A social scientist and public health researcher based in Kenya, Professor Vicki Marsh aims to understand and strenghten policies based on social and ethical aspects of international collaborations. Improving communications between researchers and the patients and local communities is not only ethically important; it can also lead to better research.
In settings with high level of poverty and over-stretched health services, researchers have even greater responsibilities to the communities and study participants. Strenghtening the ethics of research will help address the burden of disease and death born by low to middle income countries.
Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.
Vicki Marsh: Perhaps to frame that first: I work within the Oxford Tropical network, as part of the Centre for Tropical Medicine and Global Health. I have been based in Kenya, working at a collaborative programme on the coast of Kenya for most of the last 20 years.
That is a setting in which people experience a lot of poverty, and health services can be very over stretched. That immediately presents lots of issues related to what researchers' responsibilities are to the communities and to study participants, and to other stake holders that they interact with in that kind of situation. That is a very important part of my work.
Q: How do you actually solve these sorts of issues?
VM: The way into this is to really try and characterise the issue in detail. This means taking a kind of theoretical standpoint to look at guide lines, literature, the ways in which people have thought about particular problems in the past, and try to draw on this information.
In our practice, it also involves talking to a lot of local stake holders, community members, study participants, etc and then trying to bring their views in to our overall analysis.
We often find that we also need to do more research to find out more about the issue in question. We we will try to develop relationships with other agencies or institutions, particularly the Ministry of Health, because it often turns out that some of these researcher responsibilities can be shared. But this generates new responsibilities, in terms of perhaps capacity building.
Q: What advice might you give to someone who is contemplating doing health research in a complex setting like this?
VM: This would definitely come back to engaging and involving different sorts of stakeholders, study participants, community members, those who provide health services in that setting, and there will be other relevant stakeholders too. It is critical to understand the context and to build relationships with stakeholders in order to support your research.
Q: What are the most important lines of research that have developed in this area over the last 5-10 years?
VM: Perhaps I can talk about some of the areas that I have been directly involved in (without assuming those are the most important!)
An area that I have been fascinated with is health systems research and access to care. I was involved in a whole series of studies on the way in which people manage children with malaria at home. Most children who die of malaria in Africa die without any contact with health facilities at all. Instead, they are often being treated with over-the-counter medicines bought from the nearby village shop.
There were a series of projects that worked through the feasibility and proof of principal of a malaria control programe, moving up to national level, including trying to evaluate the programme (at the national level) how this kind of strategy would work.
My current work is more based around community engagement in research; this is a set of ethical issues and I am particularly interested in looking at goals, approaches and ways of evaluating that.
Q: Why is your research important and why should be fund it?
VM: If you believe that international health research in low to middle income country settings is important, then it follows that it is important to strengthen the ethics of that type of research.
The argument of course is that the majority of deaths and diseases globally are borne by low to middle income countries, and research is an important way of trying to address those challenges, both for health and also for economic growth.
Q: How does your work fit within translational medicine within the department?
VM: I think that the kind of research that we do, the area I have been describing to you, maps very directly on to policy, because we are actually looking at research policy and how we can strengthen ethical practise within research policy. Obviously the work that we are doing is quite context specific, in taking account of local views and local social realities. That does have some challenges in terms of transferring those findings to other kinds of settings.
One way in which we are able to do this is to think about methodologies and applying methodologies in different places and also by sharing our findings within international collaborative networks that we are part of, particularly around bioethics, which allows us to compare and contrast the findings in different settings.