Embracing the Everyday: Reflections on using video and photography in health research.
    
    Vincent O!Brien
    University of Cumbria, UK. +44 (0) 1524 384 384
    
    Kenesh Djusipov
    Kyrgyz State Medical Academy, Kyrgyzstan.
    
    Nazgul Esengulova
    Ak Terek Public Fund, Kyrgyzstan
    
    vincentobrien@mac.com ABSTRACT
    
    kenesh@mac.com
    
    gentlefl@yahoo.com
    
    Recent developments in digital media hardware and software offer new opportunities for research and community development. Participatory video and photography have a unique potential in helping researchers and communities to explore different aspects of everyday life. While the use of digital cameras, camcorders and mobile phones is commonplace in economically advantaged countries these technologies are not so readily available poorer countries. In this paper we report on our experiences of using video and photography in our work with semi nomadic herder communities living in the remote mountain villages of Tolok and Kokjar, Kyrgyzstan. This paper outlines some of the ways that digital media technologies were received and used by the villagers and offers an insight into how communications technologies are beginning to impact upon traditional herder lifestyles in these remote communities.
    
    In 2006 we began our first participatory video and photography project with semi nomadic herder communities living in the remote mountain villages of Kokjar and Tolok, Kyrgyzstan. (13) Our hope was that participatory photography and video could be used as a mechanism for helping the communities to identify, explore and voice local health concerns. We call our projects ‘Visible Voice’ (www.visiblevoice.info) because they enable participants to use visual storytelling to explore and voice their concerns about everyday issues. In our 2006 project villagers made four films about the challenges they face in their everyday lives. In 2008 we returned to Kokjar and Tolok and worked with the villagers as they devised, filmed and edited five new films reporting on developments in the villages and exploring various issues around adaptation to cultural and environmental change. In this paper we explain the local conditions and focus on the how the villagers made use of digital media technologies to create their stories. We illustrate and comment upon their responses to using the technologies and on the growing potential for video, photography and mobile phone technologies to support local initiatives in these remote mountain communities.
    
    Categories and Subject Descriptors
    J.4 [Social and Behavioral Sciences]: Sociology H.5.2 [Information Interfaces and presentation (e.g. HCI)]: Impact of technologies on traditional lifestyles, Miscellaneous
    
    2. Technology and Development
    One of the persisting problems in international development has been the challenge of making projects fit local needs. Radio and video have been a feature of international development for some years (10). Communication media offer the opportunity to disseminate knowledge across wide geographical areas and can help to enhance and develop democratic systems, health care and education provision . Many development interventions are characterised by biases, which are Eurocentric, positivist, and informed by disempowering, top-down implementation strategies. (10) The development of more participatory approaches can increase the efficiency and cost effectiveness of development programmes and may also inform social transformation within a community (14) the comparatively low cost of new digital media technologies can help to open up traditionally top down forms of media communication encouraging greater engagement of communities in community development.
    
    General Terms
    Human Factors, Digital Media, Social Change
    
    Keywords
    Participatory Video, Visual Ethnography, Mobile Technologies
    
    1. Background
    The use of participatory video has its roots in the early work of Canadian activist and academic Don Snowden during the late 1960’s (9). Snowden’s work demonstrated the potential of community devised visual storytelling as community development tool. Individuals and their communities were able to determine the focus and content of Snowden’s films. The notion of participatory filmmaking was established but the high cost and technological complexity of filmmaking meant that filming and editing of the stories had to be undertaken by skilled technicians. More recently the development of digital media technologies has substantially reduced both the cost and the technical complexity of the whole process of visual storytelling. It is now possible, with much less technical support, to turn over the whole process of visual storytelling to project participants.
    
    2.1 Local Conditions
    Using digital media technologies in developing countries in the absence of a developed technological infrastructure inevitably
    
    presents some challenges. Typically these include, absence or inadequacy of power supplies, telephone networks and low levels of literacy. (3) High levels of poverty, lack of sanitation and clean water supplies, political inertia and poor population health status present additional challenges to the implementation of ICT programmes in many developing countries. The Kyrgyz republic, the second poorest country in Central Asia (6), has been struggling to regain lost ground since it gained independence from the Soviet Union in 1991. Although literacy levels within the population are high income levels are low and in the years following independence outward migration of Russian and Slavic communities contributed to a severe skills shortage amongst the workforce. (2) The political structures in Kyrgyzstan draw heavily on tribal and family allegiances particularly in rural areas. Kokjar is home to 2,500 ethnic Kyrgyz from one single tribal group lending some consistency to local administrative decisions and actions. The village is situated on the main road between the capital Bishkek and the regional capital, Naryn. An internet café has recently been established in the district centre Kochgor, 10Kms from Kokjar. While villagers are aware of the internet, mostly through watching TV, few have had any opportunity to use it. The local political administration does have a desktop PC but electricity supply to the Village administration office is currently non functioning. Tolok, the most remote village in the project, is home to around 1,500 people originating from 17 different tribal groups. The lack of a common familial or tribal origin weakens the local administration and community collaborations.(5) Tolok has it’s own electricity sub station and overhead electricity lines run through the valley carrying power to China. However, many households cannot afford to connect to the power system. In addition semi nomadic lifestyles means that families are without electricity for large parts of the year as they move to spring and summer pastures with their animals. This year, changing climatic conditions have compounded the existing infrastructure challenges. The main source of electric power in Kyrgyzstan is the hydroelectric power station at the Toktogul reservoir in central Kyrgyzstan. This year the country experienced an unusually dry, cold winter. Delayed spring melting of snow and ice and depletion of local glaciers (16) has resulted in a shortage of water to the reservoir. Since early spring 2008 electricity supplies have been rationed across Kyrgyzstan in order to conserve the available water supply. In rural areas electricity is only available for 6 hours each day. Ak Terek provide small grants of $500-$1500 to support local community projects. Amongst the projects funded by Ak Terek is a micro power project that provides some families with small solar panels capable of charging mobile phones and powering a small radio. (5) Landline phone services throughout Kyrgyzstan are poor and Internet access, although available in larger towns, is slow and unreliable. Even in the capital Bishkek, broadband Internet access is uncommon. In 2006 telephone contact with the villages was almost non-existent. In early 2008 mobile phone networks began to become more widely available in rural areas and today many families have a mobile phone. The basic conditions needed to support the use of ICT; access to network connectivity, low-cost devices, appropriate user interfaces, and power (3) are not readily available in the remote mountain communities of Kyrgyzstan.
    
    Outside of their involvement with Visible Voice in 2006 villagers had no direct experience of using cameras, camcorders or digital media applications. However when the electricity supply is operating some households have access to satellite TV. Through intermittent TV viewing most villagers have gained a good sense of the language of visual storytelling, which is evident in their approach to constructing their videos. .
    
    Figure 1 Satellite Dish, Tolok Village
    
    3. Researching Differently
    The participatory construction and dissemination of films and photo galleries form an integral part of the ethnographic process. They provide a means of engaging participants in debate and discussion about local issues. Digital technologies such as video are changing the way that social researchers operate in the field and new ways of presenting their work. The customary ‘invisible wall’ that characterizes the relationship between researchers and the research participants in most research is changed and can be characterised as a video active “fluid wall” (15) that emphasises that the camera is an actor in the research process. As a consequence the research data is generated within the context the production negotiations, behaviours and decisions as well as in the raw and edited recorded materials. The research activity, the analysis and exchanges occur between the researchers and participants in both directions, in front of and behind the cameras. Participatory development entails cognitive strategies that aim to change modes of understanding; political actions that seek to empower the ‘voiceless’ and instrumental proposals that offer alternatives to existing conditions (10). Within the Visible Voice projects we ask participants to construct visual narratives that express some self chosen aspect of their everyday lives. The participants produce individual and collective visual exhibits that draw attention to community issues, personal experiences, opinions, aspirations and concerns. The visual materials are designed, created and edited by the participants with technical support from members of the research team. Completed narratives are exhibited within the group and to the wider community where the ideas and representations provide the stimulus for community debate. The whole process is one of collaborative engagement, discussion
    
    and analysis of everyday experiences within a group, which extends to a discourse with the wider community as the materials are disseminated and exhibited. Community screenings provide an opportunity to contextualise the views and opinions of the participants.
    
    enabling the authors to feel a strong sense of ownership of their work. As an outsider one of my first tasks is to reassure the communities that they will have full control over the storylines, editing decisions and share ownership of the materials with Visible Voice.
    
    3.1 Thinking Differently
    Getting the participants to work visually encourages different forms of thinking (7) participants seek out metaphorical and representative images that illustrate aspects of their lived experiences. The requirement to construct a public exhibit requires them to reflect on how best to represent these experiences and ideas to a wider audience. Working with digital photography and video has the advantage of enabling people to view, edit, manipulate and select materials more accurately represent their viewpoints and experiences. Even after the public exhibition the authors can revise, edit and reconfigure their narratives in response to audience reaction. Working visually also minimizes the difficulties of working across language and cultural boundaries. Using photography and video enables people to tell their own stories in their own language minimizing the need for translation during planning and production and enabling participants to express their ideas in a linguistic style that is closer to everyday language and discourse.
    
    3.2.1 Working Together
    Although almost all Kyrgyz people are Muslim the underlying beliefs and traditions that inform Kyrgyz culture are those of Tengrianism, a Turkic religion predating Islam that draws attention to the importance of nature, spirits and ancestry. For the nomadic Kyrgyz health is both an individually and a socially contingent. In this harsh environment survival depends as much on social support as it does on an individual’s capacity to endure. (8) Working together comes naturally to Kyrgyz people and this evident in the minutiae of daily life. For example the practice of serving your neighbour at mealtimes is a strong feature of Kyrgyz hospitality. The serving role changes according to who is at the table and although it often falls to the youngest adult to serve others at the table neither gender nor age are consistently the determinant of role. What this means is that, although Kyrgyz culture is predominantly patriarchal and age is closely related to social status the underlying notion of supporting others and working together means that social roles are very often interchangeable. In terms of group work we found that group members, their roles and contributions changed continuously throughout the project without any adverse effect on the production process.
    
    3.2 Participation, Representation and Ownership
    Awareness of the potential for misrepresentation by ‘outsider’ film makers was evident in discussions during the pre project village meeting in Kokjar. “We had a film company who came to the village and asked our women to eat our ’five fingers’ meal with their hands. But when they edited the film they showed our women licking their arms, eating like animals” (Field notes, Village meeting Kokjar, Kyrgyzstan, 29th May 2008) Gaining the trust of the participants and their communities is particularly important where communities feel they are stigmatized or misrepresented by mainstream media. Ensuring that participants understand the participatory nature of the film making project and feel confident that they will make decisions about content, style, editing and distribution of completed exhibits is critical to gaining trust. Participatory video and photography not only provides a way to engage the research participants in active reflection and public discourse but it also allows the participants to challenge the norm within popular visual media, where experts or journalists are empowered to broadcast and represent the lives of others through ‘outsider’ reports on issues. Photography and video enables participants to ‘capture’ examples and representations of their everyday lives. Events can be reenacted, recorded and described. The recordings can be reviewed, revised and reconstructed according to the changing circumstances of the authors and their audiences. Working with video typically involves more than one person. As a consequence the production process: the discussions, negotiations and differences of opinion, are played out for the researcher and the participants. The message is rehearsed and refined throughout the filming and editing phases of production
    
    Figure 2: Kokjar film group recording reporter segments Figure 2 above, shows a film group at work. A young villager operates the camcorder while an older man holds the script for the female reporter to read. The mix of ages and genders within groups was common. Group membership shifted and changed constantly throughout the whole filming and editing process although mature women tended to be the most consistent members of the groups and usually made most of the editing decisions.
    
    problems with degradation of village and spring pastures. Four other films were produced by mixed gender groups from Kokjar and Tolok. In these films women took a lead role in planning and coordination of the group as well as acting as reporters. Younger men were given responsibility for filming. Although young women had attended the village meetings prior to filming, and later attended the community screening they did not play a significant role in filming or editing. We think this was moist likely due to taking on responsibility for childcare and cooking family meals food while their mothers were engaged in the film making process. Two young women from Kokjar came to the Village meeting in traditional costumes and sang and played traditional Kyrgyz songs which we recorded, at their request, for inclusion in a project film (12). Figure 3 Tolok group planning their film The use of photography and video presents few cultural challenges to Kyrgyz people. Most are enthusiastic and request for photographs are common. This cultural predisposition towards collaboration and collective action contributes to the speed and efficiency with which our participant groups completed their films. Planning the films rarely takes longer than half an hour and filming and editing for each is usually completed within 8 hours. However groups rarely function as a coherent whole. Movement in and between groups is very common. During filming and editing we observed frequent movement of individuals in and out and between groups. Even leadership of groups was subject to change. Although middle aged men dominate the formal political administration of both villages we found that women typically took on leadership and coordination of the film groups. Younger men tended to be given responsibility for using cameras but they rarely took part in editing.
    
    4.1.1 “Kalmak Pass: A hard way”
    The Kalmak Pass is a high mountain pass (3,200 m) between Tolok village and the summer pastures at Son Kul lake. In this film we see a group of young men at the top of the Pass digging through deep snow. The group have spent 6 days clearing a route for shepherds families, enabling them to bring yurts and animals over the Pass to the summer pastures. In the film the young men explain how they use a mobile phone to call down to people lower down the valley to request food and water. The mobile phone network became available in the valley in 2007 but, despite the relatively high cost of calls, mobile telephones have already become an essential part of the shepherds’ everyday lives.
    
    4.1.2 “Mountainous Initiatives for a Mountain Village”
    This film reports on the success of a womens’ felt making workshop initiative in Tolok that emerged featured in the 2006 film “Health in a Mountain Village”. The 2006 film helped secure initial funding to establish the workshop. The film shows how the women took advantage of the Now the group wants to extend their workshop facilities in order to keep up with orders from local families and overseas visitors. In addition the film reports on the work of the local available herbs, which are used as dyes and medical remedies. The film makers draw attention to the value of digital photography and computing as means to preserving and developing local knowledge about these important local resources.
    
    3.2.2 Mobile Phones
    Although there was a physical phone line into the villages this rarely functions. When we returned to the villages in 2008 we began the project with a village meeting attended by around 60 people from the villages. We used a car battery and power inverter to charge camcorder batteries and power our projector and laptops. We were surprised to find that our discussions were frequently interrupted by mobile phone calls to people in the group. Mobile phone use seemed to be fairly widespread amongst adult men and women within the communities. During our previous visit to the villages we had experienced some difficulty getting groups together for a meeting and had spent time going form house to house locating and calling people to the village meeting. This year the availability of mobile phones meant that village meetings were easier to organize and better attended. Mobile phones were also used by the film groups to communicate with each other as they traveled up and down the valley filming conditions in the spring and summer pastures.
    
    4. Making the films
    The films were devised, filmed and edited by members of the village communities with technical support from Vincent O’Brien and Kenesh Djusipov. The film groups were self selected and interchangeable throughout the whole filming and editing process. In keeping with our previous experience in 2006, (13) planning for the films was completed quickly and with no apparent dissent between members of the groups. In Tolok a group of young men and one of the male village leaders got together to make a film about livestock diseases and the
    
    Figure 4 Discussing the potential of creating a database to support a local herb project
    
    “Here we have many problems with herbs that we should pay attention too. Firstly, we need to study the properties of herbs with specialist support. Secondly, we’d like, while we study these herbs, to take pictures of them so we can develop a computer database. For that we need a digital camera and a computer.” (Mountainous Initiatives for a Mountain Village, Tolok Village, June 2008)
    
    5. Editing
    Various people from the group contributed to the film editing. The most consistent involvement during editing all of was carried out by the groups with technical support from the research team. Villagers viewed the footage, made notes on each clip and then carried out the edits using Apple iMovie 6. We use iMovie 6 because it is visually intuitive, reducing dependency on translation, translation and technical support by the research team. Within a few minutes participants can learn to navigate through the workspace and manipulate the video clips. Minimising technical support helps to develop confidence amongst participants and contributes to the sense of ownership that is essential to longer term sustainability. Working in an environment with intermittent electricity supplies we relied on a small power inverter and car battery to supply power for the laptops and to recharge camcorder batteries.
    
    projects. In 2008 they completed five new films reporting on progress in the villages over the previous two years and drawing attention to environmental and land use issues. Many of the original project participants returned to take part in the new film projects and a number of new recruits joined the groups. In total 35 people are named on the film credits although around 30 others took some kind of role in the productions such as transporting groups to film locations, providing food for the film crews and providing intermittent input to the planning editing process. Editing was carried out collaboratively although by ever changing groups of participants although two or three people from each group tended to provide the most consistent input throughout the whole editing process. A distinctive feature of villagers use of technologies was the nature and extent to which collaboration was taken for granted. Although film making is usually a group activity, in most cases membership and roles within the group remain fairly consistent, membership and roles within and across project groups changed frequently throughout the whole period of film making and editing. This appeared to have little adverse impact on the group and the continuity of film storylines remained consistent even when key members of the groups were absent. Although there were clearly ‘enthusiasts’ within each village a large number of people contributed in some way to films illustrating the extent of community rather than individual engagement with digital technologies. In contrast to the essentially individual use of ICT in developed countries, shared use of ICT is more common in many developing countries (3). In part this is a consequence of the lack of resources but we also think that cultural values, and the emphasis on community collaboration From our experience we conclude that the presence of a reliable and well developed technological infrastructure: electricity, network connections, access to computers ICT literacy etc, whilst obviously important are not essential to the effective use of digital media technologies in developing countries. The notion of one laptop computer for every child in the developing world (http://laptop.org/) may be more an illustration of the preoccupations of the developed world rather than the needs and interests of the developing world.
    
    7. ACKNOWLEDGMENTS
    Figure 5: Editing films, Kokjar Village, June 2008. When the groups finished editing their films we were able to transfer the movie files directly to Bluetooth enabled phones prompting some members of the group to share their movies via phone links with other people around the village. Our thanks go to the villagers and participants from Kokjar and Tolok who showed us such hospitality and shared their stories with us. To the Christensen Fund and the University of Cumbria for funding this project. All of the films and a number of photographs from the 2006 and 2008 projects are currently available for viewing online at www.visiblevoice.info. Films from the 2008 project are also available at http://uk.youtube.com/threevoices
    
    6. Conclusions
    Since we began our Visible Voice projects in Kyrgyzstan in 2006 we have observed cognitive, political and instrumental changes occurring within the village communities. Despite the lack of technological infrastructure, electricity or familiarity with digital media technologies we found that the participants demonstrate a high level of enthusiasm for using digital media. The films they produced are coherent, engaging narratives that are accessible to their intended audience. Local issues are clearly identified and are well presented. In 2006 the participants produced four films illustrating different aspects of village life and supporting their bids for small grant funding for village
    
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