The Mint:
Good evening, Wendy, and thank you very much for joining us here at The Mint to talk about your work and career.
Wendy Adamba:
Thank you so much. Thank you for the warm welcome, Henry, and it’s nice to be here.
The Mint:
Brilliant. Well, maybe Wendy, you could start by explaining what your profession is and how you gained the skills that you use in your job.
Wendy Adamba:
Okay. So I am a social and behaviour change practitioner and I also do community development. And what I did at campus gave me a very good background into what I am doing right now. So at campus, I did Sociology and Social Administration and a bit of Gender, and that gave me a background into just being able to work with the different communities, being able to understand that people’s behaviours are shaped by different things, that is the background in which they live, the cultural beliefs, the education level.
So that gave me a very good background into just understanding what different people in different societies really value, and how that affects behaviour. W hat I do right now is social and behaviour change, especially in the health sector. So we work mostly with the communities in both rural and urban areas, and we identify who our target audience are and just study them in terms of what are their cultural backgrounds, what are their beliefs, what is it that they really hold dear to them that affects either positive or negative behaviour. What is important for us is to be able to understand who our target audience is fast before we even agree with them what their behaviour is.
The Mint:
Brilliant. That sounds fascinating. And can you give me a specific example of a community you’ve worked with where they live, the conditions in which they live, the sort of cultural background and so forth that you are engaging with?
Wendy Adamba:
Good. So what I want to tell you Henry, is that I have worked with very many communities in Kenya. I will give you an example of a community called the Kambas, that are based in Kitui, in the Eastern part of Kenya. One of the things we were doing there was programmes on family planning, and water, and hygiene and sanitation. And so it was very interesting for us because part of the things that was really hindering the uptake of good behaviour for them was their religious beliefs. They have sect group called Kavonkya. For Kavonokya, what they believe is you’re not supposed to go to seek help in a health facility. You’re not supposed to go for family planning. If you get hurt, for example, today, you’re not supposed to go to a health facility because when you go to a health facility, then you are sinning. That is a sin. You’re going against God’s rules.
For them, what they believe is if you die, you die because it has been planned that you will die that day. So you’re not supposed to seek any help from a health practitioner, because then if you do that, then you will be excommunicated from that particular religious group. And so it was very interesting for us to just go and talk to them. For us, we believe that behaviour change does not take a day. Behaviour change is something that takes some time, so it requires that you talk to the people about the kind of behaviour you want them to adopt. And so we had very meaningful conversations with them. And what we are happy about is that by the time the project was coming to an end, we had a few of them going to deliver in health facilities because then they understood the dangers of not delivering in health facilities.
The Mint:
Yeah, I was just wondering because, obviously this phenomenon of religious sects who believe that various things shouldn’t… They shouldn’t have their bodies interfered with, or whatever they shouldn’t be treated in certain ways is widespread, isn’t it. And usually in those circumstances, as you say, you might be excommunicated and that is so disastrous that I would’ve expected no one to have taught up to let alone done anything because presumably they might get marked as potential people who would disobey the rules of their group. How was it they were willing to talk to you and willing to change given the risks to them, of being thrown out of their communities, which would be presumably a disaster.
Wendy Adamba:
One of the things that we realised in programming, especially for that particular programme is one of the things that you have to do even as you get into a particular community that you want to work with, is the involvement of the leaders. What we did at the beginning was to involve all religious leaders and that included religious leaders of that particular sect group. They came into a meeting despite the fact that even in that particular meeting, there was that sort of discrimination from the other religious leaders because the other religious leaders know the practises of this particular sect group. That was the first thing that we did. Identifying that for us to move forward, there are people that we need to bring on board. That religious leaders meeting really gave us a good entry point into all the religious groups that we are going to work with.
From them, we just singled out who in this religious sector group do we need to work with closely so that they’re even able to mobilise their people. And I can tell you for sure that particular sect group, the members of that group are very friendly. The only thing that will make you understand is for you to appreciate their beliefs so that you’re not forcing them. As I told you before, is yes, we identified who the leaders are, who the most influential people are. And we told them what we’re going to tell them, and we’re not going to coerce them to take up any behaviour. It wasn’t very easy, but I think when you’re doing social behaviour change programing, then you need to identify who are the key people that will help you to enter into a community that you want to work with moving forward.
The Mint:
Well, I was just wondering whether the leaders of the sect gave permission to their people in their church to talk to you and get treatment.
Wendy Adamba:
They gave us permission to talk to the people and we used that opportunity. You know what they normally say as a behaviour change practitioner, is when you’re talking to people, you need to identify at what point of behaviour change a particular person is. So yes, they gave us permission to talk to their members. The only thing is that they also had to sit there and listen to what we are telling their people.
They know the kind of information we are giving to their people. That was very key for them.
The Mint:
Did they seek to influence or remind people that if they were ill, that was a judgement of God or whatever?
Wendy Adamba:
No, it’s very interesting because for them, they stuck to what they believe. Even when they were giving us permission, they were very clear on the fact that please do not come and coerce people, do not come and force people to take up the behaviour. We will listen to you, but that doesn’t mean that we are going to follow your ways. And so for us as behaviour change practitioners, what was exciting is that we were given that forum to talk to the people because then that is the first step of behaviour change. For me to be able to give you information and more information and more information. Eventually you will make a decision on what you want to do with that information.
The Mint:
But the people who did take steps and kept treatment, were they excommunicated?
Wendy Adamba:
They were not ex communicated. What happened is they came to talk to us on the sides. That is after the meeting with the larger group. Those who seemed interested, and those who wanted to be converted, came to talk to us on the side. What happened eventually is for us to be able to talk to the health practitioners so that they also know that these people will come and they will come secretly, they do not want to be seen coming for health services.
The Mint:
Oh, right. So you were basically having people coming to you secretly, to avoid the danger of them being excommunicated.
Wendy Adamba:
Yes. Again, for us, it is very important to be able to appreciate that these are not people who want to leave their sect group, but on the other hand, they’re interested in getting more information about the things that we are talking about. For example, we were telling them if a pregnant woman who is due for delivery, for example, bleed so much, it means that you are going to die and that means you will leave your children. So what does that mean? It means you need to go and deliver in a health facility.
The Mint:
Okay. Have you seen people going subsequently to health facilities from this sect?
Wendy Adamba:
Oh, yes. We saw that.
I can give you examples. They went to deliver in health facilities, or rather some of them requested the health practitioners to help them deliver in secreted places, as long as your child is being delivered by a health practitioner. The other interesting bit was on immunisation because initially they never used to take their kids for immunisation. But then what happened is they used to talk to the health practitioner. The health practitioner can do that in a place where they cannot be seen by their fellow sector members.
The Mint:
Wow.
Wendy Adamba:
So for us, we were saying at the end of the day, that is behaviour change. Someone has shifted from what they never used to do, to what they do, which is desirable behaviour.
The Mint:
That’s really interesting. I suppose it’ll be very interesting to see in the medium term, whether that affects the beliefs, or whether the leaders will turn a blind eye. Presumably someone could report them or it could get out what they’d done, but maybe in the interest of the leaders to sort of let it happen undercover so that they still are supporting things on the front. There can be a lot of democracy in these situations.
Wendy Adamba:
Yeah.
The Mint:
That’s a fascinating example. Can you give me another example? Cause obviously this particular sector is quite peculiar. I would imagine that unusual. Can you give me other examples of the challenges in different communities that you’ve found and how you’ve dealt with them?
Wendy Adamba:
I think the other challenge we faced was, for example, if I may speak about family planning, uptake, or family planning, because that is what I have done for a long period of time. If I may talk about uptake of family planning, the other challenge has been getting support from the male partners. Male partners have a lot of beliefs on family planning, on the methods. They have these myths and misconceptions that they really believe in. It becomes very difficult for you to change their mindset. What we did to counter that was to engage the male engagement and male involvement in our community engagement sessions. What we did was to have male only groups and just ask them, what is the problem? Why don’t you think your women should go for family planning? They gave you all sorts of reasons. One of the things they say is you need to understand where the problem is and then find a solution together. We had those discussions with the males and we had male champions and male champions in this case, people who have practised the behaviour that is desirable. So we also had male champions.
The Mint:
Can you give me a specific example of the sort of behaviour that you were wanting to be practised and the reasons why men didn’t want to do that?
Wendy Adamba:
I’m just encouraging their women to go for… For family planning, you can’t choose for someone to either take up a short term or a long term family planning. For us as a programme, it was about promoting family planning methods. So the males, most of the spouses are not comfortable encouraging their women to go for any family planning method, even condom use.
The Mint:
All right. Because what, that means they won’t become pregnant. They actually want as many children as possible.
Wendy Adamba:
Yes. Number one is that. Number one is in the African setting, the more the children, the wealthier you are. Oh yes. For most men, part of the questions they ask their women, the main reason you got marriage to me is to give me children. So why would you then go for family planning?
The Mint:
Oh, right. So it’s a betrayal of the deal effectively, the marriage.
Wendy Adamba:
Oh yes. And it is rooted in the culture because in the African setting, you’re supposed to have very many children. It doesn’t matter that you can’t take care of them.
The Mint:
So it’s about the principle of family planning. If this is a fundamental belief about status of men in Africa, how do you go about addressing that? What sort of conversations can you have, that can actually affect how men think about that?
Wendy Adamba:
Number one is to look at it from… What we normally used to do is to engage the males through small group sessions, mostly. So it’s just a group of men, of course, within the same economic groups. Have those discussions. Number one for us is to identify where the problem is. What are these things that you really believe in that are affecting your mindset about family planning methods, and why you shouldn’t support your wives to take up the family planning method. After you understand what the problem is, then it is to give as much information as possible. Part of the things we were doing was to look at it from an economic point of view. For example, if you have eight children, and these are just discussions, very candid discussions that we have with them.
For example, if you have eight children with the current economy, are you even able to give them the best education. That kind of education you’d want your kids to have, that is number one. Then to also look at it from the health perspective, because we make them understand that the more a woman gives birth, the riskier it is for her. Then that’s translates into maternal deaths and neonatal deaths. We make them look at it from all those perspectives. At the end of the day, there is always a call to action. What have we agreed we are going to do? Are you going to support your woman? Are you going to work your woman to health facility, to look for a family planning method and such things?
The Mint:
If they make a commitment, do you check whether they fulfil that commitment? Does the group monitor who fulfils the commitment?
Wendy Adamba:
Okay. What used to happen, we used to meet our target audiences in groups. For example, I don’t know if you know bud, but about the bicycle, the bicycle riders, the motorcycle riders. You meet them in groups, but then you also refer them. There was the aspect of referring them to the health facilities that we used to work closely with. There’s that aspect of referring then helps us to know that this particular, when they get to the health facility, they will be asked, where did you get this information? How did you come to know about family planning? How did you come to know about this health facility? There is the background information the health practitioner picks from that particular person when they go to that health facility.
The Mint:
Okay. Does that allow you to know how effective you’ve been?
Wendy Adamba:
To some extent yes, but other times, no. Again, it becomes difficult for you to track everyone who decides to take up their behaviour. For some we can easily attribute that to the kind of information that we give them. We also used to work with community health volunteers who then have the responsibility of doing follow ups. After those kind of discussions, then we have a community health volunteer, both males and females who do follow up and just ensure that someone is doing what they promise to do during the declarations.
The Mint:
Okay. We were talking about in the last example, how you get leading people on board. That was slightly different in that, just to get permission, they weren’t actually going to change anything. Presumably you could find influential people in the community who could put your message out about the economics and the benefits. Have you been doing that?
Wendy Adamba:
Oh yes. As I mentioned, part of the reasons we decided to use the religious leaders is because, I will take you back. We do participatory approaches. Even when you’re deciding what it is you want to implement in the community, you sit with the community members and agree. What do you think is going to work in this community? Where do you even think, who do we need to talk to? Part of the things that were coming out clearly is for example, women. Women were saying, if you sent a religious leader to me, I will listen to them more than any other person.
The Mint:
Okay.
Wendy Adamba:
Part of the things that we were asking them. Who do you think is your greatest influencer within your community? Who is your greatest influencer, and they will tell you.
They told us the religious leaders, they told us their own peers. For example, most women will go for family planning methods because their friend went for that family planning method.
The Mint:
Right.
Wendy Adamba:
Yes. They identified the different people that, if those people went to talk to them, if those people went to give them some sort of education about family planning methods, about the people cancer screening, about immunisation, then they would listen to them more than if a stranger came and talked to them.
The Mint:
Right. Do you monitor at all how the overall attitudes change in communities? You were saying to start with this general belief amongst African men, that more children is better. Do you do some monitoring how that general belief, whether that general belief is changing over?
Wendy Adamba:
Part of the things we do. For example, when we were doing the small group sessions that I have to talked to you about. What we did and we still do, is to talk to the same group several times. With time you will get to know, are these people the same people that I met in the first place? For example, if you are to meet a group of women, because women in the African setup have their own small organisations where they come and meet frequently. If I went there this month, I will go there maybe after two months and talk about the same topic. It is not just exposing them to that particular topic or exposing them to that particular discussion once. You go there several times and with time, you will see if there is change in attitudes and beliefs. Also since we work directly with health facilities, some of it then translates into uptake of the particular behaviour that you want to promote. We look at various things to help us know that there is a change in attitude.
The Mint:
Can you give me any other examples of work you’ve done apart from family planning and the issues that have arisen there?
Wendy Adamba:
Okay. Initially I used to work for an organisation that was church based and we still used to work with community groups. Our role was to build capacity of those particular groups and building capacity was in areas of food security. You understand that a lot of communities in Kenya, not everyone has a big piece of land where they can do farming. The sort of farming that will give you enough food to sustain you throughout the year, until the next harvest. One of the pillars was food security. Just looking at the different people in their groups and most of them are farmers. Again, it just starts from problem identification. What is the problem? That I have a piece of land that cannot give me adequate food. In most cases, whatever you harvest will only last you for two, three months. After two, three months-
The Mint:
Two, three months out of 12? That’s not long, is it.
Wendy Adamba:
That’s not so much. Remember these are people with families. After two, three months, that means someone has to start buying food.
The Mint:
Right.
Wendy Adamba:
What we used to do was to identify. Why is your farm not giving you enough food for you to be able to feed your family throughout the year and even get a little bit more for you to be able to sell and get a few coins? Pillar number one was food security. Linking them to the various ministries within the country so they’re able to get a fertiliser, a subsidised threats so that they’re able to be trained on how to use the locally available material to ensure that their farm is producing more in case there is free fertiliser they were able to get. Number one was linkages. Number two was training. For them to be able to just ensure that they have better produce out of their farms, then number two was… Yes?
The Mint:
I was just wondering, you were saying that the moment the food lasts about two or three months. To get enough food out the same bit of land for four times, for a whole year. That is a huge change, in productivity, isn’t it? You think it’s very unlikely even with a bit of fertiliser, et cetera, that you could produce four times the amount of food on a bit of land.
Wendy Adamba:
So Henry, this is how we looked at it. I am glad that even by the time I was leaving that organisation, two or three of the farmers were calling me and telling me, you really helped us. We were looking at this from this perspective. Number one, is it the plants that you’re putting on your farm? Where I come from that is in Western part of Kenya. So many farmers believe in planting maze. Maze will take a very long time. By the time you harvest, that’s like six months wasted and you are waiting for one bag, a 90 kg bag of maze. That will not sustain your family. Number one was to just try and change their mindsets through interactions with the different experts in the agricultural sector. Okay. Changing their mindsets in terms of, it doesn’t have to be maze. You can do vegetables and vegetables will take a shorter time. What you will get from the vegetables will allow you to buy food for your family. That food even includes mazes, that you really insist on planting and it doesn’t give you a lot of produce.
That is number one. Number two is how do you even plan your farm? How do you even plan it? Are you putting maze on the entire farm or are you saying this particular portion, maybe a quarter of it, I will put maze a quarter. I will put beans a quarter. I will put vegetables and then I will be able to sell the vegetables and buy other things and even pay school fees for my children. Number one is just changing the mindset. There are things you really believe, you really think it has to be maze, but that is not the thing.
The Mint:
And these farmers would listen to experts?
Wendy Adamba:
Oh yes.
The Mint:
That’s interesting.
Wendy Adamba:
The good thing is that those experts, most of them live within those societies. There are people they interact with daily. The problem is most communities don’t even know that these experts are within them or those experts are put there to help them.
The Mint:
Okay. So you are really just connecting people and as they’re local, they don’t seem like they’re strangers or they’ll listen to them.
Wendy Adamba:
Yeah. In most cases you don’t get someone from outside that particular area. You get someone who comes from within that area. In most cases these are people they interact with in funerals, in functions and what, but they don’t know that they can tap into the strengths of that person to help them. Our biggest breach was to just link you to the people who are going to help you to get you from this level to the next level.
The Mint:
And were they able to go visit farms that were doing multiple growing lots of different things and…
Wendy Adamba:
Yes. What they used to do is… For example if you have met a group of men, maybe they sit together, they have what we call chamas. For example, they come together and contribute money to support one another. For example, for practical sessions, maybe we’re going to Henry this piece of land. That is where we will do our practicals. This particular expert, we call them that particular expert, will keep going to that particular piece of land and meeting the same group of people to ensure they are doing the things they agreed to do.
The Mint:
Brilliant. Well, that’s absolutely fascinating. Can you just tell, as a final thing, I just wonder. What do you find most worthwhile and what makes you feel best about the job you do?
Wendy Adamba:
I think for me, it’s being able to realise. To admit the most fulfilling part of my work is to be able to just get someone from a particular level that you found them to a desirable level. That level that you are proud of. For example, if I’ve given you an example of the farmers. If you found them getting this little and they call you to just give you feedback and telling you, the kind of training that I received has made me a very good farmer. In the health sector, it is just about trying to change the mindsets of people and appreciating that it’ll take a long time. Going back to the same people and just listening to them talk. Some of those people that you found practising the behaviour that is not desirable, being champions. Being the ones that are championing the positive behaviour. For me, that is very fulfilling.
The Mint:
Brilliant. Well, thank you very much for giving us your time to talk about your work, which does sound incredibly exciting and worthwhile.
Wendy Adamba:
Thank you.
The Mint:
Thank you and goodbye for the moment.