Stories From the Shore
By Jumwoh Miguel and Patrick Okwen
In Cameroon’s coastal communities, like the Wovia Village in Limbe, improper fecal disposal is more than an environmental nuisance; it is a health disaster time bomb waiting to explode. It’s a serious health hazard, leading to a rise in diarrhea-related illnesses. A cholera outbreak in these communities would lead to the loss of thousands of lives before our emergency public health systems could respond. Despite proven water, sanitation, and hygiene (WaSH) interventions, these communities remain hesitant to implement effective fecal disposal interventions like using latrines, proper hand washing, protecting watersheds, etc. This hesitancy is promoted by cultural and community practices on the one hand but also by the cost of rolling out effective interventions. This blog explores eBASE Africa's efforts to transform awareness into action through "Evidence Tori Dey," an innovative storytelling approach developed at eBASE.
“To poison a nation, poison its stories. A demoralized nation tells demoralized stories to itself.” (Ben Okri)
Community Diagnosis
Many residents in Bota Land Village continue the community practice of defecating and pouring human and animal feces into the sea, a behavior that has been practiced over generations. However, this behavior has serious health implications, contributing to preventable diseases like diarrhea and cholera. A revealing moment occurred during the storytelling session in Wovia Village Limbe, when a female colleague, needed a restroom, and none of the participants had a toilet in their homes. This highlighted the urgent need for improved sanitation facilities. Our community diagnosis of the Wovia community, using the Prochaska transtheoretical model of behavior change, placed Wovia as a community predominately in denial or pre-contemplation of evidence on the use of effective human and animal fecal disposal interventions. This is due to strong ties with traditional, community, and cultural practices and a lack of knowledge.
Our Approach in Wovia
In Wovia we enabled the comings of the two rivers through ETD for proper fecal disposal to reduce sanitation-related illnesses. In bringing together the two rivers of scientific data and stories in local languages, we used the eBASE ETD storytelling cycle which consists of 6 steps. We identified this topic after observations of community behaviors and practices in open sea defecation and how that affected environmental pollution and tourism. We then conducted a community diagnosis using the Prochaska transtheoretical model of behavior change for the Wovia community on the uptake of evidence on effectively disposing of fecal matter. Then we synthesized evidence on effective interventions in human fecal disposal interventions. Using evidence statements from our rapid review, researchers and storytellers co-created a set of stories to influence knowledge, intention, and behavior toward more uptake and use of evidence for proper fecal disposal. We then conducted a one-night by the full moon in the Wovia community, where we recounted 10 stories to 2 hundred community members. Our stories consisted of a mix of relatable and interactive narrative stories, comedy, spoken word, proverbs, drumming, and dance. Following the storytelling event, we gathered community member's experiences, knowledge, and intentions to change behavior. We also weighed in on persisting evidence of hesitancy within the community.
An example of proverbs used at this event is “A man who does not like uninvited visitors does not look for trouble,” (Jumwoh Miguel). This proverb conveys that improper fecal disposal invites sickness into the household. This strategy makes scientific data relevant and relatable, encouraging behavior change. This proverb dwells on a behavior change technic recognized in the BCT taxonomy by Abraham and Mitchie known as providing information on consequences, which dwells on the theory of reasoned action and operant conditioning. In this community, we had a preference for using stories that would scare people from defecating in the sea by highlighting how this could potentially bring them disease or turn away tourists and a potential source of income. A contrary approach which was to tell them stories about how not defecating in the sea could encourage them by showing that they will have fewer diseases or attract more tourists was not used. The reason for not using the latter was that this community assumed that lack of disease and the presence of tourists was the norm and therefore took this for granted.
Impact
While formal data collection was not conducted, participant comments indicated increased awareness and intention to adopt safer practices. We had initially planned on collecting pre and post-event data on knowledge, intention, and behavior, however, due to timing and poor planning on the part of the storytelling team this data collection was not possible. Our assumption was based on the comments of the participants after the events.
“We live by stories, we also live in them. One way or another we are living the stories planted in us early or consciously absorbed. Some of these stories are beneficial, some are not.” (Ben Okri)
Challenges
We faced a series of challenges including:
- Politics and Leadership: Engaging with village chiefs required careful navigation of local power dynamics.
- Logistical Issues: Weather disruptions and time constraints limited some planned activities.
- Data Collection: The lack of pre-and post-event data hindered the ability to measure the impact quantitatively.
“Where there is perfection there is no story to tell.” (Ben Okri)
The Road Ahead
The big picture is to continue using storytelling to generate evidence, translate evidence, and evaluate impact. Addressing evidence hesitancy and prioritizing evidence-based recommendations. By involving community members in data collection and integrating their lived experiences, the goal is to generate evidence that they trust and accept.
Conclusion
As the tides flow along the shore, so too must our understanding move between two vital rivers “Storytelling and Science”. In "The Comings of the Two Rivers," the importance of collaboration is clear. While scientists unearth the data and uncover truths, “facts tell, stories sell”
Together, they create a powerful current and raise the riverbed for people to drink the river of knowledge. In transforming complex jargon into relatable stories that resonate deeply, especially with underserved populations, we are ensuring equitable access to evidence and hence a better use of research evidence.
By intertwining research with narrative, eBASE ensures that no truth is left stranded on the rocks of inaccessibility but instead reaches the hearts of those it was meant to serve. It is only when storytellers and scientists come together that the rivers of knowledge truly meet the ocean of possibility, nurturing a more informed and inclusive future.