Anatomy of a collaborative study

I’m here in South Africa for two workshops on the development of a huge planned study. Its challenging to bring together such diverse groups to work on one study, to communicate and truly collaborate. And the politics can be such a minefield, often tough to negotiate – though for now its not me who will be doing that. Again the time “before independence” defines a lot of how people relate and its hard for the foreigners to sort it all out. We’re often making inadvertent blunders. Luckily we have two young South Africans on our team, to help us negotiate all that.

The site visit yesterday was just great. It was so helpful to see to a certain extent what the level of care is like here, and what is available. The Drakenstein valley is really beautiful, in a basin surrounded by mountains with wineries all around. The hospital & HIV clinic we visited was much better resourced and better developed than what we had last year. The “Emporium of Care” provides a variety of health care services, social support, spiritual support and income generating activities. Its just a really neat holistic facility. Our conference badge lanyards were made by the beadwork project from there – www.kidzpositive.org

Yet the health care workers all talked about being discouraged with the system and how draining it is. I wonder if part of that is the fact that there are such riches here.

I’ve been struggling a little with what my role really is; I’m not an expert in any area and I sure don’t have any experience in designing and implementing any large study much less one of this scale. So I find myself wondering what I can really contribute.

The anthropologist that has been working with us has been really good – although she’s just working on her Masters, she’s worked on a number of prior studies in the area, and in other parts of Africa.

One of the challenges has been to establish “community participation” and “community driven” … no one in the core group (especially of the Canadians) has actual experience in doing that in low and middle income country settings. Yet how you go about community engagement is different if you are selling / engaging them on a study that is essentially already designed is quite different from really finding out what the community wants and studying that. My public health hero, Dr. Bang has taught us about projects that ultimately fail when they didn’t take into account the community.

Anyhow, there are no easy answers, that’s for sure. We’re all learning incredible amounts along the way though.