I smiled when I saw a video of Keke Palmer this morning. It was a video, a masterclass even on how to shoot your shot with what you want. Keke Palmer was on the view and she took the time on live TV to ask Whoopi Goldberg if she could be an actress on Sister Act Three. To which Whoopi, responded yes. I paused after seeing this because for one, I love when black women celebrate each other, propel each other to new heights to. It isn’t often on display when we do so too, so seeing it in this young generation was refreshing. It also helped to frame my thoughts for today on why black women, in fact all women in general need to keep shoot their shots with whatever you want. We are already putting in the work, sometime a lot of time that is never fully accounted for in a typical 40 hour work week, hence the need to go for what you want. Of course have the data to prove you deserve that which your heart desires. Be accountable to people not just in words but through tangible proofs illustrating why you deserve that request and you just might receive a positive response. I am looking forward to shooting my shot in this next phase of my life. I intend to live our the biblical principle, ask and you shall receive, seek and you shall find, knock and it shall be open to you. I will not ask for something I cannot do and if I am asking, know that it is already done.

One of my favorite magazines of late is Breathe. It’s optimism infused with wellness, kindness, mindfulness and inspirations actually helps me breathe. I usually have it by my nightstand and every now and then I pick it up to become focused on what matters for me. Today, creativity that cures. Finding opportunities for self care, opportunities for life care, is my crusade these days and of course writing it as these lists helps me get through each day. For me writing each day, whether short or long, whether research or not, helps me stay grounded, helps me focus on being human. We don’t practice real writing anymore for the sake of simply writing. I believe that every time I write, I am getting better at my own self care, getting better at my life care simply because I choose to breathe.

I presented at the 2021 AORTIC Cancer research in Africa. There was a pre-conference the past two days and I was asked to lead this morning with a discussion on why implementation science research for cancer in Africa. What many people do not know was that the invitation which came July 12, came exactly one month before my sister in law passed August 12. I took it as her parting gift. She knows I love to talk. She also knows that I do research, implementation science research in Africa. But I have never done Cancer work. Never even felt it was my place to do so until her cervical cancer came knocking at our door steps. The preparation for the presentation has been one giant healing process for me. I literally wrote poetry, yea or maybe verses on ways to disseminate cervical cancer research using her experience as an entry point. I was so tempted to do so at the presentation that I opted out last minute. Not because I don’t think they were great and I will publish them here one day, but more because ours is still a very conservative field and the idea of decolonizing how we present research or even saying anything anti racism scares people, though I am working on verses for research. But I digress. For now, here is the standard presentation I gave and yes, I gave it in her memory as stories still, to help guide those who want to fight like hell so we don’t have to tell anymore stories like Angie’s.

I know we have heard a lot about implementation science the past couple of days, with a lot of talks about what it is and how to do, but let me paint another picture if I may of why this matter for the region.

So I am an implementation researcher, interested in how you sustain evidence-based interventions in resource-limited settings.

I am also a storyteller.

I grew up in Lagos, Nigeria, with a show called Tales by moonlight which is similar to what griots do in many other African settings, and so stories are all I know, and it was refreshing to hear Dr, Eche tell his implementation story these past few days. I think we heard yesterday for example, that policymakers respond to data, I agree.

As someone who used to work in the UN, I would also add that policymakers respond to stories, especially stories about data, stories about what works or doesn’t work, even stories about the constituents they serve. So let me tell you a story If I may of why implementation science matters for cancer research in Africa

And I want to begin from with the story of Angie. Angie, a 53-year-old woman, as is typical in most African countries, presented in the clinic with stage 4 cervical cancer.

There were no warning signs, or least when she saw some, she didn’t take it seriously. She never had pap smear in her life until she presented. She didn’t even have any access to universal health care insurance.

Only reason she presented actually, was because she couldn’t eat anymore, and felt something was obstructing her ability to eat, and was seeing blood in her stool. Angie’s story is typical in many African settings, and in particular for understanding why context matters for implementation science cancer research in the sub-Saharan Africa.

And to illustrate that a bit, I allow me to use some analogies. In our settings, analogies are like proverbs, they are like miniature tales, building blocks if you like in simple form of ways that the field can proceed.

This recent paper by Haines in implementation science describes context as a fabric. A blue fabric in this case, and just as embroiderers must first understand the fabric they are working with, researchers and practitioners of implementation science must obtain an understanding of the context in which they work in before selecting or adapting an intervention or any implementation strategy.

The red needle in this case represents the implementation strategies and thread is the intervention you may have in mind, and all of that have to be in harmony with the context in which you find yourself in.

I really like this paper, but let me address context in another way. Enter Yucca which many of us in Africa, may know as Cassava.

But if you traveled to South America, it is called yucca and it is used to make empanada, yucca fritters or yucca chips. Now this same tuber, if you come to my home country of Nigeria, can be found in local dishes such as Abacha, or what the Igbos’s call African salad, or eba and soup, eba being a typical Yoruba dish, or quite simply garri and groundnut, something we all eat in Nigeria as a favorite meal.

I use Yucca and Cassava here to illustrate again context matters. It the same tuber, but if you went to South America, its used differently, if you come to Nigeria, even within one country, it is also used differently. Context, like all the stories we will tell with implementation science it matters.

Another reason why context matters is that, the past couple of days was spent on ideas of what works with implementations, the how to do it literature of implementation science, and to all of that I want to add one thing that was missing and is this idea of starting with Why. And So for implementation science in the region, always start with why.

And if we stayed with cervical cancer, Remember to start with why for something so preventable and treatable, Remember to start with why for something where one in four women will die, unless they have access to life saving evidence-based therapies that exisit. Remember to start with why with resolutions that exist, the historic 90-70-90 resolution last year for example which calls the 194 member states of the World Health Organization (WHO) to achieve specific targets by 2030. Resolutions like this are actually fertile grounds and justification for implementation science in the region.And when you start with Why, you will find out that implementation science is an open and inclusive field that basically means workings not only within the context you find yourself in, but also broadening your collaborators, to include working with multiple experts and non-experts that you can work with to expand the field.

And as you do, as you pick out which outcomes, or frameworks or strategies you will use, be prepared to optimize them for your context. Many of them will not fit ERIC, storytelling isn’t in ERIC as an implementation strategy and that’s ok.

I say go for what works for you, let all that was shared these past few days be a guide, so long as you remember your why and that your context matters. This is the time to begin to galvanize efforts to decolonize even all we know with implementation science and just because it has been done in the West doesn’t meant it has to be in your setting.

In addition, and if we stay with decolonizing the field, also maintain what you know works in your setting, in your context.

You live there, so you know it better than any expert that may come to your setting. So harness that knowledge, it is just as vital as whatever knowledge you will bring from IS to your context.

And finally, be prepared to evolve. Change is evitable, CoVID 19 being a great example Of the need for example to embrace disruptions. Embrace whatever struggles you come across as you evolve. That and be open to other ideas, like the idea of health or implementation science occurring beyond a Western Paradigm.

Professor Collins Airhihenbuwa, my mentor, over 30 years ago, developed a framework called the PEN-3 cultural model, which helps to situate some of the work many of us do in the region, and it asks that we begin always by interrogating what is positive about our context, what is existential or unique about where we find ourselves, and then ultimately what are the hurdles, or challenges to be mindful of along the way, and for me the past few days of listening in, has allowed me to see first-hand, that the leadership within Aortic, in fact all they have done with setting up this conference, is the right start for tackling cancer research in the region.

I wholeheartedly believe that AORTIC is going to be a great resource and leader for anyone in the region try to navigate the rugged complexity landscapes of doing implementation science research in the Africa. And the stories we will tell, for example with the Aortic implementation science special interest group will be the escort that propels the field forward in the region. It’s your story that will convey all our gains, all our failures, and all we hold dear, or should condemn or de-implement for example with implementation science in the region.

So finally as you think through context, one thing I want to emphasize is that we all get into the habit of doing is rapid cycles of what will work or not work in our setting. Some of the speakers, Donna Shelley for example, talked about rapid cycle evaluations. The response to the COVID pandemic has been one massive rapid cycle evaluation, that I believe everyone trying to do work in the region should seize upon because the tools for cancer, whether with prevention or treatment exists and have been in existence for decades yet they continue to remain out of reach to the people who need it the most.

This idea of making a plan, then doing, then studying, then acting, or making another plan will do the field well and help save lives now. If you choose to move in this direction, let me stay in the issue of just planning and tie it squarely to the issue of sustainability. I believe that it is unethical for people to implement interventions in regions with limited resources without even a simple plan on how you last.

Most of the research you will come across implemented in the region, are never sustained. This paper for example by Johnson et al on NIH R01 grants in general with an implementation science focus found that none had plans to last.

We found the same thing in a systematic review I led, about 5 years ago about the sustainability of research in the region. We also noted that if you are going to come do any implementation science work in the region, the least you can do is plan to last.

It should not be done in the end, not even in the begin, but throughout the lifecycle of whatever interventions you have in mind. Having a plan, can be as simple as gathering the right stakeholders to work with, learning from them, be willing to change or adapt along the way, while nurturing what truly matters in within the context in which you find yourself.

And so in recap, I loudly and enthusiastically appeal to the group to come do implementation science work in the region particularly with cancer, and as you do, with whatever frameworks or strategies you use, plan, plan, plan to last.

Thank you to the organizers of this conference for allowing me to speak, Drs. Odedina, Alaro, Bello, I thank you for the invitation. Your invitation came at a time when my family was dealing with the stage 4 cervical cancer burden of Angie my Sister in-law. We lost her to cervical cancer this past August 12th. But I give this presentation in her memory for the many other Angies we all have to fight like hell for, so they live, in a region where context matters. Implementation science needs more storytellers and I hope that AORTIC works to cultivate the next generation of storytellers truly making a difference in word and deed for cancer research in the region.

‘Currently the scientific process is doing a major disservice to patients and society.’ That was the conclusion of a paper that popped on my Twitter field today. It’s like the entire universe is conspiring to say something to all of us in this field and I am so here for it. The authors led by Calster et al. (2021) basically stated that ours is an enterprise where the quality of the work we do remains poor. The criticisms remain longstanding. Business as usual is the backbone of the enterprise where most initiatives to address this issue are top-down. I guess I am not alone is all I can say. That and we all need to do better. COVID19 made it painfully clear. According to Calster and colleagues (2021) ‘the focus remains more on the destination (research claims and metrics) than on the journey. And so the problem of poor research persists. The problem is deteriorating further.’

Notwithstanding, research should serve society more than the reputation of those involved. Science should not be a game in which we collect credits to reach the next level of our career.Which made me decided to keep this today. With research, even with the publications you write, keep being in service to people.

Be in service to people as you study disease prevention, disease management and disease treatment. Be in service to people without focusing on disease too. Be in service to people as you reduce poor quality research, reduce poor design, reduce poor research conduct, or reduce poor reporting. Be in service to people to simply reduce ‘research waste’. Be in service to people with research that has value for patients, research that has value to society. Be in service with research that is simply of value and not harmful.

But of all this, know that research waste remains a persistent problem. Research waste is structural injustice. Research waste is costly and truly harmful to society. Research waste is a function of all of us in academia. We are the problem with research waste. We can also be the solution. And I want to be counted in the number of those working towards a solution.

I know I have been dark and gloomy these past few days. My field has been dark for a long time. The crisis we find ourselves in isn’t new. We just lack the willpower to truly lead hence this darkness I feel for us. But today, I want to change course. Today, I actually want to use my platform to introduce light. We can act, we truly can do so as long as we gather as leaders to ignite and transform our field. That’s my hope anyways, that we will become the next generation truly taking action in word and deed, not in service only for our resumes but really for the public we serve. It will not be easy. They status quo will always prevail and rightfully so. They have over 120 years gap ahead of us so I don’t even expect to be in competition with them. This isn’t a race. But there is a sense of urgency that has been brewing for a long time and I want to be counted as those in generation public for the public’s health. I want to be counted as those in generation light for the public’s health.

I was inspired by the work of Paul Cornely, the first black President of the American Public Health Association. He was the first with so many other things too that I am so sad we don’t have a lot in his honor. This is my attempt to change that. I was inspired by an essay he wrote back in the 70’s about an ardor for change. It’s has taken over 50 years, but your enthusiasm for the field has been caught by a few of us and together we will work to bring light to the public’s health. Know too that all you suggested then about our society being sick, even the malady of racism is just as relevant as you are for today’s generation of light bringers for the public’s health. We all remain aware of the marked deterioration taken place in our society. We also know the irresponsibility and immorality of ignoring social issues too, social justice even or the right to health for all. And when we still evaluate all the field has done, it’s all remains little, 50 years later since your remark. And this pandemic has revealed openly the stark injustices that permeates our field to. The institutional racism you harped on 50 years ago, even among so called associations and experts, myself included, in service really to our curriculum vitae’s and not the public we purport to serve. So who remains in the business of the public’s health. No one, even in 2021 or in 2022. If I have been dark, it’s because our field has been left behind for so long that we could not even be called upon during the greatest and once in a lifetime pandemic that has killed over 850, 000 Americans and still counting. There are no great leaders in public health and not medicine, public health, leading the public at a time when the public desperately needs attention and care.

Dr. Paul Cornely

But now in moving this notion of light forward, in propelling light for public health, I penned the following verse inspired by Job (yea Bible Job). Our field can learn a thing or two about someone who lived through darkness. I hope you like it.

What if we sent light to places dark as death? What if we taught light to people that lacked insight? What if we gave light to those that wander confused and lost? What if we allowed light to flow to those who fall? What if we let light be the voice of the forgotten? What if we used light to direct the lives of all Gods’s creatures?

Then we might all become light. So long as we send light to the dark, teach light for insight, give light to the lost, allow light to flow, let light speak, and use light to direct lives and places as dark as even the forgotten public’s health.

There was a time when we had a sense of urgency in public health. When this urgency spread through all we did. We had a sense of urgency with our history. A sense of urgency for severe miseries. A sense of urgency with racism. A sense of urgency with poverty. A sense of urgency with addressing real needs. A sense of urgency with achieving social justice. A sense of urgency with prevention. A sense of urgency with decisions. A sense of urgency with where we live. A sense of urgency with the schools we build. A sense of urgency with food insecurities. A sense of urgency with housing insecurities. A sense of urgency as our climate changes. A sense of urgency as our landscapes derange. A sense of urgency with social, economic and political policies. A sense of urgency with the impact of these polices. A sense of urgency with the frustrations inherent with our field. A sense of urgency with the tensions inherent in our field. A sense of urgency with new crisis. A sense of urgency with old crisis too. A sense of urgency with many protocols. A sense of urgency with our downfall. A sense of urgency with resolving neglected issues. A sense of urgency with redressing perplexing ones too. A sense of urgency for vigorous leadership. A sense of urgency for active partnerships. A sense of urgency to literally breathe. A sense of urgency to literally last. A sense of urgency for fruitful survival. A sense of urgency to simply thrive. Whether these urgencies will translate into anything meaningful remains to be seen. Until then, may all of us in the field know that the time has come for public health programs to be run by the public with the problems.

This sense of urgency was inspired by this piece written by Mr. Rudolf Sellers for the American Journal of Public Health. Mr. Sellers was the Director of Health Education and Community Organization within Hill Health Center in New Haven and a Research Associate at Yale School of Medicine.

In 1968, Dr. Morris Schaefer, a Professor and Head of Department of Public Health at UNC, Chapel Hill wrote a striking paper about the current issues in delivering better health services. He presented it at the 95th annual meeting of the American Public Health Association and many of what he shared then resonates with the state of public health today. In it he shared ‘how our incapacity to appreciate the character of the problems we face, may render us helpless when we encounter future challenges. Our field is not only confronted by new challenges, but also an increased urgency attached to old problems, new responsibilities, new functions, all at an increasingly rapid rates. Also with each
new challenge, comes the need to respond to continuing changes, all while maintaining the stability necessary for effective Public Health Service.’

If only our field heeded his advice in 1968. That and the idea that Public Health for better or worse is deeply enmeshed in political activity, despite the fact than antipolitical ideology persists. The handling of the pandemic is a glaring example of this. One section though that I choose to keep today is his focus on how ‘the past is still present.’ He was so thorough with the significance of the past and why we all need to have a reorientation in our attitudes about public health that it only makes sense to render it in verse for the present.

Without no further ado, read my keep below inspired totally by Dr. Schaefer entitled the ‘keep knowing that the past is present in public health:’

Public health faces a new day. While a hangover still remains.

Unsolved longstanding problems remain. Unfamiliar areas of services too.

Shortage of personnel remain. Solutions for the future too.

Conditions of uncertainty remain. Clamor for demands too.

Varied programs and goals remain. Complicated disciplines too.

Target populations remain unknown. The public we serve too.

Useful but limited textbooks remain. Old, standard associations too.

Struggles between agencies remain. Tensions across disciplines too.

Uneasy frontiers for public health remain. Uneasy boundaries between agencies and governments too.

Delusions of a old and well-propagated myth of the non-political character of public health remains. The persistence of the non politics myth too.

Lost opportunities remain. Lack of clarity of vision too.

Unsolved current problems still remain. An extension and intensification of past problems too.

Social problems significantly remain. The hands of the past on the future too.

Discerning local interests remain. Harmonizing initiatives too.

The need for imaginative and highly capable actions remain. Increased competency with information technology too.

Enormous strains on coordination remains. Responsibilities and resources too.

Long standing tensions among professional groups remain. Equal status of groups too.

The need for greater visibility with public health remains. Shortening lines of communications too.

Loss of potentially fruitful research remains. Duplicating research and services too.

Existing fragmentation of agencies remain. Business as usual too.

The urgency of problems affecting particular groups remain. Disruptive and limited responses too.

Struggles for allocations remain. Visibility and authorizations of those allocations too.

And so the continuing problems of the past remain. In the midst of new problems too.

Limited understanding of the persistence of these problems remain. So too our inability to solve them still (whether in 1968 or 2021).

Dr. Morris Schaefer address on current problems and issues with public health.

In a 1987 interview with Chris Searle, Chinua Achebe shared why it took him nearly 15 years before he wrote his next novel ‘Anthills of the Savannah.’ It’s is one of my favorite of all his books for his critical stance on the significance of the story. The story, according to Achebe, is ‘our escort through life without which we are doomed. It’s the story that remains to convey all our gains, all our failures, all we hold dear, even all we condemn. The story is the only way we keep going from generation to another, almost like a transfer of genes, to the next generation,’ Achebe noted, a transfer far more important than anything else. I always come back to interview as a guide for what I do professionally. I may call it different things, papers, grants, implementation science, global health, but really at the core of what I do, there is a story that keeps brewing, one focused on the people I work with, one totally committed to helping them tell their stories. It’s their stories that will get us to a healing, healthful generation, their stories will transform and help to convey what is important, what is of value, and what must be preserved and yes Chinua Achebe is leading me all the way.

Towards the end of the interview Chinua Achebe talked about the dangers ahead for those committed to whatever stories they are telling to their generations. We can all be antiracists for example with public health, that’s my hope, using tools that begin to center the public as they find the words to tell their stories, but until then, Chinua Achebe noted that we will struggle. He stated that for those committed to the story, there are dangers on the way, mostly because of our human condition, one where our lives are always soaked in a struggle. We may never know whether what we are doing will bear fruit and even if we fail, hopefully those that come after us, may learn from our struggles. That is the great hope and my keep for today turned into verse (all inspired by this interview) with Achebe reminding all of us interested in health equity work to know:

There are still dangers in the way. Still a lot of work ahead before we all achieve equity, before we all become antiracists. Until then, we shall always struggle for our people, struggle for their dreams, struggle for their light, struggle for their plight, struggle with our might, struggle at night, struggle during the day, struggle for a say, struggle for pay, struggle while we play.

We struggle for justice, struggle to end injustice. Struggle for voices, that struggle to be heard. We struggle to achieve, struggle for what we believe, struggle to see, struggle to simply be, struggle while we flee, struggle with their knees, struggle with our hands held up, struggle with our heads held up, struggle to rise up, struggle to even standup.

Some of us struggle to cope, struggle for hope, struggle out of scope, struggle with their grope.

We struggle with racism, struggle with sexism, struggle with ageism, struggle with classism, struggle with ableism. We struggle for optimism, struggle against their narcissism, struggle with their pessimism, struggle for our activism, struggle with their symbolism.

We struggle for our lives, struggle for ourselves, struggle for all our gains, struggle when it rains, struggle in pain, struggle in vain. Still we struggle to breathe, struggle to eat, struggle in heat, struggle till beat, struggle for seat, struggle in defeat.

We struggle to survive, struggle to thrive, struggle for our values, struggle for importance, struggle for what we preserve, struggle even if we fail, struggle even as we struggle.

We struggle for our past, struggle for today, struggle for tomorrow, struggle for our history, struggle for our story.

We started the day in church and ended it on a hayride across our village. We were covered in hay and my heart was full. This Halloween was fun and something I didn’t know my soul truly needed. For all the loss, for all the pain, for even all the heartache, it was simply glorious, I tell you, downright splendid to see our kids just be kids and happiness flow like waters that run deep. I wouldn’t trade this happy place for anything. This forever gift my children continually gift to me. Happy Halloween and may yours lead you to treats full of happiness.