So it’s one month on and sadly/happily this student has now left South Sudan, after two and a half years living there. It was a pretty hectic last month, trying to get everything finished before I left, and of course full of a lot of emotions, and goodbye parties. In amongst all that I must admit there was not a lot of time for studying, although now I am safely arrived in Cairo and have my own room to study in, this trend is changing. I had a lot of fun being massively culture-shocked going into a supermarket to buy stationery for studying :). I am trying to be philosophical about the small amount of studying I’ve done recently and hopeful that I can catch up.
One thing I did read over the past month, however, on a day when the internet wouldn’t allow me access to my textbooks, was the excellent article by Sir Richard Doll which outlines the causal link between smoking and lung cancer.
I found this pretty amazing because, of course, it’s a knowledge I’ve always had, for as long as I can remember. Yet this article really does clearly start from a position of merely having a hypothesis that is then stringently tested, nothing is assumed. As could only be necessary in a former era when this was not necessarily something that all people knew or believed, and a desire to show facts in a purely scientific matter was also paramount. I thought he did so in not only a convincing but also an elegant way, addressing every possible riposte to his conclusions.
I found this quite beautiful to think about and relate to the study of epidemiology that I am just embarking upon, to realize that at one point none of these things we take as common knowledge now were even suggestions, let alone taken as fact. The years of discovery that have gone into finding the facts and then further years in disseminating this knowledge. Recently, in Ajuong Thok refugee camp, I had to hire some workers, for a job that was pretty hard work, out in the sun on your feet all day. They were attempting to persuade me to pay them a full day’s wages but reduce their hours, because, as they insisted “we will get malaria if we stay out in the sun for so long”.
Unfortunately for them this was not sufficiently persuasive for me to reduce their working hours, however it was interesting, as these were relatively educated people (by which I mean all had started or completed secondary education). They had undoubtedly been exposed to the knowledge that mosquitoes caused malaria, from which it follows on that exposure to the sun does not. However, they still had this belief, one which I’ve heard numerous other people express. My attempt to explain that the sun had no relation to malaria was met with rather stony faces! Similarly, my Facebook feed is regularly clogged up with claims that ‘drinking cold water causes colon cancer’ or ‘the HPV vaccine doesn’t protect against cervical cancer and kills girls’.
And so I guess, in conclusion, that the Richard Doll article cemented the knowledge I’d already had – that one needs an objective way to assess the evidence. I wasn’t really expecting reading such a good example of this to feel both exciting, even in retrospect, and also strangely beautiful, but it did. I feel happy to continue studying and even as I’m struggling to revise and calculate the incidence rate ratio as opposed to the odds ratio of developing a certain disease in a hypothetical population, at least I’m not finding it a purely abstract endeavor. I can see the purpose and the practical application of this knowledge, and that is what makes studying interesting and not a chore.
Nadia is studying the Postgraduate Certificate in Public Health by distance learning. She is originally from the UK but currently living in Cairo.