25 Years of CISM-Community Interaction: A Mutual Learning Process

[This blog post is a one of a series of articles to commemorate the 25th anniversary of CISM]

In the context of biomedical research, the people who belong to local communities are undoubtedly the primary stakeholders in the research. The Manhiça Health Research Centre (CISM) has understood this from the outset, but it has taken some time to learn how to transform this community-centred mindset into concrete actions linked to the centre’s research.

What made us realise the importance of the local community?

In a low-income country like Mozambique, especially in rural areas where investments are less common, the creation of a research institution tends to be quite visible and, therefore, expectations surrounding its impact on the community are unduly high. A comment from a community member during our field activities in 2004 illustrates this misperception: “CISM sells our samples—that’s why they hired so many people all at once and were able to buy so many cars.”

Health research is an activity that only generates visible results in the long term, often impacting generations that did not necessarily take part in the research. Therefore, it can be challenging to demonstrate the correlation between a specific research activity and the benefit to the community.

Our first lesson was that we needed to maintain constant dialogue with the community in order to reconstrue the concept of research and make it understandable within the local context.

A lack of understanding in this regard creates space for community members to be influenced by misinformation about research. This is precisely what happened in 2003 when CISM undertook a clinical trial to evaluate the effectiveness of intermittent treatment of malaria in children under one year of age in Manhiça. During recruitment, we noticed that an unusually large number of people did not want to participate in the study. On one day in particular, we were not able to recruit any participants at all.

After speaking with local mothers, we realised that various rumours had been going around. The one that struck me the most was the belief that CISM intended to kill the children: “They even use coffin-shaped boxes to measure the children so that when they die, CISM can distribute coffins of the correct size.” The “box” in question was an adapted stadiometer used to measure the children’s height as part of the study procedure. Without adequate explanation, this device became “evidence” to support the rumour.

How did we address the main challenges we encountered?