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Mixing cannabis and pregnancy

New research from Queen's and Western universities show real risks associated with cannabis exposure during pregnancy.

A new study from researchers at Queen’s University and Western University is the first to definitively show that regular exposure to THC, the main psychoactive ingredient in cannabis, during pregnancy has significant impact on placental and fetal development. With more than a year since the legalization of recreational cannabis in Canada, the effects of its use during pregnancy are only now beginning to be understood.

The study, published today in Scientific Reports, uses a rat model and human placental cells to show that maternal exposure to THC during pregnancy has a measurable impact on both the development of the organs of the fetus and the gene expression that is essential to placental function.

“Marijuana has been legalized in Canada and in many states in the US, however, its use during pregnancy has not been well studied up until this point," says Queen's University associate professor David Natale (Obstetrics and Gynaecology). "This study is important to support clinicians in communicating the very real risks associated with cannabis use during pregnancy."

The researchers demonstrated in a rat model that regular exposure to a low-dose of THC that mimics daily use of cannabis during pregnancy led to a reduction in birth weight of eight per cent and decreased brain and liver growth by more than 20 per cent. The research team was also able to characterize how THC prevents oxygen and nutrients from crossing the placenta into the developing fetus.

"This data supports clinical studies that suggest cannabis use during pregnancy it is associated with low birth weight babies," says Western University associate professor Dan Hardy. "Clinical data is complicated because it is confounded by other factors such as socioeconomic status. This is the first study to definitively support the fact that THC alone has a direct impact on placental and fetal growth.”

The researchers point out that there are currently no clear guidelines from Health Canada on the use of cannabis in pregnancy and some studies have shown that up to one in five women are using cannabis during pregnancy to prevent morning sickness, for anxiety or for social reasons.

Queen’s oncologist moving mountains to improve cancer care

Dr. Bishal Gyawali is working to reduce the he challenges facing cancer patients in Nepal.

Dr. Bishal Gyawali is working to reduce the he challenges facing cancer patients in Nepal.
Dr. Bishal Gyawali, an assistant professor in the Department of Public Health Sciences, recently received a prestigious award from the American Society of Clinical Oncology.

The Himalayan country of Nepal has a population of 33 million and yet there are less than 20 medical oncologists in the country to treat the rising rates of cancer among the Nepalese people. If you compare that to Canada, there is quite a difference. We have about 620 oncologists available to treat our population of 37.5 million.

For a Nepalese cancer patient, this disparity means that access to care is not as simple as going to the local hospital each week for chemotherapy. There are only two public cancer centres in Nepal that offer treatment: one in Kathmandu and the other in Bharatpur. And in a country characterized by mountains and variable road conditions, those centres can be difficult to get to. Living expenses in Kathmandu are prohibitive, leaving some patients to travel more than 500 km to get 45 minutes of chemotherapy on a weekly basis.

Dr. Bishal Gyawali, an assistant professor in the Department of Public Health Sciences, is acutely aware of the strain the lack of oncologists places on individuals and on the Nepalese healthcare system. After completing his speciality training in oncology in Japan, Dr. Gyawali – who was born in Nepal – returned home and spent six months working in a public hospital in Kathmandu.

There, he witnessed the challenges facing cancer patients.

“One of my young male patients was from the far western part of Nepal and he needed chemotherapy every two weeks,” he says. “It would take him more than 36 hours to come to Kathmandu for chemotherapy. This disrupted his job, on top of the cancer diagnosis and hassle of travel.”

With the burden of childcare often falling to Nepalese women, they face particular challenges.

“A woman from rural Nepal stayed in Kathmandu with her relatives for more than three months to complete her chemo. She had two little kids back home who needed her care, but she had to complete the chemo first,” Dr. Gyawali says. “A weekly commute was impossible.”

But Dr. Gyawali sees a way forward.

He has a plan to import an initiative that has been successful here in Canada to Nepal. It’s a training program for primary care doctors, which builds their capacity to deliver basic cancer treatment in rural settings. Here in Canada, this has dramatically increased the number of patients who can receive care close to home. Upon completion of the training, the Canadian physicians gain the designation of General Practice (GP) Oncology, and go on to provide rural cancer treatment.

When Dr. Gyawali came up with the vision for this project, he lacked the resources to make it happen.

“I had thought about doing this for a long time but had no money or ability to implement it,” he says.

That changed last month when Dr. Gyawali received a prestigious award from the American Society of Clinical Oncology (ASCO) which will allow him to lay the groundwork for a training program modelled on the Canadian one.

Nepal mountain scene
For many people living in rural Nepal, travelling for oncology treatment is very difficult.

The $50,000 award will be used to perform a needs assessment and to collaborate with Nepalese doctors to develop a training curriculum in basic oncology care. The training will be delivered to primary care doctors who practise outside the two main cancer centres in Nepal, thus increasing the capacity of GPs throughout the country. Ultimately this will make cancer care more accessible to patients, regardless of geography.

In some cancers, chemotherapy needs to be administered once a week for 12 weeks. With that frequency, Dr. Bishesh Poudyal, Associate Professor and Chief, Civil Service Hospital in Kathmandu, agrees that a training program is much-needed.

“If we can train GP oncologists, then patients can be treated locally and they don’t have to travel just to show bloodwork reports,” he says. “This will save lives and make treatment more affordable and efficient.”

Dr. Bishal Gyawali joined Queen’s in March 2019. In addition to his appointment to the Department of Public Health Sciences, he is a clinical fellow in the Department of Oncology at Queen’s.

What attracted him to the university was the global focus within the Department of Oncology under the leadership of department head, Dr. Scott Berry. He is thrilled to have Dr. Christopher Booth as a colleague, an oncologist who has worked extensively in India.  

“The Queen’s Global Oncology team is made up of similar-minded people,” he says. “I am fortunate to have this career path.”

As with our other Global Health initiatives in the Faculty of Health Sciences, Dr. Gyawali’s work is premised on building local capacity to address a specific need within a community. I am pleased that his work will be added to the slate of partnerships and projects that we have across the globe and I look forward to hearing about the impact that it has.

This article was first published in the Faculty of Health Sciences Dean's Blog.

Three professors emeriti appointed to Order of Canada

Governor General recognizes Peter Harrison, Brian Osborne, and Duncan Sinclair for their contributions to the nation

Three professors emeriti are among the latest appointees to the Order of Canada.

Governor General Julie Payette recently announced 120 appointments to the Order of Canada, including Peter Harrison (School of Policy Studies), Brian Osborne (Geography and Planning), and Duncan Sinclair (Physiology, School of Policy Studies).

“The Order of Canada is one of our nation’s highest honours, recognizing outstanding achievement and dedication to the community and to Canada,” says Principal and Vice-Chancellor Patrick Deane. “Dr. Harrison, Dr. Sinclair, and Dr. Osborne have made significant contributions not just to Queen’s but to the broader community throughout their distinguished careers. I congratulate them both on this well-deserved recognition.”

Duncan Sinclair
Duncan Sinclair

Dr. Sinclair is being recognized for his “contributions to the Canadian health care system as a teacher, university administrator and advisor, and for his leadership in health care reform in Ontario.” With the appointment he joins his son, Gord Sinclair of The Tragically Hip, in the Order of Canada.

“I am, of course, very pleased and deeply honoured to be appointed to the Order of Canada,” Dr. Sinclair says. “It is humbling to be considered worthy of inclusion among such a group of distinguished and accomplished people, many of them friends and acquaintances of long-standing, and one being my son.”

At Queen’s Dr. Sinclair has held a number of administrative positions including Dean of Medicine and Vice-Principal (Health Sciences) – the first non-medical doctor to serve in these positions in Canada – as well as Vice-Principal (Institutional Relations), Vice-Principal (Services), and Dean of Arts and Science.

Away from the university, he headed the governance subcommittee of the Steering Committee for Review of the Public Hospitals Act in Ontario and was a member of the National Forum on Health. He was the founding chair and acting CEO of Canada Health Infoway/Inforoute Santé du Canada – an organization designed to foster the development of Canada’s health information management. In 2015 he was inducted into the Canadian Medical Hall of Fame.

Brian Osborne
Brian Osborne

Dr. Osborne is being recognized for his “contributions to historical geography and for his distinguished research on Kingston’s geographic heritage.”

“When I received the call from the office of the Governor General a month ago, I was positively shocked and overwhelmed by my inclusion in this prestigious array of award winners,” he says.

It was exciting news, but he wasn’t able to share it until the official announcement. That provided time for reflection of his decades as a professor in the classrooms of Queen’s, as well as communicating his research in historical geography and interactions with the local community.

“Then, on Dec. 28, the whole world was informed of the appointment of new members to the Order of Canada and I gained a new perspective. Firstly, I feel gratitude to the Governor General for awarding me the honour. Secondly, I am thankful for the motivation to reflect on its meaning to me personally.”

Dr. Osborne’s research areas include Indigenous history, settlement history, cultural landscapes, and the role of the culture of communications in the development of a Canadian sense of place. He has published extensively on the Kingston area, including Kingston: Building on the Past (1988), co-written with Donald Swainson, and was subsequently reworked into Kingston: Building on the Past for the Future (2011). Other recent volumes are The Rock and the Sword: A History of St. Andrew’s Presbyterian Church, Kingston (2004), and Landscapes and Inscapes: Drawn to History with Brush of Serendipity, with Shirley Gibson Langille.

Dr. Osborne has served as a consultant for the National Capital Commission, Heritage Canada, Parks Canada, Canada Post, and the National Film Board. He is Past President of the Ontario Historical Society, Past President of the Kingston Historical Society, and has served on the boards of several heritage organizations.

Peter Harrison

Dr. Harrison is being recognized for his “dedication to Canada’s stewardship of the Arctic Ocean and to the enhancement of its role in Arctic and northern issues.”

“Being named a Member of the Order of Canada is an extraordinary privilege and honour.  It is totally unexpected, and came as a complete surprise,” he says. “I am particularly thrilled with the citation which notes my dedication to Canada's stewardship of the Arctic Ocean and to the enhancement of its role in Arctic and northern issues.  This has always been a passion of mine, and it is enormously satisfying that my efforts in this regard have been recognized in such an extraordinary way.”

Dr. Harrison arrived at Queen’s as the federal Skelton-Clark Fellow in 2008 and also served as Stauffer-Dunning Chair and director of the School of Policy Studies (2009-2013).

During his nearly-30 year career in the Public Service of Canada, he was appointed to Assistant/Associate/Senior Associate Deputy Minister positions in a number of departments including: the Privy Council Office (PCO); the Department of Finance; Indian and Northern Affairs Canada; Revenue Canada; and Human Resources Development Canada. 

His research, writing, and public speaking have focused on the management of the oceans, with particular reference to the Arctic Ocean and Canada’s Northern regions and peoples.The appointments include five Companions (C.C.), 38 Officers (O.C.), and 77 Members (C.M.).

Other Order of Canada recipients with Queen’s connections include:

T. Robert Beamish (Sc’60, LLD’11), Director, The Woodbridge Group
“For his leadership of and contributions to industry and for his philanthropic support for causes related to education and health care.”

Peter Kendall (Artsci’89), Executive Director, The Schad Foundation
“For his steadfast commitment to conserving and protecting Canada’s biodiversity for future generations.”

• Debra Pepler (PHE’73, Ed’74, DSc’16), Distinguished Research Professor, Psychology, York University, and PREVNet Co-Founder
“For her innovative, community-based research on social issues involving children and youth, which changed the way psychologists study bullying.”

Jennifer Tory (Artsci’77), Retired Chief Administrative Officer, RBC
“For her commitment to advancing women and minorities in the banking industry and for her extensive community work.” 

The recipients will receive their insignia at a ceremony in Rideau Hall at a later date.

Created in 1967, the Order of Canada, is one of the country’s highest civilian honours, and recognizes outstanding achievement, dedication to the community and service to the nation.

Haitian children abandoned by UN fathers

The voices of young victims in Haiti can now be heard for the first time thanks to a groundbreaking new research project.

Marie* was 14 years old and enrolled in a Christian school when she met and became involved with Miguel, a Brazilian soldier working in Haiti as a UN peacekeeper. When she told him that she was pregnant with his baby, Miguel said he would help her with the child. But instead, he returned to Brazil. Marie wrote to him on Facebook but he never responded.

After learning that she was pregnant, Marie’s father forced her to leave the family home and she went to live with her sister. Her child is now four and Marie has yet to receive any support from the Brazilian military, an NGO, the UN, or the Haitian state. Marie provides what she can for her son but she cannot afford to send him to school. She works for an hourly wage of 25 gourde (around 26 US cents) so that she and her son can eat. But she needs help with housing and paying for school fees.

Sadly, Marie’s experience is far from unique. In the summer of 2017, our research team interviewed approximately 2,500 Haitians about the experiences of local women and girls living in communities that host peace support operations. Of those, 265 told stories that featured children fathered by UN personnel. That 10 per cent of those interviewed mentioned such children highlights just how common such stories really are.

The narratives reveal how girls as young as 11 were sexually abused and impregnated by peacekeepers and then, as one man put it, “left in misery” to raise their children alone, often because the fathers are repatriated once the pregnancy becomes known. Mothers such as Marie are then left to raise the children in settings of extreme poverty and disadvantage, with most receiving no assistance.

Mired in controversy

The UN Stabilisation Mission in Haiti (MINUSTAH) – the longest-running mission by the organisation in the country (2004-2017) – was originally mandated to assist local Haitian institutions in a context of political instability and organised crime. Its mandate was then extended due to natural disasters, most notably an earthquake in 2010 and Hurricane Matthew in 2016, both of which added to the volatility of the political situation in the country. After 13 years of operation, MINUSTAH closed in October 2017, transitioning to the smaller UN Mission for Justice Support in Haiti (MINUJUSTH).

MINUSTAH is one of the most controversial UN missions ever. It has been the focus of extensive allegations of sexual exploitation and abuse. A shocking number of uniformed and non-uniformed peacekeeping personnel have been linked to human rights abuses including sexual exploitation, rape, and even unlawful deaths. (For the purposes of this article, we use MINUSTAH personnel, agents, and peacekeepers interchangeably to refer to uniformed and non-uniformed foreign staff associated with MINUSTAH.)


This article is part of Conversation Insights
The Insights team generates long-form journalism derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.

 


With regard to public health, it is undisputed, and now officially recognised by the UN, that peacekeepers also inadvertently introduced cholera to Haiti. More than 800,000 Haitians are known to have sought medical attention for cholera and at least 10,000 died from the disease.

Various media organisations have reported that minors were offered food and small amounts of cash to have sex with UN personnel, and MINUSTAH was linked to a sex ring that operated in Haiti with seeming impunity: allegedly, at least 134 Sri Lankan peacekeepers exploited nine children in a sex ring from 2004 to 2007. As a result of this story, reported by the Associated Press in 2017, MINUSTAH became a classic example of lack of appropriate response to allegations of sexual abuse. In the wake of this report, 114 peacekeepers were returned to Sri Lanka, but none were ever prosecuted or charged after repatriation.

Extensive research has demonstrated that children born of war are often raised in single-parent families in precarious economic post-conflict settings. The association with the (absent) foreign father, along with birth out of wedlock, often result in stigma and discrimination for the children.

Yet little is known about the impact of being a mixed-race child fathered by peacekeepers. Even less is known about the experiences of the so-called “Petit MINUSTAH”, or Haitian-born children of foreign UN peacekeepers. This is one of the reasons we set out to bring to light the stories of those affected by the UN mission.

Our study

We collected stories by asking participants to tell us what it’s like to be a woman or girl living in a community that hosts a peacekeeping mission. We audio-recorded the resulting stories, and then participants interpreted their experiences by responding to a series of pre-defined questions. This allowed us to better understand the circumstances and consequences of their interactions with peacekeepers.

Participants could share any story they chose, about anyone, and were not prompted in any way to talk about sexual abuse or exploitation. Narratives were captured by trained Haitian research assistants in the communities surrounding ten UN bases in Haiti in the summer of 2017. About 2,500 Haitians were asked about the experiences of local women and girls living in communities that host peace support operations. A variety of positive and negative experiences were captured, but 265 (10 per cent) of all stories were about peacekeeper-fathered children. This is particularly noteworthy since the survey did not ask about sexual relations with peacekeepers or about children conceived through such relations.

This would suggest not only that sexual abuse and exploitation by UN peacekeeping personnel is not rare, but also, as one Port-Salut research participant said in her own words: “There are many young women who have children with the MINUSTAH.” This was echoed by a man in Saint Marc who told us: “MINUSTAH gave us many children without fathers.”

Map of stories. © Sabine Lee/Susan Bartels, Author provided

Some stories were first person, shared by those who had given birth to children fathered by UN personnel, while other stories were told by family members, friends or neighbours about women and girls raising children fathered by peacekeepers. To the best of our knowledge, these stories make up the first empirical research to bring forth the voices of families affected by sexual exploitation and abuse by UN peacekeepers.

Sex for one meal

Some sexual encounters between local women and girls and UN peacekeeping personnel were described as sexual violence. For instance, a male community member in Cité Soleil recounted: "All day, I heard women who are complaining about the sexual violence that MINUSTAH did to them. And they had given them AIDS through sexual violence. There are also some of them who are pregnant."

There were not only stories of women and girls being sexually assaulted by MINUSTAH but also of men and boys being similarly abused. But in our research, sexual assault was in the minority of reported sexual encounters. Instead, our data highlighted a much more pervasive problem, albeit one that has been reported less in the media – transactional sex with UN personnel.

One married man from Cité Soleil described a common pattern in which women received small amounts of money in exchange for sex: “They come, they sleep with the women, they take their pleasures with them, they leave children in their hands, give them 500 gourdes.”

In other cases of transactional sex, women and girls received food in exchange for having sex with members of MINUSTAH, highlighting the extreme poverty that contributes to these sexual encounters. One male community member in Port Salut reported: “They had sex with the girls not even for money, it’s just for food, for one meal.”

Evolving relationships

Another narrative that has received far less attention in previous reports is how consensual sexual relations between members of MINUSTAH and local women evolve. In some instances, these were casual dating relationships that resulted in a pregnancy, as was the case in this story, shared by a man in Port Salut: "I had a sister who was dating a MINUSTAH soldier. My whole family knew about it, my mother as well as other people. She became pregnant … Ever since, my sister’s life is a mess."

Other relationships were described as being more committed and loving, such as in this story shared by a woman in Cité Soleil, who said: “I was living in Cité Soleil and I was in a love relationship with a MINUSTAH. I became pregnant from him.”

We found that intimate relations with fair-skinned peacekeepers and having fair-skinned children were sometimes perceived as desirable. A woman in Leogane described “rumours” about girls having relationships with MINUSTAH and having their children because they “wanted these children to be beautiful”.

Calico beach, which became notorious as a location for transactional sex. © Chantel Cole, Author provided

Regardless of whether the relationship was consensual or transactional in nature, particular patterns were noted in how and where the interactions took place. For instance, meeting on the beach or in a hotel was common, as in this story shared by a woman in Cité Soleil, about a friend of hers: “He used to go to the beach with her, now the white man paid for a hotel for her, the white man goes to the hotel with her, he comes to have sex with her.”

Also of great concern is that many of the mothers giving birth to and raising children fathered by UN peacekeepers were themselves adolescents and not old enough to give consent for sex. One woman in Cité Soleil told us: "I see a series of females 12 and 13 years old here. MINUSTAH impregnated and left them in misery with babies in their hands. The person has already had to manage a stressful, miserable life."

Abandonment

After learning of a resultant pregnancy, most shared stories indicated that the MINUSTAH personnel were repatriated by the UN. One woman in Port-Salut told us: "One of my sisters gave birth to a child of the MINUSTAH. My sister had a baby with him because she met him, fell in love with him, he took care of her, but you know, they were sent away. That is why he stopped sending her things."

A male participant in Hinche described a similar experience for a girl he knew, saying: “She was pregnant from a soldier of the MINUSTAH … [He] was moved from his station and left his post and was never seen again.”

After the departure of the peacekeeper fathers, most young women were left alone trying to raise the children in extreme poverty. Some described being fortunate enough to receive support from their families, although certainly not all.

In almost all cases, access to education was beyond the mother’s or the family’s means, as described by one woman in Port Salut: "I started to talk to him, then he told me he loved me and I agreed to date him. Three months later, I was pregnant, and in September he was sent to his country … The child is growing up, and it’s myself and my family that are struggling with him. I now have to send him to school. They put him out because I’m unable to pay for it."

A man in Cap Haitian said: "The soldiers destroy these young girls’ futures by getting them pregnant with a couple of babies and abandoning them. Basically, these actions of the soldiers can have a negative impact on the society and on the country in general because these young girls could have been lawyers, doctors or anything that would have helped Haiti tomorrow … Now some of them are walking in the street, or in the flea market and other places with a basket over their head selling oranges, peppers, and other goods in order to raise children they have with the MINUSTAH soldiers."

In a few extreme cases, community members described women and girls who were left with little option other than to engage in further sex with peacekeepers in order to provide for the MINUSTAH children they were already raising. A man in Port-au-Prince shared one example: "He left her in misery because when he used to have sex with her it was for little money, now his term reaches its end, he goes and leaves her in misery, and then now she has to redo the same process so she can provide meals to her child, can’t you understand."

There were many requests in the stories we collected for MINUSTAH and the Haitian authorities to help support these children. One man in Port-Salut stated his request very clearly: “I would like to ask the head of MINUSTAH to take responsibility for the children of MINUSTAH members … We are just doing what we can but you cannot raise children like this…”

Power and exploitation

Our research has underlined what is implied in much of the academic literature on peacekeeping economies – namely that poverty is a key underlying factor contributing to sexual abuse and exploitation by peacekeeping forces.

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In many cases, the power differential between foreign peacekeepers and local populations allows foreigners, knowingly or unknowingly, to exploit local women and girls. The prevalence of transactional sex in our data underscores the significance of the structural imbalances – peacekeepers have access to some of the resources that are desired or needed by the local population and so they are in a strong position to exchange those for sex.

While many of the stories cited above were collected in Port Salut and Cité Soleil, similar narratives were shared across all interview sites in Haiti and the phenomena described are not unique to the Haitian context. Our preliminary work in the Democratic Republic of Congo suggests a comparable situation.

In its zero-tolerance policy, the UN acknowledges the existence of socioeconomic and other power imbalances and their potential to render “intimacies” between peacekeepers and local women exploitative. In essence, the policy bans almost all sexual relations between peacekeepers and local women. In addition to suggesting that this blanket ban is ineffective, our data indicates that a more nuanced approach with targeted training of UN personnel is required alongside tackling the impunity that still surrounds peacekeeper wrongdoing.

Another key finding is the need for more effective mechanisms allowing victims of sexual exploitation and abuse and their children (as well as children of consensual and non-exploitative relations) to access support. This could potentially break the socioeconomic downward spiral that traps victims – and in particular children – in circumstances of extreme economic hardship, perpetuating the cycle of poverty.

The UN Base in Cité Soleil, 2019. © Chantel Cole, Author provided

Child support

In January 2018, the Haitian-based Bureau des Avocats Internationaux (BAI) filed paternity suits in Haitian courts on behalf of 10 children fathered by UN Peacekeepers, with the aim of lobbying the UN to secure child support payments for those children. A year later, an open letter from the bureau to UN Victims’ Rights Advocate Jane Connors betrays their frustration with the UN’s lack of responsiveness and co-operation in the paternity suits, which “has made it nearly impossible for our clients to obtain justice”.

Evidencing the UN’s refusal to furnish results of DNA paternity tests that are vital to the mothers’ cases despite a Haitian court order compelling it to do so, the letter concluded that the UN was sending “an alarming message of lack of respect for the Haitian judicial system and the rule of law”.

This raises questions regarding the UN’s rhetoric about supporting the dignity and rights of those affected by sexual exploitation and abuse perpetrated by UN peacekeepers. It also calls into question the effectiveness of interventions of the Office of the UN Victims’ Rights Advocate, which exists to advocate for the rights of victims and to bring their needs to the forefront of the UN’s fight against sexual exploitation and abuse.

Recommendations

The findings from our research have led us to make three key recommendations.

1) Training of UN personnel must include a cultural awareness aspect to enhance understanding of the impact of power differentials in fragile peacekeeping economies, the perceived desirability of having a child fathered by a peacekeeper, and the socio-economic consequences for a vulnerable woman being left with a peacekeeper-fathered child.

2) The UN practice of repatriating any UN personnel implicated in sexual exploitation or abuse must stop as it has a double-negative consequence. First, it removes the alleged offender from any effective prosecution in the cases of alleged wrongdoing, and second, it removes them from any jurisdiction within which the victim/child/mother of a child would have any chance of securing the appropriate financial support for the child.

3) The recent appointment of a Victims’ Rights Advocate for those affected by sexual abuse and exploitation must be followed by a policy that will allow the advocate to tackle some of the injustices created by the exploitation and abuse at a structural level. At the same time, they must be allowed to become a powerful voice of the victims, speaking and working on their behalf within the UN and in collaboration with the host countries and the troop contributing countries.

Many of the participants interviewed expressed similar sentiments around the need for recognition of and support for children fathered by UN peacekeepers in Haiti. One man said: "I know a lot of young women, young girls, children, who are living with MINUSTAH children in their care… I would like for them [the UN] to take responsibility, to take the initiative to look for and rejoin those young girls so that they can help them with the children."

* Names have been changed to protect participants’ anonymity.The Conversation

_______________________________________________________________________

Sabine Lee is a professor in Modern History at the University of BirminghamSusan Bartels is an emergency physician and clinician-scientist at Queen’s University. She is an associate professor of Emergency Medicine and holds a cross-appointment in the Department of Public Health Sciences.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Diabetes on the rise in First Nations populations

New report shows the disease has reached an all-time high within Canada’s First Nations communities, impact on children is concerning.

A first-of-its-kind, First Nations-specific report, co-authored by Queen’s University professor Michael Green, shows the number of First Nations people in Ontario living with diabetes is at an all-time high at 14.1 per cent.

According to the report, developed jointly by the Chiefs of Ontario (COO) and ICES, the increase is particularly concerning as there is a rising, disproportionate number of First Nations children affected by diabetes.

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“Lower monitoring, lower levels of diabetes control and less access to primary care mean First Nations people are more likely to experience complications of their diabetes at an earlier age and sooner after their diagnosis which is why focusing on prevention is key to making to changes to how diabetes affects First Nations people,” says Dr. Green, professor in the Departments Family Medicine and Public Health, and a senior scientist at ICES.

First Nations and Diabetes in Ontario takes a detailed look at diabetes and its consequences on First Nations people in Ontario from 1990 to 2014. The data presented in the report highlights specific inequalities and supports the development of effective health policies and programs to prevent diabetes in First Nations people.

The researchers highlight that the three dominant individual risk factors for type 2 diabetes among First Nations people living in First Nations communities are physical inactivity, weight/obesity and smoking. However, efforts to address these risk factors must consider the cumulative effects of ongoing racism, dispossession from land, childhood and intergenerational trauma, changes in diet and an increase in sedentary lifestyles associated with colonization.

The report found that in 2014/15, 39.3 per cent of First Nations people living in First Nations communities had good control of their blood sugar, compared to 56.5 per cent of other people in Ontario.

“This report is a step in the right direction to fill information gaps which have led to health policy gaps. This report builds on relationships and formal agreements to understand Indigenous health today, and in order to do that we have to know Indigenous history, government relations with Indigenous people, and the collective that the people have experienced,” says report co-author, Jennifer Walker (Laurentian University), the Canada Research Chair in Indigenous Health and the Indigenous Health Lead at ICES.

A series of studies, including this one, are being published in the journals CMAJ and CMAJ Open. These studies are the start of a series of papers on diabetes and First Nations health. They are part of a partnership between researchers and COO which engages First Nations patients, families, elders and community members in the project.

The research was funded by the Ontario SPOR SUPPORT Unit.

Major upgrade for MRI facility

Queen’s University announces new state-of-the-art equipment for Centre for Neuroscience Studies.

[The new 3 Tesla MRI for the Centre of Neuroscience Studies]
The Centre for Neuroscience Studies recently unveiled its state-of-the-art MRI machine, a Siemens Magnetom 3T Prisma, the most powerful 3 Tesla whole body MRI on the market. 

Keeping up with the fast pace of technological advancements in the neuroimaging field, the Centre for Neuroscience Studies (CNS) at Queen’s University recently unveiled the latest state-of-the-art MRI machine, the Siemens Magnetom 3T Prisma. The Prisma is a next generation, whole-body scanner and is a major upgrade to the centre’s current system.

“A research-dedicated MRI facility is an essential component to any research-intensive neuroscience program, allowing investigators to study the structure and function of the living human brain in remarkable detail,” says Dr. Roumen Milev, Director of the CNS. “This is the most powerful 3 Tesla MRI on the market, allowing for high precision imaging of smaller tissues and enhanced tracking of brain connectivity.”

[Brain scan using the 3 Tesla MRI]
Using the Centre for Neuroscience Studies' new Prisma MRI, 30,000 white matter tracts are revealed through diffusion spectrum imaging (DSI).

With the support of the Canadian Foundation for Innovation, the CNS MRI facility first became operational in 2005. Over the last 14 years, approximately 6,000 participants have been imaged for over 140 different research projects – leading to hundreds of research papers and important findings.

Research goals have spanned the spectrum from answering important fundamental questions about brain function and organization, to large multi-site studies searching for biomarkers of disease, to industry-sponsored clinical trials. A wide variety of disorders and diseases have been studied, including Alzheimer’s disease, Parkinson’s disease, Amyotrophic Lateral Sclerosis (ALS), epilepsy, Attention Deficit Hyperactivity Disorder (ADHD), Fetal Alcohol Spectrum Disorders (FASD), spinal cord injury, and fibromyalgia.

“In recent years, the facility has been an integral part of many large multi-site initiatives, involving partners such as the Ontario Brain Institute (OBI) and Kids Brain Health Network (KBHN),” says Dr. Milev, speaking to direct patient impact. “These initiatives allow us to collect large numbers of participants throughout Ontario and the country, exploring the brain mechanisms that underlie neurodevelopment, neurodegeneration, and neuropsychiatric illness, and potentially finding biomarkers of related disorders.  These studies impact not only our understanding of the biology of these disorders, but lead to the formulation of early detection tests, as well as translating our research to the clinic.”

The CNS MRI Facility has also recently been renovated, outfitting the facility with high-performance computers and cutting-edge monitoring equipment and devices.

“The new facility will allow us to be competitive with any imaging centre in the world for the next decade and beyond and help further cement Queens’ reputation as a top-tier center for neuroscience research” Dr. Milev adds.

For more information visit the CNS website.

[Ribbon cutting for Centre for Neuroscience Studies new MRI]
The Centre for Neuroscience Studies recently installed a state-of-the-art MRI system, the Siemens Magnetom 3T Prisma. A special ribbon cutting brought together: Christopher Simpson Vice Dean (Clinical), School of Medicine; Jill Atkinson, Associate Dean, Faculty of Arts and Science; Patrick Deane, Principal and Vice-Chancellor; Kim Woodhouse, Interim Vice-Principal (Research); and Roumen Milev, Director, Centre for Neuroscience Studies. (Supplied photo)

 

Forging a new path for medical students

Queen's medical student Thomas Dymond changed the course of his education to focus on Indigenous health.

Medical students Thomas Dymond with Ann Deer, a Indigenous Recruitment and Support Coordinator at Queen’s.
Medical student Thomas Dymond (left) with Ann Deer, an Indigenous Recruitment and Support Coordinator at Queen’s.

This year, Thomas Dymond became the first-ever student in the Queen’s School of Medicine to do an extended clinical rotation in an Indigenous community, under the supervision of an Indigenous physician, caring for Indigenous patients. However, his path to doing so was not always clear – in fact, he charted an entirely new one that could change the way Queen’s medical students approach their upper-year clerkships.

Dymond, who is Mi’kmaq from the Bear River First Nation in Nova Scotia, hasn’t always found his medical school experience to be easy. Last year, he took time away from his studies because of stress, and began to feel uncertain about whether he would complete his degree.

During this time of uncertainty, he reached out to Ann Deer, an Indigenous Recruitment and Support Coordinator at Queen’s, who connected him with Dr. Ojistoh Horn, a Mohawk family physician in the Indigenous territory of Akwesasne – a community of 14,000 people that straddles the borders of Ontario, Quebec, and New York state.

Thomas Dymond did his clerkship under the supervision of Dr. Ojistoh Horn, the sole full-time physician in Akwesasne.
Thomas Dymond did his clerkship under the supervision of Dr. Ojistoh Horn (left), the sole full-time physician the Indigenous community of Akwesasne.

Soon after reaching out to Dr. Horn, Dymond arranged to do a four-week elective – a precursor to clerkship – in Akwesasne. Dr. Horn, the sole full-time physician there, regularly works with visiting medical students to care for patients at a variety of clinics, on home visits, and at a long-term care facility. Thomas spent a month working alongside her, and for the first time, felt like he had found his place in medicine.

“The elective revitalized me mentally, physically, emotionally, and spiritually,” says Dymond. “I felt lifted up, like I was contributing, learning, and engaging. I wasn’t just giving back, I was also getting something out of it.”

A return to studies

At the end of his elective, Thomas knew he wanted to return – not only to his studies – but to this community he had come to adore. His biggest obstacle: there was not yet an approved path to completing his longitudinal integrated clerkship in Akwesasne. Newly invigorated, Dymond pushed onward.

With Dr. Horn’s support, Dymond drafted a letter to the Director of Clerkship and the Assistant Dean, Curriculum. In it, he made a passionate case, detailing how he would meet all of the curricular requirements for his pediatrics, family medicine and psychiatry clerkship courses by spending his four-month integrated rotation in Akwesasne, and laid out his plan.

“I wanted to go back to Akwesasne, but I also wanted to change clerkship, to change the system, to change medicine,” he says.

Returning to Akwesasne

He knew that it was an atypical request, and was fully prepared for the school to say no. Instead, his letter was acknowledged and passed along to Dr. Shayna Watson, Director of the Integrated and Family Medicine Clerkships, who was in immediate support of Dymond’s request. There were hurdles to be overcome in a short period of time – Dymond’s request was made only two months before his clerkship was to start – but she committed to making it happen.

Just before his clerkship was set to start, Dr. Watson confirmed that Dymond’s request to go to Akwesasne and work with Dr. Horn had been approved. Dymond is now completing his clerkship rotation at Akwesasne, and he could not be happier.

“I feel like I am fully supported for who I am,” says Dymond, “both an Indigenous person and a medical student.”

Thomas worked hard to forge a path for other Indigenous students in the School of Medicine, and his clerkship has broken new ground. While he navigates the challenges of establishing a new clerkship, he is setting a path for others, and helping to build an important relationship between the School of Medicine and the community of Akwesasne.

“As we work to Indigenize the school of medicine’s curriculum, forming relationships with nearby Indigenous communities is a crucial step,” says Dr. Leslie Flynn, Vice Dean Education, Faculty of Health Sciences, “Thomas is an exceptional student, and I am thrilled that he took the initiative to make this happen. He has led the way to enhancing our community partnerships.”

National honour for international research impact

Queen’s University researcher inducted into the Canadian Academy of Health Sciences for scientific advancements in the treatment of bowel disease.

Queen’s University professor of medicine Stephen Vanner has been named a Fellow of the Canadian Academy of Health Sciences (CAHS).

[Stephen Vanner speaks about his research]
Stephen Vanner, director of the Gastrointestinal Diseases Research Unit (GIDRU) at Kingston Health Sciences Centre and Queen’s, has been named a Fellow of the Canadian Academy of Health Sciences.

One of Canada’s most prestigious honours, Fellows are chosen for their international leadership, academic performance, scientific creativity and willingness to serve.

The academy describes Dr. Vanner, director of the Gastrointestinal Diseases Research Unit (GIDRU) at Kingston Health Sciences Centre and Queen’s, as “an internationally recognized clinician-scientist whose work in bowel disease laid the foundations of the new field of neurogastroenterology.” They add that “his discoveries have advanced understanding of bowel disease and improved patient outcomes worldwide.”

“I’m deeply honoured to be recognized by the academy in this way,” says Dr. Vanner, also a clinician-scientist at KGH Research Institute. “For more than 30 years, my research and related volunteer activities have been guided through the lens of ‘yes, but what are our patients telling us?’, because I believe that engaging patients in research leads to better treatments and better outcomes.”

He is cited for his work in transforming the GIDRU into one of the top facilities of its kind in Canada, and for his pioneering role in engaging patients in his research. Dr. Vanner has also served in leadership roles on national gastroenterology and related patient advocacy organizations, and at the grassroots level has been a thoughtful and articulate voice for patients and the public. Internationally he is a member of the prestigious Rome Foundation Committee, helping to develop global guidelines for bowel disease.

More recently he was named co-lead investigator on Canada’s largest-ever study of bowel disease, comprising 88 researchers and 17 centres across Canada. This groundbreaking initiative is targeting diet, gut bacteria, and mental health with an aim of developing new treatments that improve both the physical and mental health of sufferers of irritable bowel syndrome and inflammatory bowel disease.

“Dr. Vanner is an exceptionally talented researcher and a passionate advocate for the role of patients in his research,” says Steven Smith, Vice President, Health Sciences Research, KHSC, Vice-Dean (interim) Research, Faculty of Health Sciences, Queen's University and President and CEO, KGH Research Institute. “As well, he is a gifted mentor to his students and trainees – indeed, during his time at Queen’s and KHSC, at least 50 new gastrointestinal clinician-scientists have benefited from his training and guidance, and several of these are now considered research ‘stars’ in their own right. Stephen represents the absolute best of the academy’s values. We extend our warmest congratulations to him on receiving this well-deserved honour.”

For more information on the Canadian Academy, visit the website.

Two-Spirit physician visits Queen's to discuss decolonizing medicine

New lecture series debuts with expert in Indigenous and LGBTQ2+ health.

James Makokis (centre) standing with lecture series supporters M. Nancy Tatham (left) & Donna Henderson (right).
Lecture series supporters M. Nancy Tatham (left) and her partner Donna Henderson (right) pictured with guest speaker James Makokis.

A new lecture series promoting equity, diversity, and inclusivity in medical education debuted with a talk by James Makokis, a family physician from Saddle Lake First Nation in Alberta who leads one of North America’s most progressive and successful transgender-focused medical practices.

“Indigenous youth have one of the highest rates of suicide in the country, and that rate increases even further when we look at transgender members of that group,” said Dr. Makokis to an audience that packed the Britton Smith Lecture Theatre and a second, overflow space at the Queen’s University School of Medicine. “Every family medicine physician has within their scope of practice a general medical license that gives them the ability to provide transgender care. Medical students and residents, take time to learn to do this in your practice. It will be one of the most fulfilling areas of your career and you will help save lives.”

His lecture, entitled Decolonizing Medicine: Creating an Inclusive Space for Transgender and Two-Spirit People, is the first in the newly-created Dr. M. Nancy Tatham & Donna Henderson Lectureship – a series of talks featuring scholars and experts from diverse backgrounds discussing inclusivity in health, with a particular focus on LGBTQ2+ and Indigenous issues.

Dr. Makokis, who is both Cree and Two-Spirit, discussed language used around gender in medicine, the history of gender and First Nations people, and access to transgender care and hormone therapy. He explained that ideas of transphobia and homophobia are colonial social constructs, and argued that decolonizing medicine can be achieved through simple acts, like acknowledging and accepting LGBTQ2+ patients and providing care that meets their needs.

“Take off your white lab coats,” he said. “It holds so much institutional symbolism, but it can also serve as a barrier. Take it off and seek to relate to your patients in a human way. I guarantee this will help you have a long, healthy, and happy medical practice and career.”

Supported by a donation from Dr. Tatham and Ms. Henderson, who are both long-time activists, the lectureship is organized by the School of Medicine’s undergraduate Diversity Panel. Students on the panel expressed a deep enthusiasm in putting Dr. Makokis forth as the first speaker in the series.

“Understanding the impacts of the historical and ongoing oppression faced by our patients is so essential in being able to provide excellent care,” says Ayla Raabis, Queen’s medical student and Diversity Panel member. “We must constantly strive to undo our own biases to be able to truly connect and ensure we are seeing our patients as the complex people we are tasked with caring for. Dr. Makokis’ talk was such a valuable opportunity to learn from his unique personal and professional experience, and to inspire us to push for making medicine a safe space for all patients.”

Notably, Dr. Makokis and his partner Anthony Johnson won the most recent season of well-known television competition The Amazing Race Canada. They were praised for using the platform to raise awareness of Two-Spirit people.

The October 23 talk from Dr. Makokis was the first in the new annual lecture series. Information on future Dr. M. Nancy Tatham & Donna Henderson Lectureship talks will be shared on the School of Medicine website.

“We're excited to carry the momentum of this talk forward by hosting additional events centred around improving access to healthcare and delivering culturally-informed care to LGBTQ2S+ and Indigenous populations,” says Danny Jomaa, Queen’s medical student and member of the Diversity Panel. “As trainees in medicine, it's important for us to build approaches to care that are formed on the principles of equity and respect for marginalized groups.”

Harnessing microbes to treat gut pain

Queen’s University researcher receives funding to help those suffering with pain from inflammatory bowel disease.

The digestion of food is a complex process and millions of different types of bacteria are  one part of the process that help get the job done

That said, there are a number of bacterium present in a healthy bowel that perform the unexpected function of helping suppress gut pain. Queen’s University researcher (Department of Medicine and Department of Biomedical and Molecular Sciences) Alan Lomax is studying how that bacterium could be the secret to suppressing pain for people living with inflammatory bowel disease (IBD).

To support the five-year project, Dr. Lomax, who is also scientist at Kingston Health Sciences Centre’s Gastrointestinal Diseases Research Unit, has been awarded $790,000 from the Canadian Institutes of Health Research (CIHR) to study how the presence of some human gut microbes can help modulate the pain of IBD such as Crohn’s disease and ulcerative colitis.  Canada has the highest rate of IBD in the world.

The project builds on his group’s discovery that the pain suppressing bacterium is present in healthy bowels.  This bacterium is missing in many patients with IBD, which may remove a brake on the pain that these patients experience. Their research has also shown that other gut microbes from patients with IBD can produce substances that cause pain.

“A number of studies have showed that this pain-relieving bacterium is absent in patients with IBD,” says Dr. Lomax.. “We’ll identify what chemicals those bacteria are producing, and whether those secretions could be used to relieve pain.”

The research team will also use metagenomics analysis to understand how the changes in microbiota in patients with IBD lead to worsening pain. Ultimately the researchers hope to develop a microbe-based treatment for IBD that is a safer and more effective alternative to existing opioid pain medications.

The study is part of a growing body of research that has linked gut microbes to several illnesses including depression, anxiety, diabetes, autism, and even cancer.

“These bacteria have all sorts of influences around the body,” Dr. Lomax says. “The more we understand about how these microbes affect health, the more we can move towards designing new treatments that target these microbes.”

For more information on research at Queen’s, visit the new Queen’s Research website.

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