How can TfD be utilised as an effective action and participatory research tool for reducing water and sanitation hygiene issues in a local community in Southeast Nigeria?
Key Objectives
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- Investigate the health challenges a selected community in Nsukka, Southeast Nigeria faces, using purposively selected applied theatre research methods: Community dialogues, interviews, and surveys.
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- Test/utilise the TfD model of Methodological Conversation developed by Steve Abah as a behavioural change action tool using water and sanitation as a paradigm.
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- Identify challenges associated with W.A.S.H. within the selected Nsukka, southeastern Nigeria community.
Research Design
The Department of Theatre and Film Studies identified Iheakpu-Awka as the community where the TfD project would be held. Before this selection, five communities were considered within the Nsukka Local Government Area, and after consulting with the University Team Prof. Benjamin Ozumba, Vice-Chancellor; Dr. Uche Nwaozuzu, Head, Department of Theatre and Film Studies; the Heads of Research Team: Jonathan Eze, Dr Ikechukwu Erojikwe, Dr Ndubuisi Nnanna, and Dr Cindy Ezeugwu, as well as Prof. Vincent Chigor, as a resource person from Microbiology, suggested Iheakpu-Awka after proper security and geographical considerations and applied for funding and approval.
A meeting was held with student facilitators (43 persons) to discuss the modalities and expectations of the intended visit. Four students were then selected to join Eze, Erojikwe, and Nnanna in visiting the community for ethical approval. The preliminary visit involves familiarisation and advocacy with gatekeepers (initial contact with the community). The first action was visiting the Igwe (traditional ruler of Iheakpu-Awka) led by an intermediary. The core researchers introduced themselves and encouraged the Igwe to support the proposed project. He asked the team to return in a fortnight. This enabled him to involve his council and other stakeholders since he could not make decisions alone. This preliminary visit conformed with the ethical requirements of the Community Dialog method of health humanities research.
As agreed, the team returned and informed the council and stakeholders of the proposed TfD project for their community. For security reasons, every issue with the project was explained in detail. For example, the number of people coming, the purpose of the visit, the duration, etc. The Igwe, members of his council, and stakeholders (women leaders, youth leaders, and representatives from the Christian and traditional institutions) welcomed and approved the proposed project and promised to work with the team to achieve desirable results. The two groups (the host community and the team from the University of Nigeria, Nsukka) agreed that the 'visitors' should not violate their customs and traditions. The Community Dialog enabled the researchers to gather information about the norms and value system of the community. It empowered participants with knowledge about the significance of the TfD project for dealing with their water-related health challenges.
A team of 43 students and three lecturers from the University of Nigeria, Nsukka, arrived at Iheakpu-Awka on the appointed date. The team used music and dancing to announce its presence. The community members came out, and initial interactions and contact started. A warm and interactive atmosphere was, therefore, set for the research. With the aid of the leader of the local security outfit, the principal of the secondary school, and the palace secretary, a community mapping of the environment with details of strategic locations was developed, after which the transect (reconnaissance) engagement was conducted to assist the team in the familiarisation process.
The next step, Community Research, is essential to the success of any TfD project. For this purpose, the researchers adopted the health humanities methods of interviews and surveys to assess the lived experiences of community members. This approach permitted emic and etic interpretations and followed the six steps recommended by [6]:
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Defining the Research Question (How can TfD be utilised as an effective action and participatory research tool for reducing water and sanitation hygiene issues in Iheakpu-Awka, Igboeze South Local Government Area, Enugu State, Nigeria),
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Designing the interviews (the researchers, in consultation with the participants, opted for a closed and semi-structured format to accommodate varied literacy levels and occupational variables);
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Applying for Institutional Review Board Approval (the interview questions were drafted and sent to the Igwe and his council of chiefs and stakeholders, the Local Government Chairperson, and the leadership of the Department of Theatre and Film Studies, University of Nigeria Nsukka) for approval,
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Data Collection: The team used various approaches to obtain information from the community members. These approaches were vital informant interviews (KIIs), in-depth interviews (IDIs), and focus group discussions (FGDs). A total of 4 FGDs, 5 KIIs, and 20 IDIs were generated. The form and content of the agenda for the entire exercise were determined from within the community and by the community members themselves. The average number of participants per FGD was 8. The participants were randomly selected. The minimum criteria were that the participants:
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Must have lived in the community for at least three years
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Should have interest in the proposed project
Community leaders assisted in selecting the participants. For data clarity, the groups were separated according to age and gender.
IDIs (20) were selected from among the 15 villages, while the KII was conducted with Igwe, the local government chairperson, and health centre staff. The student facilitators recorded discussions in Igbo and Pidgin English and later transcribed them into standard English.
The KII corresponded to various facets. For instance, the facilitators were warned about dress codes and time movements due to a masquerade festival happening at the same time as the project period. Some of the participants in the IDI believed that we had introduced them to Nollywood (the Nigerian Video Film industry), an impression that was corrected immediately.
(Of the 48 FGD participants, 24 were female, 16 were male, and 8 were children.)
v. Analyzing the data: the unanimity observed was health-related. Most community members were worried about the prevalence of health challenges in their community but often attributed those to superstition. Some were aware of the consequences of consuming contaminated water and unhealthy practices but attributed their unwillingness to take positive action to poverty. Many community members blamed the government for almost everything.
vi. Communicating the Findings: The researchers assembled the participants and openly shared the results of the interviews. There was a consensus that the findings were correct and that most participants were validly identified. The meeting involved interactions, familiarisation, gaining trust, and sharing in people's pains, joys, and meals. This encouraged trust and confidence between both parties. The meeting also provided the forum to conduct a survey, a valid research method in the health humanities. The survey involved sharing actual narratives of real experiences by community members and asking carefully constructed questions, mainly requiring yes/no answers in an interactive and relaxed form. This approach enabled the researchers to collect critical, descriptive data about prevalent opinions from a larger community population.
Prevalent health issues:
Participants were asked to ascertain the predominant health problems in the community. Various answers and reasons were given. Some believe that with improved lifestyles, good health and well-being will be sustained, while others are unaware of the reason for their poor health.
'I do not go for a test. I buy drugs from the pharmacy. However, it is mostly stooling and vomiting' (female participant).
'It is mostly typhoid and malaria that we suffer' (male participant).
'Our enemies poison us' (female participant).
'Government refuse to bring development and clean water' (female participant).
Water concerns
The team discovered that the lack of safe water was a primary concern of most host community members. Water sources include rainwater, streams, and local groundwater wells. These materials are often stored in locally baked earthenware pots and locally fabricated tanks. Figure 2 shows sources of water drank by community members in earthenware pots and a big metal fabricated material called a tank in local parlance.
'I get my water from a bore-hole, but it is a long distance' (male participant).
'I do not have water, so I use any available one. I do not consider if it is dirty or not. We must eat' (female participant).
'We buy tank water, which is very expensive' (male participant).
Many patients had solid preferences for open defecation without knowledge of the consequences. They believed the procedure was safe since they had no cuts or bites. A remarkable number said they had never been to the community health centre due to the incompetence of staff and lack of drugs.
An interactive session was held between the research team (facilitators) and community members who identified the most pertinent problems that required immediate intervention. Using problem tree analysis, the group agreed on the identified problem. Next, the causes of the focal problem were identified, and these became the roots. The next step was to identify the consequences that affected the branches. The method used for this purpose was interactive, and everyone was allowed to contribute. The tree included branches and fruits related to many concerns, such as bad roads, poor health care, water-related diseases, lack of money, unemployment, distance from water bodies, inconsistent rainfall, ignorance, myths, and superstition. After in-depth analysis and discussion, the lack and high cost of clean and safe water and government insensitivity were identified as the root causes of these problems.
EFFECTS (Water-related diseases, poor health care)
PROBLEMS (lack of clean/safe water, high cost of water, bad roads).
CAUSES (poverty, government insensitivity, unemployment, distance of water bodies, inconsistent rainfall, ignorance and poor sanitation culture, myths, and superstition) below in Fig. 3 is a diagram of a problem tree. See below the diagram of a problem tree portrayed in Fig. 3.
The problem tree has gained widespread acceptance and has been used over the years for discussing the cause and effects of a situation. [26]
Erojikwe et al. 2022 (Field research)
Pairwise ranking
This is a participatory learning and action research tool utilised effectively during the project. The team adopted it since it functions as a scale of preference or ranking system. This approach helps identify communities’ priorities and preferences. It portrays the democratic process of theatre for development, where community members oversee decisions and take control of their development process. The facilitators used symbolic objects to represent the items in the chart for effective communication. An object represented each item in the chart to clarify the voting process. Therefore, each item in the chart was represented by stones, empty plastic bottles, rope, paper, or sticks.
The community members conducted the entire process with minimum supervision from the facilitators. To encourage participation and fun, women members raised songs that were chorused by all. With these and some dancing, a relaxed atmosphere free from tension was created to enable functionality. Participants became relaxed and asked questions about their confusion, and trusted members were selected to oversee the voting process.
The entire process was smooth and fair, with keen attention given. The community members carried out effective mobilisation to achieve active participation. The person recording information on the chart drawn on plain white paper differed from the person collating numbers, and each person tallied smoothly. The Table below shows the sample of pairwise ranking chart used during the study. Table 1 below gives graphic imagery of the pairwise ranking charting used in the community theatre project at Iheakpu-Awka, Enugu State, Nigeria.
| Items | Number of times preferred | Rank |
| Bad roads | 7 | 4 |
| Lack of money | 3 | 5 |
| Distance of water bodies | 5 | 3 |
| Government insensitivity | 3 | 5 |
| Poor health care | 5 | 3 |
| Lack of clean, safe water | 12 | 1 |
| Sanitation | 8 | 2 |
| Table. Pairwise Ranking Chart |
At the end of the exercise, the facilitators explained the results in detail. They agreed that creating the scenario for the drama would follow the most preferred item, which was the lack of clean, safe water, followed by sanitation and bad roads. The community members were concerned that the bad roads had already caused many deaths, which was captured as undesirable.
The information gathered from the field during the research and the villagers' views strongly corresponded. This step is essential because the data collected would provide materials for scenario creation. Furthermore, priority concerns within the community are imperative to the project's success.
Theme identification and scenario creation
The facilitators began to create drama skits using the information gathered from the research and the problem tree as a guide. The team, comprising the villagers and community members, created exciting, engaging, and enthralling performances using dance, drama, and music with indigenous registers.
Rehearsals
The interested villagers and those who participated in the scenario creation joined the team in rehearsals. The rehearsals were always adjusted so that the team and community members could work together. This was to facilitate the development process. The project began to take shape because of the active participation of community members. The interactions and synergy led to the 'learning process' being interactive, informative, and exciting.
Production and Post-Production
This was the last rehearsal. The community and the researchers from the University of Nigeria, Nsukka, gathered at the village square.
In the final performance, the first scene showed a young woman who was ill and whose family ran around trying to get medication for her condition. A narrator reported that the cause of the ill health was the contaminated water she had been drinking, and during the narration, the sick woman took her last breath. With this turn of events, the orchestra changed and sang a dirge as the son who went to fetch water for her to take her medication rushed into the scene and saw his dead mother.
The second scene depicted a car accident (an exciting representation of a human, not an actual car) involving two children on their way to fetch water. They were taken to what appears to be the nearest health centre. It was discovered that the facility was locked, and there was no one to attend to patients. A call-response session between the narrator and an audience member affirmed that their roads were indeed bad and that their water supply sources were deplorable, with possible severe contamination and illnesses such as typhoid waiting to happen. Another audience member spontaneously broke into the arena and lamented that the community needed boreholes and a potable water supply. The respondents unanimously affirmed that government negligence in their community had led to a high mortality rate from unattended ailments.
The narrator agreed with the audience members but advised that they must not rely on the government alone but rather resort more to self-help and community action for their well-being by maintaining clean and healthy environments. Therefore, sanitation was imperative to community members' health and safety.
One of the project's resource persons took over from the narrator and said they must try their best. He urged the young people in the community to get off their backs. He stated that in the primary school where the visitors were working, they had already refurbished toilets with a small quantity of money and teamwork. The community members sounded surprised at how little it took to make something better with a little effort.
The resource person spoke about the monitoring and evaluation committee, which was set up to sustain the theatre for development project while stressing the importance of teamwork. Volunteers were called upon to form the committee. The next scene showed a young man defecating in a bush. A snake suddenly bit him, and he limped away. Other groups of people are displayed using a toilet without cleaning it after use, even though they are uncomfortable with the horrible smell.
The scenarios captured the data obtained, using the problem tree, regarding the primary challenges (fruits): water-related diseases; poor health care; the branches: lack of clean/safe water; bad roads; and root causes of the health problems: poverty, government negligence, and insensitivity; the distance of clean water bodies; and ignorance/poor sanitation culture on the part of community members.
Monitoring and Evaluation
To ascertain the level of impact of the TfD project, IDIs were used after a three-month baseline. Below are some of the data received:
A respondent noted a "reduction in sicknesses like diarrhoea."
Another respondent captured the reason for this, "There is the provision of water. Most people have changed their toilets. Good personal hygiene by the youths." Another respondent provided the following information: "Efficacy of the medical personnel in the health centre improved because the government got someone else to replace the arrogant medical personnel." Another respondent noted, "Poor hygiene, i.e., drinking rainwater without boiling it, has reduced, but we do not all have toilets; we use the bush system; there is no money to build a good toilet."