Innovation: Can stories help to change lives?
Having access to accurate information about health topics can be life-saving, says Kate Hughes.
Things like the symptoms of diseases, where to get medical help for specific problems, and what measures you can take to keep your children healthy are all vital knowledge that can make a huge difference.
But for many communities, accessing this kind of information can be challenging. That's why MSF teams worked with people living in remote communities to develop a new way to spread information: 'Stories of Change'.
You can read more about the initial pilot project below, or check out the video to meet one team in Nigeria who are using this approach to make a difference.
What is the "Stories of Change" project?
We all tell stories. For a health promoter, they can be an important communication tool because they follow the natural patterns of social interaction in a community and can spread quickly among people.
Typically, health promotion activities focus on a specific message (e.g. the importance of hand-washing) and involve health care providers giving out information to communities based on bio-medical facts (e.g. to prevent the spread of pathogens). However, this approach can mean that local perspectives and local knowledge are sometimes missed out in developing and delivering health promotion activities.
Instead, developing joint stories between MSF health teams and local communities about health-related topics allows messages to be spread in a way that fits in with local practices – combining medical knowledge with local knowledge.
The pilot project: Noma in Sokoto
In Sokoto Children’s hospital in northwest Nigeria, MSF is working alongside the Nigerian Ministry of Health to provide specialist treatment and reconstructive surgery for patients with noma, a disfiguring and often deadly infection which mainly affects young children.
Raising awareness of the disease is crucial to reducing the suffering noma causes, and the MSF team in Sokoto includes specialists in outreach and health promotion. They work to share information including simple steps that can help prevent the disease, and the importance of seeking swift medical care.
In 2018 MSF piloted a new project in Sokoto. The aim was to train health promoters to harness the power of interactive storytelling. They'd use these skills to help people learn about noma and to challenge perceptions of the disease that could be barriers to people accessing care.
How does it work?
The first stage of the project was to train MSF health promotion teams in community participation and active listening skills, before they began a series of discussions and interviews with local people, asking them about noma.
A whole range of people shared their experiences and a total of 45 stories were collected by the team.
These stories were grouped by theme into a story web, which allowed staff to better understand how people in the community perceive noma. The web covered everything from perceptions about where noma comes from to how it can be treated.
The interviews fed into the main objective of the project: the development of a new story co-created by community members and MSF teams, promoting good health practice.
Changing the story
In groups, community members developed new stories about noma, based on their experiences and knowledge. The groups decided on:
- The main character of the story
- The challenges the character faces
- The support the character receives
- The plot
- How the story develops and ends
These stories were analysed by MSF teams and one new story was created from the themes, issues and ideas. The ‘Story of Change’ had been created!
This excerpt from the finished story below shows how Mariya, a midwife, and a local Imam help persuade the family of Abubakar, a young boy suffering from noma, to take him to hospital for treatment.
Last time Mariya saw the child, he had a swelling in his mouth and the gums were bleeding. Mariya told his mother to rinse his mouth with salt water. But now she sees the boy again and he looks terrible. His cheek has fallen off. Mariya is afraid the boy has Zaizayar Baki, also known as noma disease. She has seen noma before. It develops real quickly and the boy needs to be treated straight away.
She tells the father and mother about Noma Children Hospital in Sokoto. Although Abubakar’s mother is very worried, she does not want him to go. She does not know about noma and she took the boy to the traditional healer, who gave him some herbs. They did not work. The healer told her the boy is suffering from Maci dan Wawa, the dumb disease. Dumb disease resists all medicine and does not want to go.
Abubakar’s father cannot convince his wife to find treatment elsewhere and goes to see the village Head. He gets the imam and the traditional healer to discuss the problem. The imam preaches in different villages and has seen how quickly noma destroys a face. He always teaches hygiene and how important it is to wash children’s hands and clean their mouth and teeth.
His grandmother offers to take Abubakar to Noma Children Hospital, so his mother can stay home to look after Aisha and the land.
Changing attitudes
The MSF health promotion outreach teams were given additional training on delivering this story to the communities they were working in, as well as mapping the story spread to monitor its spread.
Even before the pilot ended, MSF health promotion teams using the approach reported that local communities were more engaged with the health promotion messages and had been challenging the discrimination that people with noma can face.
What now?
After a successful evaluation of the pilot project, and with the support of MSF's Sapling Nursery Fund, the Story of Change training has been scaled-up to nine new MSF projects.
Teams across Pakistan, India, Sudan, and Nigeria have all adopted the new approach.
All contexts were different, yet the different teams all found that they learned something new about the communities they work with, and that harnessing the power of stories is an effective way to spread health information.
By co-creating knowledge, local people and MSF teams are creating change at ground level. It is by working collaboratively that MSF teams and the communities that they serve can create healthier societies, together.