Kusumsheela Bhatta, MPH

Significance of Qualitative Research in Public Health:

As I was pursuing my Masters of Public Health at Patan Academy of Health Sciences, I was sure of one thing. That is, I wanted to pursue my thesis in an underprivileged and marginalized community, and with this in mind, I decided to conduct my research among the Chepang community of Raksirang Rural Municipality in Makwanpur District. But little did I know that this decision would take me on a transformative journey filled with challenges, learning, and heartfelt connections.

In the field of public health, qualitative research plays a vital role in understanding the lived experiences, perspectives, and health needs of communities. It provides valuable insights that quantitative data alone cannot capture. Recognizing the significance of qualitative research, I embarked on my journey to delve deep into the world of the Chepang community and shed light on their unique health challenges. My research was particularly focused on assessing the prevalence and factors associated with adolescent pregnancy among Chepang women.

Stepping into the Unknown:

Before I began, I had limited knowledge about the Chepang community—where they were located, how they lived, and what obstacles they faced. Armed with determination, I stepped into the unknown, fully embracing the subjectivity of qualitative research and preparing to reflect upon my experiences. This article serves not only as a personal account but also as a guiding light and a wellspring of inspiration for other early career qualitative researchers who will embark on their own research journey in unfamiliar settings.

Building Relationships and Trust:

As I set foot in the Chepang community, I realized that the path ahead was uncertain. Nevertheless, with the support of local NGOs that had been working in the area, I established early relationships and constructed a sampling frame. Their guidance proved invaluable in navigating the unfamiliar terrain and connecting with the locals.

Recognizing the importance of building trust and acceptance within the local community, I sought the assistance of individuals who were familiar with the customs and traditions of the Chepang community. Two kind-hearted Chepang sisters became my companions throughout the data collection process. Their guidance proved invaluable in establishing a strong rapport with the community members and overcoming language barriers. I learned the customary greeting, “Jay Masi,” which helped me assimilate better into their culture.

The Power of Relatability:

During my time in the field, I quickly realized that my youthful appearance worked in my favor. As my respondents were between 10 to 25 years old, my relatable age allowed them to feel comfortable sharing their personal information, including their reproductive health experiences. This resulted in a deeper level of trust, and I felt more like a friend or big sister who was there to listen and support them in their struggles and joys. Being an outsider in the community was actually beneficial for me during the data collection process. Since I had no previous connection or history with the locals, they felt more at ease sharing information with me, knowing that their confidentiality was assured.

Challenging beliefs and assumptions:

As a public health student, I was initially driven by the notion that adolescent pregnancy had negative health consequences. However, when I entered the field, I realized that this community’s experiences were far from what I had imagined. I challenged my beliefs and tried to understand their perspectives and worldview, asking questions with a neutral mindset. As a result, I became more enthusiastic and eager to learn about their ways of life, thinking, and attitudes toward health. During the interviews, my focus was to listen to their values, without imposing my own. I cherished the moments of living life as they did – enjoying their food, celebrating their festivals (chewar), dancing with them, and attending church on Saturdays. These experiences allowed me to gain a deeper understanding of them than the 20-45 minute interviews could provide, and I found the beauty of being a part of qualitative research.

Ethical considerations and power dynamics:

During my time in the field, I was initially worried that participants might feel pressured to tell me what I wanted to hear or modify their responses based on my education and social standing. However, to my delight, I found that the participants were steadfast in their beliefs and values. Their responses were honest and genuine, and they didn’t seem to be swayed by my background or credentials. I greatly appreciated their sincerity and was impressed by their unwavering commitment to their own belief system.

While conducting qualitative interviews, I always kept in mind the ethical considerations and potential power dynamics involved. I made a conscious effort to build trust and rapport with my participants and create a comfortable environment for them to share their experiences. Sometimes, I even forgot that I was there as a researcher and found myself engaging in heartfelt conversations with them. To ensure their comfort, I refrained from recording these conversations and instead focused on actively listening and being empathetic. It was important to me that they felt heard and understood, and I was grateful for the opportunity to connect with them on a personal level.

Beyond Data Collection:

Some of their life stories would even tear me down emotionally. I would feel really low and just start looking for ways to support them in any way I could. One of the respondents asked me for an abortion pill as she had just given birth and didn’t want another child at the age of 16. I suggested to her where she could get one and also taught her about family planning methods after the data collection. Some of the respondents were as young as 15 and planning for home delivery while some of them had no clue about family planning and ANC service. As a part of my ethical duty, I gave them all the information after the data collection was done.

Overcoming Geographical Hurdles:

Gathering data from the community was a challenging but fulfilling experience, given the geographical hurdles that had to be overcome. The entire ward was susceptible to landslides, which added to the complexity of the task. Many of the participants were occupied with farming activities, which meant that I had to go looking for them in the fields, sometimes requiring me to climb steep hills and cross rivers multiple times. While it was tiring, my experience with hiking and trekking came in handy, and the stunning views from the top of the hills made it all worthwhile. I developed a deep fondness for the place and the people. Luckily, the favorable weather conditions made traveling and walking more feasible.

It was a strategic decision to start data collection in Ward 5, where access and transport were relatively easier, before moving on to the more challenging terrain of Ward 8. In retrospect, it proved to be a wise decision as it allowed for a smoother transition and adaptation to the new environment.

Navigating Cultural Differences:

It was interesting to observe that many members of the Chepang community had converted from Hinduism to Christianity, and as a result, had given up alcohol. However, given the physical demands of working in the fields, a few individuals still drank alcohol. During data collection, some respondents were under the influence of alcohol, which required me to ask questions more than once to ensure they fully understood. Despite this challenge, I remained respectful and patient throughout the interviews.

As a Hindu researcher working in a community that has been predominantly converted to Christianity, I found myself in a new and unique experience. The pastors in the community often shared their perspectives on Christianity, Jesus, and the benefits of following their religion. While I deeply respected their values and beliefs, I also had to be mindful of any potential influence or manipulation. It was an opportunity for me to broaden my understanding of different religions and cultures and to maintain a neutral perspective during the data collection process.

Communicating Research Benefits: A Unique Challenge

Communicating to the respondents that the research study does not offer immediate benefits posed a significant challenge, as the community was accustomed to receiving assistance and support from outsiders, either individually or through institutions.

Gratitude and Appreciation: A Two-Way Street

Despite the challenges of poverty and limited access to basic necessities, I was warmly welcomed into the community with open arms. The locals went out of their way to provide me with the best food available and made sure that I was safe and comfortable. However, at times, they would converse among themselves in the Chepang language, which I did not understand. This made me feel like an outsider, and I found myself laughing along without fully understanding the context. It was a valuable lesson in the importance of knowing the language of the community one is working with.

In addition, the participants and the entire community were grateful for my presence despite the challenging living conditions such as the difficult terrain, lack of electricity, proper food and accommodation, and even basic necessities. Everyone I encountered on my journey expressed their appreciation for my efforts in traveling to listen to them and conduct a study on their health status. I believe this also gave them a sense of significance and a feeling of being appreciated.

Bittersweet Goodbye:

On the final day of my data collection, I couldn’t help but feel emotional as I knew it was time to leave the community I had grown so close to. Throughout my time there, I interacted with so many people, observed their culture, and developed a deep connection with them. Their warm and welcoming nature, their openness to share their feelings, and their innocent values have left an indelible mark on my heart.

Transformative Journey:

My journey among the Chepang community was not merely a research endeavor; it was a life-altering experience. It exposed me to the complexities and nuances of qualitative research in unfamiliar settings. By sharing my story, I hope to inspire and guide fellow early career qualitative researchers, encouraging them to embrace the unknown, challenge their assumptions, and foster meaningful connections. May this account serve as a beacon of hope and inspiration for those embarking on their own research journey, reminding them that each community holds a treasure trove of knowledge waiting to be discovered through the lens of qualitative inquiry.

Kusumsheela Bhatta
Master of Public Health
Patan Academy of Health Sciences
bhattakusum3@gmail.com