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Setting the StageforPublic Health

By Maggie Bucholt
Global Health

Many of the public health challenges Boston University researchers engage on a daily basis occur thousands of miles from campus. The University’s global initiative to improve health in low-income countries around the world includes projects such as an evidence-based study of childhood pneumonia that changed the World Health Organization’s guidelines for treatment. A Spanish immersion program for School of Medicine students that benefits local citizens and community health care projects in Ecuador. In Nicaragua, researchers are seeking answers to a kidney disease epidemic affecting young workers, and in Peru, a theater arts pilot program has shown promise in improving public health.

At the heart of these efforts is the Center for Global Health & Development, where numerous research projects in Africa and Asia contribute to the body of knowledge about HIV/AIDS, malaria, and infant mortality. A new focus is rapid urbanization in India and its impact on public health. To support the complex strategic and operational issues involved with international research, education, and community service, the University established the Global Programs Office and is encouraging cross-disciplinary collaborations to address major global challenges.

Parades. Music. Contests and prizes. An absorbing 12-episode stage drama about two families in a fictional shantytown in Lima, Peru, that was similar to the communities where the performances were held. Theater for Health, pioneered by Arts for Behavior Change (ABC), educates people about disease prevention and household cleanliness through theatrical performances that keep adults and youngsters coming back for more. Scientifically measured outcomes demonstrate the effectiveness of this pilot program in addressing public health issues.

“My job was to assist in the arts methodology and process,” says André de Quadros, professor of music at the College of Fine Arts and one of the team members involved in the partnership led by the Clorox Company and Canyon Ranch Institute, a nonprofit organization that advances health literacy. “Every question about the process is a major question,” says de Quadros, “from the makeup of the plays to how audiences should be seated. What time of day is a big issue. It can’t conflict with soccer games or church, and Saturday is washday.”

The structure of the play Siempre (which translates to always in Spanish and, in this case, refers to perpetual illness) was based on the popular Latin American telenovela, a TV genre similar to a soap opera but with a finite number of episodes. The ABC Program integrates theories and practices from the Theater of the Oppressed methodology of community engagement through storytelling with the best practices of health literacy and the science of hygiene.

After two weeks of training actors from the Peruvian nonprofit organization Kallpa, the team followed a demanding schedule to develop the performances that ran from October through December 2011. Each week, artists and scientists collaborated to write scripts in Spanish. Rehearsals and actors’ feedback followed, and adjustments were made. Then came the performance. Hundreds of women, men, and children attended the outdoor shows.

During the performances, the play’s facilitator, a local physician with a degree in public health, interacted with the audience, discussing hand washing, cleaning food-preparation areas, and treating water and waste-disposal holes. After each episode, de Quadros helped to guide the post-performance discussion process; he assisted the artists and scientists in assessing the videotaped performance and audience responses. Then, they developed the story line for the upcoming episode, and the process started anew.

Program partners, including microbiologists from the Mel and Enid Zuckerman College of Public Health at the University of Arizona, conducted pre- and post-program evaluations. A Peruvian nonprofit organization called Instituto de Investigación Nutricional conducted the evaluation fieldwork. “One of the challenges was to figure out whether it was working,” says de Quadros. “Using the arts to change behavior has been shown to be viable. We are engaged in productive discussions on replicating this program in other parts of the world.”

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