The papers and presentations from the IFLA Special Interest Group – “Evidence for Global & Disaster Health” – have just gone live.
Evidence for Global and Disaster Health
What does this mean to you?
If you’re reading this, you’re probably some sort of information professional, so the evidence bit is probably pretty straight forward – research literature which tests the effectiveness of interventions, be they diagnostic tests, or treatments, or predictions of prognosis.
The disaster health is probably pretty obvious too, but what about global health.
The Sendai Framework for Disaster Risk Reduction identifies 12 macro level types of threat:
|· Financial shock
· Trade disputes
· Geopolitical conflict
· Political violence
· Natural catastrophe
· Climatic catastrophe
|· Environmental catastrophe
· Technological catastrophe
· Disease outbreak
· Humanitarian crisis
· Other shock
Yes, externality (the impact of a meteor hit, or a sun spot) might seem a little bit Hollywood disaster movie, but did you include the consequences of financial shocks, or trade? Yet the rise of poverty related illness because of austerity in the UK will attest to the relevance of this as a category.
I attended the inaugural meeting of the IFLA special interest group on Global and Disaster Health. It’s the culmination of tireless work by Shane Godbolt, Anne Brice, and many others. That it happened at all is only the start, and yet it’s very much a sign of how much work has gone one, and continues to go on in this area.
Aim of the E4GDH SIG
To explore, map and strengthen the potential for librarians and information specialists, and their services, to play an enhanced, pivotal role in the collation, organisation, assessment and deployment of information concerning global and disaster health including disaster preparedness and risk reduction.
All the slides will be going up on the E4GDH site shortly, but you may also want to have a quick browse through the tweets: #e4gdh
I knew that as information professionals there was the potential in us all to contribute through the voluntary work I do with Evidence Aid (read more about that here), but the variety of opportunities was a surprise as exemplified by Bethany McGowan. She talked about Using GIS Data and Mapping Parties to Expedite Disaster Relief Response to Vulnerable Places: just as you might contribute to Wikipedia to improve the knowledge of a particular topic, you can make maps better and thereby aid relief efforts. Amazing! Read more here and here
“Humanitarian mapping activities combine open data and crowdsourcing to support disaster relief response and humanitarian aid to vulnerable populations.”
Merlita M. Opeña talked about her work: Philippine Research on Disaster Risk Reduction in Health: Mapping a Research Roadmap and Creating a Framework for Information Sharing Nationally and Globally. She’s working to help improve health resiliency – one of the measures of how bad a disaster is, is how long it takes the community to return to “normal”, all the more reason to help them be better prepared to withstand a disaster. But this needs research, and evidence, and this is where Merlita and her colleagues come in.
I discovered that the language of disaster health is still evolving so research about research is vital to better clarify and unify everyone’s understanding: Diana Wong’s work in Disaster Metrics: A Comprehensive Framework for Disaster Evaluation Typologies achieves exactly that. “This is a framework outlining the different types of evaluation types that can be used in the disaster setting. It will help provide consistency and structure in disaster evaluations and improve the science of disaster health.” Read more here.
The role of librarians in the development of policy is crucial in so many ways, but the work of Prof Daisy Selematsela and Blessing Mawire in South African exemplified this: “The transitionary role of Research and University Librarians/Knowledge Specialists in developing countries in facilitating transformation for sustainable development.” Their work is influencing the way in which the South African government is working to achieve UN Sustainable Development Goals, particularly #3 and #4.
When disaster strikes closer to home – as Feili Tu-Keefner experienced with 2 hurricanes ravaging South Carolina in almost as many years – it’s crucial that public librarians understand how best they can support their communities in times of crisis. Feili has investigated “Lessons Learned After a Disaster: Investigations of Public Librarians’ Health Information Services to the Community and Community Members’ Information Needs Following a Catastrophic Flood”.
I learned so much from Caroline de Brun and Blessing Mawire in their practical session raising awareness of sources of high quality information – their padlet of resources will be part of any future teaching and searching I do. Particular favourites were medbox, and 3ie and openwho, but I’ll also be reading more about the PARIHs framework. All details at: www.padlet.com/caroline_debrun/e4gdh
Now I’m starting to believe Prof Virginia Murray, when she called libraries “a secondary emergency service”, and I am proud to have been part of the event, and to be involved in the work.
For the first time in 10 years I attended the Health Libraries Group conference. I contributed to the programme in 3 ways:
- co-presenting with NHS colleagues Helen Else and Deborah Lepley about Can Do Cafes, an initiative we set up with Leanne Kendrick and Laura Wilkes (aspects of which I’ve shared before)
- poster presentation of collaborative work with NHS colleague Mary Smith, and clinicians Richard Williams and Matt Smith, resulting in publication of multiple guidelines on epistaxis
- the honour of delivering the Bishop LeFanu lecture, on the voluntary work I do with Evidence Aid (aspects of which I’ve shared before)
It’s a really important aspect of any conference that it gives an opportunity to meet up with colleagues, and I had the pleasure of chairing 2 sessions too, which is always fun.
There were 2 standout presentations, one of which had been inspired by a presentation at EAHIL 2016, which I was lucky enough to also attend. Alicia F. Gómez-Sánchez, Mar González-Cantalejo, Gaétan Kerdelhué, Pablo Iriarte and Rebeca Isabel-Gómez presented their work assessing the quality of reporting of a certain subset of systematic reviews. It’s great reading, if you like reading about just how badly reported most systematic reviews are.
Jane Falconer referenced this paper when she reported on her own survey of the systematic reviews produced by her own institution, London School of Hygiene and Tropical Medicine.
— Isla Kuhn (@ilk21) June 14, 2018
Key points from her talk
- great respect to LSHTM for being willing to share the fact that Jane found that a large proportion of their publications failed aspects of assessment on the basis of PRESS, PRISMA and AMSTAR criteria.
- the frustration that all the teaching and guidance that Jane had provided over the years still hadn’t resulted in better outcomes in this audit (though of course we don’t know how much more poorly papers would be reported without her influence)
- that by carrying out this audit and presenting the results to the leadership at LSHTM, the profile of the library was raised.
— Isla Kuhn (@ilk21) June 14, 2018
If the statistic that 85% of research is wasted is still true, then the cost of poorly reported SRs must surely contribute massively to this, and peer reviewers must take a portion of the responsibility for this – how do these papers get accepted?
I was already looking forward to hearing Kate Miso‘s paper, but after Jane’s I was really fired up!
Echoing aspects of that blog by Iain Chalmers and Paul Glasziou, Kate quoted Doug Altman:
Again, there was a sorry tale of school-boy errors in the reporting and a catalogue of other increasingly tooth-grinding errors. They culminate in significant errors which would have consequences for the interpretation of the results. Any poor method will bias the results, and any bias unrecognised will result in problems if the results are applied in practice.
One of the take-homes for me, was that if the review doesn’t actually have “systematic review” in the title, then start looking for more flaws.
Kate was kind enough to share her slides with me after the event, but clearly they’re not for me to share here.
As with Jane’s presentation, I have to wonder about doing an audit of local SRs in a bid to check that my own house is in order, and I’m also minded to start a process of local PRESS activity with reviews that my librarian colleagues and I produce to ensure that the strategies we put together in collaboration with researchers are the best they can be. Watch this space for how both these projects progress.
Librarians can make a difference to improve reporting SRs, but perhaps we also need to do some work to give our colleagues a wake-up call that they need some help.
Last week I went to ‘The Art & Science of Clinical Problem-Solving’ by Professor Sanjay Saint. It was a great presentation, interactive and engaging, and despite (as well as?) being pretty much the only non-clinician in the audience I learned a great deal.
While I’m not involved in any clinical decision making, there’ plenty of decision making that goes with my job, and even more that goes with life – and insight into the amount of bias, conscious or not, that comes with each decision, and the process of coming to a decision can be a huge advantage.
Now I wont go into all the possible forms – there’s Wikipedia, postgraduate qualifications and books aplenty on this. The forms that Prof Saint focused on were:
- availability bias
when we just don’t have enough information, yet we might make a decision/come to a conclusion anyway. Sometimes this is because we’re feeling pressure to take action, but it might be because we’ve already decided what we want to do and just want to get on with it, despite subsequent information perhaps warning against it.
- anchoring bias:
that we pay too much attention to one piece of information (likely to be the first piece of information we receive), and then this skews our decision making from here on. (this is Blink by Malcolm Gladwell in a nutshell)
- confirmation bias
when we only look at new pieces of information as evidence to confirm our first conclusion.
- premature closure
that when we come to a conclusion we stop hearing new information, which might otherwise require us to change position, or to at least reconsider our first conclusion.
- framing effect
This is how we come to a conclusion based on how the information is presented, rather than on what the information is.
We can use this to our advantage (particularly when we want someone to do something they might be otherwise reluctant to do), but you have to know what will ring the other persons bell if you want it to work.
I’m afraid to say that I know myself well enough to know that I often fall into the trap of several of these – and that I don’t spot (or ignore) at the time and fail to work harder against my natural tendencies….. but maybe with the next decision I make it will be different, eh?
A tenth anniversary for any organisation is quite a milestone, and not least for UHMLG – University Health and Medical Librarians Group. I’m lucky to have been on the committee for the past year, and thoroughly enjoyed putting together this years programme with my colleagues.
All the slides from the event, and a bit more detail about the even are available on the UHMLG blog, so here’s some of what I considered my highlights/take-homes from the event.
Alison Day spoke about her leadership course. I thought she introduced a tremendous discussion topic, by asking us to have a super-speedy knowledge cafe on “what makes a good follower” – great to have the topic turned on its head, and a useful reminder that a good leader needn’t be in a management position. Nor does being in a management position automatically make you a leader – plenty to think about here.
There were several standout moments for me from Adam Young and Taryn Jackson’s talk about what primary school children are taught. The level of computational thinking that they encourage was fascinating, and perhaps needs to be taught retrospectively to those who’s primary school years are long behind them. Perhaps the whole concept of “process fixing”, or process mapping means at least some of these skills are ingrained already, but I don’t think it would do any harm for me to seek out some further training in this area.
Amy Icke gave me a light-bulb moment when she said that her secondary school students thought that books carried more weight (ahem!) than journal articles: that they didn’t really understand the difference, and considered “magazines” as being of less value. This prompted me to consider the starting point of the dissertation sessions we run for our undergraduate students – who’ve primarily only had book-based reading to do up till that point. We march in, talking about pubmed and searching, and referencing, but should maybe start from the point of “why should you be looking for articles as well as/instead of books?”, “what’s the difference?”, etc.
We also got a great example of how a lecturer has embraced a new way of teaching their students, when Tim Vincent introduced us to the way that one of the lecturer’s has completely transformed the way he delivers his teaching – by using interactive tools, by chunking up the presentations into shorter blocks, and using video. Tim included lots of different tools into his own presentation, and the possibilities are really exciting. I used Padlet recently to get feedback from a lecture hall full of students who were working in small groups, and I think it’s something I’ll be exploring more.
Tim also pointed us to a short video that I think should be compulsory for all presenters – 5 Things Every Presenter Needs To Know About People
Do watch it, it’s a really useful reminder of stuff we know, but sometimes don’t put into practice.
Finally, I was really excited by our first “peer assist” – well at least a version of this knowledge management technique. I asked everyone to bring along a challenge that they were facing (anonymised to protect the innocent), and then shared them out to get the hive mind to suggest solutions. While we’ve not shared this on the UHMLG blog, the collected problems and proposed solutions were shared amongst all attendees, and I found it fascinating as a process. This knowledge management malarky is actually pretty useful!
There was plenty more I could say, but mostly I’d say join us! If you’re a health / medical librarian working in HE in the UK, please join us. We have a spring forum: 23rd March 2018, and a summer residential event, and together with the email discussion list, they’re all great ways of getting together with HE colleagues to discuss common problems and topics that are interesting to us all.
It’s free to join, and I’ve got a lot from all the events I’ve attended, as well as from the (continuing) experience of being on the committee with a great bunch of colleagues. Happy birthday to us!
Hope to see you at the next UHMLG event.
In the past few weeks we’ve been overwhelmed with examples of extraordinary courage from ordinary people. People who have run towards danger, whether it’s been their paid role or not. It’s truly humbling and inspiring. I don’t like to assume that I would be able to act so selflessly (and hope I never have to put it to the test). These sudden flash points sometimes require an instinctive reaction, as well as a planned and rehearsed response.
Natural disasters and epidemics require a slightly different response from those who go to help. Organisations like Medicine sans frontier, Doctors of the World, Red Cross and many more have extraordinary teams who come together in times of crisis. The story of Will Pooley might be familiar to you. I know one doctor, with significant experience in emergency medicine, who has gone to virtually every crisis in the past 25 years – from war-torn Sarajevo, to famine-ravaged Sudan, the earthquakes in Nepal and Haiti, as well as the effort to stem the spread of ebola in Sierra Leone. A highly skilled and highly experienced medic who also sees part of his role to be bearing witness and then advocating for the professionals involved on his return.
But outside the highly dramatic, glamorous? world of emergency relief work, there is a political landscape that can have consequences for peoples’ health. There are also many people who try to help those who reach our shores fleeing political persecution, working for organisations like Freedom from Torture. I know a GP who volunteers by writing medical reports which form part of the appeals procedure when asylum seekers have had their initial applications turned down. The report gives expert opinion on whether the asylum seeker has scarring (physical or mental) consistent with torture. The conversations, between doctor and asylum seeker, usually with the aid of an interpreter, are harrowing for all parties. Interestingly part of the benefit to the asylum seeker, beyond the legal document, is the opportunity to tell their story, to be heard.
I can’t do any of that. I can’t run into a war zone, or the aftermath of an earthquake, date stamp at the ready, and do anything useful. I don’t think I have the emotional resilience, never mind the medical skills to be able to cope with a conversation about the torture that the person in front of me had sustained. And that was starting to make me feel pretty impotent. Even a monetary donation didn’t seem very satisfying, though it was something I could and did do.
My skill set is different, which is why, when I heard about Evidence Aid, I thought – now’s my chance! I came across Evidence Aid rather by chance, because I follow CEBM on Twitter and noticed a tweet about their partnership.
I had a poke around on the Evidence Aid website, and saw lots of words that matched my skill set – systematic reviews, evidence summaries, open access publications. I came the conclusion that this could be my way of doing something practical.
I dropped them a line, had a lovely conversation with Claire Allen, and discovered that librarian volunteers were exactly the sort of people they needed to support their work in summarising and synthesising evidence on various topics – the big one at the time was Zika Virus.
So here I am, 6 months in, and
what does it actually mean to volunteer for Evidence Aid?
I’m just about to submit my 9th summary of a review on Zika & Dengue (I’ve got to know a lot more about Zika than before, but you don’t need to be an expert by any stretch). I get a couple of papers at a time, and have taken roughly 2-3 weeks to summarise them. The workload is very flexible – I just keep in touch, and say in advance if I’m away, or unable to take on more work.
Using a mixture of Slack, Mendeley and Dropbox, I liaise with the project coordinator, Shona, via Slack. She assigns me a paper using a shared group on Mendeley. There is a standard format for presenting the summaries (I draft mine using Google Drive) which I then upload to Dropbox. Shona gives them the once over, gives me any feedback via Slack (this was very helpful in the beginning, and I’m pleased that I seem to be getting the hang of it now!), and then the summaries are loaded onto the Evidence Aid website. Really simple.
Now I have to confess that there are additional benefits to the warm and fuzzy feeling that I’m actually doing something socially useful (yes, I know, simply by being a librarian I’m doing a socially useful, but you know what I mean, I hope).
I get to practice the synthesising and summarising skills which I want to develop for my day job. But that’s ok, isn’t it? Everyone wins.
I would thoroughly volunteering for Evidence Aid, or a similar organisation – it’s only as much of a time commitment as you are able to offer, lets you contribute to a really worthwhile aim, and might let you practice a professional skill that you mightn’t otherwise be able to.
Finally, a date for your diary:
The aim is to provide an international platform (held each year) for actors that contribute to the generation, use or dissemination of evidence in support of humanitarian action, to share and discuss views on the topic, and to promote related activities.
You and your library can be an associate or a supporter – find out more, and please get involved.
#HumanitarianEvidence & #HEW2017
On Thursday at EAHIL there was the launch of a new special interest group – Knowledge management in global & disaster health. For the last 6 months or so I’ve been doing voluntary work for Evidence Aid (more on this in the next post) so I went along.
The session was led by Anne Brice of Public Health England (@annebriceuk) with presentations by Claire Allen of Evidence Aid (@evidenceaid); Neil Pakenham-Walsh of HIFA (@hifa_org), Dr Caroline de Brun of PHE (@debrun), and Prof Maria Musoke giving a perspective from Sub-Saharan Africa & IFLA.
Claire started with an overview of the origins of Evidence Aid. After the Indian Ocean tsunami of 2004 a government funded psychiatrist responded to a Cochrane offer of help. The group was able to provide evidence of the unproven benefits or even potentially harmful effects of brief debriefings for survivors. Feeding this back to the government meant that funds and resources could be deployed elsewhere.
They have continued this work to support better use of resources (both money and manpower), and achieved registered charity status in 2015.
The aim of Evidence Aid is: To create and satisfy an increasing demand for evidence to improve the impact of humanitarian aid by stimulating the use of an evidence-based approach.
The work they do depends heavily on the work of volunteers, with librarians particularly involved in searching for, summarising and synthesising evidence. They also advocate free access to pay per view systematic reviews. If you’re interested in the story of my connection with Evidence Aid, please see below.
Neil then talked about an organisation I’m sorry to say I was unware till now: “Health Information For All”. But even as Neil was speaking, I signed up to HIFA– which will mean that I can take part in conversations with their 16,000 members in 175 countries, across 5 forums.
It’s not just about ensuring that aid workers, and their organisations are working with the best evidence. Everyone deserves to have access to and the skills to appraise (health) information. Without supporting and enabling these 2 things, we deny them a basic human right of informed choice and further burden the healthcare systems by only minimal (or even harmful) self-care being possible. As Neil said “people are dying from lack of knowledge”. And indeed one of the WHO Universal Health Coverage goals specifically mentions information: skills, equipment, INFORMATION, structural support, medicine, incentives, communication
Amongst the wide range of projects in they are working in: with healthcare professionals, with citizens, with healthcare policy makers, around mobile healthcare information, they also have one with library and information services. This last project is around supporting local LKS to support their local healthcare professionals, citizens and policy makers. They also want to explore the role of LKS in global and disaster health.
This last point led to Caroline speaking about the brief review she carried out on the role of librarians in providing support to disaster management teams and the general public during times of crisis. (NB this is not about librarians coping with their own disasters – eg how to cope with a flood and its effects on a collection, or even worse, the circumstances that the Syrian librarians are enduring).
This was about (amongst other things)
- how public libraries in particular can be a community hub during times of crisis, acting as a meeting point, communication channel and even performing such basic functions as being a charging station or internet connection point.
- new roles which being created, such as Global Health Informationist, or Disaster Information Specialist (like we needed more job titles! 🙂 )
- how effective knowledge management can link members of the same organisation who are unknowingly working on the same topic (how many times does that happen?);
- how our existing skills we can support information dissemination using social media; and
- how we are already working to reduce the digital divide which is so glaring at the best of times, and which is only exacerbated in crisis situations.
A clinician in the audience who had worked in disaster zones raised the very specific point that access to evidence was important, but putting it into a local context was critical: it’s all very well know that water can wash a wound as effectively as saline (so cheaper) but if the water supply is contaminated then it’s appropriate to ignore that evidence. Or that the logistics of transport severely restrict access to the saline to begin with. This is also an area that Evidence Aid will be expanding into – getting right information for the specific context and environment that the aid workers are facing on the ground.
Caroline’s full briefing is available and I would recommend it.
Maria then spoke about her personal perspective, as a librarian, indeed as a professor of information science, living and working in Uganda, and from her association with AHILA and IFLA. Maria was one of the founder members of AHILA in Nairobi in 1984.
The challenges facing librarians in sub-Saharan Africa actually resonate very much with me as a European librarian: that the provision of information is increasingly complex, and that there is increasingly disparity between info-rich and info-poor owing to variations in access to the internet. That Maria and her colleagues have a significant and active role to play during epidemics and natural disasters on their doorstep is only where the difference becomes clear owing the lucky distance I enjoy from most of the health disasters that I might be accessing information about. What Maria does is to use “Knowledge to transform the resources we have into things we need”.
She’s got a new book out “Informed and Healthy: Theoretical and Applied Perspectives on the Value of Information to Health Care” (which had a high profile launch), which is already winging it’s way from Amazon.
In terms of next steps, from the SIG’s perspective, its:
- HIFA LIS Project working group meeting is on 27 June at 10am, via Skype
- Thematic discussion on the role of libraries in times of crisis, to take place on the HIFA Forum
- Meeting about setting up an IFLA Special Interest Group on knowledge management in global and disaster health taking place on Monday 21st August in Poland during IFLA.
In the meantime, a date for your diary: November 6-12th: Humanitarian Evidence Week.