Posted on by mamothena

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.

Posted on by Loosely Translated · 1 Comment

“Read this and call me in the morning”

-Darryl Herron, Tree Doctor

The forest floor may not always seem as impressive as the giant trees that congregate around it but it is probably one of the more interesting places you’re likely to come across. During certain times of the year, if you’re lucky, have patience, and timed your visit after some rain, you will see a once plain forest floor come to life with wonderful colours and weird shapes, like the glowing pale green cap of Mycena chlorophos; the bird’s nest fungus, Cyathus novaezelandiae (yes, resembles a bird’s nest with eggs); and the characteristic creamy star-shaped earthstar, Geastrum triplex. My friends call me a tree doctor, and that’s what I am, sort of…

 

Side note: Before mycology was a recognized field, fungi were thought of as plants and were even grouped with them. The first scientists studying fungi were really botanists; so if we were living in 17th century, my friends would have been right.

I’m actually many things. I am a microbiologist by training; that is my broad field of study. The core focus of my PhD is on a fungus, which also makes me a mycologist (I study fungi). The fungus I work on kills pine trees and is a huge problem for the forestry industry, globally. Because I study a tree disease and work, part-time, in a plant clinic which diagnoses tree health issues, it also makes me a forest pathologist. I could call myself any one of these (and more) but I have adopted the title tree doctor. Like human doctors need to know about human physiology, the diseases which affect them and the medicines to remedy them, I need to understand that about plants.

Herron_Eucalyptus_2
A tree doctor in action

Tree doctors are as awesome as — no, wait — are more awesome than medical doctors because a tree doctor has (or will have, in my case) the title “Dr” without having to worry about medical malpractice. We face a tougher challenge, however: tree doctors, like veterinarians, work with “patients” that cannot tell you what is wrong and the medical research for plants is far behind anything we have for humans and other animals. I essentially treat plants in the medical Stone Age! Yes, there are high mortality rates.

The knowledge gap is wide and that makes my job both interesting and disappointing. A few weeks ago I was called out to give some advice on a beautiful 100-year oak tree that was dying. The owner— having grown up with this tree, like her father before her—was willing to do anything to save this tree. Unfortunately, this oak was suffering with a root rot that was quite advanced and would eventually kill it. Had I the chemotherapy equivalent, the technology to safely cut out the diseased tissue or the knowledge of synthetic root growth, we could have done something to save this tree. But yeah, we’ve focused on animal health for millennia, and we still almost nothing about green living things.

Some individual trees have great sentimental value to people, but generally we seem to take them for granted. We should not. Trees quite literally provide the air that we breathe, and many animals (birds, squirrels, various pollinators) rely on them for safe spaces or food. We need healthy trees. As a farmer or forester, you realize the value of plants because you sell the plant or its products for a living. While these commercially important species are well protected and somewhat studied by many plant doctors, there are far too many plant species that do not receive the same attention—unless there are small pockets of them left, like many of our cycads or the redwoods in the US. Because our knowledge and the technology for plant health is so far behind, should these precious plants ever become diseased, it’s going to take a miracle to save them.

When you walk out of your house tomorrow morning, take a moment to look at what’s around you. Look at the plants in your garden, the trees on the street and those lining the horizon. Now, imagine if the only plants you’d ever see were grown in commercial plantations or massive, monotonous farms.

Herron_Eucalyptus

Research shows that green spaces in cities boost our own mental health, that getting out into nature (not just well-tended gardens or farms) restores balance in our own rushed lives. It’s not just the green spaces, but the pale green, bird-nest lookalike, star-shaped spaces too—trust me, I’m a doctor.

Plants may not always seem as impressive as the humans that congregate around them but they are the lungs of our planet, and keep us mentally rooted (pardon the pun). We need a few more tree doctors to make sure that they don’t simply disappear and turn to dust under our feet.