NALA, an organisation tasked with reducing the incidence of Neglected Tropical Diseases (NTDs) in East Africa, have come up with a unique communication tool: Toto, a graphic creation who cuts works through the limitations of literacy and complex medical knowledge.
Visual literacy is “the ability to recognise and understand ideas conveyed through visible actions or images.”1 The term encompasses a diverse range of tools which are used to communicate and exchange important ideas, including, but not limited to graphic illustrations.2
Over the last few decades, graphic illustrations, specifically the use of comics have been widely used in the field of health and medicine for the past few decades.3 Especially powerful throughout the 1980s, as a tool for building awareness and challenging the stigma surrounding the HIV pandemic4, illustrations in relation to health have been termed “graphic medicine,” a recently popularised field that continues to explore and publicise the power of art within healthcare5.
Beyond healthcare however, the use of visual literacy in rural communities with low literacy rates is particularly important with respect to their development. This includes the use of graphic illustrations and play, amongst adults and school children respectively.
NALA, an organisation that works to eliminate neglected tropical diseases (NTDs) through health education, national policy, and improvements to water access, has harnessed the power of graphic illustrations to educate thousands of men, women and children on disease transmission and prevention in Ethiopia—a country whose most recent census reported over half the population to be illiterate6.
NTDs, including schistosomiasis (Bilharzia), intestinal parasites, and trachoma, are often termed “diseases of poverty” due to the disproportionate impact they have on the world’s poorest and most marginalised populations. Predominantly impacting women and children, NTDs flourish in unhygienic environments, created principally by a lack of access to clean water and proper sanitation infrastructure.
Hagit Ganini
Girl Collecting Water
Watercolor and pencil
2020
The use of adaptive, appropriate, and relatable graphics has been key in this process; from school children to mothers and caregivers, they have been carefully curated to match the needs and wants of the varied communities and cultures in Ethiopia.
Virtual Exhibition, Schisto Ethiopia, 2018
Rural women are a group at increased risk of contracting NTDs due to their daily activities’ Limited schooling has led to extremely high rates of illiteracy in this group. Many of these women are members of the Health Development Army (HDA)—a group of volunteer women who model their households as hygienic and safe environments, setting standards for their community’s and mentoring their peers’ households in the process.
Making up a core sector of NALA, HDAs use cascaded training mechanisms to educate communities on disease transmission and prevention, via carefully designed and context-specific graphic tools.
Having realised the struggle many women were having with relaying manuals and texts due to their limited reading and writing abilities, NALA created powerful and easily understood illustrated materials to guide these women in disseminating information in rural communities, enabling greater impact at the community, and household level.
Through understanding the diverse needs and contexts of different populations, NALA has utilised illustrations, as a means of education, with the knowledge and evidence of art’s power to regenerate and strengthen communities7. These materials include illustrated A3 flipbooks and card games, which are used by HDAs to describe routes of transmission, common symptoms, and recommendations for disease prevention.
Toto exhibited at NALA and Early Starters International exhibition as part of Tel Aviv's 8th annual illustration week
Hagit Ganini
Children with Trachoma
Watercolor and pencil
2020
Through understanding the diverse needs and contexts of different populations, NALA has utilized illustrations as a means of education, with the knowledge and evidence of art’s power to regenerate and strengthen communities
Having evolved over the years to become increasingly appropriate for targeted communities, the illustrated materials have been noted as such a successful model of intervention that the Head of the Bench Sheko Zonal Health Department reported to NALA that “other departments, such as family planning, will be adopting illustrated materials as part of their interventions.”
In addition to utilising illustrations as a means of educating rural women, children in such settings, similarly have relatively limited access to relevant school materials. Building on the use of song and play by Ethiopian school children and supported by vast experience and close partnerships on the ground, NALA introduced an innovative form of communication, with the illustrated character “Toto.”
Prompted by research that found that children under the age of 9 are at the highest risk of contracting trachoma—a disease that can lead to blindness in later life—Toto, a cartoon figure without indicators race, gender, or ethnicity, was developed in collaboration with Early Starters International as a pilot program for pre-school children (aged 1-9) in northern Ethiopia.
Toto was used to interact with young children in an engaging and interesting way, by prompting the children to correct the forgetful character’s errors with respect to preventing trachoma transmission.
The character was reported to be so well received by schools that prior to a school being directly targeted by NALA and Early Starters International, the teachers and children had already heard about the renowned Toto and were keen to receive the associated materials.
The power of graphics in development settings has grown enormously and is expected to expand further, particularly with the occurrence of pandemics and potential lockdowns limiting in-person events. Throughout the COVID-19 pandemic, graphic images were used across social media, on billboards and at handwashing stations to both encourage COVID-19 preventative measures and quash misinformation and fear around the virus.
Throughout the past decade NALA has continued to adopt innovative approaches in an effort to eliminate NTDs and break the formidable cycle of poverty that at-risk communities suffer from. The use of adaptive, appropriate and relatable graphics has been key in this process: from school children to mothers and caregivers, they have been carefully curated to match the needs and wants of the varied communities and cultures in Ethiopia.
With its vision of expansion to new countries in the coming decade, NALA hopes to create a procedure of best practice for combatting NTDs. These include the use of adaptable and location-specific graphic materials for promoting health education and sustainable behaviour change, breaking the cycle of poverty, and encouraging the organic development of communities around the world.
References:
1. Visual literacy Definition & Meaning—Merriam-Webster (Internet). https://www.merriam-webster.com/dictionary/visual%20literacy (Accessed 2021, Dec 23.)
2. What is Visual Literacy? – Visual Literacy Today (Internet). https://visualliteracytoday.org/what-is-visual-literacy/ (Accessed 2021, Dec 23.)
3. Graphic Medicine Manifesto. Somatosphere (Internet). http://somatosphere.net/2015/graphic-medicine-manifesto.html/ (Accessed 2022, Jan 12.)
4. Williams, Ian. “Graphic Medicine #5: Of Comics and HIV.” Comics Forum (Internet). https://comicsforum.org/2011/10/07/graphic-medicine-5-of-comics-and-hiv-by-ian-williams/ (Accessed 2022, Jan 12.)
5. Czerwiec M.K., I. Williams , S.M. Squier, M.J. Green, K.R. Myers, & S.T. Smith (eds). “Laynor G. LibGuides: Graphic Medicine: What is Graphic Medicine?” Graphic Medicine Manifesto (Internet). (2015): 195. https://jefferson.libguides.com/c.php?g=736076&p=5352191 (Accessed 2022, Jan 12.)
6. Literacy Rate by Country 2021 (Internet). https://worldpopulationreview.com/country-rankings/literacy-rate-by-country (Accessed 2021, Dec 23.)
7. Kay, A. “Art and Community Development: The Role the Arts have in Regenerating Communities.” Community Development Journal 35, no. 4 (2000):414–24.
SARIT BAUM
Graduated from the London School of Hygiene and Tropical Medicine in 2020 with a master’s degree in Nutrition for Global Health. She has since made aliyah and now lives in Tel Aviv. Sarit is currently Communications and Donor Relations officer with NALA, an organization promoting awareness about the elimination of neglected tropical diseases (NTDs).
