Malaria-Prevention Message Reaches Hill-Tribe Members Through Theater

sen monorom, Mondolkiri province – Will the play be the thing, or will the video work better? The NGO Nomad will soon find out when both a play and a video on malaria prevention and treatment are shown in the ethnic Phnong community.

Nomad conducts studies among ethnic minorities living in remote areas to identify their beliefs concerning matters of health and sickness. The NGO then tries to combine traditional medicine with modern science to design health programs for those communities. In addition to Cambodia, the NGO has also been running projects in Nepal and India.

In Mondolkiri province, whose population of 40,000 is 80 percent Phnong, a major issue has been prevention and treatment of malaria. The disease is the province’s biggest health problem, followed by respiratory ailments, said Kep Sych­heang, provincial health director. Forests which cover most of the province are fertile ground for malaria-carrying mosquitoes.

The Phnong have lived in isolation with their own culture and dialect for centuries. Since most don’t speak Khmer, the challenge has been to create educational tools for malaria prevention in their community. Adapting information material to each province is one component of Cambo­dia’s national strategy for malaria prevention, said Roberto Garcia, European co-director for the European Commission Malaria Control Pro­gram.

In June 2000, Nomad, in cooperation with the NGO Medecins du Monde, which has been offering health care in Mondolkiri province for a decade, started researching the Phnong socio-cultural approach to disease. “They don’t really look at malaria the way we do,” said Kristina Mitchell, Nomad program coordinator. Phnong people have a tendency to identify diseases by their symptoms, and call malaria “chikop-chikat” (hot-cold) because of the fever associated with it.

The Phnong are not Buddhists. “They believe that the natural world and the spiritual world are closely linked,” Mitchell said.

Therefore, they may attribute an illness to a spiritual as well as to a natural cause, said Kate Hencher, health education supervisor for No­mad. Depending on the cause they perceive, they will seek a spiritual or a traditional healer, she said.

While Nomad was collecting information, Sylvain Vogel and Jean-Michel Filippi, respectively professors of linguistics and phonetics at the Royal University of Phnom Penh, were developing a Phnong learning method for health workers. (Most of the medical staff in Mondolkiri province is Cambodian and does not speak Phnong.) The project involved inventing spel­lings for the sounds and words of the Phnong oral language. Vogel and Filippi produced a learning kit complete with cassettes and a section on Phnong people’s culture, values and beliefs related to health.

The research completed, Nomad began creating information material for Phnong communities. The NGO came up with the idea of writing a play dealing with malaria prevention and treatment, which would also be made into a video and an audiotape. With the support of the European Com­mis­sion Malaria Control Program, Nomad launched a pilot project to determine which medium—play, video or audiotape–-works best to convey the message.

Why a play? “Phnong people have a tradition of storytelling,” said Hencher. Health workers and Phnong representatives helped Mitchell, Hencher and Sorn Sarun–-Nomad’s local supervisor–-write the storyline. “We discussed what the message should be, and how and who should present it,” Hencher said.

They agreed that the cast would include actual health workers, traditional healers and two village elders to give the message credibility. The performance would start with a gong ceremony, during which actors would cross the stage playing the traditional Phnong instrument. This would be followed by a series of sketches: A village gathering during which the elders would sing and talk about malaria symptoms; two men sleeping in the forest after fishing and collecting wood, one with a mosquito net and the other without; a man who rejects his wife’s suggestion to use a mosquito net, causing his entire family to be bitten in their sleep and become sick. Throughout the play, actors would give information on malaria symptoms and treatment.

Once the storyline was done, it took the Phnong cast two months to stage it. “It was difficult,” said Pol Sovan, Nomad’s Phnong adviser. “I spent a lot of time trying to understand [the story line and information]. It’s very important [information] for Phnong people who don’t understand Khmer because people are often sick with malaria.”

On April 7, approximately 350 Phnong and foreigners quietly settled down in front of an outdoor stage for the official opening night. Cam­bodian and foreign officials had come from Phnom Penh for the event. Minister of Health Hong Sun Huot, Aldo Dell’Ariccia, and representatives from the EC Malaria Control Program and from the National Malaria Center were in the audience.

Actors performed scene after scene under the spotlights with the ease of natural storytellers, making their characters both credible and entertaining. The audience listened attentively, commenting in low voices, until the final song. After a few words from health workers, Hong Sun Huot and Dell’Ariccia, actors, spectators and some official guests joined together in a dance.

A few weeks earlier, a video crew from the Phnom Penh-based NGO Action filmed the play. “It was very difficult for us,” said director Chheng Daravuth Kosal.

Crew members spoke Khmer, French, Eng­lish and Russian, but that was no help for a play in Phnong. “We didn’t know what the actors were talking about,” he admitted. “So we tried to follow [the story] as best we could.”

Nomad also will have an audiotape produced, said Mitchell. In the coming months, the NGO plans to take the play, the video and the audiotape to Phnong villages and study their effectiveness at transmitting the information. Those findings will be used to develop future malaria education campaigns for Phnong communities.


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