Child Protection in Emergencies

Drawing by Anastasia, 7, from a village in east Ukraine bombed by the Russians.

“Children’s exposure to adverse experiences is much higher than we had once thought, with a global systematic review finding that a billion children a year are victims of violence. The past two years have tipped the balance of these scales against all children. Emergencies increase family violence and mental health distress. More than seven million children have lost a parent or main care giver to covid-19, and the global pandemic has exacerbated pre-existing inequalities and risks for childhood adversity. Parenting in war is violently undermined: in chaos and emergency, families face extreme, unanticipated challenges. We also know that adverse experiences are often unwittingly transmitted across generations.

On the positive side, we now have convincing evidence of how to increase protective factors for children. Parenting programmes have been found to be effective at supporting parents to be the good care givers that they overwhelmingly want to be. They prevent and disrupt the intergenerational transmission of violence and trauma and improve mental health for parents and children. When combined with economic assistance (“‘cash plus care”) they are even more effective. The research is now so strong—with 77 systematic reviews and more than 100 randomised trials in lower resource countries—that the World Health Organisation (WHO) is developing guidelines for parenting programmes. In doing so, parenting programmes parallel other public health interventions for children that are backed up by robust evidence, such as polio vaccines and antenatal care. In emergencies, families need evidence based support that is accessible, relevant, and simple.”

More on Ukraine’s children: use evidence to support child protection in emergencies via BMJ.

Access to Self-Care Inventions

“Health for all will not be achieved if the current estimated 100 million people experiencing homelessness continue to be underserved. Actions by support workers, health workers, health administrators and health policy makers, legislators, and regulators is needed to improve access to self-care interventions among people experiencing homelessness.20

People experiencing homelessness must be engaged as part of the solution to improve access to quality health services and the uptake of self-care interventions. Support organisations working with people experiencing homelessness should involve people who have been homeless as peer educators to provide one-to-one support, reliable information on self-care interventions, and facilitate access to quality health services. For instance, the use of peer support has been shown to reduce drug and alcohol use and increase healthy behaviours. Additionally, support organisations, in partnership with health workers, need to engage directly with people experiencing homelessness, such as through group dialogues and individual support sessions to rebuild their trust, dignity, and self-esteem—both to overcome previous negative experiences of accessing healthcare and to prioritise self-care.

Health workers have a specific role in supporting people experiencing homelessness and their ability to self-care. Increasing the skills and competencies of health workers to provide non-stigmatising, trauma informed care for people experiencing homelessness is essential. A good model is the health worker training developed by Pathway, a UK charity that enhances care coordination for people experiencing homelessness admitted to hospital.”

More on Access to self-care interventions can improve health outcomes for people experiencing homelessness via BMJ.

More on a good model: Pathway. Healthcare for homeless people—what we do. 2019. https://www.pathway.org.uk/about-us/what-we-do/

CAR T-cell Therapy in Cancer

“Chimeric antigen receptor (CAR) T-cell therapy is a novel therapeutic T-cell engineering option, where T-cells obtained from a patient’s blood are engineered ex vivo to express specific tumour antigen receptors. The highly selective nature of CAR T-cell therapy has led to a revolution in cancer treatment. The use of CAR T-cell therapy has been successful in treating haematological malignancies and there is also a growing interest in using CAR T-cell therapy to target solid tumours. However, there are notable challenges with CAR T-cell therapy, including non-sustained responses, antigen escape, and life-threatening adverse effects. Studies are underway to improve the safety of CAR T-cell therapy by limiting their expression, producing switchable CAR T-cells, and producing genetically engineered T-cells that are equipped with genes to reduce adverse effects.”

More on Opportunities and challenges for CAR T-cell therapy in cancer via Cambridge Medical Journal.

Ableism in Medical Education

The Capability Imperative: Revealing Ableism in Medical Education:
“The movement to diversify medical education recognizes that various perspectives and life experiences enrich medical training, practice, and patient care. However, students with disabilities remain underrepresented in medical education and face barriers in structure, culture, and climate. Efforts to remedy exclusion have focused on bettering accommodation policy and practice.

This presentation draws from a constructivist grounded theory of four U.S. medical schools that asked: how is disability inclusion enacted in medical education? Amongst other things, the study shows that inclusion was informed by the capability imperative, a context-specific manifestation of ableism that upholds a cultural logic of compulsory hyper-ablebodiedness and mindedness. I describe this logic and argue that it renders disabled students’ misfits in medical education. Their inclusion is constrained, always exceptional. To be truly inclusive of diverse bodyminds, the capability imperative must be interrogated and dismantled.”

Learn more on The Capability Imperative: Revealing Ableism in Medical Education here.

Practice Patterns & Family Physicians

The Early Career Primary Care (ECPC) study is exploring changing practice patterns among family physicians, as well as practice intentions and choices among family medicine residents and early career physicians.

In this seminar on April 13, 2022 at noon PSTDr. Ruth Lavergne and Dr. Ian Scott will share findings that call into question common narratives about changing practice patterns and generational differences in primary care, and point to the need for different approaches to ensure access to quality primary care in Canada.

For more information and updates, check out the Department of Family Practice Website.

The Labor of Story Telling

Illumination, 2005 Ukrainian Artist: Katerina Omelchuk

“When my father was a young physician, around my age, he experienced a tragic event that changed the trajectory of his life. Many years later, he wrote about the experience. He told the story of a pregnant patient under his care who experienced an ‘anesthesia catastrophe’ during a cesarean delivery. He had been her family medicine physician and was present as first assistant for the procedure. The patient had a cardiac arrest that resulted in severe brain injury and, several days later, was removed from life support and died. Her infant survived but had severe neurological injury.

‘Everyone who’d been involved left the hospital,’ my father wrote. ‘You’re the family doctor,’ he recalled being told, ‘it’s best if you speak to them.’ He remembered breaking the news, alone, to the patient’s family. ‘I assumed my career was over,’ he said. My father described being in a kind of ’emotional shock’ after this. He reported feeling abandoned by his colleagues and targeted by the news media. Although a malpractice suit was filed, my father was not named in it. He wondered if this was because he was the only one who talked to the family.

In reflecting on this event, my father described the personal and professional cost as ‘incalculable.’ At the same time, he said he became a more conscientious physician because of it, sometimes catching mistakes by less attentive colleagues over the ensuing years. He hoped that his own reflections on the event would encourage discussion of medical errors more openly, including the emotional toll they can have on clinicians. He also described a profound sadness that he continued to feel decades after this loss. For him, it was ‘a sadness that doesn’t go away.’

Although I’ll never know for sure, I suspect this sadness played a role in my father’s premature death. In many ways, it has also played a substantial role in my life. While it may not have been the inheritance I hoped for, the sorrow and grief that flowed into my life through my father’s death has shaped me in important ways. During medical school, I grew interested in the field of palliative medicine, drawn by the opportunity to help patients through grief and loss and to be a steward of opioid medications. In palliative medicine, I have found kindred spirits and a feeling of being at home in my work. I have also found a community where stories of loss—stories like my own and my father’s—can be acknowledged, held with compassion, and allowed to move and to heal in their own time.

The labor and art of story telling has the power to transform our lives. In sharing and receiving stories, we connect more deeply to one another: We become more real, more fully human. We feel less alone. The labor of story telling is not necessarily easy, though. It requires honesty, vulnerability, and the courage to contact the wounded places within ourselves. Sadly, these are not things that most of us are taught to do as physicians. Instead, we learn early on in medical training that it is risky to be our authentic selves, to acknowledge our imperfections, and to share our struggles. I am convinced that this has contributed to the epidemic of burnout, depression, and suicide among physicians.”

Read more on The Labor of Story Telling by Megan Ann Brandeland, MD. via JAMA.

Comic Strips & Health Care

“Comics creator Sam Hester is part of a growing movement within health care: graphic medicine. In short, literally drawing attention to a patient’s needs and goals with pictures to foster better and more accessible caretaking. Hester shares how illustrating small details of her mother’s medical story as she struggled with mysterious symptoms alongside her Parkinson’s and dementia led to more empathy, understanding, communication and peace of mind.” via TED.

Global Health Conference 2022

On behalf of the Centre for International and Child Health (CICH) at BC Children’s and Women’s Hospital and the School of Population and Public Health at the University of British Columbia, we present to you the 4th Annual Global Health Conference.

As promoted at the 7th Annual Women’s Health Research Symposium, the 2022 Global Health Conference is an event for global health researchers, students, and organizations to come together and explore the reimagining the postpartum and postnatal period.

Please note that this is a hybrid conference. Based on provincial health restrictions in British Columbia, they will offer in-person attendance at the Chan Centre for Family Health Education at BC Children’s Hospital.

Attendance for this conference is FREE and open to everyone. Attendees must register via Eventbrite.

Registration is now open: https://www.eventbrite.com/e/246737086267