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
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.
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 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
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