By Lalith Senarathna (EV 2012; PhD Candidate – Sydney School of Public Health, University of Sydney, Australia; Research Fellow – South Asian Clinical Toxicology Research Collaboration (SACTRC), Sri Lanka)
Emerging voices (EV) 2012 was a great platform for us to share ideas and experiences on different topics and in different settings. It was very inspiring to see the work done by EVs on a vast range of topics from all continents. More interestingly, different research projects, despite being focused on sometimes very different health issues, often seemed to have many things in common. The conclusion is obvious: research work done in one area can often be useful for other areas too. After coming back from Beijing, I began to wonder whether we should think about our research methods in a more generic way rather than limiting their relevance to a specific topic. Let me give a few examples of what I mean.
While listening to focus group discussions of hospital staff in rural Sri Lankan hospitals following an educational intervention in 2010/11, I realised that the strengthening of rural health systems is not possible without linking communities with small hospitals. Currently, there are no tools available in hospitals to maintain bilateral communication with the community. Due to this limitation, villagers try to influence hospital treatment decisions (so that they meet their expectations) by putting pressure on the staff or sometimes even by threatening them. In this difficult environment, hospital staff members in smaller hospitals feel forced to continue with the established (but often outdated or downright inappropriate) practices in order to limit confrontation with the community. This needs to be changed. Developing more productive bilateral communication mechanisms with communities and improving their awareness of treatment updates could hold the key to improved patient care. But how could we do that? In Beijing, while listening to Rakhal (an EV from India), during his presentation about his community project in Southern India whereby communities are empowered in order to seek their contribution to improve hospital capacities, I realised that this was a method which I could apply in a rural hospital setting in Sri Lanka too. Rakhal said: “A community intervention would link hospitals with people and would also encourage service providers to share the power with people”. I asked myself, wasn’t this the approach I wanted to create better communication aiming to improve practices or promote treatment guidelines?
A second example. In Sri Lanka, we have used outreach educational workshops to train hospital staff on treatment guidelines. The results have been promising so far – they showed that there were indeed changes in practices following educational workshops. Yet, the sustainability of observed improvements in these rural settings is a concern. Hence, we have been planning an extension to the previous study with repeated interventions at regular intervals to maintain the improvements. But regular outreach workshops can be quite pricey, especially in low-resource health systems. While listening to Godson, an EV fromNigeria, when he talked during the pre-conference about the use of short text messages (SMS) to improve immunisation coverage in Nigeria, I began to wonder whether he showed me a way to sustain changes following outreach educational workshops with minimum cost. A reminder in a simple text message may be an economical way to repeat key messages and sustain the improvements in low-resource settings.
Final example. I have also been working recently on research to improve patient outcomes after acute self poisoning, by changing practices in rural hospitals. During my presentation in the pre-conference, many fellow EVs asked why these people try to kill themselves. Although there are lots of hypotheses and results from smaller studies which have attributed self poisoning to mental health issues, alcoholism, sexual abuse or domestic violence, I didn’t have a straightforward answer. In our study, we concentrated on secondary prevention and did not look at the underlying causes. But, thanks to Mridula, another EV fromIndia, who showed us how she used verbal autopsies to understand the issues related to maternal deaths in an Indian district, now I know that we could perhaps use verbal autopsies to get more insight into the incidences, which could lead us in turn towards better primary prevention strategies.
For me, collective learning and sharing experiences and knowledge is the spirit of Emerging Voices. This venture has immense potential and will definitely make us stronger, not only as a group, but also as individual researchers. Therefore, continuous discussion is needed to unlock the potential of sharing and adopting ideas from each other. Let’s share and learn from each other and grow together.
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