Global Health Nursing Conference 2016

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On Tuesday, March 15, 2016, I attended the Global Health Nursing Conference held at the University of Toronto, hosted by the Nursing Undergraduate Society at UofT. The purpose and the theme of the conference this year was to shed light on Refugee and Immigrant Health.

This year’s conference is particularly poignant due to the current social climate regarding the war conflicts that have started occurring in 2011 (and are still ongoing) within Syria, and the large influx of Syrian refugees within Canadian borders. Throughout this night, we explored topics related to refugee and immigrant health, and ways in which nurses play a significant role in facilitating access to safe and appropriate for a vulnerable population. The wide variety of panelists, speakers, and session facilitators encompassed a diverse group of registered nurses [RNs] and nurse practitioners [NPs] from a variety of different global health backgrounds. They offered their experiences and perspectives on global health, the impact that nurses can create in health care on a global scale, and the types of work in which nurses can play a part in on an international health care level.

This event garnered significant attention from a variety of different undergraduate nursing students. The evening was comprised of attendees from UofT’s second-entry BScN program, Ryerson’s BScN program, Nippissing, York, etc. It was refreshing to see variety in different nursing backgrounds, making it an optimal night for opportunities to network, meet new people, and make new nursing friends!

The first part of the evening began with a panel of four RN speakers with diverse careers within global health. Some of them worked in various acute care and community health settings in different parts of the world (i.e Sudan, Ethiopa, Sierra Leone), implementing global health initiatives such as surgical programs, vaccination clinics, maternal health education, etc. Some of them worked within the local community (i.e Women’s College Hospital), addressing refugee and immigrant health needs and concerns in the Greater Toronto Area. Having these varied experiences and backgrounds in nursing come to light truly widened perspectives and opened many minds. The nursing students in attendance, a majority of whom have yet to have any solid exposure to global health nursing, were able to think of adequate health care outside of a framework that is well-resourced, highly affluent, and well-supported by a competent government structure. We were forced to think critically about what health care and health care delivery looks like in various populations and cultures, and how we – as Canadian nurses – can use our influence to affect change, in order to improve global health outcomes. Moreover, we also had the opportunity to think critically about how to address global health issues within our own local community. Various speakers spoke about what immigrants – specifically refugees – experience, in terms of health services, once on Canadian soil. We discussed barriers they often face to receiving appropriate care, such as a lack of adequate health care insurance coverage and a lack of unfamiliarity in terms of navigating a new system. The panelists did a fantastic job in articulating that our roles as nurses are to ensure that immigrants and refugees receive a care that is reflective of our health care system’s values and beliefs – that is, a care that is individualized, patient and family-centred, and comprehensive.

 A highlighted global health organization that was brought to attention during this period of the evening was Medicins Sans Frontieres [MSF]/Doctors Without Borders. A number of the RN panelists discussed their own experience in working with this organization and how MSF carries out various global health initiatives in a number of resource deficient countries. The purpose of MSF is to provide medical support and services where it is most needed on a global scale, and to ensure that health care systems and organizations are well-supported and have sufficient resources to deliver adequate care across boarders. More information on MSF and their work, as well as how to get involved, can be found on:

Medicins Sans Frontieres/Doctors Without Borders

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The next portion of the evening was a dinner and Social, where we got to engage with the founders of the company iamsick.ca. iamsick.ca is a company that has created a technology platform in the form of an app and a website, to help facilitate access and equity to adequate health services in your own area. They have developed a system whereby one is able to access the most appropriate health care provider, for their specific needs, online. Furthermore, through this system, they are able to minimize things such as emergency visits, wait times, etc., as it specifically matches the individual’s health need with the specific health service and provider that addresses that need. iamsick.ca is a company that began at UofT and has grown over the last four years, with a large number of consumers that have been helped through its services. They work directly with healthcare providers and organizations to ensure that the link between patient and provider is more effectively established. iamsick.ca ensures that health needs do not go unaddressed and are addressed appropriately. For more information on iamsick.ca, please visit:

iamsick.ca

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The last portion of the evening involved Breakout Sessions, from which students were to choose whichever session they would like to partake in, to develop more knowledge in more specific niches of global health nursing. I chose to take part in the Sick Kids International Paediatric Global Health session, due to my interests in maternal and paediatric health. In this last hour of the evening, the Nursing Manager and the Advanced Nursing Practice Educator from Sick Kids International and Sick Kids Centre for Global Child Health spoke about paediatric health and nursing care on a global scale. They spoke about their past, present, and future projects and global health initiatives to address gaps in international paediatric care. A significant gap that they have found in terms of global child health is that nurses internationally lack the advanced competencies of paediatric nursing care, making it difficult for them to deliver the care that their country’s paediatric population requires. Sick Kids Centre for Global Child Health has taken steps towards developing a project that educates nurses abroad about paediatric nursing and paediatric care, in order to empower that country’s health care providers. This project has been a focus for a large part of their work and they hope to continue educating various nurses in various parts of the world, to ensure they receive adequate paediatric nursing education and training. For more information on Sick Kids Centre for Global Child Health, and to learn more about their work, please visit:

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The Hospital for Sick Children – The Centre for Global Child Health

Needless to say, the night was successful and the nursing students in attendance learned a lot about global health and how nursing plays a pivotal role in global health. With Canadian nursing school curriculums having a strong focus on nursing in the local and national community, there is a significant lack in education about the work nurses do on an international and global scale. This conference has definitely enabled nursing students across GTA to develop their knowledge and awareness in global health nursing, and has inspired us to build careers built on the foundation of community health development alongside with acute care development.

Tie a Red Ribbon Round the Ole Oak Tree

In 1988 the world was so captivated by the sudden emergence and destruction brought on by an itty-bitty virus that they gave it its own international day, World AIDS Day. Every December 1 the world recognizes what has come and hopes for what will be for those living with and affected by Human Immunodeficiency Virus (HIV). The World Health Organization (WHO) states that approximately 34 million people have died from HIV/AIDS and that almost 37 million people are currently living with HIV. Additionally, WHO states that there are 2 million new HIV infections each year.

To give some context, HIV is a lentivirus that attacks the immune system and reduces it to the point where an individual cannot defend themselves from other pathogens. Once an individual has reached the last stage of HIV infection, as determined by an extremely low level of white blood cells that leads to the occurrence of more than one opportunistic infection (tuberculosis, pneumonia, etc.) they are diagnosed with Acquired Immunodeficiency Syndrome (AIDS). HIV is obtained through sexual intercourse and blood-to-blood contact with an infected individual, such as sharing infected needles, blood transfusions, and during pregnancy. HIV cannot be contracted through common day-to-day activities such as hugging, kissing, and sharing objects such as food and water. This may seem silly to point out but less than 20 years ago it was still common to be confused about the transmission of HIV. It may still be confusing in certain parts of the world where people are not educated about HIV. All of the confusion that surrounded HIV/AIDS is what led to the paranoia and stigmatization of people living with HIV and in particular homosexuals, sex workers, and intravenous drug users as they were the majority populations the virus was found in early on. Thankfully, due to education and awareness initiatives the confusion and by extension the stigmatization has been decreased, at least in the minority world. In the majority world it can still be dangerous to reveal your HIV status as there is still heavy stigmatization. Fear, stigmatization, and a lack of education are the primary barriers to the treatment and prevention of HIV infection.

While the treatment of HIV has been a long and bumpy journey, the prevention methods have not changed very much. There are few prevention methods for HIV infection but they are very simple. Harm reduction techniques for intravenous drug users, such as sterilizing and not sharing needles, and proper sterilization and disposal of medical equipment will prevent HIV infection. Additionally, for sexually active individuals the best protection is the proper use of male and female condoms. However, there have been recent developments in HIV prevention. This is the use of antiretroviral medication for individuals who are not infected but may be exposed to the virus. A pre-exposure prophylactic, or PrEP, is a once-a-day pill that impedes HIV infection in those exposed to the virus. If taken properly and consistently PrEP has been found to be an effective prevention technique. PrEP works by supplying the body in advance with HIV medications that lower viral levels in the blood, in an individual who is not infected the medication will stop HIV from spreading if they are exposed to it. However, PrEP is not a replacement for condoms or other prevention techniques, it is to be used in conjunction with them as it is not 100% effective. There is only one prevention technique that can claim to be 100% effective and that is abstinence, at least in cases of sexual or drug transmission. Along with prevention techniques there is a psychological side to HIV infection and prevention and Ryerson has been playing around with it for some time.

The psychology department at Ryerson operates the HIV Prevention labs. Dr. Trevor Hart and his associates conduct research on how to prevent HIV transmission among high-risk groups and how to promote quality of life among people living with HIV. Their current research is dealing with how HIV negative men who have sex with men protect themselves from HIV and those men who use alcohol and substance abuse to calm sexual anxiety. Additionally, their research revolves around the psychological aspects of sexual interaction, such as the courage and strength it takes to say no to someone who doesn’t want to use a condom when you do. Sex can be intimidating and sometimes we go along with what the other person wants even though we feel differently. If you don’t know the HIV status of your partner you should use a condom, be selfish and use a condom.

It is not surprising that Ryerson puts so much thought into HIV prevention, it has been educating its students on prevention methods for some time. In the 1980’s and 90’s Lynn Morrison, a professor of anthropology, headed education seminars and workshops to educate students on HIV and safe sex. This included practical information and experiences such as how to properly use a condom. At one time Ryerson had an AIDS awareness week and even a mascot, Condom Man, a giant penis with a condom on walked our halls handing out contraceptives. There was also the AIDS Education Project, which was a peer service out of Pittman Hall that provided students with AIDS information and support for those living with HIV. This is something that has survived time and can still be found as part of Ryerson Health Promotion (JOR03 and JOR04). However, there is something that has not survived time here at Ryerson, at least not to my knowledge, and that is the outright promotion of safe sex. It may seem outdated and common knowledge but how many students really use condoms or think that they will contract HIV if they don’t? HIV doesn’t seem like a threat until it’s right in your face. Moreover, we wouldn’t need an HIV prevention lab if HIV were not a problem. HIV is still very much alive in Toronto and Canada; 21% of the HIV positive people don’t know they have it and everyday 7 Canadians are infected with HIV. We need to think about the implications of our sexual habits and we need to have safe sex.

I use the Ryerson Archives for my Ryerson related research and as I was sifting through the AIDS related newspaper clippings I came across an article about a man named Steven Bailey. In 1992 Bailey spoke as part of the Nursing Students Association AIDS Education Conference. Bailey related the feelings that he had when he was diagnosed with HIV and the pain that it caused him to be labeled as positive. At this time in Canada HIV was heavily stigmatized and considered a death sentence as there was no viable treatment available. In the beginning Bailey told people that he had cancer because he found that he got more respect that way, people treated him better thinking he was dying of cancer rather than AIDS. Bailey believed he would beat AIDS, at a time when there was no hope that was all he had. Everyone living with HIV or AIDS needs hope and they need support. Someone infected with HIV is not the child of a lesser God, they deserve love and they deserve life. Bailey was 31 when the article was written and all he wanted was to live to his 35 birthday. I cannot say what happened to Steven Bailey but I can say that I hope he and anyone living with HIV is able to live their life to the extent they wish. HIV is no longer a death sentence and should not be treated as such; we should not continue to stigmatize those who live with HIV.

People living with HIV or AIDS do not need pity they need support. I call on Ryerson and its health committees to be vocal on campus. We should be informing students and helping them to be confident and safe in their sexual practices. We should also be supportive of those living with HIV, why make it harder for someone to find support? Lastly, I want to know what happened to Condom Man.

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In Conversation with Stephen Lewis

Human immunodeficiency virus, or more commonly HIV, is a deadly and destructive infection that has plagued our world from, potentially, the late 1800s onward. Researchers believe that HIV can be traced to a type of chimpanzee in West Africa and that contact with their blood through hunting is what allowed the virus to enter the human population. HIV and AIDS came to North America in the mid 1970s and in 1981 appeared on the global medical radar when the level of infection was out of control and the pandemic and pandemonium began. As fear of this unknown killer virus spread through the Western world people began to look for answers, solutions, and wrongly, someone to blame. The scapegoat for HIV and AIDS in the 1980s and into today has been homosexual men as this was a major population the virus infected, while this was entirely false the discrimination still exists and is still stigmatizing. In reality, there are several risky behaviours that put someone at risk for infection with HIV. Also, transmission occurs because the individuals partaking in these behaviours are unaware that they are infected with the virus or that the people they are engaging with are. Unfortunately, the spread of HIV is only one of the problems in this discussion, the treatment of HIV and AIDS and the funding required are an entirely separate demon. This is merely an introduction to one of the most controversial and unsettling discussions our world has had and will continue to have as the fight against HIV and AIDS goes on.   

 

This past Wednesday evening I had the pleasure of attending one of the Stephen Lewis conversations, which is an ongoing series of discussions put on by the Faculty of Community Services and Ryerson University in collaboration with the Planetary Health Commission. The discussion, co-hosted by Dr. Alan Whiteside, was on the AIDS pandemic and where we are now in its development. Stephen Lewis is currently a professor of distinction at Ryerson and at one time was the leader of the Ontario New Democratic Party, UN Secretary-General’s Special Envoy for HIV/AIDS in Africa, Deputy Executive Director of UNICEF, Commissioner on the Global Commission on HIV, Board Member of the International AIDS Vaccine Initiative, and the co-founder of the Stephen Lewis Foundation which works with community-based organizations in Africa that are trying to end HIV and AIDS. Dr. Alan Whiteside is an internationally recognized academic and AIDS researcher, he is the co-author of numerous articles and books regarding AIDS, and he established and is the executive director of the Health Economics and HIV/AIDS Research Division at the University of Natal in South Africa. These are two very short biographies of two very remarkable men who exposed some of the truths of this horrible disease to the world and continue to do so. Both Stephen Lewis and Dr. Alan Whiteside focus their HIV and AIDS work in Southern Africa where the virus is still rampant and where their discussion on Wednesday was localized. I will try to relate what was discussed so as to provide a better understanding for those who could not attend.  

 

It is important to note that the vocabulary in health has changed; we say that people are living with HIV and yes that’s true in Canada, there are people living with HIV because they have access to medicine and can remain on that medicine. However, this vocabulary is not necessarily applicable to Southern Africa where people are dying from HIV, where it is still a threat as it once was in Canada. It is believed that HIV has killed over 30 million people since 1981, and that 2 million people are infected annually. According to the World Health Organization (WHO) 1.2 million people died from AIDS-related causes in 2014. HIV is a virus that we know how to prevent and control, and yet there are at least 6 million people infected with HIV in Southern Africa and 400,000 new infections every year. What is going wrong? Why is it that we have the answers but still haven’t solved the problem?

 

Looking at prevention, there are some very easy ways to slow the spread of HIV. As mentioned above there are certain risky behaviours that put us at an increased risk for HIV infection, these are most commonly having unprotected sex and sharing infected needles. The reason men who have sex with men (MSM) are more readily infected is that HIV is taken up by the body more easily during anal intercourse rather than vaginal. With the added dangers of not using a condom it is more than likely that an untreated individual with HIV will spread the virus to their partner. Unfortunately, the homophobia that is endemic to Africa does not help. Homosexuality is illegal in some African countries. Homosexuals are driven underground and fear death if they are outed, which makes access to medication even more difficult. Another risky behaviour is sharing needles with infected drug users. When intravenous drug users (IDU) shoot up, their blood enters the needle and is then passed on to the next user thus spreading HIV. IDUs have the highest risk of infection as they have direct blood to blood contact with HIV, this makes transmission extremely easy and the virus can spread throughout the community and beyond fairly quickly. One solution to this problem is safe injection sites, such as the Insite in Vancouver, which provides a clean space as well as equipment and medical staff to ensure that IDUs are safe while they are injecting themselves. It may seem odd to help someone inject themselves with illegal drugs that harm them, but these people are suffering from an addiction and still have the right to health. After all, they are still human and if they are going to use drugs we can at least make sure they are doing so safely and negating the spread of disease and avoiding potentially deadly overdoses.

 

Other at risk groups are sex workers, if they are having unprotected sex, and most notably women. In Southern Africa women are the population with the highest infection rates of HIV. The reason women have such high infection rates is because they face sexual violence. Women are often raped and abused sexually and this is the gateway for their infection. These women then have children and pass the infection onto their offspring, who will not live a long or enjoyable life if not given medication. Within the infected female population in Southern Africa, teenage girls have the highest rates of infection; they have 8 times the level of infection compared to boys in the same age group (15-18), again due to sexual violence. This is an at risk population that does not have an easy solution. How do you stop girls from being raped? Unfortunately, I don’t know the answer but I do know that if these girls are given medication and resources they can stop the spread of HIV to their children and other sexual partners and live a much better and longer life. If medication is the answer to this problem and we have the medication, then why is the disease still spreading. The answer is simply that these people are not getting the medication. They belong to stigmatized and oppressed groups that no one cares to think about and often are left to die. HIV infection is in itself a stigmatizing factor in Africa; add in the fact that you are a homosexual, a drug user, a sex worker, or a woman and people stop caring whether you live or die. Aside from the oppression that keeps people from their medication, there are rumblings that global AIDS funding given to African governments keeps disappearing after it is given out.

 

Corruption within African governments is not a new phenomena and it doesn’t seem to be going away. Both Stephen Lewis and Alan Whiteside commented on the way Southern African countries are run by their kings and while the King of Swaziland has a jet his people can’t seem to find their HIV medication. There are billions of dollars raised and donated to AIDS funds every year and for some reason the grassroots organizations in Southern Africa aren’t seeing this money. Where is it going? The United Nations (UN) stipulates that global AIDS funding needs to be distributed through HIV and AIDS committees which give the money to governments and presumably health departments to be used for medication, education, and the spread of resources so that infected individuals can live. However, people are still dying and being infected and kings are buying jets. Of course, some people in Africa are getting medication but money is still evaporating. The only way to determine where this money is going and to make sure it is going to the right places is through auditing. Neither Mr. Lewis or Dr. Whiteside knew why these governments are not being audited. What makes this reality even more terrifying is that AIDS funding is beginning to flatline globally. While the global funding is not going down very much it is not getting any higher and there is a risk of it beginning to diminish. Countries are slowly stagnating with their funding, such as the Netherlands which cut its AIDS funding by 1 billion Euros. Additionally, at the UN the funding for communicable diseases is starting to be targeted by non-communicable diseases as they begin to take a stronger chokehold on global populations. The funding pie is now being sliced for more diseases and more causes and this means that eventually HIV and AIDS will begin to lose funding. This leads into a much larger ethical discussion that is beyond my scope, but I will leave you with a question: how do you decide which diseases need more funding, how do you decide the cost of human life?

 

Dr. Whiteside did have one suggestion for the issue of AIDS funding and it was to be smarter about the way researchers and organizations go about asking for money and how it is spent. Dr. Whiteside was explicit in that governments should be responsible for the health of their constituents and that non-government organizations (NGO) should be there to pick up the pieces and to remind governments of the diseases that are being forgotten. Unfortunately, this is not the case in Africa at the moment. The grassroots organizations are the ones providing health to the people of Africa and the money is going to the government. So one solution is to get the money to the organizations on the ground and skip the corrupt kings and health ministers. How this will be done still needs to be determined.    

 

In our society we don’t always think about the threat of AIDS. However, prevention is shockingly simple and that’s probably the more devastating side of this story. A simple condom or having access to safe and clean injection sites- in essence having harm reduction policies in place will protect us. HIV and AIDS have been devastating our world for over 30 years and they are not going away unless everyone takes the responsibility to be safe. Behaviour change is difficult and it takes time but isn’t it worth it? Isn’t your life worth wearing a condom?

 

HIV and AIDS are two topics that require lengthy conversation and attention and that is why I will be writing about them again in another post on December 1, World AIDS Day. In the meantime, to learn more about HIV/AIDS visit the Center for Disease Control and Prevention, UNAIDS, the Stephen Lewis Foundation, and the World Health Organization. One last side note, free condoms and lube are available at the Student Centre, as well as at Ryerson’s Medical Clinic (KHW 181). Outside of Ryerson but still close to campus there is the Toronto People with AIDS Foundation at Sherbourne and Gerrard and the Hassle Free Clinic at Church and Gerrard (above Starbucks) where free medical testing is also available.