Arts in Malawi

By OTIYELA MTEMA

What are the local arts practices in Lilongwe, Malawi? The Culture and Bodies project aims to work with communities to identify how arts can be used to spread awareness of how people can reduce their risk of non-communicable diseases such as hypertension and type 2 diabetes.

We wanted to work with people in Area 25 Lilongwe, so I set out to find out more about local arts practices and learn from the residents how we could attract people to take part in our upcoming Culture and Bodies workshops and events.

We drove around the area to get a feel for the place, noticing that many of the shops and grocery stores had been branded using paintings. We identified two artists at a sign-writing stall along the road and had chat with them.

They told us that they were fine-art artists, who ran a sign writing business to make a living. There was a more substantial demand for signs than there was for general artworks.

Dance

On the second day as I was chatting to another artist at the local Nyamithambo Arts Palace, I noticed a group of about five youths, listening to music on a portable Bluetooth speaker just outside the gate.

I spoke to one of the older youths. He explained that he and his friends were part of a dance group that danced to mostly dancehall and hip-hop genres. They were waiting for some of their friends, so they could rehearse at Nyamithambo .

Bawo

I also saw various groups of men in different parts of Area 25 converging around games of Bawo, a traditional game evidently very popular in the area. Residents I spoke to also talked about Bawo.

Other local arts

I also wanted to know what other forms of arts were popular in the area.

Pottery

This came out in the discussion with the two artists. One person mentioned that his brother made flower pots from clay as a business, and gave me some pictures of the various pieces.

Music

In most of the discussions, residents spoke about music.  People mentioned local bands, and how many people played and even recorded music for various reasons including fame, money and just for fun.

Bracelet-making, crafts

We also found out that some people make and sell all sorts of bracelets. Pictures of these were again shared with us.

Attracting people

How could we attract people to our events? People suggested we use a very common local advertising technique with project members walking around the community blowing whistles and screaming out the details of an event.

Someone also suggested that we make T-shirts and have a designated day where people would wear them to walk through the markets to generate intrigue and curiosity from marketgoers. They would then be given information about the project, including specific workshops and events we wanted them to attend.

Other ideas put to us were sticking posters up around the markets, and broadcasting digitally-recorded messages through PA systems on the back of a minibus or pick-up truck.

 

Posters, poetry and plays – taking the hypertension prevention message to the community

people holding postersOn 1 July, the Culture and Bodies team and community members joined together for a public event in Lilongwe, Malawi. Participants chose posters, poetry and drama to raise awareness of the dangers of hypertension – a growing problem in the country.

Social scientist Otiyela (Oti) Mtema, who is responsible for the day to day running of the Culture and Bodies project in Malawi, shares his experience of how the day went…

“We held our event at Mjoa Market  after our participants identified the market as the best place because of its size and the number of people who go there.

“To advertise the event, a week beforehand we put up posters the participants had created and we used a truck with a PA system on the day, inviting marketgoers to come along.”

Spreading awareness of hypertension risks

Before the public event took place, Culture and Bodies researchers worked with community members to identify ways of spreading awareness about the risk factors for hypertension and how people could improve their lifestyle to reduce their own risk of getting hypertension.

The fifteen participants were divided into three groups—one chose poetry, the other drama and the third posters.

Reducing salt intake

chips with pile of saltOne poster urged people to reduce the amount of salt they used in cooking. Another highlighted a ‘sprinkle, don’t dip’ message when eating from local take-aways as it is common for people to put too much salt on chips and other fried food. The third poster asked people not to put salt on the table at home.

Oti added: “The drama encompassed many of the anti-hypertension measures, such as reducing your salt intake and the amount of alcohol you drink, as well as making sure you get your blood pressure tested.

“The play focussed on a man who was drinking too much, while his wife told him he should be careful because she’d heard that alcoholic intake could affect blood pressure levels. He was reluctant to do anything about it, but then he collapsed one day and needed to go to the hospital.

“At the hospital, tests showed his blood pressure was high putting him at risk of developing hypertension. The doctor then gave the man and his wife advice about ways he could reduce his blood pressure, such as reducing how much salt he consumed and how much alcohol he drank.”

Know your numbers

The poem, which participants performed ‘live’ at the event, included stanzas about screening for hypertension and what happens if you don’t get tested (and have high blood pressure).

Some 300 people attended the event, coming and going throughout the afternoon. The performance was repeated and question and answer sessions took place to let attendees find out more about hypertension, the risk factors and how they could prevent it.

To add to the fun, the Culture and Bodies team handed out specially designed T-shirts and caps with the message ‘Know your Numbers’ (encouraging people to go and get their blood pressure tested), and held a dance off for participants with the crowd voting for their favourites – to get home the message that physical activity is good for you and can be fun.

What surprised Oti was the number of people willing to join in. People freestyled poetry and joined in the dances.

Feedback

What was the feedback?

Oti said: “We asked those who came along, ‘What did you learn?’ and they told us they’d take onboard the salt reduction message, and that the whole event had been relevant to everyone who came along. A lot of people said they wanted to share what they had learned with others.

“Plenty of people asked us if we would be able to do similar workshops and events in their areas—especially in places that are more rural and out of the way.”

What’s next?

“Now we have all the data from the pilot project, we’ll be reviewing it, working out what went well and what we can improve on, writing up papers and putting forward everything we find. We have planned to scale the project up if we can find the funding to try out the Culture and Bodies model in bigger sites.”

Pic of salt and chips thanks to Pixnio.

Bagamoyo Workshops – Angel’s Experience

Dr Angel Dillip is a social scientist and epidemiologist who has extensive experience in public health research. She works for the Ifakara Health Institute in Tanzania and has an interest in grassroots development interventions.

Along with Dr Sally Mtenga, Angel facilitated three arts-based workshops in Bagamoyo that took place in February and May.

Angel said: “Type 2 diabetes [T2D] is a major issue in Bagamoyo. When we sought out people to take part in our workshops, we worked with the ward executive officers and all of them mentioned diabetes as a health concern in the area. This came up time and time again.

“Our creative workshops backed this up—with both the men and women’s groups agreeing T2D was the non-communicable disease they wanted to focus on. They debated between diabetes and hypertension , but  all participants came to an agreement that diabetes was more problematic, which was why they chose it.”

Angel and Sally heard from plenty of people who had personal experience of T2D through relatives or neighbours, and many of them had a good understanding what the condition entailed. Many people knew, for example, that being overweight was a risk factor for T2D.

DIABETES IN TANZANIA

There were 897.000 cases of diabetes in Tanzania in 2017. Total adult population : 25,039,000. Prevalence of diabetes in adults : 3.6% Total cases of diabetes in adults : 897,000. 2% of all deaths*

Verbalised senses activity

“What I found most interesting,” Angel added, “was the verbalised senses exercise we did with participants, where they described sight, sound, touch, taste and smell and how they are related to the condition.

“People described T2D as looking like a snake that goes through your body. The snake bites you and the poison once you get it is very dangerous, more so even than HIV if you can’t control it properly.

Angel added: “What we wanted our participants to do was come up with an arts activity they thought could best explain T2D—that could include anything from a poem to a play. The activity was to be used to explain what can cause T2D, risk factors and what its consequences can be.

Poems describing the impact

“Our different groups focussed on activities such as a poem which described the impact of diabetes where the disease isn’t treated properly, and the risks such as amputations.

“Another group came up with a drama which they performed. In this, a son spoke to his father about diabetes, trying to persuade him to reduce the amount of sugary drinks he [the father] drank.

“I found the group’s activities very interesting to watch.”

Angel enjoyed the final workshop—where men and women came together to discuss what had happened at the previous workshops, the interventions they had come up with and what they thought would be the most effective activity.

Addressing misunderstandings

Angel and Sally also used the opportunity to work with the participants on their understanding of diabetes, its causes and the measures you can take to prevent it. They also had the chance to address any misunderstandings.

During the final workshop, the facilitators divided the participants up into three groups, asking them to come up with an intervention activity based on the risk factors for diabetes and what can be done to address each of those risks.

The first group opted to emphasise the important of regular exercise. The second group zoned in on the eating smaller meals. In Tanzania, there is a tendency for people to help themselves to big portions of rice with their meals.

The third group wanted an intervention that had highlighted the over-consumption of sugary drinks.

Angel continued: “We told the three groups to come up with different ways to communicate their messages. Our first group wanted to use posters. The second group weren’t quite as sure what to use for their message of eating smaller meals, but thought story-telling posters might work, while the third group wanted to use drama.”

WHAT NEXT?

“We are currently analysing the data we got back from all the workshops and working with a local arts teacher to help the participants develop their intervention activities—how they spread the message and making their activities more focussed. We’ll buy any equipment the groups need and look at other ways to publicise what we are doing—T-shirts perhaps?”

The intervention activities are to take place in the first week in July. Participants identified the market place as the best venue for performances/activities as a lot of people come to the market.

Angel is looking forward to seeing what the participants come up with. “Ultimately, we want our intervention activities to encourage people to change their behaviour, so they can reduce their risk of being diagnosed with T2D.”

 

 

*Sources – the International Diabetes Federation, and The World Health Organization.

 

Malawi workshops – an update

Sharon KalimaSharon Kalima is the Make Art/Stop AIDS programme officer at ArtGlo Africa, and the Culture and Bodies arts facilitator for the project.

In May, she helped run three workshops in Lilongwe, Malawi. Here, she talks about those workshops and what she found inspiring about them.

Malawi workshops – an update

Sharon Kalima is the Make Art/Stop AIDS programme officer at ArtGlo Africa, and the Culture and Bodies arts facilitator for the project.

In May, she helped run three workshops in Lilongwe, Malawi. Here, she talks about those workshops and what she found inspiring about them.

“The conventional workshops are usually mainly talks—where we sit people down and talk to them about non-communicable diseases such as hypertension and type 2 diabetes, and how to prevent them.

“People find them boring, and do not pay attention. When we use art to communicate, we use a universal language. We hoped the workshops would allow us to use art to explore participants’ experiences of non-communicable diseases and to work with them to develop interventions that would really resonate with local residents.”

Focus on hypertension

The workshops took place in February and May  2019. Two were creative workshops where women and men separately used arts-methods to portray non-communicable diseases and their risk factors. The third workshop brought the men and women together to design interventions aiming to encourage local people to improve their own risk factors.

“At our workshops,” Sharon continued, “there was a feeling that we should definitely be using the arts. The participants told us that drama was the arts-based method most people understood. There was also a suggestion that we use poetry.

“A poster was also one of the art forms that the participants chose to do as part of their intervention; participants will create posters from scratch and add in their own messaging around non-communicable diseases.

“During the creative workshop, we asked our participants to use their bodies and senses to express diseases like hypertension and cancer. What did they look like? Sound like? From there, we developed performances.

Arts ‘really powerful’

“Arts-based methods help us explore what people know about conditions such as hypertension and cancer, and they told us they had never thought about those conditions in this way. Arts-based methods can be really powerful.

“What I found fascinating was people’s understanding of what causes non-communicable diseases. Participants came up with many different reasons, which allowed us to think about how we could put across preventative messages such as the importance of exercising and eating a low-salt diet.

When Sharon and the other workshop organiser asked where the best place would be to perform their intervention activities, the participants suggested the market. This event will happen at the beginning of July, and Sharon is confident it will attract a big crowd.

What had Sharon enjoyed the most from running the workshops?

“Traditionally, art isn’t something people in Malawi take seriously, so I enjoyed seeing how much value our participants took from the workshops.

“One of the groups created a poem together—writing one stanza then and there. They created such a powerful poem and it was really fun watching them come up with it. It was so exciting! I wanted to hear more.

“It’s an exciting project to be part of—and I can’t wait to see the next developments.”

 

 

 

Project analysis – our different takes on the information we read

women performing at a creative workshop

 At the start of the year, the Culture and Bodies project ran a creative workshop in Bagamoyo, Tanzania facilitated by Dr Sally Mtenga.

In the workshop, nine local women used community arts to display their perceptions of and lived experiences of type 2 diabetes and diabetes risk.

Participants were asked to use the five senses (sight, taste, sound, touch and smell) to describe diabetes. Then, they worked in pairs to use their bodies to create images that represented the causes of the disease.

Collective performances

In the third part of the workshop, the pairs joined together to create collective performances of how people’s lifestyles led to them getting diabetes. Finally, Dr Mtenga asked them what they learned from the exercises.

The Culture and Bodies team – social and biomedical scientists, arts researchers and arts practitioners  – read the workshop transcript and viewed photos and videos taken on the day. They then met to discuss what they had taken from the various data sources. The different points made by the team members gave a fascinating insight into the different approaches people bring to analysis.

Potential for unintended (negative) consequences

Many of the team had concentrated on the workshop participants’ perceptions of diabetes in the transcripts, and it was noted that there seemed to be a number of misconceptions around diabetes.

This raised the point—would the workshops result in the participants then being seen as ‘experts’ in diabetes by their communities? The workshops are not intended to be a health intervention, but there is a risk that this is how the project is seen by the local communities.

The team agreed that in future workshops additional steps would be needed to address these misconceptions and ensure the workshops did not produce any unintended negative consequences.

Verbal versus visual data

Many of the team had found the verbal data easier to interpret that the visual data. The creative researchers found themselves reading “between the lines” as they analysed the transcript and seeing if the photos communicated something that was not intended. Another point made was the extent to which participants respond to the facilitator in the way they think the facilitator wants or expects them to respond. How far did the exercises, creating images and performances, allow them to respond more in their own way?

Perceptions of disease

One of the biomedical researchers commented that the transcript made him think about how diabetes was perceived  across different populations. What did knowledge of diabetes look like in Tanzania compared to the UK, and why?

To date, four workshops have taken place with women and men in Tanzania and Malawi. Further analysis of the transcripts will take place and be used to inform development of intervention activities to prevent diabetes and other non-communicable diseases. The activities will then be presented to local residents in community dissemination events.

If you are interested in finding out more about our work in this area, please email us at cultureandbodies@glasgow.ac.uk or follow us on Twitter, @Culture_Bodies