'Like sugar and honey': the embedded ethics of a larval control project in The Gambia.
This paper describes a malaria research project in The Gambia to provoke thinking on the social value of transnational research. The Larval Control Project (LCP) investigated the efficacy of a microbial insecticide to reduce vector density and, ultimately, clinical malaria in Gambian children. The LCP's protocol delineated a clinical surveillance scheme that involved Village Health Workers (VHWs) supported by project nurses. Combining insights from ethnographic fieldwork conducted at the Medical Research Council (MRC) Laboratories in Farafenni from 2005 to 2009, open-ended interviews with project nurses, and eight focus group discussions held with participant mothers in October 2007, we consider the social impact of the LCP's investigative method against the backdrop of several years of research activity. We found that while participants associated the LCP with the clinical care it provided, they also regarded the collaboration between the nurses and VHWs added additional benefits. Organised around the operational functions of the trial, small-scale collaborations provided the platform from which to build local capacity. While ethical guidelines emphasise the considerations that must be added to experimental endeavour in southern countries (e.g. elaborating processes of informed consent, developing strategies of community engagement or providing therapeutic access to participants after the trial concludes), these findings suggest that shifting attention from supplementing ethical protocols to the everyday work of research -embedding ethics through scientific activity - may provide a sounder basis to reinforce the relationship between scientific rigour and social value.
Kelly
Ann H
AH
London School of Hygiene and Tropical Medicine, London, UK. Electronic address: ann.kelly@lshtm.ac.uk.
Ameh
David
D
Medical Research Council Laboratories, Fajara, The Gambia.
Majambere
Silas
S
Ifakara Health Institute, Dar es Salaam, Tanzania; Liverpool School of Tropical Medicine, Liverpool, UK.
Lindsay
Steve
S
London School of Hygiene and Tropical Medicine, London, UK; School of Biological and Biomedical Sciences, Durham University, Durham, UK.
Pinder
Margaret
M
London School of Hygiene and Tropical Medicine, London, UK; Medical Research Council Laboratories, Fajara, The Gambia.
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002648:Child; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers; D003299:Cooperative Behavior; D032984:Ethics, Research; D005260:Female; D017144:Focus Groups; D005714:Gambia; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008288:Malaria / Q000517:prevention & control*; D009035:Mothers / Q000523:psychology; D009726:Nurses / Q000523:psychology; D011369:Professional-Patient Relations; D012962:Sociology, Medical