it easily, while Maya participants described it as a close up of a fungus that grows in corn or water droplets. Similarly, when presenting the Maya Kajtzuk (an ancient symbol with multiple layers of meanings), only those with knowledge of Maya spirituality could recognize it, while others imagined it was a strange Catholic cross. The exercise made participants aware that they were using their knowledge systems as a reference to interpret the same objects. This moment was used to introduce the concepts of emics and etics, commonly known as the insider’s and outsider’s views on an issue. A general awareness concerning the added value of exploring concepts from diverse points of view was reached, prompting from then onwards, community representatives to share their views more comfortably.
After gaining awareness of emic interpretations, the participants were engaged to discuss their genuine interests and demands to enter the transdisciplinary (TD) partnership. To avoid one sector taking over the discussion, and to prevent one group speaking for another (ventriloquism) (Spivak, 1988), each person had three flashcards upon which to write their interests. Once completed, participants joined groups by sector (academic, government, etc.), agreed on common aims, and jointly presented the flashcards they had made to the plenary. Each interest was discussed and placed in a three-column matrix according to: (i) which interests would be addressed by the TD partnership; (ii) which would be referred to other institutional efforts (e.g. initiating contact with an NGO building a school); and (iii) those not to be addressed at all. From this participatory exercise, clarification and agreements of the project’s expectations and limitations emerged. Allowing multivocality leveraged traditional power differentials and enabled usually excluded concerns of indigenous participants to be taken into account. Throughout the course of the project, participants understood the value of diversity and equal representation of Maya and biomedical knowledge systems, so by the last of four TD workshops, held in May 2018, community leaders accounted for 31% of participants, with more women participating.
In summary, offering a platform for balanced participation required modulating power differentials through three mechanisms: (i) inducing self-reflexivity of participants to acknowledge diversity of experiences (the exercise with animals); (ii) participants’ understanding of the difference between emic and etic constructs leading to bias or mutual understanding (the culturally significant picture exercise); and (iii) acknowledging the value of diverse views to address zoonosis as a health topic (through translation and use of flashcards for equal representation of views). Once these three preconditions were met, a successful negotiation of interests (avoiding power overrides) was possible. Figure 6.3 shows the adapted reflexive approach derived from backward planning used to develop specific tools as modulators of change, in order to achieve the desired goal.
Fig. 6.3. Adapted reflexive approach derived from backward planning used to develop specific tools as modulators of change, in order to achieve the desired goal (overlaid with Fig. 6.2). For each condition, workshop participants were asked to define the needed modulator of change.
This reflexive process was used throughout the project life to make sure that the team went from a multicultural approach where many ‘cultures’ or knowledge systems coexisted without cross-over understandings, towards an intercultural approach where mutual learning and knowledge co-production was promoted. The pragmatic value of this approach is seen in the following outcome.
A surveillance system for detecting signs of two targeted zoonoses was implemented. In order to increase sensitivity, case definitions for respiratory, febrile and diarrhoeic syndromes were initially developed by epidemiologists and presented to the multicultural academic team. Maya health personnel discussed among themselves how erroneous the biomedical terms were according to local understandings. Noticing a reluctance to publicly contradict a senior epidemiologist, social scientists developed an exercise inviting each team member to propose new categories for surveillance from their own emic perspectives. What followed was a discussion on 23 different Maya Q’eqchi’ terms that local indigenous people could use to define different types of fever, diarrhoea or respiratory illness. This elaborated range of local terms was used to prepare research instruments to test how local people perceived each syndrome. Results of these analyses were later used to develop materials for communication campaigns for explaining at household level how surveillance would operate. Most importantly, it helped Maya health staff unify recruitment criteria for Maya patients for whom case definitions of the protocol had to be completed. Throughout the project the field team met on a regular basis to discuss new emic categories that emerged during interactions with patients. This increased the cultural pertinence in medical response and provided culturally relevant ‘danger signs’. For example, whenever a patient indicated they had ‘susto’ or ‘itzel yax’, the health team knew it to be an illness in dire need of attention. We could show that awareness of emic categories of disease reduced misconceptions leading to erroneous interpretations of medical data, while it increased mutual understanding between representatives of different epistemic systems (Berger-González et al., 2016; Hitziger et al., 2017). However, this awareness did not occur without facilitation, as depicted in Fig. 6.4. Communications that nullified the experiential reality or identity of indigenous persons, called microinvalidations (Christopher et al., 2008), and attitudes of ‘cultural discounting’ were observed. The latter were based on the assumption that indigenous partners were passive recipients of knowledge to ‘improve’ their livelihoods and could not contribute usefully to the research. The critical analysis of inter-ethnic relations served as a base to modulate spaces for equal participation, which included constant reminders to use all languages, to address all relevant emic categories, and to promote respectful listening skills. This facilitated multidirectional conversations rather than unilateral information transfer. Health teams learned to replicate this process with patients and were rewarded with rich insights into Maya healing systems and a better understanding of perceived desirable outputs in collaborating with the public health system.
Fig. 6.4. Backward planning tool employed to increase sensitivity of the surveillance system implemented for detecting two targeted zoonotic diseases in Maya communities of Guatemala.
Transdisciplinary process in the Jigjiga University One Health Initiative (JOHI)
JOHI is a research-development project currently implemented in the Somali Regional State of Ethiopia to create innovative integrated health systems for improvement of health and well-being of pastoral communities. It is a 10 year (2015–2025) project co-funded by the Swiss Agency for Development and Cooperation (SDC), the Swiss Tropical and Public Health Institute (Swiss TPH) and the Jigjiga University (JJU). The project includes three main actors: (i) JJU for legal status and curricula; (ii) Armauer Hansen Research Institute (AHRI) for policy and research support and technical collaboration; and (iii) Swiss TPH providing technical expertise.
Setting up the project followed a process of extensive consultations with communities, authorities and technical experts within participatory processes in Jigjiga city and Gode, the main city of the study area in Adadle district (woreda). A preparatory workshop took place between representatives of the JJU, AHRI and Swiss TPH together with SDC staff in September 2014. The inception phase aimed to prepare the full project document. A stakeholder workshop in March 2015 in Jigjiga identified the main priorities of communities and representatives of the regional government bureaus. A first batch of PhD and MSc students went to be trained at Swiss TPH in the fields of human nutrition, midwifery, tuberculosis, animal health and rangeland management. Upon their return, the students prepared their field work. In June 2016, the supervisors together with the project accountant visited JJU and the field site in Adadle woreda and met the local authorities and communities.
The
