A key challenge the CEHP program has faced is related to delays in obtaining research ethics approval from multiple ethics/institutional review boards (both from Northern and Southern partner institutions) and the timely release of funds from the program funder. The CEHP program has also experienced challenges related to the on-going reorganization of several partner institutions and thus the coming and going of individuals involved in organizing and implementing the various research efforts. Some synergies between the research programs that were initially envisioned were not realized due to the complexity of working with multiple institutions with different timelines, and in some cases training was provided more than once so that the study methodologies would be fresh in the minds of the participating research assistants (for example, if more than one year had passed before the study was able to begin).
Another challenge, yet also a key indicator of the success of this program, has been the expansion of all of the program’s core research topics well beyond its initial mandate (for example, as previously mentioned, 12 instead of 4 countries involved in the POPs study; 8 instead of 4 countries involved in the BOI study; a MSc degree and diploma program at UWI instead of one distance education course; moving the AML to 3 instead of 2 islands).
Given the magnitude of the major regional POPs and BOI studies undertaken in the CEHP and their significant jurisdictional and institutional complexity, many of the studies are just beginning to wrap up in the fourth year of the program. At the other end of the spectrum, not all of the AML-based local demand-driven studies were large enough to warrant publication in peer-reviewed journals. These studies, however, have significant non-trivial value in both informing local decision-makers and encouraging interest in the use of analytical methods to guide and shape policy. Further, given the magnitude of the CEHP’s research program and their local, national, regional and international significance, it has become quite evident that such collaborative research efforts will take much time – indeed much longer than the 5 year timeframe of this grant – to fully realize and see the full impact CEHP program efforts have borne in the Caribbean region. Thus the CEHP program PIs are facing the challenge of thinking how best to leverage its existing human and non-human resources over the remaining period of this grant so as to maximize the benefit of the CEHP program for the people of the Caribbean.
Another key challenge we wish to address is how to integrate the CEHP’s program research findings into place-based polices, particularly national polices. The CEHP research agenda has deliberately focused on filling key knowledge gaps in the CARICOM region. Towards that end, the connections between projects were deemed less critical than the value that would be gained to the region by addressing these missing pieces. Having said that, the CEHP from the outset of the program has seen the benefit of the convergence between the research programs. Early efforts were made, for example, to link the rainwater cistern project to the BOI study in Grenada and Carriacou. In addition, a zoonoses component was added to the POPs study, although originally the former was to have been based out of CAREC’s laboratory in Trinidad. Due to the challenges experienced due to the very different timelines (including difficulties finalizing MOUs and transferring funds), combined with the logistical challenges and timelines inherent in rolling out individual research programs, and not underestimating the institutional challenges caused by the shuffling of key actors in the program, potential synergies have been underdeveloped to date. Nonetheless, over the remaining period of this program, there is the potential to regain some integration by building on the country-level reports created by the research teams. These include detailed POPs and BOI study reports, several of which have already been released. It is also hoped that this integration may be further enhanced through country-level meetings with key policy partners, or via a planned regional forum to be held in the last year of this grant.
The CEHP’s experience provides some insights into the challenges of conducting global health research. The CEHP’s experience illustrates that in order to successfully tackle environmental and public health issues, dynamic teamwork and respectful partnerships are often needed. The CEHP’s wide-ranging network of research team members has facilitated the recruitment and engagement of key government and institutional partners, with each party bringing different resources and capabilities to the group. While it is typically true that the larger institutions and the Northern partners in the CEHP partnership may have access to funds, it is the smaller LMIC partners that are typically more in tune with the critical questions and gaps in research in the region and it is they that tend to have a well-nuanced understanding of who needs to be engaged in order to get ambitious research projects done.
Notwithstanding what has already been said above and what will be highlighted below in the ‘Successes’ subheading, the CEHP program has found it a challenge to effectively capture all of the successes of the CEHP on paper to our funders and partners. Part of this problem may be that the usually evaluation metrics such as the of number of peer-reviewed journal papers published, number of reports written, and amount of additional co-funded secured are all ill suited to capturing the other less tangible but still highly significant (e.g., the creation of dynamic and sustainable networks of highly motivated professionals within the region, synergies of having multiple agencies and multiple expertise working on current environmental problems which lead to novel and more holistic solutions, etc.) outcomes. With this in mind, the CEHP partners are exploring alternative media wherein it can meaningfully communicate the impact it has truthfully had in the Caribbean region. One option that is currently under development is commissioning of a video-based evaluation of the program and its research efforts. The final product will include an analysis of the overall effort, its successes and failures, and the direct and indirect benefits provided by participation in the collaborative effort. In addition, specific short videos on the BOI, POPs and AML experiences may have particular utility for future knowledge translation efforts. We have no doubt that this program will lead to a significant number of ‘traditional’ indicators of success, such as peer-reviewed journal articles, but are aware that these are not likely to be apparent until 1-2 years after the program ends. Given the regional scope and sensitive nature of the research undertaken, as well as their significant policy implications, it is important that the data are first reported and discussed nationally before they are synthesized into journal articles. Indeed, by working with regional government organizations, such as CAREC, these steps are required.
As is true in most LMIC regions of the world, so to in the Caribbean it is important to identify key gaps in scientific knowledge pertaining to the state of environment and health relationships. The dearth of such data in the Caribbean makes it very difficult to engage decision-makers in the quest for policy action that is required to move beyond the status quo. A key advantage of regional studies, such as those that the CEHP program has designed and implemented, is that these studies have been self identified and collaboratively researched by internal and external expertise. Such studies thus have both national and international significance, and participation in these studies is often of particular interest to national governments as it creates a more level playing field in terms of who is impacted by the results and what should be done.
The use of the Atlantis Mobile Lab (AML) in catalyzing new science in the Caribbean region and in providing the equipment and expertise required to conduct innovative studies in a cost-effective way has been a major success of the CEHP program. In addition to carrying out CEHP research projects, the lab has been used by other organizations to carry out other specific analyses. These additional studies were made possible because of the CEHP’s contribution of the lab and its technicians to the studies. The analyses provided to study partners at their request were done on a cost-recovery basis in that the requesting entity was only required to either provide or pay of the cost of replacing materials used to support these research projects. This fact alone was extremely powerful in creating demand for data related to questions of on-going concern. For example, the Soufriere Marine Management Association in St. Lucia was able to pay for sampling of marine and surface water for pathogen and metal testing. Information from that study was presented to the community by the CEHP program manager and the lab technician at a meeting of the SMMA. This has led to increased interest and demand for watershed-based programming to protect surface and marine water quality in the area.
The Environmental Health Department of the Government of Dominica took advantage of the opportunity for low-cost analysis to investigate issues related to marine pollution from land-based activities including inadequate liquid waste disposal practices and metal pollution, as well as seafood safety. In addition, a request from the local government and the indigenous Carib people, led to microbial and chemical analyses being carried out on six (6) rivers, springs and public water supplies in the Carib Territory. After the AML left the island, the government made a formal request for the CEHP to prepare a list of equipment that the government should invest in, in order to create on-island capacity to undertake the ecotoxicological and public health studies that it benefitted from during the AML’s stay. Many of the studies were undertaken in partnership with scientists from the Ross University’s School of Medicine. These localized research partnership were significantly strengthened by the CEHP collaboration.
There has also been a very strong demand for the services of the lab not only from University researchers in the region but also from private consulting firms who are looking to have samples analyzed locally. Currently, most samples must be shipped to the U.S. or Europe for analysis due to the lack of equipment and training professionals within the region.
Through the CEHP human capacity and resource development and enhancement initiatives, it has not only provided the equipment but also has now helped further develop the pool of available highly qualified personnel that can undertake such analysis within the region. The benefits of having a mobile lab in the Caribbean region are clear, perhaps mounted on ship in the future as per the AML’s work in the Arctic, as such a resource not only helps in the promotion of new science, but it can also be used to assist with post-disaster recovery efforts related to ecological change and human health (e.g. water quality testing, active epidemiological surveillance, etc.). Coming out of the intensive interest shown by the region’s governments and the region’s environmental and public health agencies, there is an active interest in expanding the capabilities of the lab to better support environmental and public health monitoring initiatives in the Caribbean.
One area in which the CEHP program has had notable success is in its efforts to tangibly link ecology with human health issues. A good example of this was our one-week Oceans and Human Health (OHH) course held in Barbados in November, 2010. This interdisciplinary field course was open to both mid-career professionals and graduate students and was oversubscribed. Final chosen participants came from throughout the Caribbean region, including Mexico and the U.S. Virgin Islands. This course clearly demonstrated the need to better link the professionals charged with adapting and mitigating threats to our ecosystems with those focused on protecting our health. Course participants included, for example, fisheries scientists, ecotoxicologists, epidemiologists, microbiologists, engineers, environmental scientists and public health professionals.
The CEHP program has lead to the creation of new opportunities in Caribbean region for graduate students and professionals in that in addition to training and skills development, it has also provided fora where these newly highly qualified personnel can be encouraged and meaningful utilized within the region where they are most needed. Multi-year, large-scale research projects, such as the CEHP program, foster interest, excitement and camaraderie for the next generation of global health researchers in both the North and South. The longer they last, the greater the opportunity to build and foster this critical capacity.