The ‘theater’ of the shadow pandemic: Lessons learned collecting data
Author: Gabriela Penelopé Carolus1
1. Division of Health Systems and Public Health, Faculty of Medicine and Health Science, Stellenbosch University, Stellenbosch, South Africa
Introduction
During the COVID-19 pandemic, I found myself in a ‘theater’ of artists-activists campaigning against sexual and gender-based violence (SGBV). At the time, I was a remote Master’s student in the Division of Health Systems and Public Health, in the Faculty of Medicine and Health Sciences at Stellenbosch University, South Africa. In one of my research assignments, I examined SGBV public health advocacy approaches by artistic activists, in response to the public health emergency measures imposed by the COVID-19 pandemic. This blog describes that specific context and the lessons learned from data collection in a health crisis with artists as activists, as well as key take-home messages.
Background: Sexual and gender-based violence in a pandemic
In an open letter dated April 2020, South Africa’s President Cyril Ramaphosa wrote that the ‘shadow pandemic’ of sexual violence was widespread and the emergency public health measures put in place during the COVID-19 pandemic had placed women at greater risk, with SGBV reported as a hidden consequence of the pandemic. President Ramaphosa recognized that the constraints placed on people meant that they were “not [able] to leave their homes [and] women and children in abusive situations were left vulnerable.” In addition, women and young girls were deprived of agency as they “may not have [had] access to phones or airtime, or public transport to take them to a police station, shelter or a doctor” (Presidency of the Republic of South Africa, 2020).
The restrictive public health measures implemented as a rapid emergency response failed to consider internal migration of women and girls to unsafe spaces, and the absence of social, mental and physical support. This occurred within the context of a country with a high rate of crime perpetrated against women and girls. Due to the lockdowns imposed during the pandemic, women in South Africa were disproportionately affected due to their role as caregivers. Moreover, most healthcare workers in South Africa are female, meaning that women working in the health sector were also particularly affected.
Gender intersects several social determinants of health, such as age, geography, demography, class, religion, ethnicity, and citizenship. These determinants acted as barriers to healthcare use by women (Wenham, Smith & Morgan, 2020). In an emergency, healthcare providers may be reluctant to focus on SGBV issues because of the prioritization of other acute healthcare needs (John et al., 2020). Nevertheless, the health sector response to SGBV was lifesaving for survivors, and consideration should be given to crucial actions at the onset of every emergency (Enguita-Fernandez et al., 2020).
The Zika virus and the Ebola virus epidemics in West Africa are cases in point in which adaptation of public health emergency policies failed to take into account the SGBV crisis, particularly data collection on SGBV in humanitarian and emergency settings (Adhiambo Onyango & Regan, 2020; International Rescue Committee, 2019). In such situations, protection of the subject of interest, along with healthcare workers and/or data collectors, is missed. Furthermore, public health interventions restrict qualitative data collection methods due to limited mobility, in person data collection, and service data collection (Singh Chandan, et al., 2020). The sensitivity involved in collecting SGBV data during humanitarian crises and public health emergencies also failed to take into account the importance of applying an intersectional approach to data collection.
Hudson and Lowe (2004), as cited by Gilson (2012), state that health systems and policy research is imperative to understand the impact of policy changes on individuals (micro-level analysis), the balance of systems, as well as how the interactions between these structures (institutional influences) and agency (autonomy), and the broader influences over decisions shape such actions. Thus, the impact of artists-activists on policy change—as external actors to the healthcare system—was an opportunity to conduct a micro-level analysis on how they interacted within structures, if at all. This warranted an empirical examination of global health activism, SGBV policies, and service provision adaptation in a pandemic.
What worked?
My research project provided an in-depth understanding of public health advocacy, and the role of the artist as health activist, with potential recommendations for action to address restrictive emergency measures during a pandemic. The study was well received by artists as it provided potentially ‘unsettling’ insights into the new role of SGBV activism in a pandemic (Pentassuglia, 2017). Thus, an arts-based approach, namely, art in qualitative health research, provided an insider perspective, which worked to my advantage (Fraser & Al Sayah, 2011). In this way, I found that art in research, combined with health policy formulation research, became a potentially new means of constructing emergency public health interventions that would prove effective in a crisis.
What didn’t work?
I used online platforms as the primary research field and source of data collection. This necessitated a methodological turn in qualitative research methods as well as the arts in a pandemic. Considering that I was a frontline worker in psychiatric research and a public health student in a remote community, conducting interviews became a challenge. My research questions demanded granularity, and I was interested in the use of online forums specifically in the pandemic for women as ‘safe spaces.’ Thus, it seemed fitting to remain within that environment and use virtual ethnography as a means of answering my research question. While in theory this was well conceptualized, I had to become ‘creative’ with how I conducted interviews. I had to shift from Instagram to WhatsApp interviews. I had to share data bundles with my participants as opposed to monetary contributions or food vouchers. I was not necessarily able to speak to people during normal working hours. I had to adjust the interview schedule based on people’s availability, safety and access to stable internet connections.
What would you do differently in the future?
I think as an early career researcher, I should have consulted my supervisors about how to effectively conduct remote interviews with precarious workers in a health crisis. Therefore, in the future, when conducting research on global health, I would seek out a mentor to assist with data collection strategies in a health crisis. I would have gained more had I obtained insight on how to navigate this type of research, particularly should it have scaled up from a research assignment to an actual study.
Lessons learned
I gained lessons on how to collect better data from these actors by applying adaptive measures needed to be an actor, a writer and a poet through public advocacy and mobilization in a health crisis. As a researcher, I had to learn to be adaptable, applying equal measures of rigor and flexibility. This enabled advocates to be heard when they were once formally employed, and now shifting to precarious work environments in health crisis. I believe it is also important to learn from your study participants and how they adapted; thus, your data collection approach should be tailored to cater to the participants’ context and needs.
References
Adhiambo Onyango, M. & Regan, A. (2020). Sexual and gender-based violence during COVID-19: lessons from Ebola. https://theconversation.com/sexual-and-gender-based-violence-during-covid-19-lessons-from-ebola-137541
Chandan, J. S., Taylor, J., Bradbury-Jones, C., Nirantharakumar, K., Kane, E., & Bandyopadhyay, S. (2020). COVID-19: a public health approach to manage domestic violence is needed. The Lancet. Public Health, 5(6), e309. https://doi.org/10.1016/S2468-2667(20)30112-2
Enguita-Fernàndez, C., Marbán-Castro, E., Manders, O., Maxwell, L., & Matta, G. C. (2020). The COVID-19 epidemic through a gender lens: what if a gender approach had been applied to inform public health measures to fight the COVID-19 pandemic? Social Anthropology: The Journal of the European Association of Social Anthropologists = Anthropologie Sociale, 28(2), 263–264. https://doi.org/10.1111/1469-8676.12803
Fraser, K. D. & Al Sayah, F. (2011). Arts-based methods in health research: A systematic review of the literature. Arts & Health, 3(2), 110-145. http://dx.doi.org/10.1080/17533015.2011.561357.
Gilson, L., editor. (2012). Health Policy and Systems Research. A Methodology Reader. WHO Document Production Services: Geneva, Switzerland.
International Rescue Committee. (2019). Everything on her shoulders: rapid assessment on gender and violence against women and girls in the Ebola outbreak in Beni, DRC. https://www.rescue.org/report/everythingher-shoulders-rapid-assessment-gender-andviolence-against-women-and-girls-ebola.
John, N., Casey, S. E., Carino, G., & McGovern, T. (2020). Lessons Never Learned: Crisis and gender-based violence. Developing World Bioethics, 20(2), 65–68. https://doi.org/10.1111/dewb.12261
Pentassuglia, M. (2017). “The art(ist) is present”: Arts-based research perspective in educational research. Cogent Education, 4. https://doi.org/10.1080/2331186X. 2017.1301011
The Presidency of the Republic of South Africa. From the desk of the president. (2020). https://mailchi.mp/presidency.gov.za/president-desk-mon13apr20.
Wenham, C., Smith, J., Morgan, R., & Gender and COVID-19 Working Group. (2020). COVID-19: the gendered impacts of the outbreak. Lancet (London, England), 395(10227), 846–848. https://doi.org/10.1016/S0140-6736(20)30526-2
To link to this article - DOI: https://doi.org/10.70253/KQWD2183
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