Throughout September we’ll be hosting a series of blog posts from the CE4AMR project’s summer workshop in Nepal. This interdisciplinary meeting looked at how community engagement and participatory arts methodologies can tackle major health challenges including antimicrobial resistance (AMR). This week we hear from three academics from very different backgrounds. Each shares their thoughts on the workshop which brought together researchers from cross disciplinary fields to discuss the use of creative methodology to tackle One Health issues.
Jane Plastow: Professor of African Theatre, University of Leeds
Things That I Learned in Nepal
Number 1. Never look over the side of the bus as it takes you up the mountain to Nagarkot as you will be convinced that death by precipice is imminent. Rather engage in fascinating chat about how you might encourage the Arts and Humanities Research Council to focus more on looking at real arts-based research.
Number 2. Antimicrobial Resistance is pretty terrifyingly present – just about everywhere – and I have been both pretty ignorant and horribly complacent about the enormity of the problem and the public health risks.
Number 3. There are far more fascinating researchers interested in arts approaches to health issues at University of Leeds than I ever knew about. (Nod to sub-learning here about the importance of hand washing. Thank you, Catherine Stones.)
Number 4. My suspicion that there is a problem with research and communication about how best to use appropriate art forms in relation to public engagement and public empowerment was confirmed. I had been considering already, but am now thinking more actively, about how socially engaged arts practitioners really need to go beyond promoting their particular art form and to work with partners to help them think about what might be the most appropriate art form for the needs of a particular project. So, for example, film is frightfully trendy right now, but when is it the best medium to use? Lots of people were using comic strips which were fascinating, but was this just because it was easy? Cheap? What they knew about? It seems to me that we need to expend more effort on researching, understanding and communicating, both amongst each other and to public health or social science partners, on how particular art forms exert agency and in what situations they are best used.
Linked to this is developing research and understanding of just what we are doing with our use of the arts. I have for some time been differentiating, for example, what I think is a crucial difference between message-based arts and information initiatives. Messages might be used in public engagement projects, such as those targeting people in relation to use of antibiotics, because the projects involved wish to unequivocally promote behaviour change. But we need to recognise that in these instances we are basically telling people what we think they need to do. Information-based projects, however, are not telling people you must, or you need, to do this, rather they are - in my case at least – seeking to help people overcome information deficits so that they can make the right choices for them. So, in my own recent work in relation to contraceptive use in various African countries the work, using a range of art forms, has all been about trying to overcome the poverty of lack or misinformation. What I am not doing is telling people what they should do and this it seems to me is crucially different. There are many other reasons and ways we might be using the arts, but I did find it a bit worrying at our meeting that so little time seems to be being spent on thinking about WHAT our aims are and HOW we go about achieving them based on any real research.
Number 5. Nepal is really beautiful and its mountains are mind-bogglingly high. You really should be fitter than I am if you want to visit them. (This information was mainly learned not at the conference but on a 4-day trek I went on immediately before. It meant I was very grateful for the lifts in our hotels because I was temporarily partially crippled. It was worth it.)
Juan J Carrique-Mas: Wellcome Trust Intermediate Clinical Fellow – ViParc Project
The global emergence of antimicrobial resistance exemplifies, like no other, the concept of One Health and the pressing need of embracing a ‘One Health approach’ to tackle this Global Health issue. This means that each and every one of us who is involved in generating knowledge, policies or simply as potential users of antimicrobials need to play a part. There is not much time for philosophical or theoretical debate anymore. We have left this to happen for far too long and now we need to act. By this stage, we all know what we should be striving for: to reduce unnecessary use of antimicrobials without restricting them for those that need them. The Community Engagement Workshop in Kathmandu was an excellent example of this much needed effort in South and Southeast Asia, a ‘hotspot’ of antimicrobial resistance and also the home of a large fraction of the world’s human and animal population. Communities in Asia are diverse and complex. Reaching out to the communities, rather than the scientists and policymakers, is therefore crucial if we want to have a chance of reducing unnecessary antimicrobial use and the undesirable impact of antimicrobial resistance. ViParc (www.viparc.com) is one of the few examples of a research project with a strong focus on the poultry farming community. The lessons from this project are likely to be valuable to other farming communities in low- and middle-income countries.
Emmanuel Tsekleves : Senior lecturer in Global Health Design at Imagination Lancaster, Lancaster University, UK
Driven by the United Nations Sustainable Development Goals, my research focuses on tackling community health challenges across the world. Be it by exploring how cleaning practices can drive antimicrobial resistance and infections from homes in Ghana; by developing health and care policies for senior citizens in Malaysia; or by promoting seafood across Europe through co-designing new ready-to-eat seafood products and their corresponding packaging with groups of older people.
Developing strategies for promoting health or preventing ‘illbeing’ of the population forms one of the most complex global challenges. Global health challenges, such as Antimicrobial Resistance (AMR – where bacteria found at homes, hospital, schools etc. are changing to protect themselves against antibiotics) are hugely complex problems with diverse influences, driven by human activity as much as by biological mechanisms. Biomedical, clinical and medical expertise alone cannot tackle global health issues; collaborative and innovative interdisciplinary approaches are needed to tackle such challenge.
From an epidemiology and public health perspective, combining knowledge from multiple sources presents the best opportunity to adequately address public health concerns, such as in the case of AMR. The Arts and Humanities Research Council (AHRC) Dust Bunny project I lead demonstrates that the use of a design research approach (that allows us to understand complex human behaviour and turn that into actionable insights) to address antimicrobial resistance management at the household level can provide insights into behavioural challenges, which is key to changing behaviour that contributes to global health challenges. Using a design research approach is a practice that adds more value to the microbiology and public health aspects of the project, which would typically not engage further with households after sampling has been completed.
The value of transdisciplinary research and in particular participatory design in this context was well echoed in the Community Engagement for Antimicrobial Resistance conference I participated in late June 2019. The insights gained from combining design and microbiology in the Dust Bunny project, as well as from the aforementioned event suggest that there are still challenges to address in enabling and supporting such transdisciplinary collaborations. Furthermore, there is still work to be done on enhancing other disciplines’ understandings of the role and function of design in such specialist medical areas. There are, however, several opportunities arising in embedding design in health research, such as developing a better understanding of the health context and the individual, social and household drivers, and promoting best practices for public health implementation by engaging communities of citizens and professionals.
As the design research community, along with other research communities, are called upon to tackle the complex global challenge of improving health and wellbeing, our research efforts should focus on co-producing with partners from the Global South strategies for promoting health and preventing illbeing of population.
Disclaimer: The views expressed in this blog belong to the authors and are not necessarily representative of Changing the Story.