Geographic Information System (GIS): A growing application tool both in research and policy implementation

Written by Muhammad Asaduzzaman, PhD Research Fellow, Department of Community Medicine & Global Health, Institute of Health and Society, University of Oslo

Geographical information systems (GIS) is becoming a mounting concern to understand the disease burden, transmission dynamics of infectious diseases and programmatic management of the prevention strategies. As an environmental epidemiologist and One Health (OH) researcher, my research interests are focused on antimicrobial resistance (AMR), zoonoses and planetary health topics. GIS can play a vital role in these topics as well. Therefore, I aimed to equip myself in GIS methodology through specialized training to better understand my research questions and to present the research findings in comprehensive way. Recently, I attended such training with the financial support from Norwegian Research School of Global Health (NRSGH).

Descriptive Epidemiology of the Course (what, who, where, when and Why/How)

This was a specialized and residential summer course on ‘GIS in Environmental Epidemiology’ held from 4 -7 July 2022 at the Centro Studi in northeast Florence, Italy. This comparatively new course is part of the European Educational Programme in Epidemiology (EEPE) which is active since 1988. The course participants were doctoral and post-doctoral fellows from different countries such as Norway, UK, Denmark, Malaysia and Argentina. Dr. Danielle Vienneau and Dr. Kees de Hoogh, 2 experienced researchers on spatial modeling and environmental epidemiology from the department of Epidemiology and Public Health, SwissTPH, University of Basel, Switzerland were the course instructors. The course aim was to provide basic knowledge to the course participants on GIS for spatial data handling and analysis through a mix of lectures, demonstrations and hands-on practice using ArcGIS and QGIS.

**GIS course cohort’2022 with the course instructors**

My learning and achievement from this course

My PhD topic is the transmission dynamics and digital surveillance potential of OH-AMR in resource poor settings. Visualization of spatiotemporal distribution of AMR bacteria and genes is therefore crucial to identify the environmental hotspots as the mixing hub of such superbugs for both humans and animals . I have already collected the geolocations of my study samples and aimed to learn the fundamental skills to analyze and map GIS data. I found this course very helpful through which I have learnt geocoding, visualization by mapping, geographic scale and spatial precision, spatial relationships and how to integrate spatial and non-spatial data. I have also met few friends who have similar research interests and came to know about various projects from the fellow participants how they have utilized GIS in their studies. This course may not be sufficient to become a pro in GIS but definitely a good starting point for my future career goals. The course instructors have also provided few other resources to further work on. Based on the newly gained knowledge, I am working on a manuscript on environmental dimension of AMR using GIS mapping.

The way I would reflect on the course for me and my peers

First of all, this is an introductory course on GIS for which no prior and relevant knowledge or experience is required. Therefore, I would suggest this course to anyone who is interested in the use of GIS in his/her research, but particularly for those who are working on any aspect of environmental research. However, it seems intensive over time if anybody would like to understand the models and logics behind spatial linkage of exposure and contextual information for case studies used. Being a residential course in a nice venue on mountainside and far from the city, the ample time and concentration for the course required are ensured. Still I would like to have some break, peer-to-peer grouping and home task in between the course days to conceptualize every module well enough and 1-week course instead of 4 days might be better. As I mentioned earlier that GIS is an important and emerging tool in research and program perspective, that is why I recommend this course to the global health researchers to better realize its importance in public health and to acquire basic knowledge to visualize data through mapping and spatial analysis in GIS software.

**My precious recognition for the successful completion of the course**

Life in Tuscany (Florence and Fiesole)

As my first visit to Italy, I should have some impressions of this journey for my fellow colleagues who will visit next. Traveling during summer from one European country (Norway) to other was not such surprise for me before. The tropical hot and humid weather (temperature was 38-400C) in Italy reminded me about Bangladesh, my birthplace with sudden rain, lightning, mosquito and delicious fruits. I would not recommend any type of full sleeve dress if anybody wants to visit here in summer. Our training venue was in Fiesole, at the scenic height and northeast to Florence. I loved the surrounding mountains, neighboring big old houses with gardens and trees and picturesque nature.

While Fiesole is a calm and quiet residential suburb, Florence is a vibrant city with numerous museums, historical architectures, tourist spots and shopping places. Oniomaniacs (who have compulsive desire for shopping) should visit Italy, specially food and clothes are much cheaper here. Every year, few course participants lose their luggage in Florence airport (this year it happened to 3 persons I know ). If you don’t have memorable stuffs in the luggage, Florence is the right place to reform your attire. I trimmed my hair with 6 € and had 4 course dinner (including desert) with 9 €. The must visit site is the Cathedral of Santa Maria del Fiore and Piazza Duomo which are one of the greatest Italian architectural treasures. Uffizi Palace and Gallery, Piazza della Signoria, the Loggia dei Lanzi, Michelangelo’s Medici Tombs, Palazzo Vecchio and Ponte Vecchio are some other nice tourist attractions in the city centre. I hope everyone would enjoy the course and the city as I did.

Epidemiology is for Everyone: Or How I Learned to Stop Scrolling Twitter and Calculate Incidence Rates

By Virginia Kotzias, PhD Research Fellow at the Centre for Global Health Inequalities Research (CHAIN), Institute for Sociology and Political Science, Norwegian University of Science and Technology

There’s a running joke on the internet that the COVID-19 pandemic turned everyone into an amateur epidemiologist. Suddenly, people who had never even heard of the field were well-versed in case-fatality ratios, risk factors, and the burden of infection. As months wore on and results from epidemiological studies were translated into policies that affected people’s daily lives, the importance of epidemiology within the field of Public Health became very clear, very fast.

Meme about armchair epidemiologists (Source: imgflip.com)

Spoiler alert: I am not an epidemiologist (except in the armchair-internet sense), but as a researcher in health policy and practice, I’ve worked closely with some amazing epidemiologists and have long understood the value of the field. This is why, when the Norwegian Research School of Global Health (NRSGH) offered an opportunity to take a deep dive into the discipline, I jumped.

In April 2022, NRSGH and the Centre for Intervention Science in Maternal and Child Health (CISMAC) at the University of Bergen co-hosted two back-to-back epidemiology courses. The first, “Conceptual Foundations of Epidemiologic Study Design and Analysis,” was taught by the blockbuster scholar, Kenneth Rothman (Boston University) and pharmacoepidemiologist Vera Ehrenstein (Aarhus University). The purpose of the class was to provide an introduction to the core concepts, methods, study designs, and limits of modern epidemiology. Preparation for the 5-day intensive course was no joke: we were required to read Epidemiology: An Introduction, several articles, and complete homework assignments that served as the basis for group discussions. It was pretty awesome, and meant that I walked away from the class with a solid, beginner’s grasp of measures of disease and effect, types of epidemiologic study design, approaches to analysis and managing bias, and the strengths and limitations of each.

The second course, simply titled “Advanced Epidemiology” was taught by Matt Fox (Boston University). This class built upon the basics of the prior week to “go deeper” into epidemiological topics, with a special focus on causal inference and models. We spent a significant amount of time on the importance of framing clear research questions and describing the counterfactual, and learned varying approaches to identify and account for different types of confounding and bias. We ended with a survey of statistical and other approaches to identifying associations between exposure(s) and disease(s) and the threshold of validity and precision necessary to make causal claims in epidemiological research. I gained so much from this class that I didn’t want it to end – so I was thrilled to find that Matt is the co-host of two podcasts (SERious EPIand Free Associations) that continue these discussions about epidemiological topics. (I may or may not have listened to the entire back catalogue of SERious EPI episodes over the summer).

Posing with Rothman’s Epidemiology: An Introduction.

Since completing these classes, I’ve been able to define my current PhD project more clearly and think through tough questions in a more systematic way. I work pretty definitively in the social science space, which is complicated – relationships between social policies, complex health phenomena, and the natural world are messy and confounding (in every sense of the word). Luckily for me, epidemiology is a discipline that tackles difficult relationships like this all the time and has developed a pretty robust toolbox of methods and approaches to handle them. Thinking like an epidemiologist – or at least, trying to – helped me approach my research questions and study design in new ways.

I appreciate the importance of public health, am dedicated to the field, and have always found my work to be meaningful. But by combining my prior training as a health policy analyst with what I learned from these classes, I feel better equipped to take on the increasingly complex challenges faced by all of us working in the public health world. Though it required a lot more effort than a long night scrolling Twitter and earning my social media badge as an armchair epidemiologist, my training as an amateur epidemiologist has been useful in my current PhD work – and will continue to shape my thinking about research, populations, and study design throughout my career as a health researcher.

A typical day in the Conceptions of Epidemiology course.

Special thanks to Drs. Rothman, Ehrenstein, and Fox for teaching excellent courses, to NRSGH and CISMAC for hosting them, and to NRSGH for generous travel funding to support my attendance.

Medical publishing in high impact journals: learning from editors’ notion

Blog post written by Muhammad Asaduzzaman, PhD Research Fellow, Department of Community Medicine & Global Health, Institute of Health and Society, University of Oslo

Medical publishing or publishing of medical research is a fundamental need for the scientific advancement of both modern treatment and disease prevention. Similarly, it is equally important for global health researchers particularly the early career researchers such as doctoral and postdoctoral research fellows who need their research to be published in impactful journals. Therefore, I was willing to join the highly recognized ‘2-day Course in Medical Publishing’ organized by the University of Oslo (UiO), Oslo University Hospital, New England Journal of Medicine, Journal of the Norwegian Medical Association, and Annals of Internal Medicine which is being conducted since 2017. This course is highly competitive due to limited space, high profile resource persons (the editors of the high impact journals and experienced researchers from UiO) and course gap in last 2 years for the pandemic. However, I am grateful to the Norwegian Research School of Global Health (NRSGH) who supported me to join the course this year from June 07 to June 08, 2022 held at Gaustad Sykehus, Sognsvannsveien 21,Oslo.

**Darren B. Taichman is presenting on scientific writing**

At present, I am at the final year of my PhD fellowship and focusing on the manuscript writing and publishing. My research topic is the transmission dynamics and One Health digital surveillance of antibiotic resistance, which is also a global pandemic and alarming threat to all. That is why, the research findings of my PhD project should be well communicated and publishing in good journals is one of the most important dissemination pathways to public and scientific community. My motivation to attend this course was to learn from the editors of high impact journals on what they look for and how they handle the whole publishing process from writing the cover letter to the acceptance of a manuscript.

The course was a mix of lectures and group works based on assignments such as critical review of published articles and peer review of the manuscripts from group members. The lectures and presentations covered almost every aspect of open access publishing of an article. Dr. Michael Bretthauer, Professor of Clinical Effectiveness Group, UiO talked about the study design, planning, ethics, data sharing and protection policies and clinical trial registration process whereas Mette Kalager from UiO gave the outline of the structure of a good paper (including tables and figures) and the checklist to choose a good journal based on topic of interest and target audiences. We were fortunate to have Christine Laine, Editor-In-Chief, Annals of Internal Medicine and Darren B. Taichman, Deputy Editor, New England Journal of Medicine (NEJM) as the guest lecturers. Christine provided a brief but necessary overview of the peer review process and the journals’ work process as well as the elements of good title and abstract. Darren focused on the scientific writing process, language editing and how to deal with the rejection of the manuscript to move forward. All these information are very practical and new to me from the editors’ perspective.

The group works in between the lecture sessions were very helpful to the participants to know about others’ works and to have feedback from the peers and the editors assigned to the group. My group was assigned to Are Brean, Editor-In- Chief, Journal of the Norwegian Medical Association. In the group sessions, we critically reviewed several already published articles and gave feedback on our peers’ works which helped us a lot to improve our current manuscript. However, the group distribution beforehand with sharing submitted abstracts among group members and more time allocation in group work would be more beneficial for the early career researchers.

**Are Brean, Editor-In- Chief, Tidsskriftet and the author**

To my context, this course was a great learning platform and I would suggest this for all PhD students irrespective of disciplines. This was also an eye opening experience for me to know about the publishing process in the high impact journals, which passes through several layers, and process (e.g. involves editor, deputy and associate editors, reviewers, in-house statistical editors with multiple communications). NRSGH has always been supportive for its members and this is another wonderful initiative for scientific capacity building to aid global health researchers in Norway.

The ping pong story: a symbol of global North-South cooperation?

Blogpost for Norwegian Research School of Global Health (NRSGH) written in Amsterdam whilst attending a PhD course funded by NRSGH and Department of Community Medicine & Global Health

The last two and half years and counting, presented monumental challenges to people around the world, that may take decades or more to recover from. Similarly, the past years also taught us novel ways of doing things differently with efficient results. A lot has been written and said about COVID-19 and the impact it had and continue to inflict on lives and livelihoods. For this reason, I will not dwell much on this.

Most if not all PhD students that started their research journeys during this period or thereafter have a story or two to tell about their experiences. Each story is unique and so are mine – one of which I will narrate now. To set the context for this blogpost, I will digress a little in one sentence and return to the theme in a jiffy. Please stay with me 😊

My country – The Gambia is described as ‘The Smiling Coast of Africa’ because most people are warm and sociable. One of the unique attributes that non-Gambians see when they visit Gambia or meet a Gambian, is the smiles. One of my European friends who visited Gambia few years ago was perplexed by this and calls it a paradox. How could people keep smiles on their faces when the socio-economic metrics are heavily stacked against them? Although I am equally fascinated with this uniqueness, I really don’t know the answer. Perhaps the answer lies in our strong social bond which makes us resilient in the face of adversity.

Coming from a society that places high premium on socialisation, it was both refreshing and exciting when the Norwegian government removed COVID-19 restrictions. This means PhD students can now go back to their offices, attend lectures in person, have lunch together with postdocs, professors and department staff and most importantly, meet supervisors to discuss research projects. It was during one of these lunches that Frode Eick – a Norwegian PhD candidate – and I reminisced ‘The Good Old Days’ and discussed how PhD students can leverage reopening of society and spend more time together. Out of the blue, the idea of having a table tennis (ping pong) in our department was conceived. Initially, it was meant to encourage PhD students and postdocs to take time off their busy work temporarily to play with each other as a way of refreshing their memories and getting to know others in the department. But as discussions continue, professors, department staff and master’s students also showed keen interest and thus, a ping pong for the whole department was born.

As trivial as it may sound, the ping pong story symbolises strong partnership and collaboration between two nationals from The Gambia and Norway. Although some people, myself included, do not fully understood the term “Global North-South cooperation” and what it signifies, I will use it for description purpose only. The gist of the matter is a collaboration between Frode and I, which was based on mutual respect, transparency and harnessing each others talents and knowledge. Our collaboration to realised the ping pong dream can be a model for inclusive and participatory global health agenda setting through bilateral or multilatarism.

In a chronicle for the United Nations, Professor Ilona Kickbusch describe global health agenda setting as managing two complex domains: interdependence and globalization, and also addressing the increasing inequalities within and between nations through shared development strategies. The COVID-19 situation for instance has laid bare the sheer inequalities and inequities in the world. A lot has been said about vaccines inequalities for instance but there are other domains in global health that are often overlooked, which are as critical as vaccine inequities. There are growing calls for waiving of trade-related aspects of intellectual property rights (TRIPs) for critical diagnostics, therapeutics, and other tools to prevent, diagnose and treat COVID-19 as well as make vaccines available for more than 60% of the world’s population. As expected, some high income countries and big pharma companies are strongly resisting these calls despite billions of dollars of profits these companies raked in since the pandemic started. Global health agenda setting must therefore take into considerations these realities and how to mitigate their impact. Of course, we should recognise that these are complex issues to navigate through. Nevertheless, we should direct our resources, advocacies and lobbying to issues that we can influence in a positive way.

Even though I proposed the idea of having a ping pong table, Frode and I jointly discussed the most critical aspects of the ping pong project including resource and logistics implications. Even though we discussed these practicalities in detail, we admitted that two of us alone cannot pull this off. We therefore need to popularise the idea and get as much support as possible. We suggested the idea to PhD candidates and postdocs and received overwhelming support. We proposed the idea to the head of department and faculty staff and to our surprised, I guess, it received strong support. The head of department advised that we discuss with administration whose support is critical to the realisation of the ping pong project. Lesson to learn is global health agenda setting should be inclusive, participatory and transparent and getting the support of key stakeholders is as important as the decision itself.

The ultimate goal of global agenda setting is to get things done and the most important resource beside human resource is financial resource. Our decision to make this project inclusive and participatory based on shared values and mutual respect makes it easier for administration to finance part of the ping pong project. I offered my time and labour, whereas Frode offered not only his time and labour but also his car to transport the ping pong to the department and work tools to reassemble the table with my support. This symbolises counterpart/local funding and this gesture promotes ownership and sustainability of programmes or intervention(s) that are agreed during agenda setting.

A happy ending – a ping pong project that was discussed over lunch is now realized. This indoor game is being utilised by both PhDs and master’s students, postdocs, faculty and administrative staff.

In conclusion, global health agenda setting should take an inclusive, participatory and transparent approach utilising knowledge, skills and resources from both Global North/South. The intricacies and complex domains in global health agenda setting should be thoroughly examined and discussed as they are critical to decision-making.

Dissemination of research findings: ‘The forgotten audience’?

Written by Hassan Njie, PhD researcher, University of Oslo

Most researchers would think presenting abstracts or posters in conferences is the best way to communicate our findings. This would be an undisputable fact if our research is confined to academic and research environments only. But, this is not the case.

The forgotten audience outside academia

As researchers, many of us would agree that fulfilling this task and publishing our papers in reputable journals would be considered ‘mission accomplished’ for our research group. However, we think our work would be considered incomplete if the communities where we collected our data from don’t get access to our findings. This is one key oversight that researchers – including PhD students – don’t consider when planning how to disseminate their research findings.

Sharing key findings to inform public policy

Few months ago, the Ministry of Health of The Gambia invited me to share key findings of our research with policy and law-makers, development partners and researchers. This invitation came in the wake of government’s effort to reform the health financing landscape with a view to propelling the country towards the path of Universal Health Coverage. To achieve this, the government is in the process of introducing a mandatory National Health Insurance Scheme (NHIS) that will pay the healthcare cost of patients in The Gambia.

We think our work would be considered incomplete if the communities where we collected our data from don’t get access to our findings.
Hassan Njie, University of Oslo

There is growing call to use research to inform public policy particularly in developing countries. This is important because it enables governments to formulate and implement policies that are responsive to the needs of their populations. The need to use strong evidence to design and implement a successful NHIS in The Gambia was clearly outlined in ‘The Gambia NHIS Bill, 2020’, which is currently undergoing public scrutiny before its enactment by the national assembly.

Our research, which falls within the ambit of evidence-informed policy and decision-making, is aimed at providing strong evidence to inform NHIS implementation in The Gambia. For our findings to add more value to ongoing NHIS policymaking, we shared our findings with all stakeholders. We received positive feedbacks following our dissemination with a recommendation to craft a policy brief to inform current and future decision-making.

Dissemination at community level gives better research

I believe that every researcher’s goal is to provide strong and compelling evidence that may address every day challenges we face in our respective communities. Therefore, our work would be more meaningful if we share our findings in informal settings. Using The Gambia as an example, most community meetings are held at village ‘Bantabas’ akin to communal town halls where major decisions affecting communities are made. This and other community platforms can be utilized by researchers to share their findings with communities. Dissemination at community levels should also be used as opportunities to subject our research to public criticism and take onboard recommendations that can enhance our work better. We should never underestimate the knowledge of communities because they could hold the keys to addressing our research objectives.

Adapting dissemination to local conditions

One of the positive lessons to learn from the COVID-19 pandemic is opportunities for digital solutions. For this reason, some would argue that social media platforms such as WhatsApp can be utilized to share research findings as alternative to in person dissemination. This is true for most if not all middle- and high-income countries where cell phone penetration rate and access to strong broadband internet are high. In contrast, many low- and middle-income countries continue to grapple with weak internet, unstable electricity, and cyber securities issues. The decision to virtually disseminate findings with communities should take these challenges into account.

Among other reasons, finding workable solutions to complex societal challenges is what makes a good researcher.
Hassan Njie, University of Oslo

Making it easy to understand

To conclude, there is a need for researchers to extend dissemination of their findings to non- formal settings to enable all stakeholders including communities give constructive feedbacks. Worth mentioning is the need to share these findings in a language that most community members understand and are most comfortable with. We should simplify the messages without stating the not so well understood p-values, ratios, and other complex research jargons. I know some of you are already thinking of the in-person dissemination challenges- cultural differences, language barriers, logistics etc. However, we should endeavour to find solutions to these challenges. Among other reasons, finding workable solutions to complex societal challenges is what makes a good researcher.

Dissemination at community level (Photo: Hassan Njie)

World Diabetes Day 2020: Let’s join hands together to mark this day successful!

Pushpanjali Shakya, Registered Nurse and Diabetes Educator in Nepal cum PhD candidate, Global Health, NTNU

World Diabetes Day important for awareness

Addressing World Diabetes Day on 14 November each year is imperative to create awareness about diabetes. Being one of the top four chronic diseases in the world, the word “diabetes” must be well known to most people – especially those who have been dealing with it.

Diabetes is a complex disease

Even though it is a single disease, diabetes can lead to co-morbidities like hypertension, heart disease, nephropathy, neuropathy, stroke, and diabetes foot among others. Diabetes has a dreadful impact in terms of health, emotion, and economic condition of the patient. Long term management with medical checkups, proper lifestyle modification, and adherence to medication are required in diabetes. This is costly, especially in those countries where people have to pay out of their pocket for treatment.

Treatment and prevention

Even though it cannot be cured, diabetes can be controlled with the aforementioned strategies. People can live life happily and normally for a long period even though they have diabetes. It does, however, require acceptance and adjustment in lifestyle. Another essential aspect of diabetes is that it can be prevented beforehand if we detect its risk factors on time, especially for type 2 diabetes mellitus and gestational diabetes. People with high risk of developing diabetes and people with prediabetes can be prevented from developing diabetes with simple lifestyle modification, even without taking any medications.

Preventing diabetes by detecting risk factors

Detection of prediabetes stage is vital for prevention of diabetes. There should be thorough screening among risk groups of diabetes like those having a family history of the disease, age above 45 years, obesity, co-morbidities like hypertension, among others. In addition to screening, proper counseling regarding psychological, social, and medical aspects would help people to prevent diabetes.

PhD project about diabetes in Nepal

My PhD project is aimed towards prevention of diabetes in the Nepalese population with prediabetes. The title of my project is “Effectiveness of Diabetes Prevention Education Program in the prediabetes population in Nepal: A cluster randomized controlled trial (DiPEP)”.

The project leader with health care workers in Patan (Photo: Pushpanjali Shakya)

Working closely with the community

The project is a community based interventional study. Hence, a screening camp was the best option for us to reach the target population/participants in the allocated study sites of Dhulikhel Municipality and Patan (Lalitpur Metropolitan City). Community work needs adequate collaboration and cooperation from local stakeholders. We had several rounds of meetings and orientation programs about the project in the local government body – municipality level as well as sub-municipal levels in wards and toles (settlements). That was one of the key factors leading to successful organization of more than 150 camps in the study sites within four months (max 88 camps in December 2019). We organized four camps within a single day allocating two hours for each tole mobilizing enthusiastic research staff and community. We conducted camps in all possible areas in different time slots of the day starting from 9 am until 5 pm to include as many potential participants as possible. In every screening camp, we measured random blood sugar and HbA1c with the help of a point of care testing method after taking verbal consent for the screening. We defined our participants as prediabetes with an HbA1c ranging from 5.7- 6.4%. After detecting, we enrolled them in our intervention sessions conducted in the community.

Training of health care workers in Dhulikhel Municipality (Photo: The DiPEP project)

Creating a diabetes prevention program tailored for Nepal

Diabetes prevention programs have been in existence in the Western world since the 1990s and their effectiveness has been studied thoroughly. However, developing countries like Nepal have not yet started any such programs. Hence, we developed a curriculum of four weekly sessions lasting from 1 to 1.5 hours, which is tailored to Nepalese cultural context. We trained community health care workers and volunteers to facilitate during the intervention session. However, the main intervention was conducted by a diabetes educator (myself) and other nurses who were trained specially for this intervention. We also provided a pictorial diabetes prevention brochure in the Nepali language, a diabetes prevention exercise calendar and a daily food booklet to all the participants of the intervention clusters. They were followed up by trained community health care workers and volunteers biweekly, either via phone call or by conducting follow up sessions in the community. We provided only the pictorial diabetes prevention brochure to the participants of control clusters.

Involving people from the community (Photo: Pushpanjali Shakya)

The project continues – with certain COVID-19 adjustments

Because of the COVID-19 pandemic, we stopped both our screening camps and intervention sessions from mid-March 2020. After adjustments to the project following the COVID-19 situation, we could only resume group intervention sessions to remaining participants via digital media from mid-August 2020. Our trained health care workers and volunteers are with the help of our research staff following up our participants biweekly via phone call and also we are conducting monthly digital meetings. We are also having endline data collection through phone calls. It is indeed a challenge to continue the project activities during this pandemic, but we are encouraged by the positive feedback from our participants that they feel cared for even during such tough times.

One of the screening camps (Photo: The DiPEP project)

The biggest task

Working for diabetes care needs immense support, collaboration, cooperation from all stakeholders like institutions, government bodies, local bodies, medical and non-medical professionals, community members, volunteers and all direct and indirect support. Let’s join hands together and mark World Diabetes Day 2020 in honor of all the people with diabetes and everybody working for diabetes care!

Some of the local stakeholders (Photo: The DiPEP project)

Research with children: upsetting for whom?

Written by Samita Wilson, PhD candidate from the University of Stavanger (UiS), Norway

Samita discovered a number of reasons why children and young people wants to contribute to research. Photo: Colorbox

Over the past thirty years, there has been increasing interest in the experiences of children and young people. It has also been argued that in research about Child Protection Services, the involvement of children and young people is limited. My PhD research project sought to address this gap. As a part of my research, I interviewed children and young people from minority backgrounds about their experiences of being with Child Protection Services (CPS) in Norway.

Samita interviewed children and young people with minority background about their experiences with Child Protection Services (CPS) in Norway. Photo: Colorbox.

When protection increases vulnerability

In order to access children, I contacted adults in in CPS offices, schools, and activity clubs, as well as local community leaders. While some grown-ups supported the aim of this research and the importance of listening to children, there was a general sense of ‘paternalism’ and ‘protectionism’ towards children in the field. Grown-ups in the latter group seemed to believe that children would get upset by the research invitation as they felt shame to be in CPS. Despite their good intention of protecting ‘vulnerable’ children from participating in potentially sensitive research on their time with CPS can add to their vulnerability. As this protective attitude could result in hindering the child’s right to information, participation, and being heard. Consequently, children would lose out on an opportunity to improve the services being delivered to them by CPS.

Children and young people should be heard. That makes their involvement in research projects so valuable. Photo: Colorbox.

Children’s motivations for participation

This research project involved voluntary participation. Children were informed about the objectives and had consented to be part of the research. They had a right to say no to participate, to not answer any question that they may not want to, and to leave the research project anytime without giving any reason. A few children did assert those rights during the data collection.

I discovered a range of reasons why children and young people participated in my research. During the interviews, the children (all names are anonymised) told about their motivation for participating. Following are some of the points that children mentioned as their motivation for participating:

“I have not told others, what I am telling you….”

For 17-year-old Zarah, this was an opportunity to share what she actually felt and experienced. This was not an investigative interview as those conducted by CPS where she had to be careful about what she tells; neither was this an inquiry from her family or people she knows. However, I was not a total stranger either. She knew that I am researcher from an immigrant background, whose work is to explore and understand how children experience being with CPS in Norway. Everything that she tells me would remain anonymous and confidential. This made her feel safe enough to share her story with me, for which I am grateful.

“I want to help other children through sharing my story…”

Zoe (16 years) wanted to help other children by voicing her experiences and sharing her story with me. While I could not promise that this research would influence the policies and practices in CPS, there was still a sliver of hope that it might. She shared her story hoping that it would make a positive difference somewhere for someone at least. That her difficulties will not go in vain, and that someone can benefit from it. This kind of hope can contribute towards children’s empowerment, positive self-esteem and resilience.

“I just want to help you get your PhD…”

Marianne (16 years) was altruistic as well. However, her motivation to participate in the research was to help me: A female PhD student from Pakistan. She was very generous with sharing her experiences and reflections on her time of being with CPS. This was an empowering position for Marianne that she was able to help a grown-up to achieve something in comparison to her being dependent on grown-ups in CPS to help her.

“It helped me to own my story….”

For Zoe and some other children, the interview helped them to hear their story and take an ownership of it. Going through the CPS process (reporting, investigation, intervention etc.) was so stressful that they never got a chance to reflect on their experiences and talk to someone about it. Therefore, participating in the interview and talking about their lives helped them to acknowledge that it is their life; they were able to reflect on the choices they made and how all these experiences have made them stronger.

“I like talking to people, so here I am….”

Jane (19 years) feels strongly that CPS is an important institution for children in need and it needs to be improved. Therefore, it seemed like that she takes up any opportunity that might have a chance of improving the services. Her initial knowledge about my study came through a grown-up. She agreed to participate because she was curious about the research, wanted to help and, she liked meeting new people. She felt comfortable about sharing her experiences in a non-judgemental and safe environment.

Many of the young people who contributed to the study, felt empowered by sharing their experiences. Photo: Colorbox.

Empowered by contributing

Most of the young people participating in the research grew up in difficult circumstances and had contacted CPS themselves to seek help. Their stories were not pleasant. It was hard to imagine that children had to go through so many hardships both at home and then while receiving help from CPS. However, previous research shows that children do not always agree to the label ‘vulnerable’ being ascribed to them. They see themselves as survivors and resilient. For most of the children in this research, the neglect and abuse at home was a ‘normal’ reality of their life for about 15 to 16 years. Even though they were aware that what is happening at home is not right, it was still their normal life. While their experiences were hard and was not always easy to talk about, the above statements show that children found sharing their stories as therapeutic, cathartic, empowering and social. This is what they had gone through and they should be appreciated for making it through to the other side.

Let’s listen to the children!

While I learned a lot from these children, the most important one is that protecting children “too much” can be harmful for them. Their right to protection should not come at the cost of their right to information and participation as this can make them even more vulnerable. Adults should not make unilateral decisions on behalf of children. Rather we should invite children to participate in research and let them decide to say ‘yes’ or ‘no’ to participation.

Finishing a PhD during lockdown with a toolbox of coping strategies

Written by Prudence Atukunda, PhD research fellow, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo (UiO). The author has been granted COVID-19 fundings through Centre for Healthcare Education (UiO).

In a situation of a sudden life change, one needs to have some coping strategies in order to maintain a healthy mental state and well-being.

Students extra vulnerable for changes
So, what is a copying strategy? It can easiest be explained as a series of actions used when meeting stressful situations. The overall goal of a coping strategy should aim at promoting one´s feeling of happiness in everyday life.

Such coping strategies are perhaps especially valuable for students, as students are extra vulnerable for changes of economic and social nature. This especially goes for international students, located far from family and known environments.

To the students out there, getting out and finding out what one is surrounded with is worthwhile. It makes life a little easier. Those in student villages can reach out to their colleagues and participate in various activities. There are Facebook groups that have very useful information on several outdoor activities that offer help to individual mental health at times when studies and life out of school feel stressful.

There is no doubt that the COVID-19 pandemics and the following lockdown affected the lives of many students. As a foreign student in Norway, I have made my own experiences and I hereby propose various activities that one can engage in, from hands-on personal experience.

The toolbox of coping strategies

Yoga and mindfulness meditation
The beauty of mindfulness training is that it transcends beyond yoga styles. The skills are easily self-taught and can help you to get motivated to continue during a crisis. For example, during the total school lockdown I taught myself the basics of the practice and how to apply them in lockdown. This coping strategy can be learnt by anyone interested in harnessing and improving his or her mental health state. The beauty with this is that meditation brings calm and focused attention to the endless stream of thoughts floating through in one’s mind. This strategy enabled me to reduce stress and increased my productivity.

Writing
Writing is therapeutic. For example, writing poems is known to have several benefits, including improved cognitive function, learning new words, finding new ways to articulate thoughts and creating good feelings for the brain. In addition, it also helps heal emotional pain, express love and affection, leads us to greater self-awareness, and provides a gift of inspiration for others. For example, during this time of COVID-19, I chose to dedicate time each day to write a poem. Between 30 March and 11 May 2020, I have daily written down a poem. My poems have featured different topics, including the pandemic, weather, trees, birds, the Oslo fjord, the immune system to name but a few.

Spending time in nature
While in Norway, I learnt that “When an English prince took his new love on a romantic getaway, he chose a cabin holiday in Norway. He’s not the only one, Norwegians flock to the mountains and more new cabins are being built than ever before. I myself had the opportunity to visit a “hytte” (cabin) in Nordmarka in Oslo during lockdown. Thus, I got intrigued into looking at the COVID-19 lockdown as a gateway into the Norwegian mountain cabins used as a symbol of the simple life outside of town. In addition, one can include fishing and camping out in the wilderness as an essential part of the “hytte” experience.

Hiking
Interacting with the wilderness is worth the initiative, especially during a crisis such as lockdown. It is such an amazing get-away and a way to find peace and quiet. Imagine a walk from one amazing viewpoint to another, ending at forest lakes perfect for a swim or just finding berries and other goodies nature offers. I believe this is a gift to almost everyone going out there and spending time with nature’s gifts.

Bird-watching
Almost all countries are blessed with beautiful birds. These amazing animals can be experienced through hiking trips in the forest. One can learn to identify birds’ gender through colour, sound and behaviour, and to see rare birds, as for example the national birds of a country. I personally saw the Norwegian national bird called the Cinclus Cinclus, fossekall in Norwegian (white-throated dipper), woodpeckers, little grebe, common divers, pigeons, gulls, and many more.

Seasonal activities
Seasons come and go, thus one should move along as life unfolds in various seasons. A season that offers planting opportunities, when one can grow plants and flowers, adds benefits like the ability to learn different flower types and names. In my own experience I learned about the various margarita flowers, mixed fairly primrose, forget me not flowers (scorpion grass), purple heather, which is one of the national flowers of Norway. This crowned my coping strategies during the lockdown. The flowers paint a very great image of the strength that lies within a given society and the togetherness.

Finishing a thesis during lockdown
It was through these coping strategies that I successfully had my final paper published and wrote my thesis to completion and delivered it to the university. The process that started when the COVID-19 lockdown was implemented is all ending with a PhD thesis defence in October. This would not have been possible if I did not come up with a coping mechanism plan.

Trials and tribulations of a PhD student: how COVID-19 upended my fieldwork and research stay in The Gambia

Written by Hassan Njie, PhD Candidate – University of Oslo

En route to field work as COVID-19 breaks loose

In the early hours of March 12 en route to Oslo Gardermoen Airport, my attention was drawn to the eerie quietness and vast empty seats on the Flytoget airport express train. As the train sped towards the airport, I looked up at the screen facing me to catch a glimpse of COVID-19 breaking news. Norway continues to register many new cases on daily basis with the infection spreading far and wide. Right at that moment, I concluded that the increasing COVID-19 infection in Norway and other parts of the world explain the noticeably few numbers of passengers on the Flytoget train that morning.

Cognizant of the fact that airports and airplanes could be potential hotspots for the spread of COVID-19, I prepared a travel kit – hand sanitizer, face mask and a handful of disposable hand towels the night before.

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Home quarantine instead of field work

I arrived in The around 5pm GMT on the same day. The Gambia at this point has not registered a case of COVID-19 and it was business as usual at the airport albeit temperature checking and recording of travel history. An hour earlier, the Prime Minister of Norway, Erna Solberg announced series of COVID-19 emergency measures including travel restrictions. Norway went into full lockdown at 6pm CET on March 12.

In view of my travel history and exposure at two main airports – Oslo Gardermoen Airport and Brussels Airport, I decided that home quarantine is the right course of action for me, my family and the country at large. I communicated my decision to a senior official of the Ministry of Health and commence a 2-week voluntary home quarantine. A senior surveillance officer visited me and took a thorough history and advised that I called a dedicated COVID-19 hotline if I develop COVID-19 related symptoms. Fortunately, I did not.

Home quarantine in the context of traditional Gambian family system is difficult to observe due to varied reasons, notable amongst which are cultural norms and values that formed the bedrock of families. Most families eat together, greeting is mostly through handshakes and we prefer living with our aged parents and grandparents. Few people will send their aged parents or grandparents to nursing homes. Despite these challenges, I completed two weeks home quarantine.

COVID-19 in The Gambia

Two weeks after my arrival, the President of The Gambia in a televised speech announced that a state of public emergency (SoPE) exist in The Gambia. Although The Gambia has not registered a case of COVID-19, our immediate neighbour – Senegal continues to register new cases exponentially. This is worrying for Gambians because geographically, the country is surrounded by Senegal on three sides except for its western coast on the Atlantic Ocean.

Reciprocally, Senegal also announced SoPE. The closure of air, land and sea borders in both countries did not stop the movement of people from either side of the aisle because of the vast open borders and numerous unofficial entry points. This had made the work of the Ministry of Health in The Gambia logistically, operationally and financially untenable. As at the time of writing this blog, The Gambia has registered 49 confirmed cases, 20 active cases, 27 recoveries and 2 deaths. In sharp contrast to The Gambia, our immediate neighbour Senegal registered over 7000 confirmed cases, 4500 active cases, more than 2000 recoveries and 121 deaths.

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Fieldwork in the time of COVID-19

The main reasons for visiting The Gambia are to undertake fieldwork as part of my research project and research stay at the University of The Gambia (UTG). I could not proceed with the latter from the outset because of the SoPE part of which include shutting down of academic institutions like UTG. This made it impossible to collaborate with UTG researchers to hone my research skills. Furthermore, the shutdown resulted to cancelation or postponement of planned conferences and symposia. The good news is that following a protracted delay, I successfully delivered my planned lectures on basic literature search and introduction to scientific writing to students at department of nursing and reproductive health. Feedback received from students were positive and the experience will be invaluable in my PhD journey.

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As some doors closes, other doors open

The COVID-19 situation in The Gambia and bureaucracy at the level of the ethics committee contributed to delays in my fieldwork. But if you ask me, I would point to the latter as the main culprit since it took more than three months before I received ethical clearance from The Gambia Government/Medical Research Council Gambia (MRCG) Joint Ethics Committee. Hopefully, in about a week’s time, I will be out in the field with my enumerators collecting first set of data. To say that the long delay has little toll on my mental wellbeing is far from the truth. My family and friends help a lot by reminding me constantly that there is light at the end of the tunnel. Johanne Sundby, my supervisor has been very helpful during this period of uncertainty.

I and two Gambian graduate students – Samba Bah, PhD candidate at Ohio University and Ebrima Baldeh, Masters student at New York University in the United States are co-hosts to weekly virtual panel discussion on COVID-19 streamed live on Facebook. We conceived this idea to contribute our quota collectively towards the fight against COVID-19. Our weekly discussions on Zoom is still ongoing and revolves around COVID-19 in the context of The Gambia, Africa and the wider world. Our panelists comprise people from different walks of life – epidemiologists, laboratory scientist, public health specialists, legal scholars, activists and law enforcement officer. These experts are drawn from different countries – The Gambia, Brazil, United States, Guyana, Senegal, Madagascar etc. and has wider viewership in The Gambia and beyond. Our discussions are academically engaging and very useful to the hosts, guest panelists and global audience. Our plan is to continue engaging in academic discourse on wide range of issues post COVID-19 and in the foreseeable future.