Countering youth and urban violence with a community engagement cultural therapy program in Kingston, Jamaica (2013-2015).
This joint initiative in collaboration between the University of West Indies (UWI) and the Jamaican Government run Community Mental Health program in inner-city garrison communities in Kingston metropolitan area, attempts to influence the levels of interpersonal violence in two pilot communities: Seaview Gardens and August Town (population ≈ 7,000 each). These two garrison communities are of similar size and socio-demographic characteristics, high unemployment, low and very low income, high levels of interpersonal violence, and escalating homicide rates (Jamaica is the third most violent country in the world). The specific intervention is called Dream-A-World Cultural Therapy (DAW-CT) specifically targeting high-risk Grade 3 school children enrolled in two experimental and control schools and the wider youth and adult community population, with Cultural Therapy (CT) intervention. The proof of concept aims to validate and demonstrate the cost effective use of CT as a socially relevant and culturally sensitive community-based rehabilitation intervention in global mental health for future scaling-up to the school system in urban and rural settings and eventually the whole country. This is conducted in partnership between the Caribbean Institute of Mental Health and Substance Abuse (CARIMENSA) - UWI; the Douglas Hospital Research Centre; and the Institute of Family and Community Psychiatry, Jewish General Hospital. The research team is lead by Frederick Hickling and Geoffrey Walcott. The co-investigators are Duncan Pedersen (Douglas Institute) and Jaswant Guzder (Institute of Family and Community Psychiatry, JGH). Nicole D’Souza is a PhD Candidate ascribed to this project.
Tackling maternal psychosocial distress among marginalized indigenous women in Guatemala: a community-based approach (2013-2015).
Guatemala has the lowest indices of human development and one of the highest scores of social inequality in Latin America. The country’s stunting prevalence is 54%, the 3rd worst worldwide; most affected are peoples of indigenous in rural areas, with rates reaching 80% in some Mayan communities. Within urban poor areas such as Guatemala City, settlements of internally displaced, and marginalized rural populations, there is rampant poverty and increased susceptibility to psychosocial distress and infant stunting, among other problems. Marginalization of indigenous women contributes to low levels of education, poor health and low earnings, all of which in turn generate dependency, low rates of self-esteem, misunderstanding of rights and resources, and reluctance or inability to act independently. High levels of violence against women (one of the highest femicide rates in Latin America) and generalised tolerance toward it, reinforces dependency and impunity. At the same time, with high rates of out-migration of men in rural areas, women increasingly carry sole responsibility as head of households. Through a Participatory Action Research (PAR) framework, we will collaborate with community health workers and local leaders to develop and implement an intervention to improve access to mental health care for women in need. A prominent component of the intervention is to maximize the use of existing local resources, and empower communities to develop their own solutions to local problems. This is a collaborative initiative between the Douglas Hospital Research Centre, the Instituto de Nutrición de Centro América y Panamá (INCAP) and the London School of Hygiene and Tropical Medicine, United Kingdom. The research team is lead by Anne Marie Chomat (McGill PhD Candidate) and Victor Lopez (INCAP); and Duncan Pedersen (Douglas Institute) and Ricardo Araya (LSHTM), as co-investigators.
Vulnerability and adaptation of indigenous health systems to climate change (2011-2015).
The Indigenous Health Adaptation to Climate Change research program (IHACC) (www.ihacc.ca) has created a multinational interdisciplinary team to develop an understanding of the vulnerability of remote Indigenous health systems to climate change as a basis for implementing pilot adaptation interventions and adaptation planning. The program reflects the needs identified by community, government and indigenous organizations, and is currently under implementation among the Inuit (Canada), Pygmy (Uganda), and Shipibo and Shawi populations (Peru). Research, training, and intervention activities will be conducted on a regional and site-specific basis. Comparative analysis is built into program design through the utilization of a consistent vulnerability approach and methodology across countries and focused on cross-cutting global health issues. This is a collaborative initiative involving the Department of Geography, McGill University; the Universidad Peruana Cayetano Heredia (UPCH), in Peru; and Makerere University, in Uganda. The research team is lead by James Ford, A. Llanos and S. Lwasa. Duncan Pedersen (Douglas Institute) is a co-investigator and Carol Zavaleta is a PhD candidate ascribed to this project.
Defeating the Giant with a Slingshot: Testing a new technology to fight the global trauma epidemic (2012 – 2014).
Traumatic stress remains a global mental health problem of increasing proportions in resource-scarce countries. Large segments of the population suffer from the after-effects of traumatic events, such as natural and man-made disasters, war and interpersonal violence. Given the debilitating and long-term duration of the disorder, there is an unmet need to provide victims with effective and readily available treatments. This is particularly true in many developing countries, where treatment options are limited, despite the high incidence of certain types of intentional violence and trauma, notably torture. Reconsolidation blockade using the beta-blocker propranolol is emerging as a promising simple and inexpensive new treatment for PTSD. This research project will have both a quantitative and a qualitative component to test this new technology. The randomized controlled trial will compare the efficacy of reconsolidation blockade with propranolol vs. Selective Serotonin Reuptake Inhibitors (SSRI) to treat Nepali torture survivors suffering from PTSD. The qualitative component will be complementary to reinforce the assessment of feasibility and usefulness of the reconsolidation blockade approach for a future, larger study implementation. The overall goals of this project are (i) to replicate our work and show feasibility in a non-western sample and (ii) to establish the non-inferiority of reconsolidation blockade vis-à-vis the current gold standard pharmacological treatment for PTSD (paroxetine). If successful, this project’s societal impact could be important in helping demonstrate that reconsolidation blockade using propranolol could offer a fast and inexpensive solution to treating individuals suffering from PTSD across the world. The collaborating institutions are the Centre for Victims of Torture (CVICT) and the Douglas Hospital Research Centre. The research team is lead by Hanna Kienzler, Research Associate, and Co-investigators are Alain Brunet and Duncan Pedersen (both from the Douglas Institute). Ram Prasad Sapkota is a McGill PhD Candidate ascribed to this project.
Global Health Research Capacity Strengthening Program (GHR-CAPS Program) (2009 – 2015).
In 2007, 13 teams across Canada were awarded the prestigious GHRI-Teasdale-Corti Team Grant, averaging $1.5 million each over a four-year period. Four of the successful teams are housed in Quebec’s four major universities. The research agenda is representative of the wide spectrum of themes that constitute global health: land use, environment and eco-system health (UQAM), mental health of populations exposed to organized violence and complex emergencies (McGill), foodborne, waterborne and zoonotic diseases (Laval), and vulnerability and equity in public policies and health systems (Montreal). The teams are led by established researchers and GHR partners in Canada, Africa (Benin, Burkina Faso, Mali, Senegal), Asia (Nepal, Sri Lanka) and Latin America and the Caribbean (Brazil, Guatemala, Guyana, Peru, St-Lucia, Suriname, Trinidad and Tobago). Transcending this diversity, the four university-based teams are united by the principles constituting the above mentioned integrated platform that guide the way global health research is undertaken in resource-poor countries: responding to identified health and development needs in particular research contexts, employing a transdisciplinary perspective, furthering ethical and critical deliberation on GHR practices, building equitable research partnerships, and a commitment to capacity building and integrated knowledge translation. The overarching goal of the training program is to contribute to the production of an integrated ontological and methodological platform for GHR through the establishment of an international network for GHR and capacity building in Quebec, Canada and selected low and middle-income countries. (see webpage: www.pifrsm-ghrcaps.org). The research team has as principal investigators: Slim Haddad (UdM), Duncan Pedersen (McGill U) and Pierre Fournier (UdM).
Political violence, natural disasters and health outcomes: developing innovative health policies and interventions (Trauma and Global Health) (2007 -2012).
This Global Health Research Initiative: Teasdale-Corti Team Grant Program aimed at building a sustainable research environment in partnership between McGill University and research teams and their host institutions from four low and middle-income countries: Guatemala, Nepal, Peru, and Sri Lanka. The ultimate objective of the program was to reduce the mental health burden of civilian populations exposed to protracted and endemic political violence and episodic natural disasters, foster the process of healing, psychosocial rehabilitation and recovery, and generate improved mental health policies and services in the participating countries [website: www.mcgill.ca/trauma-globalhealth].