MAMOTHENA CAROL MOTHUPI

Pick a topic you are interested in, and follow it into the interesting directions it takes you. Where that curiosity lies is often where the gap is.

Tell us about the background of your research.

My research focuses on determinants of maternal health outcomes. I specifically wanted to measure health systems performance and its relationship with outcomes such as maternal mortality while taking into consideration the social determinants of health.

Despite investments, quality improvement programs and the continued commitment, maternal mortality rates in South Africa are still high when compared to similar countries. The reasons for high mortality rates are varied, and exist at the individual, community and health facility level. They include high infection rates for HIV, hypertension, and obstetric haemorrhage. These outcomes, on the other hand, can be related to the social determinants like drivers of HIV infection in South Africa, the rise of obesity and NCDs, poor quality of antenatal care, the efficiency and effectiveness of referrals and emergency obstetric services, and poor access to care due to constraints such as costs and transport, education/care-seeking etc. So, one can look at the clinical causes of death and/ or underlying systemic factors that make those risk factors and outcomes more likely. I used a framework called the continuum of care to help me focus on this broad public health perspective. That framework considers interventions at different stages of the pregnancy journey and even before conception, and captures the environments people live in (through water, sanitation, housing for instance) and even nutrition factors. My challenge was to develop a way to analyse these multiple factors together in a new measure of health system performance as related to maternal health. The conception of health system in this instance is of course broad, as it includes the performance of other sectors related to health, which the health system has a mandate to collaborate with through multisectoral decision making platforms.

What were the motivations for carrying out this research?

I wanted to engage with a comprehensive way of understanding public health problems, and devise new ways to measure performance that enhance the co-accountability of multiple sectors for health outcomes.

I have always been interested in women’s health and maternal health, and due to some of my background studying epidemiology I also gravitated towards measurement related research problems.

Through this research I also got to engage more with qualitative research by interviewing experts and decision makers in maternal health and related areas in South Africa and LMICs in general. So, I was privileged to be able to integrate their voices into my own approach because I believe in creating solutions that are likely to resonate with stakeholders making the policies and plans in maternal health and public health.

Research can be a long and tough journey, what kept you going during this process?

Different things at different times. Mainly it was my interest in my research topic, the more it evolved the more intricate it became. It was a steep learning curve for me because I was learning a lot of new theories and methodology in order to build my own approach. It felt like endless learning and discovery but whenever it translated into tangible progress in my research it gave me a real shot of extra motivation to keep going. So, the interest in my topic kept me learning, the learning enabled progress, and the progress or little milestones along the way convince you that you are that much closer to the finish line. Whenever I felt stuck, I would step away from the research and do some broad general reading of things that interest me in maternal health and public health in general. somehow reminds you that research can be exciting and that your work is meaningful in the grand scheme of things.

Who is your biggest inspiration/What inspires you?

The desire to know. That’s the more internal reason for being in and doing research. I am a bookworm and I am inspired by knowledge, learning new things that I feel can be transformative and make our experiences or way of doing things better in some ways. Sometimes solving system wide problems necessitates paradigm shifts in our minds that enable us to look at problems a different way and devise the solutions differently. But I am also inspired by being an inspiration to my family and loved ones, those I grew up with, my friends and so on. The people that are my biggest inspiration are the ones that opened doors for me in different stages of my life. It means they see something in you that you don’t yet recognise in yourself. May I be that way for someone else. They are a combination of people who spoke positively over my life, encouraged me to take up an opportunity, offered friendship and support, and other ‘little’ things. The little things can really make all the difference in the world.

What is the funniest/scariest/most embarrassing or best thing that has happened to you as a researcher?

The scariest thing was having one of my articles rejected by a journal. I thought I would never graduate! But when I look at the reasons it was mainly a poor fit with the journal and the fact that I could have included more data and framed the whole paper slightly differently. None of these were indictments on my ability as a researcher (hello imposter syndrome) – one can always collect more data and do more analysis (which I was already doing) and sometimes taking a step back and reframing helps YOU communicate your own research better. You learn something about the audience on the receiving end of your research, and the nuances of article vs thesis writing. In the end it was one of the best things to have happened in my PhD research journey. It made me detach myself from outcomes because they are never guaranteed, and focus more on my efforts and to be clear about my purpose. I published four papers from my PhD.

There are certainly lots of lesson you took from your journey, what can you share with an aspiring researcher/post grad student?

Pick a topic you are interested in, and follow it into the interesting directions it takes you. Where that curiosity lies is often where the gap is. And that may be the only thing to keep you going when the realities of day to day research and life hit, and threaten to distract you from the project. But discipline is equally important. Sometimes the only joy/pride I could derive was that each day I actually put in an x amount of hours into my work, regardless of how I felt about it at that time. When you take pleasure in the discipline itself, one day you wake up and you have made progress through a very difficult process and you start to believe that you can actually do this. My setup and challenges were different from my colleagues and you play the cards you are dealt the best way you can. So, needless to say, do not compare yourself with someone else in your program because you are dealing with a different starting point, topic, set of tools and resources, support systems, and coping mechanisms as individuals. Just make yourself proud in how much you try, given your own unique circumstances.

I gained a lot of support from being in touch with my fellow PhD students and the faculty members, trying as much as I can to be a part of the community by attending the meetings, retreats and being involved in various initiatives. Sometimes it can feel routine but really that is where a sense of belonging comes from, collaborations are made, your future opportunities, and possibly lifelong professional networks can come from. So as much as you can, even if you are studying remotely, make yourself available for others, check on them, allow them to check on you.

COVID-19 has been a huge challenge in the society at large, how did you cope with this challenge?

I was quite negatively impacted by covid. It hit just as I was writing my thesis and completing one of my publications. So in what needed to be my last year of the PhD. I was isolated from my husband and young children for a few months due to lockdown and suffered quite a bit mentally and physically. It felt like a real sink or swim moment. So I realized that I needed to swim. And friends and family and colleagues who would call, give encouragement, send a pizza, or flowers, really helped me stay afloat. Life in that scenario really becomes about the little things –a walk, a healthy meal, a nap, a video call. Those little things keep you positive that things can get better, and with that little bit of faith you do what you need to do – like write your thesis.

How was your your supervision experience inone word?

Empowering

What are you currently doing (work/academics)?

I am a postdoctoral research fellow studying gender and health issues in the SoPH at UWC.

What does the future hold for Mamothena Carol Mothupi?

More research-oriented work, I try not to overthink it. I slowed down a bit on my volunteering and community projects in the last couple of years of my PhD and I would like to build those connections where I live now. For the long term, alongside being a researcher, I think quite a bit about social entrepreneurship as a way to more tangibly plant my skills in the community where I grew up ( and others like it )and grow with my people that way.