Let's communicate

Let's communicate by Gloria Gordon T he theme of this year's World Health Day is "Let's talk about health ." But let's do more than talk. Let's communicate about health. Conversation without communication won't save lives, but effective communication will affect behaviour, thus helping establish a lifeline to good health. As we work with the vital health problems facing the global com- munity, whether they be within highly sophisticated "first world" countries or in obscure and isolated locations where even basic informa- tion on nutrition, hygiene or health is lacking, it takes team effort to save lives. In addition to deploying the medical and teaching skills of physi- cians, nurses, pharmacists, midwives, health advisers and practitioners, why not make communication part of the team? Communication skills will help you "tell it like it is" effectively, and thus add another link to the lifeline of health. The AIDS epidemic made health care professionals painfully aware of the need for open, candid, honest, no-holds-barred distribution of information. When health officials realised the enormousness of the AIDS situation and how rapidly the disease was spreading, along with misinformation and fear of the un- known, it became obvious their communication procedures needed to be rethought drastically. At this time the only real defence against the spread of AIDS is through beha- viour change. No drugs, operations or other medical answers exist for its cure - just communication on how the disease can be prevented. In a precedent-setting measure, Dr C. Everett Koop, Surgeon General of the United States, drafted a bro- chure to be sent to every household in the country. Words and illustra- tions describe exactly how AIDS is spread; for the first time, many people were exposed to the graphic and explicit information that just five years ago would have been unaccept- able to any general population. For the most part, this type of direct mail information, as well as television , radio , posters and billboards conveying such explicit illustrations and descriptions, can be presented - and generally accepted - in "first world" countries such as the US, the United Kingdom, Europe A mother waits for a consultation at a Jerusalem clinic; behind her- a graphic poster shows how she can help her child to grow. Photo World Council of Churches/ M. Murray WOR LD HEALTH, January-February 1989 Extreme examples of the haves and have-nots. Much of the battle for health consists of finding the golden mean. Photos WHO/ P. Almasy and most of Asia. But this would be unacceptable for dissemination in most "third world" countries where cultural and religious taboos about sex exist. But where there is a need, there also must be a way to fill it, and in this case, the need is to save lives. Dr Koop and hi s communication advisers are meeting the challenge head-on and with candour - by going back to communication basics. Which leads us to the challenge of communication - how can we communicate any and all vital health information to a ll people everywhere? Pharmaceutical companies, health care agencies, doctors, nurses and health workers as well as government agencies are beginning to see that talks, education programmes and reporting are not enough to awaken awareness of today's critical health demands. Another dimension needs to be added, and that is the develop- ment and putting into effect of the basic communication skills to effect behaviour change. For example, some speech writers use this edict to convey a message: 1) Tell them what you're going to tell WORLD HEALT H, January · February 1989 them, and why. 2) Tell them. 3) Tell them what you told them, and why. 4) Answer questions and, in your answers, tell them again. It sounds easy, but when cultural barriers have to be crossed, some fine tuning is in order so that you can direct your message to influence and persuade your receiver. messages must be interpreted within the cultural framework , the greater the cultural disparity between the communicators and their receivers, the less likely the communicator will be able to define and interpret. To communicate is also to per- suade. And a key to effective persua- sion may lie in discovering how a situation affects a family or com- munity in such a way that it becomes a part of them personally. Since Gestures, symbolic movements, may be unique to one ethnic group and have entirely diverse meanings in different cultures. So the challenge comes in how to define them and work with - or through - them to convey a message to the individual. Communication expert Roger Haywood of Haywood Associates, -Promote actions which are realistic and feasible within the constraints faced by the community. -Build on ideas. concepts and practices that people already have. -Repeat and reinforce information over time, using different methods. c - Use existing channels of communication such as songs. drama and storytelling. and be adaptable. -Entertain and attract the attention of the community. -Use clear. simple language with local expressions and empha- sise short-term benefits of action. -Provide opportunities for dialogue and discussion to allow learner participation and feedback on understanding and implementation. -Use demonstrations to show the benefits of adopting practices. (Reprinted with permission of Dr John Hubley, senior lecturer in health education at Leeds Polytechnic. U.K.) 13 Let's Communicate London, offers the follow guidelines in designing and crossing cultural communication boundaries. Firstly, look for similarities in cultures and ethical standards, but beware of stereotyping. Secondly, be sensitive to space, planning, status symbols, personal content, methods of agreement, attitudes, cultural details. Pace the degree of development. Explore ethical dimensions. "What is the receiver's view of reality? What are his or her needs? What factors affect his everyday existence? A message needs to square with hi s environmental and situational realities. It needs to relate to individuals' value systems and levels of understanding," adds David Pincus, communication professor at California State University , Fullerton. lndi Rana, in a recent article for the Clearing House on Development Communication, explains how researching and eventually distribu- ting a comic book became an effec- tive tool for offering information on immunization to rural schoolchil- dren, and to their parents, in India. "The idea was to use child-to-child and child-to-parent communication to carry the message that all children under 12 months of age should be immunized. Children between 8 and 12 years were to read the publica- tion, perhaps in class, perhaps as an extra-curricular give-away and take the message home to their parents." To test this theory, a survey was conducted to discover the target audience's pre-knowledge of immu- nization and determine how much information should be included. It also assessed their visual literacy to determine their level of sophisti- cation, and their interest in story types so as to select the most accept- able vehicle for the health messages. Results showed that, given the right kind of comic book, rural children, being naturally eager and curious, would adapt to this new and interesting form of reading and - it was hoped - would take the message home to their parents. In this case, the children became the agents of change, the communicators. Did the comic book meet the objectives? Rana says, "UNICEF in New Delhi is distributing 85,000 copies in Hindi. The comic book will eventually be translated into all of the Indian languages. WHO offices worldwide have received copies and have shown interest in adapting the book for their regions. Other health agencies in Sri Lanka, Nepal, the Maldives, Bhutan, Burma and 14 Indonesia are looking into adapting the publication. "With careful research and thoughtful presentation , comic books with health information built into their storylines could become a common sight in rural communities, helping to dispel the belief that this popular format is not suitable for social messages." The shrinking globe with its open- ing channels of awareness is also affecting the communication pro- grammes of large worldwide cor- porations and agencies. Most find that the grandiose communication programmes of the past just don't work any more. Going directly to - and through - the people is what works best. Johnson and Johnson, one of the world's largest distributors of phar- maceutical products, directs its 167 satellite companies in 53 countries to work through local management to disseminate information about its products and services. Bob Andrews, assistant director of corporate public relations, says: " It is far more effec- A ball-game helps to convey the message of immr,mization to children in a Beijing park. Photo WHO/Chinese Health Education Institute. Below: Cartoon from Jian Kang Bao, the popular Beijing health newspaper. tive to tailor individual communi- cation programmes to suit the communities served, using residents of the country to relay information. Our corporate guidelines may contri- bute to consistency, but it's those who actually live and work in an area who make a programme work." Merck, Pfizer and other com- panies also find that effective dis- tribution and proper use of pharmaceuticals in developing coun- tries are best carried out through indigenous groups rather than from "front office headquarters." Peter Keating, executive vice- president in charge of operations of Americares, an organization which works with pharmaceutical com- panies and other agencies to distri- bute medical information and supplies in areas of dire need, says: " We initiate discussions, make con- tacts. Our concern is getting information to people to help them- selves. We help retrain physicians and find physicians who are willing to donate their time. We use them to work in a community and train local medical staff. The end result is that, through training and communicat- ing , pride among participating residents develops. " Inconsistent laws Distributing life-saving medical help doesn't always work as smoothly as intended, though. Spokesmen for most of the pharmaceutical com- panies I talked with. agreed that it is a frustrating experience to have available the means to help, but not to be able to do so because not only communication but also consistent regulatory measures are lacking. " Each country has its own laws governing distribution. What requires a physician's prescription in one country can be picked up at a local market over the counter in another," says a pharmaceutical communication specialist. He adds, "There is no such thing as a safe drug. All can be dangerous if misused. We have strict guidelines requiring us to provide printed in- formation with each product - but if that information disappears in tran- sit, we lose control. It becomes a political problem. The result is that activists campaign against the dis- semination of pharmaceuticals in Third World countries because of inconsistent laws and misinform- ation about their distribution and use. Why should this be? If we can't reach all in need, why deprive those we can reach?" • WOR LD HEALTH, January- February 1989