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Moumini Niaoné is a doctor and public health specialist in Burkina Faso. But often, he feels like a translator.
During the COVID-19 pandemic, more than ever, his work involves searching for a way of speaking about health with people who may have limited literacy, scientific knowledge, and financial means. “I will come to the community and look at the problem from their eyes. When I know where they stand, it's easier to design the intervention,” he says.
Since the first cases were detected in Burkina Faso – a West African nation battling a jihadist insurgency, where literacy rates are low – Dr. Niaoné knew that citizens would have to go door to door to outpace the misinformation circulating on social media.
He gathered hundreds of volunteers, who set out to crowded places like the Grand Marché, the capital city’s largest market: a two-storied African futurist brick structure, made up of alleyways choked with electronic goods, glittering with imitation gold rings and chains, and crammed with fabrics, buckets, and chairs.
Their approach is simple, Dr. Niaoné says: listening to people’s concerns, analyzing their understandings, and working out how they can protect themselves, in a way that makes sense for their everyday lives. But there is a long way to go.
Moumini Niaoné, a doctor and public health specialist, bounds into a radio studio in Ouagadougou and takes position behind a microphone, 6 feet from the show’s host. He draws down his white mask accented with gray stripes, matching his African tunic, to make himself more audible. He’s ready to field coronavirus questions from the public.
The host fires off a true-or-false, aimed at the false information circulating the city.
“After the lifting of the curfew and restrictions people can cuddle and kiss,” she says.
Dr. Niaoné smiles. “False,” he says. “We must beware of a second wave that could worsen the epidemic.”
Two translators conveying his words into Fulfude and Gourmantché, two of the nation’s many languages, struggle to find a word for “kiss,” for which there is no literal translation. They settle on “saying hello with your mouth.”
For Dr. Niaoné, a former Fulbright scholar who completed his master’s at the University of Indiana, his own work is not dissimilar to translation: It involves searching for a way of speaking about health and illness with people who may have limited literacy, scientific knowledge, and financial means. “I will come to the community and look at the problem from their eyes. When I know where they stand, it’s easier to design the intervention,” he says.
While training in Ouagadougou, the capital of Burkina Faso, Dr. Niaoné remembers seeing the high cost of patients’ poverty and lack of basic medical knowledge, as he witnessed deaths from preventable or easily treatable diseases. Watching a patient come back “two weeks or two months or one year later with the same disease or with another sickness, related to the same risk factor,” he recalls, “it’s like no, you are doing nothing.”
He saw the role that careful listening and public messaging could play in saving people’s lives – and the novel coronavirus is no exception.
Since March 9, when the first cases were detected in Burkina Faso – a West African nation battling a jihadist insurgency, where literacy rates are low – Dr. Niaoné knew that citizens would have to go door to door to outpace the misinformation circulating on social media. He put out a call for volunteers on his Facebook page and WhatsApp, made an announcement on the radio, and soon gathered hundreds of volunteers across the country, among them his own medical students at the University of Ouagadougou.
Next, he took to the airwaves in a popular show called “Allô Docteur,” where ordinary Burkinabés would call in and ask questions about the virus: from whether it was invented by the government or a laboratory, to how someone could be asymptomatic. In many Burkinabés’ understanding, “someone is only sick when they are in a bed,” Dr. Niaoné explains.
He and his volunteers set out to places where the virus could easily spread, like the Grand Marché, the city’s largest market: a two-storied African futurist brick structure, made up of alleyways choked with electronic goods, glittering with imitation gold rings and chains, and crammed with stacks of batik and indigo fabrics, plastic buckets, and chairs.
His teams stood at entrances in fluorescent orange vests, making sure customers and sellers washed their hands and put on masks, before taking their temperature. They wore handmade masks of bright-patterned, hand-woven fabrics that tied at the back – based on Dr. Niaoné’s many conversations with people who said they found the elastic bands that hooked onto their ears uncomfortable.
The doctor carefully wove through the alleyways of the Grand Marché, and in a soft-spoken voice advised marketeers to put their masks on and stay behind social distancing lines. They obliged, but he complained of the lax enforcement around him, and offered a cynical explanation: “It is an election year.” Although the doctor serves on the government’s departments of medical emergencies and logistics, he is of a younger generation of professionals unafraid to criticize leaders, though public dissent remains limited.
Partners in prevention
A few weeks later they moved on to a rapidly growing, low-income community on the outskirts of Ouagadougou known as Nioko II, where their work is especially key. The local chief – or naaba, in the culture of the Mossi, the largest ethnic group in Burkina Faso – met Dr. Niaoné in a palaver hut outside his walled house, adorned with a large faded painting of himself surrounded by key advisers. As community members wheeled in heavy metal barrels and clustered around a local water depot a short distance away, Dr. Niaoné knelt, as is custom, and presented the naaba with a plastic jerrycan full of handmade soap.
Here and everywhere, Dr. Niaoné says, his strategy is simple: listening to people’s concerns, documenting and analyzing their understandings, and working out how they can protect themselves, in a way that makes sense for their everyday lives. Then comes identifying and mobilizing leaders, like the naaba. Those include “legal” leaders and, as he calls them, “legitimate” ones: people who have earned trust and recognition, regardless of official status, and could be trained to form their own groups and continue the work.
“We need to get communities involved from the beginning. When we saw people fighting to open the mosques, it’s because the religious leaders weren’t involved in the response,” he says.
For Dr. Niaoné, it soon became clear that residents in Nioko II felt only wealthy people were affected. “They said, ‘I’m not going to wear [masks] because I don’t go to Ouaga 2000,’” he says, referring to a suburb where embassy staff and the Burkinabé elite live. And with high levels of distrust toward the political establishment, many thought the pandemic was a government ploy to make money.
The team mapped the community and identified potential hot spots: water depots, bars, marketplaces, churches, mosques, and places men gathered to play cards and drink tea. Student volunteers – studying everything from economics and sociology to law and medicine – visited four hours a day, three times a week, working out who leaders were and educating them about the virus.
After a long Saturday morning out on the field, Dr. Niaoné’s team members come back to the tree where they’ve parked their scooters. Dr. Niaoné speaks to a woman selling a fried doughnut-like snack called bourmassa and asks her why she isn’t wearing a mask. “It’s too hot; I can’t breathe,” she says. A man sitting outside a health clinic said he wouldn’t wear a mask because the pandemic was brought about by the “will of God,” and high infection rates in the U.S. and Europe.
Rashida Ouédraogo, a pharmacy student working with Dr. Niaoné’s team, says their work “has helped people understand,” though “there are people who will never believe because they haven’t seen cases with their own eyes.” But there is still a long way to go. The government and other groups needed to give soap and masks to people without means to purchase them themselves, she adds.
As West African nations prepare to open their borders, Dr. Niaoné is nervous that people have become too relaxed. Government measures have decreased, but for him the fight against COVID-19 has only just begun. With a presidential election in November, he is concerned health measures will be sidelined.
“It is like in the United States – if the leadership doesn’t show the right behavior, people will not take the right measures,” he says. “We need to give communities finances and support so that they can work to prevent the disease themselves. We need stronger civil society actors doing what I’m doing. We need people who trust what we tell them.”