Where are you based, and what is your role within the Nuffield Department of Medicine?
I am a social scientist with a human geography background. I am based in Oxford, with strong ongoing links to the KEMRI-Wellcome Trust Research Programme in Kenya, where I lived for 26 years. In Oxford I co-lead the Health Systems Collaborative (HSC) with Professor Mike English. HSC is an interdisciplinary research group working with colleagues and collaborators globally to improve health systems, health care delivery and patient outcomes. My roles include grant writing, leadership of research projects, mentoring colleagues at earlier stages in research careers and teaching at PhD and masters levels. I admit that I never imagined myself being an Oxford Professor, and often still pinch myself today.
Tell us about your research or area of work.
Most of my work focuses on how health systems in resource constrained contexts can better respond to community priorities and needs, and on how to conduct health research ethically in these settings. I usually use an equity and applied lens, with common themes being vulnerability, agency, patient and staff experience, accountability and organisational resilience. My expertise is primarily in qualitative and participatory methods, and embedded implementation research. Collaborating with others is crucial to all of my work.
A current example of how my interests and experiences are brought together is a large study on moral distress among frontline staff. Moral distress arises where there are uncertainties, tensions or dilemmas about the right thing to do, or where institutional constraints make the right action difficult. Together with amazing colleagues in UK, Kenya, Zimbabwe, India, Bangladesh, Thailand, Vietnam, Malawi, Nepal and South Africa, we are seeking to better understand moral distress, and to develop evidence-based guidance targeting different actors (funders and policy makers, institutional leads and managers, study PIs). Our ultimate goal is to contribute to more equitable and resilient health and research systems.
How did you come to become a Professor at Oxford?
If you had told me in my 20s or 30s that I would be an Oxford Professor in my 50s, I would have laughed. My ‘career journey’ was messy and unplanned, with some attempts at rebellion. I was brought up in Malawi, where I lost an argument with my parents to replace my British passport with a Malawian one. At 13, our family moved to Liverpool: I loved Liverpool, but kicked against my private school background. This may have contributed to me dropping out of my Geography degree in Durham (after just 8 weeks!), working in a Mozambican refugee camp in Malawi for 8 months, and then taking up a one-year full time Art Foundation course in Bootle, Liverpool. The art course and my fellow students were brilliant, but I decided against my fine art place in Birmingham, opting instead for Geography again, this time in Newcastle. I was inspired by the course this time, which included African politics, race and racism, local cultures/global processes, feminism and medical anthropology. When I finished, I was given an opportunity to volunteer in KEMRI-Wellcome in Kenya for a few months, where there were 15 staff. I ended up staying until 2020, by which time there were over 800 staff.
Over 26 years of living and working in Kenya I learned from all kinds of interactions with an incredible range of inspiring people inside and outside of work. At work, I slowly climbed the ladder from field worker, to research assistant, researcher, senior researcher, group head and ultimately Professor. Although I was employed by Oxford for all of that time, I was largely ‘soft funded’ (ie I had to find my salary to keep the job). Key grants over that period were a Wellcome Trust Early Career Fellowship, a Career Development Fellowship, and being co-applicant on several major international collaborative grants. All of these grants expanded my local and international networks. After nearly 20 years of working in Kenya, I was encouraged by lifelong mentors (Mike Parker, Kevin Marsh, Lucy Gilson and Mike English) to apply first for Associate Professor and then full Professor. My first attempt at full Professor was rejected. I felt like giving up, worrying that I had applied too early, or should never have applied at all. But my mentors encouraged me to go back in again, and two years later, it was a yes.
What does your day-to-day work look like now?
Being awarded the Professor title had virtually no influence on my day-to-day activities. I continued to juggle my grant writing, project leadership and teaching roles. The biggest change was with my move back to UK in 2020, with a culture shock of kinds (Oxford is so different from Malawi, Liverpool, Newcastle and Kenya) and much more of my work becoming online. But online work is common globally now, as working norms changed with the Covid-19 pandemic. I still travel quite a bit to meet with wonderful colleagues and collaborators all over the world, and they also come to Oxford. But I try to balance travel with environmental considerations and being home for teenagers doing important exams.
How have you managed work alongside other responsibilities or interests over the course of your career?
I feel privileged with my upbringing, and to have had incredible colleagues and collaborators at all levels throughout my research career. Nothing would have been possible without their insights and generosity, and often their reassurance. I have also been lucky that my husband was willing for his own career as a teacher, manager and researcher to be flexed around mine, and that he happily took on a central role with our three children. And we cannot deny that having home help during the day, the norm in Kenya, allowed us both to continue with full time work after my maternity leaves. This would have looked very different in the UK.
What challenges or setbacks have you encountered along the way and what’s kept you going?
The biggest challenge has been the uncertainty, and the rising pressure with each big research application. My job has rarely been secure for more than several years, and with each application came greater jeopardy for my family (losing our main income, having to move continents), and for research teams (big grants include team member salaries too). Three major grants - each related to each other - were rejected by funders in relatively quick succession. Those were the toughest times and I STILL believe they were great applications! But collaborative awards, colleagues, friends and my husband’s growing career kept us afloat and helped me take forward the ideas.
Looking back, what advice would you have given your younger self?
Academic careers are a combination of hard work and luck. Don’t judge yourself too harshly, recognise your privilege, never take your colleagues for granted, celebrate your wins together and have a Plan B in case things go wrong. Remember that very few people you look up to and admire expected they would be where they are now. Everybody has their own journey - make the most of each opportunity and enjoy.