Journal Article > ReviewAbstract Only
BMJ Sex Reprod Health. 2022 November 7; Volume 49 (Issue 2); 118-128.; DOI:10.1136/bmjsrh-2022-201526
Nicholls EJ, McGowan CR, Miles S, Baxter LM, Dix L, et al.
BMJ Sex Reprod Health. 2022 November 7; Volume 49 (Issue 2); 118-128.; DOI:10.1136/bmjsrh-2022-201526
BACKGROUND
Most cervical cancer can be prevented through routine screening. Disparities in uptake of routine screening therefore translate into disparities in cervical cancer incidence and outcomes. Transmasculine people including transgender men experience multiple barriers to cervical screening and their uptake of screening is low compared with cisgender women. Comprehensive evidence-based guidelines are needed to improve cervical screening for this group.
METHODS
We searched for and synthesised clinical and programmatic guidelines for the provision of cervical screening for transmasculine patients.
FINDINGS
The guidelines offer recommendations addressing: (1) reception, check-in and clinic facilities; (2) patient data and invitation to screening; (3) improving inclusion in screening programmes; and (4) sexual history taking, language and identity. Guidelines offer strategies for alleviating physical and psychological discomfort during cervical screening and recommendations on what to do if the screening procedure cannot be completed. Most of the guidelines were from and for high-income countries.
DISCUSSION
The evidence base is limited, but existing guidelines provide recommendations to ensure life-saving screening services are available to all who need them. We were only able to identify one set of guidelines for a middle-income country, and none for low-income countries. We encourage the involvement of transmasculine people in the development of future guidelines.
Most cervical cancer can be prevented through routine screening. Disparities in uptake of routine screening therefore translate into disparities in cervical cancer incidence and outcomes. Transmasculine people including transgender men experience multiple barriers to cervical screening and their uptake of screening is low compared with cisgender women. Comprehensive evidence-based guidelines are needed to improve cervical screening for this group.
METHODS
We searched for and synthesised clinical and programmatic guidelines for the provision of cervical screening for transmasculine patients.
FINDINGS
The guidelines offer recommendations addressing: (1) reception, check-in and clinic facilities; (2) patient data and invitation to screening; (3) improving inclusion in screening programmes; and (4) sexual history taking, language and identity. Guidelines offer strategies for alleviating physical and psychological discomfort during cervical screening and recommendations on what to do if the screening procedure cannot be completed. Most of the guidelines were from and for high-income countries.
DISCUSSION
The evidence base is limited, but existing guidelines provide recommendations to ensure life-saving screening services are available to all who need them. We were only able to identify one set of guidelines for a middle-income country, and none for low-income countries. We encourage the involvement of transmasculine people in the development of future guidelines.
Journal Article > ResearchFull Text
BMJ Glob Health. 2022 March 16; Volume 7 (Issue 3); e007707.; DOI:10.1136/bmjgh-2021-007707
Sheather J, Apunyo R, DuBois M, Khondaker R, Noman A, et al.
BMJ Glob Health. 2022 March 16; Volume 7 (Issue 3); e007707.; DOI:10.1136/bmjgh-2021-007707
This paper explores the quality and usefulness of ethical guidance for humanitarian aid workers and their agencies. We focus specifically on public health emergencies, such as COVID-19. The authors undertook a literature review and gathered empirical data through semi-structured focus group discussions amongst front-line workers from health clinics in Cox’s Bazar, Bangladesh and in the Abyei Special Administrative Area, South Sudan. The purpose of the project was to identify how front-line workers respond to ethical challenges, including any informal or local decision-making processes, support networks, or habits of response.
The research findings highlighted a dissonance between ethical guidance and the experiences of front-line humanitarian health workers. They suggest the possibility: (1) that few problems confronting front-line workers are conceived, described, or resolved as ethical problems; and (2) of significant dissonance between available, allegedly practically oriented guidance (often produced by academics in North America and Europe), and the immediate issues confronting front-line workers. The literature review and focus group data suggest a real possibility that there is, at best, a significant epistemic gulf between those who produce ethical guidelines and those engaged in real-time problem solving at the point of contact with people. At worst they suggest a form of epistemic control—an imposition of cognitive shapes that shoehorn the round peg of theoretical preoccupations and the disciplinary boundaries of western academies into the square hole of front-line humanitarian practice.
The research findings highlighted a dissonance between ethical guidance and the experiences of front-line humanitarian health workers. They suggest the possibility: (1) that few problems confronting front-line workers are conceived, described, or resolved as ethical problems; and (2) of significant dissonance between available, allegedly practically oriented guidance (often produced by academics in North America and Europe), and the immediate issues confronting front-line workers. The literature review and focus group data suggest a real possibility that there is, at best, a significant epistemic gulf between those who produce ethical guidelines and those engaged in real-time problem solving at the point of contact with people. At worst they suggest a form of epistemic control—an imposition of cognitive shapes that shoehorn the round peg of theoretical preoccupations and the disciplinary boundaries of western academies into the square hole of front-line humanitarian practice.
Journal Article > CommentaryFull Text
Confl Health. 2020 November 4; Volume 14 (Issue 1); 72.; DOI:10.1186/s13031-020-00319-4
McGowan CR, Baxter LM, DuBois M, Sheather J, Khondaker R, et al.
Confl Health. 2020 November 4; Volume 14 (Issue 1); 72.; DOI:10.1186/s13031-020-00319-4
Infectious disease outbreaks represent potentially catastrophic threats to those affected by humanitarian crises. High transmissibility, crowded living conditions, widespread co-morbidities, and a lack of intensive care capacity may amplify the effects of the outbreak on already vulnerable populations and present humanitarian actors with intense ethical problems. We argue that there are significant and troubling gaps in ethical awareness at the level of humanitarian praxis. Though some ethical guidance does exist most of it is directed at public health experts and fails to speak to the day-to-day ethical challenges confronted by frontline humanitarians. In responding to infectious disease outbreaks humanitarian workers are likely to grapple with complex dilemmas opening the door to moral distress and burnout.
Conference Material > Slide Presentation
van Zandvoort K, Bobe M, Hassan AM, Ismail M, Saed M, et al.
MSF Scientific Day International 2023. 2023 June 7; DOI:10.57740/t9ve-m563
Journal Article > CommentaryFull Text
Lancet. 2022 November 5; Volume 400 (Issue 10363); 1561-1563.; DOI:10.1016/S0140-6736(22)01991-2
Baxter LM, McGowan CR, Smiley S, Palacios L, Devine C, et al.
Lancet. 2022 November 5; Volume 400 (Issue 10363); 1561-1563.; DOI:10.1016/S0140-6736(22)01991-2
The climate emergency is a humanitarian and health crisis. Extreme weather events, heat stress, declining air quality, changes in water quality and quantity, declining food security and safety, and changes in vector distribution and ecology threaten all of us. As the planet heats, climate risks are increasingly complex, frequent, and unpredictable, compounding existing vulnerabilities and inequities within populations and causing emergencies that cascade across different systems and sectors. Humanitarian agencies are now seeing how these problems are putting millions of people across the world at immediate risk of famine and death.
Journal Article > ResearchFull Text
Confl Health. 2020 November 4; Volume 14 (Issue 1); DOI:10.1186/s13031-020-00319-4
McGowan CR, Baxter LM, DuBois M, Sheather J, Khondaker R, et al.
Confl Health. 2020 November 4; Volume 14 (Issue 1); DOI:10.1186/s13031-020-00319-4
Infectious disease outbreaks represent potentially catastrophic threats to those affected by humanitarian crises. High transmissibility, crowded living conditions, widespread co-morbidities, and a lack of intensive care capacity may amplify the effects of the outbreak on already vulnerable populations and present humanitarian actors with intense ethical problems. We argue that there are significant and troubling gaps in ethical awareness at the level of humanitarian praxis. Though some ethical guidance does exist most of it is directed at public health experts and fails to speak to the day-to-day ethical challenges confronted by frontline humanitarians. In responding to infectious disease outbreaks humanitarian workers are likely to grapple with complex dilemmas opening the door to moral distress and burnout.