##VIDEO ID:fwoQEBFfmsk## e e e e e e e e e e e e e e PA fla Health meeting of October 21st 2024 please note this meeting is being recorded and will be available shortly Hereafter for scheduled and on- demand viewing on any smartphone or tablet if anyone else is recording the meeting please notify the chairman pursuant to Governor Healey's March 29th 2023 signing of the acts of 2023 extending certain covid-19 measures adopted during the state of emergency suspending certain P certain provisions of the open meeting law until March 31st 2025 this meeting of the chat and Border health is being conducted in person and via remote participation every effort will be made to ensure that the public can adequately access the proceedings as provided for in the order a reminder that persons who would like to listen to this meeting while in progress may do do so by calling the phone number 508 945 4410 and the conference ID is 371 93537 pound or join the meeting online via Microsoft teams through the link in the posted agenda well this is a live broadcast in simoc cast on chadam TV channel 8 and 1072 1072 despite our best efforts we may not be able to provide realtime access we will provide a record of this meeting on the town's website as soon as possible I'll turn the meeting over to our chairman Dr Noble Son thank you it shall be the policy of this board to conduct its meetings under the open meetings law so as to encourage public participation whenever time permits and as part of agenda item discussions uh so we have two uh items on the agenda today and first we'll establish a quorum so when I call your name please say present Carol Boyce present Ron Broman yeah dick Edwards present Noble Hansen I'm here uh so we have a quorum and uh first on the agenda is preliminary subdivision plan review for Ronald rudnik 104 CW Road East Southeast LLC and uh we have Terry Eldridge as the um presenter applicant I don't see him here or on online um this is a preliminary plan I don't I mean I can try and answer some questions it's going to go back to the planning board and then it'll come back to us again as a definitive so we could still take a look at it yeah I just say is there anyone in in the audience or online um that have that have something to do with the uh 104 crawl Road uh preliminary subdivision again okay um so we can discuss it and then it'll come back for a final approval with later time mhm okay I am going to share my screen if I can get that to work so you can see it at home we've got my a lot of apps all right there we go so um this is um on CR Road 104 C Road Road the theater is uh where you see lot two on the left side um the plan is to take the um the lot to the right of the theater lot which is now labeled Lot 24 25 and 23 split that into three lots this is on sewer um and then they're also requesting a small small par portion of lot two to add to Lot 25 in order to give that the required Frontage that they need for a building lot um again there's no um no more detailed than that I think that we're going to need um more more information um in the planning board we'll be getting more information moving forward so the zoning rules require 100 ft of Frontage on the road for a building lot today that sounds right I'm not a zoning expert but that does sound so by putting this road this road in the Panhandle there then that's why they need to get that additional 27 feet uh from the drama Guild so that they would then have 100 feet of Frontage yeah and then the Panhandle lot I I don't know how that works actually they don't have any Frontage I guess you know I don't understand the frontage business they didn't get they didn't give us any drainage information either so this will need um from my understanding from talking to the town planner this will need some more information before they'll approve it this is going to connect to the sore yes so there's no question about that that's going to be they're not going to put in any septic system or anything it's going to just connect to the it'll be connected to the sore yeah and then then uh because of that the the issue of the number of bed bedrooms allowed for the size lots and all that will come under the sewer regulations which comes under the select board and not us we're not well I mean they're allowed um what we would have allowed under our regulations so a 16,000 foot lot would be allowed um three bedrooms cuz we are regulations said before we changed that that any vac well they still say any vacant lot is allowed two bedrooms then with sewer we would allow the third so if it was a septic system they'd need an IA system but since it's a sewer they can just have the three but they can't have four not unless they get approval from the sewer department we really don't have anything any involvement with this at this point no it's just a recommendation for that you don't see any public health reasons uh you know concern that this would not be able to be buildable for sewage disposal or any other environmental health issues and if they can't purchase lot three then the whole thing falls apart right they about they may only be able to have two lots so this may come back to us in a different reiteration right okay okay looks pretty straightforward from what from our role so it'll go through what planning board and then we come back to take a vote at that time well you you can take a vote to approve the preliminary oh as without without a presenter yeah you can motion to approve okay and and a second I'll second that so it's a vote to approve the preliminary subdivision um and any input from the public comments and I think we can take a Voice vote all in favor of approving uh the preliminary subdivision say I I I and po say no okay so that is granted okay uh next on the agenda is um the lower Cape Community Health needs assessment review and discussion and Judy has been working on this and is a part of the group and she's going to make a presentation and tell us what this all is all about and what the results of the assessment are so I will turn it over now to and I'm going to share my screen again get that my slid show Okay so so um I participated with the communities of Brewster chadam harch uh chadam obviously harch in Orleans um we this April into the summer to conduct this lower Cape Community Health needs assessment just keep going so uh we're gonna tonight I'm going to give you a very brief presentation on the outcomes and I do urge anybody to take a look at the full report because there's a lot more in-depth information I did provide it um and it will be on the website um it's it's on there now I just have to make it easier for people to find so I'm going to do that um and we're going to do the overview goals and objectives methodology key secondary data findings um some voices from the community some quotes from people um and just basic results and identify some of the needs that we saw so from April to July cresendo Consulting Group whom we hired um partnered with Barnesville County and our lower Cape towns that I mentioned to do this community health needs assessment um so what we we plan to do what we wanted to do is establish a profile of community needs and resources identify key needs and um the population's most impacted use both quantitative and qualitative datas for data for insights and help guide strategic planning for Community Health improvements so that last part is um key the health agents um have have joined together in a regional um Public Health Group which is most of the towns on the cape right now and we have uh funding for that group and we wanted to see on in the lower part of the cape uh what our needs were and what the best way to possibly use that funding um and a regional from a regional standpoint moving forward so that's that's kind of where we came up with this idea let's see is this not going so our our uh goals and objectives were to do a CommunityWide um exploration engaging a broad spectrum of the community and highlight key are key areas that are both common across the region and unique to each Town um and prior prioritize the needs um of the of the region and the towns and identify actions and strategies for moving forward we did secondary data research which is gathering data from En from analysises that have already been done um and we did stakeholder interview we did focus groups which you participated in um we did a NE a uh Community survey which was a paper survey and an access audit so I'm going to go through those as we go through the secondary data was completed from data pulled by barnable County um and other lower Cape towns where we looked at Social determinants of health and behavioral health related measures um basically we used um some surveys from the Census Bureau American the 2018 to 2022 American Community survey which is a five-year estimate that the CDC puts together um and public health uh Department of Public Health Data and other resources uh we also did stakeholder interviews 19 one-on-one interviews each Town gave a list of who we wanted to be interviewed who we felt were important voices in our community some of those people were overlapped and we they did were able to do six stakeholder interviews in-depth interviews um we did six focus groups in the towns um each town did one and then they did some um more general ones across the region and the access audit was done they made calls to 13 facilities including healthc care Behavioral Health primary care and community Assistance programs those were were basically to see what the barriers to care are so if you call call people and say I need an appointment or um how easy it was to get through and get and talk to some someone and and actually get access um and there was a paper survey as well and we' got 384 total responses from um community members we had a very large response in Brewster and um chadam had a fairly large response as well um just have a few notes Here see if there's anything I'm missing just gonna keep going J why why was do you think larger in booster response get banged on the window Judy why do you think their response in Brewster was larger um I I think it had something to do with the way it was put out into the community by a board member or something yeah yeah they they were quite successful in getting it out there how many surveys were sent out uh the surveys were all done online so it was a link to go in and and um 384 those are those are the responses so we had total yeah um so wasn't a paper survey no there were paper surveys available um so do you know how many people received the survey how many well again it was online so it was an open we they weren't sent to people it was we adverted weren emailed to them they they no you had to know there was a survey right and we put that out there in in you know online and in the media and the paper and you know we mentioned it at Board of Health meetings and such so we did our best to get it out there so I'm going to start with some of the secondary data that I mentioned um this is a kind of a snapshot I think it clearly shows in the communities um chadam being here on the lower leftand corner um population by age no surprise uh medium age is 64 most of our um our community are uh ageed 65 and older chadam and Orleans are the two of them the older communities um in the state so um hartch and Brewster have a a younger demographic as you can see by this slide um and of course older populations have different needs require different Services they are more vulnerable to social isolation cost of living changes and um mobility and transportation issues so that's information that we can use when um trying to decide what services are vital to the people of chadam um chadam as you can see 92.5% white 1.5% Latino and 2.5% speak language other than English at home um I don't know what else to say about that the racial ethnic and language breakdowns of populations do provide insights into a vulnerable population that may need trusted Community Partners but again we we um we seem to have a a more white affluent population here in chadam uh one 10 adults age 65 and older in the lower Cape towns uh live alone so this is not just chadam but we do again have a large percentage of population living alone and that's important because we can have social is isolation Aging in place without resources uh climate change impacts mobility issues disability issues Financial stability and transportation these are all good plugs for our Council and aging and Center for active living and the great work that they do um and most communities are prioritizing that type of work Judy where did this data come from again this is from the well these are secondary data findings so these are not just a surve this is sensus Census Data basically it just gives us an idea of what the community looks like uh medium single family home cost this is in interesting as you can see chadam is the top line here um from 2019 to 2023 the median age excuse me the median single family home cost has gone up from approximately 800,000 to over over a million um High housing costs you know obvious is is uh contributing to the housing crisis um and providing problems with um finding employees to work and live in our communities police fire teachers Etc this is an interesting um again these are Regional some of this this is regional data uh people living in in poverty as you can see chadam is in this dark number here on the you know where we are on the map here um we are considered we have 10 to 16% of our community um living below the prop poverty level which I think a lot of people don't realize so even though we are affin Community we do have areas of town that people are living um below living wage which is they say is 4391 an hour where the minimum minimum wage is actually $15 an hour for a for a threepers family so that's telling I believe what's the definition of poverty that's a good question um I'm not sure whether they use on this percent below property level at census tract I'd have to find that out I don't have that I'd have to look and see if it's in the deeper in the report so I will find that out food insecurity levels have increased 20% in barnable County since 2018 you can see them fluctuating um we all know that the prices the cost of living and um the cost of food is all related uh especially with those with L lower incomes and lower wages it's definitely a problem um Cape Cod does have an extensive network of pantries and food programs um but it can be an issue getting access so more more findings uh barnville County ratio of people per Health Care Providers uh to me this OBGYN number there's 6,000 people to every one OBGYN on Cape Cod um whereas for Massachusetts it's about 3,000 to one um we talked I think at our Forum about the difficulty in finding Primary Care Providers I think we've all been affected by that dentists are difficult to find as well um and pediatricians so the the OBGYN is the number of OBGYNs per total population so the percentage of well for for OB the percentage of women in chatam and childbearing age is pretty low yeah that's for the whole region so Barnstable County so in in doing this survey um the cresendo put together it's just some some quotes from uh people that they talked to in interviews and in surveys um we had talked about some of the opioid issues in the past lower Cape towns have more than a drug use problem there's a lack of Education about what's happening in the community and how people who are struggling with these issues and how to help people who are struggling with these issues issues in towns do exist but certain members of the community have such a deep stigma about things like substance use and mental health that they don't talk about it um it's likely that everyone in this community has been affected or knows someone that has been affected by substance use but no one talks about it when we don't talk about the issues we can't deal with the root causes uh and work on preventing them in the first place there was a question on community strengths uh so it's not all bad and um well I guess I can keep going with our Community Connection um somewhere to meet up we need somewhere to meet up um that's not a bar and doesn't require money we don't have teen activity centers that focus on physical activity or healthy pastimes I'm not sure that's true of chadam because we do have a very active Community Center that works with our kids but again this was across our four regions our four towns um the co pandemic made it every man for himself we need accessible free events where people of all ages can interact and learn about their neighbors just a few comments that came up and I just wanted to give you something from Community strength so it's not all bad news some in chadam we had a quote there's a real sense of community and support it's a small town where people know each other and find ways to work together there are low taxes and a well-run government with an absence of partisan politics so that's an interesting um positive comment so I'm going to go right into the community survey results uh according to the survey the top three General health issues community members struggle with again Primary Care Services health care services for the elderly elderly and health care services for adults no not surprising I don't think uh top three health screening and education programs that commun community members would like more of programs that encourage and facilitate healthy aging programs for skin cancer screening programs for sun safety awareness these are all things that I think we can work work on and we're doing quite well I believe in um programming in at the Council on Aging um we've started a new Adult Day program um skin cancer screening we're going to be doing some health faires and um I know Barnesville County does a lot of Education around skin cancer screening so that's that's an interesting one um say sun safety aware Ness as well top three General Community issues access to affordable housing live livable wages job opportunities and affordable quality Child Care those are those are big issues that I don't believe on the local level we can address but working as you know in conjunction with other departments and um agencies we can hopefully make an impact in those areas top three mental health and subsides programs that the community lacks but needs are counseling services for mental health issues for adults counseling services for mental health issues for adolescence and children and crisis or emergency care for mental health no surprising that mental health um is a big issue in people's minds and the lack of uh availability for care current mental health and substant use needs in the community one in 10 survey respondents said that they had an adult family Menor with an current unmet mental health or substance use need more than half of the respondents reported experiencing depression Andor anxiety over the past two years and half of the respondents did not know or unsure of where to turn for help if they were experiencing mental health or substance use challenges Comm current Community knowledge and interest in local and County Health departments um this I think is interesting two in five survey respondents know what the local Health Department is responsible for in the community so that's not very many um only one and three know what the county health department is responsible for and three and four would like to learn more about the local and Community Health departments so that's again something that we can address directly and we're we're hoping to do that in the next few weeks at our board meetings based on all the information gathered during the the community health needs assessment a list of needs was created and organized into high level categories um this was something that we kind of did at the health agent level we we took all this information we said okay what what are these needs and how can we um address them um from left to right Community Education um increase the presence of the local Health departments learning um learn about existing resources and it reduce stigma about Community issues next was substance use use early intervention programs uh substance use disorder treatment and recovery options um we're working on that uh not just locally but regionally with our um opioid um funds that we receive from the state so hopefully we're going to chip away at that um mental health enhanced Mental Health crisis Services increase options in mental health counseling youth um and adults again chadam has just hired uh in the past year a mental an adult mental health uh clinician and we also have a um recovery coach and they're working closely with uh the health department and the EMTs and um the police and fire so uh I think we're we're working on this and they're doing a great great job it's been very successful so far um Judy H H so how do residents um access the adult mental health clinician that the town has now they can call um they can call the health department and we can put them in touch they can call the police department or the fire department um they're available uh they work out of the well I think she she works out of the police department the recovery coach works out of the police department and she's there every Wednesday from 12:00 to for um and the mental health clinician works out of the center for active living and she's full-time so is available and are these free services if you go them yeah y they're they're people who can guide you to the services that are available so they're not going to become your private mental health clinician but they're going to they're going to coach you and guide you who's paying for all this the um the town hired a full-time yeah that's more money that was passed in the budget last year and that's a full-time position um they actually approved two positions one for an adult and one for a teen and youth counselor that position has not been filled the recovery Coach position is um the opioid funds are being used for that so so this is something that can continue with the program another we're not going to run out of money in a year no the the um opioid recovery funds are um guaranteed for the next 16 years we're going to receive over $300,000 and um we're using funds to enhance these programs so it's it's a positive thing um so addition of community well-being additional community health programs address issues with senior isolation again I think the center on active living is doing a lot a lot of great programming in those areas to bring people um out of their homes and um you know get get people together and and work on loneliness issues and um lots of exercise programs and lunches and you name it they're doing all kinds of great stuff so I I you know I hope people will check into the the U Council for active living what they're doing in our community um U did you say that there are other funding sources that are coming into the uh to deal with the results of this survey that are available besides the opioid funds um for this survey well for to to implement what the survey uh recommends um we have our Public Health Excellence um Grant which is to form a regional health uh taking all the health departments and regionalizing them we have funds um and we have to use that funding as we see fit um and and as what would be approved by the Department of Public Health so yes there is some funding and we are going to be using the results of this to look at ways that we can um satisfy some of the issues that that we're seeing here um in the next and then that years that goes through the group of of Health departments on the cape as a whole some sort of yes yes okay there's I think 12 or 13 of us that are in this Coalition now so we just we did a this was a sub kind of a subgroup of the bigger group that did this survey that did this needs assessment and any general ballpark figure about what the amount of these funds ranges around um I I couldn't give you that off the top of my head we we have Katie O'Neal uh I think you you've met um she came and spoke to you she's the director so we've we have staff um you full-time hired people right yeah right so but we're just we're trying to come up with ways to best use the money to address some of these needs uh again um going down this list the bigger things that are hard to address our Primary Care gaps senior health care including Home Care Transportation those are a little above what we could probably do at the local level but um always working in support with other with other groups on the C for affordable housing for Community infrastructure affordable housing available housing Recreation food access Child Care again um a little above what we can do on the local level but always supporting agencies that do this type of work um and local local um Town departments around affordable housing and Etc wreck food access Etc let's see so that's the base of it again I I really encourage you to look through the report uh it's really easy to read there's a lot of really in interesting stuff in there um it breaks down uh I mean I just gave you the basic data uh there's a lot more information uh breaking down how chadam is um what we really look like you know high school education population changes in the last you know 20 years um medium household income Etc so there's a lot of great information in there and um a lot more information about what the what the survey found um and again to answer your question before we are looking at this data and we'll we'll be meeting and trying to decide ways to um I think a lot of it's going to be about Community um education I think that's going to be the bit the biggest need that we saw that getting the information out to the community as to what's services are available and and how we can support people moving forward uh uh any specific um suggestions for uh things that that should be set up differently you know with food pantries or Transportation or any any specific things that that came out of it or is that next part of it um we didn't we didn't get down too much to the nitty-gritty on on transportation and food pantry Etc I think that we have a good network of food pantries here that are doing a good job um transportation which can be barriers to care um you know for we do have a fund from our opioid funds to help people that are in need um to to make appointments uh we can use some of that funding um there are other agencies like lower Cape Outreach Etc that have funds to get people where they need to be the council and aging provides Transportation um the the dart service or RTA they they will bring people it's just it's a way of it's really about connecting people to to the what's out there you know what the services are and and um connecting people there used to be a service in chadam uh where older people could get rides from uh I forget what the name of the agency was but but they were volunteers who would use their own vehicles and drive people to doctor's appointments or other appointments and then during Co it fell apart yeah uh I I have a friend who's 95 years old who used to use that he used to drive for them all the time and then uh when he was in his like 88 he was driving people to hyanis to go to the doctor but then Co came and it and it sort of fell apart and it I guess it's not getting is it is n rein yeah was that like it was like the fish program yeah fish I guess yeah I don't know if that still exists I would have to find out um a lot of this information is available uh through the council all and aging the the center for active living um they have great contacts in all the local communities and can and can help people that need those types of services but if you do uh notify the um Council on Aging I yes uh within you know 48 Hours advaned Serv they provide really good service this guy about three months ago had an appointment in hyanis and he wanted to go to a Romeo club meeting in the armouth and they took him to the to the do doctor's visit in hyas waited for him picked them up and then took him to the restaurant in in in Yarmouth for his for his club meeting so you can get very good service um from from those people people need to know it's available right exactly and in our next meeting we're going to do have a forum with some a few agencies that are available in chadam um C the um Community Services director um yes yeah we could uh so this is Community Health and part of this discussion in our survey before it a lot of it led to uh community services so at our next meeting we're having a little Forum on Community Services we'll continue the discussion here but just for to answer Judy and that will be uh Aid support group of Cape Cod Narcan presentation addressing opioid issues the shine program by Pat Burke which is done over at the Council of Aging which is for uh Medicare uh programs uh Leo lacrosse director of community services in chadam works for the town of chadam um has a lot of knowledge we're asking about uh I think and we'll cover a lot of that and then Morgan Eldridge from the fishing partnership will address the fishing community and their issues and services available to them so that'll be um hopefully a lot of information there and answer a lot of the specific questions that I think this brought up but um then we'll go back any more questions or comments about Judy's presentation and any I think this this this concern about the availability of primary care uh continues to be a big issue and I think it's just critically important that people realize that Physicians assistants and nurse practitioners provide excellent primary care and you can go to Outer Cape health services and have an an appointment for a new uh Primary Care visit in two months uh with somebody who's not going to charge you concierge Dr fees and I use them and I've been I right now I'm having a lot of issues and it they they're great they're absolutely great you call them and you can see them within two days if you've got a problem you know they set up consultations they do everything very well are you talking about nurse practitioners of Physicians assistance yes available to you yeah right right if you go if you call out of Cape Health Service you need new PCP you will have an appointment with a new for a new visit for an initial visit for a PCP in about two months Y and it's Physicians assistant or a nurse practitioner there's a physician in the building if there's a something that they can't deal with but they can deal with almost everything that a PCP needs to deal with and do it very very well there's an there are Community Health um operation I mean they're they're funded by the the federal government and they that's their job is to be available to the communities that they serve serve um they do a great job at it and they were there during Co I worked very closely with them um getting out vaccine and and testing Etc um so I I agree they're they're a great they're a great organization they're actually to get over this reluctance y go there when you call them and they say well you'll see a nurse practitioner in two months and they people will say no I want to see an MD and they say well you we we can't do that here we have right extenders uh and people will hang up and and then wait 8 months to find an MD uh it's it's crazy yeah I would agree totally with with what dick said um nurse practitioners and Physicians assistants uh I mean they can do the routine um dayto day screening and reminding you of tests that need to be done follow your data and with the shortage of pcps it's kind of the way of the future that they're going to be used more and more and they can certainly uh do the job uh and then make referrals as needed but any other any comments or questions from the public or from anybody in the room um or any other board comments or questions you can go up to the mic please I will hello I'm Pat Burke from the Council on Aging your name has been I'm surprised welcome that there's not more people here I talked this up at our meeting this morning because Judy sent me the report and I thought the report was excellent I thought it was extremely well done I thought the data was for some of us nothing unexpected no um I think chadam is in a better place than other places um I can give you the federal poverty level if you'd like so in 2024 a family size of one the federal poverty guidelines the annual income is $5,185 261,000 377 and4 $93,600 that's for the country these are the federal poverty guidelines yes for for chadam or for this no not for chadam I don't you know these are just go so when you look at people that um may need Services there's Federal the federal guidelines and then they could keep going up like what's 150% of the federal poverty level which I used to know off the top of my head but can't bring it to the front so when you're trying to gather information to get people into services that they need there are many new services available to people particularly people over 65 uh in chadam through the um uh Medicare Savings Program but the it's um you need a lot of money to live nowadays you know chadam right but if you had a if you're a single person with a with a a family income with your with an income of $50,000 in Louisiana uh you're not in poverty where but in chatam you're an adject poverty yeah so I those numbers are strer if they're for the whole country they put them out every year the federal government puts them out every year and I don't think the probably the latest ones aren't out but I just wanted to commend you Judy because I thought the data was excellent and I thought you would have a lot of people here and I was going to log in but I thought oh I'll just come because there'll be so many people I'm surprised I think I think Judy has tried to put out the word um especially for our next meeting yeah which we'll have a lot of information in it uh so we'll work on that but I I would ask you um so the Council of agent what transportation services are available to get rides to Boston to hospitals or your local primary carees are there dip R um I'm sure Leah will cover this next week when she's here but we have four drivers um and I I you know I was at the meeting this morning and I I can't pull from my memory the number of rides we gave each um month but it's a significant amount we drive people back and forth to the orene supportive day because um ours is yet to open uh doctors visits um if people need to go to even the grocery store they will go to the grocery store and pick up groceries and bring them back these are volunteer drivers these are no they're pay they're employees the town chadam yeah through and so you contact the Council of Aging and you can you do and it's set that up I they're very busy but they make I mean they're they're tremendously dedicated and they um will make adjustments for people they H they will take the time I mean I had a fellow come in to see me one day who needed to go home and get something for his visit with me and uh they they drove him home drove him back waited for him and then drove him home again so they're very um very dedicated so okay thank you and thank you I'm sorry you don't have more people here I was very impressed well it is archived so people can go on the website and thank you Pat thank you okay other comments questions from the board or com followup from Judy yeah Ron anything on the transfer station I know you sent out a letter new business uh no I have not heard it an update on that I don't think he has given his presentation Rob yet he was going to be presenting to to the select person the the selectman um the select board I should say and um they would come up at that point I assume it hasn't been done yet I don't I don't think they've done the Pres I think it's in November any feedback about the letter that we sent um recommendation letter about the transpar to the no I've had no feedback again I they make that might be something they'll discuss when they have Rob fail and to discuss the transfer station that would be my guess other old business or um okay we went over uh the form at the next meeting so um that's good so we have I think a set of um minutes from October 7th anybody have any additions or uh corrections to those and if not maybe I can get a motion to move accept the minutes in a second second all in favor say I of accepting the minutes I and opposed okay so those minutes of October 7th are accepted and um I think we can adjourn the meeting can I get a motion I move to adjourn second all in favor say I I I and opposed okay the meeting is adjourned pap