ReAct Interview: From zoologist to community engagement on AMR

2020-06-16

Being a zoologist, Jessica Mitchell worked in different countries traveling to remote sites and engaged with the local communities. She enjoyed being able to bring her biological knowledge to an applied problem and support communities to develop their own solutions.

This is when she realized she wanted to develop her human behavior skillset and at the same time use her biology background to address applied problems - such as antimicrobial resistance.

What motivated you to first become a zoologist, and then shift focus to community engagement on antimicrobial resistance?

– As a zoologist a large amount of my field work involved travel to remote sites and engagement with the local communities. During my PhD I became involved in side projects around education, human-wildlife conflict, and human health, and found that I really valued this community interaction. I enjoyed being able to bring my biological knowledge to an applied problem and support communities to develop their own solutions. For example, using bees to prevent elephants from damaging fields.

– I also became very interested in the academic study of human behavior, finding out what motivates people to take action and make change in different situations.  As I advanced my career, I wanted to work in an area that would allow me to develop my human behavior skillset and use my biology background to address applied problems such as antimicrobial resistance (AMR).

What is your role at CE4AMR?

– On a day-to-day basis I manage network communication, which includes sharing successes and challenges experienced by the network as well as new resources. I keep our website and twitter account up to date and also plan and deliver workshops and other events. In the broader sense, I work with Professor Paul Cooke and Dr Rebecca King to develop the CE4AMR strategy and ensure we are supporting the AMR research community to utilize community engagement methods.

– CE4AMR is an international network of researchers and practitioners who use community engagement methods to address the challenges of antimicrobial resistance in low and middle income counties. The network is interdisciplinary and includes those working in human and veterinary medicine, graphic design, participatory film making and theatre.

Why is community engagement particularly important in addressing antimicrobial resistance?

– Antimicrobial resistance is ultimately a social issue. Even if we were to suddenly develop a new type of antimicrobial drug, we would still need to protect its efficacy through human behavior.  Community engagement goes beyond simple awareness raising tactics and allows a given community to explore their relationship with a problem such as antimicrobial resistance and this allows them to consider solutions and behavioral changes which are meaningful in their lives.

How can community engagement help fulfill the goals of the World Health Organization and country-specific AMR action plans?

– Community engagement allows long-term sustainable solutions to be developed because it takes into account the specific needs of a community. This supports National Action Plans – finding approaches to address antimicrobial resistance in their specific contexts. Although, even within a given country it is likely that a variety of different community engagement approaches will be needed to support different groups of the population.

–Community engagement as an approach to antimicrobial resistance lends itself to interdisciplinarity, that is that the research or practitioner team is likely to be broad in terms of their knowledge and experience. Thus, several aspects of National Action Plans on AMR may be addressed by a single community engagement project dependent on the needs of the community in question.

How do you create community engagement that lasts after a project ended?

–  At CE4AMR we are explicit in our aims to create equitable partnerships at all levels of research and practice. We believe this allows all partners within a project to feel ownership, responsibility and autonomy. This facilitates sustainable engagement. One way to do this is to embed the research into an existing community structures such as community health clubs, school-based education or village meetings.

– We consider community engagement to fully involve the community at all stages of the research and to ensure they retain rights and open access to all outputs and resources. If the community have co-created a project, they will fully understand what AMR action they can personally take. As such any outputs or resources created during the project will be locally meaningful. Now the community will be motivated to keep using them and upholding behavioral change – beyond the scope of the project or funding.

In what regions of the world does CE4AMR do this?

– CE4AMR is focused on low-and middle-income countries. Current network members are mainly based across South-East Asia with some in sub-Saharan Africa.  We welcome interactions from any low-and middle-income country based projects across the world.

Is community engagement more effective in low resource settings?

– Community engagement is particularly well-suited to address antimicrobial resistance in low-and middle-income countries because it adopts a bottom-up approach. This can balance power between people and authorities, giving communities autonomy in addressing the challenges of antimicrobial resistance.

– Additionally, in countries with weak health care systems and unregulated access to antimicrobials, top down changes to policy and health systems will likely take time to become successful and impact on the wider public. For example, antimicrobial stewardship programs for hospital staff may optimize antimicrobial prescribing but this will have little effect on the behavior of a community that buy their antimicrobials without prescription from street vendors.

– Instead, directly engaging people through community engagement approaches allows the community to evaluate their own behavior and make realistic modifications based on their own context.

What do you think is the biggest challenge in addressing antimicrobial resistance?

– The lack of interest and subsequently funding is an overarching concern.

– The COVID-19 crisis has allowed us to see just how quickly governments can act to fund new research and action dramatic behavioral changes such as social distancing measures the likes of which we could never have imagined 6 months ago. However, antimicrobial resistance is a crisis which currently bubbles under the surface, meaning it is difficult to support such drastic action.

– Currently, the public are not supported to fully understand the challenges of antimicrobial resistance.  For example, GP surgeries in the UK are decorated with awareness-raising posters showing that antibiotics are not appropriate treatments for viral infections. However, the messaging does not currently join the dots between antibiotic misuse and either the development of antimicrobial resistance or the health and financial consequences of losing antibiotic functionality.  –––––

– Additionally, there is very limited public discussion of other drivers of antimicrobial resistance such antibiotic overuse in veterinary health or antimicrobial leaching from factory waste into the environment. This lack of public awareness on the breadth of antimicrobial resistance and the potential health and economic costs makes the problem difficult to relate to, and subsequently any action on antimicrobial resistance difficult to gain public support for.

What are you most proud of in regards of what you have accomplished in your role at CE4AMR so far?

– Last June I was involved in organizing a residential workshop in Kathmandu, Nepal. This brought together a network of researchers and practitioners to discuss our shared understanding of community engagement and how this approach could be applied to new AMR research. This is where CE4AMR began. I was relatively new to the role at this point and organizing the event’s schedule was one of my first tasks.

– I am proud of the way the event ran. It was very open and honest with participants feeling confident to discuss both successes and failures in their research which I think helped everyone to learn. I presented my first AMR-related talk in the opening session of the workshop and felt really proud to be part of such an important research area involving so many other interdisciplinary teams with the shared goal of tackling AMR through community-led solutions.

What would you like to accomplish in the future?

– I was recently awarded funding to co-produce an AMR education program for high school students in Nepal. COVID-19 is understandably pressing the pause button on this project for now but I am very excited to get back to work with our partners at HERD International in Nepal.

– I have always enjoyed working with young people and we understand from other health challenges that they can be key change makers in adopting positive health-related behaviors.  Our education program will be co-designed by school staff and members of the local community so I am really excited to be working as part of a much bigger team to develop educational materials that will be specific to each school.

– In the future I would also like to return to working with wildlife on antimicrobial resistance, particularly if I can link wildlife-based research to community engagement. I think this will be a great opportunity to showcase antimicrobial resistance as a One Health issue.

More about CE4AMR

CE4AMR was developed in summer 2019 following an interdisciplinary workshop in Kathmandu, Nepal. The aim of this meeting was to bring together researchers and practicioners in both the antimicrobial resistance and community engagement fields to discuss the potential for community engagement f methods to address antimicrobial resistance in low-and middle-income countries.  It aimed to support dialogue between projects of various scales and a key finding was that whilst many AMR projects saw the benefits of community engagement approaches, most were not confident to utilize community engagement without better methodolgoical support.

CE4AMR is now a network which champions the use of community engagement, participatory and creative approaches to address antimicrobial resistance in low-and middle-income countries.  We share best practice and resources as well as prompting discussion on the key challenges of utilizing community engagement in antimicrobial resistance, and the research gaps in this field.

The CE4AMR team is based at the University of Leeds and works within the broader antimicrobial resistance and community engagement landscape at the University.