Sierra Leone

The President’s Lecture 2021 webinar hosted by RSTMH brought about some thought provoking conversation and presentations from Professor Sally Theobald and her colleagues, Abriti Arjyal, Bachera Aktar and Zeela Zaizay.

The webinar was a great opportunity to share learning on analysing and addressing intersecting inequities in global health across different contexts, projects and health issues. The presentations demonstrated the power and the potential of social science, participatory process and co-production processes for change.

The event highlighted three different projects that focus on three different types of neglected areas. These are neglected countries: particularly fragile and shock prone contexts, neglected communities in urban informal settlements and neglected health issues or conditions like neglected tropical diseases and stigmatising skin conditions.

Metaphors exert a powerful influence on our daily lives and Sally used a very significant one as she launched her speech. We are all in the same storm, but we are not all in the same boat. COVID-19 has demonstrated that we live in an interconnected but unequal world. We are differentially positioned in terms of our vulnerabilities to the pandemic. COVID-19 has been seen as a spotlight that amplifies the existing inequalities; exposing and often exacerbating these inequities.

In the UK, black and minority ethnic groups and people living in cramped conditions have been particularly adversely affected. The pandemic has also impacted and exacerbated how inequalities play out on a global stage.

Neglected Countries

Neglected communities

It is not only an epidemiological pandemic but a social one, that has uncovered the perpetual global social, economic, health and political inequalities. Lynda Keeru and Kate Hawkins report back from a recent webinar, ‘Exposing the cracks: COVID-19 and global inequality’. Hosted by The Gender, Justice and Security Hub this event brought together researchers to discuss whether the pandemic can be used as a disruption to the system – exposing cracks that can be exploited to confront power and inequality – or whether it is business-as-usual – exacerbating inequalities and privileging those with power.

Uganda

Josephine Ahikire painted the clear divide that exists between the rich and poor in Uganda; further worsened by the pandemic. The wealthy in Uganda still move freely facilitated by permits issued to them by resident district commissioners. However, circumstances are completely different for the poor. They are the recipients of the strict lockdowns with minimal livelihood options. They can no longer meet their basic needs like putting a meal on the table as they depend on daily income and live hand to mouth. In an attempt to mitigate these challenges, the government put in place a ‘response for the vulnerable’ – a move in the right direction. However, this was slowed down by the process of identifying the vulnerable. That the government did not know who was vulnerable is alarming as they are the ones most affected by government policies. They are the people beaten on the streets, those who can’t access general healthcare, those that can’t find transport because public transport is prohibited and those who face hurdles when trying to access health services.

The situation in Uganda demonstrates the priorities of the government in investing in control and militarism than in facilitating the population to respond to the pandemic. This is an indication of the close connection between neo liberalism and rising militarism. Militarism is being legitimized as a response to a global health challenge and this is a pattern that is being seen in many other contexts.

South Africa

Faisal Garba explored how existing inequalities had been exacerbated in South Africa, through the lens of migrant rights.  In the context of refugee protection, countries are using COVID-19 to double down on closures to try and further isolate and marginalize refugees and prevent them from accessing what they are entitled to. Countries are using controls on migration to demonstrate their control of the pandemic.

South Africa adopted migrant blind polices in dealing with the pandemic. An example of this is a policy that was executed by the state at the height of COVID-19. A grant was issued to support families and small businesses. However, one of the eligibility requirements was citizenship. This meant that refugees – who were in critical need of food and other necessities – were excluded, deepening the divide between locals and migrants.

The long-standing fallacious belief that began during the HIV/AIDS era in South of Africa that migrants spread diseases has been upheld during COVID-19. The narrative being peddled is that the porous borders provide a gap for migrants to come into the country with COVID-19. State officials unfortunately amplify this message, creating false unity by selling the idea of citizens protecting their country and their country’s health from people who come in with diseases.

India

Surekha Garimella began by outlining how poor people have struggled for decades and that COVID-19 has brought this to the fore and in doing so made many people uncomfortable. In India the lockdown meant the cessation of livelihoods for many. The extension of women’s care work within the family, community, or for the state has been a considerable burden. Lack of access to health services and health system disruption has led to home deliveries and associated deaths.

During COVID-19 the most marginalized who most need to access protective measures were the ones who got the least. This is happening in a context where people have for decades lived with a huge basic need deficit. The implementation of the Disaster Management Act provided the state with huge power. This was wielded to regulate the lower classes to prevent them from infecting the dominant classes.

Surekha made a powerful intervention about the role of research and researchers in the pandemic response. She argued that the evidence used to formulate public health policies during COVID-19 does not adequately take the poor into account. There is a need to challenge mainstream conceptions of what evidence counts and go beyond the biomedical. This needs to consider that actions have different implications depending on the different societal divisions whether it be class, gender, caste, or geographical location.

“I learnt so much from the webinar and the engaged speakers, who are embedded in a range of different contexts, working to better understand and strategically address the multiple inequities that are amplified by COVID-19. It was excellent to bring learning together across three sister GCRF hubs, on social justice, gender and equity, and I look forward to further joint dialogue and action.“ Sally Theobald, PI, ARISE hub

Speakers:

Kirsten Ainley – Associate Professor of International Relations and the Deputy Principal Investigator of the UKRI GCRF Gender, Justice and Security Hub

Heaven Crawley, MIDEQ Hub

Faisal Garba – Teaches Sociology at the University of Cape Town (UCT) and is the Co-Convenor of University’s Global Studies Programme and works with the Migration for Development and Equality Hub

Dr Surekha Garimella – Senior Research Fellow at the George Institute (@GeorgeInstIN), holds a PhD in Public Health, Gender and Work and works is part of the ARISE Hub

Dr Josephine Ahikire – Principal, College of Humanities and Social Sciences and former Dean, School of Women and Gender Studies and Co-Director on the UKRI GCRF Gender, Justice and Security Hub

This blog was co-produced by researchers and co-researchers in Sierra Leone to share our experiences mapping urban marginalized spaces.

We conducted GIS mapping of three informal settlements to identify key landmarks, physical features, environmental hazards, health risk areas and social groups. The purpose of this work is to use the map to aid participatory data analysis that will identify key health and wellbeing challenges within communities and make maps accessible to community members so they can use them as they wish.

Building our capacity

Our Field team in Sierra Leone is comprised of eight researchers (three women and five men) and 15 co-researchers from across three project communities (seven women and eight men). Before taking up the GIS mapping of project communities (Cockle Bay,

Dwarzark and Moyiba), we held series of workshops to build our capacity as researchers and co-researchers on how to use GPS for boundary mapping and Open Data Kit (ODK) to map services. Workshops were facilitated by CODOHSAPA’s mapping expert (Richard Bockarie) and the team’s capacity and confidence were improved for the intended task.

“We also learned about the GPS and surveying; it was the first experience for some of us. We acquired technical knowledge. We listened to each other; we held meetings. If we made mistakes, we would find ways to correct them and go back on the field. The mapping exercise also allowed us to know our communities better and what the real boundaries are of our communities.” (Co-Researcher)

Organizing the team and completing the mapping

Eight days was allocated for boundary and service mapping across three communities (five days for boundary mapping and three days for service mapping). Three researchers and five co-researchers were assigned to the Dwarzark community, three researchers and five co-researchers were assigned to the Moyiba community and two researchers and five co-researchers were assigned to the Cockle Bay community. One community pointer was assigned to each community. Dwarzark and Moyiba had more researchers due to larger land size and rugged terrain which makes it difficult to navigate. With limited equipment two GPS and three phones were allocated to each community.

Informal settlements have unique power dynamics. There are local chiefs found across these settlements who were installed by the local government either as tribal or community chiefs. They are charged with the responsibility of regulating customary or bye-laws in their communities. Before our activities began, community leaders (councilors, community chiefs, chairmen and chairladies) and other relevant stakeholders were informed about our objective. This was intended to enhance community buy-in.

In the field, the bigger group assigned to each community was divided into sub-groups in order to cover more ground and efficiently manage time. We also agreed that groups should have a briefing before and after every exercise per day. This was to help us build confidence and address unforeseen challenges.

Reflection from Co-researchers on mapping community boundaries and services

A reflexive session was held after the mapping exercise with co-researchers and community pointers on the importance of the features mapped and the usefulness of the maps to their communities, successes, challenges and lesson learnt from the mapping exercise. The following reflections were share by co-researchers:

Identifying health and wellbeing issues and environmental hazards

“It is important to map the health centre. If the mapping shows that there are no health centres, we can show the government that help is needed. It gives us information on what should be improved.” (Co-researcher; Fatmata B Sesay Moyiba community)

“The health center is a key feature in the community because they help the community people. The environmental hazards are important to map also. In Dwarzark community, we do not have dumping site, so people use the drainage to dump the waste. But this is not good because if rain comes, it will overflow.

It is important to map these features to know what the issues are and to have improvement, for example constructing a dump site.” (Co-researcher; Zakiatu Sesay Dwarzark community)

“It was useful to map out important features within our communities. All of these features are important. In the Dwarzark community, those who are living in the upper part are very prone to disaster and deprived of certain facilities. Those who live down are a little better-off. These physical features are important to identify to gain in-depth understanding of the community.” (Co-researcher; Mohamed Sesay, Dwarzark community).

“All the features mentioned are important. The environmental features (flooding area and dumping area) are important to map. During this project, we categorized the communities as hillside or sea-side. The hillside communities have health hazards. Through the mapping and observation, we know where they are located, in which CDMC (Community-based Disaster management Committee, these are groups formed in every informal settlement to champion disaster mitigation activity within their communities.) were later notified, so that they would clean the areas.”

“The edge of the banking area is a particularly important feature to map. We need to identify this boundary. There are massive banking activities currently going on there which has changed the landscape of the community. Cockle Bay is situated on wet land and very prone to flooding.

We are very scared that one day high tide and heavy rain will happen simultaneously, which has never happened before, but if it does happen the community would be seriously damaged. We need to work as a community to prepare ourselves for this day. We wouldn’t be able to save our properties, but we need to be ready to save our lives.” (Co-researcher; Frank Bubu Kamara Cockle Bay community)

“The boundary mapping is also important; it helps the community to know what the boundaries are. For the seaside communities, it is important to map the boundaries because people are banking. So, in 5 years, we will be able use the map to asses and indicate the extent of the banking activity and the threat it poses to the community” (Co-researcher; Esther B. Sesay Cockle Bay community)

Supporting to strengthen accountability mechanisms to address identified challenges

“My position influences my access to services in the community. In hilltop areas, it is hard to have water access especially for young girls. So, we sensitized the water manager on this issue and allocated a certain time for young girls to fetch water to protect them. This allows us to reduce issues related to teenage pregnancies and early marriage.” (Co-researcher; Zakiatu Sesay Dwarzark community)

“I am also a community animator for NGOs working in my community. So, people know me because of this community work. It makes me feel good. I am also the community chairlady and I control 32 taps in the community.  This taps really helps the community by protecting young girls from early marriage and teenage pregnancies. It also prevents school dropout by enhancing water access.” (Co-researcher; Jamestina Sia Bayo Moyiba community)

“I am a CDMC chairlady, so it is important for me to map out the dumping site to organize the CDMC team to clean these areas and reduce health hazards. All of the features are really important for me to map since they allow me to better understand and coordinate programme more efficiently.”  (Co-researcher; Zakiatu Sesay Dwarzark community)

“We had to explain to the dwellers that we were not surveyors but mapping the community boundaries as part of the ARISE research project so that they would let us pass. We learnt a lot about the GPS mapping techniques. Now we are able to map anything. It also allowed me to know more about my community.” (Co-researcher; Saud Kamara Moyiba community)

Building capabilities and capacities

“There was a good working relationship between the researchers and co-researchers in the field as always. We divided the team in two sub-groups, but the information circulated well between the groups allowing the work to be successful. We would meet every morning and do a briefing on how to tackle challenges in the field. We were happy to do the work, so we got the best out of everyone. For most of the co-researchers, it was the first time we were doing this work, and we were very enthusiastic.” (Co-researcher; Mohamed Bangura Dwarzark community)

“The researchers were very caring and respectful to us which helped a lot to get the work done. There was a good working spirit, we ate together etc.… This good interaction really helped realize the work.”

“It is important to have good pointers that know the community well for the work to go faster and easier.” (Co-researcher; Jamestina Sia Bayo Moyiba community)

“We are happy because we learnt a lot. As co-researchers we did our work on our own. (Co-researcher; Issa Tuary Moyiba community)

Challenges in mapping informal settlements

Mapping informal settlements comes with lots of unforeseen challenges that might be encountered. These can range from challenges of equipment, personnel, personnel, time management, geographical terrains of communities or the community residents themselves.

• We underestimated the size of Dwarzark and Moyiba community, so it took more days to complete. To complete the mapping than we had anticipated.

  

• The GPS had a technical fault which also delayed the pace of work. There were also doubts about whether to map certain areas as informal settlements or not. This is because some community zones had massive properties. In the end, the contested areas were mapped since the technical team and community pointers (who were selected because they lived in these communities) gave directions on how to draw appropriate boundaries.
• Community members in Cockle Bay were fearful when they first saw the team mapping the boundaries. Community members repeatedly asked about whether it was part of the eviction process. The intervention of co-researchers and the community chief, allayed their fears. The community Chief assigned one community stakeholder to us so we could explain our objectives to residents. With support from the co-researchers and community pointers we were able to gain their trust.
• It was difficult to take photos and map out boundaries on the coastline in Cockle Bay due to high tides. As a result, researchers had to wait for low tides to continue, causing delays.

  

• There were few incidents of accidental falls and minor injuries sustained by some co-researchers and researchers during the mapping exercise. They were taken to the community center for treatment and we tried to find better ways of navigating rugged terrain using ropes and support to each other to cross rivers and climb hills.
• Resident in Moyiba community reported to us about incident of violence and robbery in a section of the community. That section of the community was inaccessible by the team for several days.

Although faced with many challenges we were able to complete the mapping exercise. It was a great experience for us all, as we learnt new things about our communities, exhibited great teamwork and had fun.

Upon completion of the boundaries and service mapping, a draft map was produced and a validation workshop convened. The validation workshop comprised of all those who participated in the mapping exercise such as researchers, co-researchers and community pointers.  During the validation session, co-researchers were asked what they wanted to do with these maps within their communities and for ARISE data analysis. They stated that they want to use the map to advocate for development in their communities and also to change the behavior of people doing banking, building in hazardous locations and for proper waste management.  We are continuing to support communities to take forward their priorities.

Notes

Produced by (Researchers) Samira Sesay, Abu Conteh, John Smith, Dr. Bintu Mansaray, Mary Sarah Kamara, Daphnée GOVERS, Samuel Saidu, Ibrahim Gandi and (Co-researchers) Mohamed Bangura, Mohamed Sesay, Zakiatu Sesay, Sinneh Turay, Hafsatu Kamara, Jamestina Sia Bayo, Fatmata B Sesay Suad Kamara, Issa Turay, Abdul Karim Kamara, Alieu Bah, Frank Bubu Kamara, Esther A Kamara, Abu Sesay.

 MAPS (Boundaries and services)