Fieldset
A small army of anthropologists

Could you talk to a stranger about something as sensitive as family planning? How about doing it in a marketplace or while waiting in line? British health promoter Elizabeth shares how a team in South Sudan are reshaping health education...

The health promotion team in Bentiu, South Sudan

I eagerly awaited meeting my South Sudanese teammates. This was my first assignment with MSF.

Soon, I would be amazed – and it would not be long until my co-workers had completely transformed my approach towards conducting research, a central component of health promotion.

Craving collaboration

Before MSF, I worked on a number of occasions as an independent researcher; investigating opinions and representing voices in each respective humanitarian situation in which I worked.

The team quickly challenged my comfortable assumptions of what I thought it meant to conduct research

Despite being painstakingly passionate about the topics, life as an academic researcher is ghastly independent and I craved the collaborative sharing of ideas attached to working as part of a team.

This was a key motivation in applying for MSF.

Shaping health education

When I arrived in Bentiu, the health promotion team were holding focus group discussions on family planning – qualitative research that would help the medical team understand the attitudes and perceptions held by the communities beyond the periphery of MSF’s facility.

The insight gained from these discussions helps the outreach team shape health education sessions around the community's educational and emotional needs.

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An MSF community health worker talking with local people
An MSF community health worker talking with local people

For example, if women want to try family planning but are anxious about how their husbands will react, the outreach team would respond by going to public spaces where men congregate and raising awareness there on the importance of family planning.

Likewise, if discussions revealed confusion and scepticism around family planning methods, health education sessions would be designed to deliver detailed information on the different methods available – how they work, the longevity, and the support provided from MSF's sexual and reproductive health clinic.

The overall objective is promoting reassurance, confidence and informed decision-making amongst the community.

Challenging assumptions

The team quickly challenged my comfortable assumptions of what I thought it meant to conduct research.

[ Read next: South Sudan - Preparing for the swamps ]

In Bentiu, there was no single researcher but a 23-person team – MSF community health workers who all played an equally important part in the collection of data.

As the team split-off into different directions and exited the compound gates each morning, I couldn’t help but to envisage them as a small army of anthropologists. Reporting on local behaviour and attitudes – not alone, but as working members in a tightly interdependent team.

Overflowing with information

I joined my team of community health workers on outreach in the community as much as I could; but as I could not speak Nuer, the most widely spoken language in Bentiu, it was often more useful for me to be in the office, analysing and collating the data the team brought back from the field.

By the end of the week, the team would hand me an overflowing pile of hand-written notes. Judging from this alone, I assumed that they had discussed contraceptive methods and family planning with every man, woman and youth living local to Bentiu town.

The size of the pile equated to a small book.  I certainly would not be short of work to do… 

I was overwhelmed by how many members of the community they had been in discussions with – whether in the street, the local youth centre or in the tukuls – the rounded huts that are traditional homes in South Sudan.

Traditions and tight-lipped conversations

The snip-its of discussions that the team had noted-down depicted conversations with people that were rich with experience and opinion. The close proximity they had established with their participants was impressive – family planning is a difficult topic to discuss in South Sudan.

I remembered my own experience conducting research on sensitive and often awkward subjects. Participants would finish-up conversation and seal their lips as if quickly zipping up a winter jacket.

Characteristic of the region, large family size is highly demanded – mothers acquire wealth with each new child and the status of the family increases as the family grows. Traditionally, more children translated to more warriors and therefore a larger number of children served as a protection measure against rival clans.

This local custom precludes the medical benefits of "child spacing", where a couple of years are spent between each pregnancy with the objective to protect the health and wellbeing of both mother and child.

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Health promoters are often well-trusted members of their community
Health promoters are often well-trusted members of their community

I remembered my own experience conducting research on sensitive and often awkward subjects. Participants would finish-up conversation and seal their lips as if quickly zipping up a winter jacket. Others nodded their head and smiled sweetly, slipping into selective listening.

I empathised with my health promotion team. Striking conversation around intimate and personal topics was a difficult task – chatter around family planning was likely to be a world away from the conversations on cattle and crops spoken in the minutes before the team’s arrival at the tukuls.

A talented team

Although acutely aware of the sensitively of the topic, the team’s professionalism, their knowledge of the subject and their deep understanding of the local context meant they were able to carefully shape the conversation to account for participants’ different personalities.

Crouched down at the entrance of someone’s tukul, over a market stool, or adjacent to the queue of people positioned at the local borehole, to my observation, it seemed as if they were able to engage almost anyone in the discussion.

The community health workers are not trained anthropologists. In fact, many have not received any formal education and a large percentage cannot read or write. Yet, they were no less capable of facilitating the group discussions required to collect rich and meaningful data.

The community health workers were all well-trusted members of their community – slipping into conversation with the average passer-by seemed as easy as sipping their early morning chai.

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Read more: Stories from South Sudan

> From child refugee to MSF medic: This is my incredible story
> Crossing the swamp: How we get healthcare to the people in remote areas