Climate, Health and Resilience:

A photo voice exploration from the

Indian Sundarbans

Shibaji Bose, Upasona Ghosh, Rittika Brahmachari, Sabyasachi

Mandal, Asha George

3rd Global Symposium for Health System Research

2nd October, 2014

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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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

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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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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Climate induced livelihoods effect on health and health system

To some crab catching is the

only livelihood…very

strenuous, hazardous and

time taking

‘Meen dhara’ (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

Barriers in accessing existing health system and other resources

This 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.

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 option

It is common to take help

of traditional healing

techniques for common

ailments like fever.

We plant mangrove to give

a support to the

embankments

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

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 photovoice to 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.

THANK YOU

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