Managing Ebola Will Take Powerful Communication

by CHRISTOPHER GRAVES
Comments (4) | August 8, 2014

Whether the world’s scariest outbreak of
Ebola can be managed may come down to
communications. Can governments, NGOs,
and doctors communicate with very
different audiences – with accuracy,
agility, and ingenuity? Can they be
convincing?
After years of civil war, many people in
the affected countries don’t trust their
governments or the foreigners in bio-
hazard suits who seem to bring the virus
with them. They don’t understand how
the virus is being spread. Local custom is
to bathe the bodies of the dead – but in
doing so, the living catch the virus.
Traditional sources of food – wild animals
– also carry the virus.
Think of the tough barriers that
messaging must get through to stop this
outbreak: don’t eat the animals you have
always eaten in the past; don’t touch
your loved ones if they are ill; don’t
follow age-old or religious customs in
washing a dead relative’s body; don’t use
the shaman’s cure you have always
trusted in the past; and yes, many will
survive if they get proper treatment
(though there is no cure). Think of how
you might try to get the message out to
a rural population with little electricity
(and therefore limited access to TV and
radio, let alone the internet) and low
literacy rates.
To find some ideas for the terrible
situation unfolding in West Africa now, it
may be useful to look to past efforts in
fighting HIV, leprosy, and diarrhea (a
major killer of children under the age of
5 in emerging markets). Those campaigns
educated and informed through the
ancient arts of personal and personalized
local folk media.
Nearly 800,000 children under the age of
five die every year due to diarrhea
( according to WHO ). It is the second
biggest killer of kids in the world. Many
of those deaths could be prevented if the
caregivers would simply wash their hands
with soap and water. However, in poor
areas, soap is considered too precious to
use all the time. Many organizations,
communications agencies, and even
companies have made a positive impact,
however. They create street theater,
puppet shows, skits and songs that do not
depend on reading leaflets or having
access to TV or internet. They craft
analogies to teach about concepts such
as germs or viruses, since assuming they
already understand basic biology is a
fatal assumption.
For instance, Ogilvy PR created an
award-winning campaign that saved many
lives in Indonesia called “Fantastic
Mom.” The insight was moms were the
reason children were getting diarrhea —
because they did not wash their hands at
crucial times. Local communicators
created puppet shows and songs that
made heroes of the mothers, brought the
idea to life – and saved lives.
Ogilvy also worked with Unilever, maker
of Lifebuoy soap, to turn roti (Indian
flat bread) into a messaging vehicle. At
an enormous festival, the roti were
stamped with a hot branding iron that
bore a message to wash your hands
before eating. Unilever has also run a
sustained initiative to teach proper hand
washing that has reached 130 million
people.
In Uganda, Medical Research Council
AIDS Directed Program also found
positive results using theater as the
educational vehicle. In rural Ghana, folk
media (puppetry, songs, proverbs,
theater, and storytelling) has combatted
HIV/AIDS, according to CARE
International researchers. In India, the
World Bank Health, Nutrition and
Population department has seen a
positive impact from the use of folk
media in combatting leprosy in rural and
illiterate populations. Theater works in
rich, educated countries too. Kaiser
Permanente has reached more than 15
million in the U.S. through its
Educational Theater Program. No matter
where you are, facts alone won’t change
minds, and fear is a powerful distorter
of any message.
Here is why drama and storytelling work.
Lawrence Kincaid is health
communications expert and scientist at
the Faculty of Social and Behavioral
Sciences at the Johns Hopkins Bloomberg
School of Public Health. His research
(“Drama, Emotion, and Cultural
Convergence”) delves into drama theory
— basically how audiences empathize
with characters and vicariously live their
conflicts through them, even riding with
them through their change of mind. His
work has been used to help prevent risky
behavior leading to HIV transmission
through creation of TV and stage
dramas. Researchers such as Raymond
Mar, Melanie Green, and Geoff Kaufman
have also found that fiction — far more
than expository or non-fiction evidence
— has the power to change minds and
thus behavior. Mar, assistant professor
of psychology at York University says:
“The more that people are transported
into the world of the narrative, the more
they feel immersed in the story, the more
likely they are to change their beliefs to
be more consistent with those expressed
in the world of the narrative.”
“We’re stepping into the lives of these
characters,” says Green. “The empathy
we create goes out beyond just those
few moments when we were thinking
about the story.”
Kaufman’s work using drama to change
high-risk behavior related to HIV
transmission found: “People who report
higher levels of experience-taking are
subsequently more likely to adjust their
behavior to align with the character’s.”
But creating such stories takes time –
more time than crafting a Facebook
campaign or A/B testing different
messages on Twitter. And it also takes
time to get the message out into the
community. As an expert at the Council
on Foreign Relations, Laurie Garrett,
who is a Pulitzer Prize-winning author
(“The Coming Plague”) answered my
question in a special CFR session August
5 that a “Western style of doing a media
campaign … is not what is needed on the
ground. What’s needed is really direct
communication that begins by identifying
key community leaders, village-by-
village, neighborhood-by-neighborhood.
Who are the influence-makers? Who are
the individuals that everyone else follows
and obeys for one reason or another,
whether they are religious, political,
gangsters, whoever they are, and
winning them over step by tedious step.”
Garrett went on to caution that beyond
tedium, “it’s dangerous work.” “They’ll
throw rocks at you … and you don’t
know who’s infected.”
To manage what the WHO has declared an
international health emergency will of
course take clear, accurate, consistent
communications updated in real time and
using all the always-on, digital, and
social media tools at hand for 21 st-
century communicators. But stopping
Ebola at ground zero will require the
ancient arts of story and drama that
predate Pinterest, Facebook, and Twitter
by thousands of years.