Taking on Covid-19 in different ways
In the past week I’ve been part of four different conversations in four different settings about Covid-19. Not just the gossip about what it is and where it might be heading, but the specifics of what we could do about it within each of these settings – or communities.
The first conversation was in a hotel seminar room in Abidjan where I was running some training for about 20 participants. At the time nobody in Cote d’Ivoire had been diagnosed with Covid-19 but many of the participants (including me) were frequent travellers and so one of the participants asked to take the floor and to suggest a few simple ways to avoid spreading germs. We agreed what you could think of as an informal contract, to be adhered to for the week. Occasionally one person had to remind another that, say, we had agreed not to shake hands. Because all of this had been discussed and agreed no offence was taken.
A few days later, back home in the UK my neighbourhood Facebook group (the only reason I am still on the platform) had a discussion where we agreed to share information from reputable sources; to look out for elderly or other vulnerable neighbours who might in particular be affected by movement restrictions (for instance if they rely on family or social care visits); and to behave positively and supportively to anyone in the area who eventually becomes infected and not engage in gossip or stigmatising behaviours.
Hours later I was discussing with leaders of a local primary school what the contingency plan should be in case anyone in the school community is affected, how to support families who are anxious about the school staying open, and how to provide ongoing learning to pupils in the event schools are shut down. We also talked about the difficulty of schools continuing to provide other essential services such as free meals or safeguarding support if this happens.
And a day after that I was down at a running track, with yet another of my communities or tribes. While it is open air and we don’t run in very close proximity to each other there are normally sweaty handshakes and back-slaps after the workout. We agreed we could give these a miss. We also agreed to avoid spitting on the side of the track. It’s rather unpleasant but it is a reality for a lot of runners and everyone who was there understood and knew exactly what the deal was.
I wanted to write all this down because it reminded me of a couple of things. Firstly that groups, or communities, can work together and come up with practical ideas to deal with anticipated or actual problems. Secondly that the settings or activities that different people are coalescing around have specifities that might require a certain reaction. I don’t remember reading any WHO guidance on spitting; on the other hand if I’d suggested to the Facebook group or my Health financing training participants that we don’t spit I would have got some funny looks. I imagine choirs, dog walkers, HIIT fitness squads and plenty of other groups could all think about what they do and how to do it more safely too.
So: get together with your gangs, tribes, communities. Get informed using reputable sources. Discuss. Identify things you can do, practically, that are in line with sound information on how Covid-19 spreads and what it’s impact (and the impact of control measures) might be. Don’t just wait for the government or public health authorities to spell it out. They can give overall guidance and frameworks but they have limited power to compel people. They’ll play their role but so must people and communities.
Hopefully what I’ve written above will be intuitive and understandable to most people. But the experience of the past few days has a deeper resonance for me and those of a navel-gazing disposition might want to read on. I’ve been working in what people call “community health” for about 21 years. I started off working on HIV, which is another salient example of how people who were affected by a scary, unknown new virus organised themselves and did something about it. The response to HIV was and still is very much driven by those most affected by it.
In my work I spend quite a lot of time designing programmes and assessing, analysing and describing how community practices can and should support health promotion and health care. Something I struggle with is providing specific recommendations of what communities should “do”. My clients – who tend to be international NGOs and funders, but also governments and NGOs mostly in sub-saharan Africa – often ask for very detailed plans for community programmes. When I end up writing about issues and solutions being context-specific, and instead making recommendations about how to support communities to figure stuff out for themselves, I expect people roll their eyes… before asking me to break down each context and give specific recommendations for each.
If I was writing about Covid-19 the expectation would be that I’d write a long list of bullet points like “don’t spit on the side of running tracks” or “find ways to stop your dogs chasing balls or sticks that other dogs or people have touched”. These points would be completely lost on anyone but the runners and the dog walkers who happen to be reading. Either that or I would have to write up a similar but slightly different set of advice for every single group. The ones I listed above but also the scouts, the football clubs, the birdwatchers…
What I tend to look for and talk about in my work, then, is not the specific practices that people adopt to keep themselves healthy and safe – although I have no objection to describing these. But more importantly I also describe the factors that made it possible for those agreements to be arrived at. The reasons we had constructive conversations in my four brief interactions were because we were well-informed, committed and not restricted to just following the five or seven handy tips tweeted out by Public Health England. We had autonomy and confidence. In most cases, someone stood up and took the lead. It didn’t mean they became in charge of Covid-19 – it just took someone to see beyond the awkwardness and suggest their groups discuss what they can do. And so this is the sort of thing I tend to emphasise in my professional life too. While governments, and funders – and in fact many ordinary people – tend to be attracted to the idea of top-down, prescriptive actions these tend to lead to very poor, limited results. They also tend to like fancy, “innovative” approaches when the reality of what can be helpful is a bit more boring and mundane. I’m very inspired and re-energised by the examples I’ve seen recently of people in my immediate spheres thinking about and taking on this huge new challenge. I am also reminded that context is important. And that most people aren’t part of one monolithic community but move in and out of many at the same time, playing different roles in each – something we say a lot in community health without always knowing why it matters.
But most of all I remain convinced that ownership is important. What works – I believe – about the different groups I’ve ended up discussing Covid-19 with, is that we were able to discuss the challenge, and agree pragmatically what to do about it. Because we’re figuring things out in an informed way but among ourselves we’ve got a bit more of a stake in sticking to our plans. And it also means that if and when things change in the next few weeks – a dramatic increase in cases; restrictions on our activities – we will be able to rise to the challenge and to talk about what else we need to change in these new, uncharted times.