Community Based Participatory Research Great Hope Educational Centre

The Kayole/Soweto Participatory Photo Mapping (PPM) project began as a series of three workshops held from the Great Hope Educational Centre in Kayole, a suburb of Nairobi, Kenya. The Pilot was made possible with the full support of the Great Hope school director, manager, teaching staff and school counsellor to work with eleven of its secondary students on the PPM study and use the space for conducting focus groups. Before conducting the field work, a letter of consent was attained from the local government to permit the students to conduct the research activities and take photos in the community. The student participants of the PPM project ranged in age from Standard (grade) 8-12 and consisted of 11 students (3 males and 8 females). Each of them was a local resident of Kayole. Before heading out into the community to begin the field work, a focus group was facilitated with the students during the first workshop to brainstorm the community development topics they wanted to explore while engaging in their photographic research. Each student had an opportunity to speak, and the following were the initial list of the themes which were mentioned: Garbage collection Health care services Slums/ living conditions Education Security/ safety Environment Status of the roads Pollution Plants Hunger

The field work was conducted by breaking up into three separate groups, each one supervised by a teacher, and heading out into the community with the students for them to take photos of the above themes. Each group was led to separate areas of Kayole and Soweto in order to document

as much of the two communities as possible and avoid overlap. Students were provided with a camera to share for each group, and were given notepads and pens to write notes while taking their photographs. Often times the students wanted an insight into the experience of other residents, and would interview them to enrich their understanding of the health and living conditions facing others in their community. After the field work, the three groups would reconvene back at the Great Hope Educational Centre and participate in a focus group discussion about the photos they took. These discussions yielded insights on why the photos were taken, and were transcribed by the lead researcher. The data collected during focus groups was supplemented with the notes taken by the students in their notebooks while photographing the community. This process was repeated for each of the three workshops. The following provides a summary and analysis of some of the photos taken by the students corresponding to the themes they explored during the research process. Additional GPS location points are featured to assess spatial trends of the themes.

Food, Nutrition & Hunger Despite the appearance of fruit and vegetable stands all
Fresh tomatoes: they come from very far places, as reflected in the price - Student

throughout Kayole, the perception of how they contribute to food & nutrition security encompasses more than physical proximity and quantity of access points, indicators

commonly used in several quantitative or GIS-based community studies on food deserts

Tomatoes have diseases which affect the seller Student

(SmoyerTomic,

2006;

Larsen,

2008; Clarke, 2002). As indicated in the focus group discussion, students perceived the fruits to be expensive due to the fact that they are brought in from distant places,

as opposed to grown locally, ultimately affecting their perceived accessibility to youth. On instances where fruits were found to be affordable, such as these discounted tomatoes one street over (picture above left), they were perceived to be less edible with disease. Despite the lower price, the students were quick to mention how this negatively impacts the profits of the seller, and their ability to make a profit for the day. These discussions highlight that, despite frequent proximity and access to fruit/vegetable stands throughout Kayole, the indicators of quantity or accessibility are not a large enough factor to positively influence perceptions of how such foods contribute to community health. Food cost, and subjective associations of quality based on where the food is from, how its made, and how it looks all play a role in determining how healthful a food is perceived. As one student explained, some of our foods are not good for our bodies; they give bad diseases like cancer. Community gardens, often portrayed in public health literature as a positive attribute to the health of community social and physical environments (Armstrong, 2000;

Francis et al., 1994; Hynes, 1996), were sometimes portrayed differently by the PPM students. Some shambas (vegetable garden in Swahili) were seen to be overfilled with weeds, and in the case of the garden featured right, hazardous to human health. As the geotagged location of the photo above right indicates, the shamba is located alongside a dam which is currently being used as a landfill and an open pit quarry. Several contaminants from the quarry, the landfill, human and animal waste, and (as explained by a community leader) toxic effluent from a nearby factory upstream reach the water. This water is then used to cultivate the plants of the shamba, indirectly entering the diets of those who eat them; hence the concern of the youth pertaining to community gardens. Living Conditions, Slums and Garbage Collection Perhaps nowhere was a spatial cluster of health risks more evident than in the lower class slums, as the Great Hope teachers referred to them; a community of 184 people along the riverbank. The photos taken from the students for the themes living conditions/slums and garbage collection show a close geographic proximity to one another. As the compar ison of geotagged photos below indicates, a spatial cluster of health risks pertaining to both living conditions and garbage collection is situated along the river bank and dam on the east end of Kayole.

Spatial clusters identified via photos taken for Living Conditions/Slums (left) and Garbage collection

One of the primary attributes of this area which present a risk to public health is the landfill site situated on the river Dam, which happens to be adjacent to the settlements of the lower class slum. With routine burning of garbage, the landfill not only contaminates the water but poses a direct risk to the air quality of those living within its immediate surroundings. The photos below, taken by the PPM students, portray the relationship between unhealthy living environments and the issue of garbage collection:
Relationship between unhealthy living environments and garbage collection

The issues surrounding the health of local residents, their living environments and the adjacent proximity of a landfill, becomes further complicated by an economic imperative; many of the local residents depend on the landfill as a source of income. Residents can be found rummaging through the waste in an attempt to find recyclables which can be sold for small earnings to local companies. Despite the fact that some rely on recycling as a sole form of income, and the fact that they are providing a public service through the separation of waste, no attention is currently given by government to ensure that the residents have proper safety equipment (e.g. masks, gloves, rubber boots) to limit exposure of the contaminated water to the skin, or prevent direct inhalation of burning garbage. As the students image (right) shows, residents looking to find recyclable materials are often forced into direct contact with the waste. An intervention sensitive to this local context may need to take into account the role of livelihoods in addition to just the issues of garbage collection and poor living conditions. The overall improvement of health for this community remains contingent on the present reality of economic imperatives. Plants and Safety/Security In addition to the risk identified between living conditions/slums and garbage collection, another cross-cutting theme that emerged through the photo-voice project was the relationship between plants and safety/ security and how this impacted health for children and youth.
Residents recycling from local landfill with no protection given

Through the focus group discussion, the theme of plants was brought up in relation to a number of perceived health risks for the community. Greenspace,

often viewed in western literature to be an environmental enhancement for neighbourhood well-being (Ulrich, S. et al, 1981; Barbarosa, O. et al, 2007), was sometimes discussed in a different light within the context of Kayole
Thick bushes: problem areas for mosquitoes and crime PPM Focus Group

and Soweto. Thick bushes, such as the ones featured right, were photographed and documented as hotspots for the cultivation of mosquitoes, a major health concern given the prevalence of malaria. Additionally, one of the students in the focus group who was particularly concerned with the issue of safety and security indicated that bushy areas with lots of plants in Kayole were also the places youd likely find the drug dealers and drug addicts, or where bad boys were likely to hang around to plan their movements. In fact, bushy areas were identified as one of the top three locations lacking in security or safety the other two being the bad alleys along Kayole Road by Calvant Church (where thugs plan robberies), or the bad roads where t hugs are likely to move, making them very unsafe at night.

Health Services Having discussed some of the social and environmental risk factors to community health that were documented through the photo-mapping project, this theme brings together an analysis of preventative and curative health services offered in Kayole and
Soweto Kayole Clinic

Soweto. Although the Soweto Kayole clinic (pictured above right) was explained to be the biggest and most well-known health clinic in the area, the students mentioned that its efficacy is limited due to the fact that it is unable to meet demand and due to lack of medicine and qualified staff. Herbalists, who provide herbal remedies for various ailments, are also found throughout Kayole; however, their perceived impact on the publics health is negative as opposed to the clinics or chemists (pharmacies). Herbalists are not viewed as trained medical people; they are perceived to be exploitative, extracting money from slum dwellers making medicine from

Chemists (pharmacies) sell medications, but there arent enough of them to meet demand in Kayole

Herbalists: they are just extracting money from slum dwellers - Student

plants using poor hygiene (PPM Student from focus group). The focus group discussed that there is currently little offered in terms of preventative health services in the community, and that several social and environmental risk factors continue to jeopardize the health and learning potential of children and youth. Out of this realization, the students mentioned that effective community health and development would require extensive community sensitization on topics ranging from sanitation & hygiene in common public spaces to and methods for keeping healthy and preventing disease within a slum environment. The students voiced their opinion that improving overall community health outcomes will require investment in health and education, the sewage and road networks, and programs that address substance abuse and unemployment key factors for safety and security. Based on the view points of the PPM students, interventions for community health and development need to be holistic in approach both preventative and curative, and focused on a broad range of determinants which affect vulnerable population groups of the community, especially its fast growing demographic of children and youth.