Tag Archive for: healthcare

Behind the Science: Enhancing Cervical Cancer Screening in Rwanda

Interviewee: Dr. Katherine Gray; UBC Obstetrics and Gynaecology resident, PGY-2 | Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators)

Published: July 5th, 2024

Can you tell me about your research?

I am a first year resident in Obstetrics and Gynecology (Ob/Gyn) at the University of British Columbia (UBC). I started doing global health research within the theme of women’s health in my fourth year of medical school. My research focused primarily on equity and care surrounding women’s health in Rwanda.

I initially delved into a project centered around enhancing access to cervical cancer screening for women in Rwanda. Since then, my endeavors have expanded to various projects within the realm of Ob/Gyn care in Rwanda. One noteworthy initiative I spearheaded was the optimization of cervical cancer screening and accessibility in Rwanda by gaining insights from healthcare providers. My study, which concluded last year, looked at the practices of Ob/Gyns, nurse midwives, and family doctors regarding cervical cancer screening, shedding light on the challenges they encounter.

Additionally, I’ve been involved in diverse research themes in Rwanda, including an exploration of preterm premature rupture of membranes and the existing guidelines, comparing them to Canadian standards of care. I’ve also investigated operative vaginal deliveries in Rwanda, and my current focus lies on various facets of cervical cancer screening.

Are there any findings from your research that you’d like to highlight?

From my study on healthcare provider perspectives, a lot of the findings did align with similar studies in other low-resource settings. One prominent theme that emerged is the significant barrier posed by patients’ knowledge and education levels regarding cervical cancer and screening. Many patients exhibit a limited understanding of either the disease or the screening process, which limited their engagement with screening initiatives.

Additionally, the training of healthcare providers in conducting cervical cancer screening emerged as another influential factor in accessing screening. A small subset of physicians and nurses receive formal training on how to conduct screening, leading to a shortage of proficient providers. This shortage of trained professionals was consistently cited as a barrier to screening by every provider interviewed in my study. Overall, the training landscape appears inconsistent, resulting in notable gaps in screening and subsequent care provision.

How did you get involved with this kind of work?

In my fourth year of medical school, I knew that I wanted to pursue Ob/Gyn and I have always been interested in global health. I was connected with my research supervisor, Dr. Marianne Vidler and got involved with her work and the theme of global health and maternity care in Rwanda. I have been interested and involved ever since! I am immensely grateful for the opportunity to continue my residency at UBC, as it enables me to sustain my research endeavors alongside my exceptional team, both in Canada and Rwanda.

What impact do you hope to see with the work you’re doing?

My research is dedicated to identifying and understanding the barriers hindering both patients from accessing care and providers from delivering it effectively. By comprehending these obstacles, we aim to take proactive steps towards enhancing screening accessibility. With a primary focus on understanding these barriers, my aim is to progress towards devising strategies and implementing them effectively.

Currently, my team and I are delving into the concept of self-collection for HPV testing in Rwanda. This method has gained prominence, particularly in British Columbia, primarily because of its heightened sensitivity compared to traditional Pap smears in cervical cancer screening. Our research will involve integrating this more sensitive and efficient approach, which allows individuals to self-collect samples, into Rwanda’s healthcare infrastructure.

Looking ahead, I hope that I can continue working on the integration of HPV DNA testing and self-collection methods in Rwanda. By doing so, I hope to shed light on how these innovations can significantly enhance access to and rates of cervical cancer screening in the region.

 

 

 

 

 

 

Behind the Science: Racializied Women’s Physical Pain Dismissal


Interviewee: Negin Nia, B.A., M.J., University of British Columbia, Author/Editor: Romina Garcia de leon (Blog Co-coordinator).

Published: June 17th, 2022

In this week’s Behind the Science, we highlight work done by our current Blog Co-Coordinator at the Women’s Health Research Cluster (WHRC), Negin Nia. She is a recent Master’s graduate from the UBC School of Journalism who specialized in public health. Negin’s final research project in the program sought to examine the intersection between women’s physical pain, race, and treatment in North America’s hospitals and beyond.

Negin did not only complete a literature review but also released an audio documentary covering the lived experiences of racialized women. Her podcast was recently awarded the 2022 Radio Television Digital News Foundation JJ Richards Award. Read more about her project and the lived experience that drove this work. 

Can you please tell me about the work you have done during your Master of Journalism degree? 

For the last year in my program, I decided to focus my journalism specialization on health reporting. This work was driven by my lived experience but also because I believe health impacts every aspect of our lives. 

I did my final research project, which was a combination of a literature review, and an audio documentary on women’s physical pain, race and treatment. There is a lot of research that shows that women, especially racialized women, experience a heightened degree of discrimination, stigma and dismissal of their physical pain because of stereotypes and biases. This is particularly striking as women already experience more chronic pain than men. 

So, the audio documentary explores the lived experiences of many women, including my own story surrounding physical pain, race and accessing treatment across North America’s health care systems. And then the final literature review was more of a deep dive into why this is happening. It included the research in the statistics, whereas the audio documentary was more testimony with facts — they complement each other well.

What led you to pursue this work in the field of health? 

Back in 2020, I had to undergo open-heart surgery for a benign heart condition that I have had my whole life. The situation caught me by surprise because I was an outwardly healthy, 22-year-old. But I had been having a lot of heart palpitations during that year and the doctors kept telling me it was just my anxiety. 

Finally, I got referred to a cardiologist who took such great care of me and took my pain seriously. He scheduled me for an MRI, which is an uncommon test to run for my condition. Usually, it’s an echo scan. The MRI showed more than the echo scan did, that my heart condition had all of a sudden become severe with no explanation. I underwent surgery as soon as possible. 

That experience was super scary and shocking, but I have come out of it a lot stronger — it taught me so much. And just being in the hospital that week, and talking to other people who have been dealing with chronic health issues, really opened up my eyes to the disproportionate dismissal that women, people of color, and non-binary folk face in the healthcare system. 

Do you incorporate the knowledge you gained from your undergraduate degree into what you do now? 

I did my undergraduate degree at UBC in political science and law, and it taught me how to develop my writing skills. I also focused a lot on health policy during my degree. I originally wanted to become a lawyer, but after I started writing for the school newspaper, I realized that I love writing and journalism. 

That degree equipped me for a lot of what I’m doing now in my work at the WHRC, and it also gave me the skills to pursue my master’s degree and the work that has come from it. 

What are your next steps, and long-term goals? 

I’m very interested in pursuing work that’s meaningful, similar to what I did in my podcast. I enjoyed the aspect of sharing stories and highlighting the voices of marginalized and racialized groups — which is my passion. I think that it’s really important to do something you’re passionate about because it shines through your work. 

I’m also currently working at the Women’s Health Research cluster as a Blog Co-Coordinator, which has been amazing because it’s so enriching. Every week when we post blogs, there’s a new topic and I’m constantly learning about women’s health issues and people doing amazing work in the health field. 

How can people reach you and know more about your work?

My Twitter handle is @_neginnia. My podcast is titled “Let’s Talk About: Women’s Physical Pain, Race & Treatment,” and you can find it on Spotify.

Challenging Oppressive Maternity Healthcare in Canada

Authors: Stephanie Ragganandan Hon. BSc, York University & Dr. Karen Lawford midwife and PhD, Queen’s University | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: August 9th, 2021

At no time in the present era have healthcare systems been subject to the same extent of research, analysis, critique, and challenge as they have been during the global COVID-19 pandemic. There is a temptation to view any failings in these systems as a matter of contemporary shortcomings. While the health outcomes facing marginalized populations are certainly exacerbated by 21st century technological, economic, and social disparities, in addition to being disproportionately impacted by COVID-19, it is crucial we remember the root cause of these disparities. It is only by understanding the past that we can make sense of the present and imagine a future that liberates us all from oppressive, ineffective, and unsustainable healthcare services.

Canada, like many other countries across the world, was founded on colonialism. Colonialism is often framed as something from the past and as having no association with current times, but this is not the truth. We are living in an ongoing colonial project that is geo-politically known as Canada.

What is colonialism? It is the process by which one group takes control of another group’s lands, resources, and governance authorities and maintains that group in a state of subordination based on the beliefs of racial and cultural inferiority of the subordinated group. In Canada, the legal, education, and healthcare systems—for example—are deeply rooted in Eurocentric, Christian ideologies and practices that purposefully oppress Indigenous Peoples’ philosophies, values, ways of making knowledge, and kinship relationships.

As healthcare researchers, we strongly assert it is vital to acknowledge and recognize the existence, maintenance, and practice of the ongoing colonization project in Canada via Euro-Canadian healthcare services, programming, and education, and within medicine itself, because Indigenous Peoples’ knowledge systems are currently marginalized, made irrelevant, and tokenized. The invisibility of these areas of colonization is ethically unsound, immoral, and does not contribute to the Truth and Reconciliation Commission of Canada’s Calls to Action, specifically Calls 18-24.

We are especially committed to drawing attention to the implications of colonization on the sexual and reproductive health of Indigenous Peoples. Since contact with white Christian colonizers, Indigenous Peoples have fought to protect their customary practices, languages, and ways of health and wellness. Yet, nationally coordinated and funded assimilation efforts via various genocidal mechanisms, such as the Indian Residential School system, have resulted in the degradation and criminalization of Indigenous Peoples including their customary healing practices and practitioners.

We strongly assert that the process of improving current systems-wide healthcare must begin by recognizing the interconnected webs of colonization that are woven into all colonial healthcare systems in Canada.

Comprehensive Gender-Inclusive Sexual and Reproductive Health Care

Indigenous customary practices and practitioners that support and manage pregnancy, labour, birth, and postpartum periods have sustained Indigenous Peoples on these lands since time immemorial. In fact, their technologies, skills, and medicines were used by white Christian settlers when they first invaded these lands to ensure their own pregnancies were conducted in a safe manner. Over time, the Euro-Canadian biomedical model and its practitioners purposefully marginalized and criminalized Indigenous knowledge and practices. The ability of Indigenous Peoples to determine how to achieve their own health and wellness eventually became—and continues to be—oppressed. Consequently, the health of Indigenous Peoples from a Euro-Canadian lens shows that Indigenous people are less healthy than non-Indigenous people. But, healthcare systems in Canada continue to refuse to see, let alone acknowledge, the harm they have caused to Indigenous Peoples via neglect, refusal of care, and structurally ingrained colonial oppressions.

While the term decolonization has become a buzzword, especially following the Truth and Reconciliation Commission of Canada reports, we advocate for the recognition of colonization in health, which includes education, training, programming, funding, and practice. High-quality, comprehensive gender-inclusive sexual and reproductive health care for Indigenous Peoples can be achieved, but we must first come to terms with the extent to which colonization has purposefully obstructed the health and wellness of Indigenous Peoples.

Canada’s Evacuation Policy for Indigenous Peoples

Beginning in the late 1800s, the Government of Canada decided to introduce European-trained obstetricians to those who live on reserve. Alongside the medicalization of childbirth, the criminalization of Indigenous healthcare practices and practitioners, the immigration of British trained nurse-midwives, and the establishment of Indian hospitals, birthing for Indigenous Peoples shifted from home and community to nursing stations, then Indian hospitals, and now urban hospitals. The federal policy driving this relocation of birth is underpinned by the Government of Canada’s evacuation policy, which requires that pregnant people between 36- and 38-weeks of gestation are relocated to urban settings to await labour and birth. In addition to physically removing pregnant people from their families, communities and pregnancy customs and practices, the evacuation policy results in increased experiences of racism as well as feelings of isolation, fear, distress, sadness, and loneliness, which can lead to post-partum depression.

Canada’s evacuation policy supported “…colonial goals to civilize and assimilate [Indigenous Peoples] into a generic Canadian body.” So, colonial maternity care practices established during a time of aggressive assimilation and civilization tactics, which were implemented and funded by the Government of Canada, have resulted in the current, disjointed approach to maternity care practices for Indigenous Peoples. In fact, evacuation for birth has not resulted in comparable outcomes: the infant mortality rate for Indigenous Peoples in Canada ranges from two to four times that of non-Indigenous people. Clearly, the justification that the evacuation policy improves the maternal and infant outcomes is unfounded. It is thus clear that the Euro-Canadian biomedical model of maternity care must change so that Indigenous Peoples can realize the health and wellness they so deserve.

What’s Next?

Indigenous Peoples’ customary practices and practitioners must be reframed as necessary components of healthcare systems across Canada and globally. The exclusion and even criminalization of Indigenous People who are healthcare providers—like Indigenous Midwives—deliberately creates oppressive barriers to health and wellness for Indigenous Peoples.

It is extremely important to understand colonialism within the historical and contemporary contexts because it globally impacts Indigenous Peoples byways of land destruction, separation from family through colonial training programs (e.g. the Indian Residential School System), and the oppression of Indigenous customary philosophies, values, ways of making knowledge, and kinship relationships.

For those of us with influence in Euro-Canadian healthcare systems, we must work towards the creation of inclusive healthcare that promotes a plurality of knowledge systems, and put these systems and practitioners who provide care for Indigenous Peoples at the forefront of our agendas. We must also contemplate the nature and extent of repairs that are required to bring justice to those who have suffered at the hands of colonial systems.

It is time to acknowledge the ongoing colonial violence in healthcare and dismantle the oppressive cultures that constitute Canadian healthcare systems.

 

**If this is an issue you are passionate about, consider becoming a supportive member of the National Aboriginal Council of Midwives (NACM) here.**

Here is a list of benefits of a supportive membership from the NACM

  • Act of reconciliation and allyship
  • Promote the growth of Indigenous midwifery
  • Contribute to the improvement of reproductive and child health in Indigenous communities
  • Receive NACM newsletter