Dying to help
What’s more important? Academic respectability and caution, or the lives of millions whom you might be able to help? Suppose there’s a major health problem in developing countries, to which you believe you’ve found a fundamental solution. Should you publish only in academic journals refereed by your competitive peers? Or should you also try to influence the world and save lives?
Villagers in Burkina Faso, in West central Africa, know their answer. They’ve been laughing and crying at theatrical performances written by researchers, and played by comedians, on saving pregnant mothers facing difficult childbirths. The plays were the inspired result of the Immpact research programme (the ‘Initiative for maternal mortality programme assessment’), which has been seeking means to reduce the staggering maternal mortality in developing countries.
Mothers die in and around childbirth at a rate some 175-fold higher in poor countries than they do in the rich world. Puerperal sepsis, an overwhelming bacterial infection of the blood mostly acquired at delivery, and many other complications of giving birth, can be fatal - unless emergency care is both available and affordable by mothers.
Immpact is based at Aberdeen University, where the programme’s Director, Professor Wendy Graham, told People & Science, ‘We want universal awareness of Immpact’s key finding: that the poorest women must have access to emergency care.’
Immpact’s studies in Indonesia, Ghana, and Burkina Faso - supported primarily by the Bill and Melinda Gates Foundation, the UK Department of International Development (DFID) and USAID - demonstrated this clearly. But how should the programme communicate their results to those who needed to know, and potentially could take action? The play was one example - a pilot study - for how that could be done at the level of communities.
But there’s also the world of political commitment and funding to address. So Graham is engaging at the highest level, with leaders at G20 and G8, through UN agencies, the White Ribbon Alliance, and through the High-Level Leadership Group on Maternal Mortality, of which Bience Gawanas (Commissioner for Social Affairs of the African Union) and Sarah Brown (wife of the British Prime Minister) as the co-chairs.
For this group, Graham and her colleagues have been producing hard-hitting, two-page briefing documents aimed directly at individual countries attending G20 and G8. Much discussion goes on behind the scenes at these meetings, out of the sight of the media, among leaders and first ladies at dinners and other social occasions, and ‘having the right arguments and information in these situations is crucial to winning hearts and changing minds’ Graham told People & Science.
Graham says it’s become imperative that researchers enter the ‘unfamiliar territory’ of communications. ‘We have to go there. We’ll be dinosaurs if we don’t. Some colleagues doubt whether it’s our role - because we have so many other things to do, and because we are not skilled in this. So for those of us treading this path at the moment, it’s a lonely path.’
‘There’s a real tension between academic credibility and advocacy,’ said Sue Fairburn, Immpact Knowledge and Advocacy Manager, and one of the co-applicants for the next stage of communication activities in Burkina. ‘We must find the balance between the two.’
My own view is that is that there’s even an academic benefit to communication in these life-changing subjects. If subsequent actions and consequences are measured, they will add to understanding, and help refine practical interventions.
But the fundamental conclusion is moral. Where communication is life or death, communicate! Or pass by, on the other side of the road.
High-Level Leadership Group on Maternal Mortality: www.who.int/pmnch/media/membernews/2009/20090312_mmlg/en/index.html
The White Ribbon Alliance: www.whiteribbonalliance.org/