Globally mental, neurological and substance use disorders (MNS) affect 10%, but jumps to 22% in conflict settings while 75% of persons with MNS in conflict settings such as Horn of Africa region lack access to mental health care. The region has faced decades of conflict and climactic shocks that eroded resilience and coping mechanisms. While the mental health services including its workforce are almost non-existent, it is unlikely the region will be able to train sufficient mental health specialists. That is why we propose developing of regional mental health strategy and enhance capacity through task-sharing using WHO Mental Health Gap Action Program (mhGAP) to train frontline workers. mhGAP is designed to support non-specialist to provide MNS services for conflict-affected communities
The research and KT activities include; regional stakeholder engagement, contextualized training materials, trainers of trainees to ensure local capacity and website/social media presence
The anticipated outcomes and; increased access to services, improved awareness and enhanced workers capacity
Potential impacts. The project aims to strengthen mental health through policy and capacity building with potential to cascade across the region
Program: Scholar
Decolonizing Planetary Health: Rebuilding Social, Cultural, and Environmental Relationships for Indigenous Well-being
Systemic racism against Indigenous peoples is an enduring problem in British Columbia’s health care system. Education and training programs to date have fallen short in producing necessary structural and systemic change, due in part to the lack of consistently mandated training for health care providers in cultural safety and humility. The overarching goal of this program is to support re-emerging nation-to-nation relationships in Canada as a key determinant of Indigenous health, as a pathway to improving Indigenous experiences of care within the BC health system and creating healthy lands and waters on unceded Indigenous territories. My research program examines how Indigenous peoples are asserting self-determination in community health and wellbeing in response to wide-spread anti-Indigenous racism, and how land-based, Indigenous knowledge may transform relationships. I use storytelling and other knowledge creation methodologies to examine the connection between colonization and Indigenous health and wellbeing, and Indigenous communities’ strategies to exercise self-determination in the face of persistent inequities and injustice. These methodologies are guided by Indigenous community partners and OCAP® principles.
Advancing Equitable Cancer Care: A Innovative Approach to Transformative Action in BC
In BC, some groups face unfair barriers in receiving adequate cancer care due to factors like racism, stigma, discrimination, poverty, mental health and substance use challenges, and/or disabilities. Over the next five years, my research aims to tackle these disparities. First, we will team up with people who know these issues firsthand to form a community-engaged research team. Together we will identify what research is most needed and lead innovative studies to address cancer-related inequities. Our primary focus involves developing a new approach to caring for cancer patients. We will create an equity model of care based on principles of equity-oriented healthcare, integrating trauma-informed care, cultural sensitivity, and strategies for addressing substance use health. Additionally, we will gather patient feedback to continually improve care quality. These new approaches will be piloted in specific cancer clinics to assess their effectiveness. Success means more equitable and improved cancer care for the diverse communities we serve in BC.
Life-course socio-economic adversity and trajectories of aging from early to old age
The way people age varies significantly from one individual to another. This variation is attributed to a combination of factors, including genetics, environment, psychological and social factors, and lifestyle choices. Individuals from lower socioeconomic groups often experience faster physical and mental aging, contributing to a growing health divide and increasing health inequities. Socioeconomic conditions affect not only the rate at which health deteriorates but also the highest level of health a person can achieve, starting from conception. The specific mechanisms of this impact, particularly in early life and in older age, require further research. This research program will analyze data from population cohorts of different ages to understand the influence of social and economic environments on developmental and aging trajectories from early life to old age. It aims to identify factors that might protect individuals from the adverse effects of lower socioeconomic conditions on health and aging. This knowledge will assist in shaping and implementing targeted health policies to improve the health and aging trajectories of the population, thereby reducing health inequities and lessening the burden on the health system.
Sharing medicine bundles and pathways to community wellness: articulating nation-specific ceremonial, land-based wellness practices
Prior to the Indian Act and the Potlatch Ban, Indigenous nations in Canada had complex and complete healthcare systems with intrinsic ties to the land and spirit-based understandings of the cosmos. Within these holistic systems, the individual, family, and community were cared for. These systems included medicinal plant use; ceremonial practices across the lifecycle; mentorship; and land-based connections. The purpose of this research program is to: a) enliven the concept of land as healer, b) reclaim ceremonial healthcare practices that were outlawed by the government for several generations, and c) articulate nation specific pathways to community wellness in contemporary contexts. Working with several nations on community identified land-based wellness projects, life-experience and traditional stories will be gathered with knowledge keepers, youth and community to answer the research question: How can we enhance intergenerational knowledge transmission to advance community wellness and the revitalization of traditional health systems? Recommendations will inform the development of nation-specific community wellness frameworks and present ways forward for Canadian healthcare systems that engage the role of traditional healing.
Molecular mechanisms and genomic consequences of transposable element hijack strategies during embryogenesis
Transposable elements (TEs) are selfish genes that self-copy and move around the genome. Robust defense mechanisms silence TEs to prevent them from causing devastating mutations that break DNA and destroy genes. Failed TE suppression is associated with myriads of disease phenotypes including tumorigenesis and sterility. But the defense is not failsafe; TEs repeatedly acquire evasion tactics, enabling them to amplify at the expense of the genome. Using the powerful model organism, the Drosophila, this proposal aims to dissect hijack strategies TEs adopt during embryonic development. The first strategy is the timely activation of TEs before silencing is fully established. The second is for TEs to concentrate their activity near cells to increase the chance of passage to the next generation. To further reveal the full mutational impacts of TEs, we will artificially induce TE activity across multiple generations. Large numbers of new TE insertions will enable us to determine the deleterious impact on epigenetic state, gene regulation, and nuclear organization. Elucidating how TEs “cheat” and disrupt the genome will critically inform preventative and treatment plans for diseases caused by genome instability.
Towards improving pain management for children using patient-specific genetic information
In children, ongoing pain can interfere with brain development, disrupt behaviour and increase the risk of chronic pain. This can be particularly devastating in children with high burdens of pain, such as children with cancer, many of whom experience highly-distressing pain requiring opioids. Providing timely and adequate pain treatment for these children is critical, yet it remains challenging to predict who will experience pain requiring opioids and how these children will respond to prescribed opioids. This is especially difficult in young children who cannot articulate their level of pain, limiting their ability to receive appropriate relief without harm.
My research program is working to identify unique genetic signatures that predict how likely a child is to develop painful conditions, experience severe pain and respond to opioid-based pain relievers. This information will be used to develop predictive genetic tests to inform medication choices that will enhance the safety and effectiveness of pain management strategies for children. This work also has the power to combat the opioid crisis that continues to devastate British Columbians, where opioids can be restricted to patients most likely to benefit without harm.
Digital interventions for concussion: Connecting youth and their families to care
Concussions are very common among children and adolescents. While many recover without complication, a third of those who sustain a concussion will experience symptoms that last months or years after injury. Children and adolescents who experience a slower than typical recovery report lower quality of life. This means they have increased physical and mental health concerns, more family stress, and reduced participation in valued activities (e.g., school, sports). Despite the prevalence and negative impacts of concussion, treatment options are lacking and often inaccessible (e.g., expensive, only located in major city centers). My research aims to create accessible treatment options for children and adolescents who sustain concussions. I will develop and test digital health interventions that support children, adolescents, and their families with their recovery (e.g., psychoeducational websites and smart-phone app-based behavioral interventions). This research will improve the lives of the many Canadian youth and families who have been impacted by concussion. This knowledge will be shared with other researchers and healthcare providers to improve concussion care.
Optimization of cardiovascular health in postpartum women with reproductive and pregnancy-related risk factors
Heart disease is the number one killer of women worldwide and the leading cause of premature death in Canada. In recent years, heart disease related death and illness has increased in women after childbirth. Besides well-known risk factors, women after childbirth face an additional burden of pregnancy-related risk such as high blood pressure and diabetes during pregnancy, however, the risk often gets unrecognized in primary care. Though there are many risk prediction models, they are designed to predict risk in general population and do not take into account the reproductive risk factors that limits their use in women after childbirth. My program of research on Women’s Heart Health, aims to answer the following questions: 1) What are the contribution of reproductive and pregnancy-related risk factors in predicting the heart disease risk in women after childbirth? 2) What is the feasibility and acceptability of using risk prediction tool in primary care? 3) What is the effectiveness of risk prediction tool in screening heart disease risk in women after childbirth? The proposed local research in BC will aid in solving a problem in Canada by recommending a heart disease risk assessment and risk management of women after childbirth.
The Lifetime Exposures and Asthma Outcomes Projection Model (LEAP): A Platform for Improving Asthma Prevention in Canada
Asthma is the most common chronic disease among children in Canada. It has several main causes that occur in utero and early in life. These ‘risk factors’ can be reduced through public health interventions that prevent asthma before it develops. Despite the opportunity to drastically reduce asthma in Canada, little progress has been made on asthma prevention due to a poor understanding of which interventions to invest in and when they should be applied. My objective is to provide high quality evidence to patients, providers and policy makers on how healthcare resources can best be used to prevent asthma in children. My research program will accomplish this objective using a computer simulation model of asthma (the Lifetime Exposure and Asthma Outcomes Projection [LEAP] model), which simulates the development and life trajectory of asthma. I will evaluate a series of preventative interventions that patients and knowledge users have identified as priorities, and determine their lifetime health benefits and impact on the healthcare system. I will work closely with patients, providers and policy makers to make sure the resulting policy recommendations are aligned with their values and can be implemented in healthcare systems.