Publishing research from developing countries
Research done in developing and non-English-speaking countries meets obstacles on its way into the international literature: authors who see language as their greatest challenge when organisation can be as large a problem, journal processes they find opaque, and few local journals, editors and science journalists to carry their work. Mentoring, workshop, editing and capacity-building schemes have been built to close the gap, and a medical writer can serve in them as a volunteer, a teacher or an editor.
Research from developing countries in the international literature
The medical communication world is increasingly becoming one, yet countries differ in the traditions, conditions and institutions relating to medical writing.
Just as health disparities are rooted in fundamental social, political and economic inequalities, so is the representation of authors from low- and middle-income countries in scientific communication. The scientific literature is heavily dominated by researchers in the United States, the United Kingdom and Europe, while the remaining 88% of the world's population produces less than 12% of it. Authors from low- and middle-income countries increasingly contribute to reporting global health research, but in 2024 their representation, especially in leading authorship positions, remained inadequate, which has important ramifications for the attention given to health issues in their countries.
Language and organisation in authors' manuscripts
For Chinese researchers, writing papers in English presents enormous difficulties, and inability to express ideas precisely in English is a frustration. In a survey reported in 2007, 50 Chinese biomedical authors who had attended a lecture on writing were asked to name their greatest challenge: 34 named English language proficiency, 7 organisation, 4 content arrangement, 4 format and 1 something else. The editor and teacher who surveyed them held that, although authors ask her to "please help me revise the English", organisation is an equally large problem.
The journal process
Chinese authors also face barriers in publishing, in the account of an editor who works with them. They sometimes misunderstand a journal's instructions to authors, language barriers and the Chinese emphasis on courtesy hamper their communication with editors, and how journals process manuscripts seems mysterious to many of them. Most expect journals to provide detailed suggestions for revision, and some expect journals to include staff with a Chinese background to help with communication.
Translators and author education
In the view of an editor who works with Chinese authors, translators are unlikely to ease these authors' difficulties, because translators generally lack biomedical knowledge and are unfamiliar with the conventions of biomedical journals. She favoured instead educating Chinese authors about English-language biomedical writing and developing biomedical editors in China. By 2007 the China Medical Board programme in writing and editing had trained more than 300 biomedical authors and more than 40 biomedical editors. By 2010 the programme, based in China, had existed for twelve years, with Barbara Gastel as its United States coordinator throughout.
Local journals, institutions and science journalism
In 2007 a journalist who grew up and trained in Colombia named four constraints on communicating science and medicine there: few journals are based in Colombia, researchers prefer to publish outside the country, many English-language scientific terms lack Spanish equivalents, and science news in the Colombian media focuses largely on discoveries in the developed world. The few Colombian science journalists had little time to report on science, because they also had to cover other topics, and little space in which to publish.
Three bodies ran initiatives to promote science communication in Colombia. The Colombian Institute for the Development of Science and Technology ran interactive science museums, science and technology fairs, science journalism, publications including textbooks, magazines and popular science books, and science curricula for public schools. The Colombian Association for the Advancement of Science published the magazine Innovación y Ciencia and produced educational videos and an electronic newsletter. The Colombian Association of Scientific Journalism had established a press agency publicising research done by Colombians.
In 2011 the publications of the Theodor Bilharz Research Institute in Cairo were similar in range to those of most large medical institutions, including journal articles, book chapters, grant proposals, lectures, and slide and video presentations. Its information and documentation centre had five units, for decision support, the library, documentation and publication, computer and information technology, and information systems and statistics, and the Egyptian Journal of Schistosomiasis, Infectious and Endemic Diseases was published there. The centre's library held a collection of texts, mostly in English, on liver and endemic diseases, particularly schistosomiasis, and the institute's staff drew particular attention to the dissertations and theses of its MD, PhD and MSc students. The work of the institute's publication department was exemplified by a videotaped presentation by its chairman of gastroenterology and hepatology, which, as part of his continuing-education objective, was scheduled to accompany his lecture at the Arab Health Congress in Dubai and was available on the institute's website.
Regional scientific journals can face problems including plagiarism and other ethical issues, difficulty finding editors and reviewers to handle submissions, unscrupulous authors, and barriers to getting indexed. To discuss and address these and other challenges, the Academy of Medical Sciences of Bosnia and Herzegovina convened a congress on science writing, editing and publishing in Sarajevo in December 2016, attended by interested parties from Balkan and Mediterranean countries. It produced the Sarajevo Declaration on Integrity and Visibility of Scholarly Publications, an aspirational ten-point statement aimed at improving the quality of journals published in the represented countries.
The declaration reminds editors, reviewers and authors of their responsibilities in general and specific terms, and emphasises the benefits of following the ICMJE, Council of Science Editors and similar guidelines. It advocates using social media and ORCID to publicise papers, and encourages journals to increase their visibility and credibility by improving their websites and making their editorial practices transparent. It suggests that journals devote space for students and more senior people to publish material in return for continuing professional development credits. It urges publishers to increase their editorial teams' skills by recruiting experts in statistics and design. One commentator on the declaration judged such recruitment perhaps easier said than done and the declaration's overall impact hard to measure, but held that journals that start following its guidance will surely be expected to improve their standards.
The World Association of Medical Editors, founded in 1995, was put together, in the words of one of its founders, to help the smaller or poorer journals, most of which have part-time, volunteer editors with fixed terms and very little experience. By 2011 editors in Africa and the Eastern Mediterranean had associations of their own: the Forum of African Medical Editors, which held its founding meeting in 2003, and the Eastern Mediterranean Association of Medical Editors.
Journals and copyediting in Pakistan
English is an official language of Pakistan, used in government, the courts and higher education, and an estimated 49% to 58% of Pakistanis have some proficiency in it. It is not the first language of many researchers, which can make manuscript preparation difficult, can increase the likelihood of grammatical errors, and leads to linguistic inaccuracies that can cause misinterpretation and critical errors in medical understanding. In 2024 Pakistan published about 2,874 journals across all disciplines, about 70 to 90 of them medical, with about 86 recognised by the Higher Education Commission. Some are indexed in PubMed, Scopus or Web of Science, and their standards vary considerably: some meet international benchmarks, while others face inadequate peer review, limited editorial oversight and resource constraints, which affect the credibility and international recognition of the published work. Limited funding, lack of training in editorial practices and language barriers contribute to these problems, and the scarcity of professional editorial services and developmental editing support affects both the quality and the quantity of scholarly output.
Specialised copyeditors are rarely employed in Pakistan, as in many developing countries. Copyediting is typically done by editorial board members, who often lack specialised training in copyediting and proofreading, and there are few formal structures or private companies for medical editing. Money for editing software, plagiarism-detection tools and training is short, article processing charges for international open-access journals can be prohibitive, and talented editors and researchers may leave for better prospects abroad. The varied standards of the journals affect how the global medical community views research from Pakistan, sociocultural factors may influence research topics, and keeping editorial practices up to date with advances in medical science may be hard under these limits of resources, training and expertise. A study of articles accepted by one Pakistani journal found extensive grammar mistakes, inappropriate references and unnecessary tables, and a study of articles submitted to another found misused punctuation, incorrect tense and voice, and errors in article use. Editors of medical journals tend to focus more on scientific soundness than on language quality. Authors must review their manuscripts thoroughly and might benefit from specialised training in manuscript preparation before submission. In 2024 no Pakistani journal offered developmental editing, the work beyond correction on structure, argument and logical flow, to improve its authors' writing.
Freelance copyeditors are an underused resource in Pakistan's medical publishing. Freelance copyeditors in Pakistan have carved a niche on global platforms such as Fiverr and Upwork for their linguistic skills and domain expertise, while Pakistan has relatively few specialised editing companies, and the local and international editing services that exist may not be widely available or affordable for many authors. Commissioning freelancers per project would give journals flexibility and scalability without the cost of full-time staff, their familiarity with international editing benchmarks would let journals align with global standards, and integrating them with in-house editorial teams would give a more diverse editorial collective. The collaboration would also offer employment to the freelance community. The Higher Education Commission accredits journals, funds research and trains editors through capacity-building programmes. The recommendations for journals and the Commission are to bring qualified English language teachers and freelance copyeditors into editorial work alongside scientific peers, widen editorial boards to include copyediting and language skills, run regular training in English, paraphrasing and technical editing, develop training with international editing associations, offer grants or incentives to journals committed to good copyediting, review copyediting quality periodically, write transparent standard operating procedures for submission, editing and publication, set up dedicated medical editing firms and platforms connecting freelancers with publishers, and partner with international editorial organisations.
EMWA and AMWA offer support, resources and training to medical editors and copyeditors, but in 2024 their annual fees of €130 and $199, converted to local currency, often exceeded what the average Pakistani copyeditor could afford, and their fee structures do not account for economic disparities among countries. The remedies proposed are fees adjusted to each country's economic conditions, exchange programmes and training with international peers, awareness campaigns about the value of copyediting, and local copyediting and medical writing associations offering affordable training, resources and networking suited to the Pakistani context. The insight language teachers gain by working with researchers on their research could ease their editing workload, and the expertise could enhance their credibility as intermediaries in scientific literacy and as specialists in English for specific purposes. In 2024 the copyediting of medical manuscripts in Pakistan was in its early stages but on a clear upward path, and involving specialised copyeditors becomes more essential as Pakistan's research influence grows. Clear, concise language helps editors and reviewers concentrate on the science and so smooths peer review.
AuthorAID
Much valuable medical and other research from developing countries often remains largely unknown, and one main reason is that many researchers there lack training in research communication, lack familiarity with publication and presentation procedures, and lack confidence in their ability to publish and present. AuthorAID was designed mainly to help researchers overcome these barriers and so to build capacity in communicating research. Others had given medical and public-health researchers in developing countries workshops and courses on scientific communication, but Phyllis Freeman and Anthony Robbins, from whom the concept came about a decade before 2013, envisioned delivering guidance largely through the Internet, increasingly accessible in developing countries, and in particular as a vehicle for one-on-one mentorship in scientific writing. In 2007 the International Network for the Availability of Scientific Publications, a charity focused on supporting global research communication, established what became the most extensive and visible of the projects named AuthorAID, funded mainly by the UK Department for International Development and the Swedish International Development Cooperation Agency. Other projects not associated with the network have used the same name, among them AuthorAID in the Eastern Mediterranean and the AuthorAID project of the International Society for Environmental Epidemiology.
In 2007 AuthorAID was a new set of initiatives to help researchers in developing countries publish their work, pioneered by Robbins and Freeman, editors of the Journal of Public Health Policy. It emphasised mentoring by well-published scientists and editing by expert editors. Its activities were being established through the International Society for Environmental Epidemiology and the International Network for the Availability of Scientific Publications, and other groups were discussing involvement.
The network's programme was to have three components: an online system for mentoring by scientists and editors, workshops on scientific writing, and a web-based knowledge community whose openly accessible content would focus initially on writing scientific papers, the publishing process and writing style. The mentoring was to be a carefully monitored pilot programme. Barbara Gastel was named Knowledge Community Editor, responsible for the openly accessible content on the website. The first openly accessible content was expected in late 2007 or early 2008.
In 2009 AuthorAID was a pioneering project funded by European agencies and based at the International Network for the Availability of Scientific Publications, and its key features were online mentoring, worldwide workshops on scientific writing and openly available content. Its site had 25,196 visits from 173 countries and territories in the year ending 21 October 2009, and 1,047 individuals had registered on it by late 2009, when editors, researchers and others were encouraged to sign up as mentors. In 2010 AuthorAID helped researchers in developing countries publish their research in scientific journals, in part by pairing them with mentors who had substantial experience of writing or editing scientific papers.
By 2013 AuthorAID's components were on-site and online instruction, a resource library, a blog, an e-mail discussion list, small grants and mentorship, run by a core team with volunteers and others contributing to aspects such as mentoring or translating materials. It is intended to serve developing-country researchers in all disciplines and regions, and medical researchers and professional medical communicators make up sizeable parts of its community.
Since 2008 the project has held several research-communication workshops a year in developing countries, among them Bangladesh, Colombia, Ethiopia, Ghana, Kenya, Nepal, Nicaragua, Pakistan, Rwanda, Sri Lanka and Tanzania. Researchers from the host country and sometimes elsewhere in the region attend, the network's local coordinators in its partner countries help arrange the workshops, and some are held jointly with partners such as the International Foundation for Science and the Pan Africa Chemistry Network or alongside conferences. The workshops typically last two to five days and combine lectures meant to give core content with small-group activities meant to help participants assimilate it and start applying it to their own work. They focus mainly on how to write and publish journal articles, with lectures on approaching a writing project, the content and organisation of the parts of a scientific paper, and the publication process. They commonly add material on posters, oral presentations and grant proposals, some deal mainly with grant proposals, and most include presentations on effective scientific writing in English and on further resources. Each workshop generally has one or more local co-facilitators, who relate the content to the local context and learn to give such workshops themselves. Attendees are encouraged to share the learning with colleagues and students, train-the-trainer workshops increasingly follow, and several co-facilitators and attendees have gone on to give workshops themselves. Besides imparting knowledge, skills and confidence, the workshops publicise the project, give a direct opportunity to assess needs and offer chances to test teaching materials. However, they reach relatively few researchers a year, and researchers in some high-priority countries cannot attend them.
To extend the workshops' reach, the project began giving online courses based on them. The courses run for about five weeks on a moderated platform, with numbers limited so that interaction and feedback stay ample, and participants either apply or are invited if they meet given criteria. A research-writing course was piloted in autumn 2011 at the National University of Rwanda and then run two or three times a year, a grant-proposal-writing course was first given in summer 2013 for women researchers who had applied for the project's grants, and a version on writing about research in environmental health was run with a charity working on pollution in low- and middle-income countries. Participants complete lessons and take part in a discussion forum, and almost all complete the assignments and receive a certificate. For sustainability, by 2013 the project was emphasising the embedding of instruction in developing countries, preparing researchers and others there to provide research-communication instruction themselves. It started in Sri Lanka in the first half of 2013 with a workshop on teaching research writing online and a more general one on teaching research communication, with mentorship and other guidance to follow in Sri Lanka and elsewhere.
The online community extends far beyond the researchers that workshops and courses serve. As of October 2013 the resource library held more than 600 items, among them presentations, largely from the workshops, articles and links to them, and links to relevant websites, searchable by subject area, language and medium. It included translations of project presentations into Arabic, Chinese, French, Portuguese, Spanish and Vietnamese, with more sought, and a Spanish-language version of the website had launched in June 2011. The blog, running since 2007 and weekly from 2008, carried three posts a week: a general post on a research-communication topic, a tip of the week, and a resource of the week. Many general posts give advice on communicating research, others report on the project's activities and opportunities or on relevant conferences, posts are increasingly written by researchers in developing countries, and all are archived on the site. The library and blog are open without registration, and registering adds the e-mail discussion list, through which researchers request advice, seek resources and share information, as well as blog notifications and the ability to contact other registrants, for example to find a mentor or mentee. By October 2013 there were more than 7,600 registrants from 183 countries, of whom about 1,500 had chosen biological sciences, 1,300 medicine and dentistry, 1,000 subjects allied to medicine and 700 veterinary sciences, agriculture and related subjects. In the year to July 2013 the site had nearly 64,000 visits from nearly 34,000 unique visitors, almost half of the visits from returning visitors. The most visits came, in descending order, from the United States, India, Nigeria, the United Kingdom, Kenya, Bangladesh, Uganda, Nepal, Pakistan and Ethiopia, and at least 1,000 each from Mexico, Canada, Sri Lanka, China and South Africa.
Small grants have been offered since 2011 in two kinds: workshop grants for giving research-communication workshops, which may but need not use the project's materials, and travel grants for presenting work accepted by conferences. They are restricted to applicants from countries the network and its funders specify as high priority, which in mid-2013 were Bangladesh, Bolivia, Cuba, Ecuador, El Salvador, Ethiopia, Ghana, Honduras, Kenya, Lesotho, Madagascar, Malawi, Mozambique, Nepal, Nicaragua, Pakistan, Rwanda, Sierra Leone, Sri Lanka, Tanzania, Uganda, Vietnam, Zambia and Zimbabwe. Competition is stiff, with dozens of applicants for the few grants in each category.
Mentoring was a distinguishing feature of the original vision, and it remained an important part of the project. Prospective mentors and mentees identify and contact each other through the website or are matched by the team, then continue through the site or by e-mail, video call or, where feasible, face-to-face meeting. The relationships range widely in content and duration and commonly centre on helping the mentee write or revise a paper for submission to a journal. Mentoring resources on the website include an explanation in the form of a comic strip, a brief guide for mentors, and a learning agreement that mentors and mentees are encouraged to complete and submit. Because reporting a mentoring relationship is voluntary and privacy issues have limited monitoring, only limited information was available in 2013 on the scope and outcome of the mentoring. Case studies and individual reports indicate that some relationships have been rewarding and productive, and efforts were under way to characterise the activity more extensively and build on it.
Contributing to AuthorAID
In 2013 demand for AuthorAID mentors was unmet. As of October 2013 about 5,500 registrants had indicated they could benefit from mentorship and only about 900 that they were interested in becoming mentors, and among registrants in medicine and dentistry the figures were about 1,000 and about 100. Anecdotal evidence suggests that professional medical writers and editors have been among the most committed and productive mentors. Mentoring is a chance for medical writers to provide substantial and satisfying international service, and for early-career writers a way to gain experience, broaden their horizons and build their CVs. A medical writer who taught researchers in Mozambique suggests that a writer who wants to promote good scientific writing more widely might register with AuthorAID, where the exchange with researchers from developing countries can help both parties; answering their questions often forces the writer to think a topic through more thoroughly.
Medical writers can also contribute in other ways, some of which need not be very time-consuming: suggesting existing resources on research communication or offering to develop new ones for the library, translating project materials if they are proficient in other languages, suggesting blog topics, posting comments or writing guest posts, sharing their knowledge on the discussion list, and, where the opportunity arises, helping facilitate a workshop or an online course.
AuthorAID's materials are also resources for medical writers to use and share. The resource-of-the-week post alerts writers to resources they can use themselves or suggest to the researchers they work with. The library holds much that writers can pass on to researchers wishing to refine their communication skills, teaching materials that a writer who gives workshops can employ or adapt, and material that junior writers may find helpful in learning the craft. The news archive, which held more than 600 blog posts by autumn 2013, has much that writers can use themselves or supply to others, and searching the website can reveal material on a wide range of topics in or related to medical writing. Although the project was developed for researchers in developing countries, much of the content can help anyone interested in skilful research communication.
Writing workshops and AuthorAID in the Eastern Mediterranean
Medical researchers in Middle Eastern countries have been forced to confront the fact that scientific publication has become the cornerstone of knowledge dissemination and academic promotion. Because scientific publication is essential for academic promotion and for comparing scientific output between countries, ministries of health and higher education in the region have promoted national and university initiatives to create scientific writing workshops. By 2013 the number of workshops had increased several fold, and they were held regularly. In some institutions, special centres have been created to help researchers and academics not only write their manuscripts but also design study protocols and statistical analysis.
The idea of the AuthorAID project in the Eastern Mediterranean (AAEM) emerged from the meetings of the Eastern Mediterranean Association of Medical Editors (EMAME), and the project was initiated in 2009 by Karen Shashok and Farhad Handjani with the support of Shiraz University of Medical Sciences in Iran. It matches AuthorAID volunteers with academics and researchers who have prepared manuscripts but need help to improve the English and the quality of the manuscript. It also gives regional journals consultations and editorial guidance to upgrade their quality and help them get listed on major indexing systems, and it includes talks and workshops on various aspects of scientific writing and publication. In 2013 the project was still active and still seeking volunteers and host institutions.
In the decades before 2013 the Middle East took great steps forward in medical research, writing and publishing, and regional initiatives such as the foundation of EMAME and AAEM had helped, but challenges remained. Increased training and educational programmes are needed, and medical researchers need to be better informed about the concept, importance and principles of scientific writing, topics that need to be incorporated earlier in existing educational programmes.
Mentoring authors who use English as an additional language
A mentoring programme for authors who use English as an additional language, whose key contributors were a journal editor, a language professional and a researcher on writing for publication in a global context, arose from the need to address inequalities in academic publishing. By 2013 it had included 55 authors over more than four years. Acceptance in anglophone centre journals, academic journals published in English in the UK and the USA, tends to carry the highest status but also considerable competition.
Writing support in research capacity-building programmes
Better Health for the African Mother and Child, a research and capacity-building programme formed in 2000 between the University of Zimbabwe, a Tanzanian university and medical centre, and the University of Oslo, had produced 41 publications by 2016. They appeared in African and international journals, on topics including predictors of failure to return for HIV test results, female genital cutting, the cognitive development of children born to HIV-positive mothers, and multidrug-resistant tuberculosis. The programme influenced policy in Tanzania, particularly in nutrition and in the prevention of mother-to-child transmission of HIV, and created networks of researchers within research topics and between several international universities. One of its studies, from 2010, explored why HIV prevalence among pregnant women is so much higher in Zimbabwe than in Tanzania, 26% against 7%, although all the risk factors tested were more common in Tanzania. The reason was still unclear in 2016, and the discrepancy was what first drew one of the programme's professors into its studies in Africa.
A medical writer was engaged in 2006 to help write applications for the programme's funding, and in 2013 was asked to give a manuscript writing course. She taught at a research centre in Harare established in 2010 for the programme's students, where in December 2015 a doctoral defence held in Oslo was followed in real time by more people than were present in Oslo.
In Mozambique, whose official language is Portuguese, researchers at a centre that does first-class research in infectious diseases and the social sciences struggled to communicate their science well in English. A medical writer who taught there for four months in 2015 started with very basic things, such as how to structure a research article, because what is taught in every European university does not come naturally to scientists who have not had that training. Her examples came from editing manuscripts by non-native speakers in Spain, since the mistakes Portuguese and Spanish speakers make in English are very similar. Daily visits to the hospital next to the centre opened her eyes to the human plights there and showed her that neglect is not solved by simply getting the necessary resources and technical knowledge.
She was later scientific coordinator of the same centre, in Manhiça, in 2017–2018, a role that included identifying and easing bottlenecks in publishing research results, and in which she found EMWA's training instrumental. One way medical writers can address the inadequate representation of authors from low- and middle-income countries is to expand young researchers' skills so that they can take the initiative in publications.
The Child Health and Mortality Prevention Surveillance network, funded by the Bill and Melinda Gates Foundation, identifies the real causes of child deaths in low- and middle-income countries with a minimally invasive method instead of traditional autopsy, and generates data crucial for designing interventions against preventable deaths. Its success hinges on teams of sociologists and anthropologists who prepare its implementation in communities. Its coordinators judged that its teams would benefit from structured in-person training in communicating their work, so a three-day workshop was held at the network's global meeting in Addis Ababa for participants from nine African and Asian countries, many with a humanities background writing for scientists and healthcare professionals. Besides structuring papers, writing abstracts, improving flow and style, overcoming writer's block and publication ethics, it covered formulating research questions and concrete objectives and writing concept notes for qualitative studies, which required the facilitator to read extensively on social-science conventions in design, analysis and publication formats. Individual work on each researcher's manuscript in progress was much appreciated, because their different levels needed very different input, from structuring an introduction to the clarity of particular sections and the editing process. Virtual follow-up meetings a month later were planned to ensure accountability.
In the experience of one writer who runs such workshops, working with authors from low- and middle-income countries brings particular challenges and rewards. Their baseline may be hard to judge when designing a workshop, because they often had no formal scientific writing training at university, and some are non-native English speakers, which workshops should keep in mind. Opportunities are rare, and funding for formal training has to be identified and may come from limited project funds, although capacity building has become a more frequent budget item. In return the audience is fresh and motivated to apply what it learns, and a wealth of data collected in larger research projects in many of these countries is yet to enter the public sphere, so enabling local researchers to publish it contributes indirectly to better health in their countries. The facilitator sees the impact up close, celebrates the authors' wins on their way to becoming cited researchers, and learns about the work of skilled researchers. She suggests that a workshop's facilitator would ideally accompany researchers over the long term, but only the largest and most affluent institutions can afford a fixed writing-support post. Such support is often not budgeted in global health projects, and the same writer holds that these researchers need it to give a voice to their research and challenge the authorship inequalities that prevail in international collaborations despite calls to decolonise global health.