A Participatory Action Research approach to telemedicine supported health care delivery in rural Nepal

Rural and geographically isolated, the majority of Nepalese communities have very low incomes, poor transportation, and scarce health care resources; these people provide the context for this study. The consequences of these deprivations include high maternal and infant mortality rates, high prevalence of infectious disease and poverty. There are therefore exceptional challenges and disparities in meeting health care needs. However the recent advent of modern information communication technology (ICT) or Telemedicine has unleashed a new wave of opportunities for supporting the delivery of health care services. Despite suggestions that telemedicine will offer hope in developing countries there is only limited published evidence to support this claim. Telemedicine is and must remain a process of the delivery of care rather than a technology. The system must connect patients and healthcare professionals in a chain of care, rather than follow the wide array of existing or new and advanced technology. The successful introduction of telemedicine with tangible outputs requires an in-depth understanding of the existing health care system of the country and its challenges; strongly expressed ‘genuine need’ for the service by all the stakeholders as interested partners (patients, practitioners, health care service providers and the public); the actual status of ICT infrastructure in the country and costs. This study used a Participatory Action Research (PAR) approach to explore the feasibility, acceptability and impact of a telemedicine system in partnership with Dhulikhel Hospital: Kathmandu University Hospital and with three of its 12 rural, remote outreach centres, and the populations they serve. Participatory, repeated data collection methods included surveys, interviewing, listening and being with staff and communities over a two year period. The researcher and researched engaged in a complex inter-locking journey from which the Unlocking, Unblocking and Validation concepts emerged. The findings of this study emphasise the pivotal role that the rural health care workers play. Telemedicine not only has a place in improving access to healthcare through enhanced communication but it also empowers health care workers. These people need continued support to develop their competencies and boost their confidence within the changing health care environment. In conclusion telemedicine is primarily about people rather than technology. Effective and holistic telemedicine development is built upon a combined, interactive model involving access, communication and empowerment

Characterization of glacial sediments from a 700,000-year-old Lake Junín drill core

Lake Junín (11.0°S, 76.2°W) is an intermontane lake at an elevation of 4085 masl in Junín, Peru. The lake spans ~300 km2 and has a water depth of ~12m. It is dammed at its northern and southern ends by glacial alluvial fans that have been dated \u3e250 ka, indicating that the lake is at least this old. Lake Junín has never been overridden by ice in the past 1 million years making it one of the few lakes in the tropical Andes that predates the last maximum extent of glaciation and has a continuous record of waxing and waning of nearby Cordilleran glaciers. In July and August of 2015, piston cores were obtained from three sites in Lake Junín. These cores were overlapped to form a continuous record spanning the past ~700 ka. Siliciclastic flux, magnetic susceptibility (MS), mean grain size, and Ti/Ca of sediments from Lake Junín provide proxy records of glacial erosion and glaciation in adjacent valleys. Seven periods of glaciation are determined by relatively high magnetic susceptibility, low CaCO3, high clastic flux and Ti+Si+Al /Ca ratio. Mean grain size during all glacial cycles, irrespective of glacial extent is ~1- 2 microns. The dominance of fine glacial sediments and absence of coarse sediments in the lake core indicate that there is no ice rafted debris (IRD) in Lake Junín. This supports the hypothesis that while the glaciers reached the lake edges, it never calved into the lake. The oldest glacial cycle has relatively coarser sediments (\u3e3 microns) but this distinctive change in grain size is hypothesized to indicate a fluvial depositional environment indicating the birth of Lake Junín to be around ~600,000 years. Despite smaller ice extent in the LLGM, siliciclastic flux between MS2-4 is higher than in other glacial periods which indicates that the glacier at the time was warm based with a higher activity ratio. Furthermore, comparison between skewness and mean grain sizes of glacial sediments in Lake Junín show that the two are inversely related. Coarser sediments have negative skewness with a finer tail while finer sediments have a positive 3 skewness. This variation in mean grain size distributions reflects a mixed signal of different mean grain sizes either from a single dominant valley with different rock types or from different valleys with prominently different rock types. In general, mean grain sizes are very fine (1-2 microns) so the sediments would have followed Stokes Law and travelled into the lake either as an interflow or overflow

Species and People: Linked Futures.

A report, with case studies, on the contribution of wildlife conservation to rural livelihoods and the Millennium Development Goal

Tectonic Evolution of the Bhumichula Plateau: A High-Elevation Low-Relief Surface in Western Nepalese Himalaya

The Bhumichula plateau is an anomalously high elevation low-relief (HELR) surface at >4000 m in the midst of the western Nepalese Himalayan fold-thrust belt. The plateau is situated in the northeastern part of the Dadeldhura klippe, an erosional outlier of Greater Himalayan high-grade metamorphic rocks surrounded by low-grade, structurally underlying Lesser Himalayan rocks. Using low-temperature thermochronology, we test whether the Bhumichula HELR surface formed at low elevation and was later uplifted, developed in situ at high elevation following tectonic disturbance, or if it is a remnant of an older, more extensive HELR that has been shrinking due to recent tectonically driven incision. Average apatite (U-Th)/He ages are ~6 Ma on both the plateau surface and along the valleys that cut through the surrounding region, whereas apatite fission track ages are ~7-9 Ma on the plateau surface and ~11-14 Ma on the flanks. Thermal modeling suggests that the main period of exhumation and erosion was ~14 Ma for the valley bottom samples in the southwest limb of the klippe and ~7 Ma for Bhumichula plateau in the northeast limb of the klippe, consistent with the timing of slip on the Ramgarh thrust and initial growth of the Lesser Himalayan Duplex (LHD), respectively. Spatial differences in the timing of cooling for the northeast and southwest limbs of the klippe 24 is interpreted to indicate heterogenous exhumation due to structural variation. Slow exhumation since ~7 Ma on the Bhumichula plateau suggests attainment of high elevation by mid-Miocene time. Exhumation and uplift ~7 Ma due to growth of the LHD is therefore likely to be responsible for drainage reorganization and resulting preservation of low-relief at Bhumichula due to a combination of fluvial and glacial processes.Release after 06/29/202

Localising climate change: science, nature, fire and weather in the Blue Mountains

Theoretical thesis."Thesis presented for the Master of Research degree""10 October 2014"Includes bibliographical references.1. [Introduction] -- 2. Conceptual framework -- 3. Methodology -- 4. Results & discussions -- 5. Conclusions -- References -- Appendices.The belt of south east Australia where the Blue Mountains lie, with its extensive Eucalypt forests, is among the most fire prone regions in the world. Co-existing with fire in coming decades will mean greater challenges for the people in this landscape as recent reports link climate change to increasing bushfire risk (Climate Change Authority, 2014; Hughes and Steffen, 2013). A survey by CSIRO (Leviston et. al. 2014, page 2) on the attitudes of Australians towards climate change show that 47.3% believe in human-induced climate change. But what does that mean in terms of how people behave and act for climate change? The same survey noted that the degree in surety of climate change did not predict behaviour.Experts have commented that climate science is reductionist, techno scientific and disengaged from the everyday lives of ordinary people (Brace and Geoghegan, 2010; Hulme 2009; Backstrand and Lovbrandt, 2006). This study contends that it is important to consider local perspectives on linkages of climate change to recurring natural hazards as these may provide acceptable approaches to adapting to and addressing increasing risks from climate change. Hence, drawing on Foucauldian theories on discourse and the work on social nature (Castree, 2005; Castree and Braun, 2001) this study analysed the social constructions of bushfire and climate change among pro-environmental Blue Mountains residents.The results of the study present strong evidence that individuals are merging science based knowledge with their lived experiences of place-based weather and landscape observations. The study participants shaped a dominant narrative that constructs bushfire as part of nature and life, but their practice in response to it was dependent on varied socio-economic and cultural backgrounds that in turn influenced their priorities for action. Overwhelmingly, the participants agreed that in the face of increasing bushfire risks, community engagement and mobilization would be the most practical and effective way to go. The findings indicate that communication on climate change needs to be context, culture and audience specific rather than abstract one-model-fits-all approaches. This study concludes that recognizing bushfire as a socio-ecological phenomenon, rather than simply a natural hazard, is an important step in developing appropriate locally-imbedded responses.Mode of access: World wide web1 online resource (x, 84 pages) illustrations, map

Time for an organized cervical cancer screening in Bhaktapur, Nepal

Background Cervical cancer is the most common cancer in Nepal and most often they are diagnosed as stage 2 or more. Despite having country’s cancer referral hospital B.P Koirala Memorial Cancer Hospital (BPKMCH), the biggest well equipped in terms of infrastructure, treatment facility and expert manpower is in Bharatpur, organized cervical cancer screening service is not yet exists in this area. Objective To start a new programme like this it is essential to assess a cervical cancer program and its ability to detect a proportion of possible abnormal cervical smear and assess women’s barrier for attending cervical cancer screening service. Thus the present study aims at identifying determinants of these factors that are necessary for successful cervical cancer screening programme in Bharatpur, Nepal. Methods Population based cross sectional study was carried out from October 2006 to march 2007. 1547 ever married women aged 15-59 were selected with cluster randomization procedure from ward number 11 Bharatpur municipalities. Ethical clearance to carry out this study was sought from Nepal Health Research council (NHRC) ethical clearance committee. Pap smear test was carried out in BPKMCH and reporting was done on Bethesda system. Interviews were performed using a standard questionnaire pertaining to socio-demographic and reproductive characteristics, their awareness and knowledge regarding cervical cancer and their barriers to utilize the cervical cancer screening service. Results Out of 1547 total study population 1033 participated in the study and 977of them had Pap smear. Proportion of abnormal cervical smear detected in this study includes ASC: 2.86%, LSIL: 0.2% and HSIL: 0.5%. Thus total prevalence of different grades of abnormal cervical smear was found to be 3.5%. Those who had previous Pap smear 29% belongs to women aged 16-29, 46.6% with aged 30-44 and 42% with aged 45-59. Though 40% have heard of cervical cancer only 26% have responded correctly about the possible prevention and 24.7% responded correctly for its treatable nature when diagnosed early. Health workers role for information dissemination was found lower (47.8%) than mass media and social networks78.5% & 78.5% respectively. Increase proportion of women with awareness of cervical cancer is noted as education level increases and chances of having previous Pap smear among women who have heard of cervical cancer is noted twice than those who have not heard. These differences in proportion were significant with P value of 0.000. 33.2% of the total study population were non participant. Among them 71% were from non slum area compared to 29% from slum area. Major determinants of these women’s barrier were their lack of perception about preventive role of Pap smear, lack of time and lack of permission from there husband to go to cervical cancer screening. Conclusion Proportion of women with HSIL in our study was not more than other study in developed country, yet cervical cancer is number one malignancy in Nepal. Existence of many societal behavioural patterns in Nepal that are risk to cervical cancer and present opportunistic cervical cancer screening services which have low coverage rate of cervical cancer screening for women with aged 30s and 40s who are considered highest risk group makes the establishment of organized screening service a must. Favourable rate of participation from women with lower socio economic status in our study could be due to free cervical cancer screening service that we have provided. Therefore to reach women with lower socioeconomic status the screening fee must be very nominal. Awareness of cervical cancer is crucial factor to increase cervical cancer screening coverage. Dissemination of proper information to the women, their husband and community at large and inclusion of women’s barrier in the community to cervical cancer information is a pre-requisite to have increase cervical cancer screening coverage

Telephone management of severe wasp stings in rural Nepal: a case report

We describe a young woman from a rural village in Nepal who suffered multiple wasp and hornet stings. She collapsed and was managed by a telephone consultation between a village health worker and a hospital specialist. The patient recovered fully. Not only was the telephone consultation efficient in terms of cost savings from avoided hospital treatment, but it was also effective since, with conventional care, there was a strong possibility that the patient would have died on her way to hospital. This case illustrates the potential for telephone-delivered rural care and management in emergency situations