Malay Heart Health

A Straits Times article highlighted that Singaporean Malays faced a higher risk of heart conditions. The Malay Heart Health project was thus established to develop a community-centric heart health intervention. Solidly grounded in Culture-Centred Approach’s (CCA) communicative principles of participation and dialogue, the initiative was funded by the Singapore Heart Foundation. Proceeding from the central CCA tenet that communities are in the best position to identify their problems and the concomitant solutions rooted in cultural meanings of health, the team conducted:

  • 60 in-depth interviews with community members
  • 50 hours of participant observations
  • 12 advisory board meetings
  • 6 focus group sessions.

The team sought to co-create entry points for understanding the meanings of heart health and co-develop community-grounded heart health interventions built on local cultural logics of daily life.

The findings pointed to a few key factors that made it ripe for a culture-centric intervention. One key finding revealed that taste was a significant anchor to social interactions and food practices in Malay life in Singapore. Many participants were not receptive to healthier Malay cuisine because it lacked strong flavours, which enhanced the joys of everyday social interaction. Healthy eating therefore carries culturally-specific meanings in this context, which provided the basis for working with them, rather than stigmatising them.

 

Another important finding was that social events such as wedding receptions, gatherings, baby showers and of course, Hari Raya festivities, have significant bearing on the participants’ ability to control what they ate. Owing to a culture of eating together, participants reported hesitation in declining to eat more when asked to join by others, despite being full themselves . The sociality of food highlighted the importance of developing culturally-centered interventions that draw on food practices as relational practices embedded in community life.

Participants’ voices pointed to a large information gap about chronic diseases, resources of prevention, and strategies for coping with cardiovascular disease. Particularly salient was the absence of culturally rooted and culturally meaningful health information that addressed the heart health needs of the Malay community.

The Intervention:

The first phase of the intervention was  a collaboration with Jurong Green MAEC, a branch within Jurong Green Community Centre. The second phase, demonstrative of the CCA’s ability to utilise alternative community infrastructures,  comprised of collaboration with community members from Chai Chee rental blocks.

The collaboration with Jurong Green MAEC saw 12 advisory board meetings with 14 members who linked diet and stress as contributors of cardiovascular diseases. The strategies of prevention include introducing healthier Malay cuisines without altering the taste that they were used to, community-driven group activities of learning about food and Malay culture, financial management seminars to help the lower income community members manage their budget better, outings for families to relieve stress, health screening, and exercise activities.

These were manifested in the campaign Gaya Hidup Sihat Sepanjang Hayat or “Healthy Lifestyle for Life” which was carried out over a span  of 2 months and was launched through  a community event with  celebrities like Sufi Rashid, Khairudin Samsudin and Suria Mohd who shared  tips on preparing easy healthy recipes.  To encourage bonding with their family, the advisory board members visited Bollywood Veggies where 120 of them got a personalised tour around the farm and shared insights about the vegetables they could use in their daily cooking. Again, to reduce stress and encourage families to come together, they organised an outdoor Zumba activity in the void deck of a nearby HDB block.

In the second phase, 12 advisory board members from Chai Chee rental blocks began a focus group, after which they collaborated with Sunlove Senior Citizen Centre (SCC) to ensure that the activities they came up with reached a wider audience. Once again, the advisory board members identified several issues they thought should be addressed in their community, including an emphasis on a healthier diet, education on cardiovascular diseases and smoking, and community-grounded group activities centered on heart health.

With many low-income families in the community, the group wanted recipes that they could easily and affordably make and adapt to their needs. Using healthy Malay cuisine recipes, Healthy Cooking Wednesday at the SCC was launched. These recipes were compiled with the assistance of Khoo Teck Phuat Hospital, tested  by the community members and later distributed to the senior citizens through recipe cards in Malay featuring recipes from community members and tips on keeping the food healthy.

Community members also designed culturally relevant posters and brochures to create awareness about signs of heart attack and stroke, and the dangers of smoking, especially while pregnant. These posters were put up at lifts, at the SCC and Residents’ Committees centres; while the brochures and recipe cards were distributed by the advisory group members at the launch of the campaign. The campaign launch witnessed the members cooking for the guests followed by a short explanation of the brochures with a dance-off to wind down the event.

The CCA principle of placing the community as the locus of decision making resulted in the community members taking ownership of this project with a deep interest in sustaining it. Consequently, Healthy Cooking Wednesday continues to this day.

As Professor Dutta shares:

The voices of community members form the soul and spirit of this campaign, generating a positive dialogic space for celebrating heart healthy behaviors and beliefs in the community. What is powerful about this advisory board and the work of community members is their ability to identify cultural resources of healing from within the community, connecting back to cultural traditions, and cultural meanings, and demonstrating the importance of community participation in dialogues for health and well-being.

The nuts-and-bolts of building cultural resources for health in a Santali village, West Bengal

In 2008, the village of Piyalgeria in Jhargram, like many other villages in the area at the time, had erupted in protests against the extreme marginalization, poverty, and police harassment experienced by the Santali community in the region. Attacks on dignity of the Santali life were often voiced by community members as the underlying causes of the protests. When the CARE research team led by Prof. Mohan Dutta started working in the villages, one of the key questions guiding the culture-centered projects was: What, according to community members, is the source of health? Drawing then on this fundamental question, the CARE team collaborated with community members in identifying the challenges to health they experienced, and the potential solutions they envisioned. In the voices of community members, the dignity of Santali cultural life held the threads to good health. Thus started our collaborative journey in building a community cultural center as a health resource. This health center would serve as a space where the young and old participate in songs and dances. These songs and dances, in community voices, are repositories of health, healing and wellbeing.

Listening to voices of the poor: Academic freedom and policy making

The work of the Center for Culture-Centered Approach to Research and Evaluation (CARE) has applied the tenets of the CCA to work in communities across the global margins. The poverty and communicative inequalities projects that are carried out by CARE reflect the overarching theme of the CCA, theorizing the communicative constructions of poverty in the global mainstream, and creating spaces for the voices of the poor in these mainstream and elite platforms through collaborations in solidarity with the poor. Comparing the discourses of poverty in mainstream  and elite networks with discourses of poverty as voiced by those living in poverty across countries offers a conceptual framework for examining the ways in which communication of/about poverty works in mainstream/elite constructions, the gaps in these constructions, as well as the possibilities of transformative change when  these stories are grounded in the accounts of the poor about their lived experiences. Essential to this work then is a commitment to empirically work in contexts of poverty. The CARE team and I spend countless hours conducting participant observations, in-depth interviews, focus groups, surveys etc. to arrive at the empirical constructions of experiences of poverty. A CARE project is minimally a product of two to three years of rigorous, field-based empirical work, with strong CARE projects spanning over a decade. However, more importantly, the communicative turn of actually listening to the voices of the poor ensures that we spend many hours collaborating with advisory board members, shaping our research instruments, reflecting on them, and most importantly, undoing and redoing them when and where necessary. The actual lived experiences of collaboration in academic-community partnerships teach us about the mechanisms of communication that work toward generative frameworks that address the needs of the poor as envisioned by them. In this sense, a well conceived culture-centered project becomes one of the poor, turning the tools of research into the hands of the poor, and working through these tools to challenge the misconceptions around poverty that circulate in the mainstream. Reflecting this overarching tenet, the “Voices of Hunger” projects that have been carried across seven countries spanning North America and Asia reflect the value of stories from the margins as shared by the poor in challenging the overarching stereotypes about the poor that are often misguided and factually incorrect. Of course, the sanctity of culture-centered projects rests on the pillar of academic freedom. Moreover, the usefulness of the projects depend upon their ability to engage with policy making. The voices of the poor often offer vital lessons that policy makers ought to pay attention to. Take for instance the narratives of the poor in our fieldwork in India that point to ways in which the Aadhar card, an ID system implemented across India to supposedly streamline the delivery of public services actually fails to deliver these services because of faulty technologies, inaccess to technologies, and the interplays of poverty and technology inacess. As a result, those who are the poorest are often the ones that are being unserved. This narrative emerging from the grassroots not only interrogates the power of a monolithic story, but more importantly, offers a framework for redoing policy. Such lessons are only enabled by a sufficient commitment to academic freedom. Academic freedom enables the inconvenient but empirically grounded stories to emerge. Academic freedom offers in this sense of the CCA an opportunity for thus ultimately developing policy frameworks grounded in the lived experiences and struggles of the poor. Because the narratives of and by the poor fundamentally disrupt the dominant assumptions held by elites, the power of the work of culture-centered approach lies first and foremost in keeping intact these spaces of academic research that are anchored in a steady commitment to authenticity and truth. Rather than telling stories of and by the structure, framing these stories in symbolic artifacts that appeal to the elite, culture-centered stories engage empirically the very bases of these dominant narratives. The CCA has worked, however contingently, across global spaces because the tenets of academic freedom retain the spaces in academe where this work has been carried out and where it continues to be carried out. It is after all, an overarching commitment to the broad ideas of academic freedom that makes possible the continuous search for truth, grounded in the lived experiences of the have-nots in a highly unequal world.

The Voice of Hope – Remembering the past and Recrafting the future

The Center for Culture-Centered Approach to Research and Evaluation (CARE), a research center under the Department of Communications and New Media at the National University of Singapore, is launching an online campaign on the 4th July to co-create stories of resilience, hope, and healing with the survivors of the Indonesian mass killings of 1965/1966. Based on scripts created by community members, the campaign seeks to create a narrative entry point for articulating the lived of experiences of sufferings and the pathways of hope. This online campaign titled “Learning65” celebrates the possibilities of hope amid suffering. Voices of hope come in various forms of stories and articulate the human rights, health and wellbeing issues faced by the survivors of the mass killings. After more than 50 years, the community members struggle to fight for justice amid the human rights violations under the New Order regime, which included mass killings, forced disappearances, sexual harassment, forced labor, imprisonment without trial, and many others. Community members share experiences of trauma, recounting physical torture, sexual harassment, and ongoing stigma. Voices of the victims have been systematically erased from the discursive space.

This online campaign was conceptualized by an advisory committee comprising 10 men and women from the community of 1965 survivors. Guided by the tenets of the culture-centered approach (CCA) pioneered by Center Director, Professor Mohan J. Dutta, this research study began with the understanding that community members are their own best problem configurations and solution providers. Therefore, when spaces for listening are created and communities are invited as co-participants, solutions to their health and well-being emerge from their lived contexts offering entry points for addressing trauma and suffering.

Over the 8 month-period, the advisory board identified key issues faced by the community of survivors and developed communicative solutions to tackle these problems. Stigma, restrictions to gather and to express thoughts, inequality, and communicative inaccess, are some of the problems that the community members face in their everyday lives. In collaboration with the NUS research team, the advisory board designed the campaign and the key messages in the collaterals. The media campaign developed by the community will include a dedicated digital story telling website, social media outreach, and a documentary research film.

Besides the media campaign, the advisory committee also highlighted that a key element in building collective consciousness about the history and the 1965 tragedy, and enacting positive changes in their lives was to engage with the key stakeholders in solution-making. In line with this, two focus group discussions and peer leader meetings were organized, bringing together the younger generations, volunteers, artists, scholars, and activists. The community highlights the importance to engage with the younger generations through arts and performance to battle the stigma, and to address the erasures experienced by the victims and their family members for more than 50 years. The outcomes of the discussion and the solutions proposed will be summarized in two White Papers. The culture-centered campaign foregrounds voices of the the marginalized community of 1965 in creating a narrative entry point for health and wellbeing. The full White Paper will be available online at: http://www/care-cca.com/. To find out more about culture-centered approach, please visit http://www/care-cca.com/ CONTACT INFORMATION: Prof Mohan J. Dutta (cnmhead@nus.edu.sg) Dr. Dyah Pitaloka (cnmpd@nus.edu.sg)/ (itareksodirdjo@gmail.com)

 

 

Fortifying Migrant Workers in Singapore

With our “Respect Our Food Rights” campaign launched last year, we partnered with DSM and BOP Hub to address the micronutrient deficiencies faced by our Migrant Construction Workers in Singapore due to the poor quality meals they received. This video below showcases the soft launch of the ‘45Rice’ project in delivering micronutrient-rich rice to this migrant community and eventually the wider public at large in Singapore. The concept of “Hidden Hunger” is introduced and they addressed the issue through the strategy of producing and supplying this micronutrient-rich rice. Our Director, Prof Mohan Dutta, was present to give his insights about the event and the fortified rice that was served.

The Piyalgeria Community Center Construction

Prof Mohan gives an account on his project in the Piyalgeria Village where community members come together to materialise the idea of constructing local spaces for their activities through participatory workshops, designing surveys and village-level meetings . With the community’s decision to build a local community center, the members took charge of the budget, the design and the labour of the project.

[Left Behind Families] Liu Village Dancing and Drumming

During his trip to the rural Liu village, Dr Kang Sun noticed how its traditional drumming and folk dancing practices are still active despite the condition of the settlement. He collaborated with the left-behind villagers to organise cultural activities as part of a healthy lifestyle and they were given the invitation to perform their drumming and dancing at the local carnival. Dr Kang documented the whole process in this short clip.

Drumming up Social Change

Drumming up Social Change By: Kang Sun, Daniel Teo, and Sarah Comer While China’s economic development is no news to anyone, the social cost of such development is yet to be explored. Kang’s project focuses on the rural villages where elderly family members have been left behind by their adult children working in cities. In this social background, elderly villagers’ everyday health conditions and care (or lack thereof) become a social critique of economic development.

The Spurious Kang: An Ethnographic Account of Culture’s Place in a Chinese Village – A Talk by Dr Kang Sun

Recognizing numerous elements of culture in the field can pose challenges to researchers. The concrete, unexpected, practical, and sometimes tedious issues that need to be addressed add rich and dynamic meanings as well as messiness to projects. Frequently, such recognition results from constant negotiations with history and present, first impressions and in-depth knowledge acquired through trial and error. In this presentation, Dr Kang showcases the uncertainties and negotiations of recognition experienced in a village that is both familiar and strange to him, his hometown. As an ethnographer, he argues that recognition of cultural elements is a social process that often defies simple academic categories. Only by accepting such social processes that take place in the real field, can real inquiries of interests be identified and investigated. In his case, field research has been an ongoing process in which he and other participants have discovered the importance of an old local art form and worked together to push for its revival. This presentation is marked by its visual impact.

Brave.

Brave /brāv/ verb. Endure or face unpleasant conditions or behavior with courage. This week, we had our very first focus group with 10 women who are domestic helpers in Singapore, and we are also continuing to interview women who are currently working in their employers’ homes. “Brave” only scratches the surface in describing the stories we heard. Together, the CARE team and the focus group discovered that there are so many problems, injustices, and issues to tackle together and through all the tears in the focus group, mine included, I was confronted with how different our worlds are but how similar our hearts are. At the very core, regardless of socioeconomic status, occupation, or culture, people want to be treated like real people, with respect and dignity, and as we all know, it’s painful when it is not afforded to you.