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Greece, Sierra Leone

From the Challenge of User Fees in Sierra Leone to Rehabilitation for Victims of Violence in Greece: Diving into the World of Qualitative Research

MSF manages the Robarrie clinic in Tonkolili district in collaboration with the Ministry of Health. An MSF nurse is examining a one month old baby showing the symptoms of malaria. © Giuseppe La Rosa/MSF
Operational Research News 
At the House of BioHealth in Esch-sur-Alzette, LuxOR, the Operational Research Unit of Médecins Sans Frontières (MSF), has facilitated a Structured Operational Research Training Initiative (SORT IT) course focused on qualitative research. In just seven days, the five participants developed research protocols to investigate questions they encounter in the field, ranging from HIV treatment in South Africa to care for survivors of torture in Greece. The findings will help improve health programs around the world, and the resulting studies will be published in peer-reviewed scientific journals.

    Mariangela Psyrraki is an MSF social worker who has been working at the MSF clinic for victims of violence in Athens, Greece since it opened in 2014. Together with local partners BABEL Day Center and the Greek Council of Refugees, MSF uses a multi-disciplinary approach to provide medical, psychological, social, and legal services to people who have been subjected to targeted systematic violence in their country of origin or during their journey to Greece.

    Her research project focuses on exploring how refugees and migrants from the Democratic Republic of the Congo (DRC) view rehabilitation after torture, including integrating into a new society, participating in daily activities, re-establishing self-worth, and developing trust in others. “This is a personal, complicated, and multi-faceted question, as it’s linked to individual and cultural beliefs,” said Mariangela. “The key is to listen: the patients are the experts on what has happened to them. In order to improve our services and provide better care, it’s essential for their voices to be heard.”

    “We are starting our research with patients and community members from the DRC because they compose the majority of self-referents at the clinic. There is an established Congolese community in Athens, and with so many people coming to the clinic for care, information about MSF services is spreading, either by word of mouth or by other means,” added Mariangela. “Perhaps our work with the Congolese community will inspire investigations into how other ethnic communities perceive the rehabilitation of survivors of torture too.”

    In addition to improving the services MSF provides, Mariangela hopes that this study will help to decrease the stigma surrounding torture and to raise awareness of torture and mental health issues, as well as lead to better screening of those who may need services.

    The key is to listen: the patients are the experts on what has happened to them… it’s essential for their voices to be heard.
    Mariangela Psyrraki, MSF social worker who has been working at the MSF clinic for victims of violence in Athens

    Norman Sitali, an operational advisor in the MSF Berlin office overseeing operations in Russia, Belorussia, Tajikistan, Uzbekistan, and Sierra Leone also participated in the course.

    The 2014 West African Ebola epidemic, the largest Ebola outbreak in history, caused more than 11,000 deaths, mainly in Guinea, Liberia, and Sierra Leone. “The Ebola crisis in Sierra Leone caused people to drop everything and focus on fighting the outbreak,” said Norman. “Now, the healthcare system is slowly being rebuilt. MSF provides services in nine locations, and we have been present in the Tonkolili District since the Ebola crisis, and remained after the crisis to continue providing care.”

    In the next three years, however, MSF is looking to hand over its services in Tonkolili to the Ministry of Health. “During this process, it’s important to consider people’s future access to healthcare,” Norman added. “MSF services are free to all, but for services provided by Sierra Leone’s healthcare system, user fees will be introduced for some services, in line with Sierra Leone’s national regulations. Pregnant or lactating women, children younger than five, and malaria patients are exempted. Everybody else needs to pay.”

    Using in-depth interviews and focus group discussions with religious and community leaders, Norman’s research aims to understand how patients, the community, and healthcare workers perceive the challenge of having to pay for medical care, and what strategies may help facilitate access to care to raise the necessary funds.

    The objective of Norman’s study is to help MSF mitigate the transition from free to fee-based healthcare services prior to the handover of healthcare services to Sierra Leone’s Ministry of Health.

    After a week of developing a research question, exploring current literature on their research topics, learning about qualitative data collection and analysis, and working with facilitators to design their study protocol, the five SORT IT participants presented their protocols to each other and the facilitators. The second module of the course will focus on writing manuscripts, which will be submitted to peer-reviewed scientific journals in early 2020.

    Several challenges await the participants along their research journey, but after spending the week in Luxembourg, Mariangela found a unique metaphor for her introduction to qualitative research. “Developing a research protocol can be scary but exciting – it’s like looking at all the spirals and dips and turns of a roller coaster from below and wondering, ‘Am I really going to do that?’ But then you get on and start rolling, and once you get to full speed, you’re enjoying yourself.” When asked if she has any advice for people hesitating about starting research, Mariangela had one thing to say. “Get on the roller coaster!”

    This Qualitative SORT IT course was generously funded by the Fondation Veuve Emile Metz-Tesch, Luxembourg.