Stevan Bruijns är en av pionjärerna inom akademisk akutsjukvård i Sydafrika och grundaren av the African Journal of Emergency Medicine. Han är en av lärarna på kursen i akutsjukvårdsforskning 15 mars och talar under SWEETs om hur man med små medel kan bedriva högkvalitativ forskning och med egna innovationer lösa praktiska problem.
How did you end up where you are now (and where is that)?
I’m not quite sure. I started emergency medicine by fluke and ended up becoming a researcher by fluke. I never intended for this to happen. I was going to be an orthopaedic surgeon when I finished medical school but ended up working my mandatory community service (something all South African doctors have to do) with one of the most inspirational clinicians I have ever known, Dr Aziz Aboo. He is retired now, but was regarded by all who knew him a beacon of light to what was then regarded as emergency medicine. I guess I owe all of what I have done to date in my career to him. So after he put me on the straight and narrow I ended up in the United Kingdom for about a decade which is where I got my FRCEM and did a PhD with another inspirational clinician/ researcher, Dr. Henry Guly. He is also retired now so I count myself very lucky to have brushed with greatness before they moved out of the limelight. Prof Wallis then nicked me back to Cape Town to lecture at the University of Cape Town in the Emergency Medicine Division. I have been there for almost two years now. Dr. Sa’ad Lahri kindly tolerates me for one day a week at his fantastic emergency centre in Khayelitsha. Khayelitsha is the large informal settlement you can see from the plane as you are coming into Cape Town International airport from a Southerly approach.
How did the AfJEM come about and why is it needed?
This was all Prof Wallis. He is a very adventurous man. We launched the first Emergency Medicine of South Africa conference back in 2007 and it was clear from the outset that African researchers were really struggling to submit good quality abstracts. We also found a disconnect between what our non-Africa colleagues advocated for emergency care and what was actually feasible within our resource limited settings. By the time we got to the second conference in 2009 it was clear that we needed a journal that could address this niche. It was only the following year that we formalised the agreements and the journal was launched in 2011. The AfJEM currently publishes about 20% of African emergency medicine literature with around 44 other journals publishing the rest. That is pretty awesome considering we are doing this without Medline indexing.
What are the main obstacles when conducting research in research limited settings?
This varies from region to region. It is actually very interesting. The Middle East publishes a lot of papers but the quality is really poor. South America publishes very little, but the quality is very good. Africa on the other hand publishes very few papers and the quality is not so good as well. So a double whammy for Africa. From an African perspective conducting research is hampered by lack of adequate research training, lack of political motivation and lack of funding- there are no money unless you are researching HIV, tuberculosis, malaria and more recently Ebola. The research that is conducted tend to be very basic descriptive work. There are no formal databases that can provide reliable information about various acute care issues (the published numbers you read about in the papers tend to be estimates, or rather underestimates as some of my African colleagues would say tongue in the cheek), so we just don’t know. There is nothing sexy about what we do, but I do believe the descriptive data is laying a foundation to do the sexy stuff from. I’m being unfair, we do do sexy stuff. The research surrounding the South African Triage Scale has probably saved tens of thousands of lives already and the fairly recently completed pathways to care study by one of Cape Town’s up and coming researchers, Peter Hodkinson, is consider ground breaking stuff. So we have our moments.
What are your best tips and tricks to get started?
Getting started in Africa? Get in touch with the African Federation of Emergency Medicine (AFEM). AFEM has established a huge network of emergency care workers of various disciplines, abilities and interests. If we can connect you with one of our partners, or draw you in on an existing research project, you could have a much greater footprint for the research you do and get so much more out of it as a result. In general I’d probably just repeat what others have said before. You have to do something that is of interest to you as that will come in handy on those dark nights when your stats are not going the way you want it to. You have to pick something that you don’t have to go out of your way to data collect, as you’ll quickly fall out of love with it if you have to. So if you work in out of hospital care, don’t do a project that requires data collection in a critical care unit. That is just silly. Even I (who do full time research coordination from the luxury of an air conditioned office) pick projects that is closer to home. It just makes practical sense. I have a few more tips and tricks but I’ll save those for Karaoke night when everyone is slightly tipsy.