Interview: ‘Research is the first step’

Dr Safieh Shah, a research fellow with MSF, talks about her public health research in Pakistan and the need to translate research into the basis for advocacy and change
Let’s start with an introduction. Tell us, what do you do?
I’m a medical doctor, data specialist and a public health researcher committed to fighting health battles plaguing our world today. I have been pursuing an unconventional career path, having been disillusioned with out-dated, myopic curative approaches; while I wish to pursue more preventative, holistic approaches to health by utilising an interdisciplinary tactic that makes use (ideally) of  all branches of science.
Thus, I liaise with different sectors/groups/actors, as I especially enjoy and am skilled at bridging different cultures, socio-economic classes, political leanings and levels of expertise. I look to accomplish these via frameworks, critiques and solutions based on research and theory.
I am currently also working with MSF in various capacities, which include overseeing and mentoring research papers from Kunduz in Afghanistan, and on tuberculosis in Pakistan. As part of my work with MSF, I also travel frequently to provide consultancy services on various projects. I have looked to work at the frontline of important health battles, having worked on the Ebola outbreak in Africa, sexual violence in India and migrant crisis in Europe.
Outside of MSF, I have also been working across Pakistan with a gender-based collective on exploring ideas for disseminating basic public health messages in ways accessible to the most vulnerable sections of society; therefore I am involved with various advocacy groups and institutions related to health.
Apart from my work in health sciences, I have also been working with the Pakistani music streaming service, Patari, on multiple fronts, particularly in helping design their expansion strategies, and to help streamline their database and enriching their existing content-tagging systems. I also write op-eds and blogs on topics ranging from public health, health policies, gender-based issues as well as music and culture in the Pakistani press.
Since when have you been working with MSF?
I started working with MSF in Pakistan in 2012, before leaving as a permanent, full-time employee in 2014. Since 2013, I have been a research fellow of the LUX-OR program within MSF.
When it comes to research, are there any specific challenges associated with Pakistan? Could you please elucidate these challenges?
The most crucial requirement for strong research is the availability of good data, and that is the most glaring challenge in Pakistan. There has been no reliable population census in decades and it has led to spotty and unreliable data. Although, there is a lot of information, it is difficult to then utilise it properly. Creating links between researchers in Pakistan and also adapting the lessons learned from research around the region is important.
One of the research papers authored by you is titled Unregulated usage of labour-inducing medication in a region of Pakistan with poor drug regulatory control: characteristics and risk patterns. Could you please elaborate why this topic was chosen; what was the nature of the cohort and methodology selected; and what did the paper conclude and recommend?
The reason I chose this topic was because it highlighted two pressing issues affecting the Pakistani health sector – the dearth of trained healthcare workers especially in rural areas, coupled with unregulated, over-the-counter availability of labour-inducing medications. The combined effect of these two problems has a significant bearing on Pakistan’s infant and maternal mortality rates, with the country having the second highest maternal mortality ratio in South Asia, and the seventh highest neonatal mortality in the world. We set out to describe the exposure to labour-inducing medication in this sub-population in Timergara, Lower Dir, KPK, and to assess the assumed associations between unregulated use of such medication and adverse maternal and neonatal outcomes.
All women delivering at the maternal and child health (MCH) centre of Timurgara District Headquarter Hospital between the end of December 2013 and mid-October 2014 were included in the study cohort. Women with a known gestational age <27 weeks were excluded, in order to focus the study only on those women who were presented in their third trimester.
In terms of methodology, it was decided that in order to avoid a selection bias–in which women at higher risk of complications may have been more likely to receive oxytocin from lower cadre healthcare workers – we analysed the risk for adverse outcomes in subgroups of patients, which could be considered at uniform risk for specific outcomes.
The paper concluded that exposure to unregulated usage of labour-inducing medication was a common phenomenon, and one that carries a great risk for both, mother and child. It was recommended that tighter regulatory control of labour-inducing drugs was needed, and sustainable training of the mid-level cadres of healthcare workers to further their professional autonomy and careers was also required. 
With reference to the aforementioned research paper, do you think it is sufficient to bring about a policy intervention? In other words, how crucial is research when it comes to advocacy?
In theory, all advocacies should be evidence-based, which means that in order to call for change it has to be well informed, and one of the main ways to do that is via localised research. This allows for any policy change to be contextual, to be based on facts and takes into account the roles played by different actors – local and international – as well as sectors.
That being said, research is the first step of a process. The dissemination and communication of its conclusions in a relevant manner to specific actors is what leads to advocacy, and in that process research is the most important basic tool as research methodology standardises in a logically agreed upon manner within the scientific community, worldwide. However, in order to effect change it requires further steps in aligning the interests of the actors involved at different levels, which goes beyond the scope of research, alone.
MSF organises Scientific Days every year. Do you think platforms such as these are important? If so, how?
I am a big believer in the value of an event like the Scientific Days, and I feel several of my answers to the earlier questions address why I think so. The Scientific Days provide an invaluable opportunity to bring together people with similar objectives (combating disease and ill health) in order to cultivate a vibrant and cross-cultural community. It showcases the work of people by introducing new ideas and innovations in the field of medicine and in other scientific disciplines too, and helps foster a dialogue between different researchers seeking similar goals through different approaches. As I’ve said before, it is vital that the scientific and research community cuts across cultures and regions and acts more cohesively and respectfully of the other, seeking to collaborate on some of the biggest issues affecting our world today. Without having such events, we condemn research into cut-off silos of self-important irrelevance, unable to pollinate their ideas to other actors and institutions that may be able to benefit from them and inspire change. Research should not be conducted purely for research’s sake alone, and the MSF Scientific Days provide an ideal and necessary platform for translating research into the basis for advocacy and policy change by being based on reality and for the reality it seeks to study and effect change upon.

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