Engaging and involving mobile, stateless and displaced communities

Gary Hickey, NIHR Senior Research Manager for Patient and Public Involvement and Engagement hosts this episode and is joined by Dr Jayakayatri Jeevajothi Nathan, Research Manager at Universiti Malaya, Farzana Khan, Chief Executive Director of Fasiuddin Khan Research Foundation, and Jo Vearey, Associate Professor at the African Centre for Migration and Society, University of the Witwatersrand. 

Together, they discuss what is meant by leaving no one behind, the impact and challenges of engaging mobile, stateless and displaced communities in their research, and community engagement and involvement (CEI) tips.  

Get to know our speakers 

Dr Jayakayatri Jeevajothi Nathan (Kay Nathan) and Farzana Khan are affiliated with NIHR Global Health Research Unit on Respiratory Health (RESPIRE-2). 

Kay Nathan collaborated with the RESPIRE team in Sabah, Malaysia, to develop a clinical algorithm for diagnosing smear-negative pulmonary tuberculosis in resource-limited settings. Her efforts focus on engaging stateless communities who face compounded challenges — legal barriers, societal stigma, and high illiteracy rates — that limit their access to healthcare. Through community outreach, Kay raises awareness, dispels misconceptions about tuberculosis, and reducing stigma, adapting health information into pictorial formats and videos in local dialects to bridge literacy gaps. Inspired by the principle of “leave no one behind,” her commitment is to create trust and ensure these marginalised communities have access to essential healthcare, overcoming barriers step by step.

Dr. Farzana Khan, a Bangladeshi physician, scientist, and CEO of the Fasiuddin Khan Research Foundation (FKRF), holds a PhD in Global Health from the University of Edinburgh. With a professional background encompassing palliative care and public health, her research endeavors center on investigating the delivery and impact of quality palliative care in marginalized environments such as urban slums and humanitarian settings in low and middle income countries.

Dr. Khan's contributions extend to her collaboration with the UN-IOM in Cox's Bazar, where she has been pivotal in establishing palliative care services in Rohingya refugee camps in Bangladesh.

Jo Vearey is affiliated with Global Health Research Group on Disrupting the cycle of GEndered violence & Poor Mental health among Migrants in precarious Situations (GEMMS). 

Jo’s internationally recognised and globally-impactful research in the field of migration and health is informed by her commitment to social and epistemic justice. Fundamental to her research practice is investigating the ethical, empirical and methodological factors —  and their entanglements — that are associated with engaged research approaches. At international and local levels, Jo exlpores approaches that encourage genuine engagement with epistemic injustice in agenda-setting processes and in the development of evidence-informed migration and health governance framework, policies and programmes.

Gary Hickey is a Senior Research Manager at the NIHR and Chair of the International Patient and Public Involvement Network. He is passionate about promoting and sharing knowledge from across the globe on how to involve the public and communities in research. Gary works with researchers and the public, providing advice, guidance and training on patient and public involvement in health and social care research. He also writes, presents and is involved in several podcasts on these issues.

This episode was recorded in late 2024. The views and opinions expressed in this podcast are those of the host and guests and do not necessarily reflect those of the NIHR or the Department of Health and Social Care.

Transcript

Engaging and involving mobile, stateless and displaced communities

Host: Gary Hickey

Guests: Kay Nathan, Farzana Khan and Jo Vearey

Gary Hickey  00:00

Hello, listeners. My name is Gary Hickey and I work for National Institute for Health and Care Research, an organisation based in the UK that funds research, both in the UK and indeed globally. And welcome to our podcast series, Spotlight on community engagement and involvement: Leaving no one behind, exploring how we involve and engage people and communities in health and social care research with particular focus on those who are most marginalised and vulnerable.

This is the third episode in the series, and today we'll be focusing on engaging and involving mobile, stateless, and displaced communities. And I'm delighted to be joined by three guests who tell us all about these issues. And so it's my pleasure to introduce first of all, Kay Nathan, a Research Manager based at University of Malaya in Malaysia. Hello, Kay!

Kay Nathan 00:58

Hello Gary!

Gary Hickey 01:00

Fantastic, and also Farzana Khan, Chief Executive Director, and the founder at Fasiuddin Khan Research Foundation, which is a social enterprise in Bangladesh which aims to improve healthcare access and quality in Bangladesh, and I'm sure I pronounced [that] the name of that incorrectly Farzana, but please do put me right. And hello, Farzana.

Farzana Khan 01:21

Hi Gary, it was absolutely correct. The pronunciation is absolutely right, thank you.

Gary Hickey  01:26

Fantastic, that's pleased me no end, Farzana, thank you so much. And indeed, we are also joined by Jo Vearey, who's Associate Professor at the African Center for Migration Society at the University of Witwatersrand in South Africa. Hello, Jo!

Jo Vearey 01:42

Hi! Lovely to be here, thank you.

Gary Hickey  01:44

Marvellous, thank you very much. So, I'm going to just give you a chance to introduce yourselves a bit more, that was a very brief introduction from myself. So, let's start with Kay, and could you tell us a little bit about yourself, your research, and how you started working with marginalised and or vulnerable communities.

Kay Nathan 02:07

Thank you Gary, thank you so much. So, basically, I'm a Research Manager in National Institute for Health and Care Research Global Health Research Unit on respiratory health - RESPIRE study. So in terms of our research, focuses on developing a clinical algorithm for diagnosing smear negative pulmonary tuberculosis particularly in settings with limited resources. In Sabah, we engaged with stateless populations who often face significant barriers to accessing healthcare due to their legal status. So, these communities are frequently marginalised and endure stigma which can prevent them from seeking treatment for diseases like tuberculosis. So, a significant number of individuals within this population are also illiterate, so which further complicates their ability to understand health information.

So, my involvement began with RESPIRE study where I collaborated with the Sabah team on community engagement activities. We organised outreach initiatives to raise awareness and understand the unique challenges these stateless individuals face. So, during our visits, we aim to reduce stigma and dispel harmful misconceptions about tuberculosis, so fostering an open dialogue that encourages this individual to share their experiences and concerns. So, to address literacy issues, we adopted our healthcare messages into pictorial form using media that resonates with them such as short videos featuring local colloquial slang. So, that is a brief introduction about our initiative in Sabah. Thank you, Gary.

Gary Hickey  04:07

Thank you, Kay, and we'll dig down into that a little bit more in a moment. Farzana, do you want to tell us a little bit more about yourself, your research, and how you started working with marginalised and or vulnerable communities.

Farzana Khan 04:20

Thank you, Gary. Let me first extend my grateful thanks to NIHR to have me in this podcast, and I also warmly welcome the audience into this session. 

Actually, I'm a palliative care physician from Bangladesh. So, under the RESPIRE programme at the University of Edinburgh, we are conducting a multi-country feasibility study on pulmonary rehabilitation for patients with chronic respiratory diseases across low resource settings in Bangladesh, Bhutan and Pakistan. Our specific study area is Cox's Bazar, Bangladesh, a region that is not only low resourced but also exceptionally vulnerable. Cox's Bazar, located at Bangladesh's southernmost part bordering Myanmar, hosts the sprawling Rohingya refugee camps, one of the world's largest and most rapidly growing refugee settlements.

Following the August 2017 military conflict in Myanmar over 1 million people fled to the area and now live across 34 camps. At the height of the crisis, hundreds of NGOs were providing healthcare services in these camps, yet palliative care was notably absent. 

During a two-day medical camp I joined in October 2017, we saw over 600 patients, most of whom presented with acute respiratory symptoms, fever, diarrhoea, pain, cough, etc. As a palliative care advocate, I quickly noticed that patients needing palliative support were not among those seeking care. When I inquired, locals explained that many cancer patients and others in need of palliative care were too debilitated to travel or lacked support to reach the clinics. With this insight we realised the gap in care for these individuals. Drawing on the experiences of the Fasiuddin Khan Research Foundation (FKRF) in providing community palliative care to displaced populations in Dhaka's urban slums, we decided to expand our services to include refugees in Cox's Bazar. This effort has become a part of our mission to bridge critical gaps in health care for those most in need. 

Gary Hickey  06:37

Thank you, Farzana. And Jo, can you tell us a little bit more about yourself, your research, and how you started working with marginalised and or vulnerable communities?

Jo Vearey 06:47

Sure, thanks. So, I've got a background in [in] public health; my [my] PhD is in public health. And as part of that work I was looking at the intersections between migration, HIV, urban governance and informal settlements, so informal living, in [in] Johannesburg. And at this point, it was working with people who had moved from elsewhere within South Africa, and it was really about exploring the kinds of risks and prevention strategies you know that would be the most appropriate around HIV and STI. And through the research and through the various pieces of the work, really recognising that we are not effectively and efficiently engaging with issues to do with movement. 

So, the NIHR programme that I'm part of is a Global Health Research Group known as GEMMS, within which we're looking at ways in which the relationship between gendered violence and poor mental health in precarious contexts where different migrant groups are found, and exploring ways in which to better understand that in order to intervene and develop interventions that may address those issues. In the [the] Southern African partners, it's South Africa and Zimbabwe. We're working with colleagues also in India and Cambodia. 

Gary Hickey  08:17

Thank you, Jo. So, you've all given very good answers there about your background and you all referred to various marginalised and vulnerable communities. As you know, the theme of this podcast series is about leaving no one behind, and I'd like to start with you, Jo, is what does leave no one behind mean to you?

Jo Vearey 08:42

There's increasing recognition at the global level about the importance of understanding the relationships around migration, displacement and health. And linked to that there's been sort of a clarion call around you know, there's no health without migrant health, and the recognition that by leaving different groups behind, nobody is benefiting. We need to ensure that everybody is [is] involved and on the way. And we know that because health interventions in particular, but other SDG related activities do not necessarily engage with the movement of people, and as a result, people get left behind.

And just one, I think important and relevant way of thinking about this is when we want to think about, you know COVID and the pandemic and trying to roll out vaccination, and a) obviously a whole range of issues around inequities and access to vaccines, but in a context like South Africa, how do we provide and develop safe ways for people with different documentation statuses to access vaccinations because if we only vaccinate some of us, none of us benefit, and I think that remembering the public health reasons in leaving no one behind is is very important. 

Gary Hickey  10:00

Thank you, Jo. Fazana and Kay, what does leave no one behind mean to you? 

Farzana Khan 10:06

Thanks, Gary. For me, leave no one behind means that every individual, no matter who they are, where they live or what illness they face deserves access to the best possible opportunities and care. 

Gary Hickey  10:21

Fantastic. That's very succinct and full, thank you, Farzana. Kay, would you like to add anything to that?

Kay Nathan 10:27

Yes, Gary. So to me, leave no one behind is a very powerful commitment. So, basically to ensuring that everyone, regardless of their background or circumstances has access to the health care they deserve. So, it speaks to the very core of our humanity, so acknowledging that each person's life matters. In the context of our work, it means tirelessly addressing the barrier that marginalised group, such as the stateless individual in Sabah, Malaysia face, they can seek the treatment and care they need, without fear or hesitation. 

Gary Hickey  11:13

Thank you, Kay. It's almost like a moral cause, very much so. And you touched on there, Kay, about some of the challenges, as indeed did you all. And could you tell us a bit more about the main challenges for engaging the groups with whom you're working in your research and talk to us about how you've addressed these challenges?

Kay Nathan 11:36

So, engaging stateless community in Sabah, Malaysia has not been without its challenges. So, one of the most significant obstacles is the stigma and pervasive misinformation surrounding tuberculosis. So, there's a lot of myths that can grip individuals with fear, such as (the) idea that TB is untreatable, or that only certain groups are affected. So additionally, many stateless individuals are reluctant to seek help due to concern about their legal status. However, through open conversations and our community engagement activities we strive to build trust and share accurate information.

Gary Hickey  12:20

Fantastic, thank you. Fazana, have you got anything to add to that in terms of main challenges for engaging groups in the research, and [and] how you've addressed them?

Farzana Khan 12:29

The context itself is a barrier. The extreme heat and hilly surroundings in Rohingya camps makes participation physically challenging, reducing stamina and limiting engagement of patients, the patient or other participants also. And to address this, we conduct sessions in shaded areas, try to use portable fans or provide water and keep sessions brief with regular breaks to ensure participants comfort and sustained attention. And, as you know, that building trust is another major challenge in refugee camps. Like due to past negative experiences and concerns about external motives, many refugees may initially be reluctant to trust outside groups. So, establishing a continuous transparent presence and collaborating with culturally aware facilitators, ideally from within the community or similar backgrounds, is essential.

So, we made cooperative agreement with UN IOM, that is the International Organisation for Migration. And this partnering with IOM allows us to include their trusted doctors, nurses, and community health workers who have long standing relationships with the community. By clearly communicating research goals and community benefits we work to build a safe, inclusive environment. 

And there is another barrier that is language barrier and identifying literacy levels of the patients or other participants. And so effective communication is really a barrier over there. So, we use interpreters fluent in Rohingya language and incorporate visual aids, videos and storytelling and engage community leaders, such as religious figures, majhis and teachers who can breed understanding effectively. We believe that solutions are actually about creating circuits of communication and taking action. 

And there is another problem in refugee camps, that is lack of incentive is a barrier. So, with limited economic opportunities, so participation without compensation may pose difficulties. That's why we provide non-cash incentives [incentives] because in refugee camps, you cannot provide cash incentives to the participants. So, we provide non-cash incentives, such as food, transportation vouchers or small health kits which motivate participation with within ethical and cultural guidelines. Even sometimes modest acknowledgments of participants’ contributions can enhance the engagement and motivation.

Gary Hickey  15:36

Thank you, Farzana. You mentioned a couple of things that [that] are really of great interest to me, and one was trust, which I think is at the heart of any successful community engagement and involvement. And the one of course, was like the incentives/the feedback given to people. And [and] particularly with trust, because I think that's something that's very hard to [to] build up, but [but] very easily lost and very quickly lost. 

So, something there isn't there about investing in time and investing in those longer term relationships rather than [than] us as researchers zooming in and out of communities, I think that's really important. Jo, over to you, what are the main challenges that [that] you've had of engaging the [the] various groups you spoke about, and how (have) you've addressed those?

Jo Vearey 16:21

I think as others have indicated and you've also raised is, you know, trust is a huge thing. And I think the importance of working with partnership, you know, partners, that you that as a [as a] the kind of research team, as it were, ensuring that as part of that consortium, we have partners who are based in local context and through them really ensuring that they are directing us in the best ways to engage, that they are involved in the development of the research process, that they are able to really provide input into processes, into best ways of engaging, but importantly, really, being able to then translate that actively with different communities on the [on the] ground with whom [whom] we're [we're] engaging. 

And I think what we cannot underestimate is the amount of time, as you say, that this requires, and you know some of it you know the framing of slow research as a very specific approach which is not suited to, you know the ways in which grant funding in many ways, but the importance of having that ability at the beginning of a programme to slowly build those relationships or be returning to ones that already existed but you need to refresh them.

Obviously, there's the context, and you know, things shift and change. And in the in one of our context, for example, in the South African case, where changes in immigration legislation, in social attitude towards foreign nationals, you know, increased levels of xenophobia, fear of the state by foreign nationals, for example, then shifts and and pushes people into other spaces, pushes maybe people in less interested in [in] engaging, whereas perhaps 12 months previously, they were actively engaged in a programme like a [like a] research and intervention programme. So being able to adapt to those changing contexts that are really the structurally driven contextual factors that we have no control over, communities have no control over, but [but] how do we adapt and respond within those and ensure that we can undertake relevant, ethical, safe research that won't place people at harm. 

Gary Hickey  18:52

Jo, can you tell us a bit more about that adapting to the [the] changing circumstances? If [if] you've got like a an example of how you [you] adapted to that changing landscape?

Jo Vearey 19:05

So, I suppose one example would be that the location of our main research, I'm just going to talk a little bit about the South African context.

The space where we are locating the [the] South African Research component is in an area that we as a research centre have a long history of working with, and it is incredible to see the difference between 2 years ago, 3 years ago, when you're developing a proposal and the ways in which migration and the movement of people across borders is being viewed. It's always been a difficult space, but that's pushed people who are living and moving through those spaces, who perhaps have an irregular documentation status, has pushed them into different ways of living, ways of trying to [to] seek work. But that has meant working with our local community partners through our local advisory group to really, who are the ones who are there all the time working and supporting them, in [in] re-identifying what today a safe space looks like, which might not have been what we had anticipated several years ago. So, just being able to adapt to that and being guided by our community partners is incredibly important, and being willing to listen to them, and recognising their expertise in that and and support to that process.

Gary Hickey  20:35

Fantastic, thank you, I mean some real sort of [sort of] themes that you're [you're] all bringing out. And I just jotted some things down; obviously adapting to changing circumstances/environment is clearly important, creating safe spaces, linking with existing organisations Jo, that was something you said was really important, and I think it came out from what Farzana and Kay were saying. Trust, and that involves time, invest in that and developing those longer term relationships. And I think that they seem to be like core whenever [whenever] we do these podcasts and talk to people, there seems to be some core things. I wonder, like sort of building on that, if you could all give me some examples of some of the things that you've done in terms of your community engagement and involvement activities that have worked in specific contexts. And as we were with Jo, I'll start with Jo.

Jo Vearey 21:28

So, from the initiation of the [the] project, and you know sort of outlined from the you know, when we started thinking about building this group together to put a proposal together, it really was about, how do we ensure that we are not sort of flying in and coming up with abstract research that doesn't have any relevance to a particular context. So, establishing systems for building local advisory groups, thinking about then regional advisory groups that would [would] look at a wider area, you know, for example, Southern Africa, or perhaps a region of India let's say, and using those different actors and their expertise and their connections and their experiences to also allow us to really gain different insights into different spaces. 

What I found very interesting was when we were working during our first community workshop in the South African context and the number of people from all of the different organisations that are active in the space, how many people wanted to come and participate, and who wanted to share. And we ran it as a very much a workshopping space, but I don't think any of the team, including our some of our main community partners, had realised just how many people were looking for a space to share their experiences of working with different groups. Whether it was about sharing frustrations, whether it was about sharing things that they'd found that had worked. But really saying, “this is what needs to be done and how do we build that in”, and we ended up shifting that into really thinking about a community advisory network rather than a group, and through that, then having several representatives who form that kind of more formalised group. But really being able to use those different people and their organisations, many of which are very informal, small community led groups and bringing everyone into these spaces to share, reflect, and learn together.

Gary Hickey  23:47

Fantastic. Thank you, Jo. Kay, can you give some specific examples of [of] what's worked in terms of community engagement and involvement and in what context.

Kay Nathan 23:56

Sure, Gary. So, is this that we are currently in the process of monitoring and evaluating the impact of our engagement activities so it is too early to draw a definite conclusion. But however, we have taken important steps toward raising awareness about tuberculosis within the community. So, the one significant development is the recruitment of community volunteers from the group we engaged with. So, these volunteers are crucial in identifying individuals with tuberculosis and helping to break down the stigma associated with this disease. So, basically to facilitate their effort, we have set up a WhatsApp group where volunteers can share information and support each other. So, while we haven't yet seen measurable changes, this initiatives are laying the groundwork for a more informed community, so we remain hopeful that as we continue our work we will witness increased awareness and more individual feeling empowered to seek early treatment for tuberculosis. So, that's from me.

Gary Hickey  25:05

Fantastic, and also, Kay, a nice timely reminder that monitoring your community engagement involvement activities obviously is really, really important.

Farzana, have you got some examples of things that have particularly worked and in what context?

Farzana 25:20

I think in our case what actually works is [is] a compassion. We use compassion as a practical tool, not as a nice idea or sentiment. So, in everyday terms, compassion might mean that [that] having a [having a] good, nice feeling, and to feel other people's feelings, but you just cannot feel other people's feelings, you have to care about their feelings. So that's what we try to do. And what we do, we design our activities that directly address the specific concerns of the patients and making engagement more meaningful. And we try to provide them holistic support. We address the interconnected challenges they face like health, social and economic issues to provide comprehensive support. 

And I would cite an example, but that is a very, very I would say difficult example. Two patients were coming to attend our pulmonary rehab exercise - we have 5 centres - and in one of our centres and they got a severe accident. And after the accident one patient immediately died, and another was severely injured and was hospitalised. Later he survived. So, after that what we did, we [we] continuously connected with the [with the] families. And later on, while we visited their homes with [with] actually our cultural things like when we visit a patient who already died with some fruits and other things. So we went there and gave solace to the family members, and the neighbours also came together over there. And we also gave commitment that we'll bear a part of their expenditure that was that they had to spend in the hospital, and that's a very, very big amount.

So, this was not a nice example but that is compassion to, that is (what) compassion means to us.

Gary Hickey  28:03

Thank you. Thank you for sharing that, Farzana.

Obviously, you've all worked with and engaged communities as part of your research, I'll be interested to know what you think the impact has been on them.

Kay Nathan 28:13

It is still too early for us to make a [a] definite conclusion about it, but in terms of how it has benefited us for our research, I would say that, you know, involving this stateless community has enriched our research in a way that we never anticipated. So, their insight into the cultural and logistical barrier they face have been invaluable. So, allowing us to basically tailor our approach to their real world experiences. So, this collaboration not only enhances the relevance of our work, but also reinforces the notion that we are in this together, striving [striving] for a healthier future for all.

Gary Hickey  29:02

Brilliant, thank you, fantastic. And in many ways, you have sort of started to answer my next question. So I'll hand this one onto Farzana, how has including such groups benefited your research? 

Farzana Khan 29:14

Actually, involving refugee groups in research helps us understand their needs better. So, their unique insights provide valuable information that improves our findings, although we are in the midpoint of collecting data, and we haven't analysed those, but so far, whatever we did, we have found that their insights are really valuable information that is going to improve our findings. And by hearing their firsthand experiences we can identify specific challenges and their health behaviours allowing us to design truly effective and culturally appropriate interventions. 

So, we try to be inclusive as I said, that building [building] trust, and this has encouraged long term engagement with them and leading to better data quality and new discoveries might come that may enhance our research. So, by empowering the participants and addressing the barriers they face, we have we are trying to create a more ethical and community driven approach that offers practical solutions that can influence also health policies later on. Ultimately, including these refugee groups not only improves the quality of our research, but also strengthens community resilience, ensuring that our work has a meaningful and lasting impact. 

Gary Hickey  30:54

Thank you. And Jo, have you got anything to add about how including these groups has benefited your research? 

Jo Vearey 31:01

I think the one thing really is about a willingness to recognise that we are entering spaces we don't know, really, even if we've worked in these spaces. And I think the [the] importance of really being confident and okay with the fact that you are not the expert in these spaces. And the knowledge held by the people you're working with is important, and it must be recognised, and you know, ensuring ethical practices have been mentioned that ensures that we're not you know we are [we are] addressing concerns around sort of, you know, knowledge, politics really, and thinking about extraction of information versus ways of supporting information being curated in different ways that benefit everybody. And for me, that's [that's] a really important sort of approach that over the years, you know, you always have to relearn it in different spaces, but really trying to [to] ensure that you foreground that in [in] any approach to research.

Gary Hickey  32:10

Fantastic. I've [I've] got one last question, a quick fire question for each of you, and I'll start with Kay. What one piece of advice would you give to those people engaging communities on how to be inclusive and leave no one behind? 

Kay Nathan 32:27

I truly echo what Farzana said. So, I would say it is crucial to build trust through engagement and understanding. First and foremost, take the time to really listen to the specific misconception and concern [concerns] within the community. So, it's amazing how much you can learn this by having those conversations. Addressing stigma directly is key. Open conversations allow people to share their fears and clarify any misunderstanding, so it is important to create a safe space for dialogue where everyone feels heard. 

On top of that, collaborating with local healthcare personnels and community leaders is vital as they can help ensure that your messages are relevant and relatable. So, use simple language and relatable examples in your communication, and for those with low literacy incorporating visual aid can make a huge difference. 

Lastly, maintaining a consistent presence in the community is essential. So, being there regularly, fostering trust, encourages ongoing dialogue. When people see that you are genuinely invested, they are more likely to engage and share their thoughts.

Gary Hickey  33:54

Thank you. Farzana, have you got anything to add to that? 

Farzana Khan 33:58

So, I would say that vulnerable settings matters and marginalised population also matters. So, try to be compassionate, be inclusive, listen, and be open and encourage participation. That's how we'll be able to leave no one behind. 

Gary Hickey  34:22

Thank you Farzana. And Jo, what advice would you give to those engaging communities on how to be inclusive and leave no one behind? Have you got anything to add to what Kay and Farzana.

Jo Vearey 34:31

One of the main things I would say is, and in some ways it's a very obvious thing, but is really respecting people's time and availability and interest. You know, is this something that somebody is interested to invest time in? You know, if I'm moving through somewhere, if I'm living in a precarious space, I've probably got lots of priorities in my day, and that might not be participating in research. So, how do I learn from that in order to reconsider approaches that would allow people to be [to be] involved and learn from them about what types of approaches could [could] be more efficient and effective. Thanks.

Gary Hickey  35:12

Thank you and thank you, Jo, thank you, Kay, and thank you Farzana, we're going to close the [the] podcast here, and a huge thank you from all of us to you the listener. 

Please do share the podcast, post it on [on] X or Twitter as it was called, and tune into other episodes in this series which can be found on our website or wherever you listen to your podcast. And please do let us know what you think by sending an email to social.media@nihr.ac.uk. 

And finally, a reminder that the NIHR/Mesh online course, An Introduction and Practical Guide to Community Engagement and Involvement in Global Health Research, is now available and it's free to everybody. For more details on that, please visit the Global Health Training Centre website or visit www.nihr.ac.uk and search for community engagement and involvement and you'll find the course in the resources section. 

And so that's all from us, so thank you very much again for listening, and please do enjoy the rest of your day.