Health promotion in Pakistan: "Where there are a hundred challenges, there are thousands of reasons to smile"

A creative approach is getting results in a slum area of Karachi, Pakistan

Mona is a health promotion supervisor working for Médecins Sans Frontières / Doctors Without Borders (MSF) in her native Pakistan. Health promoters do vital work with local communities, helping to spread the word about behaviours which can help people stay healthy. Today Mona explains how a creative approach is getting results...

Often I wish that a good health could be infectious, so just by shaking hands all the monsters causing disease would go away.

Machar Colony (“Mosquito colony” in the local name) is a big slum of the densely populated city Karachi. It is a place where there are vibrant multi-colours of culture and eyes shining with happiness shared. Catching fish and making wooden ships is the specialty of the area.

I have been working in this slum for more than five years with MSF. Here MSF combines primary health care, including remarkable treatment of Hepatitis C, with empowering and strengthening the community through a behaviour change approach. This means helping to share understanding about small actions, like handwashing, which can make a big difference to people's health.

A health promoter dressed as a disease. She has a mask and is covered in drawings of germs. It's pretty wild!

A costume used to share messages about germs. Photo: MSF.

I still remember my first day. Although I was living in Karachi I had never heard about this place before. What to do? How to start? Questions like these revolved in my mind.

I decided to step in and start meeting with people in the schools and madrassas (religious schools). I also attended different celebrations and gatherings in the community.

Step by step, little by little, I got known by the community. Their friendly behaviour made me more confident to move forward and start doing health education with local people and groups. By then I had also learned a lot about health myself, and I realised that something as simple as washing hands could save many lives.

The encouragement from the community and their thirst for awareness and learning pushed me to do something different. Me and my health promotion team started to seek out different ingredients and put more flavours in community engagement activities.

The team put on a health promotion play to a crowd of women and children

A health promotion play in progress. Photo: MSF

Our team want to do more than just to talk one way, giving lectures. We want to do something fun and to show the community practical actions they could take to improve health, so we dressed up in costumes, we put on plays, we even had a puppet show.  

We found that if the audience really enjoyed an activity, our health promotion messages are more memorable than just talk and instruction.

Kids play a health promotion game

Children enjoy a game with an important message. Photo: MSF. 

As I have been working here I found other ways to engage people, through story games and character play. I found I enjoyed the creative intellectual challenge of creating these games and plays, and it was a lot of fun to see how much people enjoy them. I could see that community engagement is more than a theory, it really works for learning and everyone has a good time.   

For me, the big reward is when children sing a song and do the demo of hand washing steps whenever they see the MSF car passing by.

I believe that where there are a hundred challenges, there are thousands of reasons to smile.