Photo Voice exploration of Climate induced livelihood effect on health systems.

1. Climate, Health and Resilience: A photo voice exploration from the Indian SundarbansShibaji Bose, Upasona Ghosh, RittikaBrahmachari, SabyasachiMandal, AshaGeorge3rdGlobal Symposium for Health System Research2nd October, 2014

2. The Sundarbans……
Triple betrayal:
Geography
Climate
History/Politics
4.5 million people
•on 54/106 islands
•Subsistence agriculture and forest /river products
•Chronic poverty
•Double burden of disease
•Sub-optimal health care system
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3. Why Photo Voice?
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To empower Voices of the most vulnerable
To empower Voices of the ‘second sex’

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Whose Voices more specifically?
Mothers with children 0-6 years of age, who also are
Crab and fish collectors
Living on embankment
Schedule Tribe
Religiously minority community (Muslims)
Women headed households
Community with large agricultural land

5. To explore Voices from the ground on how….
Climate induced livelihoods effect on health systems
Barriers to accessing existing health system and other resources
Adaptive strategies taken by the communities to be resilient
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6. Shifting the research to the community….
1.Establishing rapport with community through group meetings and informal interactions
2.Selected group leaders through community consensus
3.Selecting participants with the help of the leaders
4.Training on use of camera and consent forms
5.Piloting, learning and modification
6.Data collection and supportive visits
7.Fortnightly group meetings
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7. Climate induced livelihoods effect on health and health system
To some crab catching is the only livelihood…very strenuous, hazardous and time taking‘Meendhara’ (prawn seed collection) entails standing in waist high saline water for long periods causing uterus cancer. There are lot of example in our village
Husbands are out migrated. Mothers have to go to the RMP for treating the ill child. We are scared but no options

8. Barriers in accessing existing health system and other resourcesThis is the situation of the road leading towards the PHC during high tide
The mothers and children has to precariously cross this water body on this bamboo pole. It becomes more difficult after sunset and if the mother is carrying a child in her arms
The women have to regularly cross this water logged portion to access potable water.

9. Adaptive strategies taken by the communities to be resilient: positive and not so positive
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I leave my younger child with the elder one. I know it is very risky but we do not have optionIt is common to take help of traditional healing techniques for common ailments like fever.
We plant mangrove to give a support to the embankments

10. Expressing and raising Voices….
1.Brainstorming with participants to select pictures and narratives
2.Initial meets with local panchayet, civil society representatives and grass root health workers

11. Challenges, limitation and ethical issues
1.Geographical hurdles and monsoons extend the time of photo voice process.
2.Photo voice in one site stopped due to sudden inundation
3.Political bias affect photovoiceto some extent in one site
4.Most of the respondents were illiterate. They had to depend upon the researchers to read out the consent form.

12. THANK YOU
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