Learning by doing: Public Health meets The Arts in Nepal

Earlier this month, as part of Changing The Story’s sister project CARAN – Community Solutions to Antibiotic Resistance using Arts in Nepal – I travelled to Kathmandu to take part in the project’s ‘pretesting’ phase.


CARAN asks if participatory filmmaking and other arts-based approaches can be used to find, document and share community-led solutions to antibiotic resistance (ABR) in Nepal, doing so through two pilot programmes in Kathmandu valley. The project is led by Prof. Paul Cooke (PI, Centre for World Cinemas & Digital Cultures) and Dr. Rebecca King (Co-I, Nuffield Centre for International Health and Development). Working closely with our local delivery partners HERD International, who have expert local knowledge and robust links with policy makers at the Ministry of Health, the project seeks to promote a more meaningful role for local communities in developing national health policy, using local knowledge to better tailor international guidelines to the realities on the ground.

A new approach: Pretesting

Getting to know each other on the first day of pretesting workshop in Chandragiri.

As a creative practitioner used to working with communities around social issues such as migration or youth rights, working on an abstract health issue like ABR, where the individual effects can’t be seen directly, was a new challenge for me. The project required a basic understanding of the science behind the issue, but also hinged on our shared understanding of public health in the Global South, health priorities in development and governance, and scientific and anthropological research methodologies that I was not familiar with. One such methodology was ‘pretesting’, a process used frequently by the Nuffield and HERD but which was completely new to me and Paul. Pretesting is a trial of the key activities you intend to carry out with a test group before the full workshops begin, evaluating each activity against the research values and objectives.

As an arts-based practitioner, I was slightly sceptical of pretesting at first. I was reluctant to become too prescriptive in our way of working, aware of how different each group would be and how flexible good practitioners (which I was confident we had at HERD) should be in their responses in-context anyway. I was also conscious of retaining the spontaneity and risk-taking that I believe is crucial in creating authentic and participatory artistic encounters; there comes a point in participatory, creative projects where you must give up control as a practitioner for these experiences to be as equitable as possible. However, to my delight the week was a fantastic insight into other ways of working and a testament to the value of interdisciplinary research and practice. Here I share some of the key personal learning that I experienced through the pretesting process.

Learning by doing

Whilst I still think that the pretesting approach isn’t always required for more straightforward arts projects – and that the instrumentalisation of the arts in a development context remains a risk that we all need to be mindful of – it became clear, as our team from very different backgrounds developed, how valuable it could be as a way for us to cement our shared understanding of the project’s key concepts by experiencing each other’s expertise in practice. For me, the pretesting was not so much about testing the individual activities – though we did make some useful changes in this respect – but about providing a space for us, as a group, to learn by doing, and to do so together.

Ashim Shrestha and Romi Giri from HERD international introduce the filming equipment to the group for the first time.

By experiencing activities in ‘real’ time, you experience them as a ‘real’ person. Arts-based approaches – and indeed all good facilitation methods – are experiential and therefore there is a limit to how much we can truly understand them just through discussion. They need to be lived experiences. This is particularly crucial when embedding a participatory methodology with communities because this is at its heart a very human-centred approach. It is about creating person-to-person connections that help to build a powerful whole, based on our respectful understanding of and relation to each other. The pretesting week allowed space for this in several ways:

Practitioners as Participants

Before we travelled out to the community, we decided that I would deliver a short creative workshop with the HERD team, using the same activities we were going to pretest but on a subject we hadn’t explored together yet – pollution. Experiencing the activities from a participant’s point of view (and, from my perspective, from the point of view of a practitioner in the Nepalese context) allowed us all to build up greater empathy with the other stakeholders in the process. This is a key ingredient for building equitable partnerships and also helped us to remember a key (and yet often undervalued) ingredient of the creative process – having fun! As well as better understanding what reservations or confusion a participant may have, we were reminded of how willing people can be to take risks and to try new things.

Getting our hands on the equipment as we head out into the field.

Embracing spontaneity – and our own expertise

Having worked hard collectively to produce a facilitators’ manual in the six months prior to the pretesting, we had a solid and structured foundation from which to develop the activities. Nevertheless, there were still areas in the manual that we had returned to over and over again to clarify with limited success. In pretesting the activities, some of these areas immediately became clear – whether through additional activities we reactively added in on the day, to realisations we came to from listening to the participant’s experiences (and reminding ourselves of the importance of this in the process). It was also wonderful to be reminded of our own expertise as practitioners, recognising our ability to build a strong foundation but also to adapt things in the moment where required.

The group take part in one of our key creative activities aimed at building confidence and embracing different perspectives, ‘Where do I stand?’

Understanding ‘participation’ in the local context

Working with a local organisation that was embedded within the local context was invaluable. Whilst one might argue that the pillars of participatory approaches are universal – building respect, active listening, and equitable partnerships – each new context comes with its own hierarchies and shared experiences and it is important to understand how best to tailor a setting to the participants involved. When, for example, I asked why the practitioners had told a woman to sit down when she had tried to stand up and share her response in the discussion (something I had seen as a positive sign of confidence), they explained that the act of standing up to respond was likely a hangover from previous, more hierarchical workshops they knew the woman had participated in. They wanted to let her know that she could relax in this environment. Experiences like this underline the need for projects to support the professional development of future creative practitioners in-country – such as the wonderful young practitioner team at HERD – both for successful implementation and for long-term sustainability. I was proud that we were supporting creative skills development that they could then apply with their local expertise to other projects.

Three housewives participating in the pretest plan their filming script together.

English-last brings new findings

A key tenet in this project, identified from our recent Voicing Hidden Histories project, has been the understanding that building an equitable partnership isn’t about reducing everybody to the same thing, but having mutual respect for our individual areas of expertise within the project. What I had perhaps undervalued was the extent to which the language we communicated in affected the way in which this expertise was articulated. We had agreed an English-last approach for the pretesting week, and seeing the HERD team engage with the participants in Nepali made it clear just how experienced and practiced they were as engaging and proactive facilitators. Similarly, as I wasn’t participating directly in the activity delivery due to the language barrier, I could reflect on other aspects of the workshops, such as the building of a neutral space layout and activity timing. Back in the office, through mixed Nepali and English conversations, it also became clear how complex and important the translation of the content into the delivery language was (the manual is in English) and this has been a major shift in understanding in terms of how the manual develops longer-term.

Abriti Aryal from HERD International documenting the pretesting for use in a final film.

The pretesting was extremely successful both according to participant feedback, our own experiences (see Ashim’s reflections on the week here) and through the learning we identified as a team. It gave us a chance to reflect on unresolved issues using tangible examples, to readjust activities based on a ‘real-life’ context, to value and take stock of the invaluable work we had done in preparing the facilitator’s manual and the background knowledge this afforded us, and to remind ourselves of the spontaneity and flexibility that we all possess as practitioners in delivering participatory projects. Finally, and most importantly, it highlighted the importance of learning by doing, both for us and our participants.

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