We were surrounded by trees yesterday at Forest Park. Cherry blossoms trees as majestic as can be. Cherry blossoms signal the return of Spring. Like raindrops on a sunny day, they bring awe, and continuity for life’s many mysteries. They also bring joy. The mere sighting of a tree full of cherry blossoms evokes feelings of silence. Not because words fail me, but because they won’t do. The beauty of a cherry blossom tree is endless so silence is not needless. To see these trees blossom at once is to know the hidden message of trees. Life can be full of joy, full of silence, full of ease, if only we appease our deeper desire for continuity. For as sure as there will be another Spring weather, season after season, there will be cherry blossom trees too, season after season. This certainty, continuity as a certain thing, is why we should keep cherry blossoms in mind. For if we want our research to last, if we want there to be findings, season after season, for as long as the public health issues remain, then we must first begin like cherry blossoms. Keep continuity (i.e sustainability for those of us in implementation science) like cherry blossoms in mind.
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.
I gave a talk this week, my first for the year to a small group of Masters in Public Health students. It was on sustainability and why we need more public health interventions that last. I started by asking them to suspend all they know about the topic and go with me on a journey to Sesame Street. Yea, I took them there and let’s just say it was one of the best lectures I have ever given in a while. It came from my soul and helped me articulate for the first time to a public audience what I mean by the how to do it literature on sustainability. Of course the ideas are still evolving and in due time I will share, but if you can, keep Sesame Street in mind. They have a lot to teach on how to make programs last.
I have been thinking lately about good questions. What are they and why do we need to nurture and teach good questioning skills? By day, I am a global health researcher passionate and committed to asking questions, enduring ones focused on creating sustainable health interventions. I often begin with a grant. For to conduct research in a setting already limited with resources, access to funding is crucial. So to are questions, not just any questions, but good ones that lead to funding.
Good questions have helped to test the limits of my grant writing abilities. They pushed me to try everything, all the way, until I get the outcome I want, including the grants that allow me to address pressing public health issues. And when you find a good question to ask, questions that are enduring, it just so tremendous. And so I do feel a responsibility to ask these good questions. I have always felt and continue to feel that no one is really asking those tough but good questions. I remember after collecting my data for my dissertation on child malaria diagnosis, I told my participants, some mothers of children under 5, that my research has ended. Some asked why? It’s not like their child’s malaria has ended. They were right.
I am aware of the fact that it was rare and still rare to ask good questions overtime. Aware that though some may state they are interested in asking these questions, such as how might they last, they are never really prepared to go the distance. So I assumed two things: 1) good questions focused on lasting, focused on sustaining my global health work matters; and 2) if I ask these good questions, if I continue to hone in on what they entail, planning for it from the beginning, with the right people, learning what it takes, adapting where necessary but nurturing the questions overtime, then it will become universal. Good questions focused on lasting will become the norm.
I am hoping to train the next generation of scholars committed from the beginning to plan to ask good questions. My goal is to help them become prepared to roar if they choose to, with asking more enduring lasting questions. I call this PLAN or how people learn to adapt or nurture whatever good questions they may have. I finally wrote a research paper on it that I intend to submit this year. My goal with the paper is to a start the dialogue necessary to train a generation of scholars committed to making the necessary plan to become enduring questionologists.
The choice in the end is always up to us. We may choose to ask the typical questions that allow us to get by for the next 1-5 years, or we may go the distance and plan to become comfortable even with questioning the questions asked. When your goal is to remain, when your mission is to last, then asking all sorts of good questions becomes a necessity. We all have the power to think long and deep about how our questions can and should be good. We should all be willing to explore limits of the questions we ask for as long as the issues remain. For to be good, to hone in and polish the questions, to a gleaming finish is illuminating, exceptionally powerful to me. Keep asking good questions. Plan for them too as the world desperately needs them.