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Reflexivity, positionality and power in cross-cultural participatory action research with research assistants in rural Cambodia
Education Action Research, Pages 1-15 | Received 25 Nov 2016, Accepted 12 May 2017, Published online: 05 Jun, 2017.
Abstract: This paper draws on the experiences of a doctoral student undertaking a cross-cultural, cross-language participatory action research (PAR) project in rural Cambodia. Cambodia is a largely Buddhist country with a complex history of religion, invasion, colonisation, war and oppression. Despite a democratic constitution, political control and fear of challenging authority are ever present; and all had an impact on the participation and development of this project. I recruited eight volunteer community health workers (CHWs) and two research assistants (RAs) with an aim to explore methods and challenges faced when trying to improve health with and for community members. Over eight participatory workshops and a two-day training session CHWs identified, implemented and reflected on solutions to community health problems. Simultaneously, the RAs and I reflected on the processes and challenges we faced. Creating opportunity for reflexivity allowed for discussion to emerge around culture, position and power and how these were impacting on the research process and outcomes. Established social hierarchical power structures in Cambodia presented challenges to undertaking a PAR project with emancipatory and social change aims. Such structures also impacted on the ability and readiness of participants to be critical and analytical. The importance of the RAs as cultural navigators and the necessity of embracing their situated knowledge as both an insider and outsider is a key finding.
Grassroots responses to violence against women and girls in post-earthquake Nepal: Lessons from the field
Kay Standing, Sara Parker, Sapana Bista
Gender & Development, Volume 24, Issue 2, 2016 Special Issue: Violence Against Women and Girls, pages 187-204, 2016.
Abstract: Violence against women and girls (VAWG), including sexual violence, can increase after natural disasters. This article provides evidence from Nepal, a country where progress has been made on gender equality but VAWG remains an endemic problem. Research since the earthquakes involving women activists and non-government organisations indicates the continuing challenges facing disaster response efforts to prevent VAWG and protect women. Women and girls in camps and temporary shelters feel threatened and insecure due to the risk of violence and lack of privacy. Humanitarian aid, health care, and disaster responses can challenge VAWG, and offer safe spaces for women and girls to be established. This article draws on the views of grassroots women’s activists in Nepal and shares lessons for development and humanitarian workers about steps to be taken to challenge and minimise VAWG in emergency situations.
Professor Padam Simkhada, Aditi Sharma, Edwin van Teijlingen, Rachel Beanland
Nepal Journal of Epidemiology, Vol 6, No 1, 2016.
Abstract: Background: Increased travel abroad has a significant impact on the incidence and prevalence of Sexually Transmitted Infections (STIs). Previous reviews have focused on the knowledge, attitudes and behaviour of tourists and acquisition of STIs. Less is known about the impact on tourism operators in countries visited by tourists. The aim of this review is to ascertain factors influencing sexual behaviour between workers in the tourism industry and tourists; exploring the prevalence of sexual behaviour between the two populations, their perceptions of sexual risk while engaging in sexual activities and the knowledge of tourism operators regarding STIs. Methods: A systematic review was conducted. Database searches were performed in Medline/Ovid, EMBASE, Cochrane library and CINAHL for studies published between 2000 and March 2016. Grey literature searches were completed in the NHS database and Google Scholar between 2000 and December 2013. Papers were independently selected by two researchers. Data were extracted and critically appraised using a pre-designed extraction form and adapted CASP checklist. Results: The search identified 1,602 studies and 16 were included after review of the full text. Studies were conducted in nine countries. Findings suggest that STI knowledge, attitude and practice were fairly good among tourists and tourism workers, but there is a need for pre-travel advice for travellers, especially those travelling to low and middle-income countries. Greater importance was given to tourists than to tourism operators and locals interacting with tourists. Studies suggest that as a group both tourist and tourist workers were likely to engage in sexual activities. Overall, both condom use and STI screening were low, among tourists as well as tourism operators. Furthermore, studies reported links between drug and alcohol use and sexual behaviour and risk taking. Conclusion: Although less research appeared to have been conducted among tourism workers than tourists, it does demonstrate the need for education, training and promotion of travel medicine. STI screening, pre-travel advice, travel history in terms of contracting STIs and safe-sex awareness-raising are needed. More and better sexual health education and relevant tourism policies are needed globally.
Yagya Prasad Subedi, Professor Padam Simkhada, Bishwambher Pyakuryal
Open Journal of Political Science Vol.6 No.2, PP. 168-178, 2016.
Abstract: Background: Historically, the process of nutrition transition begins with changes in economic structures which move away from agrarian economies to successful industrialisation, with high economic growth, urbanisation and increased real per capita income. Objective: The objective is to identify where Nepal is in economic transition and whether economic transition is considered as one of the proximate determinants of nutrition transition in Nepal. Results: Nepal’s position in the economic transition has been identified by using Popkin’s framework which is scaled from Pattern I to Pattern V. The time series trends indicated that new patterns of economic transition had been observed during 1995-2010, which was similar to the pattern IV of the Nutrition Transition as described by Popkin. The national income of Nepal increased over the past four decades. The GDP of Nepal has shown an annual increase at a rate of 3.92 per cent between 1970 and 2010. Conclusion: Economic growth and agricultural trade liberalization have induced plant fats supply in Nepal. Tourism has also transferred the taste and preferences of western foods to tourist destinations and urban centres, including potential negative health consequences related to excess consumption of fat, sugar and process foods.
Pramod Regmi, Edwin van Teijlingen, Vanora Hundley, Professor Padam Simkhada, Sheetal Sharma, Preeti Mahato
Health Prospect Vol 15, No 1, 2016.
In 2000, the United Nations (UN) adopted eight MillenniumDevelopment Goals (MDGs), three of these focused on health although several other MDGs included health-related components such as nutrition and sanitation (1). Overall progress towards the MDGs has been inspiring and specifically the health-related targets, e.g. MDG4 (reduce child mortality), MDG5 (improve maternal health) and MDG6 (combat HIV/ AIDS, malaria and other diseases) have been promising. For example, the global maternal mortality ratio (MMR) has fallen by 44% (from 341 in 2000 to 216 per 100,000 live births in 2015) and under-five mortality in the same period dropped by 53% (2). Despite these achievements, the world has failed to meet these MDG targets for both maternal mortality and under-five mortality, a fact recognised by maternal health practitioners, policy-makers and researchers across the globe (3). Moreover, progress has not advanced equally across the globe, for instance, improvements in MMR have been better in Southeast Asia (69% reduction) and the Western Pacific (64% reduction) (2).
Preeti Mahato, Pramod Regmi, Edwin van Teijlingen, Professor Padam Simkhada, Catherine Angell, Brijesh Sathian
Nepal Journal of Epidemiology 5(4): 518–519, 2015.
A massive earthquake hit Nepal in April followed by a strong aftershock in May. The earthquake had an impact in 31 districts out of the 75 districts of the country and total death toll reached 9,000, injured 23,000 and damaged 900,000 houses. Recent global and regional publications have indicated growing public health concerns and rebuilding infrastructures following the earthquake [2,3,4]; however none of the articles have focused on reproductive health care services, particularly on birthing centres in Nepal.
Stipulating citizen’s fundamental right to healthcare: Inference from the Constitution of Federal Republic of Nepal 2015
Professor Padam Simkhada, Pramod Regmi, Puspa Pant, Edwin van Teijlingen, Brijesh Sathian
Nepal Journal of Epidemiology Volume 5, No 4, 2015.
Nepal has a great opportunity to learn from, and collaborate with, non-governmental development partners and private sectors, and from other governments and organizations around the world, but we must move promptly.
Edwin van Teijlingen, Professor Padam Simkhada, Bhimsen Devkota, Padmadharini Fanning, Jillian Ireland, Dr Bibha Simkhada, Lokendra Sherchan, Ram Chandra Silwal, Samridhi Pradhan, Shyam Maharjan, Ram Maharjan
Nepal Journal of Epidemiology, Vol 5, No 3, 2015.
Abstract: Mental health of pregnant women and new mothers is a growing area of concern in both low- and high-income countries. Maternity services in the UK, for example, have focused more attention on maternal mental health. We recognise that pregnancy, birth and the postnatal period is a time of major psychological and social change for women.
Edwin van Teijlingen, Professor Padam Simkhada
Nepal Journal of Epidemiology, Vol 5, No 3, 2015.
Abstract: On too many occasions researchers conduct public health and/or epidemiological studies in low-income countries without the appropriate in-country ethical approval. This article reflects on some of the underlying reasons for not applying for ethical approval. The piece concludes that we need to start by educating our (junior) researchers and research students about the importance of research ethics. We conclude with a number of recommendations for researchers, scientific journal editors and reviewers and ethical committees in high-income countries to bring the message home to researchers that ethical approval should be sought in low-income countries if and when required.
Ak Narayan Poudel, David Newlands, Professor Padam Simkhada
Nepal Journal of Epidemiology, Vol 5, No 3, 2015.
Abstract: Thousands of people are infected with HIV/AIDS in Nepal and most of them are adults of working age. Therefore, HIV/AIDS is a big burden in Nepal. This review was conducted to find the existing knowledge gap about the economic burden of HIV/AIDS at the household level in Nepal, the extent of economic burden exerted by the disease, and to provide policy recommendations. It is concluded that there was a considerable knowledge gap about the issue, and the economic burden exerted by HIV/AIDS was big enough to push the affected households into poverty. It is suggested that more studies need to be conducted to fill the knowledge gap. Similarly, Government of Nepal and other organisations working in the field of HIV/AIDS need to provide economic supports (e.g.- support for travel costs) to the HIV positive people and need to increase the awareness level among general population for reducing stigma and discrimination, and reducing economic burden on them.