Ideal research in un-ideal environments

I’ve been following the tragedy happening in the North West province, regarding the collapse of the health services due to the community and trade union protests. Health systems are the stage where the impact of corruption and bad leadership plays out very dramatically, because they cost people’s lives. What was a trade union-led slow-down of health services in the province has escalated to full-on community strikes that shut down roads and health facilities.

Mahikeng service delivery protest
Welcome to the hospital. Source Bhekisisa.org (Photo by Oupa Nkosi).

 

North West hits close to home because it is the focus of my research. I am investigating how we can measure all the elements that come together to improve maternal health outcomes, including community factors. Although I love evidence and metrics, they always show you the picture in retrospect. They show you something that has already happened. They can help model future trajectories for sure, but those depend on certain conditions that in turn depend on the whims of individuals in positions of power. And they can tell you what needs to be done but can’t make people do it. And they are not empowering to the person they are supposed to benefit, the patient. Because measurements don’t equip a patient for dealing with the unexpected challenges that spring up in the public health system.

Mahikeng protest
The worst affected are those who need health services the most. Source Bhekisisa.org (Photo by Oupa Nkosi)

In this case I use the word “unexpected” very generously. As the reports state, the trouble in the North West has been brewing for years.  And it now manifests in a health system where the budget was overspent but few of its targets met. Where prices of medicines are inflated. Where money is divested from hiring more nurses and doctors to fraudulent projects. Where the frustrated reaction of health workers that feel powerless leaves patients without medicines and being discharged prematurely from hospital. Clinics closed. Patients stranded. So I may research the effect of lack of services on health trajectories all I want, and sure enough contribute to the “evidence vault”. But I can’t make people not award contracts to their friends, and that makes me angry.

I became a public health researcher to make a difference, but instances like these make you think hard about how to do that. We are all pieces of a puzzle, I understand. But nothing makes you feel more powerless than the self-interested actions of powerful individuals who can adopt or not adopt whatever guideline you come up with. It’s a reminder of just how embedded health systems are in society – and how a researcher therefore has to be embedded in society-wide action in order to make a difference.

So I’ve been looking for the links between my academic research and those people and organisations that play a more active role. I’ve learned about organizations that track stock-outs, that advocate for rural health, that are on the ground now as we speak, monitoring the situation. They are active behind the scenes, working to entrench real change in the health system. Maybe in the next few weeks I will figure out how to align myself with these actors, beyond just a Twitter follow. Maybe the hopelessness will subside.

My people, our food

I only have one word to describe Africa, DIVERSE. In this continent there exists more than eight thousand dialects spoken among three thousand tribes that to me is diversity defined! In the past three months I have had the pleasure to experience a bit of that diversity through living with housemates from Zimbabwe, Uganda and of course the rainbow nation. Come to think of it even the chickens had a bit of diversity (in terms of behaviour)… I mean there was one naughty cage. I tell you, those birds would even poke my pants! And then there were my sweet babies, always well behaved (laughs).

Food production in process

Food matters at house no. 24

Anyway, my housemates and I have a lot in common, maybe because we are all students or it could be that our similarities emanate from the fact that we are all nourished by the African sun and our history is stained with the rich soil that produce precious stones. Nonetheless there is a significant difference in the food we eat. Believe you me in this regard (p ˂ 0.005). My house mates from Zimbabwe prefer SADZA (pap) on any day to most dishes. To them it’s their thing and without it they are “food insecure”. On the other hand there’s me, I always feel “food insecure” when I have no vegetables and of course meat. We sometimes explore each other’s meals but what I realised was, though I may like how each dish tastes, I may not necessarily regard it as food for nourishment. Same goes for the rest of the house. I never though diversity would be evident even in food. A simple meal (well, simple in my view) is complicated and sometimes unacceptable to some of my housemates because they didn’t grow up eating such foods and it won’t fulfil their hunger.

There is always hope

Yes, our food is different, but there is beauty in it. I guess as researchers we are trying to find an answer to the same question in different ways for various communities; these ways based on the environment, availability and acceptability of the foods we are so desperate to produce. The quest for food security in Africa is not new, neither is it impossible to attain. I believe food security challenges on our continent can be solved through our diverse strategies to make Africa better — research being one of them. For that reason I will continue to pursue excellence and appreciate diversity in even in food. It’s only been a year into my research about animal production and already I’m thinking it’s too late to quit now. There must be something I can do to redefine the state of our continent… (Sigh).

Food and more food is what I’m striving for.