Written by Dr. Peter Fischer, professor of medicine in the Division of Infectious Diseases at the School of Medicine
Indonesia is the world’s 4th populous country with 13,000 islands and poor access to physicians is common. Many health research projects in Indonesia are not located in hospitals or clinics of big cities, but instead are in remote settings in the field.
In these settings, local puskesmas (health centers) are often run by one nurse or midwife who is responsible for a population of several thousand residents. This situation bears special challenges to successfully perform clinical and epidemiological research projects in general and in our case, research on human worm parasite infections in particular.
Finding the perfect collaborator in Indonesia is the first challenge. While scientific excellence may be the most important criterion for most academic research collaborators, other criteria are just as essential for successful field research in Indonesia such as reliability, trust, ability to provide a safe work environment in the field, good relationships with local health personnel and sensitivity to local cultures. The DOLF Project found such a valuable collaborator in Taniawati Supali at the University of Indonesia in Jakarta. She is able to coordinate projects not only with the Ministry of Health in Jakarta, but also with locally elected officials like the district Bupatis, local health authorities, and village leaders.
Conducting research in remote areas means scientists must also become logistics experts. With so many islands, transport budgets in Indonesia are high. It is often difficult to find safe airlines that land on small airports or air strips and car rental from private persons in areas with no commercial car rental business can be problematic. Finding accommodation and organizing food supply for a survey team of 10-15 people for a period of 3-4 weeks is another big challenge. Furthermore, it is not pleasant for the research team to work with limited access to running water and electricity, especially in hot and humid conditions. Therefore, the work week often has seven working days, because everybody wants to finish the field work on the scenic islands as soon as possible.
Another challenge in Indonesia is the language barrier. Bahasa Indonesia is the official language but remote islands often have many different local languages and few people in a village will likely speak Bahasa. Therefore, it is crucial to work together with local translators who know the communities. These can become the most valuable team members as they are crucial to gain trust of the village population and will know where to find specific houses or to identify potential study participants.
While field research projects are often focused on a single disease or a group of diseases, in areas with poor access to medicine, survey physicians often have to provide courtesy treatment for many other conditions. Survey teams are frequently approached by villagers for help to treat a disease or to transport a patient to a nearby hospital, which in many cases can be hours away by car. While this is an opportunity to give back to the community which participated in the research, it is sometimes a difficult decision for the head of the survey team to decide whether the research team has the resources to provide treatment and whether one of the few cars can be spared.
After finishing a field survey, the collected samples are often analyzed at central labs in Jakarta or even at Washington University. Like many other countries, Indonesia generally does not allow the export of medical specimens. However, Indonesian scientists are allowed to analyze their samples in laboratories abroad. Therefore, when planning a research project it is crucial to include a travel budget for Indonesian scientists if they need to complete their work outside of Indonesia. Then comes the all-important work of publishing the research. Coordination between coauthors in different countries is not always easy, but it is even more difficult if your coauthors are performing fieldwork and have no internet access.
Field research in remote settings clearly has its challenges, but it may offer unique scientific and personal experiences. While it is important to have a good team for laboratory work, it is even more important to have a strong team of field researchers. This team not only works together, but also lives together for extended periods of time under challenging conditions. The quality of the overall research hinges on the success or failure of the research team working together to overcome the myriad of challenges associated with field research.