Fieldwork in Kilifi County, Kenya – Reflections

The first year of my DPhil (PhD) felt like 12 long months of organised chaos – a quick realisation that what I thought I knew I did not know, and what I needed to know was not known (or documented). Right there is where my DPhil project started to take form. That first year was a master class in trusting the process. After conducting comprehensive literature reviews, a systematic review, heart-breaking grant applications and re-drafting versions of study protocols, it was time for me to go to the field in Kilifi County, Kenya. Before leaving, I ticked all the boxes – qualitative and mixed methods training, funding, successful ethics committee board reviews (two!) and equipment check. I then set out for what is, thus far, the most intellectually stimulating and physically demanding experience of this academic pursuit.

Image Description: Sunset near a bridge connecting the two sides of an Ocean Creek, in Kilifi town. 

After about 12 hours of seamless travel, I got to Kilifi town. It was a beautiful and pleasantly warm evening - a refreshing break from the thickness of Oxford’s grey winter. I must warn you that sunsets in Kilifi are ridiculously magical (pictured above) – I will let you be the judge. Within minutes of being on the road, I was so taken in by the views that I politely asked the very kind taxi driver if she could stop for a few minutes – of course, that came with an extra charge and rightfully so, time is indeed money. She chuckled after making her fiscal case, and slowly stopped by the roadside near a bridge connecting the two sides of an Ocean Creek. That moment was magical; it felt like home, which technically is home given that I was only about 8 hours away by road from where I grew up. However, I did not speak the local language, Giriama, and I had never before visited this part of Kenya. The rest of the week went by quickly mainly involving settling in, getting lost, making friends with my new neighbours, brushing up on my Giriama and figuring out various routes to the KEMRI-Wellcome Trust Research Programme (KWTRP).

Kilifi Town is located in Kilifi County along the magnificent coast of Kenya. The historically fishing town lies on the Kilifi Creek and sits on the estuary of the Goshi River. Besides its undeniable beauty, the town is also home to a lot of archaeological sites and a buzzing health research hub. Notably, the Kilifi County Hospital, a primary care referral hospital, is home to the KEMRI-Wellcome Trust Research Programme (KWTRP), a leading medical research centre well known for its landmark progress in infectious disease control and management in the East African region. You can begin to see why this place is like no other  – the perfect blend of cutting edge science, history (and white sandy beaches). This was the place for me to be!

I would then spend the next six months based at the KWTRP as a visiting PhD student attached to the Initiative to Develop African Research Leaders (IDeAL). I have a lot of great things to say about this program, but the highlight of it all was being surrounded by young African scientists doing world-class research driven by an ethos of finding African-led solutions for health challenges in Africa and the world. This experience was incredibly empowering and quite frankly fuelled the success of my fieldwork.

My DPhil project aims to examine the prevention and management of cardiovascular risk in Kenyan primary care settings. This fieldwork component, a qualitative study, would provide insight into the current clinical practice, and the challenges of evidence-based approaches to cardiovascular disease risk prevention and management in these settings.

For the first month, I went to seven health facilities engaging the local government and community leaders (pictured above). I was interested in introducing my research project but most importantly, finding out whether the study I had planned to conduct in these facilities and communities was of immediate interest, and if not, what needed to improve. This engagement process was as eye-opening as it was critical to ethical research. The process allowed me to position my research in the everyday lives of the community i.e. participants in the research process. The ease of this process would not have been possible without the enormous support provided by the KWTRP Community Liaison Office and the County Government of Kilifi.

Image Description: (3) Off road vehicle parked outside a primary care facility, (4) a muddy road, (5) Tonny leading a research clinic for final year nursing students at the Pwani University.  

The next months involved spending weeks camped in primary care facilities (pictured above left) – dispensaries, health centres and a referral hospital – conducting structured observations of consultations and semi-structured interviews with front line health workers and policymakers. This particular bit of the process was extremely tough both in the process and in logistics (pictured centre). For example, the weather was unpredictable, and the roads to some of the facilities were impassable due to the rainy season. Sometimes, I forgot to charge my Dictaphone or carry spare batteries because ‘of the fatigue from the late nights of writing up field notes’. These are skills that they don’t teach you in class, and quite frankly perhaps a little more organisation on my end would have helped. On the flip side, a lot of great things happened while I was there – I formed new collaborations and networks with peers and mentors, presented my research in some of the top regional scientific forums (pictured below right), led a research clinic for final year nursing students at the Pwani University (pictured above right), and even won an award at the 37^th Kenya Cardiac Society Annual Scientific Conference for best oral presentation of research (pictured below left).

Image Description: Tonny winning an award at the 37th Kenya Cardiac Society Annual Scientific Conference for best oral presentation of research, Tonny presenting his research at a scientific forum.

I look back at those six months of being in the field with a lot of gratitude and a renewed motivation to do and be better.

Lastly, here are some of my top three reflections for anyone planning their fieldwork;

• Fieldwork is to be enjoyed as much as it is a serious component of your PhD journey. You will soon find out that enjoying the process (even the tough bits) makes for a great chapter and stories.
• You can never be too prepared – the field is designed to knock you off that high horse, do not stress about it.
• In the field, you are not the expert; the participants are! Your job as a researcher is to facilitate and guide the process. Be prepared to get surprised.

Special thanks to the Green Templeton College Fund, the Global Challenges Research Fund (U.K) and the Rhodes Scholarship via the Warden’s Discretionary Fund for funding this experience and research.

By Tonny Brian Muthee (Kenya & Green Templeton 2016) who is a 3^rd year DPhil student in Primary Health Care. 

First appeared in Nuffield Department of Primary Care Health Sciences Research Blog, on 16 January 2020. Read the original article.