To eradicate trachoma we need to see things differently
Imagine life as a farmer in a remote region of Africa. You spend your days using your hands and your generations of skill to grow the food that keeps your family happy and alive.
Slowly though, you start to notice that your eyelashes have started to turn inwards. They begin to scratch your eyes every time you blink. You use tweezers to pluck out your eye lashes and this helps the pain until they grow back again. Every blink hurts, and eventually your vision blurs into blindness.
This is the reality for those who go untreated for Trachoma, a disease that over 200 million people globally are at risk of developing.
But there is a lot of hope. The disease is an entirely preventable form of blindness and has been eradicated in many areas of the world. Trachoma continues to be on a steady decline in many more areas thanks to consistent and collaborative efforts by the trachoma eradication community.
A DIFFERENT APPROACH
The logic of public health is often utilitarianism; we concentrate our efforts where they can achieve the greatest good for the greatest number. This usually means the centre, not the margins. It can sometimes mean concentrating resources where the problem can be most easily tackled rather than in smaller, harder to reach or more complex sites.
But while there is a strong logic for behaving in this way, it can also be a flawed approach if we are trying to eradicate a disease such as trachoma rather than just reduce the numbers impacted by it.
To eradicate trachoma as a public health issue, there remain today some strongholds of the disease. These outlier communities have proven less responsive to conventional forms of trachoma treatment and prevention. They are isolated (if not physically then socially, culturally and linguistically) and often their environment may not support typical interventions (which rely heavily on the building of pit latrines that are difficult to build rocky and hard soils). Because of this, they have tended to fall through the cracks of conventional programming.
Through our partnership with Sightsavers, teams from our ThinkPlace studio in Kenya have been travelling to some of the most remote regions of Kenya and Ethiopia to understand how we can look at these communities differently. Here are three big lessons we have learned when designing in these communities.
FOCUS ON THE FUNDAMENTAL
Any design intervention must provide new value to the user for them to take it up. It must be distinct, beneficial and exciting in a way that is meaningful for them. When designing for unique populations, it is easy to get caught up in what makes them different from others rather than what makes them similar.
There are a whole lot of things that brings us together – caring for family, wanting a comfortable life, good health, excitement and fun. I’m yet to visit any community where these things are not important. When designing on the margins, look for which of these fundamentals are difficult to achieve or absent entirely– that is the hook for your design intervention.
THE MARGINS INFORM THE CENTRE
We know that resistors to change can provide important insight into how an innovation can be improved so that it reaches a broader audience. We can apply the same concept when working between communities, just as we can when working within them. The barriers to change in these unique communities are often just clearer, unambiguous, and more broadly shared expression of the same barriers that ‘mainstream’ communities feel – albeit more subtly. They are also often the same or similar barriers that other marginalised populations experience. By designing in the margins, we can develop better programming to serve those who have been forgotten even in prioritized areas.
IT ALWAYS STARTS WITH EMPATHY
As is the way with all design, it first begins by empathetically seeking out, valuing, and incorporating these people’s ways of life into the solutions we hope will make change. You cannot hope to create human centered design in these remote places without going there.
When we traveled to the remote northern regions of Kenya, we learned about the impacts of increasing education without providing new forms of employment, and the effect that young people leaving to the cities in search of more has on the elderly that they leave behind. We also learned about the pride that comes with a strong sense of community and culture.
When we traveled to the far southern regions of Ethiopia, we learned about the desperation for guidance that comes with physical isolation, and the difference between having access to water and having the resources to capture it safely. We also learned about the comfort and optimism for many of the families we spoke to who were living in what would typically be considered poverty. It is these insights that are giving us the inspiration for the pains and pleasures that can serve as platforms for change.
We are learning that in focusing on these ‘outlier’ communities, we can intensify the fight against trachoma everywhere. It is not just about taking the fight to where it is needed most, it also lets us better reach those who have been forgotten even in major populations.
Eradicating trachoma is a very real possibility and we will soon be sharing more about the interventions we are designing to make this change. If we can broaden our work to include harder to reach communities and create genuinely innovative and empathetic interventions, then I have high hopes that we can see the end to this entirely-preventable blindness within our lifetime.