e-MOPs

Ethics & Engagement across the Wellcome Trust Major Overseas Programmes

Highlights from the GHBN Summer School, Blantyre, Malawi, 7-11 July, 2014

The third annual Global Health Bioethics Network Summer School took place at Malawi Liverpool Wellcome Trust (MLW) in Blantyre, Malawi from 7-11 July, 2014. Attendance was open to all members of the Wellcome Trust Major Overseas Programmes in Kenya, Malawi, South Africa, Thailand-Laos, and Viet Nam and their partner sites, and to members of the Ethox Centre team in Oxford. Almost all places at the summer school were fully funded by the Global Health Bioethics Network (Wellcome Trust Strategic Award). One additional place was funded by the Malaria Genomic Epidemiology Network (MalariaGEN).

Purpose and Aim of the Summer School

The aims of the Global Bioethics Network (GHBN) are: to promote and support ethical reflection; to build ethics capacity; and to carry out ethics research across the MOPs. Annual Summer Schools are a key activity of the GHBN in all three of these respects.

Summer Schools aim to develop capacity in ethics across the MOPs through educational activities, and to facilitate research collaboration between the MOPs ethics and community engagement teams by supporting the work of the Global Health Bioethics Network Bursary Fellows and by providing a space in which members of the five MOPs and Ethox can discuss and plan research activities in person. In both these respects, the summer schools also aim to promote and support ethical reflection.


Participants

41 participants attended the summer school. Four participants came from OUCRU in Vietnam, four from Thailand/Mae Sot/Cambodia (MORU), five from KEMRI in Kilifi, two from the Africa Centre in South Africa, eight from the Ethox Centre, and 14 from the Malawi-Liverpool Programme. Additional participants included Dr Sally Theobald (Liverpool School of Tropical Medicine), Robin Vincent (Wellcome Trust), Katharine Wright (Nuffield Council of Bioethics) and Bobbie Farsides (Brighton and Sussex Medical School).

Delegates came from the following countries: Cambodia, Kenya, Malawi, South Africa, Thailand, the United Kingdom, Vietnam and New Zealand.

We were also very priviledged to have two special guests: Rob Heyderman (Director of MLW) who opened the Summer School; and Wilson Mandala (Chief Financial Officer), who closed the summer school (shown left).

Topics discussed


In advance of the summer school, participants were asked to complete a registration form in which they were invited to state their reasons for wanting to attend and their particular interests in relation to the ethics of research. Members of the Global Health Bioethics Network Project Management Group examined the registration forms, and created an agenda tailored as closely as possible to the needs of the participants.

The summer school ended up focusing on 8 different themes. Each theme reflected on-going work across the MOPs in these areas:

1. Consent & understanding
2. Research in context
3. Research with children
4. Relationships & collaboration
5. Community engagement
6. Benefits & sharing
7. Feedback of research findings
8. Data and sample sharing


Broadly speaking, the activities at the summer school fell into the following categories:


Information sharing and research updates – staff from each MOP gave overviews of their latest research, listed common ethical issues arising in their research, and shared information on their Community Engagement (CE) activities.
Ethics Bursary Fellow presentations – nine bursary fellows presented updates on their projects.
Academic writing sessions – these were focused sessions on writing papers for academic journals. The sessions provided tips, advice, and an analysis of published papers.
Ethics/research training sessions – for the benefit of some of the more junior members of the network, there were a couple of sessions dealing with issues such as: ‘how to think about research ethics’ and ‘how to turn a bursary into a policy, a research project, or a paper.’
Evaluation session – the 2014 Summer School was unique insofar as we invited an external evaluator, Prof Bobbie Farsides, to join the Summer School. She held a session focused on evaluating our current work and identifying future directions.


Most Summer School sessions were a combination of lectures, discussion, and some group work to identify cross-MOP issues.

MOP staff provided fascinating overviews of their work in ethics research and community engagement. To read about all the latest MOP work in these areas, please visit the 'MOPs NEWS' page here: http://e-mops.ning.com/page/updates-from-november-2013-september-2014

In addition to hearing the latest reports from MOP staff, we also heard from the Nuffield Council on their research with children. Due to a special visit from Katharine Wright from the Nuffield Council on Bioethics, and the presence of Bobbie Farsides, GHBN members received an update on the work going on at the Nuffield Council, which turned out to be highly relevant to work going on across the MOPs. The Nuffield Council has been exploring how best to promote research in children – an issue that is of interest to many MOP staff. The Nuffield Council is exploring how best to engage children in research and ensure their views are taken into account. To this end, a multi-disciplinary working party was established in June 2013, with the aim to report at the end of 2015. The working party has reached the conclusion that it is important to carry out research with children, not on children, and that genuine protection of children can happen only through their involvement. As a result, the Council has been thinking through what genuine involvement means in practice for research study design, for the role of the REC, and for researchers and health professionals in general. For more information, read a blog written by Bobbie Farsides on this issue and the Summer School: http://nuffieldbioethics.org/blog/2014/young-peoples-voices-global-ethics-collaboration-engagement-international/

Another special guest, Robin Vincent, led a discussion to prompt us to think about evaluating CE activities across the MOPs. The discussion often came back to the question of why is it implied that CE is a good thing? The discussion also focused on questions such as: who does the evaluation? Issues around positionality. What theoretical and practical framework to use to guide the evaluation? What methodology? What to measure, and how to know about the effectiveness of the CE activities, or the method of evaluation? We also talked about unpacking key elements of CE – such as how are communities defined and by whom; which communities are involved, and which are excluded and why, what are the roles of CAB/CAGs, and how are these negotiated and shaped over time?

In addition to the formal sessions, there were two group dinners to allow participants to get to know each other. The idea was to strengthen bonds between Network members, and inspire cross-MOP learning and future collaboration among all MOP and Ethox staff.

Ethics Bursary Fellows – updates


The Summer School provided a unique opportunity for our ethics bursary fellows to present their projects, and ask questions and advice from the staff across the MOPs. Our ethics fellows have been very busy, and their presentations generated a great deal of interest and discussion (in addition to providing inspiration to potential future bursary applicants who were among the summer school participants):

Maureen Njue, KEMRI-Kilifi, Payments and Benefits in Kilifi (Ethics Fellow as of June 2012): The overall objective of this project is to understand what are community members’ views on the way study benefits should be planned and implemented in research – and with what underlying reasoning. The ultimate plan is to support the development of guidelines on this issue. Over the past 12 months, Maureen and her team at KEMRI have completed their data collection and are continuing the analysis. They have written one article (submitted for review) and started a second. Findings thus far include: the problems that stem from giving ‘too many benefits – such as undermining voluntarism, conflict between community members, conflict between family members, etc. There are also problems that stem from giving too few benefits – such as unfair burdens to families, the undermining of the relationship between the researcher and the community, low motivation to participate in research, and so forth. In discussions around types of benefits, there was a dilemma between giving cash, goods, medical benefits or information. There was also a discussion of individual versus community-wide benefits. Maureen’s findings show that although cash is generally more controversial than goods, it is least controversial when given to compensate direct costs. Medical benefits are valued but are not a guaranteed form of benefits – they do not compensate for direct/indirect costs. Maureen’s conclusion is that it is important to have a tailored approach for different study designs and that context is important when deciding on forms of benefits.


Francis Kombe, KEMRI WT, capacity of frontline staff (Ethics Fellow since September 2013): The objective of this study is to strengthen the capacity of frontline staff, including their ethics capacity. The aim is to describe the ways in which research frontline staff/fieldworkers can be appropriately supported through supervision, continuing professional development, and performance management. In the past few months, Francis has mapped out current practices in which frontline staff are supported to undertake their research roles across different research institutions in sub-Saharan Africa. A survey was carried out to understand the various roles that FWs play and the institutional context within which they work. Then, an examination of the challenges FWs experience was carried out, including an examination of structural challenges, as well as ethical and operational challenges. A FW workshop was held in July 2014 in Kilifi, Kenya, just before the summer school. It was attended by 20 frontline staff managers and supervisors, 15 of which came from 15 different centres around Africa. In the next few months, Francis will be focusing on writing up an analysis stemming from the survey and the workshop.


Rodrick Sambakunsi, MLW, Reproduction of knowledge around HIV self-testing (Ethics Fellow since November 2012): The objective of this project is to understand how messages about HIV self-testing are reproduced as they spread through communities. Over the past year, data collection (interviews) has been carried out, and Rodrick is currently analysing the data and planning to write a paper. Preliminary findings reveal gender differences according to the location where HIV self-testing messages were first disseminated. Those who learned of HIV self-testing at science cafes tended to discuss the issue with both men and women. Those who learned of HIV self-testing at community mobilization meetings, or from a community counsellor tended to discuss the issue with primarily women. Rodrick found that occupation and socio-economic status also varied between groups. Those who attended science cafes were of a higher economic status than those who attended community meetings. Over the next few months Rodrick will be focusing on how health messages were ‘packaged’ as they were disseminated, how messages are constructed and reconstructed within social networks, and what factors influence responses to health and research messages.


Phaik Yeong Cheah, MORU, Consent and assent in paediatric research (Ethics Fellow as of April 2013): The objective of this project is to carry out an ethical analysis of consent and assent in paediatric research, develop an argument for where assent vs. consent should be sought in children, and explain objections to the current views on assent. Ultimately, the hope is to provide some guidelines on where and how assent should be sought in children, especially in low-income settings. In the past few months, Phaik Yeong has written a paper based on the research and case studies she has examined. Currently, her conclusions are that minors are excluded from research despite the fact that research is important and they want to participate. Phaik Yeong’s conclusion is that minors should be allowed to consent for themselves – if the study is minimal risk, important, approved by relevant ethics committees, and if they can provide valid consent. In the next few months Phaik Yeong will continue writing up and disseminating her research findings.


Khin Maung Lwin, MORU, Evaluating community engagement on the Thai-Burma border (Ethics Fellow as of June 2012): The objective of this project is to understand whether the community advisory board based on the Thai-Burma border since 2009 has been successful. A big question is what are the success indicators of the T-CAB? Khin has spent the last year carrying out more interviews and getting them translated and transcribed. There have been many positive changes at the T-CAB as a result of his inquiries into its effectiveness. Duties and responsibilities are better organized now, with a separate consent team, a study team, and an administrator. Khin has realized that more interviews need to be carried out, and, in addition to writing papers about the T-CAB, he is now involved in exploring the motivation of T-CAB staff. Preliminary findings show that although the relationship between the T-CAB and the researchers has improved, the relationship between the T-CAB and the community is less strong, and that is the relationship that ought to be fostered now in order to build better trust. Over the next few months, Khin will complete all interviews, and is looking forward to disseminating his results in an academic paper.

 

Claudia Turner, COMWRU – Ethical considerations, perceptions, beliefs and practices in the neonatal period in rural Cambodia (Ethics Fellow as of May 2014): The aim of this project is to record the beliefs and interpretations of illness and death in neonates that are held by a cross section of the community in rural Cambodia. A secondary objective is to explore the ethical issues faced by parents and other stakeholders regarding seeking health care in the new-born period, and to inform future studies on CE for the reduction of neonatal morbidity and mortality. The hope is that understanding community practice and beliefs will be a vital step in improving neonatal outcomes. The project has only just begun. In the next few months, Claudia will be carrying out interviews and focus group discussions. We look forward to hearing about her findings at the 2015 Summer School.


Neema Mtunthama, MLW – Paediatric research and informed consent (Ethics Fellow since December 2013): The objective of this project is to understand to what extent does the research context for obtaining consent impact on participant understanding? The aim is to evaluate the informed consent process among guardians of research participants in purposively selected paediatric research studies. The methodology will include individual and group interviews. The plan will be to disseminate findings among local researchers, and to develop informed consent guidelines in paediatric research, as well as publication. So far, the project start-date has been delayed due to beaurocratic processes. Just recently, a waiver application for ethics overheads has been approved, and a proposal will be submitted to an ethics committee in July 2014. After ethical approval, there will need to be some staff recruitment and training, participant enrolment and data collection, data transcription and analysis. After that, Neema plans to write an article based on her findings, and create new guidelines in informed consent in paediatric research in Malawi.


Mphatso Mwapasa, MLW – Bioethics of biometrics among policy makers, implementers and users within the health care system and medical research in Malawi (Ethics Fellow since May 2014): The objective of this project is to identify and explore ethical issues associated with the use of biometrics in healthcare systems. The study will be a qualitative study combining purposive and snowball sampling to conduct semi-structured interviews. After analysis and write-up, the findings will be disseminated to policy makers, researchers, and academics. Thus far, funds have been secured, and permission letters are being obtained from gate keepers. A full protocol is being developed, and is yet to be submitted to COMREC for review.


Lindsey Reynolds and Miliswa Magongo, Africa Centre – The ethical and social dimensions of representation in health research (Ethics Fellows since July 2014): The focus of this bursary project will be on the dynamics of divergent forms of representation in the context of health research. The aim is to explore the ways in which actors involved in the research activities of the Africa Centre are asked to represent: a) the Centre to the community in which the Centre’s research is based; and b) the Community to the Centre leadership, scientific staff, funders, and other stakeholders. The study will consist of individual and focus group interviews. In addition to the bursary research project, other capacity-building activities will take place at the Africa Centre over the next year, including a reading and research group on ethics, ethnography, and engagement, workshops with the Community Engagement Unit and scientific staff, the development of future research, and the building of a social science data ‘bank’.

Evaluation


We were very fortunate to have Bobbie Farsides at the Summer School. She will be carrying out an external evaluation of the GHBN, and as a result, there was one session at the summer school that focused exclusively on evaluation. Bobbie asked each of us to think about three things:


1) What have you gained from being a member of the Network?
2) What would you like to get from the Network that you are not already getting?
3) What do you wish to contribute to the Network in future?

Summary answers to these questions were as follows:

1) What have you gained from being a member of the Network?
An examination of all responses showed that Network members generally agreed that their gains fell into four areas:


Funding and publications: Several members said that they had gained bursaries, and had been led to new funding opportunities. In obtaining a bursary, they also had the joy (and responsibility) of being a PI on a project. Other members said that thanks to support and mentorship from the Network, they had succeeded in putting out publications.


Ideas: Several members talked about the inspiration and ideas they had received as a result of the collaboration that happens at the Network. One member talked about ‘realising synergies and parallels between key questions across the MOPs’. Another member mentioned he/she had received ‘new ideas relevant to our practice’.


Knowledge and skills: The vast majority of members said they had gained valuable knowledge and skills as a result of their participation in the Network. This knowledge came from either Summer School sessions, discussion with other Network members, or support and feedback on projects. Members most commonly talked about gaining knowledge and skills in: ethics training; the design and implementation of research studies; how to conduct qualitative work; good research practice; how to review bursary projects. Members also talked about receiving critical insights into their own work, and gaining a better understanding of the significance of community engagement. One member said their new knowledge had led to them being able to ‘shape’ their career and profession. Another member stated that he/she had gained “an incredibly rich education in the realities of research ethics in low-income settings”. Yet another mentioned that his/her own assumptions had been challenged, and the Network forced them to think beyond just the ‘local’.


Friendships: A great majority of members focused on friendships. Responses here ranged from the benefits of meeting like-minded scholars, developing relationships, forging links with others involved in related work. Almost everyone seemed to appreciate the networking opportunities and friendships that arise from being part of the Network. Several people said they benefitted from the support and mentorship offered by the Network, and that their own ethics work had improved as a result. People also said they felt less alone in their struggles with ethics, and enjoyed being part of a wider, supportive Network.

2) What would you like to get from the Network that you are not already getting?

In this question, as in the one above, responses tended to coalesce around four different areas:


More knowledge: It seems that although most Network members are happy with all the knowledge they have gained thus far, there is a desire for more. In particular, members said they would like:
o More knowledge on systematic reviews of qualitative research;
o More ethics training. Especially, more educational materials & readings on bioethics;
o More knowledge about how our research outputs are translated into intervention, and the effectiveness of these actions; and,
o More specific and structured writing sessions, as well as structured opportunities to engage in collaborative papers. This was by far the item that received the most interest. Several members expressed a desire to improve their writing skills (including grant writing skills), while others expressed an interest in the chance to work on a collaborative paper;


More support for on-going collaborations: Several members requested more cross-site research, and often emphasised that they wanted more time and space to develop joint outputs. There were several calls for more help developing projects within a MOP as well as across the MOPs. Some said they would like more meetings, more site visits to other MOPs in order to help collaborations foster, and more time (almost all called for more ‘time’!) for discussions, for networking, for collaborations that would bring the MOPs closer to work together as one.


More support for capacity development: A few responses to this question asked for more capacity development support within the MOPs, as well as more capacity building for upcoming researchers & scientists (but were not specific as to what form this capacity building should take).


Sustainability: A small but strident minority of voices called for more sustainability. One person wrote: ‘I keep believing that the Network will soon come to an end. What next?’ Several others expressed a desire ‘for the Network and collaboration to continue and grow’.


• Finally, there were a few ‘outliers’ that asked for other things, such as “to use the Network as a voice for lobbying”; and “a successful fellowship application”.

3) What do you wish to contribute to the Network in future?
There were many varied responses here, but they were all enthusiastic. Many answered this question by saying that they would be happy to contribute their ideas, their time, energy, and knowledge to the Network. Other common responses included:


Comment & feedback: several said they would be happy to comment on colleagues’ papers and proposals, contribute to the development of guidelines; share good practice; offer perspectives/insights from their own disciplinary background & training; and provide general support to those who wish to develop projects.


Support for bursary holders: several said they would be willing to provide bursary holders with mentorship and support.


Engagement in collaborative writing projects: A handful said they would be happy to develop more collaborative projects; lead the writing of collaborative papers; or help to crystallize some of the collaborative research into projects. One member said he/she would be happy to develop a research proposal and get funding for a study to build into the body of knowledge of the network.


Specific contributions: One member said she would be happy to organise a spin-out workshop on the ‘ethics of paediatric research’; another member said she would be happy to support a gender analysis & qualitative research materials.

It will be interesting for Network members to think about their answers to these questions above and see how close the links are between what people hope to gain from the Network, and what they also wish to contribute. It is also heartening to see that Network members already feel that they are gaining so much from the Network and wish to see it continue.

On-line resources


During the Summer School the website e-mops.ning.com was used extensively by summer school participants and organizers. This website exists for the benefit of all MOP staff and students interested in or working in the area of ethics and community engagement. It provides a platform to keep in touch, share ideas, ask each other questions, and generally maintain relationships and learn from each others’ experiences.

Site Visits

The MLW team provided an excellent range of site visits that gave Summer School participants a true glimpse into the context in which MLW projects take place. At lunch times, short tours were provided around the Queen Elizabeth Hospital, located very close to MLW Headquarters. Neema Mtunthama led these tours, pointing out the different wards - paediatrics, maternity, etc, including the examination room where specific MLW research is done (pictured on the left). The hospital was an enormous complex, and we were struck by the cleanliness and order everywhere, as well as the carefully arranged triage system.

The final day of the Summer School was devoted exclusively to three different site visits, led by Greyson Chapita, Rodrick Sambakunsi and Elvis Moyo. We travelled first to Bangwe, the site of one of Malawi's one hundred and twenty-two RLCs (Radio Listening Clubs).

In 2012, MLW entered into a strategic partnership with the Malawi Broadcasting Corporation (MBC) to link communities – through radio listening clubs – to health research.The radio listening club we visited runs out of the Community Initiative for Tuberculosis Education (CITE). We were welcomed by Mr. Frasco Dzimbiri, CITE Chairperson, who introduced the organization to us (shown below left). Then, we received a real-life peek into the recording of a radio show on the subject of Tuberculosis. A terrific summary of our visit to this Radio Listening Club is provided by Sally Theobald in a blog post she wrote shortly after our visit: http://e-mops.ning.com/profiles/blogs/strategic-media-partnerships-in-health-research-radio-listening

Out of the 122 Radio Listening Clubs that MBC has, MLW works directly with six of them. These clubs belong to MBC, but MLW provides training for the clubs and equipment such as recorders and radios. In addition, every month MLW staff members conduct visits to the radio clubs where they discuss the programs that were aired that month and record programs for the other months.

Our second stop was in Chichiri at the MBC radio offices, where we received a tour of the MBC station and recording studios. The MBC has established 122 radio listening clubs across the nation. MBC works through district and traditional structures to establish these clubs, which aim to bring the voices and experiences of Malawian communities to the airwaves. Joshua Chirwa, the Program Manager at the Development Broadcasting Unit of MBC showed us around, as well as Philip Business, the presenter of the weekly program on health and health research, and Chisomo M’dalla.

Finally, after a brief stop for lunch at Fisherman's Rest, we travelled to Chikhwawa, where we had a tour of Chikhwawa hospital (pictured below), a site where MLW carries out various research studies, such as a cooking and pneumonia study, as well as several malaria studies, to name a few. Participants also met with a few members of the local Community Advisory Group (CAG). The CAGs are responsible for informing their communities about MLW research, as well as the research of other institutions, such as the College of Medicine and the Malaria Alert Centre. The CAGS in Chikhwawa have been with MLW for about five years, and it was fascinating to hear their stories about the benefits of being a CAG member and the every-day difficulties they encountered in informing their communities about the on-going research projects in the area.

Evaluation Forms


At the end of the day on Thursday, evaluation questionnaires were handed out to all participants present. 34 participants filled out the questionnaire (85% of participants).

In summary, the evaluations suggest that participants found the Summer School useful, inspiring, and a great deal of fun.

1. Popular themes

• The most popular themes at the Summer School were the ‘research with children’, ‘community engagement’ and ‘benefits and sharing’ themes, with 22 respondents (65%) finding them useful.
• A slightly smaller percentage of respondents, 59%, enjoyed the ‘consent and understanding’ theme.
• Although 16 people (47%) found the session on ‘Writing Academic Papers’ useful, only 9 (26%) found the structured writing sessions every afternoon to be of use.
• When respondents described why they liked particular themes or sessions, one of the most common reasons given was that these themes were relevant to their work. Several said it was good to hear about real issues on the ground that affected different MOPs, and that some of the presentations gave insight into how they could approach on-going questions in their own research.

2. Utility of the 'structured writing sessions'


• The question about whether the ‘structured writing sessions’ were useful gave rise to very different responses. Most said yes, these sessions were useful, but added that they could have been vastly improved. Some said the time set aside for writing was too short; others said that an intensive writing session set outside of the Summer School would have been better; while others said a more structured approach leading to a concrete output would have been ideal. Despite these statements, there was almost unanimous agreement that the writing sessions should continue.

3. 'Least useful' sessions


• One question on the evaluation form asked respondents to list the sessions they felt were the least useful. 9 respondents said none of the sessions were bad. Two said that the writing sessions, as currently structured, were the least useful. Most respondents did not answer this question.

4. What, for you, is the most important output of the summer school?

Respondents’ answers can be grouped into four main areas:


a. Relationships & collaboration: most respondents stated that the potential for collaboration, the building of relationships, and the forging of connections was a key output of the summer school.
b. Ideas: many talked about the new ideas and the motivation they felt as a result of the summer school; the new insight they’d gained, and the inspiration they felt about cross-MOP projects. 8 people said that the new ideas for projects and collaborations was the most important output of the summer school.
c. Knowledge: this was a subject that also received a lot of mention. Respondents talked about the knowledge gained from listening to others’ presentations, the enhancement of their understanding of bioethics, the feedback and input they’d received on their own projects, and the exposure to a wide range of research studies.
d. Publication: A couple of respondents said that publications or the opportunity to get published was the most important output for them.

5. Was there anything missing from the summer school?

Although most respondents said ‘no’ or didn’t answer this question, those that did respond gave us some points to think about when planning the next summer school. Two respondents said the Summer School did not provide enough time for concrete action on collaborative projects. About five participants called for more skills-building or capacity-building sessions at future workshops. (Interestingly enough, this same issue was raised at last year’s summer school). Some called for a session on analytical work to address ethics issues (as opposed to empirical work), more training on philosophy and formal ethics, more practical skills on how to address ethics issues, and general capacity-building for new bursary holders. There was also a call for more peer-to-peer led activities, especially among bursary fellows, as well as a general call for more discussion time. One person asked for more stretching/group work/games to keep people alert in the afternoons.


6. Do you feel you had adequate time and opportunity to raise your questions, voice your opinions?

82% of respondents answered ‘yes’, and 12% said “no”. One person noted that some voices were more dominant than others, while a couple stated that timing was just too tight and didn’t allow for everyone’s voices to be heard.

7. Balance of activities at the summer school

41% of respondents said they were happy with the balance of activities and sessions at the Summer School. Those who complained here primarily complained about the lack of time. There was too little time for discussions, and one said there was “not enough time to just take a break”. Four people complained that there were too many lectures and not enough ‘practical/hands-on’ sessions. Several complained that there was not enough group work, or participatory ways of engaging the participants. One suggested that it may have been better to have the site visit in the middle of the week to break up the lectures.

8. Thoughts about the length of the summer school


68% of respondents thought that four days plus one site visit day was the right length for the Summer School, although several said they found it quite tiring, and would have liked an afternoon off. One person suggested more online preparation before the event, and another suggested setting aside one day prior to the Summer School dedicated to the capacity building of new bursary holders.

9. Thoughts about logistics, location etc.


Everyone was happy with the logistics provided before the meeting, and pleased with the location, accommodation, and so forth. The biggest complaint was the fact that internet did not always work well, and there were a couple of complaints about the sound system (microphones should have been used at all times). Also, one person said it might have been better to have the meeting at a more neutral location as given that it took place in ‘their’ office, they were torn between the Summer School and attending to their other work duties. If the meeting had been in a different location in Blantyre, they would have been able to focus on the Summer School exclusively. The participants loved being in Malawi, and many complimented the hotel and the food.

10. Did the summer school make you think differently about ethics?


About half of the respondents said that the summer school had made them think differently about ethics. (As an interesting comparison, last year, all but three said that the summer school had made them think differently about ethics. Can this be an example of general, improved ethics knowledge among summer school participants?) Some quotes include:
o Yes. Since I joined the network I would say I have become very observant, careful in my work as I now understand more now about ethics due to the exposure I have had.
o Yes, lots of different ways. Too many to list. My thinking about the network has also changed. It has really come to life.
o Ethics turns out to be more practical than I’ve thought before.
o It has made me more alert to the contextual nature of almost all ethical dilemmas.
o Not differently, but learned ways in which descriptive materials can feed into normative arguments in research ethics.

11. Will you do anything differently in your work as a result of the summer school?


With respect to the question about whether they would actually do anything differently in their work from now on, the majority of respondents said yes. One said: “I will involve colleagues, hear their views about issues. I will collaborate more with other MOPs to put research findings into practice”. Several said they had gotten useful ideas and advice for their work, and a few talked about the good insight and ideas they had received on the writing of their papers. One said: “Received interesting comments about my current work & ways of taking it forwards. Will definitely consider suggestions & recommendations in my next steps.” Another said: “[I will do] many things [differently]. Foremost is finding space and research interest for collaborative work; secondly, expand goals of CE & PE to also include understanding of science.”

12. Final thoughts


There was a lot of praise for the summer school in general.


o “…a very big thank you for enabling me to come to the summer school! I enjoyed myself far too much for a work week – and have come away buzzing with thoughts about how to re-write our report! It was a truly transformative experience – and I felt very privileged to be involved.”


o “10/10 for everything. Location, accommodation & food was good. Everything went smoothly... Thank you.”


o “Really great week in all ways.”


o “Keep it up. This was a fabulous workshop.”


o “The sessions should be done twice a year, and not only once. It is bringing experience and exposure, so is good for learning.”


• Of course there were also suggestions for improvement. Some final constructive points that people raised were:


o General time-keeping was very good, but perhaps things went a bit over sometimes, and affected other sessions that ended up being a bit rushed.
o Not enough discussion time in sessions that started late.
o More focus on capacity building, and on ethical analysis.
o Maybe in future you could consider making some sort of short course certificate – e.g. certificate in ethics that participants would get after summer school.
o Create a journal for all MOPs to publish their work.
o Sometimes it was difficult to hear clearly what the speaker was talking about. Sometimes voices weren’t loud enough – microphones should be used at all times.
o Send presentations in advance, so people can follow more easily.
o More team work/ more participatory approaches.

Lessons learned from the evaluation


After having three Summer Schools and learning from the experience, we can confidently say that the 2014 Summer School was an enormous success. We improved on the 2012 and 2013 Summer Schools, instilled many of the changes and improvements participants had suggested at the previous Summer Schools, and are happy with the result.

Last year, the improvements we considered making included:


• Ensure that participants are aware, beforehand, of all the readings available on the e-MOPs website. This year, we only referred to three readings (used in the ‘academic writing’ session), and these were sent out beforehand.
• Build into (or as a side-addition) some specific skills-building sessions, e.g. on writing a grant, empirical research, etc. We responded to this in 2013 by hosting a session specifically on qualitative research skills in Oxford in November 2013. We also attempted to respond to this need by having a specific session on writing skills at the Summer School.
• Build into the Summer School more specific, targeted help for Ethics Bursary Fellows, e.g. have a workshop session where Fellows can workshop their publications-in-progress. We responded to this need by having one session on Thursday where bursary fellows talked about their projects, and received advice on what journals they might wish to submit to.
• Ensure that participants have time to actively work on specific cross-MOP projects. Unfortunately, we did not have enough time for this at this year’s Summer School.
• Explore the level of interest in introducing an in-depth workshop aspect to the summer school to work together on a single topic e.g. ‘benefits’ over a full day. We did respond to this by devoting almost an entire day to discussions on Community Engagement. This worked quite well…except that, as can be expected, some participants ended up complaining that we had spent too much time on CE.

This year, as last year, we had a mix of old and new participants, and it worked really well. We also implemented many of the ideas that were raised from last year’s Summer School.

There are still areas where we can improve, of course. For the 2015 Summer School, we should try and keep the following suggestions in mind:


1. Set aside some time for peer-to-peer support for bursary fellows. Perhaps one day prior to the summer school, when more experienced bursary fellows can provide skills-building sessions to new/junior bursary fellows.


2. Break-up sessions so that the summer school is not too presentation-heavy. For example, add more participatory sessions, more group work, and consider having site visits take place in the middle of the week. It’s possible the group as a whole may even benefit from having someone external come to provide training on participatory facilitation methods.


3. Network members have requested more time during Summer Schools for developing cross-MOP projects. We must make a concerted effort to make time to specifically work on developing cross-MOP projects at the next Summer School. Perhaps we should set aside a day of the summer school when only presentations of cross-MOP projects will be shared, and group work will take place to work on collaborative papers.


4. Think more strategically about how to build-in and balance lectures vs. skills-building sessions. Almost everyone said that the writing sessions were needed – but not quite in the format we had them at this year’s summer school. We must figure out how to structure skills-building sessions to ensure they are concrete and lead to specific outputs.


5. Provide presentations and relevant readings to summer school participants before the summer school. This may or may not be possible (often people write their presentations at the last moment). However, it’s possible that people will like having a deadline prior to the summer school to put their presentation on e-MOPs. This way, those whose English language skills are not fluent may find it easier to follow the lectures.

Despite this list of areas for improvement, in general, respondents were overwhelmingly positive in their evaluations and in their comments directly to us. As a result, we can feel proud. The 2014 Summer School was a success, and we look forward to seeing what comes out of it. We also highly anticipate the evaluation report from Bobbie Farsides which will doubtless provide us with good advice on how to move forward and will reveal more areas for improvement.

At the end of the summer school, Certificates of Attendance were presented to each participant.

Future summer schools


The summer school in 2015 will take place in Vietnam.

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