Case 1 : Mobilizing Knowledge into Action: Best Practices in Responding to Urgent Refugee Health and Resettlement Service Needs

The Syrian Civil War has displaced 6.5 million people internally within Syria (UNHCR, 2016) and has led 5 million to flee the country and live as refugees in Turkey, Egypt, Iraq, Jordan, Lebanon, and other North African countries (UNHCR, 2017). In 2015, the Canadian government and Canadian citizens stepped in with a nationwide commitment to resettle 25,000 Syrian refugees. Due to community-based rallying, the commitment expanded to a total of 40,000 Syrian refugees by mid-2017 (Government of Canada, 2017). In response to this urgent and unprecedented arrival of refugees, hundreds of community agencies and many community groups across Canada banded together to provide services and supports to Syrian families (Hansen & Huston, 2016; Access Alliance Multicultural Health and Community Services, 2017). Various sectors were represented in this effort: healthcare, settlement, community and nonprofit, housing, education, government, language, sponsor groups, children’s services, community and civic participation, police and safety, faith-based organizations, research, employment, and food assistance. Among organizations that represented these sectors, Access for Health and Settlement Centre was a community health centre that situated itself in a temporary accommodation site, serving primary health care, interpretation, and other community services (Access Alliance Multicultural Health and Community Services, 2017). Through this effort, Dr. Zola Faraji, a senior scientist at Access for Health and Settlement Centre, and his community-based research team began to recognize the importance of documenting the manner in which the response was unfolding around them within the Greater Toronto Area (GTA). Zola knew that upon the government’s announcement to resettle so many Syrian refugees in Canada, none of the sectors and agencies who were to participate were adequately prepared to coordinate a response that matched the urgency of the situation. However, the response had been a remarkable one but not without its successes and challenges. Therefore, Zola conducted an environmental scan to document how service provider agencies within the GTA planned and delivered health, settlement, and other services for a large number of refugee families within a short period of time through a cross-sector perspective (Access Alliance Multicultural Health and Community Services, 2017). The study findings captured key successes and challenges that informed the development of best practices for refugee health and resettlement services, particularly in relation to future large-scale arrivals of refugees. Now, Zola and her team are at a crossroad. They possess vital research findings and must develop recommendations as well as relationships with key players across various involved sectors. The team is developing a knowledge translation strategy. How can Zola and her team develop and implement a strategy that ensures that knowledge is not only shared but implemented into action? How can this research be utilized in a knowledge-to-action framework to benefit these vulnerable populations in the future

Precarious Work Experiences of Racialized Immigrant Woman in Toronto: A Community- Based Study

Despite their high levels of education, racialized immigrant women in Canada are over-represented in low-paid, low-skill jobs characterized by high risk and precarity. Our project documents the experiences with precarious employment of racialized immigrant women in Toronto. We conducted 30 semi-structured interviews with racialized immigrant women. Participants were recruited through posted flyers, partner agencies, peer researcher networks and snowball sampling. Interviews were transcribed and analyzed using NVivo software. The project followed a community-based participatory action research model. Participants faced powerful structural barriers to decent employment and additionally faced barriers associated with household gender relations. Their labour market experiences negatively impacted their physical and mental health as well as that of their families. These problems further constrained women’s ability to secure decent employment. Our study makes important contributions in filling the gap on the gendered barriers racialized immigrant women face in the labour market and the gendered impacts of deskilling and precarity on women and their families. We propose labour market reforms and changes in immigration and social policies to enable racialized immigrant women to overcome barriers to decent work

Base Deficit as a Predictor of Mortality in Sepsis and Septic Shock.

Introduction: Sepsis is a common problem encountered in the emergency room which needs to be intervened early. It is always difficult to have the quick prognostic marker of sepsis in busy emergency. So this study was conducted to determine whether base deficit can be used as an indicator of mortality among septic patients in emergency room set up like ours. Methods: It was a hospital-based descriptive cross-sectional study done at Tribhuvan University Teaching Hospital, Kathmandu from March 2018 to December 2018.  Acute physiology and chronic health evaluation II score(APACHE II), Base deficit, Sequential Organ Failure Assessment(SOFA)score on first day of arrival in the emergency room were calculated. The association of 28-day outcome with Acute physiology and chronic Health Evaluation II score, Base deficit value and SOFA score were derived. Results: Out of 229 patients with septic shock 62 died (27%) and among 71 patients without septic shock,12 died(16.9%) .Overall mortality was 24.66 %(n= 74).The area under the ROC curve for Base deficit(0.864;95% C.I.=0.822-0.906), APACHE II( 0.782;95%C.I=0.718-0.848;,SOFA(0.689;95% C.I=0.620-0.757) were greater than 0.7 except for SOFA which signifies these test to  have fair efficacy to predict mortality. Conclusions: High base deficit value predicts mortality in patients with sepsis and septic shock. Keywords: Base Deficit; Sepsis; Septic Shock, Predictor, Mortality DOI: http://doi.org/10.3126/jkahs.v2i2.2516

What Role Does Type of Sponsorship Play in Early Integration Outcomes? Syrian Refugees Resettled in Six Canadian Cities

AbstractThere is little longitudinal research that directly compares the effectiveness of Canada’s Government-Assisted Refugee (GAR) and Privately Sponsored Refugee (PSR) Programs that takes into account possible socio-demographic differences between them. This article reports findings from 1,921 newly arrived adult Syrian refugees in British Columbia, Ontario, and Quebec. GARs and PSRs differed widely on several demographic characteristics, including length of time displaced. Furthermore, PSRs sponsored by Groups of 5 resembled GARs more than other PSR sponsorship types on many of these characteristics. PSRs also had broader social networks than GARs. Sociodemographic differences and city of residence influenced integration outcomes, emphasizing the importance of considering differences between refugee groups when comparing the impact of these programs.RésuméIl existe peu de recherches longitudinales comparant directement l’efficacité des programmes gouvernemental (RPG) et privé (PPR) de parrainage des réfugiés au Canada qui tiennent compte de possibles différences socio-démographique entre eux. Cet article rend compte des résultats de 1921 nouveaux arrivants syriens adultes en Colombie-Britannique, en Ontario et au Québec. Les RPG et PPR diffèrent largement sur plusieurs caractéristiques démographiques, dont le temps du déplacement. De plus, les PPR parrainés par groupes de cinq ressemblaient davantage aux RPG que les autres types de parrainage PPR sur plusieurs de ces caractéristiques. Les PPR avaient aussi des réseaux sociaux plus larges que les RPG. Les différences sociodémographiques et la ville de résidence influent sur l’intégration, ce qui fait ressortir l’importance de tenir compte des différences entre les groupes de réfugiés dans la comparaison de l’impact de ces programmes

Aspirations for Higher Education among Newcomer Refugee Youth in Toronto: Expectations, Challenges, and Strategies

A large percentage of refugees have low levels of education and official language fluency upon arrival in Canada. Thi spaper discusses educational goals of newcomer refugee youth from three communities in Toronto (Afghan, Karen, and Sudanese), and explores how these are linked to premigration and post-migration determinants. Guided by community-based research principles, we collaborated with eight refugee youth peer researchers and conducted ten focus groups and thirteen interviews with refugee youth. Results show that newcomer refugee youth develop strong aspirations for higher education in Canada as a proactive response to overcome pre-migration experiences of forced migration and educational disruptions. We then discuss how these youth negotiate educational goals in post-migration context in relation to shifts in family responsibilities and everyday encounter with multiple systemic barriers in Canada. In doing this, we examine the thin line between vulnerability and empowerment that refugee youth straddle and reveal policy gaps and contradictions in the depoliticized humanitarianism within refugee resettlement in Canada.Un grand pourcentage de réfugiés a un faible niveau d’ éducation et une faible connaissance des langues officielles à leur arrivée au Canada. Cet article présente les buts éducationnels des nouveaux jeunes réfugiés de trois communautés de Toronto (afghane, karen et soudanaise) et examine en quoi ceux-ci sont liés à des déterminants pré et postmigration. Suivant des principes de recherche communautaire, nous avons travaillé de concert avec huit jeunes chercheurs de ces communautés, avons tenu dix groupes de discussion et réalisé treize entrevues avec des réfugiés. Les résultats montrent que les nouveaux jeunes réfugiés aspirent fortement à une éducation supérieure au Canada en tant que réponse proactive aux expériences prémigration d’un déplacement forcé et aux interruptions dans leur éducation . Nous examinons ensuite les façons dont les jeunes concilient leurs buts éducationnels dans un contexte postmigration par rapport aux changements dans les responsabilités familiales et aux obstacles systémiques au Canada qui font partie de leur quotidien. Ce faisant, nous étudions la mince ligne entre la vulnérabilité et l’autonomisation que chevauchent ces jeunes et mettons au jour les manques dans les politiques et les contradictions dans l’humanitarisme dépolitisé de la réinstallation des réfugiés au Canada

The Politics of Subversion in Development Practice: An Exploration of Microfinance in Nepal and Vietnam

This paper considers the ways in which beneficiaries of microfinance programmes in two Asian countries routinely transgress programme protocols and regulations, and fail to conform to the entrepreneurial subjectivities the programmes seek to promote. It aims to develop an interpretive framework for these practices. Specifically, we take up Abu-Lughod's injunction to 'use resistance as a diagnostic of power' in order to explore the political rationalities and governmental technologies of microfinance, as well as the cultural ideologies and material conditions in particular locales. We then consider the difficult question of political agency by drawing on prevailing theories of resistance to develop a typology that distinguishes among three overlapping kinds of transgressive practices. The objective ultimately is to explore how this interpretive framework might contribute to imagining more politically engaged and responsive models of development, as well as to critiquing the market-oriented foundation of existing models.

A study on role of follow up in minor surgical procedures

Background: Minor surgical procedures are surgeries that can be performed in the clinic under local anesthesia and doesn’t require preoperative and postoperative admission. In most of the institutions in our country, we advised patients to follow up within 7 to 10 days following minor surgical procedures. Unnecessary follow up increases stress to the patients in terms of not being able to manage daily routine work and would be costly as well. As a General Practitioner, majority of the cases done are the minor surgical procedures. Methods: The study was a prospective cross-sectional study conducted in the General Surgery Department at United Mission Hospital, Palpa from Dec 2013 to May 2013. 228 patients were divided into two groups of “No follow up” group and “Follow up” group.No Follow up Group was asked pre-formed questionnaires by telephone whereas Follow-up group were asked to follow up routinely on day 7 to 10 days of surgery and asked the same questions. Statistical analysis was done using SPSS program and Microsoft Excel. P-value of <0.05 was considered statistically significant. P-value was determined by using the Chi-Square test. Result: The overall wound infection among 228 patients was found to be 14.5 percent with an infection rate of 16.4 percent in No Follow-up group and 12.7 percent in Follow-up group. The infection rate was found to be higher among the older age group of patient maximum being 36.4% in the age group of 50-59 years with a p-value of 0.053. Other risk factors like age, sex, residence, duration of surgery, socioeconomic status, history of medical illness and BMI didn’t have a significant association with the rate of infection following a minor surgical procedure. Conclusion: The routine postoperative follow up in minor surgery is unnecessary unless there are any signs suggestive of infection. Keywords: Minor surgery, Postoperative infection. DOI: http://dx.doi.org/10.3126/jkahs.v2i1.24412

Refugee youth and migration: using arts-informed research to understand changes in their roles and responsibilities

This article presents the findings from a community-based qualitative study that utilized an arts-informed method to understand the changes in refugee youth's roles and responsibilities in the family within the (re)settlement context in Canada. The study involved 57 newcomer youths from Afghan, Karen, or Sudanese communities in Toronto, who had come to Canada as refugees. The data collection method embedded a drawing activity within focus group discussions. We present these drawings, as well as explanations and discussions to capture the complexities of their experiences. The data analysis involved 1. reflective dialogue between each participant and her/his own drawing; 2. group dialogue, reflection, and elaboration on meanings in the drawings; and 3. the research team's reflective dialogue. The findings revealed that the youths' roles and responsibilities have both changed and increased following migration, often involving interpretation and translation, and providing financial and emotional support to their family members, in addition to engaging in household chores and educational pursuits. Use of drawings as a data generation method enriched the findings of focus group discussions, and vice versa in a number of ways. We also present implications for future research involving arts-informed methods. (author's abstract)In diesem Beitrag berichten wir Ergebnisse aus einer qualitativen Studie, in der kunstbasierte Verfahren zum Einsatz kamen, um Änderungen in den Rollen und Verantwortlichkeiten von Jugendlichen aus Flüchtlingsfamilien im Zuge ihrer (Wieder-) Ansiedelung in Kanada verstehen zu können. Insgesamt nahmen 57 Jugendliche aus afghanischen, karenischen und sudanesischen Gemeinschaften in Toronto an der Untersuchung teil, die als Flüchtlinge nach Kanada gekommen waren. Teil der Datenerhebung war das Anfertigen von Zeichnungen im Rahmen von Fokusgruppen. Diese Zeichnungen werden zusammen mit Erläuterungen und Auszügen aus den Gesprächen im Folgenden vorgestellt, um die Komplexität der jugendlichen Erfahrungen zu veranschaulichen. Dabei umfasst die Datenanalyse 1. den reflexiven Dialog der individuellen Teilnehmer/innen mit ihren Zeichnungen, 2. Reflexionen und Bedeutungszuschreibungen aus dem Gruppengespräch und 3. Reflexionen des Forschungsteams. Die Ergebnisse legen nahe, dass Rollen und Verantwortlichkeiten der Jugendlichen nach Migration sich sowohl veränderten als auch anwuchsen. Dies betraf Interpretations- und Übersetzungsaufgaben sowie das Hinzukommen emotionaler und finanzieller Unterstützung für Familienmitglieder zusätzlich zu Hausarbeit und Ausbildung. Die Nutzung von Zeichnungen bereicherte die Datenerhebung in den Gruppendiskussionen und umgekehrt. Welche Anregungen sich aus unserer Arbeit für künftige Forschungen mit kunstbasierten Verfahren ergeben, diskutieren wir am Ende des Beitrags. (Autorenreferat

Jóvenes refugiados y migración: uso de investigación orientada en las artes para comprender cambios en sus roles y responsabilidades

In diesem Beitrag berichten wir Ergebnisse aus einer qualitativen Studie, in der kunstbasierte Verfahren zum Einsatz kamen, um Änderungen in den Rollen und Verantwortlichkeiten von Jugendlichen aus Flüchtlingsfamilien  im Zuge ihrer (Wieder-) Ansiedelung in Kanada verstehen zu können. Insgesamt nahmen 57 Jugendliche aus afghanischen, karenischen und sudanesischen Gemeinschaften in Toronto an der Untersuchung teil, die als Flüchtlinge nach Kanada gekommen waren. Teil der Datenerhebung war das Anfertigen von Zeichnungen im Rahmen von Fokusgruppen. Diese Zeichnungen werden zusammen mit Erläuterungen und Auszügen aus den Gesprächen im Folgenden vorgestellt, um die Komplexität der jugendlichen Erfahrungen zu veranschaulichen. Dabei umfasst die Datenanalyse 1. den reflexiven Dialog der individuellen Teilnehmer/innen mit ihren Zeichnungen, 2. Reflexionen und Bedeutungszuschreibungen aus dem Gruppengespräch und 3. Reflexionen des Forschungsteams. Die Ergebnisse legen nahe, dass Rollen und Verantwortlichkeiten der Jugendlichen nach Migration sich sowohl veränderten als auch anwuchsen. Dies betraf Interpretations- und Übersetzungsaufgaben sowie das Hinzukommen emotionaler und finanzieller Unterstützung für Familienmitglieder zusätzlich zu  Hausarbeit und Ausbildung. Die Nutzung von Zeichnungen bereicherte die Datenerhebung in den Gruppendiskussionen und umgekehrt. Welche Anregungen sich aus unserer Arbeit für künftige Forschungen mit kunstbasierten Verfahren ergeben, diskutieren wir am Ende des Beitrags.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1503156This article presents the findings from a community-based qualitative study that utilized an arts-informed method to understand the changes in refugee youth's roles and responsibilities in the family within the (re)settlement context in Canada. The study involved 57 newcomer youths from Afghan, Karen, or Sudanese communities in Toronto, who had come to Canada as refugees. The data collection method embedded a drawing activity within focus group discussions. We present these drawings, as well as explanations and discussions to capture the complexities of their experiences. The data analysis involved 1. reflective dialogue between each participant and her/his own drawing; 2. group dialogue, reflection, and elaboration on meanings in the drawings; and 3. the research team's reflective dialogue. The findings revealed that the youths' roles and responsibilities have both changed and increased following migration, often involving interpretation and translation, and providing financial and emotional support to their family members, in addition to engaging in household chores and educational pursuits. Use of drawings as a data generation method enriched the findings of focus group discussions, and vice versa in a number of ways. We also present implications for future research involving arts-informed methods.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1503156Este artículo presenta los resultados de un estudio cualitativo comunitario que utilizó método orientado en las artes para entender los cambios de roles y responsabilidades familiares de jóvenes refugiados dentro del contexto de (re)asentamiento en Canadá. El estudio incluyó 57 jóvenes recién llegados de comunidades afgana, karen o sudanesa en Toronto, que llegaron como refugiados a Canadá. El método de recogida de datos integraba una actividad de dibujo dentro de discusiones de grupos focales. Presentamos estos dibujos, así como explicaciones y discusiones para capturar la complejidad de sus experiencias. El análisis de datos incluyó: 1. diálogo reflexivo de cada participante con su propio dibujo; 2. diálogo de grupo, reflexión y elaboración de significados a partir de los dibujos; 3. diálogo reflexivo del equipo de investigación. Los resultados revelan que los roles y responsabilidades de los jóvenes han cambiado y se han incrementado después de la migración, a menudo incluyendo interpretación y traducción y proveer apoyo financiero y emocional a los miembros de sus familias, además de la participación en las tareas domésticas y actividades educativas. La utilización de dibujos como método de generación de datos enriqueció de múltiples maneras los resultados de la discusión de los grupos focales, y viceversa. También presentamos implicaciones para futuras investigaciones que utilicen métodos orientados en las artes.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs150315