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Critical Health Literacy, Indigenous Practices and Family Learning in the Time of COVID-19

Introduction

The COVID-19 pandemic has highlighted the urgent need for people to engage actively and critically with health information. Governments and NGO health educators have often relied on a top-down approach to hygiene, nutrition and sanitation in poorer communities. This consists of preaching about their benefits. The challenge is to translate this information into meaningful learning for families, one that values their everyday lives and indigenous practices. Within communities, a diversity of individuals and organisations acting as educators are engaged with this challenge. Their experiences highlight the role that critical health literacy – including mobilising for resources and learning to distinguish fact from fiction – can play in the current crisis.

This project builds directly on the UEA UNESCO Chair initiatives on Family Literacy, Indigenous Learning and Sustainable Development that highlighted the need to find out how poorer families were learning about COVID-19. To investigate how communities are drawing on indigenous knowledges and practices to engage with COVID-19 related health information, researchers in Ethiopia, Malawi, Nepal and the Philippines conducted interviews, focus group discussions (including with traditional healers), alongside observation of public health campaign activities and analysis of TV/social media.

On this page, we introduce the key findings from the research. If you would like to learn more about each country team’s analysis, visit the country reports (click here). These reports include specific policy recommendations, particularly around family literacy and learning, that could be taken up at the national and international levels.

Using traditional health and religious practices to respond to COVID-19

The dangers of COVID-19 as described in mainstream discourse have caused significant worry and fear among many communities, especially when infection and death rates were increasing. From using herbal ointments to steam inhalation, families and communities have drawn on and adapted indigenous health practices and traditional medicine to tackle the health impacts of COVID-19. Often used for more common illnesses such as colds, body aches and fever, these interventions are being applied to combat COVID-19 – a relatively ‘newer’ and less familiar disease, alongside official advice:

We used garlic, ginger and hot drinks. We also consumed a mixture of different medicinal herbs and honey as well. We heard that fumigating the house with different smokes could be good; so we did that as well. We heard that lemon is good so we consumed a lot of it until we got sick of that. We also consumed a lot of spicy foods. We were also praying, fasting and going to church every day. When I got out of the house, I wore a facemask; I was also using hand sanitizers which I received from my school
A teacher in Awi Zone, Ethiopia

In two Dalit communities in a hill district in mid-western Nepal, a special type of herbal tea has been used to fight against COVID-19 symptoms, a mixture of pastes from different types of plants including vrinda/holy basil (tulasi). Community members drink the tea on a regular basis, believing that it will shield them from colds and decrease their vulnerability to contracting COVID-19.

Participants in the Philippines shared that their families have relied heavily on the use of steam intake (or suob/tuob in the local language). Steam inhalation is a local practice that is used to clear airways from nasal congestion and has increased in popularity during the pandemic. A bowl of steaming hot water is prepared with salt and the head is held over it covered with a towel. Participants shared that this practice had helped them recuperate from breathing problems as they battled against COVID-19.

Alongside intake of hot drinks with either ginger, garlic, honey, lemon (or a combination of these), families in Ethiopia also fumigate their houses with incense and leaves and distribute pungent leaves around the house for cleansing. It is important to note that these practices are often done in conjunction with ‘official’ advice from the government and health authorities, such as drinking vitamin C supplements or formulae.

Across the countries, while religious practices were being impacted by COVID-19 restrictions, religion has played a role in the dissemination of COVID-related messages. In Malawi, some of the more dominant conspiracy theories are those with religious undertones. Some social media posts claim that it is ‘devilish’ to believe in the spread of COVID-19. By contrast, in the Philippines and Ethiopia, religious organisations and churches worked hand-in-hand with other health authorities to further strengthen adherence to COVID-19 guidelines. Online prayers for divine intervention have also been common in families in the Philippines, both to ask for protection and for healing. In Ethiopia, a month-long multi-faith prayer programme was transmitted live via the national television. Priests have also engaged in fumigating the streets, as they would have done in a normal service within a church.

When the Presidential Task Force on COVID-19 in Malawi ruled to limit public events (including religious gatherings) to only about 100 people, religious groups such as Men of God in Malawi challenged such measures – arguing that these rules impeded faith practices.

In the Philippines, many churches complied with government restrictions on large gatherings but found ways of continuing their religious activities without gathering indoors. For example, in Calasiao, Pangasinan, priests have been visiting believers outside their households or in caravans and motorcades. In some communities in Bahir Dar, some church goers go to church very early in the morning for prayer – in the hope that they will not be seen by authorities

Family members engage with COVID-19 information collaboratively – at times through two-way, intergenerational learning.

With the overwhelming amount of COVID-19 related messages, families have been working together to make sense of and understand this health information. In some cases, respected elders – such as parents, grandparents, uncles and aunts – share information with the younger family members. In others, it is the young people that share important information with elders (particularly those who are unable to read or write), especially information coming from social
media. These examples show how knowledge is distributed within these communities – how individuals draw on resources that are made accessible within their social environment.

Majhi and Mushar families in Nepal offer a good example of what intergenerational learning looks like. Older generations teach younger ones about traditional cultural and religious beliefs, such as worshiping local deities to keep safe from COVID-19. In turn, some non- literate elders learn about COVID-19 from the younger members, such as how it spreads, and the importance of social distancing. The younger generations were also translating some of the information (written in Nepali – the national language) into local languages so that elder members of the families could understand.

Indigenous knowledge and intergenerational learning have also played a role in prevention efforts. An octogenarian Brahmin man from the Western hills in Nepal grows different types of medicinal plants in a small allotment near his home and keeps a list of herbal and medicinal plants in his daily diaries with the intention of transferring indigenous knowledge, skills and practices about healing. His son, daughter-in-law and grandson have all been involved in making paste of different plants which are used to treat different illnesses, including, more recently, Covid-19.

Parents also learn about health prevention advice from their children, as a housemaid in Bahir Dar explains:

My husband and I are illiterates; we don’t know anything. It is our children who have informed us about COVID-19 while they asked us to buy them facemasks; they told us that a new disease called corona has occurred and it is fatal
A housemaid in Bahir Dar

A housemaid in Ethiopia sharing how she learned about the spread of COVID in their community © BDU.

In the Philippines, some families have collaboratively made decisions on protective measures beyond what the government requires and suggests. They considered these as “family rules” before entering their homes. A health worker from Pasay City explained that:

It’s a given that men are not meticulous when it comes to their bodies. However, my youngest son always uses alcohol, spraying it all over his body when entering the house after spending some time outside. The only difference is that my husband is not a fan of using alcohol spray. You still need to remind him before entering the house, that you should wash your hands first, and don’t walk inside the house with your shoes on. Even every day, you still need to remind him not to walk inside the house with his shoes on, because men are not conscious even if the house gets muddy. You just need to wipe it with Zonrox thereafter, since you can’t do anything about it. It’s like you’re always on alert
A health worker from Pasay City

The diversity of COVID-19 information has brought into question the issue of ‘authority’ of data sources

The unpredictability and speed of COVID-19 impacts across these communities has spawned a wide variety of information and health related messages

I first heard about the pandemic on a coffee ceremony in my village; me and my neighbours then shared the information that we heard from the coffee ceremony. The people to whom I work also told me about the pandemic and warned me to take care of myself from the disease. One of my employers told me that two people he knew died of the pandemic in Addis. Then, I said that it is true that a new disease had come. Then, my brother told me that they were told not to come to school anymore. I had also heard information about the disease from radio. Later on there was the information about the pandemic on the mobile phone calling voice
A housemaid in Bahir Dar

In communities in Malawi and the Philippines, information is often circulated through government-sanctioned institutions such as the newly formed Presidential Task Force for COVID 19 in the former and the established Local Government Units (LGU) in the latter. There were similarities in their approaches. Messages have often focused on informing the public of the ‘severity’ of the spread – accompanied by latest government health statistics on new cases, those recovered, number of deaths and vaccination rates. In Nepal, many information drives (in Nepali) focus on how people can protect themselves against contracting the disease. These are often posted in public places.

In the Philippines and in Ethiopia, there has also been much emphasis on government guidelines – such as the latest alert levels and travel restrictions. In both urban Pasay and rural Pangasinan, the Philippine team noted that they dominantly retrieve information from their Local Government Units compared to other sources such as the private sector. Some of the images being spread in Malawi (often by private individuals) make use of a picture US president Joe Biden double-masked to encourage people to adhere to COVID prevention measures. The use of a mix of bicarbonate and lemon was also disseminated as an effective health practice against COVID-19, similar to the experience of Israel according to one image being shared in Malawi. These examples show how visual materials (such as digital posters and banners) can be used as stamps of authority to compel more people to comply with health advice. This strategy seems to involve fitting the images with the overall narrative, leaving out important facts . The image of Israel, for example, does not include the fact that the country has one of the most extensive COVID-19 vaccination programmes in the world.

People have questioned how ‘truthful’ some of this information is. Many have been concerned not only about the content but also questioned the authority of the people and groups that spread the information. Some of the more formal messaging strategies may have lost their power over time. In Ethiopia, the respondents noted a shift in people’s belief around the virus. At the beginning of the pandemic (March 2020), there was sense of nation-wide concern. But as new infections and deaths were tapering, respondents noted that some people no longer believed that COVID exists and that it was a means for foreign countries to break social ties and religion of Ethiopian communities. This shows that people’s attitudes towards the disease have changed. Attitudes appear to be partly influenced by national issues, such as national elections and other social issues like poverty and ethnic conflict.

The popularity of social media as a channel to disseminate COVID-19 information has also resulted in the spread of misinformation and disinformation. In Malawi, Ethiopia and the Philippines, research found that social media is laced with claims of conspiracy, such as denying the existence of COVID-19 and the necessity of the vaccine. In Malawi, for example, videos are circulating of empty coffins being buried. Similarly in Ethiopia, the vaccination programme was claimed to be a plot of the US and other foreign powers to damage social ties within African communities. These types of information have undermined trust in the general messaging in local communities.

Various formats, channels and languages of COVID-19 related communication

An analysis of COVID-19 public health campaign materials revealed that these come in a wide variety of formats – mostly visual. This includes posters (both in print and digital) in Malawi, songs and music in Malawi, text and voice messages in the Philippines and diaries of medicinal plants in Nepal. In the Philippines, government-developed health information (such as local guidelines, travel restrictions, etc) have been converted into colourful, visual materials with the view of making them more accessible to the wider audience. In Ethiopia and Malawi, many of these visual materials are accompanied by texts written in local language. As described earlier, in some cases, young people also translate this information into local dialects and indigenous languages.

By contrast, in the Philippines, many of these texts are in English. English is widely understood and considered a national language in the country. Furthermore, the language is quite formal and scientific which presumably further asserts the authority of these messages.

Beyond government messages and those coming from health professionals, information is also spread through informal means and through community practices. In Ethiopia, for example, petty traders and local alcohol vendors learn about COVID-19 health messages (especially around prevention) from their customers. A housemaid in Bahir Dar learned about the pandemic – and how to protect herself – through a coffee ceremony in their village. Coffee ceremonies are a cultural custom in Ethiopian communities where coffee is served routinely for the purpose of getting together families and community members

Conclusion

Indigenous and local practices have been important resources that families have used to engage effectively with COVID-19 related information. Contrary to the belief that religious and indigenous practices need to catch up with modern health practices, these findings illustrate how families and communities integrate indigenous health practices into more modern approaches and revise them to respond to community needs.

Given that information – and misinformation – about COVID-19 spreads like wildfire, the findings in this project are a reminder that covid-related messages have an impact on local communities to the extent that they can displace local life. Although various channels and modes of communication are used, evidence shows that they are not always easily accessible to all groups. Nonetheless, the diversity of channels used means that families can engage with these messages collaboratively, (re)formulating them so that they make sense in their own contexts.

The findings from this report show that messages and knowledge exchange are not one-way and that there is no one ‘right’ channel through which to share health messages. In the communities visited in this research, information is shared amongst young people, older people, among families and within the wider community. This is a reminder that health education approaches need to build on existing practices rather than being seen to ‘preach’ to communities through limited channels.