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Front line operations: MRC fieldworkers in The Gambia

Forming the front line of research operations, fieldworkers carry out a vital role in the work of the MRC’s unit in The Gambia. Ashwin Mehta, from the MRC resilience team, supports training in the field and explains how the work carried out by fieldworkers is fundamental to saving lives and improving health.

A fieldworker talks to a mother at the immunisation clinic

A fieldworker talks to a mother at the immunisation clinic

MRC research operations in The Gambia consist of fieldwork in communities and clinical work in hospitals and clinics, which generates samples and data to be used in laboratory research.

As well as interacting with communities to promote the MRC mission and getting consent from communities to conduct medical research, fieldworkers are responsible for a wide range of activities from disseminating health information to collecting data and samples from people in local communities.

The MRC Unit in The Gambia currently employs more than 300 fieldworkers across three main sites in Fajara, Keneba and Basse. Fieldworkers are recruited from the local population with the equivalent of secondary-school education, and trained up on the job. Mafuji Dibba, Fieldworker Training Manager, has been working in the field for 30 years and has worked at all three sites: “Fieldworkers’ experience as they progress gives them a good idea of disease prevention and treatment. This allows them to serve as advisors in their communities.

Their work helps disease research and public health across many developing countries, from implementing Haemophilus influenzae type B (Hib) and pneumococcal vaccine programmes, to preventing bacterial eye infections such as trachoma through provision of latrines. None of this can be achieved without fieldworkers, who are the interfacewith communities.”

Samba Baldeh, is a Fieldworker Supervisor on the Severe Pneumonia Studies Platform in Fajara: “I come from a community concerned abouthealth. I thought by joining the MRC I could help by disseminating health information. The community are aware that the MRC contributes towards national development. This allows me to be well known and well respected.”

Consent

A crucial element of a fieldworker’s role is gaining consent to work in communities. “Communication is key to every aspect of the MRC’s work, especially at the field and community level in our setting,” explains Abdoulie Cham, Community Relations Officer at the unit.

“Good community relations help to prepare the ground before the fieldworker goes into the community. We advise and help in sensitising the community before the projects begin and help guide the field teams in explaining the MRC’s mission. We bridge the gap between the unit and our stakeholders, working to maintain good relationships with everyone.”

Fama Manneh-Dibba is a fieldworker on the tuberculosis (TB) Reach for Kids project. Her role includes community sensitisation and gaining families’ consent for their children to be enrolled. “I do finger prick tests for malaria in children and Mantoux tests for screening TB,” she says.

Fieldworkers are trusted members of communities and become a focal point for first-line health advice. “Before people come to a clinic, you must convince them that TB is an illness, that they must take medicine to get better, and that they must visit the clinic every day for six months to get the medicine,” explains Pa Camara, a Fajara fieldworker with 20 years of experience in TB fieldwork. “People take medicine for two months, feel better, and stop taking it. They get worse and need to start again.”

Motorbikes with MRC number plates for work in the community

Motorbikes with MRC number plates for work in the community

Data and sample collection

Another important responsibility of the fieldworker is to collect data and samples from local communities. This includes taking physical body measurements, demographic data and biological samples for laboratory analysis.

Lamin Sanneh is a Field Coordinator working on the Global Fundsponsored TB project in Fajara: “Every Monday I meet community leaders and tell them about intended programmes in their community that week. On Wednesday volunteers register, the process is explained, addresses are taken in case confidential meetings are needed, and volunteers are given cups for sputum samples. Thursday we collect samples, which are taken to the lab and tested. Mostly, on Monday or Tuesday results will come through. Fieldworkers are responsible for contacting the patients, asking for a confidential meeting, giving them the news, and a referral letter to the nearest clinic.”

Training

High-quality training is essential for this demanding and diverse role. A year ago, the front-line training model was to train newly recruited fieldworkers through a 12-week classroom-based tutor-led course. Over the last year our team have developed a new style of ‘blended learning’ training course incorporating e-learning, problem-based and practical learning, and peer-discussion workshops. By changing the style of training, we have improved learning and fieldwork performance and cut the overall cost of training by a third.

Pa feels that the IT skills training element of the course is particularly important. “The time will come when data will be collected on computers, not on paper, so if you are not using a computer frequently, it will be difficult.” In parallel with changes in data collection, we hope this will help to transform the nature of fieldwork in Africa.

We hope this project will enable further development of front line workers across the MRC, to initiate a paradigm shift towards student-led, on-demand learning to support high quality medical research.

Ashwin Mehta

Find out more about research at MRC Unit, The Gambia in its newsletter.

For information on implementing e-learning or blended learning contact Ashwin.mehta@headoffice.mrc.ac.uk

This article was first published in the Summer 2014 issue of Network magazine. 

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