Indigenous Health

How can integrated health & environmental monitoring support climate change adaptation? Check out our new publication to find out!

Congratulations to Alexandra Sawatzy on her recent publication. Alex reviewed integrated surveillance used for responding to climate and environmental change impacts on human health in the Circumpolar North. The article can be accessed, for free, at: https://www.mdpi.com/1660-4601/15/12/2706

Key Messages:

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Key Message 1:

The wide range and diversity of integrated surveillance systems described in the literature can help guide and target evidence-based public health responses in support of climate change adaptation in the North.

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Key Message 2:

2: Findings offer insight into how these systems can be designed to be more responsive to public health concerns within rapidly shifting Northern environments.

What are key components of integrated surveillance?

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Recommendations & Next Steps:

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Article citation:

Sawatzky, A., Cunsolo, A., Jones-Bitton, A., Middleton, J., Harper, S.L. (2018). Responding to Climate and Environmental Change Impacts on Human Health via Integrated Surveillance in the Circumpolar North: A Systematic Realist Review. Int. J. Environ. Res. Public Health.15(12), 2706. Click here to access the article (free open-access)

Abstract:

Environments are shifting rapidly in the Circumpolar Arctic and Subarctic regions as a result of climate change and other external stressors, and this has a substantial impact on the health of northern populations. Thus, there is a need for integrated surveillance systems designed to monitor the impacts of climate change on human health outcomes as part of broader adaptation strategies in these regions. This review aimed to identify, describe, and synthesize literature on integrated surveillance systems in Circumpolar Arctic and Subarctic regions, that are used for research or practice. Following a systematic realist review approach, relevant articles were identified using search strings developed for MEDLINE® and Web of Science™ databases, and screened by two independent reviewers. Articles that met the inclusion criteria were retained for descriptive quantitative analysis, as well as thematic qualitative analysis, using a realist lens. Of the 3431 articles retrieved in the database searches, 85 met the inclusion criteria and were analyzed. Thematic analysis identified components of integrated surveillance systems that were categorized into three main groups: structural, processual, and relational components. These components were linked to surveillance attributes and activities that supported the operations and management of integrated surveillance. This review advances understandings of the distinct contributions of integrated surveillance systems and data to discerning the nature of changes in climate and environmental conditions that affect population health outcomes and determinants in the Circumpolar North. Findings from this review can be used to inform the planning, design, and evaluation of integrated surveillance systems that support evidence-based public health research and practice in the context of increasing climate change and the need for adaptation.

The article can be accessed, for free, at: https://www.mdpi.com/1660-4601/15/12/2706

New Publication: Wastewater treatment and enteric illness in the Arctic

The article is freely available for 50 days: Anyone clicking on this link before February 03, 2019 will be taken directly to the final version of this article: https://authors.elsevier.com/c/1YE0uB8ccghTq

Citation:

Daley, K., Jamieson, R., Rainham, D., Hansen, L. T., Harper, S. L. (2018). Screening-level microbial risk assessment of acute gastrointestinal illness attributable to wastewater treatment systems in Nunavut, Canada. Science of the Total Environment. 657(20): 1253-1264.

Abstract:

Most arctic communities use primary wastewater treatment systems that are capable of only low levels of pathogen removal. Effluent potentially containing fecally derived microorganisms is released into wetlands and marine waters that may simultaneously serve as recreation or food harvesting locations for local populations. The purpose of this study is to provide the first estimates of acute gastrointestinal illness (AGI) attributable to wastewater treatment systems in Arctic Canada. A screening-level, point estimate quantitative microbial risk assessment model was developed to evaluate worst-case scenarios across an array of exposure pathways in five case study locations. A high annual AGI incidence rate of 5.0 cases per person is estimated in Pangnirtung, where a mechanical treatment plant discharges directly to marine waters, with all cases occurring during low tide conditions. The probability of AGI per person per single exposure during this period ranges between 1.0 × 10−1 (shore recreation) and 6.0 × 10−1 (shellfish consumption). A moderate incidence rate of 1.2 episodes of AGI per person is estimated in Naujaat, where a treatment system consisting of a pond and tundra wetland is used, with the majority of cases occurring during spring. The pathway with the highest individual probability of AGI per single exposure event is wetland travel at 6.0 × 10−1. All other risk probabilities per single exposure are <1.0 × 10−1. The AGI incidence rates estimated for the other three case study locations are <0.1. These findings suggest that wastewater treatment sites may be contributing to elevated rates of AGI in some arctic Canadian communities. Absolute risk values, however, should be weighed with caution based on the exploratory nature of this study design. These results can be used to inform future risk assessment and epidemiological research as well as support public health and sanitation decisions in the region.

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How can understanding hospital admission patterns inform climate change adaptation for the healthcare sector in Uganda? Read more to find out!

Kate Bishop-Williams and co-authors recently published an article in the International Journal of Environmental Research and Public Health. The article explored how understanding hospital admission patterns can promote climate change adaptation. Through this article, we illustrate how analyzing hospital data alongside meteorological parameters may inform climate-health planning in low-resource contexts.

How do non-climatic factors reinforce maladaptation trajectories? Check out this new publication to find out.

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Congratulations to Dr. Carol Zaveleta for her recent publication in PLoS One.  Her participatory, community-based study was conducted in collaboration with Shawi communities. Together, they worked to characterize the food system of the Shawi in the Peruvian Amazon, climatic and non-climatic drivers of their food security vulnerability to climate change, and identify potential maladaptation trajectories. They found that transformational food security adaptation should include consideration of Indigenous perceptions and priorities, and should be part of Peruvian food and socioeconomic development policies.  Click here for free article (open access).

Citation:

Zavaleta, C., Berrang-Ford, L., Ford, J., Llanos-Cuentas, A., Carcamo, C., Ross, N., Lancha, G., Sherman, M., Harper, S.L., IHACC Research Team. (2018) Multiple non-climatic drivers of food insecurity reinforce climate change maladaptation trajectories among Peruvian Indigenous Shawi in the Amazon. PLoS ONE 13(10): e0205714. Click here for free article (open access).

Abstract:

Background: Climate change is affecting food systems globally, with implications for food security, nutrition, and the health of human populations. There are limited data characterizing the current and future consequences of climate change on local food security for populations already experiencing poor nutritional indicators. Indigenous Amazonian populations have a high reported prevalence of nutritional deficiencies. This paper characterizes the food system of the Shawi of the Peruvian Amazon, climatic and non-climatic drivers of their food security vulnerability to climate change, and identifies potential maladaptation trajectories.

Methods and findings: Semi-structured interviews with key informants (n = 24), three photovoice workshops (n = 17 individuals), transect walks (n = 2), a food calendar exercise, and two community dissemination meetings (n = 30 individuals), were conducted within two Shawi communities in Balsapuerto District in the Peruvian Loreto region between June and September of 2014. The Shawi food system was based on three main food sub-systems (forest, farming and externally-sourced). Shawi reported collective, gendered, and emotional notions related to their food system activities. Climatic and non-climatic drivers of food security vulnerability among Shawi participants acted at proximal and distal levels, and mutually reinforced key maladaptation trajectories, including: 1) a growing population and natural resource degradation coupled with limited opportunities to increase incomes, and 2) a desire for education and deforestation reinforced by governmental social and food interventions.

Conclusion: A series of maladaptive trajectories have the potential to increase social and nutritional inequities for the Shawi. Transformational food security adaptation should include consideration of Indigenous perceptions and priorities, and should be part of Peruvian food and socioeconomic development policies.

PhD position in participatory climate modeling, ethnoclimatology, and human health in the Arctic

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Looking for a great PhD research project with an interdisciplinary research team?  Apply today! Position is co-supervised by James Ford (Leeds University) and Sherilee Harper (University of Alberta). The position is primarily based in the UK.

Apply by 31 October 2018.

For more details:

http://www.see.leeds.ac.uk/admissions-and-study/research-degrees/sri/projects-with-guaranteed-funding/participatory-climate-modeling-ethnoclimatology-and-human-health-in-the-arctic/

New Publication Exploring the Hidden Costs of Enteric Illness in the North

Congratulations to Nia King for her recent publication in PloS One.  In the north, per capita healthcare costs are high. However, given Inuit communities’ unique cultural, economic, and geographic contexts, there is a knowledge gap regarding the context-specific indirect healthcare costs borne by Inuit. Therefore, Nia worked with Northern partners to identify the major indirect costs of enteric illness, and explore factors associated with these indirect costs, in Rigolet, Canada.

Citation:

King, N., Vriezen, R., Edge, V.L., Ford, J., Wood, M., IHACC Research Team, Harper, S.L. (2018). The hidden costs: Identification of indirect costs associated with acute gastrointestinal illness in an Inuit community. PloS One, 13(5), e0196990.  Click here for free article (open access).

Abstract:

Background: Acute gastrointestinal illness (AGI) incidence and per-capita healthcare expenditures are higher in some Inuit communities as compared to elsewhere in Canada. Consequently, there is a demand for strategies that will reduce the individual-level costs of AGI; this will require a comprehensive understanding of the economic costs of AGI. However, given Inuit communities’ unique cultural, economic, and geographic contexts, there is a knowledge gap regarding the context-specific indirect costs of AGI borne by Inuit community members. This study aimed to identify the major indirect costs of AGI, and explore factors associated with these indirect costs, in the Inuit community of Rigolet, Canada, in order to develop a case-based context-specific study framework that can be used to evaluate these costs.

Methods: A mixed methods study design and community-based methods were used. Qualitative in-depth, group, and case interviews were analyzed using thematic analysis to identify and describe indirect costs of AGI specific to Rigolet. Data from two quantitative cross-sectional retrospective surveys were analyzed using univariable regression models to examine potential associations between predictor variables and the indirect costs.

Results/Significance: The most notable indirect costs of AGI that should be incorporated into cost-of-illness evaluations were the tangible costs related to missing paid employment and subsistence activities, as well as the intangible costs associated with missing community and cultural events. Seasonal cost variations should also be considered. This study was intended to inform cost-of-illness studies conducted in Rigolet and other similar research settings. These results contribute to a better understanding of the economic impacts of AGI on Rigolet residents, which could be used to help identify priority areas and resource allocation for public health policies and programs.

Crystal Gong awarded Guelph Y 2018 Women of Distinction

Congratulations to Undergraduate Thesis Student Crystal Gong, who is one of the honorees being recognized by the Guelph Y 2018 Guelph Women of Distinction. Crystal is working on our research team on two research projects: (1) synthesizing the state of knowledge on food security in the context of climate change, and (2) examining how season is associated with food security.

Read more about Crystal's award:

Evaluating the strengths, challenges, and opportunities of health-related community-based adaptation research

Article Highlights

  • We examine the application of Community Based Adaptation (CBA) approaches in Indigenous community settings.
  • CBA can co-generate knowledge on climate-health vulnerability and adaptation options, build capacity, and inform decision choices.
  • CBA can also have unintended negative consequences.
  • CBA requires careful consideration of community-researcher relationships and meaningful engagement of knowledge users.
  • CBA holds significant promise but only in the ‘right’ circumstances.


Abstract

Climate change presents substantial risks to the health of Indigenous peoples. Research is needed to inform health policy and practice for managing risks, with community based adaptation (CBA) emerging as one approach to conducting research to support such efforts. Few, if any, studies however, have critically examined the application of CBA in a health or Indigenous peoples context. We examine the strengths, challenges, and opportunities of health-related CBA research in Indigenous community settings, drawing on the experiences of the multi-nation interdisciplinary Indigenous Health Adaptation to Climate Change (IHACC) project. Data collection was guided by a framework developed to evaluate CBA projects. Semi-structured interviews (n = 114) and focus groups (n = 23, 177 participants) were conducted with faculty-based researchers, institutional partners, community members, students, and trainees involved in the IHACC project in Canada, Uganda, and Peru. Results illustrate the importance of CBA in co-generating knowledge on climate-health vulnerability and adaptation options, capacity building, and informing decision choices. There are also significant challenges of conducting CBA which can have unintended negative consequences, with results emphasizing the importance of managing the tension between health research and tangible and immediate benefits; developing a working architecture for collective impact, including team building, identification of common goals, and meaningful engagement of knowledge users; and the need to continuously monitor and evaluate progress. CBA holds significant promise in a health adaptation context, but only in the ‘right’ circumstances, where considerable time is spent developing the work with partners.

Article Citation

Ford, J.D., Sherman, M., Berrang-Ford, L., Llanos, A., Carcamo, C., Harper, S.L., Lwasa, S., Namanya, D.B., Marcello, T., Maillet, M., Edge, V. 2018. Preparing for the health impacts of climate change in Indigenous communities: The role of community-based adaptation. Global Environmental Change. 49: 129–139.  Click here for open-access article.

 

Kate Patterson awarded CIHR's Michael Smith Foreign Study Supplement

Congratulations to PhD Candidate Kaitlin Patterson for winning one of the CIHR's Michael Smith Foreign Study Supplements! With this award, Kate will be hosted and supervised by Dr. Shuaib Lwasa at Makerere University in Uganda, and supported by the Batwa Development Program, the Bwindi Community Hospital, and the Ugandan Ministry of Health to continue her research, working with Indigenous Batwa to characterize maternal health. During her award tenure, she will: 1) continue her investigation to identify maternal health opportunities in Kanungu district, including the mobilization and dissemination of these findings, 2) collaborate with Indigenous partners to co-produce and co-write two journal articles, and 3) formalize an international health research network between Canadian and Ugandan students.  Congratulations Kate!

Community-based Research Update: Nia & Kate in Uganda

Written by Nia King, Research Associate About two weeks ago I arrived in Uganda to work as a research assistant alongside Kate Patterson (PhD candidate), investigating rural maternal health and working to develop a knowledge translation strategy for IHACC Uganda. We are staying at the Monkey House, and have been joined by a wide variety of interesting visitors, including a group of external hospital auditors, tropical health students from the London School of Tropical Health and Medicine, two Americans who have spent the past two years driving in a camper van across Africa, and Dr. Kellerman, founder of Bwindi Community Hospital. This has made for a very lively and fun living environment!

With the quantitative maternal health surveys having been completed this past summer, we are now working with local research associates Seba, Charity, and Grace to conduct qualitative focus group discussions and individual interviews with mothers and fathers in Batwa and Bakiga communities throughout the Kanungu District. As the primary focus of Kate’s research is Indigenous maternal health, we are conducting repeated weekly focus group discussions with women in three Batwa settlements, chosen to capture the variety in geographies and access to healthcare. By spending approximately six hours discussing with each group of women, we are starting to capture and understand many of the nuances related to maternal health in rural Uganda. In addition to these focus groups, we have conducted focus group discussions with Batwa men and Bakiga (non-Indigenous) women. Kate has also been working with 9 Batwa women conducting repeated individual interviews to gather personal narratives surrounding maternal health. Through these various engagements, we have met many amazing women throughout the past couple weeks and look forward to providing them with a platform to voice their challenges and concerns. Our findings are intended to inform maternal health programs and delivery at the Bwindi Community Hospital and surrounding healthcare facilities.

When not in the communities, we have had the opportunity to partake in several hikes, including one that leads to a ridge overlooking the Ugandan and Democratic Republic of Congo border. Kate was also amazing and arranged a birthday party (including a homemade banana-nutella cake) for me last week, which made spending my birthday away from home extra special.

Overall our work is progressing smoothly here. I am so lucky to have the opportunity to live in this amazing part of the world and to learn from all of Kate’s experience. I look forward to the next two weeks—the time here is flying and pretty soon I’ll be hopping on a plane back home!

New Publication! Water quality and health in northern Canada

Congratulations to Carlee Wright on her first first-author publication!  Carlee worked with the Rigolet Inuit Community Government to examine potential associations between stored drinking water and acute gastrointestinal illness in Labrador Inuit. Citation: Wright, C.J., Sargeant, J.M., Edge, V.L., Ford, J.D., Farahbakhsh, K., Shiwak, I., Flowers, C., IHACC Research Team, and Harper, S.L.  (2017). Water quality and health in northern Canada: stored drinking water and acute gastrointestinal illness in Labrador Inuit. Environmental Science and Pollution Research, DOI: 10.1007/s11356-017-9695-9.  Click here to access the article.

Abstract: One of the highest self-reported incidence rates of acute gastrointestinal illness (AGI) in the global peer-reviewed literature occurs in Inuit communities in the Canadian Arctic. This high incidence of illness could be due, in part, to the consumption of contaminated water, as many northern communities face challenges related to the quality of municipal drinking water. Furthermore, many Inuit store drinking water in containers in the home, which could increase the risk of contamination between source and point-of-use (i.e., water recontamination during storage). To examine this risk, this research characterized drinking water collection and storage practices, identified potential risk factors for water contamination between source and point-of-use, and examined possible associations between drinking water contamination and self-reported AGI in the Inuit community of Rigolet, Canada. The study included a cross-sectional census survey that captured data on types of drinking water used, household practices related to drinking water (e.g., how it was collected and stored), physical characteristics of water storage containers, and self-reported AGI. Additionally, water samples were collected from all identified drinking water containers in homes and analyzed for presence of Escherichia coli and total coliforms. Despite municipally treated tap water being available in all homes, 77.6% of households had alternative sources of drinking water stored in containers, and of these containers, 25.2% tested positive for total coliforms. The use of transfer devices and water dippers (i.e., smaller bowls or measuring cups) for the collection and retrieval of water from containers were both significantly associated with increased odds of total coliform presence in stored water (ORtransfer device = 3.4, 95% CI 1.2–11.7; ORdipper = 13.4, 95% CI 3.8–47.1). Twenty-eight-day period prevalence of self-reported AGI during the month before the survey was 17.2% (95% CI 13.0–22.5), which yielded an annual incidence rate of 2.4 cases per person per year (95% CI 1.8–3.1); no water-related risk factors were significantly associated with AGI. Considering the high prevalence of, and risk factors associated with, indicator bacteria in drinking water stored in containers, potential exposure to waterborne pathogens may be minimized through interventions at the household level.

Photos of Carlee's Research

Indigenous Maternal Health Research in Uganda

Written by Julia Bryson, Undergraduate Researcher PhD Candidate Kate Patterson and Research Assistants Julia Bryson, Mackenzie Wilson, and Emma Windfeld, along with two core IHACC students Grace Asaasira and Phiny Smith of Makerere University, have been working in Uganda researching maternal health among Indigenous and non-Indigenous communities in Kanungu District. Here is an update on their work and adventures!

It is hard for us to believe, but we have officially completed our work in the communities of Kanungu District and are back in Kampala! It seems like it was just yesterday that we arrived in beautiful Buhoma. We will miss its rolling green hills, and even the mischievous monkeys that frequented the appropriately-named Monkey House we called home.

The past few weeks have been busy as we approached the end of our time in Buhoma—finishing data collection, sharing preliminary findings with our local partners, and saying many, many goodbyes to all the amazing people we have worked and lived with for the past six weeks. In total, we visited twenty communities over five weeks and surveyed approximately 600 women about their maternal health histories. Mackenzie and Julia also conducted sixteen focus group interviews to learn more about maternal nutrition and antenatal care in the area, and Emma spoke with several groups of community members about climate and food security associations.

The weekend before our departure, we took the opportunity to celebrate our amazing team of local surveyors, including students from our partner Makerere University, with some delicious local food and dancing. None of our work would have been possible without their time, effort, and enthusiasm!

We were also excited to have the opportunity to share about our research with one of our key partners in Buhoma, Bwindi Community Hospital (BCH). We presented our research methods and preliminary findings with over thirty BCH health care workers and administrators and had fruitful discussions about future steps as we work together to use the information we have gathered to improve health in the area. The knowledge and expertise of our BCH partners is integral to the success of our work, and we are so grateful to be able to collaborate with them and continue to build these important relationships throughout the project.

The drive back to Kampala was lengthy, but full of adventure! We drove through the gorgeous Queen Elizabeth National Park and were lucky enough to spot one of the elusive tree-climbing lions, thanks to the sharp eye of our driver, Maddy. We also saw antelopes, baboons, monkeys, buffalo, and even elephants! An unexpected safari on the way to the city was a great way to cap off our time in the south of Uganda. We look forward to exploring the city of Kampala and meeting with our key partners at Makerere University over the next two weeks as we wrap up this stage of the project and look ahead to the future. There’s never a dull moment!

Anna Reports from Russia: The Collaborative Arctic Summer School in Epidemiology

Written by Anna Manore, MSc Candidate After many long flights, I landed in Arkhangelsk, Russia, to begin a week of learning with the Collaborative Arctic Summer School in Epidemiology (CASE). CASE is a meeting of epidemiology faculty and students from the United States, Canada, Norway, and Russia. It’s a great opportunity to meet with other researchers working in Arctic contexts, and I’m fortunate because this was my second time attending! A few other CASE participants from Alaska had been on my flight from Moscow, and after waiting for the rest of the participants’ flights to arrive, we set off on a 3.5-hour drive to Golubino.

Golubino is a resort along the Pinega River, and it was the beautiful setting of CASE 2017. The food was delicious, and always surprising! Breakfast on the first day included porridge with berries (surprisingly savoury), and small pastries (surprisingly filled with fish). Presentations from faculty and students began almost immediately, and continued throughout the week. Although every presentation focused on Arctic Epidemiology, the populations and outcomes of interest varied widely. We heard about suicide and suicide prevention, cardiovascular disease, perinatal outcomes, and environmental contaminants, among other topics. One presentation that stood out was by Ketil Lenert Hansen from the University of Tromsø- on the topic of “Ethical and methodological Issues in working with Indigenous peoples in the Arctic”, and focused on the Sámi context in Northern Europe. From Ketil’s talk, there seemed to be common themes between issues faced by Sámi and by Indigenous peoples in Canada. Ketil also recommended a film, “Sámi Blood”, which is a dramatized telling of a Sámi girl’s experience growing up in Sweden in the 1930s.

In the evenings, we had time for activities! The first night’s adventure was a walk through the Taiga forest to a holy spring. Some in our group were suffering from stuffy noses, so our tour guide showed us how to use the forest ants as a remedy. There were large anthills made of pine needles along our path, and to help a stuffy nose, you tap your hands three times on the anthill, bring your hands to your face, and inhale. The ants make your hands smell like vinegar, which, we all learned, is very effective at clearing out sinuses.

Tuesday night’s activity was an excursion to the nearby “Golubinsky proval” karst caves. These are limestone caves carved by water, and there are tunnels are over a kilometre long. The temperature inside the caves is much cooler than outside, so the white limestone was coated in ice. Unfortunately, most of the tunnels were flooded, so we couldn’t go very far into the cave. But – what we could see was stunning, and definitely worth getting all dressed up for!

Wednesday night was team-building activities, followed by a campfire, tea tasting, and traditional songs and dances by the river. We heard that the singers, dressed in traditional costume, are all local retirees! Our last night, Thursday, saw us all making “Pinega shanezhki” pies and relaxing after a trip to a monastery. Friday was our long drive back to Arkhangelsk, with a stop at “Malye Korely”, an open-air museum of wooden architecture from the Arkhangelsk Region. From the museum, it was back to Arkhangelsk and the airport – a great end to a great week at CASE!

 

 

Indigenous Maternal Health Research in Uganda

Written by Emma Windfeld, Research Assistant Kate Patterson, a PhD student at the University of Guelph, is completing her thesis on maternal health among Indigenous and non-Indigenous populations. Kate and three research assistants—Julia Bryson, Mackenzie Wilson, and Emma Windfeld—are conducting fieldwork in Buhoma, where they will spend a total of five weeks. When they arrived in Buhoma two weeks ago they were welcomed into the "Monkey House," which they are very happy to call home for their time here. The Monkey House is a quiet and welcoming accommodation built on a hill above Bwindi Community Hospital. It is named after the mischievous red-tailed monkeys that scamper around the roof and swing through the trees that surround the house, and that occasionally cause a stir by fighting with the chickens that roam the backyard. Kate, Julia, Mackenzie, and Emma often enjoy working on the back porch but have to be careful that the monkeys don’t snatch their pens or phones.

For the past two weeks here in Buhoma, the four researchers have traveled by car or on foot to nearby communities in Uganda’s Kanungu District to gather maternal health data through surveys of the local women. Half of each week is spent in Batwa settlements and half is spent in Bakiga settlements. The Batwa are an Indigenous people who lived as hunter-gatherers in the nearby Bwindi Impenetrable National Forest until they were evicted by the government two decades ago. The Bakiga are the local inhabitants of the Kanungu district. Two core Ugandan Indigenous Health Adaptation to Climate Change (IHACC) team members from Makerere University, Grace Asaasira and Phiny Smith, have been instrumental partners. In addition to helping with the community surveys, Grace and Phiny have helped the Canadian researchers get to know the local area and shared a lot of interesting conversations about cultural similarities and differences. Overall, the fieldwork has been progressing successfully so far and everyone is looking forward to the next three weeks of working with the communities.

At the Monkey House, Kate, Julia, Mackenzie, and Emma have enjoyed sharing yummy meals, stimulating conversations, and fun movie nights with the doctors and nurses who work or volunteer at Bwindi Community Hospital. On their days off, the four researchers have gone gorilla trekking and hiking in Bwindi Impenetrable National Forest with its rolling mountains and lush vegetation. They have also enjoyed a day at one of the many local coffee plantations, where they got to learn about coffee making from picking the beans to drinking the freshly roasted brew.

 

How does seasonality and weather affect perinatal health?

Congratulations to Sarah MacVicar on her recent publication that examines how seasonality and weather affect perinatal Indigenous health in southwestern Uganda! Click here to access the abstract. 

Citation: MacVicar, S., Berrang-Ford, L., Harper, S.L., Steele, V., Lwasa, S., Bambaiha, D.N., Twesigomwe, S., Asaasira, G., Ross, N. and IHACC Research Team, 2017. How seasonality and weather affect perinatal health: Comparing the experiences of Indigenous and non-Indigenous mothers in Kanungu District, Uganda. Social Science & Medicine. 187: 39–48.

Abstract:  Maternal and newborn health disparities and the health impacts of climate change present grand challenges for global health equity, and there remain knowledge gaps in our understanding of how these challenges intersect. This study examines the pathways through which mothers are affected by seasonal and meteorological factors in sub-Saharan Africa in general, and Kanungu District (Uganda), in particular. We conducted a community-based study consisting of focus group discussions with mothers and interviews with health care workers in Kanungu District. Using a priori and a posterioricoding, we found a diversity of perspectives on the impacts of seasonal and weather exposures, with reporting of more food available in the rainy season. The rainy season was also identified as the period in which women performed physical labour for longer time periods, while work conditions in the dry season were reported to be more difficult due to heat. The causal pathways through which weather and seasonality may be affecting size at birth as reported by Kanungu mothers were consistent with those most frequently reported in the literature elsewhere, including maternal energy balance (nutritional intake and physical exertion output) and seasonal illness. While both Indigenous and non-Indigenous mothers described similar pathways, however, the severity of these experiences differed. Non-Indigenous mothers frequently relied on livestock assets or opportunities for less taxing physical work than Indigenous women, who had fewer options when facing food shortages or transport costs. Findings point to specific entry points for intervention including increased nutritional support in dry season periods of food scarcity, increased diversification of wage labour opportunities, and increased access to contraception. Interventions should be particularly targeted towards Indigenous mothers as they face greater food insecurity, may have fewer sources of income, and face greater overall deprivation than non-Indigenous mothers.

Congratulations to Laura Jane for winning a Vanier Scholarship!

Sincerest congratulations to Laura Jane Weber for winning a Vanier Canada Graduate Scholarship, one of Canada's most prestigious scholarships! Laura Jane is a PhD Candidate in Epidemiology and International Development Studies at the University of Guelph.  She is working with Northern partners to explore the role of place in Inuit maternal health and wellness.  Her advisory committee includes Drs. Harper, Dewey, Cunsolo, Healey, and Humphries.

Click here to read the news story.

 

Research Photos of Laura Jane

Lessons from the Labrador Research Forum: Truth, Respect and Reciprocity, Humility, & (Re)framing Research as (Re)conciliation

Written by Alexandra Sawatzky, PhD Candidate Between April 30 and May 3, Jacquie, Mel, and I were privileged to attend the first biennial Labrador Research Forum in the Upper Lake Melville Region of Labrador. This gathering involved the communities of Happy Valley-Goose Bay, Sheshatshiu First Nation, and North West River, and engaged the three Indigenous nations of this region: the Innu, Nunatsiavut Inuit, as well as NunatuKavut Inuit. Over 150 delegates, including researchers, government representatives, community leaders and organizations, and the broader public came together to engage in dialogue and co-learning surrounding research in the North, by the North, for the North.

The Forum kicked off with an afternoon of cultural activities in Sheshatshiu First Nation, including beading, sewing, and snow shoe making. These activities, together with the opening ceremony at the beautiful Sheshatshui Ussiniun Youth Centre, instilled a strong sense of community among the attendees that set the tone for the rest of the Forum.

This Forum was structured differently to more conventional research gatherings, with presentation sessions containing a 5 minute research outline, followed by a 10-minute discussion with the audience. This led to engaging, dynamic sessions that encouraged deeper dialogue, as well as many opportunities for continued dialogue outside of the session during coffee breaks. As an audience member, I felt there were more opportunities to be an active participant within the session, and more space for deeper listening and engagement with the ideas and topics.

Grounding these ideas and topics were several intellectually and spiritually stimulating plenary panel discussions. The first plenary of the Forum was comprised of a panel of Indigenous leaders from across the region, who discussed their views on research as reconciliation and challenged the conventional understandings of the words “research” and “reconciliation.” These words carry great weight, and we have a responsibility to unpack and understand their connotations in order to use them effectively and with an awareness of their history. This first plenary, and all of the plenaries, presentations, and discussions that followed, emphasized the importance of our distinct contributions to research as reconciliation, which is premised on core values of truth, respect, and humility.

Truth

Starting from a place of truth, we can work towards reconciliation. President Todd Russell of the NunatuKavut Community Council emphasized this point in the first plenary panel, as he explained that pathways toward research as reconciliation must be developed in partnership with Indigenous peoples, partnerships wherein the research community understands its own truth, its own place.

Respect and reciprocity

Practicing respectful partnerships with people, plants, and animals can help move research forward in a good way – towards reconciliation. This idea was explored through a plenary on Caribou and people in Labrador, where the panelists described how hunters should position themselves as caretakers of the animals they choose to hunt, and engage in partnerships with these animals. These types of partnerships are also important in the research community, where there is a long history of researchers viewing people, plants, and animals merely as “subjects of study,” rather than respecting them as partners in research endeavors. Cultivating respectful partnerships requires researchers to position themselves as caretakers of data, as explained by Dr. Margaret Kovach in her keynote address titled: “Indigenous research, Indigenous methodologies, and the power of Indigenous knowledges in informing research practice.” Dr. Kovach went on to say that the word “data” in Latin means gift. The knowledge and stories shared by Indigenous peoples through research partnerships should be understood and accepted as gifts, which connects to the responsibility of all those involved in research to practice and uphold respectful, reciprocal partnerships.

Humility

The importance of cultural humility was also introduced in the “Research as Reconciliation” plenary, and was frequently revisited throughout the Forum. In research, cultural humility involves reflecting on where we are coming from as we enter into research partnerships, and where we hope to go together with that research. Moreover, cultural humility involves coming to the table with an open mind, as well as with the willingness to step back from the table every so often to listen and learn. We must be mindful of the questions we ask, and aware of the words and language we use to ask those questions. We must accept the value of the answers we receive and the lessons we learn from asking those questions – beyond accepting knowledge, we must value that knowledge. In reflecting on these ideas with Mel and Jacquie, Mel noted that she was particularly impacted by President Todd Russell (NunatuKavut Community Council) questioning the term “higher education,” as well as the ways in which we determine who is an “expert.” Jacquie and I felt similarly to Mel in that President Russell’s words reminded us that the research we do involves knowledge systems and worldviews that we have very little understanding and lived experiences of.

(Re)framing research as (re)conciliation

Participants were encouraged to critically reflect on how we frame “research as reconciliation” through unpacking the meaning of each of those terms. Unpacking these terms from a place of truth, respect, and humility is crucial in order to understand the role research has played, and can continue to play, in colonization of Indigenous peoples and lands. The plenaries, keynotes, presentations, and workshops at this Forum encouraged further explorations of the ways in which “research” transcends beyond academia to involve the communities, governments, and environments within which the research takes place. Furthermore, many panelists and presenters reiterated the fact that “reconciliation” needs to be understood as more than just a buzzword. Reconciliation involves action. Part of this action involves coming together as community, through opportunities like this Forum, to discuss and develop pathways toward reconciliation through research. Ultimately, moving towards and along these pathways requires a commitment to cultivating and sustaining relationships premised on truth, respect, and humility.