A son found his mother, slumped on the floor one night, stiff, unresponsive. He picked her up, thinking she slipped and fell, maybe from a heat stroke, a stressful day, and laid her gently on her bed. Not before he put a cool towel on her forehead and kissed her cheeks as he bade her good night.
The next morning, the son went to check on his mom. He found her just as he laid her, stiff, unresponsive, only this time, life became more urgent. Not his, but for a mother who lived and slumped, as if life never meant anything, as if all it seeks is to leave you stiff, and unresponsive too.
Stroke by stroke, each hour is a gift. Piercing through life, each moment fragile. Now son buries a mother, he first saw stiff, unresponsive. A mother departs, not as she came or lived, despite giving life to sons and daughters who still live.
I am wise enough to see that this mother could be anyone who forgets first to live. So with each passing day, I beg mothers anywhere, do what makes you smile. Cherish sunsets and long walks alone. Be friends with friends who make life glorious till the last call on a Friday evening. Laugh through ice creams and daffodils. Kiss foreheads of little ones and big ones you love. Live so life never finds you stiff and unresponsive.
Ambition to me is tied to what Ngugi wa Thiongo once described as a ‘quest for relevance.’ It is a search for a liberating perspective within which to see ourselves clearly in relationship to ourselves and to the other selves in the universe. He would go on to suggest that this question depends on the choice of material and the attitude to or interrogation of that material. How we see things, even with our own eyes, is very much dependent on where we stand in relationship to it. To him, any strong desire to achieve or do something is inherently laced with a language of struggle. And this struggle starts even from the beginning.
Sustaining global health, becoming ambitious with whatever you choose to do in this field is all about taking a leap into the land of struggle. It’s that struggle that ultimately makes you begin wherever you are, do whatever you can, to become part of the generation crazy enough to think they can change the world. I am very ambitious with global health, naming it, sharing it, so that I not only see myself clearly but work with like minded people to make the global more relevant than ever, changing how we all see it too, one story at a time. And yes, it is full of struggles, full of thinking that I can really change the world with fully-funded projects that last. How I am working to mobilize people to embrace these crazy ideas with global health is at the heart of my upcoming talk on Tuesday April 26th. It’s my hope that if you join us, you may learn ways to sustain your crazy ideas with global health, even in the midst of storms.
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;
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.
The words rise up. I note them. They come on their own, with their own nodes, own goals, that unfold one note at a time. They come with their own meaning everytime. I am obedient to the sounds that flow, the insights that grow, within minds long in need to ignite, in need of light. I am light. Like a tree that grows higher, and higher, branching out in different directions, like thick branches with lush green leaves full of water. I am green. I sit, listen, and let the words sway like trees on a windy day after hurricanes that stroke with water-like canes. Still these tree rise up and grow. For where trees grow, water flows. I am water. So to are my words. I have been discovering for the past year that where words flow, stories flow. I am stories. For one year, the stories in my mind, in spaces and boxes I once carved as private, have been flowing like a river. I am a river. A naturally flowing river, in search of an ocean, or a sea, a lake or another river. I have arrived at my destination. Words are my water, collected now in a river that flowed through a complex meandering path I called keep lists. There were no short paths. Every thing that mattered were loosened and dislodged like the rocks along the sides of river beds. I became loose with words that deepened my riverbed, eroded my hard phases, and elevated my soft places, all with grace. I am grace. An amazing grace, once blind but now open to all the spaces that make me whole. I poured myself into this space, poured my soul to the possibilities of this phase, of writing something to keep, words to keep, in a list to mold and shape as my own, in a list to own. And through this list, my words became fast-flowing. A source of energy, of life. I became soaked in the opportunities and form of each word, each list of things to keep. I am a list.
I have been reading a lot lately about lists, about why people use them in the first place. Most people write lists, to-do lists for example, to stay organized. Some write lists to stay in control, ticking things off when completed or moving things around to track completion. The first time I saved a list was in the middle of the pandemic. There were nothing to do with my lists. Nothing to track or even complete. My lists were focused on what to keep. A keep lists of experiences. The only objective: to write one list a day. The list was expected to make sense of life as a mother, a black working mother in academia with four children, one born in the fifth month of the pandemic. There were no organization necessary. No length was too long. Or to short. Everything was allowed in the lists. My thoughts, the news, my work, my family. Writing long lists was gratifying. So too were short ones that cut right to core. But lists about meaningfully people in my life, like my children, my students, my mentors, even the experiences of my husband on the frontlines or the last days with my sister in-law and her battle with cervical cancer were extra fulfilling. The pandemic and it’s impact were intense for all families. It was also equally frustrating, equally challenging, yet equally mesmerizing, and equally joyful. Not for the illness it brought or the deaths or sorrow it left behind, but for the discoveries, unexpected ones, like making a list, a virtual keeplists of time in a pandemic. There were no end in sight too. The pandemic held us all in a tight grip. And so the list grew and moved beyond the pandemic itself to capture life as we lived it one day at a time, all to preserve and protect all that mattered in a time where living was truly fragile.
Today marks the one year anniversary of this list. Words still do not fail me. They have become my everything, my hope, my joy, my hurdles, but yet my triumphs. I thank all of you that have read anything I wrote here. I thank you for coming on this journey with me. There is still no end in sight. Only that where my words still flow, my stories will surely flow.
They call it an eloquent flower. A flower full of eloquence. Poems have been written about it. One by Cummings who described it as love, and how it’s love moves with brightness to all places. We noticed it on a walk this week with by baby. I rarely go for walks these days, but something about the group of people I have been interacting with all week, made me seek air and the sun and light. I see a lot better when I walk. I also reflect better and say prayers of thanksgiving during long walks. I owed my maker one, hence the walk to just reflect on the journey so far, the insights so far and all the people I have met along the way so far. It shouldn’t be this easy, I kept saying. It shouldn’t be that we tell the stories of our why over and over again, almost to infinity and everyone we speak to gets it over and over again. So a walk was due. I need to check my blind spots, to stay humble, to listen and see the world once more for there are truly so many wonders to see, on long walks. Infinity stories being on my mind.
For this walk, our eyes were greeted by Crepe Myrtles. Their bright pink colors were hard to miss. They stood out amidst a row of green short and tall shrubs. I initially ignored them at first and kept walking. It has been a while since I walked and so I was focused. But the colors kept greeting my eyes, as if to say hello. Finally, I gave in and greeted the flower back. I smelt it as always and opened my app to learn a bit more. I have shared in prior posts how I have lived blindly through life not knowing one flower from the next. But since I started to walk in light, all sorts of flowers have become my friends. Crepe Myrtle is about to be my best friend.
Not only are it’s beautiful lush flowers appealing, but per my app, this flower is a symbol of eloquence, good luck too. I was in awe and grew closer to see why. In full bloom, it’s flower petals appear wrinkled but full of rich texture that produce brilliant crumbling spiral patterns. These spirals gather together like a crepe, hence the name Crepe Myrtle. But eloquence don’t stop with the flowers alone. Soon, the flowers will fall and it’s leaves will turn glorious gold, orange, red and purple in fall before falling off. Then, it’s bark completes this flower’s trifecta. The bark on many Crepe Myrtle peels in puzzle patterns to reveal smooth cinnamon or tan colors that glow during winter. All of this combined, helps to symbolize Crepe Myrtle’s eloquence. They also help to tell my never ending keeplist of stories of becoming a mom in light. An infinity story in the making.
On the surface, everything seems fine. A family that I am blessed to call my own for all the love, support and gifts of belonging they provide to me. A job that I am grateful to carve as I want, grateful for when things stay and last or fall off as with passing of time or even failed grant attempts. But when you peel my surface, when you come with me and feel my journey, even peel all my outer layers, then you will understand what rounds my trifecta. I am just coming to terms with it. I am a storyteller in all sense of the word. It’s where I get my eloquence, my reason for being, my persistence, my tenacity, my love, even my drive with life. Every single thing I do has a story connected to it.
Being a mother for example, one of my greatest stories ever told, one some of you may read here on a daily basis. The stories around how me and my greatest joy, my Zobam met and continue to journey through this life keeps me on my knees with gratitude to my maker. He truly saved me. Then there are the stories for how I have navigated pursuing a career in research. To think you can go to school to become a researcher seems unheard of but that’s how I earned my degree at the end for the day. I was literally trained to become a researcher from undergrad even, not in grad school. I owe it to Dr. Cassandra Veney, my very first mentor in undergrad who inspired me to probe deeply too during my days as a McNair scholar. Then of course there their stories from grad schools. Trip to Senegal all paid for by my department, just to get to Senegal and I don’t have a hotel room and I barely spoke French or Wolof. Yet, this trip would forever change me life and inspire me to be a a global health researcher passionate about seeing the world and working with people whether I spoke their language or not.
Then there are the malaria dissertation stories. Even the process of writing my first NIH grant to do this work under the guidance of my doctoral advisor Dr Collins Airhihenbuwa has a story worthy of praises for how he pushed me to become enamored by grantwriting. How I got my first job in Paris at UNESCO following graduation has a story. UNESCO itself has a story I have yet to tell but it shaped my resolve for sustainability. How I worked or lived in Paris for 2+ years has a story. Do you know what it’s like to navigate owning an apartment in a place where you barely speak the language or raising a new baby, my Belle with my mother in-law whom I met for the first time at CDG airport in Paris? The stories are out of this world.
Of course there was a growing young family at that time navigating long distance. We have stories to tell. The ones with my first job upon my return to the US are cringe worthy whenever I think about them. They tried, boy they tried to destroy me but little did they know that greater is he. Then there are the stories of how I mastered grant writing from the king himself, Dr Gbenga Ogedegbe. I owe him a lot for showing me things I never even knew existed within me. Or how I met my partner extraordinaire Dr. Joe Tucker. He is truly on another level when it comes to collaboration. Find your partner with research and you literally find heaven. This blog has been privy to stories of navigating a child on the spectrum and raising black children in America. Even cancer’s sting is now a story I intend to tell fully with all my might.
The eloquence of crepe myrtle personifies my life fully. I choose to live it out now, more brilliantly like never before, more brightly too like an infinity story. These stories are my light. Through light, I will move eloquently, one story at a time, to all places. I am a storyteller and I am inspired by the endless eloquence of Crepe Myrtles.
I had a meeting today with a very dear friend and he introduced himself to the group as a storyteller. I was taken aback. This was the first time I have ever heard anyone introduce themselves so confidently as one. Not because it’s what I really love to do, but to describe yourself as one, to showcase how one can use it as a medium to impact people’s life is an amazing feat to me. I told him I will be borrowing that line from here on out because it is who I am. I am a storyteller. I use stories to guide the work I do for a living. I connect better with stories. They help make what I do in health easy to understand.
If you call me to speak to your class about my work or global health in general, I can connect it back to a story or two. My dissertation experience for example with using malaria rapid kits at a time when the kits were $25. I use stories to illustrate the economic side of malaria and how I called the company that made the kits. I really called Binax Now and told them it was insane that a malaria test kit cost $25 when the people that need it the most barely live on $1 a day. I remember distinctively being told but it was for the people like me who travel to those places. That when we return and we become sick and present at a hospital, the hospital would have a rapid kit to see if we tested positive for malaria. The distributor went on to even say they can send me kits set to expire as many hospitals weren’t seeing many patients with malaria. They did and so the story for my dissertation research began.
Telling that story never gets old. It’s the foundation for my passion on innovations and why I think we need to partner more with companies to promote innovative tools and kits in places that need them the most. That same company today now makes COVID-19 test kits. Of course I feel tempted to call them again as this time, their kits cost $20 and most people in places I work have no access to testing of any kind. It’s stories that help me make sense of why I need to really continue what I do in public health, especially in moments where nothing makes sense and there are many moments like this.
It’s stories that keep me grounded. Stories of the youths for example with my HIV self-testing project in Nigeria, passionate about making sure that all young people they know, get to know their status. I may not be a famous or well known public health researcher. It doesn’t matter to me to become one. But a storyteller in public health, especially one dedicated to centering people in their health, takes it all to another level. I am a storyteller and I use stories to put people first. I also use stories to make health programs last. Keep being storyteller in your field. The world needs more of us.
My daughter once told me a story. Of her and her friends and their plans to save the world from goblins, or little monsters with green skins and two horns on their head. One friend was a wizard ninja, the other a pixie fairy and my daughter a purple fizzle, also known as bubble girl with a magic bubble wand and a skateboard. Together, they were unstoppable and will do whatever they could to protect the universe. She shared the picture below to illustrate this vividly.
In listening to my daughter recount this story, I became transfixed and transported into the realm of possibilities with stories. For my daughter and her imagination, there are no limits. Even a ninja with a staff can be a wizard. A pixie can be a fairy and fly around with her human friends. A bubble girl can not only possess a magic bubble wand that erupts magical bubbles, but she can also use her skateboard and run around a rainbow colored universe with her friends. Together they work to protect the universe from goblins and their their evil plans. Her story was not only engaging, but illuminating. My daughter took me on a journey to stories endless possibilities, one where openness is the destination for abilities that are limitless. Not only did she construct a narrative to describe how anyone can become anything, her narrative is also an illustration of an important lesson that she learned about own herself, something in fact expressed in the story itself. That she too can be anything she wanted to be. An endless possibility.
Stories like what my daughter shared, illustrate how they powerfully give meaning to one’s life. But authoring your own story for yourself, recounting ever act and action, every event and expression, is the greatest gift. One that takes you on a journey towards knowing and telling, reflecting and learning. Listening and learning about each character in my daughter’s story, how they feel and what they do, opened her eyes to their see their abilities, all full of endless possibilities. The reflection, inherent in the stories we tell, is the learning about ourselves that I gleaned from my daughter and her story. As her eyes opened to their possibilities, so to did her mind open to become aware of the power of her thoughts, her feelings, her actions, all infused in her story.
That to me is the power of stories, the power of authoring your thoughts and feeling as only you know how to do best. The power to resist and overcome all forms of oppression, the power of your voice with its gifts for suppression, repression, everything wanting to cause depression. With stories, the possibilities are endless. Stories are a function of our society, an opportunity to make and remake, to form and reform, to define and redefine, how we all become one. Powerful and liberating, stories help you author aspects of you that only you know best. Stories even those as unthinkable as a wizard ninja helps you claim authority over you. The world will try to define you. The world will speak ill of you to and use words meant to destroy rather than build you. But it’s in your story that you lay claim over how the world should see you. Not from the mouth of others, but from you, your acts, your actions, one after another. Such an authority over yourself is inspiring, divine, a sterling gift to oneself.
All of us, whether as young as my 8 year old daughter or as old her grandmother, have stories to tell, have point of views and values to share that many would be willing to hear. How we author our lives through stories is the thing I never knew I had in me, the thing I never knew I would also see in others until this keeplist began a little over 9 months ago. Finding stories, keeping and nurturing them, has opened my eyes to their power and freedom. They also helped me see the endless possibilities in all my life’s abilities. So for today and always, keep stories, even from a child’s lens. Find your story too. Author it. It will help you think, act, feel, the best in you that you may not even know exists. It has helped me find my way, through a life where nothing weighs me down. I am a master of my journey because stories showed all I needed. My daughter’s story by the way is called ‘The Rainbow Universe Society.’ Like I said with stories, the possibilities are endless.
We all called him Jacob. He was a gentle soul, a true gentleman. He also loved his birth country Ghana, hypertension research and golf. When the news of Tiger Woods accident was shown all over the news yesterday, Jacob came to mind. He fiercely loved Tiger Woods and would have given anything I am sure to be in his presence. Now that would never happen, because Jacob, a renowned hypertension researcher in Ghana and my dear colleague, mentor and principal investigator for my Ghana grant passed away from COVID-19 last year. He is survived by his wife and three children. I helped to coordinate a Lancet Obituary about his passing that you can read here(Dr. Jacob Plange-Rhule). What people never got to read and still haven’t read is my story of how I met Jacob, of how he mentored me when I returned to academia and how he made me fall in love with Ghana. Dr. Jacob was a true cultural bearer for all things Ghana for me and hypertension research. He is sorely missed.
When the pandemic of 1918 occurred, there were no gaze from people of color. No black stories were told. No Hispanic stories either. Yet that communities of color bear and continue to bear the burden of excess deaths from health disparities are well understood. Excess deaths have been occurring among black people in the prime of their life, over the course of a century. In a historical insight on the 1918 pandemic for the ongoing pandemic, Dr. Lakshmi Krishna shared how 1918 pandemic revealed critical structural inequities in health for people of colors that continues till this day. One thing that stood out for me in her report was how community centered and internal solutions from trusted sources were used to counter the veracity and benevolence of white responses to Black people’s plight during the pandemic. Still, this was a pandemic with shockingly spare accounts of the black experiences. Not from the point of view of illness or even disease, but from the lens of communal effort and activism, the profound engagement with health, all with a spirit of community resilience that helped to improve the health and lives of people of color. Now enter COVID-19 pandemic. That the pandemic continues to lead to disparate health outcomes in communities of color is now common knowledge. More than 500,000 Americans have died from the disease at the time of this writing and 18% of COVID deaths are from African Americans and 16% from Hispanic Americans according to a recent report from the COVID Tracking Project.
One benefit of the current era compared to the 1918 pandemic is our ability to collect more robust data. However, one critical thing lacking are the stories behind the data. Stories behind the life experiences of every death. Stories for example of Elizabeth R. Duff, the first black woman to drive a city bus in Nashville Tennessee. She was 72 years old at the time of her death. Not only did she endure sexism and racism being at the frontlines of changing gender and color barriers, but she was cool, calm, but stern while doing so. Along with her three children, she is survived by her husband, 16 grandchildren and seven great-grandchildren.
Then there is the story of Honorable Isidore Torres, the first trail-blazing Hispanic Judge in Wayne County, Michigan who died at the age of 73. Known as a fearless fighter of civil rights and equality, Honorable Torres ‘was known for the respect he showed attorneys by carefully reading their pleadings, and also for his sense of humor.’ He is survived his wife and three children.
Every COVID death has a story. Every single data point has an experience worth retelling for the past, present and future. Our lives seems to dominated by information on the data, with rising death counts being reviewed and discussed over and over again as if there were no humanity, no stories behind the data points. I have only shared three to illustrate my point, my dear mentor Jacob, the first Black woman driver in Nashville, Elizabeth and the first Hispanic Judge in Wayne county Michigan, Isidore. We have lost and continue to lose prominent culture-bearers such as these three. My goal is to ensure that these stories are told. For they are our guide, and without a recognition of the humanity behind the numbers, then as a generation, even if we survive the pandemic, we are blind.
One of my favorite aspects of the novel Anthills of the Savannah’s by Chinua Achebe is the focus on the power of the story and the storyteller. In it Achebe reminds us of ‘stories being our escorts, and our guides’ through life. Some people, the novel notes, have been given the gift of leadership, summoning their fellow citizens to rise to the sounding and timing of battles. Others have been given the gift of fighting, the gift of putting on war-time garbs and going to engage in the battle. But still others have been given the gift of waiting for the battle to end. Waiting to take over to tell the story of the battle. Achebe shared that the sounding of the battle is important, the fierce waging of the war too. But of all this, it’s the telling of the story that is most critical. The story as Achebe pointed out, ‘boldly takes the eagle feather.’ Stories are indeed connected to all aspects of our lives. Our being and becoming, our penetration and preservation, even our silence and survival or ability to enlighten and empower depend on the stories we tell. It is only the story that continues noted Achebe, beyond the war and the warrior. It’s is the ‘story that also saves us, so much so that without it, we are blind.’ Sustainability or the ‘continued use of program components and activities for the continued achievement of desirable program and population outcomes,’ are like stories.
Sustainability is connected to all the life cycles of research from initial conceptualization to implementation. Sustainability draws attention to the struggles, the values, even the quest for efficacy or effectiveness that binds a research team and how all these intersect to enable their intervention to ultimately remain. It is also where the collective memory of an intervention resides. Not the memories as with steps delineated in a protocol, but in the minds of all people influenced by the intervention. It informs the process through which an intervention defines itself from its beginning to the end. It raises awareness and builds consciousness of key values or adaptations that can take evidence-based interventions forward. It highlights the role of key people and resources necessary for any attempt to sustain an intervention, capturing key processes and outcomes that future researchers and implementers can rely on. Finally, sustainability helps implementer to re-imagine and reframe their own stories on what it means to last. It’s their for the telling and they have the capacity and ability to affect and inform the outcome, if only they know their power.
Of course sustainability cannot be separated from the social, ecological, historical or political forces in which evidence-based interventions are implemented. In a seminal review by Pan-African Studies Professor, Tavengwa Gwekwerere on the Anthills of the Savanah, like stories, sustainability ‘binds the past, the present and the future together, making inroads into the past to inspire the present, narrating the realities of the present to imagine the future, all while preparing the future for potential struggles and aspirations with attempts to last.’ Sustainability’s connections to the past, present and future, prepares researchers and implementers to make sense of ‘where they have been, where they are, and where they must go.’ It’s for this reason that having a plan becomes critical. By plan, I mean working with the right people to learn how to adapt and nurture aspects of an evidence-based research so that it lasts. It’s no surprise then that sustainability remains a threat to all statue quo form of research, so much so that those who seek to make this a career are actually called ambitious. But why even bother implementing any research if it never lasts? Keep sustainably in mind and have a plan while you are at it. That and keep remaining ambitious. Sustainability requires, no demands that you remain ambitious. So keep it as well.