In a recently published by Mtuy et al. In a study conducted in 2021, researchers evaluated Photovoice’s use as a community engagement tool by placing Maasai women on the other side of the camera, giving them control over photography, and empowering them as ambassadors for promoting health in their communities.

Trachoma Control, Photovoice and Maasai Communities

Trachoma is the most common infectious cause of blindness worldwide, caused by the bacteria Chlamydia trachomatis. It mainly affects people living in low and middle income countries, including the Maasai tribe in Tanzania. Risk factors for trachoma include restricted access and use of water; limited washing of the face, poor hygiene; and crowd. Blinding trachoma is set to be eradicated as a public health concern by 2030, and although great strides have been made, hard-to-reach, underserved, and marginalized communities may still suffer from high prevalence and recurrence of trachoma infections. A recent study examined the experiences and perspectives of Maasai communities with trachoma control programs and highlighted key social, economic, and environmental barriers that hinder the effectiveness of these control programs. A key factor underlying many of these barriers was education and the need for transparent communication, knowledge transfer and community responsibility for health priorities.

Photovoice uses cameras as a tool to visually document a specific problem. Participants take photos or videos to capture the topic in their everyday lives, to document how they interpret the topic. The photos taken by the participants are examined either individually or in groups in order to enable reflection and stimulate dialogue in order, ideally, to lead to social changes.

The Maasai were depicted as “exotic, noble savages” in various visual images, from “trading cards” in the late 19th century to contemporary illustrated books. The Maasai, who, together with the “Big 5”, are a must on photo safaris in Tanzania and Kenya, are visited to have pictures of them decorated with pearls and pose with spears. In our study, however, this intervention put Maasai women on the other side of the camera and allowed them to control the photography.

Photovoice workshops and public health interventions

We used Photovoice as part of a program to educate and empower Maasai women in the prevention and treatment of trachoma in their community. In this project, which was developed together with the community, the participants were asked to share information from a workshop on trachoma with their community and to record their experiences as educators with disposable cameras. The intervention consisted of a workshop with photo voice training, participants spreading their knowledge from the workshop in their villages, documentation of trachoma control in the community through photography and ended with a group discussion of the participants’ photos.

The workshop included basic information on causes and pathology, transmission, signs and symptoms, and treatment and prevention of trachoma. We have integrated participatory methods into the workshop.

  • Giants filled, Sorbs, were used to transferring. to show Chlamydia trachomatis. Baby powder, showing Chlamydia trachomatis, was placed around the eyes of women. It was shown that when the giant fly landed on her eye, it got some baby powder on its feet and then flew away and landed on another woman’s eye, leaving some baby powder on her eye.
  • Tell stories: Topics related to trachoma infection and treatment were conveyed through a storytelling session.
  • Video demonstration: a short video from The END Fund & Sightsavers, “Leaky Tin: A Simple Solution,” was shown and simultaneously translated into Maasai language to demonstrate a simple and effective method of washing faces and hands with minimal amounts of water. This demonstrates the use of a container with a hole punched in the bottom. When it is filled with water, hands and face can be washed by slowly trickling the water down. The hole can be closed with a pin when not in use.
  • Photography: Women were given disposable cameras to document their efforts as educators on trachoma and the challenges of trachoma control. They were taught how to use the disposable cameras, what types of images they can take, and the ethics of photography.

Women were then asked to return to their villages as ambassadors for the fight against trachoma; Providing education, advice and community mobilization. In this role as ambassadors, women shared their knowledge from the workshop with other women in their village and enabled discussions about control measures in their socio-cultural context.

“Leaky Doses” installed at (1) a participant’s home and (2) the local elementary school after the trachoma workshop. Photo credit: Tara Mtuy

Photovoice as a tool for community engagement and empowerment

The most common photos shared were of children either washing their faces or showing clean faces without flies. Women shared photos of people cleaning up rubbish or human and animal feces, cleaning clothes, and displaying “leaky cans” on themselves enkang. Some women shared photos of themselves when meeting other women in their village to educate them about trachoma. Very few women shared photos of challenges, but of those who did, the photos showed traditional practices for treating trachoma-like symptoms and animal carcasses. The workshop only mentioned feces as a source of flies, and yet the women concluded that animal carcasses are a source of flies. This is a very real source of flies in this community with many carcasses of wildlife and donkeys near them enkang.

The use of Photovoice was an effective tool in motivating and facilitating community discussion about trachoma control, and ultimately empowering the women involved in the intervention. Discussions before the start of the project dealt with the ethics of photography, with which the Maasai are regularly confronted, as photo tourism is a source of income for the Maasai, but is also perceived as the exploitation of their people. Involving the communities in the ethics surrounding the use of photography and photo voice prior to the start of the project meant that the community and the Maasai photographers had ownership and responsibility for the photos, not the researchers, which instilled confidence in the project and the women strengthened ambassadors. Women discussed the joy of taking photos of family and friends, something they had never done before, and the thrill of getting the printed photos of people they took themselves.

This project provided women with a guided and systematic approach to openly discussing which risk behaviors are appropriate and which are challenging in their sociocultural context. Photovoice should be considered as a communication tool on health issues for future public engagement and empower women to facilitate health promotion.

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