PhD Thesis – the story behind the questions..

I was once told that good writing is all about the narrative. When I started writing up my doctoral dissertation I soon learned that I was collating, and weaving together, a series of narratives into a cohesive story with some scientific value.

I also learned that the key to good research is having useful and relevant research questions. In my thesis some of the most important questions only came clear to me whilst I was already on the ground doing research in a rural hospital in Sri Lanka. Here, I remember vividly observing many critically ill patients who had intentionally consumed deadly pesticides, and wondering what their fate would be given and how we could improve the medical management in order to save lives. Thus, for me it made sense to try and provide a story about the “context” where I embodied the research questions that would culminate into the ensuing scientific narrative.

Below is a poem that never made it into the final thesis, but in perhaps captures the passion of enquiry that sustained me through the long journey of formulating hypothesises, collecting data, and publishing my final findings.

Too young to die

Side by side in the intensive care they lie,

Multiple family members hoping they won’t die,

I can’t help but ask myself why,

Surely this lady is too young to die?

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Was this the result of frustration in the home,

Did she really want to leave this world for good?

Would her family and kids not worry and feel pain,

Everything seemed like it was all in vain,

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Back to the room with the lights and the constant beeping,

Things are getting tense, she is more than sleeping,

Deep down I feel strongly that this lady should not go now,

I want to help, but the real question was “how”?

14/2/07 (21:24hrs)  The above poem was written whilst observing a 36 year old woman, from a rural town in the north central province of Sri Lanka, fight for her life whilst on an intensive care ventilator. She was the mother of 3 children, and took an organophosphorus pesticide poison following an argument with her husband. She died within 2 days of presentation to hospital.

My PhD research was dedicated to the countless patients, like this lady, and to the numerous health staff and researchers who who were all a part of the effort to save and improve these patients lives.

The following two PDF excerpts show the contextual story which lead to the eventual scientific document that comprised the final thesis.

A strategy for hope in the face of death…

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Download here (phd-thesis-preface )

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The table of contents

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The entire thesis can be downloaded from ANU digital thesis at this link  – however, I’m happy to be emailed (bishan.rajapakse@gmail.com) and send you a pdf copy if you would like to read it. I would also be delighted to hear any reflections or comments on this work that occupied my attention for the better part of a decade.

Awaken the genius within

Awaken the genius within,

Start to sing,

The songs that have no meaning,

 

 

Brush aside your heart-strings,

And begin the journey of your soul,

Don’t put it on hold,

 

 

Keep your mind on this gold,

For you never know what will unfold.

 

Yesterday I met a poet at the hospital registrar orientation and it was a very inspiring encounter indeed.

So often it is easy to feel lost in one’s workplace, which is a conglomeration of people who have gathered to work in similar roles, from varying disciplines. On the surface they have a common goal, perhaps even holding the same “job title”. However, their backgrounds, hopes and aspirations all differ quite dramatically – if only we take the time, and perhaps have the courage to enquire what inspires them in life.

One person I met was an avid kite-surfer, who also happened to know people from Canada who were my research mentors. For example, Eddy Lang is a guru in the research on “knowledge translation”. Knowledge Translation is a field that involves strategies of translating evidence into practice (which is outlined in this hallmark paper published, http://www.annemergmed.com/article/S0196-0644(06)02142-1/pdf , The principles outlined in this article had a strong influence on the theme of my PhD thesis, and i’m very grateful for this).

Later on in the day I spoke with a poet who had a passion for many things that brought meaning to her life including a fascination with animal kingdom. Perhaps the reflection from this encounter was that I would have never learned about so many interesting things, had I not asked the initial questions about what it was she was passionate about. The other side of the same coin is that we can easily shy away from “sharing” what makes us tick because of the fear of not being valued through what has become a narrow focus in our modern fast-paced world, and I have often found myself falling into this trap.

I find it ironic that in a caring profession like medicine, which is based upon uncovering the stories of our patients, we have a culture that is often misses the richness of the experiences of those with whom we work.

I am very passionate about music, and wisdom, and I would like to share an early rendition of a song I wrote years ago now.

The song is called “Peaceful Revolution”, and the song is also about how I discovered wisdom in the simplicity of the villagers of rural Sri Lanka, compared with the hustle bustle of my western urban background. Here is an earlier version in all its raw simplicity…

Believe in Yourself!

This is the message that came from the words that better describes the song that I just recorded. that I originally called “study jam”. As I pushed record on my computer I entered the words “study jam” because that was exactly what it was – some random chords and sounds that needed to be released quickly before heading to the office on a beautiful sunday to do some work.

Today I need to re-analyse data that collected in 2008 to try an answer a question related to understand what drives doctors to make clincial decisions. I never dreamed that I would still be doing this in March 2013.I am afraid of doing this data analysis which is why I needed to start with some inspiration.

Research and writing can be a lonely world, but I believe it is rewarding in the end. One of the reasons it’s so lonely is that I feel that very few people can understand what you’re talking about half the time, but still I try to explain. The reason I feel fear is that analysing data is not straightforward, and it usually take far longer than one imagines. I am also afraid becuase if what comes out of this analysis changes my findings, then i have to re-think the problem again and write about it in a different way (ie. “back to the drawing board”, yet again!)

“Why am I doing this?” is the question that comes to mind a hundred times over, but it’s already been answered a thousand times back. I had a dream in 2008, when working in the rural hospitals of Sri Lanka, of making a difference to the systems medical education in low resource settings. The research I was involved with opened so many doors, in my mind, mainly to do with understanding how making a change could be possible. However, not long after I had the vision, came a realisation that it would take a lot of time and committment and perserverance to make it all happen. These were all things that frightend the life out of me at the time, but I ignored it with enthusiam and a belief that it would be a breeze. Only much later when facing many road blocks I had to face the reality that writing up my research findings was going to be harder than I had hoped for.

Whilst I don’t expect many to understand the details of what I’m writing about, there is one concept my struggle, and occasional loneliness illustrates:-

“it is not easy for anyone to understand (and therefore judge) anyone elses struggles, no matter how trivial or signigficant they seem on the surface.”

This is why I try to maintain a deep respect for “all” human being because the chances are that I don’t fully know or understand their struggle. I believe the common suffering is the thing that binds as all, and it is something that we can embrace. Buddhist philosophy suggests that the struggle is common, and perhaps solution can be shared by all.

But what about the conditions – aren’t some people put in far more tricky situations?

Perhaps? Perhaps not? I the only thing I know is that I don’t know.

Again, I don’t profess to know about anyone else, after all i’m just getting to know myself!

I believe that the conditions of one’s external reality (ie what’s going on in your life) can really shape and affect our inner world, but only as much as we let it. It’s hard to change the external world quickly (or at all), but what we can do is change our “realtionship with that reality” at any given time through our “attitude”. Holding an attitude of hope, positivity, and friendliness, allows us to see pick up wth most import data points in the experience soup that hits our face on a daily basis.

This morning when I went out surfing the rough seas, with 4 friends, it looked like madness, but we did it with an open mind, and the result was amazing. We didn’t catch the best waves of our life, but we all had a fun time, and learned something. Ultimately isn’t this a valuable thing – this is my definition (at the moment) of what life is about – to learn something and try and have some fun in the process, and even better to share it with some others!

I hope you have a good Sunday whereever you are, no matter what the conditions.

My song has provided me with enough fun and inspiration to allow me to go and face the fears of the analysis in the office.

Adios Amigos!

ps I hope you enjoy the song!

Bish_and_boyz-sufing

(Photography courtesy of Kester Boardman)

Academic Work

 

What is Academic work?

Is it just a series of responsibilities that one must shirk,

 

In favour of a goal that seems like a mirage?

Or perhaps a slow moving barge?

 

Changing directions all the time but still keeping to its destination,

That seems like an ever-moving target?

 

No it is not!

Don’t worry if you are cold and you are hot?

 

Because this is in keeping with the rhythm of the beast,

And once you are finished you will have a feast!?

 

On the accomplishment of your stamina,

For you will have stripped yourself down to every crevice, and every lamina,

 

Only to find yet another room full of “stuff”,

Making all of what you have done so far seem like “fluff”,

 

This is PhD~!

It is a sea of knowingness into the unknowingness,

 

Looking for what answers you can find,

Only to be lost in an ocean of questions that do not bind.

 

So pick up your paddle and steer your raft,

Even if you don’t know how this is how you develop your craft,

 

You will get there with work and the force of the occasional swell,

Even thought it sometimes seems like you are paddling in hell,

 

You will survive!

And if you “like” the unknown then you will thrive,

 

For this is your drive,

Choosing to be either dead or alive,

 

Every moment of your existence,

Learning that the key is in persistence,

 

So get back to the grind,

And never forget to be kind,

 

To yourself and others on the way,

For this is the most important part of each and every day!

 

 

10-5-12

 

Overcoming the obstacles of PhD writing…


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 Ego is the Challenge

 

The ego will betray you,

“Let go of it” – I pray you!

For only then you will see your true soul,

 

It is what makes you whole,

Even beyond your imagined goal,

For the ego is but an imposter,

 

So don’t give it the food to foster,

And fret in you head,

Otherwise it will make your spirit dead!


 

Advice of a Sage…

 

“How then do we manage it?” dear sage,

If I don’t learn the secret soon I am sure to age,

And it will happen so swiftly that I will not be able to gauge,

 

It is true my ample student,

And to ask of this truth is prudent,

For you already know the answer,

 

What you should do is let go of “thought”,

Do it soon before you are caught!

To the eddy currents of the mind.

 

But Sage I feel it is already too late,

Is this really my fate??

It is as if I am blind to common sense,

Surely letting go is ‘too hard’ if you are “this” tense!?

 

Wrong again my worthy learner!

For ‘letting go’ is the way to put thought into the burner,

Releasing the veil to the consciousness that lies beyond,

Both the flower and even the lotus pond,

 

Thank you dear sage,

For even though you speak in riddle and rhyme,

I feel the wisdom of my inner bell chime,

And I will, for sure, let go next time!


 

The feelings of a new consciousness

 

It feels like a bird soaring in the sky,

Why did I for so long deny,

Myself of this great aptitude,

All for the false promise of what my friend ‘Ego’ brewed,

 

 

But at least now I am aware,

And with you I will share,

That the Ego is always there,

Weighing you down, like a ripened pear,

 

 

Nevertheless it’s okay – you don’t need to frown,

Or even run around,

Just accept it as a very necessary part,

For to live on this Earth, identity is where we all start,

 

 

But it is certainly not where we end!

The new journey is starting,

And today is where we mend,

So keep going and I’ll see you around the bend!

ANU Research Fest 2010 – Going beyond the Endpoints!

Last week was the Australian National University’s research festival week. The ‘Research fest’, as it is know to ANU’ers, is like an orientation week for research students (MPhil and PhD candidates) where research and teaching life is celebrated. In addition to seminars on “thesis writing” for new students and “strategies for completion” for more advanced students, the University holds a series of social and creative activities including competitions for a research note, presentation of a thesis, acting in skits or presenting a short film clip.
The creative part of university life is something I was loved in my undergraduate years, but unfortunately in the four years that I have been enrolled at ANU for my PhD, I have never been able to attend this Research festival because of the demands of my fieldwork in Sri Lanka. This year was no exception, but this time it was because I am back in New Zealand writing up my thesis, and I am presently on quite a tight schedule to complete this! However, I did enter two competitions ‘on-line’ despite the mounting pressures.

Research Note

For the “Research Note” competition I wrote a Poem synopsis about my research experience that was titled “Going ‘beyond’ the endpoints!”. This is about an aspect of research that I discovered along the way and is something that I feel strongly about (ie. that life is more about the journey than the destination).

Going “beyond” the Endpoints!

Beyond the endpoints are the bits that are not seen,

The thoughts and emotions that lie behind the PhD’s sheen,

And whilst they will not appear in the final binding,

They are the reminders of how the road was so very winding.

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Research is more about the journey than its destination,

It is to respect the ‘process’ as well as the final creation,

And the process lies within the changes we experience in “ourself”,

Which sometimes speaks more than that book up on the shelf.

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My story is long, but I’ll try and keep it short,

It won’t be like some kind of scientific report!

For this is about a journey of mind and soul,

How this process has helped me feel whole.

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I collected data in the depths of Sri Lanka,

Amongst my very own first culture,

Where beautiful rivers flow, and green paddy fields glow,

With coconut trees that surround, where wild elephants can easily be found.

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I studied suicidal poisoning and its medical cure,

In villagers who drank pesticides when they felt desperate and insecure.

Some would say it was a cry for help,

Either way, they did not do well.

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We tried to understand how to ease the terrible prognosis,

By studying a portable machine that could help in treatment and diagnosis,

But whilst collecting this data, an additional vision was to develop,

Another study – “training doctors in resuscitation”- was soon to envelope.

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Whilst in Sri Lanka my mind expanded more than I would have believed,

Working with different cultures and systems into which I’d soon be weaved.

And with this I began to see my thesis as more than a mere ‘cog in a wheel’,

For perhaps, it may bring about change in the world, in a way that is real.

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Film Clip

I also put together a 5 minute short film (see below) which is a story along the same theme titled :-
“Beyond the Endpoints – sights, sounds and emotions of the international journey of research”.

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I didn’t want to let the movie get in the way of my thesis write-up, because I know that whilst film making and photography are a real passion of mine, they are also a huge consumer of time. However, to overcome this challenge I had a plan of waiting until the day before the film clip deadline before I started to put something together, and in the end I managed to come up with an entry! Nevertheless, it was still an incredibly difficult task for sentimental reasons.
All I could think about when creating this film clip was, “there are just so many people to honour and thank for this incredible journey”, “where do I begin?”.
I also kept thinking to myself “this isn’t ‘my’ project, it belongs to everyone who helped me along the way”, and it really is, including the patients we were trying to help. For without the help of everyone involved in this research I would not have been able to have carried it out, and I wouldn’t have been able to have learnt as much as I did during those years.

Gratitude

I guess really wanted to write this blog entry in honour of these people. Rather than publish a long list of names of people whom I feel indebted to for helping me get even this far, I thought a better approach is to bring back the poem I wrote not too long ago called “An Ode to my friends”  (see below). Please have a read of this Poem, it’s a favourite of mine because it seems to achieve the difficult task of expressing the magnitude of appreciation I have towards so many people who have helped and supported me through these incredible years.

I guess there is really one group of people, apart from my family and friends, who I really want to thank at this stage, even before I’ve finished writing up my thesis, and that is the “SACTRC crew”. The South Asian Clinical Toxicology Research Collaboration (www.sactrc.org) is the research collaboration between the Australian National University and University of Peradeniya (funded by the Wellcome Trust/NHMRC (GR071669), who provided my academic base and was the “lifeline” and the vision behind my work.
In addition to this I am really grateful for my two supervisors Professors Andrew Dawson and Nick Buckley, because without them none of this would be possible. Beyond this I have to thank “all” those people in Sri Lanka, and of course my family and friends, but the list really is too long, which is why I have left it to my poem to do the work J

Ode to my friends

This is an ode to my friends,

Those beautiful people who are like precious gems.

The ones who help me stay on track,

Who keep me together when I want to crack.

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They are always ready to comfort me,

To give me sight when I just can’t see,

And give me might when I feel like a flea,

Yes these are my friends,

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And if you think that I’m not talking about you

Well then – think again!

For when it comes to friends, each and every one counts, I truly believe this!

For we are all at different stages of different journeys.

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And it is the togetherness and interaction itself,

That creates the movement,

That is necessary and bodes well for improvement,

And the sanctity of ‘what is’.

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They say friends will come,

And friends will go,

But this doesn’t matter,

If our acquaintance is more than chatter!

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For whether it is now, in the past, or perhaps in the future,

There will be a bend,

And I will see you beyond that my dear friend,

For, after all, there is no beginning and no end.

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It is just an ever-growing flow,

Of love, energy. and much much more,

That lies here and also beyond this shore,

This is what we must grow!

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And knead it like freshly made dough,

And bake a beautiful loaf of humankind,

One love, one world, and together – one mind!

With this, we leave all our troubles behind..

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Thank you for your friendship.

The competition

I haven’t yet heard the results of the competition from last week, but for me it was not about winning, but rather about ‘participating’ in something that struck a chord with me, and provided another dimension to this work that has been a huge part of my life over the recent years.
Interestingly, both these competition entries have helped me in the daunting psychological task of ‘writing up’. One of the hardest things in writing up the thesis is dealing with the situation of feeling like there is ‘too much’ information to put into a logical linear format. I found the situation with the competition entries to be similar in that there appeared to be too much emotion, too many memories, and too much experience to be able to string together a concise videographic or poetic story. It was a daunting task… but I did it!
Similarly with regards to my current thesis write-up, it is daunting but I “AM” doing it, which feels good.
To me these competition entries were an example of the beauty and power that exists when ‘the arts’ are in support of ‘the sciences’, and where one of these two disciplines can help carry out the tasks of the other.
[Ed Note – in the end the Film ended up winning third prize in it’s category]

Feedback

As always I would love to hear you feedback on the poems or the film clip. Regarding the film clip, I have been very selective and I do not think there is any footage that would breach confidentiality, or cause any embarrassment to anyone – even the elephants and monkeys who have been captured, (but please let me know if there are any concerns, and I will take note and action). Also, I want to make it clear (for the purposes of my own research integrity) that I have not included any of the study data from the actual studies that I conducted.
On the contrary, what I tried to do was present an overview of the four years that I had in Sri Lanka, and I think many of my Sri Lankan friends and colleagues will enjoy seeing this, even though by no means is this a comprehensive account. Hopefully, will be much  more to come after I have finished this write up.
Anyway, I look forward to hearing your feedback.
Photos
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Finally I have included a few photos of Sri Lanka below. I literally took thousands of photos in Sri Lanka during the past 4 years, and I plan to present these in some way of form after completing my PhD. However, for the moment I just to put together about 60 photos from the first half of the journey (most of these pics are of the early SACTRC days, a lot of them social pics, in honour of these people who made my stay there so nice.) This collection of pictures is by no means comprehensive, as there are so many other pictures that I would like to include, but for the moment perhaps this is something.
This is the motto I am using to get through the write up of my thesis chapters, when I feel like I don’t know where to begin because there is just so much i want to write about – and the answer that works for me is is “Sharing ‘something’ is better than sharing nothing”.

 

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