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!
Congratulations to Jamie Snook for winning a Trudeau Doctoral Scholarship!
Sincerest congratulations to PhD student, Jamie Snook, on this prestigious and well-deserved honour!
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.