I write slowly. Painstakingly slow. I have been letting the words come. They come really slow. It may seem like I can’t get to the end. I have been told to set deadlines. I do. All the time I have deadlines with my other style of writing. I always meet the ones with the grants I commit to writing. Deadlines aren’t a problem. But for this other style of my writing, the nonfiction side that seeks to challenge the status quo, that writing side is pretty slow. I think it’s because non fiction or even fiction writers don’t often prescribe solutions. We do that a lot in academic/scientific writing. We have a solution for $25k or $10million and if we are good at this grant writing style, you will probably give us that money. And chances are nothing we prescribe will actually change anything. It’s the sad but real truth about academic writing. We are in the business of offering solutions. Impossible and often unsustainable ones. Granted it may work for 705 or even 30 people we follow for 6 months or 12 months after our study ends. But visit those people 4 years later, chances are nothing has changed. And we are probably off to the next grant. That side of writing in my opinion is part of a colonial legacy that has dominated scientific writing for to long. It also has to change.
Recently, a top journal sent out an email asking people to respond to their themed paper on ways to advance racial and ethnic equity in science and health. They especially requested for racial and ethnic groups marginalized or often excluded from publishing to send in their papers. I chuckled. Not only have you excluded these groups from publishing, now you want them to end racism too. The ones you intentionally excluded? Are they god? Do people only see racial and ethnic groups in science as gods?
We are only just coming to terms with the knowledge that finally, racism can be publicly declared as a public health crisis. It was just acknowledged last year, in 2021. Something we have known for too long. And now, one year later, we are supposed to have interventions that end racism, metrics to measure progress, even ways to advance workforce diversity that advances racial and ethnic equity in health. Surely even their gods must be crazy. If you have systematically excluded voices of people and scholars experiencing inequities, if you have not allowed them to be lead authors or even accepted any paper they wrote, how then can you expect them to do the impossible as if they were gods. This is my musing for today, something I wrote as a verse below. Ooh and racial and ethnic minorities in academia cannot end racism we never started. Enjoy below.
Surely we can write, about racism, about its many forms, about the structures that perpetuate racism, about policies and practices too that are racist.
Surely we can write about how racism leads to segregation, leads to violence and incarceration, leads to inequitable access to health, leads to poor quality care, leads to color blindness, leads to systemic bias, and ultimately fails the people it serves. We can do all that with your call for papers. Or we could try truth-telling.
How might the same people, voices unheard of, voices ignored, voices suppressed, or voices excluded, end something they never started? The pernicious effects of racism are not for ignored or excluded voices to address, let alone remedy. All of that is your problem, not ours.
We know the effects of racism. We live it too. No calls for papers will end what we know about it. No selection of papers, peer-reviewed, commitment to anti-racism, will change this one fundamental fact, we are at a crossroads.
The tools we use with writing as we do scientifically are colonial.
Racism has seriously disturbed scientific writing for too long.
We will not survive using your colonial tools. This is after all the oppressors language. The master’s tool. We know this also.
But those of us committed to change will survive.
We will survive.
Not in methods, results or discussions. Not in margin of errors or regression models. Not in p-values or any rigorous statistical analysis.
We will change course and move on. We will drop what we can, forms and styles of writing we can, and continue our journey, our way.
This is our story too. We will write ourselves and the people we serve into history. Our way. With or without you. We don’t need representatives. We don’t even need papers. We will write our stories, write our histories, write our fears, write new frontiers, write until we become clear. Write until we change injustices. Our way.
We have tried to learn your ways. Tried to push back on the misrepresentation that so often defines the people we serve.
Today isn’t our morning.
We have been ready to take on this challenge. Ready to make concessions where we can. Public health critical race praxis is one fine example. Not even your exclusions have undermined what we know.
That even those presumed to have no voice, have voice. Those presumed to have no power, have that too.
And we are doing what is expected of us. Our way.
We know something better than your ways exist. We know the possibilities of light. We are also committed to proclaim like the universe once did. Let there be light.
In killing rage, bell hooks talked about the need to heal our wounds. Not to be misconstrued with moments where we survive with grace, elegance, or beauty, but rather the wounds that are often hidden or fundamentally traumatic. Living and coping with the ongoing pandemic is fundamentally traumatic and we are all not okay. I have always known this. Tried to move past it too. There is so much as stake and stopping to hold myself longer was never really an option when so many people are relying on you to be strong. Relying on you to be okay. But yesterday, in the middle of watching snow fall and learning about how trees withstand freezing rain, I realized that I have been holding on to a collective wound for too long.
It may seem trivial, but there was a time, I was always on the go, traveling from one country to another in the name of Global Health Research. Research for me was never to be done in the US. So I travelled whereever and whenever work called. I have not travelled for work in 2 years. The last time I did was to South Africa in January 2020. I call myself a global health researcher. I describe myself too as one who learns about global health in person, connecting and weaving stories about our field with people themselves whose stories I am privileged to tell. Such an approach focuses more on the dynamics of the story listener, which is as equally important as, if not more important, that those who tell the stories. I have not listened to stories in person in 2 years. I have not seen people as I normally would, to listen and learn from them in 2 years.
I have also stayed in the shadows with the pandemic. Not spoken eloquently like others or even written eloquently in academic papers about it. Honestly, I am exhausted with the way research is framed in academia. I am tired too with who gets to tell the story for others and who doesn’t. I am also longing for new ways to listen to stories and tell the stories I hear in ways that do not silence or ignore people. It wouldn’t and shouldn’t be based on impact factors within journals. It should be people factors, everything that allows us to connect first as humans and not experts or others. I want to be counted among the people that break this cycle for good.
So many things have inspired this insight within. Becoming a mother during the pandemic, while mothering 3 others, and being there for a frontline spouse may have played a role. Telling diverse stories matters, that doesn’t silence but names the woundedness within our field is so powerful too. But honestly, as we all start gearing for a post-pandemic phase, the one thing I long for is knowledge production uplift with my work. Similar to what bell hooks described as racial uplift. If I wasn’t listening and telling stories pre-pandemic, in ways that make sense to the people I work with, now and post this pandemic, I intend to retain the ideals of the people I serve.
I want my work to focus more on how we see ourselves. To enter spaces and create stories that break so many diligences. To also reclaim spaces where our lives and our stories are heard as loud as we want is also an urgent desire. One where we cannot resort to collective failure anymore. If academia has ushered in learned helplessness as with the way we write, or for whom we write, then the time for change is now, if we really want to attend to the needs of the people we serve. I don’t know what this may look like, but I am working on it and in due time, I look forward to sharing ways that I plan to heal from the trauma inflicted upon all of us that would rather listen and be in the service of others and not institutions or programs shaped by white supremacy. I know that when we all start to address our collective suffering, we fill find ways to health and recover that can be sustained long after this pandemic end. It’s now my life’s work, openly healing wounds from this pandemic.
Imagine taking seven days to frame the entire world. The kind of patience it would take to ensure that the stars and the moon are in the right place. All sorts of fishes or sea monsters swim the oceans. Mountains and hills are perfectly framed with volcanoes ready to erupt as they please. Having such a patience with fine details would be sterling. Something that only the universe can accomplish on their own without any interruptions. Well I’m no universe and it’s taken me nine years to finally make sense of this dance I have been dancing with words. One that only fully came to reality in 1.5 years. So for close to 7-8 years, this dream that I had to simply write, was dormant. In fact, dead. Of course I wrote. But for others, not myself. Of course I will always write. But again for others, not myself. The dance with the mind, the communion between the writer and the reader is one that we must all guard at all cost. When I noted earlier that I was writing, truth is I was writing in the way others told me to write. I wrote in a manner that was pleasing for the scientific community. A style that required us to have sections that we called introductions or methods or results or discussions. Master this style and you have a career. I have made a career out of this style.
This year, I’m am 2 papers away in this style with earning my 100th paper. I discovered that just the other day as I finalized my performance review for last year. Many scholars would be thrilled to say that have 100 scientific papers, yet I felt truly sad for myself. Not that none of the work isn’t important but more so, because i have been dancing this scientific dance to the detriment of the minds I would rather serve. What I mean by this is that, in science, in science writing in particular, there is no communion with the average community. Of course, we dance with other researchers, many who themselves are prepared to dance like you. But honestly, I would rather that anything I write be in service of you. Anyone and not just researchers in the scientific community. I would rather that I dance with words for people who would never think to download any scientific paper but are curious about ways to stay healthy. It has taken a pandemic for me to get here. But now, I want my writing to be in service of humanity. I want to use words to change the world. It sounds like a dream and well, I am prepared to dream and work to make it come true.
When writers and readers manage to touch another’s mind through reading, the intimate, sustained surrender that is felt, without fear or interference, this dance of an open mind, fosters a particular kind of peace that requires vigilance. Securing that peace, the peace of a dancing mind, is our work. ‘There isn’t anybody else’ said Ms Toni Morrison in her little book ‘The Dancing Mind.’ I totally agree. She may be gone, but her words, are my source of inspiration. I hope to use this blog to help you experience your own mind dancing with my own. Securing this peace, the peace of the dancing mind, is now my life’s work. Rest In Peace Ms. Morrison. The dance continues…
I imagine when we meet. When our hearts and minds connect our steps will move to the rhythm of the beat. Our minds may wander. Your beauty is like thunder. The sound of cars beeping will bring us back to the reason for our meeting. If I must confess, you make me dream. You make me soar to high points through words that allow me to dream. Clouds maybe grey. Sunrise distant. But your brilliance, your ability to outshine grey clouds, is the reason life doesn’t frighten me at all. The reason I want to keep dancing with you. For these are unpredictable times and only our furious dancing will do.
It has been a hazy week for me. Like the terrible fog we saw this morning in STL. I started the week in stride, with great news and almost immediately, bad news followed. I imagine this is what happens when you let the bad in. They reflect no stars and can keep you down, if you don’t immediately rise and praise the good. To be down and never know how to rise is my keep for today. And now, when we are certain of things we cannot see. Like the air we breathe. When we are sure of things we hope for. Like the sweetness of rain. When we are prepared for the journey ahead. Like flowers planted in the sun. But yet we leave without knowing where to go. Like the paths that thunders follow. I reckon then, oh then, will we look for our light, as we uncover all that is hidden within us. That’s how I got through this week. For even if we go through the deepest darkness. Even if we reach the depths of the earth. Underneath the same earth are sapphires, corals, rubies, silver, and dusts turned to gold. So too are your depths if only you dig your hardest places. If only you burrow through the hardest rocks in your life. When miners dig the hardest rocks, they discover precious stones. So too will you dig, and discover how precious you are. The depths of your light are precious.
I liked a paper shared on Twitter yesterday. It focused on why decolonizing geosciences mattered. I loved everything I read that I felt it was critical to keep some. The fact that we have been told that certain ways of knowing and doing are superior resonated deeply with me. That and the fact that for eons we have been told that local or indigenous ways of knowing are inferior. That experts are only outsiders with resources, and if they are coming from the West, even better. That expertise can’t come from insiders, those who carry treasures of their life within their core. Yet to address harm and change how science is done, we must deeply recognize how colonialism have benefited experts and not those with expertise for whom knowledge first belonged to.
This paper is a perfect example of why stories matters with any attempt at decolonizing anything and any field. The hunt has glorified the hunters for too long that all we know are the stories of the colonizers, the stories of the experts, the stories of the hunter. This is my attempt at changing this with this article and the work of many great minds as an inspiration. I simply call it tell your story with decolonizing anything, somethings, or everything. We have nothing to lose these days and so we might as well strut like the lions we are.
With decolonization, tell your story, they say.
While the legacy of the hunt lingers.
Tell your story, they say.
Or the hunt will continue to glorify the hunters.
Tell your story, I hear. The hunter has failed everyone, including those being hunted.
But you can’t decolonize anything. You can’t decolonize somethings. You can’t decolonize everything.
It’s a myth.
It’s a myth.
It’s a myth.
And decolonizing should mean much more said the powerful as they wield their power in powerful spaces they erect and maintain to keep telling the stories of the hunter, to maintain their power.
Yet, we know that we can’t decolonize powerful spaces.
We can’t decolonize powerful people.
They are hunters. Their weapons are mightier. Their impact last longer than a day.
But while the debate about the myth of decolonizing remains, while the powerful even join and lead the debate, are we supposed to be silent?
Are we supposed to watch and stare as they continue to cast their shadow?
Are we supposed to live as if we don’t have our own historians?
Are we supposed to continue to forget that we are lions? No.
Rather, the time has come for the lions to tell their story.
The time has come for the lions to have their own historians.
Like a tale by moonlight, let me begin with the following;
With history, be prepared to construct and reconstruct it from a different perspective, a Black perspective, an African perspective too. Our stories have been told to us by others for far too long that this time, the lions are ready to take the stage. The complexities and racist histories of colonialism is finally taking center stage with this global pandemic. Variants of it has been there from the beginning, though swept under the rug of globalism. It is rather a class on colonialism and this time, there are no more slaves in this version of history. No more white people selling bodies for profit. No more tantrums from leaders disguised as fit but truly unfit. Plus no more pretense as if we are all in this together. We are not. The inequities with vaccine distribution was clue number 1. Number 2, the injustice with flight bans.
With Omicron variant surging through countries both in Asia and Europe, why is a travel ban only issued for countries in Southern Africa? This is the truth about decolonizing Global Health worth spreading, plain and perfect. Powerful leaders will always be leaders with power. They will do and claim to do what is always in their best interest even if this interest serves only their needs. Anyone expecting anything less has not been open to all the travesties that is colonialism. The emperors maybe wearing new clothes but they remain emperors, powerful ones now with subtle charm that invokes globalism when the harsh realist is individualism. They may claim change but their change is more or less like distant skies out of reach rather that streams of water in plain view. Everything about their dominant treatment of others both implicit and explicit remains true, and will always remain so during and beyond this pandemic.
The solution, lions tell your story. There will be a struggle. Embrace it. Refuse to be enslaved again and tell your story of injustices however you choose. This time, the path to pandemic freedom will be different. Not because we relied on the West, but rather because we believed in each other. I spent my morning retweeting and sharing videos of people telling the story, this time from their perspective. Dr. Ayoade Alakija’s interview with the BBC stood out to me. Watch here and see how lions are roaring to tell their stories.
Dr. Milton Terris was an outspoken advocate for progressive Public Health Policy. See this article about him here. But briefly, ‘throughout his career, Terris was always an active and dedicated member of American Public Health Association (APHA): he served as secretary of APHA’s Medical Care Section from 1948 to 1952, a member of the section’s council from 1952 to 1959, a member of the APHA Executive Board from 1958 to 1964, and president in 1966 and 1967.’
I came across some of the papers he wrote last month while running through the rabbit hole that is the archives of the American Journal of Public Health. I am a lover of history and nothing fascinates me more than the history of Public Health, the realization that this field is a circle that keeps turning around it’s axis, and in numerous occasions, falling short on its promise. Dr. Milton Terris was speaking about this some 30-50 years ago, hence my obsession today about one article I saw that complied his last words. They are powerful. Very apt for today and for all of us committed to serving the public and not ourselves. To think that all the thoughts in my head about putting the public first has once been echoed in the past makes our field exhausting and exhilarating at the same time. Hence why I remain committed to learning the past in hopes that it will allow me and my team to understand better the crisis we find ourselves in today. So allow me to share through verses, the last words of Dr. Milton Terris. I hope they light a fire necessary within you to truly remain committed to serving the public in public health.
For the public, we have remained indefinitely in our ivory towers that have now crumbled all around us and those we serve. We remained without coalitions, a citizens coalition, made up of organized and unorganized workers, farmers, professionals, and other middle class citizens; women, Blacks, Hispanics, youths, senior citizens, and other minorities-in short, the majority of the people of our nation, who can and will assure that the principle that health is a human right, and not a privilege, will be realized for all.
We remained in the era of rampant selfism that served only ourselves and not the public we purport to serve. We remained committed to publications and conferences and not the fullest possible commitment, dedication and leadership to the public who have no access to our publications or conferences. We remained in a siloed pubic health agenda that continues to fail to ensure a peaceful, just, and hopeful society for all. We remained in privilege mode and not in humanity mode that ensures that health is a human right for all the public we serve. We remained in crocodile tears mode too rather than taking serious action to end racism, poverty and everything else working against the public we serve. We remained in lip service mode to prevention rather than advocating in deed and in word for a standard of living adequate for the maintenance of health.
We remained on the road to general principles and theoretical frameworks as if they are enough and will get us on the road that requires political will and moral courage to enact legislative measures on health for all the public we serve. We remained in recommendations mode too as if our public health crisis will go away with our evidence based recommendations rather than thoughtful and spirited analysis of the causes of the crisis and the definite and effective action to reduce their impact. We remained with our feet in clay rather than intensify our work on the defense of the public we choose to serve. But above all, we remain a generation whose discoveries are not translated into practice for the welfare of humanity in the shortest possible time, who continue to fail to create a new golden age that centers the public in everything about their health.
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.
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.