecily Jonker
Clinical Instructor, UBC Department of Surgery
Year 3 Southern Medical Program Excellence Award – Kelowna
Dr. Andrew Dickieson
Clinical Assistant Professor, UBC Department of Anesthesiology, Pharmacology and Therapeutics
Year 3 Southern Medical Program Excellence Award – Trail
Dr. Narain Varma
Resident, UBC Family Practice
Year 3 Southern Medical Program Excellence Award – Vernon
Dr. Glenn Vaz
Clinical Instructor, UBC Department of Medicine
Year 3 Southern Medical Program Excellence Award – Vernon
Dr. Travis Allen
Clinical Instructor, UBC Department of Family Practice
SMP Graduating Class Award
Dr. Marjorie Docherty
Clerkship Site Leader, Southern Medical Program
SMP Graduating Class Award
Dr. Diana Fort
Assistant Dean, Southern Medical Program

 

Congratulations to the Southern Medical Program Class of 2022. Meet some of our newest MD graduates and SMP alumni.

Jordanna Roesler
Hometown: Kelowna

What attracted you to your field?
Growing up, I saw severe dermatologic diseases exacerbated by systemic barriers in remote northern communities. I knew I wanted to help close health gaps and better understand how internal diseases and social determinants of health could manifest through a person’s integumentary system such as their skin, hair and nails. Throughout medical school, my calling to dermatology was further solidified as I thoroughly enjoyed the procedural, medical, and humanistic aspects provided by dermatology.

What is your favourite moment from your time at UBC?
There’s been so many incredible moments throughout the past four years but one of my most recent favourites was matching with my partner to our top choice programs. Opening the results together was a moment I will never forget. We are incredibly thankful to be able to continue our training together and to be close to our families!

What is one piece of advice you have for students entering your program?
Medical school can be very demanding as well as rewarding. Creating and maintaining strong connections to community and relationships were instrumental to my overall success and wellbeing. Overall, don’t forget to take care of yourself so that you can take care of others.

What’s next for you?
I am excited to start at a world-renowned program like UBC Dermatology this July and continue my journey in health advocacy and becoming a well-rounded dermatologist.


Richard Xiang
Hometown: Summerland B.C.

What attracted you to your field?
I was greatly inspired by my own family physician who provided exceptional medical care to our community in Summerland, B.C. I have always imagined myself establishing the same amazing longitudinal relationships with my own patients – celebrating their progress and successes, while helping them overcome health challenges and perceived setbacks.

What is your favourite moment from your time at UBC?
I was very fortunate to meet my amazing partner Jordanna during medical school training and each and every moment with her has been a highlight during my time at UBC. We were fortunate to be assigned to our top choice programs in Vancouver and we will be getting married at the end of May!

What is one piece of advice you have for students entering your program?
Find yourself a group of friends who boost you up and support each other. Medical school can be a long and rigorous process, having a solid support system around you will make all the difference!

What’s next for you?
Family Medicine Residency Training at the Vancouver-Fraser Program. I am beyond excited to start residency training with my amazing co-residents in one of the most beautiful cities in the world.


Svetlana Hadikin
Hometown: Castlegar

What attracted you to your field?
From a young age, I spent a lot of time volunteering with my parents and grandparents at community cultural events, and with Rotary. I knew I wanted my career to encompass what I loved most about volunteering, which was building connections while positively contributing to my community. Family medicine is the perfect way for me to interact with members of my community on a regular basis, while playing an active role in preventative medicine, empowering my patients to prioritize their health.

What is your favourite moment from your time at UBC?
One of my top moments in my four years of medical school was in my third year. I had just started my pediatrics rotation, which was my first block of clerkship. One week into the rotation, my preceptor was providing me with feedback, and she mentioned that one of the mothers of a child that I had seen that week had called. The boy’s mother wanted to express that she felt I had handled the interaction with her son very well, and that I would make an excellent doctor. I have carried this vote of confidence with me through my other clinical experiences, particularly when I am feeling discouraged after a more challenging interaction. I am reminded to draw on my strengths and embrace small victories.

What is one piece of advice you have for students entering your program?
Do your best to build connections early, particularly within the medical community. Some of my best experiences and most valuable opportunities have been the product of knowing some wonderful and very inspiring people. Be curious with your preceptors, befriend the nurses at the hospital, and don’t be afraid to reach out and ask questions if you feel you need a bit more help from an expert in a particular topic.

What’s next for you?
I am very excited to be returning to the Kootenay-Boundary region where I have the privilege of starting my residency training in Family Medicine. I am looking forward to the new adventures that residency is sure to bring, and to being closer to many of my friends and family members.


Adeeb Malas
Hometown: Damascus, Syria

What attracted you to your field?
Growing up in a war-torn country have opened my eyes toward the complexity of trauma and the variety of response to stress. The topic of mental health intrigued me, and I felt an immense desire to join a field that enables me to foster a sense of resiliency in others. The incredible privilege to care for people at such an intimate level, often exploring topics that are immensely private to patients, was a strong pull toward this career. I entered medicine wanting to make a strong impact on a micro-level. This field facilitates that perfectly with longer-than-average patient visits, chronic care and flexibility in practice settings.
Psychiatry also manages some of the most individualized illnesses in medicine, where two patients with the same clinical diagnosis present with vastly different histories. That variety assures me that I will always be challenged to learn and improve, which is essential in any career.

What is your favourite moment from your time at UBC?
One of my favorite moments was a camping trip that I arranged with my co-VP Social to Herald Provincial Park in Salmon Arm! Most of the class was able to make it. We had fireside chats, s’mores, and tenting parties! That night will always be a treasured memory!

What is one piece of advice you have for students entering your program?
Medicine is an incredibly demanding field. We often think about accomplishing the highest possible as overachieving medical students. This mentality can be destructive if you select a specialty based on the extremes in terms of prestige, remuneration, or fame. Remember that there is more to you than your career. Those other facets of you, similarly, deserve to be prioritized, whether it is being there for your family consistently, attending to your hobbies, or engaging in whatever you derive joy and fulfilment from. I hope that future students can engage in this privilege of a career, while maintaining their wellbeing and identity outside of it.

What’s next for you?
Next stop is UBC Psychiatry at Royal Columbian Hospital! I am blessed to match to my first choice specialty and site where I will work with an incredible cadre of residents!

The UBC Okanagan Interdisciplinary Student Health Conference (IDHC) brings together students from across UBC Okanagan to showcase their health science research and public health experiences at an engaging presentation event.

At our 2022 conference, an astounding 69 students presented 55 different projects from Science, Medicine, Interdisciplinary Graduate Studies, Heath and Social Development, Arts and Social Sciences, and Applied Sciences.

Congratulations to our top presenters and those selected for the three ten- minute presentation spots for this year’s conference.

10 Minute Presentations

Acute Intermittent Hypoxia Improves Orthostatic Tolerance in Chronic but not Acute Spinal Cord Injured Rats
Liisa Wainman (Medicine)

Towards an optimal integration of family physicians into the post-cancer treatment pathway in BC’s interior: A mixed methods study
Brian Hayes (Medicine)

The Co-development of Indigenous Community-led Culturally Safe Telediabetes/Obesity Care in BC’s Interior
Brookelyn Koersen (Science)

2022 top Presentation Awards

Biomedicine and Pharmaceuticals
Creation of mucus factories using colon organoids to combat intestinal diseases
Spencer Ursel, Science; Ojogbane Amedu, Applied Science

Child and Public Health
Assessing the Impact of COVID-19 Precautions on Classroom Communication for Adolescents with Hearing Loss: A Qualitative Study
Lindsay Booth, Medicine

Clinical and Emergency Care
ERCP Under General Anesthesia Compared to Conscious Sedation (EUGACCS) Study
Grant Greaves, Medicine

Community Health
The Toxic Drug Response Project
David Byres, Arts and Social Sciences; Victoria Bester, Health and Social Development

Health Policy and Advocacy
Planning and piloting peer-led food skills workshops for UBCO students
Morgan Game, Arts and Social Sciences

Rural and Remote Health
Being there: A qualitative exploration of support systems for rural adults 50 years and older with mental health concerns
Carley Paterson, Arts and Social Sciences

Student and Social Health
Understanding early semester distress in undergraduate students: The impact of work and predictability of work schedule
Jaime-Lyn MacLeod, Arts and Social Sciences; Eric Ferguson, Arts and Social Sciences

Virtual and Digital Health
Mobile App-Delivered Motivational Interviewing for Individuals on an Eating Disorder Clinic Waitlist: Pilot and Feasibility Study
Amané Halicki-Asakawa, Arts and Social Sciences

 

Download 2022 Conference Guide

The Healthcare Travelling Roadshow is seeking health profession students to help recruit the next generation of rural healthcare professionals.

Join us for a week-long road trip to rural BC to showcase career options to high school students and connect with community stakeholders and local healthcare professionals.

We have three roadshows planned for the spring of 2022:

  • May 1 to 7, 2022:  Okanagan Roadshow (Summerland, Oliver, Osoyoos)
  • May 1 to 7, 2022:  Bulkley Nechako Roadshow (Hazelton, Houston, Francois Lake, Grassy Plains, Burns Lake, Fraser Lake)
  • May 15 to 21, 2022:  Peace River Roadshow (Fort St. John, Dawson Creek, Tumbler Ridge)

Application deadline is March 1, 2022. All travel, accommodation, and meal expenses are covered for participants. Interprofessional Education Passport credits are also available.

APPLY ONLINE.

The Healthcare Travelling Roadshow is delivered in partnership with the University of Northern British Columbia, UBC Faculty of Medicine, Northern Medical Programs Trust, Interior Health, and Rural Education Action Plan.

Since its inception in 2010, the Healthcare Travelling Roadshow has connected with more than 10,500 high school students in 56 communities throughout BC. For more info, visit https://www.unbc.ca/northern-medical-program/healthcare-travelling-roadshow or contact Warren Brock at warren.brock@ubc.ca.

Dr. Mike Bergunder has been appointed Portfolio Site Lead for the Southern Medical Program (SMP), effective January 1, 2022. Dr. Bergunder is a Kelowna-based emergency physician and a Clinical Instructor with the UBC Department of Family Practice

Dr. Bergunder completed his medical degree at UBC, family medicine residency at the University of Alberta, and a fellowship in emergency medicine at UBC. He currently serves as the Medical Director for Interior Health’s Rural & Remote Framework and works a locum emergency physician primarily in the Okanagan. Since 2019, Dr. Bergunder has supported learning opportunities for UBC medical students as a Case-Based Learning Instructor, Indigenous Cultural Safety Facilitator, and Portfolio Coach. He also serves as a member of the BC Emergency Medicine Network Advisory Committee and UBC 23 24 Indigenous Cultural Safety Advisory Committee.

As Portfolio Site Lead, Dr. Bergunder will provide leadership and general oversight for the SMP Portfolio program. He will help lead the recruitment of Portfolio coaches and foster a supportive learning environment to encourage excellence in teaching and teacher retention. He will also work with SMP Faculty Development to ensure that Portfolio coaches have ongoing professional development opportunities.

Dr. Sarah Purcell has been appointed Assistant Professor with the UBC Faculty of Medicine Department of Medicine, Division of Endocrinology and Metabolism and UBC Okanagan Faculty of Science, Department of Biology effective January 1, 2022. Dr. Purcell will serve as an Investigator with the Centre for Chronic Disease Prevention and Management (CCDPM) based at UBC Okanagan.

Dr. Purcell completed a BSc in Dietetics and MSc in Clinical Nutrition at Florida State University followed by a PhD in Nutrition and Metabolism at the University of Alberta. For the past two and a half years, she has served as a Postdoctoral Fellow with the University of Colorado focused primarily on energy intake regulation among breast cancer survivors. Dr. Purcell’s research aims to improve our understanding of the unique dietary requirements of people with chronic diseases and reduce obesity in people with chronic disease by implementing nutrition and exercise interventions. She has authored 23 peer-reviewed publications and served as a Principle Investigator on three pilot grants and two U.S. national fellowships.

In her new role, Dr. Purcell will lead a strong, innovative, and internationally-recognized research program in nutrition and chronic disease prevention and management. She will work collaboratively with faculty and graduate students from both UBC campuses, health professionals and researchers with Interior Health, and communities and health populations across the BC Interior. Dr. Purcell will also serve as a national leader in nutritional interventions to prevent or manage chronic conditions.