Communication for Development One-year master
15 Credits Autumn, 2018
The use of video to communicate
water, sanitation and hygiene in Haiti
A comparison between SAWBO, GHMP and UNESCO’s
cholera prevention initiatives
ABSTRACT
Health communication campaigns in developing countries can take many different forms and make use of a wide range of communication tools. One of these tools are multimedia resources such as videos. Initiatives like the Scientific Animations Without Borders (SAWBO) or the Global Health Media Project (GHMP) have been created for the only purpose of developing videos adapted to different cultures and languages in order to tackle a variety of health issues relevant to developing countries. The present study pretends to focus on the use of such videos for water, sanitation, and hygiene (WASH) behavior in the context of cholera epidemic which hit Haiti in late 2010. By using comparative research procedures, three videos have been selected for content analysis from three different institutions: SAWBO, GHMP, and UNESCO Haiti. The results from this analysis served as guidelines for further survey analysis carried out through field questionnaires to a sample of the video’s target audience, that is, Haitian children aged from about 10 to 13 years old. The purpose of the study was to
understand and compare the impact and effectiveness of these resources in
transmitting disease prevention practices to the target audience. The results indicate that the videos usually coincided in the issues to inform about cholera, but differed in most of the features portrayed within the issues. Moreover, responses to the
questionnaires reflected that the messages portrayed were only retained by an average half of the participants, with more or less success depending on the topic.
Keywords: Health communication, WASH, cholera, Haiti, Communication for Development, video, cartoon, multimedia
TABLE OF CONTENTS
1. INTRODUCTION ... 4
1.1 HAITI AND CHOLERA ... 4
1.2 WATER, SANITATION AND HYGIENE IN HAITI ... 5
1.3 HEALTH COMMUNICATION AFTER THE CHOLERA OUTBREAK ... 7
1.4 RESEARCH DESIGN ... 8
1.4.1 RESEARCH QUESTION ... 9
1.4.2 UNITS OF STUDY ... 10
1.4.3 COLLABORATION WITH GAIN AND COGOP ORPHANAGE & SCHOOL ... 12
2. LITERATURE REVIEW ... 15
2.1 THEORETICAL FRAMEWORK ... 15
2.2 HEALTH COMMUNICATION IN DEVELOPING COUNTRIES ... 19
2.3 CONTEXTUALIZED VIDEO IN HEALTH COMMUNICATION CAMPAIGNS FOR DEVELOPMENT ... 22
3. METHODOLOGY ... 26
3.1 COMPARATIVE RESEARCH ... 26
3.2 CONTENT ANALYSIS OF CHOLERA PREVENTION VIDEOS ... 27
3.3 SURVEY ANALYSIS THROUGH QUESTIONNAIRES ... 34
3.4 DISCUSSION ON THE METHODOLOGY ... 39
4. FINDINGS ... 41 4.1 CONTENT PORTRAYED ... 41 4.2 CONTENT PERCEIVED ... 43 5. LIMITATIONS... 47 6. CONCLUSION ... 50 BIBLIOGRAPHY ... 52 APPENDICES ... 58
FIGURES AND TABLES
FIGURES
1. Informational poster for a cholera prevention campaign by MSPP ... 7
2. Knowledge rate before and after the OCV campaign (Haiti) by communication channels and type of information ... 21
3. SAWBO’s strategy to develop educational videos to low-literate contexts ... 23
TABLES 1. Summary of the impact of Cholera in Haiti, 2010-2018 ... 4
2. Variables and values for GHMP cholera prevention video ... 30
3. Variables and values for UNESCO cholera prevention video... 32
4. Variables and values for SAWBO cholera prevention video ... 33
5. Common variables and values for GHMP, UNESCO and SAWBO videos ... 41
6. Questionnaire correct answers for Group 1 (GHMP video) ... 44
1. INTRODUCTION
1.1 HAITI AND CHOLERA
Cholera “could not have emerged at a worse moment” in Haiti (Frerichs, 2016, p.2). The October 2010 cholera outbreak was neither caused by the earthquake nor by the devastating human conditions it brought about, despite the popular saying. In fact, it was proved to be brought by UN Nepali troops who were in the country since 2004 according to findings made by Renaud Piarroux, a French epidemiologist called by the Haitian government to track the origins of the epidemic.
In the first 3 months only, cholera had already caused 4.100 deaths1 and 185.000
suspects of being infected. The annual evolution of cholera in Haiti can be seen below: Table 1. Summary of the impact of Cholera in Haiti, 2010-20182
Year Population Suspect
cases Institutional deaths Communitary deaths Total deaths Incidence rate per 100 2010 10085214 185351 2521 1580 4101 18.38 2011 10248306 352033 1950 977 2927 34.35 2012 10413211 101503 597 311 908 9.75 2013 10579230 58574 403 184 587 5.54 2014 10745665 27392 209 88 297 2.55 2015 10911819 36045 224 98 322 3.30 2016 11078033 41421 307 140 447 3.74 2017 12201437 13681 110 49 159 1.12 20183 12542135 4437 18 21 39 0.27
Cholera has reduced drastically to only 39 deaths in the first 10 months of 2018, and 4.437 suspect cases. In 2017, most cases were detected in three main states4:
Artibonite (854), Centre (774) and Ouest (561) where Port-au-Prince is, and also the
1 Data accessed from periodical cholera reports by the Haitian Public Health ministry, available at:
http://mspp.gouv.ht/newsite/documentation.php
2 Idem
3 As of 27th, October 2018. It was the last data available when retrieved on 22nd November, 2018.
4Pan American Health Organization / World Health Organization. Epidemiological Update: Cholera. 6
August 2018, Washington, D.C. PAHO/WHO, 2018, Retrieved from
https://www.paho.org/hq/index.php?option=com_content&view=article&id=14544:6-august-2018-cholera-epidemiological-update&Itemid=42346&lang=es
area of concern for the present study: Ça-Ira (Leogane). However, the chances for a new outbreak seem to be always at stake. A first rupture with the decrease rate was in May 2014 when cholera reinvigorated after a rainy spring season, despite being at its lowest in the first months of 2014. The disease rebounded especially in areas “where little or nothing had been done to reduce local vulnerability” (Frerichs, 2016, p.4). Two years later, a third outbreak was influenced by Hurricane Matthew hitting Haiti in October 2016, which caused 546 deaths and affected 2.2 million people5. The cholera
death toll raised again from 275 in the first 10 months to 447 at the end of 2016. These events showed once again that adverse weather conditions are favorable for the spread of cholera, but also proved the importance of water, sanitation and hygiene facilities “since both water and sanitation were insufficient” in Haiti at the time, and bacteria “became abundant in the aquatic environment” (Khan et al., 2017, p.902). In fact, 34 cholera treatment centers out of 212 were destroyed by the heavy winds and many cholera patients were treated alongside other patients, which increased the risk of infection6.
1.2 WATER, SANITATION AND HYGIENE IN HAITI
To “ensure availability and sustainable management of water and sanitation for all” is UN’s Sustainable Development Goal no.6. Access to water and sanitation are indeed a Human Right since 20107. Still, 29% of the global population lack access to safe
drinking water and 61% are without safely managed sanitation services8.
But there is a third element to add to water and sanitation: hygiene. All three words make up what is known in development as WASH (water, sanitation and hygiene). The effects of a lack of all three elements can be perfectly identified in a cholera outbreak as was the case in Haiti. According to a WHO report, cholera and other diarrhea related diseases are linked to different transmission pathways which have to do with water, hygiene or sanitation, or a combination of them: ingestion of unclean water, lack of
5 According to UNDP:
http://www.undp.org/content/undp/en/home/blog/2017/1/11/Three-months-after-Hurricane-Matthew-seven-years-after-the-earthquake.html
6 OCHA Situation Report no.12 (17 October, 2016). Available at:
https://reliefweb.int/report/haiti/haiti-hurricane-matthew-situation-report-no-12-17-october-2016
7UN Resolution 64/292 (28th, July, 2010): http://www.un.org/en/ga/64/resolutions.shtml 8 For more on SDG no.6, see: https://sustainabledevelopment.un.org/sdg6
water linked to inadequate personal hygiene, poor personal, domestic or agricultural hygiene, contaminated water systems, etc. (WHO, 2014). But as well as a combination of water, hygiene and sanitation deficit is able to trigger diarrheal diseases as cholera, it has been proven that an integral intervention may reduce the risks in developing countries up to a 12% reduction rate. This means that up to 1.000 lives may have been saved from the Haitian Cholera outbreak with proper WASH facilities and knowledge. WASH conditions in Haiti were already a growing problematic even before the 2010 earthquake. Before the disaster, only 69% of Haiti’s population had access to safe water and 17% to improved sanitation facilities9. Sanitation coverage decreased from
26% in 1990 to 17% in 2008 (Tappero & Tauxe, 2011). Disparities between urban and rural areas were evident: 85% against 51% of access to safe water, and 24% against 10% of access to improved sanitation, respectively10. A reform of the water and
sanitation sector was voted in the Haitian parliament in March 2009, only 10 months before the earthquake. This propitiated the creation of the National Directorate for Portable Water and Sanitation (DINEPA by its French acronym). But DINEPA’s focus shifted from long term development to emergency response right after the
earthquake. At the same time, foreign governments, multi-lateral lending institutions, NGO’s and other organizations were also committed to improve WASH conditions then. More than 100 NGO’s were identified to develop projects intended to improve WASH conditions in addition to a multitude of small-scale projects from small faith-based groups (Gelting et al., 2013).
The efforts had some good results and “residents of IDP camps had been largely spared from the outbreak because of safe water supplies and improved sanitation” (Tappero & Tauxe, 2011, p.2091). Some of the developments included increased chlorination of water supplies, rehabilitation of distribution networks and water treatment stations, distributions of household water treatment products and soap, and cholera prevention and hygiene promotion campaigns (Gelting et al., 2013). However, these efforts were mostly emergency response. In the following years, many activities ceased, while DINEPA retook some of the reforms planned in 2009. A
9 WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation, 2012. Progress on
Drinking Water and Sanitation: 2012. Available at: https://reliefweb.int/report/world/progress-drinking-water-and-sanitation-2012
‘National Plan of Action for the Elimination of Cholera in Haiti’ was approved by the Ministry of Public Health and Population (MSPP by its French acronym) which provided 2.2 billion U.S. dollars for the eradication of cholera, of which 70% were designated to developments in the WASH sector11 through DINEPA. Nowadays, Haiti’s score of the
SDG no.6 went from 54% in 2017 to 61% in 201812, confirming the good progress of
WASH improvements in the country.
1.3 HEALTH COMMUNICATION AFTER THE CHOLERA OUTBREAK
One of the 9 specific objectives set by MSPP for the eradication of cholera was “that by 2022, 75% of the general population in Haiti will have knowledge of prevention
measures for cholera and other diarrheal illnesses”13. Right after the cholera outbreak,
NGO’s and public institutions immediately lead health communication campaigns tackling the risk of cholera infection and encouraging the population to pay attention to WASH recommendations. These campaigns were targeted both to health
11 “National Plan for the Elimination of Cholera in Haiti, 2013–2022, Short Term Plan 2013–2015”:
http://new.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=20578&Itemid=270
12 Data available at: http://opendata.investhaiti.ht/ttdsgad/haiti-mapping-tool-english
13“National Plan for the Elimination of Cholera in Haiti, 2013–2022, Short Term Plan 2013–2015”:
http://new.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=20578&Itemid=270
professionals and general population with the aid of the Center for Disease Control (CDC) (Tappero & Tauxe, 2011). Moreover, MSPP broadcasted messages, displayed banners, and sent text messages encouraging people to take specific measures to prevent cholera. Even Haitian President René Préval led a 4-hour televised public conference to promote cholera prevention.
In May 2011, an investigation and joint statement by US researchers informed that in the first two months after the outbreak, IDP camp managements implemented 670 cholera risk-reduction activities in camps and their surrounding communities. “UN education cluster partners distributed cholera prevention and water treatment
protocols in schools across the country; phone companies, along with the International Federation of the Red Cross and Red Crescent Societies, the International Organization for Migration, and others, sent public health warnings via SMS; and radio stations dedicated broadcasts to education programs, provided updates from the MSPP, and answered caller questions” (Farmer et al., 2011).
1.4 RESEARCH DESIGN
The present thesis covers the impact of Health/WASH communication campaigns in Haiti with a particular focus on one specific communication tool: video. Its specific goal is to compare health communication video initiatives working towards cholera
prevention and the promotion of water, sanitation and hygiene practices in Haiti. The methodology for the study is based on comparative research using two different methods: first, the comparison of video initiatives and their content by way of content analysis; secondly, by analyzing the coherence -or not- of such content with the video’s target audience perception by a survey analysis exercise. It is a sequential process, which means that the survey analysis depends on the content analysis findings to determine the content used for the questionnaires. In other words, the survey analysis uses questionnaires which questions are derived from the issues highlighted by the content analysis. This is an important feature of the research as it increases the reliability and validity for the survey exercise in a significative way.
1.4.1 RESEARCH QUESTION
From the description above, the research question can be easily stablished:
What are the similarities and differences between different health communication videos tackling WASH/cholera regarding content portrayed and content perceived by
the target audience?
First, the question reveals that it is a double-sided research question: on one side, the content shown or portrayed by the videos regardless of the public to which it is directed; on the other side, the content understood or perceived by the identified target audience to which the videos are directed. It does not mean there are two questions or even more in the research question, though. The “content portrayed” and “content perceived” part of the question might be summarized as “impact”, but then, the two phases of the transmission of content would not be as evident in the
questions. The same is applied to “similarities and differences”, which are the two objectives from comparative research. In fact, a first draft only included “differences”, but “similarities” was included afterwards.
What is the purpose of asking this research question? What do I pretend to achieve with it which may be relevant to Communication for Development? Why should the answer to this question matter? The approach to Communication for Development in this thesis, as it will be explained in more detail in the concluding chapter, is linked to the notion of “seeking change”14 and more specifically to the field of Social and
Behavior Change Communication (SBCC). By comparing the “impact” (content portrayed vs. content perceived) of these video initiatives we will be able to identify which of them has had more success and effectiveness, or which health messages were retained by the target audience, which have not been retained. Therefore, the question is leading us to understand what is the impact (change) in the target audience’s mindset, and also what changes need to be made in order to be more effective in transmitting content: Are the videos effective in order to transmit at least the basic ideas of cholera prevention practices? To what extent (percentage)? Is one video more successful than the other in the general perspective? What issues are highlighted in these videos both in terms of the message and the retention of it by the
target audience? Were the messages in the videos captured by the viewers’ mind? All these are subsequent questions that derive naturally from the primary research question.
Almost every health communication program in developing countries seeks some kind of change (Bertrand, Babalola & Skinner, 2012). This case is not an exception. Our study, however, does not deepen into the visible behavior change processes, but rather focus on the cognitive side of behavior change among children, that is the initial phase of behavior change. It humbly tries to set the ground for further SBCC
interventions and communication campaigns which might profit from the findings.
1.4.2 UNITS OF STUDY
Ti-Joel “Campaign Against Cholera” by UNESCO Haiti and MSPP
The UNESCO Campaign Against Cholera implemented after the 2010 cholera outbreak consisted of several resources integrating a famous Haitian cartoon character, Ti-Joel, “to show young people how to protect themselves from cholera at school and
outdoors, how to purify water and how to prepare oral serum”15. A total of six short
animated films were produced and spread through national public TV as well as private TV channels and made available in internet and social media16. Apart from these, a
44-page comic book was also created with the same stories. It was distributed by the Haitian Ministry of National Education and Vocational Training, UNICEF, PAHO/WHO and other organizations in schools, recreations centers for children, IDP camps, libraries, community centers, scout organizations, health centers and cholera treatment centers17.
For the sake of time and focus, only one of the six videos has been selected for study. The selection criteria was mainly based on similarities to other videos used in the study, length -the more length, the more content-, and number of shots and
15 For more on the campaign, see: http://www.unesco.org/archives/multimedia/document-2134 16 According to news article: https://www.20minutos.es/noticia/1077560/0/dibujo/animado/colera/ 17 OCHA Humanitarian Bulletin: 19th, November, 2011. Available at:
sequences -the more shots and sequences, the more content too-. The selected video can still be found in the UNESCO official Youtube channel18.
“The story of cholera” by Global Health Media Project
The Global Health Media Project (GHMP) is a non-profit organization that designs and produces video and animation video to teach healthcare practices for frontline health workers and families in low-resource settings (Monoto & Alwi, 2018). Both “The story of cholera” and “The story of ebola” videos are of important success for the purpose of developing short films to use during epidemic crisis to teach citizens on how to deal with the disease and how to prevent it. However, there are a high number of videos available at its website for different healthcare issues19.
“The story of cholera” was produced in response to the Haitian cholera epidemic outbreak in 2010 in order to help “affected populations around the world better understand cholera and how to prevent it”20. It was dubbed into 35 different
languages and it “has become a favorite educational tool among communication for development specialists, aid workers, animators, and public health experts”21.
According to the GHMP website, “several experts made sure that the technical information on cholera was accurate and up-to-date”, among them UNICEF’s Deputy Coordinator of the WASH cluster in Haiti in 2011. The video may be watched and downloaded at the GHMP platform22.
“Cholera Prevention” by Scientific Animations Without Borders
Scientific Animations Without Borders (SAWBO) is an initiative from the University of Illinois seeking to provide animation materials on different development topics in local languages in order “to improve the livelihoods of low-literate learners” (Bello-Bravo, Olana & Pittendrigh, 2015, p.27). Topics covered by the SAWBO videos include: agriculture, health, women empowerment and economic development. Most of the
18 See: https://www.youtube.com/watch?v=ruh0pashlJ8 19 GHMP video platform: https://globalhealthmedia.org/videos/
20 According to GHMP’s website: https://globalhealthmedia.org/what-we-do/projects/about-cholera/ 21 Idem
videos are short 3-D animation. These are produced through partnerships and
collaborations, and made available through the website, but also via the University of Illinois online library system as well as provided by SAWBO for communication for development projects through a recent Deployer app developed for field workers23.
The cholera prevention video was also created for the specific context of the Haitian outbreak in 2010, months before the SAWBO project was officially launched
(Miresmailli, Bello-Bravo & Pittendrigh, 2015). “A script was given to the animation team, and the animation was then created and reviewed. Upon approval, language overlays were created in Creole, French, Spanish, and English, and the animations were given out to a diversity of organizations for free distribution” (Bello-Bravo, Seufferheld, Steel, Agunbiade, Guilot & Pittendrigh, 2011, p.55). The cholera prevention video is available for watching and downloading at the SAWBO platform24.
1.4.3 COLLABORATION WITH GAIN AND COGOP ORPHANAGE & SCHOOL One of the main reasons for choosing the theme for the thesis is the previous relationship with Global Aid Network (GAIN)25, an international NGO with
development and humanitarian relief projects distributed in more than 50 developing countries. One of them is a school and orphanage rebuilt after the 2010 Haitian earthquake in the Ça-Ira village (Leogane, West Department) run by GAIN and by its local partner COGOP, a faith-based community and network of churches within the country. I was myself a volunteer in 2015 during 5 months in the project where, among other things, I worked as school teacher, an experience which has facilitated the contact with field workers for the purpose of the study.
The GAIN Spain office, to whom I have close contact, is the responsible for the
evaluation and improvement of water, sanitation and hygiene not only for the school and orphanage, but also for the Ça-Ira community. Early talks with GAIN Spain office on the opportunity to elaborate this thesis around the Ça-Ira project developed in several ideas which went from creating the basis for a WASH communication campaign
23 See: https://www.youtube.com/watch?v=1DrbWxL8dRQ
24 See: https://sawbo-animations.org/video.php?video=//www.youtube.com/embed/4kgriJ7A-IA 25 For more on GAIN’s work and structure, see: http://www.gainworldwide.org/
to integrating the study in one of the biggest necessities there at the moment: latrines and the appropriate use of them. However, two major reasons forced us to reject these ideas: 1) time constraints; 2) they required a longer and more sophisticated field research work, the success of which could not be guaranteed. After an evaluation of previous studies and availability of resources, it was decided to evaluate the impact of WASH video resources for the opposite reasons: it was very plausible in terms of time, and more simple field research work could still be carried out with much higher success possibilities.
Despite the initial possibility to join in a field trip, it was decided that the survey could be perfectly carried out remotely thanks to the close contact and communication with the Ça-Ira orphanage and school as well as with a WASH committee created by GAIN Spain. Anna Mueller, a GAIN worker from Germany living and working there for the past three years was thought to be the perfect contact in the field as I personally knew her from my time in Haiti. Also, she was now the link between GAIN Spain and the WASH committee. After explaining the purpose of the study and giving details to her of what was needed, she offered to carry out the screening of the videos and undertake the survey exercise. After her acceptance to help, more details were given to her and the videos for study were uploaded to a Dropbox folder from where she downloaded them. The videos were uploaded with different sizes in case the internet network speed did not allow to download the high-quality videos. A small retribution or donation was given to Anna in gratitude to her willingness to help, even though she refused at the first time because it was something she was “happy” to help with. Since the videos were going to be shown in Haitian Creole -despite using English transcripts for the content analysis-, it was asked from Anna to check the translation, to what she responded it was well translated from English to Haitian Creole. Once the content analysis was finished, the questionnaire was created and sent for translation to two other field contacts which will be further detailed in the survey exercise explanation. The Creole version of the questionnaires was then sent to Anna with more specific details on the procedure and deadlines. More information on the sampling and on previous steps taken for ethical considerations are explained further in the survey chapter under ‘methodology’.
Potential benefits and outcomes for GAIN
The present research may have several interesting practicalities for GAIN in its holistic approach to water, sanitation and hygiene in the Ça-Ira community. First of all, the background information gathered about different topics such as the evolution of WASH and cholera in Haiti, and others -some of which have been excluded from the degree project for several reasons, i.e., an update on the estimate census of the Ça-Ira community- as well as most of the research analysis included in the literature review will add to the NGO’s documentation.
Apart from the already existing projects, GAIN has also been thinking of the possibility to work on SBCC campaigns to teach villagers on recommended WASH practices in order to prevent waterborne diseases. This is where this study comes in. From my experience in Haiti, I discovered how much cartoon films have an impact on these children. They would stop whatever they were doing to watch a movie, no matter whether it was more or less boring, or it was longer or shorter, and they would remember scenes and messages for several months. On the other side, schools are critical to the communication of WASH practices to children, and children are highly effective change agents to their families when it comes to WASH issues, as field research shows (Bresee et al., 2016). To analyze the impact of these animated cholera prevention videos will help to understand their strengths and shortcomings, the highlighted messages which have been understood, the ones which have not, etc. All of this within the context of children from the Ça-Ira school.
Moreover, GAIN Spain has links to university students and professors in Valencia and Barcelona, which has been an important part of its strategy for involving volunteers in development projects lately. It is not at all discarded that a project like an animated video to communicate water, sanitation and hygiene in Haiti would be done in collaboration with university students or even scholars, probably not on cholera prevention (as there are some already), but on related WASH issues. Therefore, the results from this research might give indications on what information needs to be strengthened, what is the most effective model to use, etc.
2. LITERATURE REVIEW
2.1 THEORETICAL FRAMEWORK
Communication for Development and Social Change
The present study is clearly framed within the field of communication for development or ComDev. It focuses on the study of a specific communication format as multimedia and videos while analyzing its implementation on WASH and health communication campaigns for improving societal knowledge and behavior. Moreover, we have set the study in Haiti where health communication campaigns have been so important in the last years after the 2010 earthquake and the cholera outbreaks which followed. Therefore, more than asking if this study fits more or less within the ComDev field, the real question is: how is this thesis relevant for ComDev?
First, it must be clear that the notion of development used here does not concern neoliberal approaches to development where mismanagement is the principal reason for the existence of under-developed societies (Nederveen Pieterse, 2010). But it does not ignore, however, the role of economic progress in bringing better health
infrastructures and resources at a national scale, and health conditions and access to resources on a personal scale, as it is the matter of concern in the present study. Nobody questions that the new cholera outbreak and the more than hundred deaths caused by Hurricane Matthew in Haiti in 2016 were highly favored by the widespread state of poverty in the country when comparing the post disaster situation in Cuba or Saint Vicent and the Grenadines where the hurricane hit even stronger.
Post-development theorists may be right when stating that neoliberal Post-development actions such as World Bank and IMF policies do not take into account cultural and historical variables (McEwan, 2009), as well as to consider the degradation of development as a business and cultural westernization (Nederveen Pieterse, 2010). But the importance of economic progress and poverty reduction in development should not simply be taken out of the equation. It is one more factor to development, an important one, but not the only one.
As Clammer (2012) states: “The answer cannot lie in the reduction of poverty alone, but must reside in accompanying resocialization, education and cultural rather than material development, the last being the most neglected element of all in
development studies” (p.20). Health communication campaigns attend the educational and cultural side of development, but as noticed by Farmer et al. (2011), any efforts towards behavioral change and knowledge acquisition were irrelevant in the Haitian case when not accompanied by resources.
The development world is facing more severe and complex communication challenges which development agents seem not to be adequately prepared to meet (Hemer & Tufte, 2012). Meanwhile, the field of communication for development has been facing a reformulation of its core values and conceptualizations in the era of globalization. This coping with the “transitional processes of the global present” as described by Hemer & Tufte (2012) might be demanding ComDev to “step back and reflect, to analyse and understand, rather than to impose development strategies” (p.234-235). This reflection points to every branch of the communication for development field, including health communication for development.
The first World Congress on Communications for Development (Rome, October, 2006) stated that ComDev was “about seeking change at different levels including listening, building trust, sharing knowledge and skills, building policies, debating and learning for sustained and meaningful change” (World Bank, 2007, p.23). This definition is based on a strong relationship between scholars and practitioners, between academic spheres and development agents. Field research is a very important link between them in order to understand communication as a powerful force for social change.
That is indeed the objective of health communication campaigns in developing countries: social change. Communication for development has different variants depending on its goal, and it might be interpreted with different nomenclatures such as communication for social change or even combine both as communication for development and social change (CDSC). It is appropriate to remark that even Wilkins (2009) recognizes the problematization of both the ‘development’ and the ‘social change’ concepts. On one hand, development presents clear historical limitations due to its traditional meaning which usually didn’t include individuals as powerful actors for social change. On the other hand, the term ‘for social change’ is ambiguous in many aspects. These conceptualization struggles are partly explained by the intersectional function of ComDev which pursues both individual behaviour and social changes as well as socio-economical changes (Enghel, 2013). The truth is that the field seems to be
moving beyond the concept of development towards a broader emphasis on communication for social change which recognizes that processes of change are a recurrent and permanent feature of societies, and that communication plays an intrinsic role in those processes (Obregon, 2014).
Entertainment-Education in Social and Behavior Change Communication (SBCC) Besides its inclusion in the field of CDSC, this thesis also steps on the ground of a few theories related to ComDev. The most remarkable are Social and Behavior Change Communication (SBCC) and Information, Education and Communication (IEC) theories linked to Entertainment-Education programs.
First of all, let us differentiate Entertainment-Education from Edutainment in that, briefly said, the first seeks entertainment prior to education, while the latter works in the opposite way, that is, it tries to teach with an entertaining approach to the lessons, but it is not an entertainment product in itself (De Fossard, 2016). Our study moves in between them. For instance, the SAWBO video leans more to the Edutainment
concept as the narrative is purely instructional, but the UNESCO video fits better as Entertainment-Education for its mostly storytelling narrative. On the other hand, the GHMP initiative combines both instructions and storytelling in a fairly balanced way, which is a very good feature, since it is usually a fact that health communication campaigns tend to focus too much on education while not enough on entertainment, and vice versa (Piotrow & De Fossard, 2003).
Behavior Change Communication (BCC) is an interactive process with communities to develop messages and approaches using a variety of communication channels to promote positive behavior in individuals (FHI, 2002). However, this individual approach shifted into Social and Behavior Change Communication, a process which focuses more on sustainable behavior change at a societal level (McKee, Becker-Benton & Bockh, 2014). In this sense, scholars started to “move beyond individual behavior change to focus on the structural determinants of development, and the assumption that empowering communities through effective communication processes makes
individual and collective change possible” (Obregon & Tufte, 2014, p.191). Therefore, SBCC may be better defined as an approach seeking to address change not only at the
individual level, but also and specially at the community and social level through integrated communication strategies (Obregon & Waisbord, 2012).
Important to notice is that SBCC has much to do with health communication. In fact, BCC was born within the health sector (McKee, Benton & Bock, 2014) and it is generally understood as an approach used in health communication programs. Even though a larger scale study would be needed to shed more light on the impact of animated videos within health communication campaign in the Haitian society, the present study is not only about analyzing individual BCC in a small school in a village, but also serves as a pilot study for larger studies with the capacity to analyze the phenomenon of audiovisual Entertainment-Education campaigns and its effect in the Haitian society so to work on the social change processes. Moreover, narrowing down the study to a smaller and more specific audience has led the thesis to a quite
interrelated approach with SBCC: Information, Education and Communication (IEC).
Entertainment-Education in Information, Education and Communication (IEC) The differences between SBCC and IEC have never been clear enough to researchers (Clift, 1998). However, the key to differentiate them is the specificity of the latter. The IEC approach is understood as the development of planed communication
interventions and strategies that combines informational, educational and
motivational processes aiming at influencing behavior among specific audiences or groups (FHI, 2002; Clift, 1998) regarding a specific problem in a predefined period of time (WHO, 2001). IEC is a multidisciplinary approach drawing from the fields of previous theories as BCC and others such as diffusion theory, social marketing, behaviour analysis, anthropology, and instructive design (WHO, 2001). It is also very well integrated into the study of health communication strategies.
This framework is where this thesis settles as it is analyzing the impact of a specific communication strategy (Entertainment-Education) in a specific target audience within a specific community (school children in Ça-Ira) regarding a specific problem (WASH and cholera prevention behavior). Also, if a ComDev project would essentially come out of the findings, it would be the production and deployment of discrete
regarding SBCC, which rather seeks to establish communication as strategic and integrated interventions into entire programs (FHI, 2002).
2.2 HEALTH COMMUNICATION IN DEVELOPING COUNTRIES
The range of journals including articles on health communication campaigns, and the range of countries covered by such campaigns “is laudable” (Sood, Shefner-Rogers & Skinner, 2014, p.81). According to Ahmed (2012), adapting from different authors, health communication might be defined as “the study of the interactions among various participants in the health care process, the dissemination of health-related messages and messaging by individuals, groups, and/or mass media to other
individuals, organizations, and/or the general public, and the interpretation of these messages” (Ahmed, 2012, p.148). Its main goal is “to increase awareness and
knowledge about a particular issue; to modify or influence behavior; and to encourage healthier lifestyles” (Rozario & Arulchevan, 2015 citing Leiner, Handal & Williams, 2004, p.232).
There is general consensus among scholars that health communication campaigns are necessary to achieve behavioral and social change in health development. However, it is also believed that these campaigns in development contexts are usually of modest impact. These shortfalls may be explained by the common comparison with successful health communication campaigns in Western culture and by the complexity of any communication campaign in developing countries (Sood, Shefner-Rogers & Skinner, 2014).
Through their thorough research on publications about Health Communication in developing countries, Sood, Shefner-Rogers & Skinner (2014) detected several main topics: HIV/AIDS and sexually transmitted infections and contraception; maternal, newborn and child health; chronic and non-communicable diseases; communicable diseases (tuberculosis, malaria, etc.); and safe water. What is most interesting to notice from this research, though, is the importance of combining multiple approaches and channels. “The fact that most campaigns do not rely on one strategic approach, but instead combine mass media, community mobilization, interpersonal approaches and, increasingly, interactive and mobile technologies, is a testament” to the idea that
the more communication, the better the impact (Sood, Shefner-Rogers & Skinner, 2014, p.81). This has been proved in many health communication campaigns across the globe, from HIV/AIDS campaign in rural Uganda (Mitchell, Nakamanya, Kamali & Whitworth, 2001) to WASH campaigns in Rwanda (Chankova, Hatt & Musange, 2012), and even Haiti (Mathieu et al., 2004). Communication channels are demonstrated to be ineffective when used in isolation of other communication channels.
WASH communication in Haiti after the 2010 cholera outbreak
Fortunately, there is enough research to understand WASH communication campaigns in Haiti and their results after the 2010 cholera outbreak. Because of the renown explosive character of a cholera outbreak, an emergency public health campaign started immediately including health communication initiatives. At the same time, research and evaluations were also initiated even without institutional review due to the emergency character of the problem as approved by CDC (Beau de Rochars et al., 2011). Such evaluations were done through surveys to 405 households from 27 clusters in resource-limited areas surrounding Port-au-Prince before and after WASH communication campaigns were carried out by MSPP. Most of the households had access to mobile phones, radio and television, the latter being the preferred ITC to be informed about cholera, which confirms the appropriateness of focusing our research on audiovisuals. Regarding knowledge gained through the campaigns, awareness on cholera’s common signs among respondents was high as well as of transmission modes. The most common prevention method cited was handwashing (86%).
Therefore, campaigns proved to be somewhat effective, but authors recommended to keep carrying out communication campaigns, especially focusing on cholera
prevention.
A joint statement by health professionals and scholars in Haiti and the US strongly suggested the necessity to combine community education through communication campaigns with the provision of necessary supplies in order to “improve hygienic behavior and reduce social stigma” (Farmer et al., 2011, p.9). WASH communication campaigns proved to be effective, but they were worthless if the community did not have access to water treatment products, latrines, etc. Surveys carried out in schools
through Petit Goave and Miragaone (West Department) one month after the cholera outbreak also found that if facilites such as soap and proper latrines were not
provided, pupils would not retain their gained knowledge on hygiene after communication campaigns (Prandini, Giardina & Sorlini, 2013).
Evaluations on the success of WASH communication campaigns in Haiti have continued through the years. One of them was Childs et al. (2016) done through household surveys after MSPP implemented its first oral cholera vaccine campaign in 2013 in Petit Anse (Gonave Island) focusing on oral messaging, posters and pamphlets. The study found that all respondents for the pre and post campaign surveys had heard of cholera and different aspects of the disease. “49% and 50.4% reported receiving educational information on cholera within the past 6 months” (Childs et al., 2016, p. 1310). The communication channels through which they received such information and the type of information gained are shown in Figure 2 below. The increase in response rate over health professionals and CHW shows that the campaign focused heavily on oral messages while dismissing the use of radio and TV.
A different study in the Artibonite Department found that health messages related to WASH issues were retained by the community, especially regarding hand washing, use
Figure 2. Table included in Childs et al. (2016) showing knowledge rate before and after the OCV campaign by communication channels and type of information.
of latrines and proper food handling (Gaines et al., 2015). All respondents could
describe messages heard in the past year and some of their behavior changed because of these messages. Interestingly, different field research showed the same results for retention and behavior change on a larger, national scale. According to Beau De Rochars et al. (2011), household water treatment increased from 30% to 74% because of health communication campaigns. Also in the Artibonite Department, a more recent research about WASH communication campaigns concluded that messages through the different communication channels (CHW, radio, SMS, church, etc.) had been well retained, specially regarding hand washing which had been internalized in almost all participants after having heard of the consequences of not doing so (Williams et al., 2015).
2.3 CONTEXTUALIZED VIDEO IN HEALTH COMMUNICATION CAMPAIGNS
FOR DEVELOPMENT
There are several communication approaches in health communication campaigns, within which there is a disparity of communication channels and mediums used. Video animations is only one of them, but one which is attracting more and more attention from scholars and practitioners in the last decade. Not only for health communication purposes. In 2010, already 78% of development organizations in Asia and Africa used live-action videos in their training programs with farmers according to a study (Van Mele et al., 2010). Whether cartoon, 3-D animations, live-action, or any other video formats, its growing use comes aside the development of new ICT’s in developing countries which have made of educational videos and similar forms of ‘Entertainment Education’ and ‘Edutainment’ a potential competing or complementary approach to development communication for traditional mediums, especially radio (Bello-Bravo, Olana & Pittendrigh, 2015; Ramirez & Quarry, 2004). Moreover, internet as a source of information is increasing in developing countries, making access to health
communication resources more feasible. As an example, several African-based studies have proved that most people with internet access use it to inform themselves about health issues like cancer or HIV/AIDS (Okonofua and Olagbuji, 2014; Kivuti-Bitok et al., 2012). It is also known that cell phones as a tool to see health communication videos are already highly profitable in developing contexts, as it was the case with a cholera
and malaria prevention campaign in Benin using SAWBO’s materials (Bello-Bravo, Dannon, Agunbiado, Tamo & Pittendrigh, 2013).
An important notion to the development and deployment of videos as a tool to communicate on health is contextualization. Factors such as belief systems, religious and cultural values, life experiences, and group identity “act as powerful filters” through which health information is communicated (Thomas, Fine & Ibrahim, 2004, p. 2050). To adapt the content to the local reality is nothing new to development
practices, but recent studies keep arguing the importance of also developing locally-based videos. Frett el al. (2016) analysis of the impact of health communication videos in Haiti to prevent cervical cancer and promote vaccination developed into videos written and featured by local film professionals within a typical family scenario in Haiti. Results showed that knowledge on cervical cancer and prevention methods increased significantly. Another example of good practice to avoid ‘westernized’ health
communication videos are SAWBO procedures as despite being based in the US, they do not produce videos themselves, but work alongside local partners for creation and deployment (Bello-Bravo, Olana & Pittendrigh, 2015) as it can be seen below:
The effectiveness of contextualized videos in health communication for development has been demonstrated by many field research studies. To mention some examples, Chartchalerm et al. (2010) examined the knowledge of villagers in a Klongmai
community in Thailand regarding diabetes in order to develop an “effective” video (p.59). The resulting video demonstrated that both diabetic and non-diabetic
participants who watched the video gained knowledge on all dimensions of diabetes education despite the complexity of the content. As most research by SAWBO founders Bello-Bravo and Pittendrigh, their case study in Benin found agricultural as well as cholera and malaria prevention videos to be well-received by local population as training and learning tools (Bello-Bravo, Dannon, Agunbiado, Tamo & Pittendrigh, 2013). Yeager et al. (2002) research on a campaign for the promotion of hygienic feces disposal behavior in Lima, Peru, used video presentations, leaflets and counseling by health staff in consultations. All three types of communication were well-received by the community, but videos were “extremely well received” by health staff and audience (p.767).
However, probably the most related study to our subject of concern is that of Rozario & Arulchevan (2015) which analyzed the benefits and shortcomings of 10 animated cartoon videos to communicate health messages in developing countries by way of content analysis. Among the findings were: characters portrayed more adults than children; average length of videos was close to 5 minutes; there was a mix of 1st, 2nd
and 3rd person narratives; the main protagonist acted in most cases as the change
agent profile, being a male in 7/10 cases; the issue was not highlighted in detail in most cases; and 7/10 did not show heavy imagery such as wounds, blood, etc. From the content analysis results, the authors elaborated a list of 20 recommendations to animation videos for health communication in developing countries which can be read at the Appendix 1.
On the potentialities of video as a health communication tool, Bello-Bravo, Olana & Pittendrigh (2015) derived three different conclusions from three different studies: 1) information is accurately understood (Medhi, Prasad & Toyama, 2007); 2) viewers are more easily motivated (Ladeira & Cutrell, 2010); and 3) videos have the capacity to inform about complex issues in a simple manner (Lie & Mandler, 2009). Moreover, Rozario & Arulchevan (2015) identified up to 12 major benefits from using animations, also based on a thorough literature research. These are: 1) greater production
flexibility; 2) it grabs the viewer’s attention; 3) it leads to increase in recall of information: 4) it overcomes barriers of age, culture, language or literacy levels; 5)
easily customized for regional use; 6) appealing to a wider audience; 7) animated characters are more relatable; 8) depiction of complex ideas; 9) depiction of sensitive information; 10) removal of unnecessary elements such as heavy imagery and sounds; 11) emotional connection; and 12) motivation to learn and put into practice the ideas included in the message by feeling identified with the characters (Rozario &
Arulchevan, 2015, p.234-236).
Now for the limitations of videos as tools for communicating health, most of them have to do with ICT’s limitations in developing countries. A survey of 1.700 projects on mobile technology for health concluded that most services did not provide “essential, actionable, offline guidance for direct use by citizens addressing the range of acute healthcare situations commonly encountered in low-resource settings” (Royston et al., 2015, p.356). The reasons were mainly three: most mobile phones in low-resource settings are basic phones that can accommodate only voice and SMS text messaging with no internet connectivity or multimedia capability; there is a shortage of
appropriate content with the exceptions of SAWBO, GHMP and Medical Aid Films, but there is little investment in such content; and how to place the content onto individual phones remains a challenge. Videos make it also harder to target messages at specific groups, since they are generally targeting all groups from a region, country or even transculturally (Mitchell, Nakamanya, Kamali & Whitworth, 2001).
Finally, accessibility to multimedia resources for individuals is no doubt harder in developing countries than in the West. However, digital and internet access in
developing countries is also rapidly raising around health and disease prevention issues (Bello-Bravo, Lutomia, Madela & Pittendrigh, 2017). Some initiatives as distribution of micro-SD cards or the HealthPhone project to provide Medical Aid Films and GHMP resources are intended to overcome the digital gap.
3. METHODOLOGY
3.1 COMPARATIVE RESEARCH
Comparative research has been common to communication studies for decades. Since Blumler, McLeod and Rosengren (1992) considered it communication’s “extended and extendable frontier” (p.3), the number of communication scholars working
comparatively has increased rapidly and constantly until today, facilitated mostly by ICT’s which have helped to establish, maintain, and manage even large international networks of research and researchers (Esser & Hanitzsch, 2012). It is stranger
nowadays to study a phenomenon without asking whether it is or it is not distinctive to its specific context (Livingstone, 2012). However, when narrowing it to health
communication literature, there is scarce comparative investigation and those existing only comprise a few countries or regions despite the disparity of nations and regions studied within the field of health communication (Pollock & Storey, 2012).
It is important not to misunderstand comparative research with comparative analysis. The present study uses comparative techniques as a methodology for research, not as a method itself. In this sense, whatever the method used, we may define the
comparative approach as a systematic evaluation of cross-societal similarities,
differences, and associations between social entities or units (Mills, 2008; Ragin 2014; Sasaki, 2004). As any other methodology, the distinctive note about comparative research is that it builds tehory by uncovering differences and similarities between social entities as well as revealing unique aspects of these entities which would be impossible to detect otherwise (Mills, 2008; Sasaki, 2004).
What these entities look like depends on the author. It may go from societies, cultures, nations, and institutions (Sasaki, 2004) to interviews, individuals, symbols, case studies, social groups, geographical or political configurations, and cross-national comparisons (Mills, 2008). They might be divided between macro levels -societal/global,
industry/organizational, and community/neighborhood-, and micro levels -
network/primary group and individual- (McLeod & Lee, 2012). Most important is that entities for study must be comparable in some way, they should be “functional equivalents” (Esser & Hanitzsch, 2012, p.10), that is, “similar in a few respects but not all” (Olsen, 2012, p.186).
Being our study defined as comparative, it is also of importance to stablish whether it will have a qualitative or quantitative approach. It is fair to anticipate that findings and conclusions will include interpretative decoding of data. It is also true that the number of units analyzed and surveys conducted are not to be considered as representative of the real scale reality in Haiti. However, the goal of this comparative research is to spot differences and similarities whether it is about content of the videos or survey
responses, as the research question states. That makes of the present study a quantitative oriented research which will indeed use quantitative approach for its selected methods: content analysis and survey analysis. This is not as common in comparative social science as it is in most other fields, but the focus of comparison here falls more onto variables than onto the whole units for study as qualitative
comparative research usually does (Ragin, 2014). Also, as Ragin notices too, qualitative comparative strategies tend to look for answers to historically and empirically defined questions in terms of origins, which do not concern in our case.
3.2 CONTENT ANALYSIS OF CHOLERA PREVENTION VIDEOS
Krippendorff defines conent analysis as a “research technique for making replicable and valid inferences from texts (or other meaningful matter) to the contexts of their use” (Krippendorff, 1980, p.18). This definition applies to its variety of approaches. The keyword here is ‘texts’ and the ‘other meaningful matter’ clarification in the
parenthesis is also worth noticing. By “texts”, Krippendorf does not refer only to written text, but also to other forms of meaning such as “images, maps, sounds, signs, symbols, and even numerical records” (p.19) which may be included as data, that is, they can be recorded in the form of texts. This is crucial to our study as we are analyzing different sources of non-written meaning.
Content analysis may either be quantitative or qualitative, as well as inductive or deductively oriented. To be clear, the type of content analysis selected for the thesis has an inductive and quantitative approach. Qualitative or quantitative methods are defined by the research question, put simple, whether we need to answer “what” or “why” questions (Julien, 2012, p.120). In the first case -our case- quantitative content analysis is implemented. Additionally, even though trying to preserve the step by step
categorization procedure of quantitative content analysis, qualitative content analysis requires a dose of subjective text interpretation (Mayring, 2000). In our particular case, we intend to avoid interpretation as much as possible as such an approach would call for higher rates of reliability and validity which we cannot provide as it will be
discussed with the rest of thesis limitations. Also, our research question is clearly a “what” question looking for answers in the denotative level of meaning rather than in the connotative level. We are interested in manifest content that can be recognized, categorized and ultimately quantified in order to be compared between the three selected videos.
Having in mind that the analysis is done mostly upon audiovisual content, Bell’s (2004) ‘Content Analysis of Visual Images’ has been of much help to orientate the analysis, beginning with his definition of visual quantitative content analysis as an “empirical (observational) and objective procedure for quantifying recorded ‘audiovisual’ (including verbal) representation using reliable, explicitly defined categories” (Bell, 2004, p.13). Here, two concepts are especially useful to our study:
• Empirical (observational), that is, a step by step categorization procedure will be taken letting the ‘texts’ decide on the conceptualization of categories throughout the research analysis. This is the reason why the present study is not deductive-approach driven, but rather inductive. To be deductive, content analysis should begin with a precise hypothesis (Bell, 2004). This is not the case. • Quantifying recorded… representation in the present analysis may bring
confusion if a relevant puntualization is not made. Let us remember that this is a comparative study which seeks to stablish the differences and similarities of three selected units of study rather than comparing how many times are values or variables repeated in the units of study. Numbers are important to the study and they will be noticed in the results and analysis, but let us not forget,
though, that one is also a number.
Video transcription
The textual transcription of the videos was carried out using examples and guidelines provided by Heath, Hindmarsh and Luff (2010) and Rose (2011). It was decided to
transcribe all ‘texts’ separating verbal data and non-verbal data. Verbal data was transcribed first so that non-verbal data may overlay verbal data. The textual
transcription was then organized and integrated within one same timeline where every dash represented 1/5 second, and a comma represented 1 second. In the timeline, verbal data was represented with a linear rectangle around the text, while nonverbal data was represented by a dashed rectangle. As it is somewhat utopic to describe everything shown in the screen (Rose, 2011), some visual aspects of the videos have been left without analysis, for example: settings, signs or different distance or scene angles.
When it comes to unitizing verbal and non-verbal data within the timeline, different criteria was followed. For verbal data, units -rectangles- were composed by the text shown in subtitles. For visual representation, data was collected from shot to shot. Within the shots, dots separated actions from different people or other elements. As the meaning of many of the non-verbal representations -and some verbal too- was distorted when alienated from its previous and following shots, we always took those into account following Heath, Hindmarsh & Luff (2010) suggestion of interrogating the ways in which it might attend to prior conduct and how it might be treated in
subsequent action.
The whole video was identified as the unit of study. Therefore, three units have been transcribed separately. The full transcription can be seen in Appendix 2.
Categorization
Variables and values were placed within three different tables, one for each of the videos. Verbal data was first analyzed and most variables came from this first analysis. Non-verbal data was later analyzed and included in the same table. I chose to separate verbal and non-verbal content by way of text differentiation. Italic typography was used for non-verbal content. This allowed to mix verbal and visual content as part of the same ‘text’, but stablishing a clear differentiation among them. This practice has even lead to interesting findings which will be mentioned in the findings.
The majority of text is not represented in any of the categories, though. Through inductive -exhaustive- analysis, common patterns were detected among the three
videos representing different issues on cholera prevention. These have been set as variables, most of them common to more than one video. But they differ in their content, which is represented by the values and sub-values columns. It is important to note that the variables here are “nominal variables” (Krippendorff, 1980), absent of any ordering nor metric. They are unordered, but exclusive from each other as it is indispensable for the categorization process.
Close attention to the correct use of words has been paid when stablishing categories. Exact words from the transcription were used whenever possible, as avoiding
synonyms is one important feature in content analysis procedure (Julien, 2012; Bell, 2004). This, however, is not always possible in order to maintain the text’s
intelligibility. In such cases, some expressions were slightly adapted for the analysis. Table 2. Variables and values for GHMP cholera prevention video
VARIABLE VALUE SUB-VALUE
Carriers / Causes of
cholera Infected water • By vomit and defecation near the river shore • From the river • Water collected and carried home by women • Swallowed water from a glass of water
• Cholera move from the glass to mouth together with the water Flies Flies impregnated with germs of cholera touching uncovered food
Hands • Unwashed hands and fingers, hand shaking
• Grabbing a ball touched by unwashed hands and fingers • Unwashed hands and fingers grabbing a glass of water • Unwashed hands and fingers taking food
Food • Infected by a fly impregnated with germs of cholera • Vegetables
• Fruits • Fish
Non-sick people who swallowed germs of cholera Description of
cholera Tiny germs Dangerous Too small to see Effects of cholera Fast spread • So fast
• Overnight (… by morning) Acute disease
Diarrhea • Like gray water
• Containing germs of cholera that spread
Vomiting Containing germs of cholera that spread Writhing • Kneeling
• Bending • Crawling
Paralyzed in
bed •• Trembling Uncontrolled defecation
Actions to help the
infected person Go for help •• Fast Immediately • Red Cross • Clinic • Nurse • Medical kit Prepare
special drink Make 1 liter of water safe (inside a basin), filtered through a cloth (most germs of cholera do not trespass the cloth), boiled (in a
cooking pot) for 1 minute, pour water into a crystal jar and fill it to the top, add ½ teaspoon of salt, add 6 teaspoons of sugar Give special drink to the person affected by cholera
Actions to prevent
cholera Safe water •an hour Make the water safe by adding chlorine drops and waiting half • Filter and boil water
• Take bottles or closed crystal jars to share
Clean hands • Always wash hands with soap and safe water after going to the toilet
• Eat with clean hands
• Wash hands before preparing food • Always wash hands after using latrines
Latrines • Dig latrines far from the river, 30 meters away • Always use latrines
Clean food • Wash and peel the food • Cook the food
• Always eat the food hot
• Protect the food from flies by covering it with a cover • Boil the food
• Wash hands before preparing food • Eat with clean hands
Spread the word Effects of actions
to help the person affected by cholera
Recovery • Feeling stronger • Getting better
• Stomach starts to fatten Effects of actions
Table 3. Variables and values for UNESCO cholera prevention video
VARIABLE VALUE SUB-VALUE
Wrong causes of cholera A curse
Description of cholera Not a malefic disease Bacteria
Can hit everyone if not applied rules of hygiene Effects of cholera Fast spread
Death Vomit
Paralyzed in bed Actions to help the infected
person Fast reaction Oral serum • Measure 1 liter of water, pour water into the container, mix a sachet of oral serum with the water
• 6 teaspoons of sugar and ½ teaspoon of salt in a gallon of treated water
Take to health center Wrong actions to help the
person affected by cholera Do a healing ritual Drugs Shake maracas Remain without effect Not take to health center
Run after the person who brought the malefic curse
Effects of wrong actions to
help the person infected Death
Actions to prevent cholera Wash hands • Purified water • Soap
• After contact with an infected person Use chlorine water
to wash •• Hands Sheet • Clothing • Dishes • Latrines • Cutlery
• Objects affected by diarrhea of a person infected by cholera
Table 4. Variables and values for SAWBO cholera prevention video
VARIABLE VALUE SUB-VALUE
Carriers / Causes of
cholera Dirty water Vegetables irrigated with contaminated water
Glass of water Aples (fruits)
Latrines near a river Description of
cholera Intestinal infection Caused by bacteria inside water
Found in dirty water or in vegetables… irrigated with contaminated water Effects of cholera Diarrhea
Vomiting Actions to help the
infected person Go to nearest medical facility Consult with medical personnel Actions to prevent
cholera Safe water Treat turbid water
Filter Pour water to a bottle through a funnel, Use a clean cloth to strain
the water, let it stand Boil the
filtered water • Use cooking pot, cover it for a minimum of 5 minutes, allow it
to cool down before drinking,
close the bottle
• Airtight container If you cannot
boil filtered water
• Mix 6 drops of bleach or
chlorine per 4 liters of water, let it stand 30 minutes, close the
bottle, shake the bottle
• Use a clean, airtight container
Effervescent
Aquatab pills 1 tablet of 33 mg per one gallon of water, let solution rest half an hour Storage
of water Drums •• Disinfect with a cleaning utensil Keep them sealed Tanks • Disinfect with a cleaning utensil
• Keep them sealed
Containers • Disinfect with a cleaning utensil • Keep them sealed
Bottles • Disinfect with a cleaning utensil • Keep them sealed
Wash hands with soap • After using toilet • Before preparing food • Before eating
