Movies used to change health behaviour

Some innovative local organisations are using film to empower people to make better decisions about their health.

Dr Susan Levine is a medical and visual anthropologist based in Cape Town. In 2002 Levine partnered with an organisation called Steps for the Future (Steps) as a researcher. Steps is a non-profit organisation that uses film to educate, intervene and advocate for healthcare and social justice issues in impacted communities around Southern Africa.

Spotlight spoke to Levine on the side-lines of the AfroSurg Conference in Bellville following her presentation on community engagement and patient care. The conference explored the barriers to surgical care in South Africa and the rest of the Southern Africa region. Levine’s work with Steps has helped people in rural and under-privileged communities access healthcare including surgery.

“Over the past 20 years I’ve been finding ways to bring my passions in medical anthropology and the arts together, mostly documentary film, photography, theatre and dance,” Levine told Spotlight. “Leading up to 2002, I was already a visual anthropologist but I’d never thought I’d find that [both fields] can speak to one another. So, it was really amazing.”

Fear as barrier 

Steps originally began as a way to interrupt the lack of government focus on South Africa’s HIV/AIDS crisis through documentaries and mobile cinema.

“Over the past 20 years I’ve been finding ways to bring my passions in medical anthropology and the arts together, mostly documentary film, photography, theatre and dance.”

“The [Steps] films are normalising the fear, and it’s also normalising the fact that fear is bound up with love, and caring,” said Levine. “As a healthcare intervention, the idea behind the films is to say that these are really complex, painful stories.”

Levine explained that the films try to be gentle when dealing with something that may be seen as ‘wrong’ or ‘bad’, such as defaulting on medication or seeking treatment late. The films also refrain from judgement.

The work with Steps has changed Levine’s research trajectory after seeing the effects the films had on communities.

“Sometimes on the escarpment of Lesotho there’s just two young boys watching a film in a mobile cinema unit, [and] sometimes whole villages in Xai-Xai, Mozambique, would come to see films about malaria and HIV,” she recalled.

After the film screenings, Steps facilitates discussions with audience members, allowing them to ask questions about the film to experts and medical practitioners on a pre-selected panel.

“The panellists there are people who can comment on the films, and the conversations are often really robust,” said Levine.

“[The audience members are] people who thought that maybe it was fiction, that AIDS didn’t exist, or who were afraid of condoms or of dying,” she added.

While the screenings can work as political, social and healthcare catalysts for community development, they also serve as educational tools for health and social justice.

“I think the idea around using mobile cinema to spur action to anything is quite an old idea,” said Levine, “but the ways that it’s come together in terms of the research component, the community building component, the production – those things have come together in a very particular way.”

Using film to shine a light

Steps is not the only organisation using film to create change. Another organisation, Sunshine Cinema, is converting “solar power to social impact”. The South African based organisation brings thought provoking African films to audiences across the continent using solar-powered mobile cinemas.

For many people, having surgery is a scary process that comes with many big questions.

“What’s interesting about Sunshine Cinema is that while they have a large health focus, it’s not exclusively health,” said Levine. “They bring documentaries that deal with gender-based violence, sexuality, and social justice issues. They also just show really wonderful local content and African feature films if they can get the filmmaker to release the films.”

Like Steps, Sunshine Cinema also hosts a panel to respond to audience questions following each screening.

During AfroSurg, Levine showed one of the Steps films titled Ngiyakibona or I see you. The short film follows the journeys of the families of two children who need cataract surgery in rural KwaZulu-Natal. The film was produced in partnership with Orbis Africa as a way to promote eye care.

Levine said the work with Orbis allowed her to travel to hospitals in KwaZulu-Natal as well as Zambia to investigate the causes of delay in eye surgeries and treatment. Through her research including interviews and observation, Steps was able to create life stories and pathways to care, which could eventually be made into film.

“Today at the conference I’ve had surgeons come up to me and say that was an amazing film. They didn’t know about those stories of how long it takes people to get surgery because of their fear of surgery – or even the relief that somebody’s child has woken up and to see that on the film, is really meaningful,” said Levine.

As part of AfroSurg, surgeons from around the Southern African Development Community (SADC) discussed the barriers to accessing surgical care in their countries and the region. In South Africa, these barriers are categorised as factors that prevent people from seeking surgical care, that prevent them from reaching surgical care services and receiving the surgical care they need as well as factors preventing them to remain in care.

For many people, having surgery is a scary process that comes with many big questions. Prospective patients often don’t know where to go, who to speak to, what the surgery entails and how long it will take to recover. As a result of these uncertainties, people often fail to get the care they need.

In a conference workshop, community and practitioner participants stated that this type of fear, a lack of support, information and communication along with delays in the referral system were among the top reasons people were unable to access care. Other reasons included challenges with transport, staff training and a lack of equipment at healthcare facilities.

Coming Soon

Meanwhile an ongoing clinical trial in the Western Cape is testing whether exposure to a series of films are impacting exclusive breastfeeding (EBF) rates. The so-called Philani MOVIE intervention is an entertainment-education initiative that works to promote EBF through a series of 13 short films. Community members and local stakeholders in child and maternal health help to create films that are shown by mentor mothers during home visits, as well as distributed over Whatsapp.

The films address a variety of issues concerning EBF including the benefits and challenges of breastfeeding, stunting, unsafe infant feeding procedures and breastfeeding with HIV. The trial is set to be completed by July.

Dr Susan Levine is an Associate Professor of Anthropology in the School of African and Gender Studies, Anthropology and Linguistics at the University of Cape Town. Levine teaches a free, open access 6 week online course titled “Medicine and the Arts: Humanising Healthcare”, interested readers can click here for more information and enrolment.