Nova Scotia Brotherhood Initiative – February Global Health Rounds

February 16, 2016 Maria Wilson Leave a Comment

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By: Maria Wilson

Global Health Office Outreach Assistant

This month’s edition of Global Health Rounds took place on February 10th, 2016 in the Sir Charles Tupper Medical Building. Global Health Rounds is a free public lecture series, focused on highlighting and discussing the global health activities at Dalhousie, as well as contemporary global health challenges, with leaders in the field. These sessions are offered monthly and anyone is welcome (and encouraged) to attend. Speaker and location details will be posted on the Global Health Office Website, Facebook, Twitter and Instagram.

February Rounds, led by several members of the Nova Scotia Brotherhood Initiative (NSBI), focused on the health and wellness of African Nova Scotian (AFNS) men. NSBI is based on the Project Brotherhood model that began in Chicago. This model aims to create a safe space for Black men to seek health services.

Dr. Ron Milne began the presentation by justifying why the NSBI targets African Nova Scotian men. Men (in general) are less likely to pay attention to their health, perhaps due to striving to align with norms around masculinity. Men are also more reluctant to seek care, and tend to ask less questions than women when they do seek care. Though there is a dearth of data related to African Nova Scotian men, data on the health of men of African descent in the United States provides a glimpse of the challenges faced by this group. The following are only some of the health statistics cited in Dr. Milne’s presentation:

– Men of African descent have higher rates of colorectal cancer, and are 32% more likely to die from colorectal cancer than the general population.

– Compared to the general population, men of African descent have a 1.5 times greater risk of developing diabetes.

– Men of African descent are 60% more likely to develop prostate cancer, and 2.5 times more likely to die from the disease than the general population.

– Compared to adult Caucasians, men of African descent are 20% more likely to experience stress and mental health problems.

Dr. Milne noted that, in part, these statistics could be explained by genetics. However, we must also address a key issue this group is faced with on a daily basis: we have not created a safe and accessible environment for this group to receive the healthcare they require. This is due to a number of factors, including a cultural memory of abuse and lack of trust, systemic oppression, non-culturally specific health practices and a lack of AFNS health providers. Similar issues are faced by other marginalized communities, including pride and Indigenous groups. These problems are not going to be fixed overnight, but the NSBI has been working since 2009 to build relationships in target communities through trusted community groups (churches, etc.).

The NSBI came under the Nova Scotia Health Authority (NSHA) in 2014, and covers those living in the NSHA Central Zone (Halifax area). The NSBI does not strive to become a primary health home for its clients. Through this initiative, a team of health professionals provide culturally appropriate and gender specific primary medical care, while facilitating access to further care. The NSBI clinical team includes a family physician, a registered nurse, a dietitian, a community liaison, administrative support and a social worker. Most of these positions are staffed part-time. NSBI also has two community volunteer groups. One of these is the Men’s Health League, a volunteer peer-to-peer support and action group for AFNS men. The other is the Health Champions group, who are spread geographically across the Central Zone, and serve to provide advice and direction to NSBI throughout its evaluation process.

As its work progresses, the NSBI hopes to improve health outcomes, increase participation of target communities in their well-being and increase cultural competency in primary health care. Over the past year, the NSBI has taken part in health fairs across the province, attended community events, created health information pamphlets and established the Health Champions group. In the coming year, they aim to continue this work, while building community partnerships and evaluating their model. They will continue to “be the bridge for the AFNS community to the greater Nova Scotia healthcare system.”

We would like to thank members of the NSBI for leading Feburary’s engaging Global Health Rounds session. We hope to see you all at our March session!

Environmental Racism – January Global Health Rounds

January 26, 2016 Maria Wilson Leave a Comment

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Photo credit: enrichproject.org

The first Global Health Rounds of 2016 took place on January 20^th in the Sir Charles Tupper Medical Building. Global Health Rounds is a free public lecture series, focused on highlighting and discussing the global health activities at Dalhousie, as well as contemporary global health challenges, with leaders in the field. These sessions are offered monthly and anyone is welcome (and encouraged) to attend. Speaker and location details will be posted on the Global Health Office Website, Facebook, Twitter and Instagram.

January’s Rounds, led by Dr. Ingrid Waldron, was entitled “Race, Place & Waste: Exploring the Health Effects of Environmental Racism in African Nova Scotian & Mi’kmaw Communities.” Dr. Waldron discussed the Environmental Noxiousness, Racial Inequities and Community Health – or ENRICH – Project, which aims to better understand the effects of environmental racism in African Nova Scotian and Mi’kmaw communities, and to support their struggles against it. Dr. Waldron’s talk drew a crowd of more than forty students, faculty, health professionals and community members. We hope to see just as much enthusiasm for February Global Health Rounds: Health & Wellness of African Nova Scotians. Check out (and share) the Facebook event for more information, and to indicate your interest and plans to attend.

Some of the January Global Health Rounds attendees. We had to open a second room connected by video-conference because there were so many people!

What is Environmental Racism?

The first time I heard about environmental racism was in a 2013 article by Vice News about The Chemical Valley [1]. The Aamjiwnaang First Nations reserve near Sarnia, Ontario, home to about 850 Chippewa, sits surrounded by harmful chemical plants that produce gasoline and synthetic rubbers, among other materials. Why are these plants located next to a First Nations reserve, rather than in the midst of a middle class, primarily white neighbourhood? How do race and class shape where hazardous industries are located?

Dr. Waldron’s research in environmental racism seeks to answer these types of questions in Nova Scotia, while assessing the health impacts and working toward policy solutions. In Nova Scotia (and globally), there is a disparate location of hazardous industrial polluters in communities of colour, First Nations, in remote areas and among the working poor. The ENRICH project began with community consultations in the spring of 2012. Consultations took place in Yarmouth-Acadia First Nations, Eskasoni First Nation, Membertou First Nation, Lincolnville, and other affected communities. The concerns that were identified among these communities include (but are not limited to) fear of water and soil contamination, high rates of cancer, asthma and fetal anomalies and social nuisances such as loud noises, increased insects and mammals. Some women feel that their reproductive choices are limited, not wanting to expose a child to the aforementioned effects of environmental racism.

Dr. Waldron noted that environmental racism is an intersectional issue. Low income white communities also experience environmental racism, but their issues are often addressed more quickly. When there are multiple factors impacting the lack of power to be protected and heard (race, place and class) due to a history of forced displacement, social marginalization and destruction of culture and language, environmental racism worsens. Despite pushback from these communities who are affected by landfills and dangerous industries, there is a common response: in order to have grounds to remove them, there must be concrete, scientific proof that they are causing harm. The burden of this proof often falls on the communities, but it should be shifted to those responsible for environmental racism.

Bill 111

Communities experiencing the health and social impacts of environmental racism shouldn’t have to wait for 100% proof and validity to have their issues addressed. Dr. Waldron’s work, in collaboration with MLA Lenore Zann, culminated in presenting Bill 111, An Act to Address Environmental Racism, in the Nova Scotia Legislature.

In 2015, Bill 111 made it to second reading, but did not pass. Dr. Waldron is not discouraged, as the bill has introduced to the issue of environmental racism to many who were otherwise unaware. Bill 111 was featured in The Huffington Post, The Chronicle Herald, and is now on the record as being debated in the Nova Scotia Legislature [2]. She plans on introducing the bill again in the near future.

Future Directions

Dr. Waldron’s current work includes working with a dedicated team to develop an all-applicable Environmental Bill of Rights, stating that everyone has the right to clean air and clean water; the right to live, work, learn and play in healthy and sustainable places, among other standard rights that those impacted by environmental racism are not always afforded.

The Global Health Office would like to thank Dr. Waldron for her eye-opening talk about environmental racism, a pressing local and global health issue. To learn more about the ENRICH Project, you can visit their website [3].

International Development Cooperation in Global Health – Global Health Rounds

November 24, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

November Global Health Rounds attendees.

The latest session of Global Health Rounds took place on November 18^th, 2015. Global Health Rounds is a free public lecture series, focused on highlighting and discussing the global health activities at Dalhousie, as well as contemporary global health challenges, with leaders in the field. These sessions are offered monthly and anyone is welcome (and encouraged) to attend. Speaker and location details will be posted on the Global Health Office Website, Facebook, Twitter and Instagram.

The November session was titled: “Global Health from an International Development Cooperation Perspective: A North-South Approach.” The facilitator was Manfred Egbe, a visiting PhD student-researcher from Universitat Rovira I Virgili in Tarragona, Spain. Led by Manfred, attendees (pictured above) learned about upstream approaches to improving health in rural areas of Mali.

This project is taking place in several communities in rural areas of the Koulikoro region, such as Diedougou, Kolonia and Tyékouméla. The Koulikoro region is pictured below on the map of Mali in seafoam green. Some of the many partners involved in this project include OSALDE (Association for the Right of Health) a Spanish NGO, ASACO (Community Healthcare Association), CSCOM (Community Healthcare Centre), community members and other NGOs in the region.

A map of Mali for all the geography buffs, with the Koulikoro region pictured in green.

Manfred’s role within the project has been as a project evaluator and medical anthropologist. His ethnographic portion of the study involved identifying problems and challenges in the community related to health by consulting health directors and community members. As part of this research, he conducted a range of in depth individual and group interviews using both quantitative and qualitative methods, reviewed OSALDE documents and examined WHO data. Through these methods, Manfred was able to identify a tree of problems that needed to be addressed in Mali.

The central problem was identified as high infant and adult morbidity and mortality. To gain a more in depth look, the project next asked – what are the causes of mortality and morbidity? The top three causes of death were identified as malaria, lower respiratory infections and diarrheal diseases. This is accompanied by high costs of medicine, and a shortage of medicine for treating these diseases.

Instead of stopping there, they next asked – what social, cultural and environmental conditions are leading to a high burden of disease and death? These are referred to as the upstream causes of disease. This term comes from a metaphor used in the public health approach to disease prevention. The metaphor describes a dangerous river that runs through a community. Several people have been seen floating down the river, struggling and drowning. Rescue workers try to save those in danger; however, no matter how hard they work, they do not have the resources to save all victims. A straightforward, “downstream” solution to the problem may be to hire more staff, to try to save the people who have fallen into the river. However, traveling upstream to determine why people are falling into the river in the first place may be more effective. Perhaps they need to cross the river to access a food supply, but there is no safe crossing point and they are being swept away in the process. An “upstream” approach would be to build a stable, sustainable bridge, allowing people to cross the river and preventing them from falling in the first place.

Several factors were identified as upstream causes of morbidity and mortality. Environmental factors play a role in the burden of disease in Mali, where there are essentially two seasons: wet and dry. During the wet season, there is extensive flooding, leading to breeding grounds for mosquitoes. Furthermore, extremely wet conditions favor the transmission of waterborne diseases. This is paired with poor access to health care and health services in rural areas. Through the interview process, the community identified their upstream issues as contaminated wells, droughts during dry season, women being undervalued, difficulties accessing education (particularly for women) and poor sanitation in health facilities and the community.

To address the upstream issues, OSALDE has worked with community partners to support training of nurses, improving access to clean drinking water, building capacity by increasing literacy and working to improve the status of women through education.

The project also aimed to improve access to healthcare services (including the elimination of financial barriers) and improve healthcare system quality. In the Diedougou commune this involved offering a minimum healthcare service package including clinical activities, preventive activities, obstetric activities, medico-technical activities, pharmaceutical activities and management activities. They have also improved the healthcare centre, which now has a maternity ward, surgical unit and a general practitioner’s office.

The take home message from Manfred’s presentation: there are many determinants of health. These include, but are not limited to social, economic, genetics, political, and cultural factors. Straightforward approaches such as treating disease to decrease mortality are important when undertaking projects to improve health. However, most projects undertaken in resource poor countries have a fixed term (i.e. two years, five years, etc.). If we do not take the time to address sustainable solutions to health problems, and work with community partners, improvements in health status will not last.

I will leave you with a quote I really enjoyed from Manfred’s presentation: “the platform of global health accommodates people from different disciplines.” Many different minds with many different approaches can and should come together in global health to address issues that affect us all, and arrive at a sustainable solution.

Thank you to Manfred for sharing your experiences at this month’s Global Health Rounds. There will be no Global Health Rounds in December so as to not conflict with holiday plans and exams. We look forward to seeing you in January!

What in the world is wrong with global health? – Global Health Rounds

November 2, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

The Global Health Office is pleased to announce the return of Global Health Rounds for the 2015-2016 academic year! Global Health Rounds is a free public lecture series, focused on highlighting and discussing the global health activities at Dalhousie, as well as contemporary global health challenges with leaders in the field. These sessions are offered monthly, and anyone is welcome (and encouraged) to attend. Speaker and location details will be posted on the Global Health Office website, Facebook and Twitter.

This year’s first session took place on October 21^st, and was titled: “What in the world is wrong with Global Health: A discussion of ethics, policy and activism in approaching Global Health.” Along with facilitator Dr. Bob Huish (Associate Professor, Dalhousie Department of International Development Studies), attendees discussed how we can better our approach to global health.

The role of the media in global health is an important topic to consider. When you think back to the fall of 2014 in the midst of the West African Ebola outbreak, what do you remember seeing in the mainstream media? Widespread panic, fear and despair; photographs of the sick and the dead. One headline on CNN characterized the outbreak as “Ebola: The ISIS of Biological Agents.” The Ebola outbreak was obviously critical, but the representation in the majority of the North American media was very problematic. This was paired with a lack of mobilizing human resources in the early stages of the outbreak, despite the human resources shortage being identified by WHO as a major barrier to control. In all of this, Cuba emerged as a champion for change, sending more than 460 doctors and nurse to West Africa as of November 2014. In addition to their significant human resources role, Cuban health professionals ensured that the photographs they took sent a positive message of hope, progress, partnerships and change, contrary to most of the other photographs shown in the North American media during the worst of the outbreak. The photograph featured below shows a members of the Cuban team making a peace sign, and many of the other photos show team members giving thumbs-up. Furthermore, their names are written on the protective equipment. This humanizes the team members and acts as a powerful tool to put the Ebola outbreak in perspective: rather than showing anonymous humans who are sick, dying or struggling, we see named team members on the front line conveying positive emotions. Thank you to Dr. Huish for sharing some of the photographs from his presentation!

After reflecting upon the characterization of global health in the media, we also took the time to discuss and how we are conceptualizing global health as a whole, and how we may need to re-evaluate our framework. Here are a few of the key topics and messages we discussed in working together towards better health for all:

Establishing equitable partnerships.

As noted in the event description, many diseases favour the poor, but the ability to treat and to prevent illness tends to favour the affluent. In order to succeed in our global health endeavours, equitable partnerships must be forged.

Our current tendency to think of global health as individual experiences, rather than an overarching discipline needs to change.

In academia, training experiences in global health offer many potential benefits to the individual, as well as the institution. While these are important to acknowledge, they should not be the principal driver of global health initiatives. We need to re-focus on global health as a discipline that works toward achieving equity in health for all.

Rethinking our approach to maintaining and achieving health rather than treating illness.

We often see global health responses as reactionary. Take the Ebola outbreak as an example, there was a rapid outpouring of funding from many of the world’s most wealthy countries as an immediate reaction to this crisis. However, what if we re-focused our efforts on addressing long-term health needs, the social determinants of health (particularly poverty) and advocacy? Shifting our focus in global health “upstream” to structural and developmental initiatives may create a more sustainable alternative. As Dr. Huish noted, “health is always an outcome of development.”

We would like to thank Dr. Huish for facilitating the first Global Health Rounds of the 2015-2016 academic year, and look forward to many more discussions on global health in the year to come. We hope to see you at next month’s event:

November Global Health Rounds

Wed. Nov 18 @ 5-6pm, location TBD

Hosted by Manfred Egbe, Universitat Rovira i Virgili, Tarragona, Spain

Topic: Global Health from an International Development Cooperation Perspective: A North – ‘Local South’ Approach.

Profound Learning @ Global Health Rounds

November 5, 2014 Sarah Boucaud Leave a Comment

By Sarah Boucard, Outreach Assistant, Global Health Office

Some of my favorite learning experiences, whether inside or outside the classroom, have been those lead by passionate individuals. When someone loves their work, it reads in their face, in the way they lecture, and in their willingness to share their experiences and mentor others. This is why I would like to invite you to join me in attending Global Health Rounds, on the 3rd Wednesday of each month, held by your very own Global Health Office. Each of these sessions highlights a different global health activity at Dalhousie or a contemporary global health challenge through presentations and talks by leaders in the field. The rounds are a forum for discussion, questions, and interaction. Each has left me with more than just increased knowledge on the topic at hand.

The intimate setting has given me an opportunity to meet like-minded people, network, and pursue different opportunities. So far, two sessions have been held. The first, was on social accountability within medical schools and was led by Ms. Shawna O’Hearn, Director of the Global Health Office, and Dr. Jeff Kirby at the Department of Bioethics. The second, lead by Dr. Des Leddin at the Faculty of Medicine, was titled “Health Education; Can the Net Level the Playing Field?”. He spoke of international partnerships in the establishment of specialty care centres in other countries. The facets of global health explored by these leaders are relevant to health professionals, researchers, and the public alike. As an emerging health care administrator, my own values and understanding have been tested through these rounds when I learned the value of establishing specialty facilities in developing countries, even when some of the most basic health care needs still have to be met.

I have to say, I felt as though I was being exposed to “inside information” throughout these discussions, candid and unpublished truths from the mouths of the experts themselves.

Jeff Kirby, Courtesy of Dalhousie Faculty of Medicine

The next upcoming Global Health Round is with Bob Huish, Assistant Professor, Department of International Development Studies. He will explore the topic of “Why does Cuba care so much about Ebola? Understanding the Solidarity Approach to Global Health”. I hope to see you all there! November 19, 2014 @ 5-6pm Tupper G-36, DMNB Saint John Rm 218.

For more information: Global Health Rounds

Category: Global Health Rounds