Community engagement contributes to a consenting process in health research.

Nelson Mandela once said when you speak to a man in another language you speak to his ears but when you speak in his language you speak to his heart. This article explores the importance of obtaining an informed consent from participants in medical research and why it is necessary to be precise and direct when engaging the community regarding studies that are conducted both in a hospital and community settings. For an individual to participate in research one of the ethical standards is for him/ her to consent or assent whether in writing or verbally, the process is very easy especially while dealing with individuals who are literate. According to Ohio State University, when obtaining an informed consent needs to have an open and honest communication between the researcher and the study participants, the conversation is not supposed to be limited to the document that is read rather it can be open.

It’s first July- 2015 and as any other usual day, a community engagement professional put off ready to do the day’s work. Usually, community members assemble at a community ground or at the chief’s court to hear what the 'town folks’ have brought for them, it’s not unusual- day in day out- organizations and volunteers bombard the rural areas to explain issues relating to scientific research. To me, this is a very important step in as far as scientific research or health research is concerned. Before a study takes place, stakeholders, schools and more importantly the community members have to be engaged about the study since some of these people from the communities will be eligible participants. Apart from that community engagement contributes to a smooth consenting process and also fulfills the purpose of respecting rights of the entire community.   

Different from other projects that are brought by developmental organizations into communities health research respect the principle of   autonomy thus about individuals consenting before participating in a study, one has to do that under a free will. However, the community members may have a lot of expectations from the study team. Some may expect to be paid for taking part in the study, with that in mind it is important to engage communities to share with them the way the study will be conducted, doing at the beginning is crucial as it will ensure that all eligible participants have their expectations balanced.

References 

https://ccts.osu.edu/education-and-training-programs/research-education-and-training-programs/clinical-research-coordinator-resources/informed-consent-in-research

The future of research in Universities of Malawi

During the recent Unima fundraising dinner at Bingu International Convention Centre in Lilongwe, President of Malawi Professor Peter Mutharika made a controversial speech that elicited anger from scholars in the country.
The president called on the university lecturers in the country to concentrate on research and "not commenting on public trivial" as quoted by Malawi online’s Nyasatimes. Apparently, the last part did not go well with the academia who viewed the statement as a move to shut them up from commenting on issues of national interest. Whether the comment had any political connotation, the fact is the president underscored a very important point. Research is very is very important not only for the credentials of the people involved but also for the development of every country.

What variety of maize- the staple food of Malawi- can best suit the current weather pattern of the country? Apart from maize, what other crops can we grow to outsmart the persistent drought in the country?   How best can we maximize technology in the country to ensure we export more for the better health of the nation's economy? Talking of our main interest; how can we improve drugs to eradicate malaria in children/ what is a collect dosing of new drugs in Children? And more importantly how can we eradicate various diseases in the country? All these are the questions which can be answered after conducting research.

As a nation the most important question would be why we are not conducting more research and publishing more in the international reputable journals as our counterparts in the western world? The problem is however not restricted to Malawi, many nations in the region also face similar challenges. Many times than not, most of the research in Africa is conducted by people from the west who have funding and the capacity for that. The saddest part is that these international researchers are conducting studies into the very diseases that are affecting Africans; diseases that are robbing the continent of its manpower though they don’t fully understand the natural or social contexts that they are working in. Moreover, these are the same diseases costing governments thousands of dollars yearly.

The recent Ebola outbreak in Siera Leone, Guinea, Liberia and Nigeria exposed gap that exists in Africa as whole in research and containing the disease.  Thanks to U.K.’s Department of International Development and the Wellcome Foundation's- $64 million- five-year research project called the Developing Excellence in Leadership, Training and Science Initiative for African Scientists (DELTAS), the continent may as well have manpower should similar epidemic erupt again. 

 So a million dollar question would what we need to do to promote research in Malawi and even the rest of Africa? The first step will be therefore to put in place structures that will support these studies, we also need to equip our universities with laboratories and enough structure for this especially for Quantitative research  based in Laboratories. Though this may have cost implications but its worth for the government to invest substantial amount in the annual budget to carter for research in universities. Currently, there is a research component attached to Malawi University of Science and Technology. I believe therefore, that the country is on the right path in as far as research it’s concerned in Malawi, College of Medicine is also involved in a lot of research and its bearing fruits.

According to Jonathan Harle, programmes manager (research capacity) at the Association of Commonwealth Universities notes in the Guardian; career building is about institutions as much as individuals so the next step to improve research in the country would therefore be to ensure the next generation of young people are passionate about research and science careers. This should be done right away from high/ secondary schools and can be achieved by introducing modules into the science subjects which will provide a strong background for research. Through community engagement there can be other after school programmes that can expose them (students) to research and eventually help them develop the zeal to become researchers. "University's future rests on its next generation of academics," writes Harle. "...But (African) universities aren't always doing enough to nurture and support their emerging talent."

Many scholars in the world agree that doing research is not only an issue to do with funding or money but by using the available resources, a number of research studies can be conducted in our universities. As the Chancellor of the University of Malawi, I would agree and probably the lecturers can agree with him too that we need more research if we are to develop. We also need to inspire our young generation to have passion for science (Which of course involves research). Only if we provide capacity for the same, we will lag behind decades from now. So yes the President’s call for research had its own good part though it was  it came at a wrong time

References

http://www.theguardian.com/higher-education-network/blog/2012/nov/28/early-careers-academics-african-universities).

Engaging primary school in Malawi - a neglected area of community engagement

 Many researchers and scientists in the world appreciate the importance of engaging people in their projects. Not only do they get feedback, but these people readily participate in the studies or projects and assist in understanding the subject that is studied. However learners in primary and secondary schools probably benefit most, apart from being informed on the study procedures, the engagement also assist them in their career as most of the things presented by the scientist are linked to their syllabuses.

Research Councils UK (RCUK), research institutions including Universities and other places of higher learning discovered the benefits of engaging young people long ago.  For instance- as a way of 'inspiring young people into science and research, RCUK provides substantial funding to the schools and apart from that  the council see to it through Nuffield Research Placements that over 1000 students across UK work with professional scientists, mathematicians just to mention a few. 
That would be easier in the UK and America where the number of students per class is minimal and that these countries are technologically advanced than countries in developing countries. In fast forward to developing countries in sub Saharan Africa and Malawi in particular, engaging learners poise a new problem; the number of learners per class. As early as 2012, UNESCO estimated that there is a 70:1 learner-teacher ratio across primary schools in Malawi. In fact, data from some primary schools in Blantyre, Chiradzulu, and Chikwawa districts of Malawi indicates that some schools have more than 100 learners against a teacher in a class. Going by the current population growth, fertility rate and projections from the experts, the problem is set to worsen if more teachers are not trained and infrastructures put up to carter for the growing population. This is however not the purpose of this article.

If a large number of learners in a classroom, poise challenges to teachers, then it does even more when engaging them in science and health research. Recently, I was involved in an exercise of engaging learners about a new study on Pneumonia learners across Blantyre primary schools and what I found surprised me. It was simple for learners who were few in number to grasp the concepts than their counterparts who were large in numbers in some schools that we visited.  Out of the 7 schools that we visited 4 of them had an average number of 2500 students.

The fewer tended not only to concentrate during the interactive sessions but they would also ask questions and make sounding clarification. It was also easier for me as a community engagement professional to observe and get instant feedback from them. Those large in number however were noisy, lacked concentration and it was apparent that many of them could not hear what was shared during the meetings. Dividing them into small groups per session could help but this means more time on the part of us as facilitators of the sessions and of course definitely work that cannot be accomplished in a day.  Having a few learners in a class does not only make the work of the science facilitator easier but they will also understand the concept, on the side of the teachers it’s even more important because its make their work very easy especially when delivering their lessons.  The truth on the ground is contrary to our expectations, most urban schools in Blantyre are congested and the assumption is that if we have problems to engage students in various days we set aside, teachers have more problems managing them every day just because the ratio it way too off.

The importance of engaging learners cannot be overemphasized because these are future scientists, researchers and doctors. Therefore the government has a huge responsibility to provide an optimum environment for facilitating this process. There is need for the government to intervene and increase the number of teachers; school blocks, and even learning materials.

References

http://www.rcuk.ac.uk/pe/schools/.

http://m.theglobaleconomy.com/Malawi/Student_teacher_ratio_primary_school/

Challenges of engaging communities about science in Malawi

Medicine and science has for a long time been part of our Malawian modern life, at present a number of research organisations in Malawi are conducting research on different diseases and conditions in the whole world and Africa. looking at the setting in Malawi, there has always been a gap between science especially research and communities where research is conducted. Through various ways that i have been involved to engage these communities there is a lot that has been involved and it affects the way communities understand research and science.  
To begin with stories that are told  about research, it seems in the past there existed a huge gap between research institutions and researchers; the practice was that  researchers didn't bother spending time to  share with communities where eligible participants would come from. All that mattered was to make sure they have their sample size collected. The practice eventually left so many answered questions in communities.  recently i heard a story that was shared and was concurred by many members in Chilobwe, a township located in urban Blantyre. Rota virus study was conducted in the area and mothers who participated in the study were requested to give a soiled nappy for their babies.   To the researchers this simple procedure was very simple but to the communities in the area this translated into a lot of things; some said due to this practice their children ended up stunted, while others thought they will no longer conceive again. such stories just prove the fact that  there was a gap between researchers and communities hence the need to promote community engagement.

Challenges 

Looking at a story shared in Chilobwe, one of the challenges of engaging communities about medical research in Malawi  is the malpractice by other organisations in the past. Communities were not engaged, they didn't have a clear understanding of what researchers were doing such that they attached other health complication to research procedures which might not be true. So even this time at present in some communities their perception is still affected and when they hear about  any new study in their area, they never have interest to participate.

Another challenge that is very common  when engaging communities is illiteracy which is very high in the country. Acknowledging that fact that  researchers neglected engaging communities, the level of education also affect the understanding of research and its related procedures. Statistics indicate that 80% of Malawians live in rural areas.  As the Children of the Nations reports more than quarter of the nation is illiterate.  Level of education it’s one of the challenges one faces in engaging messages regarding science and medical research in Malawi. the same case when obtaining a consent for their participation in a study but of course that will be a different article on its own. In areas like Chikwawa an experience i have had recently is that in a village of about 1000 people about 2%  would have completed their secondary school education and are able to read and write while the rest are illiterate (Not able to read and write). In practice this means that the whole village would have problems understanding science once involved in a  research. Imagine a research that will collecting a stool sample from children in such communities; how do you think they would understand the whole concept? Mixed with myths and traditional believes,  the whole village would have problems to accept the study and eventually have many defaulters. In one of the study that i previously worked as a fieldworker, we had to drive  a distance to collect a stool sample from a child participating in  the study and we got many questions whenever we visited a household in rural communities; most of them thought we had other agenda which were more important and worth than the stool sample itself. some thought we will eventually bewitch the baby, others thought we were there to know about about the families in the village by disguising ourselves to visit the baby.

All these challenges are coming in because of  tradition, illiteracy, past malpractices by researchers in the past and of course on the other side exposure also plays a role; for some communities  where research has been conducted several times it is very easy for them to understand and participate in studies unlike in areas where  research is new. 

Solution

Taking note these challenges its very pertinent to suggest solution that can help addressing them. I have observed  that one of the ways of resolving challenges in community engagement about science in Malawi is to consider doing community engagement continually,  it has to be considered as a process not once off thing. With patience and and new ideas communities would be better placed to understanding medical research and their health in general.
Another way is to monitor and evaluate community engagement  activities that are conducted; this is very important aspect though very difficult to execute; measuring the impacting of community engagement is difficult because of so many factors that influence someone to individually understand but there is need to ensure that a proper plan is established to evaluate the impact of  activities.  

Another proposed solution  would advocating for ethics board have deliberate policies or guidelines  which would encourage researchers engage communities  targeted in their studies. According to the World Health Organisation, regional office, research in Malawi is  regulated by the National Commission on Science and Technology and it is this commission that delegates powers to National Health Sciences Research Committee (NHSRC) and also College of Medicine and Ethics Committee (COMREC).  It would help if these boards set it as a standard  to approve protocols that have a community engagement component.

References.
http://www.aho.afro.who.int/profiles_information/index.php/Malawi:Health_research