‘Inspiring Stories’ with Lucy Gates

‘Inspiring Stories’ with Lucy Gates

Senior Research Fellow, Musculoskeletal Global Health Team

This is part of the Engaged Medicine ‘Inspiring Stories’ blog series. The blogs explore the stories behind outreach and patient-public engagement activities of staff and students from the University of Southampton’s Faculty of Medicine. 

Public engagement in low resource settings – Developing research agendas with the public

In 2022 I moved to a new role as Senior Research Fellow in the Musculoskeletal Global Health Team lead by Professor Kate Ward at MRC LEC, Southampton. Our work focuses on musculoskeletal health in sub-Saharan Africa, much of which sees us visiting the Gambia on a regular basis. It was on one of my trips to The Gambia for our current projects (Fractures E3 and MUFASSA), that I observed the orthopaedic wards were beyond capacity due to the number of patients with diabetic lower limb complications, many of whom were awaiting amputation. Each visit I notice more and more amputees around the communities. In my day to day engagement with study related clinicians and local NGOs I was learning of other lower limb health problems that were challenging the Gambian population, although there is little scientific evidence around any of this. It was clear that a research agenda for lower limb health in the Gambia needed to be considered.

So, to get things started I formed a small team, including myself and a few colleagues from the MRC Gambia. We were awarded a PERU grant to begin having public and stakeholder conversations for the co-creation of research, knowledge exchange and education agendas for lower limb health in the Gambia. 

Gambia is a country with medical pluralism, therefore capturing data and opinions is somewhat complicated by the high use of traditional healers. It is full of cultural nuances that can be the difference between being accepted to engage with members of communities or not. Being a part of the MRC helps considerably as people know and trust the MRC in the Gambia. However, that doesn’t make it easier to find the right stakeholders or pin them down for conversations. The Gambia is a bustling country, particularly in urban locations, and there is a heavy reliance on WhatsApp and quick conversations. My Gambian colleagues joke that GMT stands for “Gambian Maybe Time” as you never know when and if people will turn up for meetings. Fortunately our project team are kind enough to generally work to British GMT! The roads are largely pot holed dirt tracks and the traffic is notoriously bad; coming from Gosport I didn’t think anything could be that bad, I was wrong. Therefore, to consider having conversations with members of the public and other stakeholders it’s essential to have a few things: i) A Gambian partner who is an excellent communicator ii) An expectation that you may have to make a few visits to the same place to catch someone and iii) reliable transport.

Luckily I had all of the above. Together with my colleagues Momodou, Nyima and Sirrimang, we mapped the key stakeholders to be included in our conversations. They diligently set about making contact with each stakeholder to prepare for my visit. On my arrival, over the period of four days, we met with orthopaedic consultants, cardiovascular consultants, nurses, community nurses, orthopaedic consultants, prosthetists, hospital CEOs, senior house officers, amputees, Legs 4 Africa (NGO) and members of the public. We had conversations around lower limb health, listening to their personal and professional experiences. We discussed the lower limb conditions that are posing the biggest problem for the Gambia and what the challenges are for managing these. Every meeting naturally led to discussion around complications secondary to diabetes or fractures, and the challenges of managing these conditions when a substantial proportion of the population turn to traditional healers first. This in turn leads to significant delays in people presenting to medical facilities, by which time many complications have reached critical points.

Through these conversations we have i) gained an understanding of priority clinical issues to consider in our onward research agenda ii) formed a network of stakeholders keen to develop this agenda with us iii) built relationships with potential partners to drive this work forward.

We are now planning a roundtable discussion with these and future stakeholders to co-design our research plans and seek sustainable funding to produce better quality data and solutions to poor lower limb health, whist driving forward in-country research capacity building.

Stay Connected! To find out more about the ‘Inspiring Stories’ series, Faculty of Medicine educational programmes and research, or to get involved use the links below or contact Prof Lucy Green. 

University staff or students click here for the Engaged Medicine SharePoint.