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Reflecting on the processes, challenges and insights gained from my fieldwork.

The story of my fieldwork has been for the most part, that of patience, perseverance and to a certain extent luck. My journey began some 18 months ago and from the start I had a sense of urgency, primarily so I could be prepared to capture current practice, implementation plans and the thoughts of the decision-makers prior to legislation changes introduced by the Falsified Medicines Directive (FMD) in February 2019. In the overall narrative, my case is seeking to capture a rich in-depth description of FMD implementation in a sample of pharmacies, whilst also placing these organizational-level descriptions in the context of a national policy to implement a technology-supported initiative in community pharmacy practice, and considering changes to pharmacy professionals’ identity and their interactions with patients.

Mona's fieldwork journey

My process in planning and achieving this was somewhat a topsy-turvy approach in the early days. Thankfully, attending qualitative research and more specific courses on ethnography helped to shape and structure my study design and I felt more equipped to go it alone. I spent weeks painstakingly drafting, redrafting and updating the study protocol, whilst keeping in touch with potential research sites and participants found as part of the scoping process, to ensure they knew I had not forgotten them and to maintain their interest in the project. I still remember the feeling of surprise and gradually, elation when the ping of the email confirming ethics approval dropped into my inbox, having moments earlier seen the sender and dreaded the potential of further clarifications and amendments. With this milestone hit, I could start the recruitment of interview participants and research sites. It was now a race against time, with 12 weeks to go to the legislation change I needed to recruit suitable participants. The gatekeepers to these participants were indeed very effective at screening their communication channels and I soon found that an email agreement from the participant did not necessarily result in a meeting. Many phone calls, emails, and direct messages later, I secured either a face to face meeting or a conference call. This translated in many hours traveling to various office locations, often in London, to then spend hours waiting in a pristine visitor’s room for a gap in the participant’s ever-changing schedule. It was not fun at the time, afraid to leave the post I had been given for fear of missing the only available meeting slot.

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I found the administrative teams to be the lifeline, providing much-needed conversation and refreshments. I would later find out that this relationship that I had unwittingly stumbled upon would be crucial in securing the second interview with the participants. The participants themselves were extremely pleasant, often very apologetic about the length of time it had taken to arrange the meeting and more importantly eager to share their point of view. Each interview provided a different perspective, I found elite participants were exceptionally skilled in directing the narrative, there was ‘on the record’, ‘off the record’ and then ‘really off the record’. The ‘really off the record’ was the most intriguing segments, the participants would not simply lower their voice to a whisper to prevent others overhearing (a strange behavioural response I thought, and perhaps one so that the voice recorder would not pick up), instead opting for the ‘tape’ to be paused, when satisfied they had shared the shocking insight they would direct for the voice recorder to be turned on again, often nodding in satisfaction at sharing a thread that would be a useful pursuit for my project. They were engaged and just as enthusiastic as I about my research. Enquiring about my progress often, wanting to see any findings and have any resulting publications shared. It was through one such inquiry that my first research site recruitment came to fruition.

I suddenly found myself responding to the call for help with a collapsed patient

I was so excited about the first site visit. Having lost all four of the recruited sites due to delays with ethics approval, this site coming on board was the encouragement I desperately needed. To save on costs, I had planned for all site visits to be done in so far as possible as day trips. The travel to this quaint village pharmacy on the outskirts of Leeds, meant a 4 am wakeup call and the first train of the day at 05:30. Four hours later, I arrive in the leafy village. The beauty of the surrounding nature providing a serene backdrop, in contrast to the bustle of activities I could see beyond the pharmacy’s window. I suddenly felt nervous, like the first day at a new school. Polite introductions took place and I settled in the lowest traffic part of the dispensary. I felt like a surveillance camera, it took for one of the pharmacy team to ask, “Did you just want to watch me work?” for me to step forward and engage in conversation. With every visit to the sites, my confidence grew and interaction with the team became more natural. The teams often keeping copies or samples of products they had come across in between my visits to show me, on one visit excitedly declaring “we have things in the cupboard for you” and that is the story of how I got a shelf with my name on at the research site.

Mona's fieldwork

I learned that research can be a messy process, what I once had mapped in my mind did not play out as anticipated. I found the travel tiring, with the excitement of my research progressing providing the oomph.  I floated between my role as the researcher and the pharmacist; no more so than the last three weeks with the COVID-19 pandemic. In one of the research sites, I suddenly found myself responding to the call for help with a collapsed patient. In a rare moment where there was no conversation, I took a few minutes to supplement my notes. When the panicked receptionist came running into the dispensary, I looked up to find the duty pharmacists and GPs were in consultations. I grabbed the emergency bag from under the counter and there I was no longer a researcher observing the events unfold. It was not until the patient had regained consciousness that I looked up to find the support staff observing from a distance, having been on increasingly high alert since a suspected case earlier in the week. I sat with the elderly lady for some thirty minutes listening to her story of caring for her terribly ill husband and her concerns that her own health was deteriorating. Her primary concern is who would look after her husband if she were to be admitted to the hospital.  The team did not receive any further information on the lady’s progress and for 14 days after the event I found myself periodically checking my temperature primarily out of uncertainty and more so out of the concern of the team at the research site. I have since postponed all site visits. Whilst my fieldwork is on hold, I am catching up on reading and writing up my findings so far and on the contingency list to support pharmacy services.

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A special thank you to everyone on the frontline and those providing support. Thank you to all the participants and research sites. To my colleagues and wonderful supervisors, this would be an arduous and lonely journey without you.

Please note: this blog post was produced on the 7th March, and the situation around COVID-19 and what we’re doing in clinical practice has moved significantly since then. I do not want my initial experience in the early stages of this pandemic to be taken as insensitive given the current situation.

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