Whether the world's scariest outbreak of Ebola can be managed may come down to communications. Can governments, NGOs, and doctors communicate with very different audiences – with accuracy, agility, and ingenuity? Can they be convincing?
After years of civil war, many people in the affected countries don't trust their governments or the foreigners in bio-hazard suits who seem to bring the virus with them. They don't understand how the virus is being spread. Local custom is to bathe the bodies of the dead – but in doing so, the living catch the virus. Traditional sources of food – wild animals – also carry the virus.
Think of the tough barriers that messaging must get through to stop this outbreak: don't eat the animals you have always eaten in the past; don't touch your loved ones if they are ill; don't follow age-old or religious customs in washing a dead relative's body; don't use the shaman's cure you have always trusted in the past; and yes, many will survive if they get proper treatment (though there is no cure). Think of how you might try to get the message out to a rural population with little electricity (and therefore limited access to TV and radio, let alone the internet) and low literacy rates.
To find some ideas for the terrible situation unfolding in West Africa now, it may be useful to look to past efforts in fighting HIV, leprosy, and diarrhea (a major killer of children under the age of 5 in emerging markets). Those campaigns educated and informed through the ancient arts of personal and personalized local folk media.
Nearly 800,000 children under the age of five die every year due to diarrhea (according to WHO). It is the second biggest killer of kids in the world. Many of those deaths could be prevented if the caregivers would simply wash their hands with soap and water. However, in poor areas, soap is considered too precious to use all the time. Many organizations, communications agencies, and even companies have made a positive impact, however. They create street theater, puppet shows, skits and songs that do not depend on reading leaflets or having access to TV or internet. They craft analogies to teach about concepts such as germs or viruses, since assuming they already understand basic biology is a fatal assumption.
For instance, Ogilvy PR created an award-winning campaign that saved many lives in Indonesia called "Fantastic Mom." The insight was moms were the reason children were getting diarrhea - because they did not wash their hands at crucial times. Local communicators created puppet shows and songs that made heroes of the mothers, brought the idea to life – and saved lives.
Ogilvy also worked with Unilever, maker of Lifebuoy soap, to turn roti (Indian flat bread) into a messaging vehicle. At an enormous festival, the roti were stamped with a hot branding iron that bore a message to wash your hands before eating. Unilever has also run a sustained initiative to teach proper hand washing that has reached 130 million people.
In Uganda, Medical Research Council AIDS Directed Program also found positive results using theater as the educational vehicle. In rural Ghana, folk media (puppetry, songs, proverbs, theater, and storytelling) has combatted HIV/AIDS, according to CARE International researchers. In India, the World Bank Health, Nutrition and Population department has seen a positive impact from the use of folk media in combatting leprosy in rural and illiterate populations. Theater works in rich, educated countries too. Kaiser Permanente has reached more than 15 million in the U.S. through its Educational Theater Program. No matter where you are, facts alone won't change minds, and fear is a powerful distorter of any message.
Here is why drama and storytelling work. Lawrence Kincaid is health communications expert and scientist at the Faculty of Social and Behavioral Sciences at the Johns Hopkins Bloomberg School of Public Health. His research ("Drama, Emotion, and Cultural Convergence") delves into drama theory - basically how audiences empathize with characters and vicariously live their conflicts through them, even riding with them through their change of mind. His work has been used to help prevent risky behavior leading to HIV transmission through creation of TV and stage dramas. Researchers such as Raymond Mar, Melanie Green, and Geoff Kaufman have also found that fiction - far more than expository or non-fiction evidence - has the power to change minds and thus behavior. Mar, assistant professor of psychology at York University says: "The more that people are transported into the world of the narrative, the more they feel immersed in the story, the more likely they are to change their beliefs to be more consistent with those expressed in the world of the narrative."
"We're stepping into the lives of these characters," says Green. "The empathy we create goes out beyond just those few moments when we were thinking about the story."
Kaufman's work using drama to change high-risk behavior related to HIV transmission found: "People who report higher levels of experience-taking are subsequently more likely to adjust their behavior to align with the character's."
But creating such stories takes time – more time than crafting a Facebook campaign or A/B testing different messages on Twitter. And it also takes time to get the message out into the community. As an expert at the Council on Foreign Relations, Laurie Garrett, who is a Pulitzer Prize-winning author ("The Coming Plague") answered my question in a special CFR session August 5 that a "Western style of doing a media campaign … is not what is needed on the ground. What's needed is really direct communication that begins by identifying key community leaders, village-by-village, neighborhood-by-neighborhood. Who are the influence-makers? Who are the individuals that everyone else follows and obeys for one reason or another, whether they are religious, political, gangsters, whoever they are, and winning them over step by tedious step." Garrett went on to caution that beyond tedium, "it's dangerous work." "They'll throw rocks at you … and you don't know who's infected."
After years of civil war, many people in the affected countries don't trust their governments or the foreigners in bio-hazard suits who seem to bring the virus with them. They don't understand how the virus is being spread. Local custom is to bathe the bodies of the dead – but in doing so, the living catch the virus. Traditional sources of food – wild animals – also carry the virus.
Think of the tough barriers that messaging must get through to stop this outbreak: don't eat the animals you have always eaten in the past; don't touch your loved ones if they are ill; don't follow age-old or religious customs in washing a dead relative's body; don't use the shaman's cure you have always trusted in the past; and yes, many will survive if they get proper treatment (though there is no cure). Think of how you might try to get the message out to a rural population with little electricity (and therefore limited access to TV and radio, let alone the internet) and low literacy rates.
To find some ideas for the terrible situation unfolding in West Africa now, it may be useful to look to past efforts in fighting HIV, leprosy, and diarrhea (a major killer of children under the age of 5 in emerging markets). Those campaigns educated and informed through the ancient arts of personal and personalized local folk media.
Nearly 800,000 children under the age of five die every year due to diarrhea (according to WHO). It is the second biggest killer of kids in the world. Many of those deaths could be prevented if the caregivers would simply wash their hands with soap and water. However, in poor areas, soap is considered too precious to use all the time. Many organizations, communications agencies, and even companies have made a positive impact, however. They create street theater, puppet shows, skits and songs that do not depend on reading leaflets or having access to TV or internet. They craft analogies to teach about concepts such as germs or viruses, since assuming they already understand basic biology is a fatal assumption.
For instance, Ogilvy PR created an award-winning campaign that saved many lives in Indonesia called "Fantastic Mom." The insight was moms were the reason children were getting diarrhea - because they did not wash their hands at crucial times. Local communicators created puppet shows and songs that made heroes of the mothers, brought the idea to life – and saved lives.
Ogilvy also worked with Unilever, maker of Lifebuoy soap, to turn roti (Indian flat bread) into a messaging vehicle. At an enormous festival, the roti were stamped with a hot branding iron that bore a message to wash your hands before eating. Unilever has also run a sustained initiative to teach proper hand washing that has reached 130 million people.
In Uganda, Medical Research Council AIDS Directed Program also found positive results using theater as the educational vehicle. In rural Ghana, folk media (puppetry, songs, proverbs, theater, and storytelling) has combatted HIV/AIDS, according to CARE International researchers. In India, the World Bank Health, Nutrition and Population department has seen a positive impact from the use of folk media in combatting leprosy in rural and illiterate populations. Theater works in rich, educated countries too. Kaiser Permanente has reached more than 15 million in the U.S. through its Educational Theater Program. No matter where you are, facts alone won't change minds, and fear is a powerful distorter of any message.
Here is why drama and storytelling work. Lawrence Kincaid is health communications expert and scientist at the Faculty of Social and Behavioral Sciences at the Johns Hopkins Bloomberg School of Public Health. His research ("Drama, Emotion, and Cultural Convergence") delves into drama theory - basically how audiences empathize with characters and vicariously live their conflicts through them, even riding with them through their change of mind. His work has been used to help prevent risky behavior leading to HIV transmission through creation of TV and stage dramas. Researchers such as Raymond Mar, Melanie Green, and Geoff Kaufman have also found that fiction - far more than expository or non-fiction evidence - has the power to change minds and thus behavior. Mar, assistant professor of psychology at York University says: "The more that people are transported into the world of the narrative, the more they feel immersed in the story, the more likely they are to change their beliefs to be more consistent with those expressed in the world of the narrative."
"We're stepping into the lives of these characters," says Green. "The empathy we create goes out beyond just those few moments when we were thinking about the story."
Kaufman's work using drama to change high-risk behavior related to HIV transmission found: "People who report higher levels of experience-taking are subsequently more likely to adjust their behavior to align with the character's."
But creating such stories takes time – more time than crafting a Facebook campaign or A/B testing different messages on Twitter. And it also takes time to get the message out into the community. As an expert at the Council on Foreign Relations, Laurie Garrett, who is a Pulitzer Prize-winning author ("The Coming Plague") answered my question in a special CFR session August 5 that a "Western style of doing a media campaign … is not what is needed on the ground. What's needed is really direct communication that begins by identifying key community leaders, village-by-village, neighborhood-by-neighborhood. Who are the influence-makers? Who are the individuals that everyone else follows and obeys for one reason or another, whether they are religious, political, gangsters, whoever they are, and winning them over step by tedious step." Garrett went on to caution that beyond tedium, "it's dangerous work." "They'll throw rocks at you … and you don't know who's infected."
