by With the sun rays shining through the windows in the DDRN’s office, Richard Sena Otio came to meet with the DDRN staff, at the headquarter in an old part of Copenhagen, Denmark. He was a 25-year-old Ghanaian, who had just finished his master’s degree study in Global Health from University of Copenhagen.
He arrived in Denmark, back in 2017, to begin his Master in the fall after finishing his Bachelor in sociology from the Kwame Nkrumah’ University of Science and Technology in Ghana, in 2016, and after working as a project assistant at the Ghana Refugee Board.
Due to the possibility of country exposure offered by the University of Copenhagen, Sena decided to do his Master here. He was able to go to both Poland and Thailand, where he could observe the differences in health policies. The exposure in Poland was part of the Global Health programme, where Sena studied the Polish health systems. As part of an elective course with the Anthropology Department at the University of Copenhagen, Sena travelled to Thailand during his first year of the two-year Master and studied the health of ethnic minorities. Both country exposures allowed Sena a practical experience from which he could relate the research methods he was taught in the courses.
Sena was awarded an academic merit scholarship by the Danish government, to fulfil his studies at the University of Copenhagen. As the scholarship only covered the full tuition fee, he took various student jobs alongside his studies to make ends meet.
Urbanization’s influence on the Maasais’ health
Sena conducted a cross-sectional study of the Maasai people, where he compared the ones living in the rural and urban areas from his sample, across different indicators, to determine the risk of getting cardio-metabolic diseases, such as heart diseases, and diabetes, among others. He focused on an ethnic minority located in the northern Tanzania: the Maasai. The Maasai community in Kenya and the northern Tanzania, with an origin in a rural setting as herdsmen, has a remarkably different lifestyle from those who migrated to the city.
Why did you choose the Maasai for your study? Was there something particularly interesting or different from this group, compared to other groups who showed tendencies in migrating to the urban areas?
“I choose to study the Maasai mainly because of the unique lifestyle they are traditionally known to live and the fact that they have been able to maintain their traditions tacitly up to this day.” Although Sena had the opportunity to study other distinct ethnic groups with particular lifestyles, an already ongoing study, led by his supervisor (Dirk Lund Christensen, a professor in the Global Health Department at the University of Copenhagen), allowed Sena access to confidential and relevant research data, without the need to gather the empirical data himself. Without the financial resources needed to conduct a thorough study by himself, Sena’s master’s thesis serves as a small part of the larger project by his supervisor.
“So, we found that more people living in the urban areas had a higher risk for certain diseases, like hypertension[1] and diabetes. And then, for women especially, their haemoglobin[2] level was higher when they live in the urban area, but for those in the rural areas, it was significantly low, which was a bit mind-blowing, because traditionally the Maasai have their main stable diets.”
The findings of the study showed that there were noteworthy differences between the rural and urban Maasai people: The urban Maasai were generally more prone to get diabetes, whereas the rural Maasai did not have the same vulnerabilities; the urban Maasais were more vulnerable to become overweight, where the rural Maasais were more vulnerable to become underweight; both groups had risks of getting high blood pressure; and the urban Maasai women had a higher percentage of body fat, compared to the rural women (read more details about Sena’s thesis and his findings, in his summary).
“The results of the findings is that – as we may expect – urbanization played a very big role in the disease risk, because the people change their diets, and they do not live as physically active as they used to do in the traditional settings as herdsmen.”
Sena is not the first researcher who showed an interest in the field of how the Maasais segregate from others, due to their distinct lifestyle. The researchers Bruce Taylor, and Kang-Jey Ho, have recounted how the Ministry of Health in Kenya, in 1965, already then were aware of the difference in health, from the rest of the society, and their multidisciplinary study of the Maasais health in 1971. Previously, the Maasais showed low cholesterol levels and very low risks of heart diseases, supporting the results from Sena’s thesis on the health of the rural Tanzanian population of Maasais. The two authors stimulated an interest in expanding the studies of the Maasais’ health, and any Western influence – an interest Sena shared.
Capacity to re-absorb knowledge
When enquired about his future, Sena stated that he did not believe that he would be able to work in his research field, in global health, back in Ghana. The possibilities for him, as a young researcher still relatively unknown among researchers in his field. He will not be able to have the same opportunities in Ghana, as he will in the global North, and especially, if he continues working and collaborating with the University of Copenhagen.
“Mostly, it has to do with the resources. The situation with my supervisor, for instance, he is someone who is well-known in the field of ethnic minority research, so it is very easy for funding authorities to approve of his projects, and when that is done, he will rely on the help of people like us – Master students, or PhD students – to do the projects, and to help him conduct the projects.”
Once Sena has been rewarded for his projects, or projects he has participated in, he will have more opportunities to gather funding for his own projects.
One of the reasons why Sena believes that his opportunities are limited in Ghana, is due to the current knowledge gap between the global North and the global South: “Research has to have happened [before it is possible to base politics and decision-making on the findings], but in low-income countries, there is a bigger gap, and we have to close that gap before we can use the research, because in strict sense, you cannot import research conducted among Danes to Ghana. It is not ethically right. You can only replicate the research in Ghana, using Ghanaians as study samples to see if the results are the same.”
In continuation of Sena’s own field of global health, without applicable research to the individual nations, narrowing a knowledge gap between the global North and South, as well as sustaining health and developing in the global South, can prove particularly difficult. The knowledge derived from research is utilized in decision-making on policies, but without such applicable knowledge, the Global South have been forced to take research applicable to the North, which in certain instances is like applying research about apples to oranges. The World Health Organization (WHO) has been active in bridging this health knowledge gap between North and South, through the Algiers Declaration on Research for Health in the African Region (2008). This declaration prioritizes to address the knowledge gap through improving the national health research systems in the global South countries. In the Algiers Declaration, the global South nations are urged to increase their investments in research, in South-South research transfer and to implement relevant research in national policymaking.
Sena, as a Ghanaian academician, wishes to give back his acquired knowledge and help the societies in Ghana, but the capacities to utilize his and other academicians’ knowledge do not exist. Therefore, he argued that the academicians, who return to Ghana, were met with a glass ceiling: “There is a glass ceiling – with no opening for them to further explore the knowledge they have gained. They will always want to go where there is an opportunity for them to serve better and gain more experience.” The glass ceiling implies, in this case, that the higher education a person has, the stronger disadvantages the person will experience[3].
Sena gave his own personal advice about how to limit the challenges with local capacities in the global North and global South collaboration: “if there is a collaboration to expand local capacity, the collaboration should not only be about building knowledge, but be about expanding capacity to re-absorb the knowledge that has been built”.
As a newly graduated academician with a master’s degree, he said that his opportunities were limited, simply because there were no resources to accommodate his newly acquired knowledge; it could not be re-absorbed into the Ghanaian society. Due to the limited resource to re-absorb the knowledge, the academicians from the global South are forced to look towards the global North for opportunities.
With Sena’s notion on capacity to re-absorb knowledge lies one of the most challenging issues in the Global South and North collaboration: The newly returned academicians have gathered extensive knowledge from the North and are ready to apply the knowledge in their home countries. However, the capacity is not there.
In one of DDRN’s previous articles, Verah Okeyo confronts the challenges PhD graduates, who have researched in developed countries’ universities, experience once they have returned to their home countries in Africa. Verah, through various interviews with former PhD students in Kenya, agrees with Sena, and recounts the inadequate facilities and capacities for the returnees to continue their research or even work in their home countries.
Sena stated, “It has to do more with the recipient countries to expand their capacities, and not only build capacity.” Lack of coordination among the donor countries, likewise, strengthens the glass ceiling – there are no coordinated efforts. However, Sena emphasised that the responsibility to absorb the knowledge should lie with the recipient country, rather than the donor countries. Regulations, from the donor countries’ side, would be difficult to enforce.
Sena, further, believed that everything was connected, and if a nation had a population that was educated, the general health would similarly improve. “The higher people are educated, the more research is being conducted, the better society would go, because institutions are bound to use the findings of research […] The better people are educated, the healthier their lifestyles are, and [they have] better choices of diet. The quality of their lifestyles [is] better, compared to people who have lower levels of education.” If the political strategies, policies and public decision-making in Ghana would be based on research findings, Sena argued that the country’s problems would, to a large extent, be solved. However, he stated that there was not really a political will to prioritize education in Ghana. The United Nations Educational, Scientific and Cultural Organization’s (UNESCO) Institute for Statistics (UIS)[4] found that Ghana only spends 0.4 per cent of their GDP on research and development, where US$ 10,5 mill. are spend on the universities, and US$ 265,7 mill. are spend on the government. Likewise, Ghana solely has 38 researchers per million inhabitants. In comparison with countries like Denmark who uses 2.9 per cent of the GDP on research and development, and US$ 2,6 bill. are spent on universities and 7,311 researchers per million inhabitants, or France who uses 2.3 per cent of the GDP on research and development, and US$ 13,4 bill. are spend on universities and 4,233 researchers per million inhabitants. Sena argued that the low investment in education, in Ghana, was because of the low political will in making unpopular decisions: “At this stage of our development, they (the politicians) have to take various trick decisions, that may not lie well with neither of us, but that is needed for our country.”
Academic differences between Denmark and Ghana
When I asked Sena what he would identify as the biggest differences in the academic culture between universities in Ghana and in Denmark, he answered: “Aside [from] the hierarchy, one thing I could probably say is that […] education in Ghana tends to be more academic focused, compared to experience. We focus on that academic prioritisation towards education, where you have to study the syllabus, you have to study book a, b, c, [and] d, to get knowledge […] we are not trained to be useful for [the] industry, but I think the Danish system allows students to do internships while they study to combine an academic curriculum with the job industry expertise, so that when you are directly out of school you fit into the industry.”
Sena believed that Ghana has tried to adopt the education strategy used in the UK, but without succeeding. The master’s degrees in the UK only have a one-year duration, where there is no possibility to do an internship during one’s study – in Denmark a master’s degree has a two-year duration. Sena, himself, wished to follow-up on his research on the Maasais with a qualitative study to support his quantitative Master thesis. For the future, he saw himself working closely with the University of Copenhagen: “My life has almost become pinned to the University of Copenhagen, so even if I don’t continue from here, I would have to collaborate with them. Because of their advanced expertise. Especially the Global Health [department] has a lot of expertise.”
[1] Hypertension is commonly referred to as high blood pressure, which may cause severe health complications, as well as increase the risk of heart diseases, strokes, and in worst-case, death.
[2] The haemoglobin level is a protein rich on iron, within the red blood cells. If the level of haemoglobin is too low, it will result in too little oxygen being carried through the body, and the function of the body will in the end not be able to function probably. This condition is also named anemia.
[3] Read more about the glass ceiling concept: Cotter, David A., et. al. (2001) ”The Glass Ceiling Effect” Social Forces, Vol. 80, Issue 2, pp. 655-681. Accessible on: https://academic.oup.com/sf/article-abstract/80/2/655/2234418
[4] http://uis.unesco.org/apps/visualisations/research-and-development-spending/
The Maasai people, traditionally, populate the northern Tanzania and Kenya. They are typically characterized as pastoralists, which means they almost exclusively have all of their income from herding livestock[1]. The Maasai people, due to their traditional profession as herdsmen, are considered nomads, with a distinct language from the official Tanzania language, as well as distinctive customs and dresses, which have made them increasingly recognisable as an ethnic group in the sub-Saharan Region, world-wide[2].
The area of the Maasai crosses the Kenya-Tanzania border, and encompasses no less than fourteen world-renowned national parks. The area is visited by tourists from around the world, which generate more than 1 billion US$ in revenues. Despite the economic prosperity, the Maasais have not benefited, and continue to live as herdsmen, a profession now threatened by various environmental regulations to protect the national parks[3].
The migration of the Maasais from their traditional rural setting to urban began in the mid-1990s, where the Maasais were compelled to move due to livestock diseases killing off their main source of income, drought and land alienation. After migrating to the urban cities, the Maasais, generally, were easily hired as night watchmen and security guards. However, the migrating Maasais are, and have been since the move, been considered to be part of the urban poor[4].
[1] Source: Lawson, David. W, et. al. “Ethnicity and Child Health in Northern Tanzania: Maasai Pastoralists Are Disadvantaged Compared to Neighboring Ethnic Groups”. Accessible on: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0110447#pone.0110447-Spear1
[2] Spear T, Waller R (1994) “Being Maasai: ethnicity and identity in East Africa” Boston University African Studies Center. Vol. 27, No. 2, pp. 380-383. Accessible on: https://www.jstor.org/stable/221034?seq=1#page_scan_tab_contents
[3] Homewood, K., Kristjanson, P. & Trench, P. (2009) “Staying Maasai: Livelihood, conservation and development in East African Rangelands.” Springer Science and Media Business.
Accessible on: https://link.springer.com/content/pdf/bfm%3A978-0-387-87492-0%2F1.pdf
[4] May, A. & Ikayo, F. (2007) “Wearing Illkarash: Narratives of images, identity, and change among Maasai labour migrants in Tanzania” Development and Change. Vol. 39, Issue 2, p. 275-298
Accessible on: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-7660.2007.00412.x
Cardio metabolic diseases (CMDs)
Currently, the number one cause of death in the world is caused by unhealthy lifestyles, physical inactivity, smoking and unhealthy diets[1] – also referred to as cardio metabolic diseases (CMDs). Through a selective prevention of the CDMs it would be possible that the burden on the general population, could be reduced. One of the steps towards a selective prevention would be, as Sena conducted his master’s thesis, through identifying the individuals within the population who are at the highest risk of the CMDs, and intervening to reduce said group’s level of risk.
[1] Waard et al (2019) “Selective prevention of cardiometabolic diseases: Activities and attitudes of general practitioners across Europe” European Journal of Public Health, Vol. 29, Issue 1, pp. 88-93 Accessible on: https://academic.oup.com/eurpub/article/29/1/88/5054640
The Algiers Declaration
was adopted in 2008, on the 23 to the 26 of June at a Ministerial Conference in Algiers. This Ministerial Conference embraced actors from various disciplines; researchers, non-governmental organisations, donors as well as the private sector. Subsequent, when the framework had been drafted by the actors, a Regional Committee for Africa, where all the ministries of health were gathered from the 46 different nations in Africa, the framework was approved by the countries.
