TEJIENDO LAZOS PARA UNA MATERNIDAD … · Marcela Tapia, Patricia Poppe, Robert Ainslie Adaptación...

2

TEJIENDO LAZOS PARA UNA MATERNIDAD SALUDABLE Un Método Participativo de Investigación y Acción a través de los Encuentros Video Participativos

manual de usomanual de usomanual de usomanual de usomanual de uso

¡Gracias por sus aportes!

Productores educativos y AsesoresMarcela Tapia, Patricia Poppe, Robert Ainslie

Adaptación para GuatemalaClara Zuleta, Demetrio Margos,

Ingrid Valenzuela, Domingo Vásquez,Ernestina Vásquez, Patricia De León Toledo

Recurso humano a cargo de la investigaciónDemetrio Margos, Ernestina Vásquez,

Domingo VásquezCarlos Lec, Dorcas Saloj, Marcela Ajtzí,

Alejandro ChamánPatricia De León Toledo

Revisores técnicosMisterio de Salud Pública y Asistencia Social de

GuatemalaPrograma nacional de Salud Reproductiva, Unidad

Ejecutora, USAID

Nota: Es importante indicar que este en este documento se ha utilizado el género masculino en la mayoría deocasiones en que el texto puede referirse tanto a mujeres como a hombres. Se ha adoptado esta medida

exclusivamente por razones de simplificar el texto sin ninguna connotación de preferencia.

Esta publicación fue posible con el apoyo de la Agencia para el Desarrollo Internacional (AID), bajo los términosdel contrato No. C.A. HRN-A-00-98-00043-00. Las opiniones expresadas aquí son exclusivas de los autores y no

necesariamente reflejan los puntos de vista de la AID

Guatemala, enero 2004

ColaboradoresPersonal técnico y administrativo del Proyecto de

Salud Materno NeonatalDirecciones de Area de Salud: El Quiché,

Totonicapán y Sololá,Comadronas de Cantel, QuetzaltenangoComadronas de Santa Catarina Palopó

Grupos de mujeres, hombres, líderes, comadronas,proveedores

(propósito de la investigación)

Lucrecia Cúmes, José López,

FotografíasDemetrio Margos, Patricia De León Toledo

Diseño Gráfico y DiagramaciónAna Victoria Chajón y Roberto A. Pérez García

3



ÍNDICEÍNDICEÍNDICEÍNDICEÍNDICEINTRODUCCIÓN 5

PARTE I:LA MATERIA PRIMA 71. La riqueza de los diferentes actores de cambio 72. Visiones del mundo y visiones de la salud 93. Partiendo de la realidad: trabajando con las

iniciativas y organizaciones existentes 104. Hacia la inclusión de género 125. Del pedido de ayuda al empoderamiento 13

PARTE II:EL INSTRUMENTOENCUENTROSVIDEO-PARTICIPATIVOS 141. Los objetivos de la investigación - acción 152. El instrumento encuentros

video-participativos y su metodología de uso 15

Paso #1. Creando una buena relación 16

Paso #2. Conociendo al equipo facilitador,a los participantes y presentandoel proyecto 17

Paso #3. Creando un ambiente fraterno:El ejercicio de rompehielo 19

Paso #4. Presentando historiasde vida: Los videos 1 y 2 20

Paso #5. Priorizando los atributosde calidad que el servicio de saluddebe practicar desde la perspectivade la comunidad 23

Paso #6. Conduciendo elmapeo comunitario 24

Paso #7. Finalizando el encuentroy continuando la acción colectiva 26

3. El equipo humano facilitadorde los encuentros video participativos 27

3.1El equipo humano facilitador 273.2Las cualidades y habilidades

del equipo facilitador 283.3Consejos prácticos para

la animación de grupos 29

4. Los participantes de la comunidadinvitados a los encuentrosvideo participativos 29

4.1El proceso de invitaciónde los participantes 29

4.2Los criterios de selección de losparticipantes 30

4



5. La organización previa y la logística 315.1Gestión de recursos 325.2Gestión del tiempo 335.3Gestión del espacio 36

6. Información recopilada 376.1 La sistematización de la experiencia 376.2 El análisis de los encuentros 38

7. El uso del instrumento dentro de un proceso 39

PARTE III:LOS LAZOS 411. Valoración e incentivos 412. El retorno a la comunidad 423. Tejiendo lazos 44

PARTE IV:ANEXOS 46

5



INTRODUCCIÓN

Este manual es diseñado para acompañar allector, paso a paso, en la aplicación de uninstrumento de investigación-acción dentro de unprograma de salud materna y neonatal. Estemétodo de investigación (instrumento oherramienta) es llamado “encuentro video-participativo.” Un encuentro video-participativo esuna reunión de discusión en la que se usantestimonios, relatos e imágenes en video paramotivar al diálogo.

El ahora conocido “tejido de lazos” refleja loscomponentes y las características del proceso deinvestigación-acción en el que dicho método deinvestigación se incluye. Elegimos esta analogíaporque el “tejido de lazos” es un elemento cultural“endógeno”, es decir, que se construye desde lacomunidad misma y la representa. Los lazosrepresentan a la vez permanencia y cambio, yaque toda tradición tiene pasado (tiene historia), asu vez tiene futuro y evoluciona con el tiempo. Loslazos son, por lo tanto, no sólo productos sinotambién procesos ya que se van creando yrecreando a través del tiempo. Es más, los lazossimbolizan la comunidad, el apoyo mutuo, laformación de redes, la solidaridad.

El manual propone tejer lazos para unamaternidad saludable a través de un proceso queimplica aprendizaje, reflexión y acción. La primeraparte del manual, “La Materia Prima,” pone enrelieve el recurso esencial y más valioso para estetrabajo; el recurso humano, es decir, lacomunidad, el personal de salud y los agentesexternos que trabajan juntos creando yfortaleciendo lazos para mejorar la salud. Lasegunda parte, titulada “El Instrumento” contieneuna descripción detallada con instruccionesprecisas para el uso de los “encuentros video-participativos” como método/herramienta deinvestigación-acción. La tercera parte, “Los Lazos”puntualiza el proceso de diálogo y participacióncomunitaria que es la esencia misma del procesode investigación-acción.

Las partes II y III son las más resumidas delManual, pero esenciales en contextualizar y enhacer comprender los principios que orientan lautilización del instrumento. La parte II delmanual es la más extensa, ya que en ella seproporcionan indicaciones detalladas quepermitirán al lector apropiarse del instrumentopaso a paso, para construir lazos con la

6



comunidad. Para completar el manual hemosincluido en la sección de anexos algunos docu-mentos para que el lector pueda fotocopiarlos cadavez que lo necesite.

Para tener una visión más completa del procesode investigación-acción y utilizar el instrumentoen armonía con los objetivos de aprendizaje mutuoestablecidos en el marco de este trabajo, esrecomendable leer el manual como un todo.Aunque cada parte del manual aborda temasdiferentes y proporciona elementos para lareflexión que se pueden aprovechar separa-

damente, las tres partes se complementan yrepresentan, en efecto, un todo dentro del procesode investigación-acción. El compromiso delpresente manual corresponde con la meta últimaque inspiró la elaboración del instrumento, es decir,crear lazos cada vez más fuertes en apoyo a la viday a la necesidad de tomar acciones desde lacomunidad cuando ésta y sus familias se enfren-tan a casos de emergencia obstétrica. Se trata decontribuir a lograr un cambio social, a determinarcompromisos y acciones de largo plazofortaleciendo las redes sociales existentes en elámbito de la comunidad.

7



PARTE I:LA MATERIA PRIMA

Todo proceso de investigación-acción para elcambio social debe enfocarse en el potencialexistente en las comunidades. Sin negar la faltade insumos e infraestructura que aquejan a lascomunidades, es esencial reconocer como punto departida del trabajo con la comunidad, los recursosya existentes. En este sentido, más allá de losrecursos materiales con los que se puede contar,se debe poner en relieve el gran potencial humanoexistente en cada comunidad. A éste se unenequipos de trabajo y personas del exterior,comprometidos en apoyar a la comunidad en supropio proceso de cambio social. Los diversospárrafos en esta primera parte del manualproporcionan pistas de reflexión sobre la valiosa“materia prima” existente en las comunidades ysobre la necesidad y pertinencia de partir de loque existe, de las fortalezas y las potencialidadesde cada comunidad. A continuación se ofrecenalgunos modelos para guiar al lector en el uso yadaptación del presente Manual teniendo encuenta la necesidad de incluir a los grupos másvulnerables de la comunidad en el proceso deinvestigación-acción. Veamos:

1. La riqueza de los diferentes actores decambio

Un proyecto o una labor colectiva no empieza porgeneración espontánea. En este sentido, el papelde los “agentes de cambio” de la comunidad y delos agentes catalizadores externos es fundamentaldurante el inicio de todo proyecto. Los “agentes decambio” de la comunidad son personas que ejerceninfluencia sobre los demás y son capaces degenerar cambio dentro de la comunidad. Son ellaslas que a menudo se dan cuenta de que existe unproblema y empiezan a movilizar a la comunidadpara encontrarle una solución. A las personas quevienen de afuera a apoyar a la comunidad se lesllaman “agentes catalizadores externos.” El papelde estos últimos es facilitar el proceso de cambioen la comunidad, utilizando herramientas comola que proponemos en este manual. A veces sonellos los que le proponen a la comunidad trabajarsobre un problema específico que ha sidoidentificado, por ejemplo, a partir de inves-tigaciones. Su papel en tanto facilitadores no es el

8



de imponer una agenda a la comunidad sino el detrabajar con ella para que ésta:

identifique y tome conciencia delproblemadecida qué es lo que se debe hacer parasolucionarlo.

El facilitador orienta a la comunidad y entra endiálogo con ella para tomar acciones adecuadas,sin imponer su punto de vista de maneraunilateral. Los agentes de cambio de la comunidady los agentes catalizadores externos pueden juntosayudar a la comunidad a identificar un problemay a establecer metas comunes para solucionarlo.

Hay sectores de la comunidad especialmenteafectados por la problemática que se quiereabordar y que es fundamental involucrar en elproceso: en este caso, las cuestiones de saludmaterna y neonatal tocan directamente a lasmujeres en edad reproductiva y a sus comadronas.Los jefes de familia son otro grupo clave, ya quede ellos dependen a menudo las acciones que setomen en casos de emergencia. Es importantetener en cuenta, durante la investigación-acción,el papel real o potencial que cada uno de estosactores tiene dentro de la comunidad. Hay queconsiderar, especialmente, las maneras en las quese puede involucrar a los grupos que estángeneralmente ausentes en las esferas de toma dedecisión de la comunidad.

No existe un modelo único, predeterminado decómo iniciar un proceso de cambio dentro de unacomunidad con el apoyo de la investigación-acción.Las características que la experiencia adoptedependerán de las personas involucradas, de losmodos de organización existentes y de lacoyuntura. Lo importante, en todo caso, dentro deeste proceso es lograr revertir el enfoque de trabajocentrado en las deficiencias y carencias de lacomunidad. Contrariamente a ese enfoque,proponemos para este trabajo el reconocimientode las fortalezas de la comunidad y de los distintosactores involucrados. Es importante estarconscientes de que el papel de cada una de las/los…

mujeresespososcomadronaslíderesagentes de cambio de la comunidadagentes catalizadores externosautoridades

Es esencial y se debe valorar y respetar loque cada uno/a desde su posición puedeaportar al proceso de investigación-acción.

Tomar como punto de partida las fortalezasde los actores involucrados ayuda a reforzarlos lazos entre la comunidad y los agentes decambio externo.

9



Ambos se reúnen con la convicción de quepueden avanzar juntos…

reapropiándose del pasadofocalizándose en el presente, eincorporando en sus acciones una visióndel futuro.

2. Visiones del mundo y visiones de la salud

Muchas experiencias de desarrollo fallaron en elpasado por no tener en cuenta el punto de vistade los interesados y por tratar de imponer patronesde comportamiento ajenos a la cultura local. Elenfoque centrado en las fortalezas vieneacompañado del reconocimiento de las diferenciasculturales entre los agentes catalizadores externosy la comunidad. El reconocimiento de estasdiferencias implica, al mismo tiempo, la necesidadde entender cómo concibe “el Otro”; el que esdiferente a mí, sus propios problemas y surealidad. Sin necesidad de aceptar ciegamente lastradiciones que pueden ser dañinas para la salud,es importante conocer qué significa la salud parala comunidad, cuáles son sus prioridades, valoresy tradiciones. El intercambio abierto con lacomunidad sobre sus costumbres y creencias nospuede llevar a descubrir tanto prácticastradicionales que se tendrían que modificar, comocostumbres que se deberían reforzar e integrar ala práctica de la medicina occidental.

En el contexto de esta investigación-acción esparticularmente importante conocer el punto devista de la comunidad sobre los servicios, o lo quellamamos los “atributos de calidad” de los servicios.Los “atributos de calidad” son las característicasde los servicios que van a hacer que los usuarios yusuarias aprecien o no el servicio. Por ejemplo,una persona puede quejarse de que la hacenesperar mucho antes de atenderla en el centro desalud. En este caso, el atributo de calidad es “laatención rápida.” Otra persona puede decir queella va al puesto de salud porque sabe que elpersonal que atiende allí la va a tratar con cariño.En este caso la persona habla del atributo decalidad “buen trato.” En el primer caso, al serviciole falta este atributo mientras que en el segundo,el servicio cuenta con el atributo o característicaque es importante para ese usuario/usuaria. Elhecho de que un servicio cuente con un atributo ono, puede llevar a ese usuario/usuaria a elegir unservicio u otro o simplemente, no acudir a losservicios. Es por eso que es importante conocerlos atributos de calidad desde el punto de vista dela comunidad.

Este proceso de investigación-acción propone unaperspectiva desde adentro, es decir, que parta delpunto de vista de la comunidad. El escuchar elpunto de vista de la comunidad, ayudará aentender mejor los modos de ser y de hacer de lacomunidad. Esto significa que vamos a escuchar

10



lo que la gente nos dice y a aprender de ella y conella. No vamos a ser capacitadotes, sinofacilitadores que van a las comunidades paraconocer el punto de vista de sus miembros sobrela salud y sobre los servicios. Esta perspectivadesde adentro ayudará por ejemplo, en el caso quenos ocupa, a comprender mejor qué es lo que lagente aprecia de los servicios y qué es lo que sepodría mejorar para que la gente se sientasatisfecha con ellos. La perspectiva desde adentroayudará también a comprender mejor cómo losmiembros de la comunidad hacen frente a lassituaciones de emergencia obstétrica y qué los llevaa actuar de una u otra forma. Esto permitirá eldesarrollo de actividades adaptadas al contexto,que tengan en cuenta el punto de vista y larealidad (psico-social, socio-económica y cultural)de los involucrados.

Lo más importante en las conversaciones con losmiembros de la comunidad es distinguir bien loque “yo” pienso de lo que “ellos” piensan. Hay quehacer un esfuerzo para dejar de lado toda las ideasque tengamos sobre la comunidad para escucharlacon nuevos oídos y poder comprender lo que ellanos dice.

En un encuentro intercultural, la apertura haciala visión del mundo de la comunidad vieneacompañada, necesariamente, de la toma deconciencia de los propios prejuicios, valores ynormas culturales.

3. Partiendo de la realidad: trabajando conlas iniciativas y organizaciones existentes

El enfoque utilizado en este manual implica partirde la realidad existente en lugar de tratar deimponer una agenda o programa que no lepertenece a la comunidad. En la medida de loposible, se debe tratar de integrar la investigación-acción dentro de las iniciativas y en las áreas detrabajo de las organizaciones existentes en lacomunidad.

Las experiencias de la comunidad al nivelde:

Desarrollo de proyectosOrganizaciones comunitarias

Gestión colectiva (por ej.,recolección de fondos)

son parte del bagaje de la comunidad que sedebe tener en cuenta durante lainvestigación-acción.

Por ejemplo, el proyecto de construcción de unacasa materna o una maternidad comunitariapuede ser el motor que anime el proceso deinvestigación-acción con la comunidad. De lamisma manera, se debe estar consciente en todomomento que el proceso iniciado en la comunidad

11



debe ser devuelto a ella, ya que le pertenece, yque las vías privilegiadas para hacerlo son amenudo los comités o grupos de salud ya existentesen la comunidad. En muchas ocasiones en lo querespecta a la salud materna y neonatal, se puedepensar en ampliar y/o reforzar las actividades derecolección de fondos que ya se hacen de manerapuntual en la comunidad. Por ejemplo, haycomunidades en las que se hacen colectas de fondospara casos de fallecimiento o de emergencia. Enlugar de proponer algo nuevo, se puede mejorarla organización, planificación y gestión de dichasactividades como parte de un “Plan de EmergenciaComunitario”, nombre que bien podría cambiarsegún lo que decida la comunidad. Cuando unoparte de lo que ya existe, se adapta mejor al medio.El proceso de investigación-acción puede ayudartanto a identificar como a mejorar experiencias yaexistentes en la comunidad. Es importante pues:

Estar atentos a las oportunidades de mo-vilización y participación existentes en lacomunidadInvolucrarse en núcleos de organizacióncomunitaria ya existentesMejorar lo que ya existe en lugar de “re-inventarla rueda”Igualmente es importante tener en cuenta elcalendario de actividades agrícolas y las agen-das propias de cada comunidad para podercolaborar más eficazmente con ella. Porejemplo, de nada sirve tratar de organizar

reuniones con hombres en un período decosecha cuando todos estarán fuera de lacomunidad. Tampoco sería útil organizarreuniones para conversar sobre la saludmaterna y del recién nacido cuando lacomunidad está en una semana de celebracióno tiene algún problema urgente que resolver(por ejemplo, una inundación).

No hay que olvidar que otro actor principal en elproceso de investigación-acción es el personal desalud. Lo mismo que abogamos por la comunidadse aplica también a los prestadores de serviciosinvolucrados en este trabajo. Por ejemplo, no seríarealista pensar que los enfermeros o lostrabajadores sociales podrían dejar de lado suslabores en los servicios de salud para dedicarsepor completo a facilitar “encuentros video-participativos”. Los que estén interesados enhacerlo tendrán que: 1) planificar su trabajo detal manera que dichos encuentros complementensus labores; 2) analizar hasta qué punto puedenasumir las funciones del equipo facilitador de losencuentros y lograr que los participantes sesientan libres de contarles las cosas tal como sony no como “deberían ser.” Sabemos, al mismotiempo, que se pueden reforzar las funciones delpersonal de salud a partir de actividades previstasdentro de la investigación-acción. Por ejemplo, el“mapeo comunitario” previsto dentro y más alláde los encuentros video-participativos, es unaherramienta para ubicar los recursos disponibles

12



en casos de emergencia en la comunidad, lo cualviene a reforzar una de las funciones de losfacilitadores comunitarios en las salassituacionales. Como sabemos que los facilitadorescomunitarios deben hacer mapas de lascomunidades, la herramienta del mapeo dentrode la investigación-acción debe servir paraayudarlos en esa tarea. Se trata de identificar enel terreno la mejor manera de involucrar alpersonal de salud en las actividades deinvestigación-acción desde donde están.

El uso de los encuentros video-participativos comoherramienta de investigación-acción debeadecuarse a la realidad de la comunidad y de losservicios de salud, partiendo de lo que existe parareforzarlo. El proceso mismo de reflexión y deacción llevará a la formulación conjunta depropuestas para efectuar cambios en beneficio detodos.

4. Hacia la inclusión de género

Partir de la realidad no significa aceptar el statusquo (las cosas como son) y las relaciones de poderdesiguales que pueden existir en la comunidad.Se trata de incluir y no de excluir y, dentro de losgrupos vulnerables, las mujeres son a menudoexcluidas de la toma de decisiones, incluso sobreasuntos que les interesan directamente, como esla muerte materna.

A pesar del papel preponderante que las mujeresjuegan en la comunidad en general y en la saluden particular, a menudo ellas están ausentes enlos comités de salud, los comités pro-maternidadu otros núcleos de organización de lascomunidades. Sin embargo, cuando se les da laoportunidad de participar, son capaces de articularsus ideas y de hacer propuestas de las que podríanbeneficiarse tanto los comités como la comunidaden general.1 Se hace necesario, propiciar laparticipación de las mujeres a todo nivel y endistintos momentos de la investigación-acción,incluyendo su participación activa en los comitésde salud y pro-maternidad. Esto se puede lograr através de distintas acciones como:

Incentivar la participación en los encuentrosvideo-participativos de mujeres de la comunidadque no acostumbran participarDiscutir con la comunidad de qué manera sepodría incluir a liderezas, comadronas y mujeresde la comunidad en general en comités en losque se toman decisiones importantes de salud.

Los agentes catalizadores externos dentro de lainvestigación-acción pueden jugar un papelimportante en este sentido, ya que aportan unpunto de vista diferente (es decir: las mujeres

1 Esto lo pudimos confirmar durante encuentros video-participativos que se realizaron en la Zona Reina.

13



pueden y deben participar) y son capaces deinfluenciar la opinión de los miembros y líderesde la comunidad.

5. Del pedido de ayuda al empoderamiento

Puede suceder que al llegar a una comunidad susmiembros y representantes pidan ayuda al equipoexterno para solucionar los problemas que losaquejan. La comunidad puede incluso expresar:

Su sentimiento de impotencia ante lassituaciones que tiene que enfrentar.Su sentimiento de incapacidad para poderresolver los problemas.Su creencia de que sólo la gente que viene deafuera es capaz de cambiar la situación.

A menudo los miembros de la comunidad pierdende vista lo que están haciendo día a día paramejorar su situación y la de sus hijos. Tienen unaimagen de sí mismos centrada más en sus propiascarencias que en sus fortalezas. Y esto mismosucede, a menudo, con algunas personas de fuerade la comunidad, que ven ante todo las carenciasy no las fortalezas de la misma. Lo que se quiereen esta investigación-acción es justamente revertiresa situación y sacar a relucir las fortalezas y elvalor de las iniciativas de la comunidad.

No hay que negar las necesidades concretas deayuda de la comunidad, al contrario, debemos

estar atentos a ellas. Lo que se debe evitar es caeren el “paternalismo” o “asistencialismo” queconsiste en hacer las cosas por la comunidad enlugar de hacerlas con ella. Hay que recordar queel proceso de aprendizaje mutuo que se inició debeayudar a desarrollar en los individuos y en lacomunidad:

La confianza en sí mismos.El sentimiento de ser capaz de hacer las cosas.Las habilidades necesarias para llevar a cabolos proyectos.

Se trata, por ejemplo, de orientar a la comunidadsobre cuáles son los pasos a seguir para formalizarun acuerdo y no hacer las gestiones por ella. Hayque sacar a relucir logros pasados y presentesdándole ánimo a la gente para seguir adelante.En otras palabras, se debe tratar de enfatizar encada momento la capacidad transformadora de lacomunidad misma. Es así como un pedido deayuda puede convertirse en una oportunidad deempoderamiento. A partir del diálogo con lacomunidad se puede propiciar un proceso decambio social, en el cual la comunidad toma lasriendas y se siente capaz de buscar soluciones asus problemas—garantía del sostenimiento de lasacciones a largo plazo. El uso del instrumento, talcomo lo describimos en la siguiente parte delmanual, se inserta dentro de ese contexto decambio social y de empoderamiento.

14



Una vez que tenemos claro el potencial existenteen la comunidad y el valor de la “materia prima”,es necesario encontrar el instrumento y el procesometodológico adecuado para trabajar con losgrupos comunitarios. Basándose en la metaúltima del proyecto que es, promover unamaternidad saludable a través de:

Valorar y reforzar la participación de lacomunidad en los distintos aspectos; elcuidado de la salud materna y neonatal y enla mejoría continua de losservicios parasalvar vidas.

Se analiza la riqueza del video como generadorde ideas y discusión, de reflexión y de “vivencia”interna de los problemas de salud. Al igual, la

participación activa de la comunidad analizandosus problemas y empoderándose para identificarsoluciones y movilizarse colectivamente da pasoa la propuesta de crear espacios de diálogo,concertación y acción colectiva a nivel comunitario.Se proponen entonces, los “encuentros videoparticipativos” como instrumento y proceso paraalcanzar la meta mencionada. A continuación seexplican detalladamente los objetivos de lainvestigación-acción, las características delinstrumento del encuentro video participativo, lametodología y proceso para su uso, el rol facilitadora cumplir por parte del equipo humano, la activaparticipación de la comunidad en los “encuentros”,y las labores de logística que asegurarán que los“encuentros” fluyan con la confianza, la capacidadanalítica y el deseo de acción de parte de lacomunidad para alcanzar un compromiso porsalvar vidas.

PARTE II:EL INSTRUMENTOEncuentros Video-Participativos

15



1. Los objetivos de la investigación - acción

La investigación-acción tiene como tema central,indagar conjuntamente con la comunidad lascausas de la muerte materna y neonatal, así comola disposición del servicio de salud para asistir anteun caso de emergencia obstétrica. Como objetivostenemos:

Conocer el punto de vista de la comunidad sobrelos servicios de salud, más específicamente enlo que se refiere a la salud materna y neonatal.2

Facilitar la participación activa de la comunidadpara analizarse así mismos ante un caso deemergencia obstétrica, observando decisionesy toma de acción.

Acompañar en su proceso de apropiación de unprograma dirigido a la elaboración de Planesde Emergencia Comunitarios3 para salvar vidasde madres e hijos/as.

En términos generales, el instrumento y procesode los “encuentros video-participativo” sirvenentonces para acercarnos a la comunidad, “tejerlazos” con ella y aprender conjuntamente:

Lo que piensa y siente la comunidad conrespecto a los servicios y las causas de muertematerna y neonatal.

Las barreras y los facilitadores reales ypotenciales para el uso de los servicios.

Las creencias, actitudes y prácticas que influyenlas decisiones sobre salud en la comunidad.

Las aspiraciones de la comunidad en lo querespecta: (a) la organización para el manejo decasos de emergencia; y (b) el trato y tratamientoen los establecimientos de salud.

Los recursos existentes en la comunidad queconstituyen o pueden constituir oportunidadesde organización para la formulación de losPlanes de Emergencia Comunitarios.

2. El instrumento encuentros video-participativos y su metodología de uso

El instrumento desarrollado para llevar adelanteel proceso de investigación-acción ha sidodenominado “encuentro video-participativo” comofue mencionado anteriormente. Uno de sus ejes

2 Para tratar otros temas usando el mismo método, setendría que adecuar tanto el contenido de los videoscomo la guía de preguntas.

3 La elaboración de los Planes de EmergenciaComunitarios supone, entre otros, la creación oconsolidación de redes comunitarias para tratar casosde emergencia.

16



centrales es la utilización de la imagen como mediopara registrar testimonios e historias de vida conrelación a un tema de salud elegido. Al presentarestas historias en video, sobre todo cuando éstasson trabajadas y producidas conjuntamente conla comunidad, los participantes en las reunionesó “encuentros”, se identifican con los personajes,las situaciones encontradas y lo vivido en supropia comunidad. Así, se genera una discusiónmuy rica que motiva a que los participantescuenten sus propias historias, ofrezcan puntos devista diferentes y/o complementarios, reflexionensobre lo visto y escuchado, y en muchos de loscasos, negocien propuestas para la toma de acción.De ahí la utilización de lo que llamamos“encuentros video-participativos” con lascomunidades, en contraste al uso de técnicas derecolección de datos sobre la comunidad. Se tratapues de un instrumento de aprendizaje mutuo ymás que una técnica, constituye una herramientapara propiciar y sostener el cambio social dentrode la comunidad.

En tanto la organización de los “encuentros”transcurre en el seno de la comunidad, se ofrece acontinuación una guía metodologíca de trabajo ydiscusión que nos ayuda a avanzar por el procesodel “encuentro video-participativo”. El “encuentro”está organizado alrededor de siete pasos claves,llamados:

1. Creando una buena relación

2. Conociendo al proyecto, el equipo facilitador ylos participantes

3. Creando un ambiente fraterno: el ejercicio derompehielo

4. Presentación historias cortas de vida: losvideos 1 y 2

5. Priorización de los atributos de calidad desdela perspectiva de la comunidad

6. Conduciendo el mapeo comunitario7. Finalizando el encuentro y continuando la

acción colectiva

Paso #1. Creando una buena relación

El primer contacto del equipo facilitador con losparticipantes es crucial en el manejo de lasreuniones de trabajo y de los “encuentros videoparticipativos”. El equipo facilitador,4 aunqueno esté en su propia comunidad, se convierteen anfitrión y, como tal, es el que da labienvenida a los participantes desde elmomento en que ellos llegan al lugar fijado parael encuentro. Para que pueda cumplir bien coneste papel de anfitrión, el equipo facilitadordebe:

Ubicarse en la sala donde se lleve a caboel encuentro con anticipación para podersaludar a los participantes en la medidaque van llegando.

4 Explicamos la composición de este equipo en la secciónsiguiente.

17



Conversar informalmente con los parti-cipantes y darles una darles una bien-venida respetuosa y amistosa.Invitarlos a dar sus datos (socio-demo-gráficos) a la persona encargada, quienpuede explicarles que se les pide estainformación sólo para tener una ideasobre sus edades, el número de hijos quetienen y si ya utilizaron los servicios desalud.

Hay que aprovechar el momento del refrigeriocomo un espacio para seguir desarrollando unabuena relación con la comunidad. En esemomento, ya sea a la mitad o al final delencuentro el equipo facilitador sirve losrefrigerios e interactúa con los participantes. Deigual manera que cuando se recibe a un amigoen casa, se atiende a los participantes de lamejor manera posible, asegurándose de que anadie le falte algo, conversando con ellos.

Un obstáculo a la interacción del equipofacilitador con los participantes puede ser elhecho de que no todos hablan el mismo idioma.En ese caso, los miembros del equipo facilitadorque hablan el idioma de los participantes,sirven de puente entre estos últimos y el restodel equipo. Además es importante recordar quemás allá de la comunicación verbal, el lenguajeno verbal, la actitud, el estar atento a que anadie le falte algo, son signos que los par-

ticipantes perciben y que contribuyen a lacreación de una buena relación con ellos.

Paso #2. Conociendo al equipo facilitador, a losparticipantes y presentando el proyecto

La presentación del proyecto, del equipofacilitador y de los participantes reunidos esesencial. La manera en que se haga estapresentación motivará a que los “asistentes” seconviertan en “participantes reales” y a sentirselibres de exponer sus puntos de vista.

Durante la presentación del proyecto y delequipo facilitador, el facilitador debe:

Explicar el objetivo del encuentro yagradecer la participación de los presentes:Se menciona que el tema que interesaparticularmente es el de la salud de lasmamás y de los recién nacidos. Losparticipantes pueden estar acostum-brados a participar en sesiones de capa-citación o en grupos de discusión en losque un equipo externo va a impartir uobtener información de la comunidad.Durante la presentación del proyecto, elfacilitador puede aclarar que no se trata,en este caso, de una sesión de capacitacióny que lo que quiere el grupo facilitador esaprender con la comunidad y conocermejor sus puntos de vista sobre la salud.

18



Tampoco busca recoger información e irse.Lo que quisiera es ver cómo puede apoyara la comunidad. En este sentido, esimportante también tener cuidado de nocrear expectativas falsas en la comunidad:hay que aclarar, si es necesario, el tipo deapoyo que se les puede brindar y loslímites dentro de los cuales se actúa. Porejemplo, debe quedar claro que esteequipo no tiene fondos que ofrecer a lacomunidad. Lo único que se puede ofreceres apoyarlos con ideas de cómoorganizarse para poder salvar las vidasde personas que se les presenta unaemergencia de un momento a otro en lacomunidad.

Explicar a los participantes el carácterconfidencial y anónimo de susintervenciones: Es muy importanteasegurar a los participantes de que nadieserá citado con nombre y apellido y quelas opiniones que viertan durante lasdiscusiones no serán repetidas o utilizadascontra su voluntad.

Explicar la necesidad de grabar la reuniónpara tener una “memoria” del encuentro:El equipo facilitador debe ocuparse de lagrabación de cada encuentro. Cadagrabación es transcrita para facilitar,posteriormente el análisis de la infor-

mación recogida. Los participantes sepueden preguntar por qué los estángrabando y sentirse intimidados por elaparato colocado en medio de la sala. Seaconseja pedir a los participantes suconsentimiento para la grabación,asegurándoles una vez más el anonimatoy la confidencialidad. En algunascircunstancias, el no pedir permiso parala grabación puede crear desconfianza enlos participantes. En esos casos, es mejorlimitarse a explicar lo más claramenteposible la necesidad de tener undocumento que ayude a recordar lodiscutido: es también una manera derespetar lo que la gente ha dicho, ya queno nos fiamos sólo de nuestra memoria.Si además de la grabación en audio, segraba la reunión en video, se les puedeofrecer a los participantes ver la grabaciónen un segundo momento. A la gente legusta, generalmente, ver su imagen en lapantalla y es una manera de compartircon ellos lo que compartimos durante losencuentros.

Explicar el procedimiento que se seguirádurante el encuentro: El facilitador lesexplica a los participantes que van a verjuntos un par de películas cortaspreparadas para la reunión y queconversarán informalmente de lo que

19



cada uno piensa. Les explica que despuésse harán también un par de presen-taciones en grupo.5

Pedir que lo interrumpan en cualquiermomento si hay algo que no está claro: Loque se quiere es que todos participen ypara eso tenemos que entendernos bien.Se aprovecha para preguntar a losparticipantes si tienen alguna pregunta osi quieren alguna aclaración antes deseguir.

Presentar a los demás miembros del equipoy pedir a los participantes que se unan a lapresentación: Ya sea que el facilitadorpresenta a los otros miembros del equipo,o mejor aún, los otros miembros del equipose presentan frente a los participantesbrevemente. Cada uno da su nombre ymenciona cuál será su participacióndurante la reunión. Si son proveedoresde salud (PS), no deben mencionar suscargos en el sector, ya que eso podría, porun lado, intimidar a los participantes, ypor otro, crear un contexto más de sesiónde capacitación que de intercambio

informal. De igual manera, los asistentesa la reunión también deberá presentarseagregando algunas palabras si así loquisieran. El equipo facilitador puedetambién participar en el ejerciciorompehielo, como uno más del grupo, parafacilitar la confianza y establecer unacomunicación de igual a igual.

Explicar que se va a empezar la reunióncon un pequeño ejercicio para conocersemejor: Punto en el cual se pasa al ejerciciorompehielo.

Paso #3. Creando un ambiente fraterno: Elejercicio de rompehielo

Hay varias técnicas de animación cuyo objetivocentral es crear un ambiente fraterno yparticipativo. Una técnica rompehielo es aquellaque sirve para que los participantes y el equipofacilitador se conozcan y empezar así a crearun ambiente amistoso y relajado para laconversación. Teniendo en cuenta las carac-terísticas de los participantes y el contexto, sedebe elegir para los encuentros una técnica:6

5 Notar que utilizamos las palabras “película cortita ó video”en lugar de “videoclip” y “representación” en lugar de“dramatización.” Es necesario simplificar el lenguaje yevitar palabras nuevas o complicadas con las que losparticipantes no están familiarizados.

6 Una referencia útil para la selección de técnica participativay de rompe hielo es el libro editado por el Centro de Estudiosy Publicaciones Alforja titulado “Técnicas Participativaspara la Educación Popular” (Tomos I y II, San José, CostaRica: Centro de Estudios y Publicaciones Alforja, 1988).

20



Que sea activa.Que permita relajar a los/lasasistentes.Que involucre la participación de losparticipantes.Que tenga presente el humor.

Paso #4. Presentando historias de vida: Losvideos 1 y 2

Los videos presentan a los participanteshistorias de vida muy cortas, “historias de lavida real” que reflejan lo que sucede en lacomunidad. Describamos a continuación losobjetivos, contenidos, de los videos y la guía depreguntas utilizada para generar diálogo ydebate, en el propósito de aprender e indagarjunto con la comunidad cómo se actúa frente aun caso de emergencia de una madre gestantey qué se piensa sobre la calidad de los serviciosofrecidos en los establecimientos de salud anteuna emergencia materna.

Video #1: Relato de una madre en emergencia situadaen la comunidad

Objetivos:

Explorar qué hace generalmente lacomunidad en casos de emergencias duranteo inmediatamente después del parto.Conocer cuáles son las costumbres y lastradiciones en lo que respecta el cuidado

materno y del recién nacido.Indagar qué es lo que puede estarimpidiendo el traslado de la mujer al serviciode salud correspondiente.Indagar qué es lo que puede facilitar eltraslado de la mujer al servicio de saludcorrespondiente.

Resumen del Contenido:

Mujer enferma en casa, la persona que está conella le explica a otra los síntomas que tiene lamujer, pero ninguna de ellas sabe que se tratade señales de peligro. La comadrona llega y ledice que en ese caso ella ya no puede hacer algopor la paciente. Al mismo tiempo llega unprofesional (o proveedor) de la salud que insisteen que lleven a la mujer al servicio de saludmás cercano. El marido no está y la suegra noquiere que se lleven a la mujer al servicio desalud. Empieza una discusión acalorada entrelos que están alrededor de la mujer sobre quédeben hacer. Ésta se ve cada vez más débil, vadesfalleciendo. Se corta la filmación.

Proyección del Video 1:

El facilitador explica a los participantes que seles presentará una película7 para después

7 Se usa la palabra “película o video” en lugar de “videoclip”que es una palabra con la cual los participantesprobablemente no están familiarizados.

21



discutir lo que vieron. Durante el video, elequipo facilitador verifica si los participantessiguen con atención el mismo. En zonas ruralesalejadas, puede ser que la gente no estáacostumbrada a ver televisión y que en unprimer momento no presten suficiente atenciónal contenido sino más bien a la forma. Esrecomendable, pasar el video una segunda vezpara asegurarse de que todos han lo vieron yentendieron de principio a fin. Se debe tambiénpreguntar a los participantes si quieren ver lapelícula una segunda vez.

Dialogo y Debate8:

Luego de ver el video se procede a trabajar engrupo con la siguiente guía de preguntas:

1. ¿Qué les recuerda lo que acaban de ver? ¿hanvivido algo igual? ¿han escuchado de un casocomo éste en su comunidad?

2. ¿Qué es lo que sucede en la película? ¿quéproblema tiene la mujer que se siente mal?¿quiénes discuten? ¿por qué estándiscutiendo?

3. En casos como éste, ¿qué hace la gente de la

comunidad? ¿qué se hace con la mujer?4. (Si es necesario, retomar el hilo de la historia

para que los participantes se acuerden).Según ustedes, ¿qué pasaría después? ¿enqué momento y cómo se da cuenta la familiade que la mujer está grave? ¿quiénes decidenlo que se va hacer? ¿qué hacen? (aceptar quese va a morir, llamar a un curandero, llevarlaa un servicio de salud: de religiosos,institucional, prestadoras). ¿Qué pasa con laenferma al final (muere, sobrevive)?

5. ¿Qué problemas tienen que pasar para tratarde salvar la vida de esta señora? ¿quénecesitan para resolver esos problemas?¿quién los ayuda? ¿quién no los ayuda? (adistintos niveles: familia, comunidad, redesfuera de la comunidad) ¿qué tan difícilresulta resolver estos problemas?

6. Si estuvieran ustedes en esa situación, ¿quéharían?

7. ¿Qué sucede cuando una mujer muere en lacomunidad? ¿Con quién se quedan los niños?¿Quién se ocupa de ellos? ¿Qué pasa con elesposo?

Video #2: Relato de una madre gestante que llega deemergencia al servicio de salud

Objetivos:

Explorar qué es lo que le gusta y disgusta(atributos de calidad) a la comunidad sobrelos servicios y cómo les gustaría que fueran.

8 La guía de preguntas para el momento de diálogo ydebate después del ver el video, se encuentra en elAnexo #1.

22



Indagar qué es lo que impide el uso de losservicios.Indagar qué puede facilitar el uso de losservicios.

Contenido:

Llegan al servicio de salud y un proveedor deservicios los recibe diciendo ¿por qué hanesperado tanto? y se muestra molesto con lafamilia y con la comadrona. Llega el médico deturno (joven) que no habla el idioma y explica,con buena voluntad, lo que la paciente tiene.El intérprete tiene dificultad para traducirporque el médico utiliza términos técnicos queno existen en el idioma del lugar. El médicobusca el instrumental que necesita paraintervenir y todos alrededor se empiezan amovilizar, y la filmación se corta.

Proyección del video II:

El facilitador explica a los participantes que sepresentará una segunda película para despuésdiscutir lo que vieron.

Diálogo y Debate9:

1. ¿Qué es lo que vieron en la película? ¿Quéestá pasando?

2. ¿Les ha pasado a ustedes o a alguien queconozcan algo parecido? ¿qué fue lo queles sucedió?

3. ¿Qué es lo que más les llama la atenciónde esta segunda película? ¿qué otras cosasven? ¿es así en los servicios que ustedesconocen?

4. (Si es necesario, retomar el hilo de lahistoria para que los participantes seacuerden). ¿Se acuerdan que lesmostramos sólo una parte de la película?¿Qué creen ustedes que pasó al inicio (enla parte de la película que no les hemosmostrado: cuando la familia llega alservicio de salud)?

(Si el tema no fue abordado en el videoanterior) ¿cómo hizo la familia parallegar al servicio de salud?¿Cómo recibieron a la familia en elservicio de salud? ¿Cómo piensanustedes que el personal de salud tratóa la familia, a la señora, a lacomadrona? ¿Les dejaron hacerpreguntas? ¿Cómo les contestaron?¿Qué le dijo el personal de salud a lacomadrona?

5. Y en el pedazo de película que vimos,¿Cómo piensan ustedes que se siente laseñora y la familia en el lugar donde laestán atendiendo? ¿Qué les parece el lugardonde atienden a la señora? ¿Cómo venese lugar? ¿Qué es lo que hay y qué es lo

9 La guía de preguntas para el momento de diálogo y debatedespués de ver el video 2, se encuentra en el Anexo #1.

23



que falta en el servicio de salud? ¿Qué eslo que les gusta y qué es lo que no lesgusta?

6. Si estuvieran ustedes en esa situación,¿qué harían?

7. Al final de la película (que tampoco hemosvisto porque la cortamos antes) ¿qué creenustedes que pasa con la señora? (¿laseñora sobrevive o muere?)

8. ¿Cuál sería un final feliz para estasegunda película? Para llegar a ese finalfeliz, ¿qué se necesitaría?

9. ¿Cómo les gustaría que los trataran en losservicios de salud?

Paso #5. Priorizando los atributos de calidad queel servicio de salud debe practicar desde laperspectiva de la comunidad

Durante el momento de diálogo y debategenerado a partir del video 2, se indaga sobrelos atributos de calidad y de satisfacción acercadel servicio de salud desde la perspectiva delos participantes. El objetivo del presenteejercicio es justamente priorizar en orden deimportancia, los atributos o características queun buen servicio de salud debe practicar y/omostrar. Por ejemplo, los participantes puedenhaber mencionado en el paso anterior que noles gusta que los traten mal o que les griten,cuando llegan con la mujer enferma al hospital,

pero que aprecian que el médico que atiende ala mujer la cure: qué es más importante paralos participantes, ¿el trato que se da a laspersonas que llegan con la mujer al hospital ola competencia técnica del médico que laatienda?

Procedimiento:

1. Se pide a los participantes que se dividanen dos o tres grupos (dependiendo delnúmero de personas). Cada grupo va arepresentar cómo le gustaría queterminara la historia que acaban de ver(video 2) desde el momento en que llegala señora a un establecimiento de saludhasta que se le salva la vida.10

2. Cada grupo presenta su dramatización. Elfacilitador le pide a los participantes quecomenten la dramatización del otro grupoy la de su propio grupo a partir depreguntas tales como:

10 Cabe mencionar que en una primera versión delinstrumento, se pedía a los participantes querepresentaran el “final feliz” de la historia que acababande ver. Nos dimos cuenta de que estos términos no tienensignificado para las personas en algunas comunidades,por lo que optamos por solicitar que representaran cómodebería concluir la historia.

24



¿Cómo se sintieron en el servicio desalud?¿Qué encontraron en el servicio que lesgustó?¿Cómo los trataron allí?¿Cómo se logró salvar a la mujerenferma?

3. El facilitador o el observador dibuja en elpapelógrafo imágenes de lo que la genteva diciendo. Esto lo puede hacer unmiembro del equipo facilitador que tengaaptitudes para el dibujo.11

4. Una vez que se agotaron los comentariosy que se tienen todas las imágenes en elpapelógrafo, el animador hace laspreguntas que lo ayudarán a poner loselementos mencionados en orden deprioridad:

Si tuvieran que poner en orden deimportancia todo lo que han men-cionado, ¿qué vendría primero? ¿ydespués...?El facilitador explora divergencias yconvergencias de puntos de vista y elpor qué del orden de prioridad queeligen los participantesReordena, simultáneamente, los ele-mentos siguiendo el orden de prioridadseñalado por los participantes (nume-rar los elementos en la lista delpapelógrafo).

5. Se consulta la lista final de prioridad paraasegurarse que el orden reflejado es lo queel grupo piensa.

Paso #6. Conduciendo el mapeo comunitario

El objetivo del ejercicio de mapeo comunitarioes el ubicar a personas claves y recursos en lacomunidad que pueden ayudar a las familiasen caso de una emergencia, entre ellas,miembros del poder local institucional, poderlocal tradicional, la red tradicional de salud, lared social local (por ejemplo, los vecinos,familiares). Una de las características del mapeoes que se dibuja con la participación activa delos miembros de la comunidad, la ubicación delos recursos y redes existentes para movilizarseante un caso de emergencia materna y neonatal.

11 Otra posibilidad es utilizar un flanelógrafo con imágenespreparadas de antemano. Si se decide fabricar uno, loque se puede hacer es extraer de las primeras reunioneslos elementos del discurso de los participantes que salenmás a menudo. A partir de esos elementos, se fabricaríaun flanelógrafo que podría quedar como herramienta deanimación para ésta y otras fases del trabajo con lascomunidades. También se puede optar por hacer esteejercicio con figuras, elegidas con anticipación, que sepuedan pegar sobre un papelógrafo durante la animación.

25



Procedimiento:

1. Se pide a los participantes que se dividan endos o tres grupos (dependiendo del númerode personas). Cada grupo va a representarcómo le gustaría que terminara la primerahistoria que vimos juntos (video I) desde elmomento en que la señora se enferma hastaque se decide qué hacer. Se les explica queesta dramatización o representación tieneque mostrar cómo se puede organizar lacomunidad para tener éxito en solucionar uncaso de gravedad (emergencia): ¿Qué decidenhacer?, ¿En qué momento toman la decisión?,¿Cómo logran sacar a la mujer de su casapara salvarla?, ¿Qué los ayuda?, ¿Quiéneslos ayudan?

2. Cada grupo presenta su dramatización. Elfacilitador le pide a los participantes quecomenten la dramatización del otro grupo yla de su propio grupo. Luego el facilitadorindaga:

¿Quiénes pueden ayudar para lograr quela madre o el hijo se salven?Por ejemplo, para llevar a la mujer a unservicio de salud donde la puedan salvar¿quién puede ayudar a tomar la decisióna tiempo?¿quién puede ayudar con el transporte?¿quién puede avisar de la urgencia a losotros miembros de la comunidad y a losservicios de salud?

El facilitador dibuja en el papelógrafo figurasque representen a estos actores.12

¿Dónde están estas personas en sucomunidad? ¿cerca de la casa? ¿lejos dela casa? ¿cómo se puede hacer paraubicarlos? ¿se puede hablar con ellos?

El facilitador, con las opiniones de losparticipantes, dibuja el mapa con los recursoscon que cuenta la comunidad en el cual sepueda ubicar las personas claves que puedenayudar a las familias en caso de emergencia.Si es posible, le puede pedir a uno de losparticipantes que pase al frente paraayudarlo a hacer este pequeño mapa.Mostrando el mapa a los participantes, elfacilitador verifica que su representacióncorresponde a lo que ellos dicen y lanza lasiguiente pregunta final al grupo:

¿Qué puede hacer la comunidad paraayudar en casos de emergencia?¿Nos podremos movilizar todos juntospara salvar vidas?¿Quiénes son las personas clave en lacomunidad para los casos de emergencia?

12 Se puede pensar también en la fabricación de unflanelógrafo como en el caso anterior.

26



¿Cuáles son los recursos existentes en lacomunidad?

El facilitador dibuja en un papelógrafofiguras que representen a estas personasu actores identificados, así como recursosdisponibles en casos de emergencia dentrodel espacio geográfico de la comunidad..13

Una vez terminado el mapa, el animadorhace la siguiente pregunta al grupo, conla que concluirá el diálogo sobre el temacentral que nos ocupa:

¿Qué puede hacer la comunidadpara ayudar en casos de emergencia?¿Nos podremos movilizar todosjuntos para salvar vidas?

Paso #7. Finalizando el encuentro y continuandola acción colectiva

Dando seguimiento a la última pregunta hechaa los participantes, el facilitador explica que elobjetivo es justamente trabajar con lacomunidad para mejorar los servicios de salud,para ayudarlos a prevenir problemas de salud,y apoyarlos a hacer frente a casos de emergencia

para lograr así, salvar vidas. Hace al mismotiempo hincapié en que se trata de un procesoa largo plazo y que éste es sólo el inicio.Agradece al grupo por su participación y losinvita a hacer sus últimos comentarios, si tuvie-sen algo que añadir.

Luego se explica cuál será el seguimiento, esdecir, se trabajará en una “devolución” de ladiscusión conjunta de la investigación-acción ala comunidad. Se plantea que con todos loshallazgos provenientes de este proceso, se puededar continuidad a la acción colectiva conalgunas iniciativas ya forjadas en muchas otrascomunidades a través de sus autoridadeslocales y su asamblea comunitaria como es eldesarrollo de un Plan de Emergencia Comu-nitario14 y el Plan de Emergencia Familiar15

en apoyo a la vida de la madre y del niño/a.

13 Como en el ejercicio anterior de priorización, se puedepensar también en la fabricación de un flanelógrafo o enla utilización de figuras elegidas de antemano.

14 Es la expresión de la comunidad organizadasolucionando juntos un problema de salud, unaemergencia que pone en peligro la vida de una madre,niño o niña. El Plan de Emergencia Comunitario es elinstrumento que materializa el empoderamiento de lacomunidad para salvar vidas.

15 El Plan de Emergencia Familiar es el que trabaja la mujerembarazada con su esposo, en el seno de la familia paratomar decisiones anticipadas sobre qué hacer ante unaemergencia obstétrica: ¿a dónde ir?, ¿Cuánto dinero tengoahorrado?, ¿Cómo ir? ¿Quién me acompaña? ¿Quiéncuida mi casa y a mis otros hijos/as? y buscar al comitéde salud en mi comunidad para que me ayude.

27



3. El equipo humano facilitador de losencuentros video participativos

En esta sección especificaremos la conformación yfunciones del equipo humano encargado de llevaradelante el proceso de los “encuentros videoparticipativos”. Así mismo detallaremos algunasde las características y cualidades que el equipofacilitador debe mostrar y finalmente, aborda-remos el tema de la animación de gruposofreciendo consejos útiles para llevar adelante losencuentros video participativos. Los/as invitamosa revisar el Anexo #2, que incluye una ampliaciónde los consejos prácticos para la animación de losencuentros video-participativos presentados enésta sección.

3.1 El equipo humano facilitador

El equipo facilitador de los encuentros video-participativos está conformado por:

(a) un facilitador (o animador) quien es la personaque guía la discusión en grupo

(b) un observador participante que es la personaque toma notas durante el encuentro y apoyaal animador (o facilitador) indicándole, porejemplo:

Que hay alguien en la sala que parecetener algo que decir;

Que habría que tratar de integrar a ladiscusión a un participante que se estádurmiendo o que no participa;Que sería bueno volver a un tema, queuno de los participantes tocó en unmomento dado, para completarlo.

El observador participante está tambiénatento a la grabación de audio para verificarque se graba la reunión adecuadamente ycambiar los cassettes a tiempo.

(c) un camarógrafo (si es necesario). En algunoscasos, se necesita a alguien que se ocupe de lafilmación del encuentro en video. El compartirlas imágenes grabadas con los participantespuede constituir parte del proceso deaprendizaje con ellos y de movilización haciala elaboración de planes de emergencia.

En esta primera etapa, puede ser conveniente queel equipo facilitador de los encuentros no estéconformado por personal de salud institucional quetrabaje en la misma localidad o comunidad. Estotiene un doble propósito: (i) evitar el sesgo de“capacitadores” que el personal de salud ya tienedebido a sus funciones y que llevaría a que losparticipantes confundieran el encuentro con unasesión de capacitación; (ii) asegurarse de que lagente se sienta totalmente libre de expresar susopiniones. Una posibilidad es que el personal de

28



salud que trabaja en una localidad, encuentre acomunidades de otra región y no de la suya. Laotra posibilidad es que el equipo facilitador estéconformado por personas del exterior, nonecesariamente personal de salud, que tenganbuenas habilidades de animación y co-animación.En el caso en el que un profesional o proveedor desalud actúe como animador o como observadorparticipante en la comunidad en la que trabaja,es importante asegurarse de que su propiapresencia no afecte los resultados del proceso.

3.2 Las cualidades y habilidades del equipofacilitador

El equipo facilitador tendrá que realizar untrabajo minucioso, que requiere rigor y capacidadde organización, pero que es a la vez divertido.Para llevar a cabo este trabajo es importanteactualizar algunas cualidades, tales como:

Saber escucharActuar con modestiaTener aperturaTener sentido del humor

Los principios de base que guían este trabajoson:

El respeto (incluyendo el respeto a lasdiferencias)La equidadLa veracidad

Las reglas de oro a seguir son:La puntualidadEl cumplimiento (de promesas,ofrecimientos, etc.)

Hay que recordar siempre, que toma añosdesarrollar lazos de confianza con la comunidad,pero sólo segundos destruirlos. La comunidadpercibe si la relación que el equipo establececon ellos es o no auténtica y lo confirma, porejemplo, cuando se da cuenta de que el equipo:

No crea falsas expectativas en lacomunidadRespeta la confidencialidad de losparticipantes

El equipo facilitador debe ser:

Participativo y a la vez estructurado¿Qué significa esto?, significa que laparticipación no sucede de maneraespontánea sino que es el producto deun esfuerzo consciente y ordenado porcrear las condiciones necesarias paraque la gente participe.Para lograr la participación hay que:

Ser estructurado y organizadoRespetar los tiemposdisponibles para los encuentrosSer lo suficientemente flexiblecomo para adaptarse a lascircunstancias y al medio

29



Ser creativo para encontrar lamejor manera de adecuarse almedio sin perder de vista losobjetivos fijadosSer disciplinado paradocumentar sistemáticamentelos hallazgos de los encuentros ypoder así retornarlos a lacomunidad y transmitirlos atomadores de decisión demanera confiable.

Finalmente, es importante que el equipofacilitador:

sepa desarrollar empatía con lacomunidad al mismo tiempo queestablece una distancia objetiva que lepermita documentar las cosas tal comoson.

En la medida que el equipo esté consciente desu propia subjetividad, de sus valores ycreencias, podrá lograr la objetividad necesariapara llevar a cabo el trabajo aquí propuesto.

3.3 Consejos prácticos para la animación de grupos

El facilitador actúa durante los encuentros a lavez como un “periodista” que:

está “en el centro de la acción”está buscando la opinión de “expertos”

que son los miembros de la comunidadquiere conocer la verdad

Como un “antropólogo”:que aprende con la comunidadlisto siempre a descubrir nuevas cosas

Y es, al mismo tiempo, un “artesano”:que trabaja con minuciosidad yque es paciente y perseverante

4. Los participantes de la comunidadinvitados a los encuentros videoparticipativos

Los participantes de los encuentros video-participativos son seleccionados a partir de criteriosprecisos y dentro de un proceso de selección queincluya a toda la comunidad.

4.1 El proceso de invitación de los participantes

Los agentes externos, en este caso el equipofacilitador, pasa a menudo por las autoridadeslocales formales para realizar las convocatorias enlas comunidades. Es importante que estaspersonas clave, que van a hacer la convocatoria,tengan una copia de la lista de criterios para laselección de participantes de cada encuentro. Peromás allá de estos criterios, es esencial dejar enclaro que se quiere invitar a los encuentros a

30



miembros de los grupos más vulnerables dentrode la comunidad.

Toda comunidad o sociedad es un universocomplejo, en el que existen distintos estratossociales. Teniendo en cuenta las limitaciones queel medio puede imponer, es importante tratar depromover la participación de aquellos que puedenestar siendo dejados de lado debido a que:

Se considera que no están interesadoso no son capaces de participar.Constituyen grupos marginales (porejemplo, son los más pobres) dentro dela comunidad.No forman parte del grupo de electoresde las autoridades vigentes.

La práctica nos ha enseñado que una convocatoriarestringida y sesgada puede causar resentimientoy desconfianza en la comunidad. Al mismo tiempo,la presencia de agentes externos, que aportan unpunto de vista desde fuera de la comunidad, puedea veces contribuir a la inclusión de grupostradicionalmente rezagados y abrir espacios dediálogo en los que estos grupos, particularmentevulnerables, puedan participar.

4.2 Los criterios de selección de los participantes

En el caso que nos ocupa, identificamos por lomenos cuatro grupos de personas que nos interesa

encontrar en grupos separados, ya que cada unode ellos puede aportar una perspectiva diferentesobre la salud materna y neonatal y el manejo decasos de emergencia en la comunidad. Se trata de:las mujeres, las comadronas, los líderes y loshombres. Es importante que cada grupo seahomogéneo para facilitar los intercambios entre losparticipantes. Por ejemplo, si invitamos a unacomadrona que es líder tradicional en sucomunidad a participar dentro a un encuentro conmadres de familia, encontraremos que su discursoes diferente al de estas últimas, hablaráprobablemente más que las otras mujeres, einfluirá tal vez sobre sus opiniones. De ahí laimportancia de encontrar a estos gruposseparadamente.

Los criterios para la selección de los participantesson, en cada caso:

GRUPO DE MUJERES

Que estén embarazadas o hayan sidomadres (pueden haber perdido hijos).Puede que se quieran incluir tambiénmujeres en pareja y en edad reproductiva,que todavía no han tenido un embarazo.Es importante incluir futuras madresjóvenes y mujeres con alta paridad.Usuarias y no usuarias de los servicios.Que hablen el idioma del lugar.

31



GRUPO DE COMADRONAS

Con distintos niveles de experiencia comocomadronas.Con y sin capacitación (de parte de losservicios formales).Que hablen el idioma del lugar.

GRUPO DE LÍDERES

Líderes institucionales (alcalde auxiliar,presidente de comité de iglesia, pastorevangélico, comité de escuela, etc.) ylíderes tradicionales (comadrona,sacerdote maya, curandero).Hombres y mujeres (equilibrio de género),pero tomando en cuenta la composiciónreal de la comunidad.Diversidad en cuanto a tipo de líderes(religiosos, políticos, etc.).Que hablen el idioma local.Invitar a comadronas con muchainfluencia a participar en los encuentrosde líderes (ya que podrían dirigir ladiscusión en los grupos de comadronascon menos influencia).

GRUPOS DE HOMBRES

Esposos o convivientes. Pueden o no serlas parejas de las participantes en el grupode mujeres.

Usuarios y no usuarios de los servicios.Que hablen el idioma del lugar.

Sobre los criterios de selección:La edad noes considerada un criterio de selección enningún caso. Especialmente en el grupo demujeres, el más alto índice de mortalidad seda al inicio de la vida reproductiva y, por lotanto, es importante incluir también afuturas madres jóvenes. Por otro lado, esimportante también invitar a participar amujeres de alta paridad, que constituyentambién un grupo de riesgo.

5. La organización previa y la logística

La realización de encuentros en comunidadesremotas del país requiere un esfuerzo deorganización y de coordinación considerable. Lapuerta de entrada a la comunidad, como loacabamos de mencionar, son las autoridadeslocales formales. Una visita previa a la comunidadelegida para el trabajo permitirá a los miembrosdel equipo facilitador hacer un primer contacto conellos y verificar el interés y la factibilidad derealizar los encuentros en la localidad en cuestión.Una vez confirmada la posibilidad de llevarlos acabo en una comunidad dada, se debe proceder aplanificar cuidadosamente la visita, previendo los

32



recursos humanos y materiales necesarios paralos encuentros.

5.1 Gestión de recursos

Es recomendable utilizar cuadros de verificacióncon la finalidad de prever los recursos humanos ymateriales necesarios para cada encuentro. Lapreparación con anticipación de otros documentos,como la ficha de datos socio-demográficos paracada encuentro o las guías de diálogo y debatetraducidas al idioma local, contribuirá igualmenteal buen desarrollo de las actividades.

Cuadro de recursos humanosPreparar un cuadro en el que se puedanindicar los nombres de los miembros del equipofacilitador para cada localidad. Dicho cuadroservirá para verificar si se cuenta con el equipohumano necesario en las fechas previstas ypara cada encuentro. Proporcionamos unejemplo de Cuadro de recursos humanos enel Anexo #3

Cuadro de recursos materialesPreparar un cuadro con la lista de materialese insumos que se necesitan para el encuentroy usarlo como lista de verificación antes desalir al campo. Proporcionamos un ejemplode Lista de verificación de materiales einsumos en el Anexo #4.

La ficha de datos socio-demográficosNo olvidar preparar, para cada reunión, unaficha en la que se vaciarán los datos socio-demográficos (más pertinentes) de losparticipantes. Proporcionamos ejemplos deFichas de datos socio-demográficos en losAnexos #5(A) y #5(B).

La traducción del instrumentoEl instrumento debe ser traducido pre-feriblemente con anticipación para usodurante los encuentros que se lleven a caboen otro idioma que no sea el castellano. Estatraducción debe respetar la formulación y elorden de las preguntas del instrumentooriginal.

Es importante no fiarse para la traducción nide la memoria del facilitador ni de sucapacidad de hacer traducciones simultáneas.No hay que olvidar que el trabajo de traduccióne interpretación simultánea requiere unaformación y experiencia específicas con la cualla mayoría de los animadores no cuentan.

Las transcripciones de los encuentrosDesde antes de salir al campo, el equipo debeempezar a preparar el trabajo de transcrip-ción. Hay que ubicar y contactar a las personasque se ocuparán de las transcripciones con

33



tiempo, para estar seguros de realizarlas a labrevedad posible. Estas personas debenhablar los idiomas en los que se lleve a cabolos encuentros, tener una buena velocidad deescritura y, si es posible, experiencia en estetipo de trabajo.

Se les debe entregar una hoja escrita coninstrucciones precisas acerca de cómo hacer latranscripción. (Esto aparece en el Anexo 7).

Algunas instrucciones para lastranscripciones

Indicar quién habla en cada caso.Traducir lo que la persona dice talcomo lo dice.No hacer resúmenes, ni sintetizar loque la persona dice.Cuando resulte difícil o imposibletraducir palabras al castellano(porque no existen en nuestrovocabulario), escribirlas en la lengualocal y explicar entre paréntesis loque significan.Cuando la traducción literal de lapalabra ilustra maneras de pensar ode ver el mundo, ceñirse a latraducción “literal” y explicar entre

paréntesis lo que la palabra significaen el contexto (por ejemplo, si lapersona usa el término “suciedad”para referirse a la menstruación,escribir “suciedad” y explicar entreparéntesis lo que significa).

El formato que la persona utilice para vaciarla información, dependerá del uso que sequiera hacer de la transcripción. Así, si seha grabado la reunión en video y se quieredespués editar lo filmado, se le proporcionaráun formato en el que se puedan plasmartanto las imágenes como el texto. Si se piensautilizar la transcripción para un análisis deldiscurso (verbal) de los participantes, bastarácon transcribir las intervenciones orales delos participantes.16

5.2 Gestión del tiempo

La gestión del tiempo es importante a distintosniveles: antes, durante y después de los encuen-tros.

16 En algunos casos, en los que se opta por analizar lainformación con la asistencia de programascomputarizados, se deben dar instrucciones precisas paraque el formato de las transcripciones resulte compatiblecon el programa.

34



Antes:

Planificar los encuentros conanticipación y, en la medida de loposible, hacer un recordatorio oconfirmación, uno o dos días antes dela fecha fijada en coordinación con elpersonal de salud o autoridadeslocales.

En consulta con personas clave queconozcan bien la comunidad,incluyendo el personal de salud quetrabaja en la zona, se elige lamodalidad de organización queconviene en cada caso. El cuadro 1resume tres modalidades deorganización entre las que el equipofacilitador podrá elegir. Es importanteque una vez elegida la modalidadmás apropiada, se prevean losrecursos y el tiempo específicosrequeridos en cada caso.

Llegar a la localidad con suficienteanticipación como para que el equipopueda reunirse y afinar los últimosdetalles de cada encuentro.

Planificar con anticipación el trabajode transcripción de los encuentros,teniendo en cuenta que se necesitanaproximadamente 8 horas paratranscribir una hora de grabación deaudio.

Anticipar las actividades deseguimiento y los “productos” apresentar como resultado del procesoy preparar un cronograma globaldetallado de trabajo, teniendo encuenta estos aspectos.

35



VENTAJAS

Muy dinámicoNos aseguramos de cubrir todoslos temas con las mismaspersonas (“grupo cautivo”)

Da más tiempo para discutir.Se terminaría todo el mismo día.

Más fácil agotar todos los temasrespetando el ritmo de lasdiscusiones y sin fatigar a losparticipantes.

MODALIDAD

Un encuentro de 2 horas

Encuentro de 3 horas con unintermedio

Dividir la actividad en 2sesiones, de hora y mediacada una, dentro de un intervalode tiempo razonable (mañana ytarde el mismo día o dosmedios días seguidos).

DESVENTAJAS

Tal vez no corresponde al ritmo delos participantes.Es difícil controlar el tiemposobretodo si el facilitador no tienemucha experiencia.

Peligro de que algunosparticipantes se vayan durante elintermedio.

Más posibilidades de perdergente de una reunión a otra.

CUADRO 1MODALIDADES POSIBLES DE ORGANIZACIÓN DE LOS ENCUENTROS

Durante:

Planificar cada encuentro teniendo encuenta las características de lacomunidad y el tiempo disponible delos participantes.

El tiempo de los participantes esvalioso. Se les debe explicar laduración y modalidad elegidas parael encuentro y respetar luego lostiempos previstos.

36



Después:

Planificar con anticipación las tareasde compilación y análisis de lainformación para poder, dentro de untiempo razonable, devolver lainformación a los interesados: lacomunidad misma y los tomadores dedecisiones.

5.3 Gestión del espacio

Hay que tomar en cuenta también, durante laorganización de los encuentros, aspectosrelacionados al espacio físico en el que setrabajará, como por ejemplo los referidos a:

Electricidad. Verificar si hay electricidaden la comunidad. Si no hubieseelectricidad ubicar un generador eléctricoen la localidad para ser prestado. Si nofuera posible, contactar a un grupo depersonas voluntarias dispuesta a hacer ladramatización o sociodrama en cada unode los encuentros.Local del encuentro. La ubicación dedónde se llevarán a cabo los encuentroses crítica para asegurar disponibilidad.Las características del local a tener encuenta:

Referirse al cronograma de trabajo yrespetar las fechas límitesestipuladas. Si esto no fuera posible,y se requiriera hacer algunamodificación al cronograma inicial,comunicar los cambios a las personasinvolucradas (es decir, a aquellos queesperan resultados del equipo).

Que sea lo suficiente espacioso comopara albergar al grupo y, si es posible,no tan grande que provoque eco o ladispersión de los participantes.Que no esté cerca de un puesto deventa o de un ambiente en el que hayamucha bulla. Esto distrae durante lasdiscusiones y dificulta la grabación.La disposición física de las sillas obancas para los participantes estambién importante: Formar un semi-círculo o círculo que incluya al equipofacilitador.La cercanía de los participantes entresí dará una atmósfera más íntima quefavorecerá la conversación y facilitaráal mismo tiempo la grabación.

Posición del equipo facilitador respecto alos participantes. Evitar que la disposición

37



del equipo facilitador al frente de laaudiencia, como si se tratara de un cursomagistral. Esta disposición da la impresiónque los unos (que están al frente) “saben”(vienen a enseñar) y los otros (los queescuchan) “no saben” (y vienen a recibir).Por el contrario, lo que se quiere promoveren este caso es el intercambio igualitarioentre el equipo facilitador y losparticipantes.Prever hospedaje para equipo facilitador.Si es necesario que el equipo se quedevarios días en la comunidad, se debeprever un lugar donde puedan dormir.Como veremos más adelante, la visita oestadía en la comunidad constituye en síuna oportunidad de estrechar lazos con lacomunidad y de encontrar informalmentea personas que no participaron en losencuentros.

6. Información recopilada

No basta recoger la información e intercambiar conla comunidad. Si se quiere utilizar la informaciónpara alimentar un proceso de cambio en lacomunidad, es preciso procesarla y analizarla paradevolverla a la comunidad, para que ésta puedaasí compartirla con tomadores de decisiones. Sehace necesario pues, por un lado, ir sistematizando

la experiencia, y por el otro, llevar a cabo un aná-lisis de lo conversado en busca de propuestas útilesque salgan de los participantes mismos y en lasque ellos se vean reflejados.

6.1 La sistematización de la experiencia

La sistematización constituye en sí un temametodológico aparte, que no pretendemos cubriren este manual. Sugerimos aquí simplemente unpar de herramientas de base que pueden servirpara la sistematización de la experiencia por elequipo facilitador y la comunidad. Se trata dedesarrollar herramientas para el registro de losmomentos, hechos, acciones más sobresalientes yconstruir así una memoria viva del proceso con lacomunidad.

Documento de reflexión y autorreflexión sedebe llenar luego de cada encuentro, enel cual se mencionen los puntossobresalientes (barreras, facilitadores,hallazgos, sorpresas) en cuanto a:

PreparaciónConvocatoriaOrganización / logísticaFacilitación e instrumentoContenido de las discusionesEl proceso con la comunidad

38



Diario de ruta en el cual se puedan docu-mentar las entrevistas formales einformales y las observaciones del equipofacilitador durante sus estadías o visitasa la comunidad:

FechaDescripciónElementos sobresalientesSeguimiento previstoGlosario de la terminología de lacomunidad

Cuadros para la compilación yorganización de datos con respecto a:

Los recursos identificados en lascomunidades, tales como los mediosde comunicación tradicionales ytécnicos comúnmente utilizados,principales canales y fuentes deinformación y comunicación formale informal, personas y grupos clave,redes existentes, etc. Estos datosservirán para el desarrollo deestrategias de participación social yde IEC (información, educación ycomunicación), así como a laformación o consolidación de redesde apoyo a la vida.

Reuniones de sistematización periódicasplanificadas de antemano para:

El intercambio y socialización conla comunidad y con el personal desalud que trabaja a distintosniveles.Estas reuniones no sonespontáneas ni casuales. Ellasdeben ser organizadas conanticipación siguiendo una agendaprecisa y un diseño metodológicoparticipativo coherente con eltrabajo de investigación-acción.

6.2 El análisis de los encuentros

El análisis de datos es un tema complejo que vamás allá de los límites de este manual. Cabemencionar aquí simplemente que el análisis condetalle de los encuentros permitirá una mejorcomprensión de las dinámicas psico-sociales ysocio-culturales que influencian las maneras dehacer y de ser en una comunidad. Estacomprensión permitirá a su vez el desarrollo deestrategias adecuadas al contexto así como laidentificación y previsión de problemas potencialesque se puedan encontrar en las comunidades enlo que respecta a la salud materna y del reciénnacido. Más allá de su utilidad desde el punto devista de agentes externos deseosos de mejorar su

39



trabajo con la comunidad, el análisis de datos eneste contexto parte del punto de vista de lacomunidad y busca retornar los resultados demanera de reforzar el proceso de empoderamientocomunitario.

Para llevar a cabo este tipo de análisis se debentener en cuenta ciertas etapas que requierenplanificación y organización, tales como:

La preparación de las transcripciones.El ordenamiento de datos en matrices.El análisis de la información.La socialización de los resultados.

Es recomendable contar con el apoyo deespecialistas en análisis cualitativo para realizarconjuntamente este trabajo. La contribución de losinvolucrados—tanto del equipo facilitador como delos participantes de la comunidad—durante la fasede análisis es esencial. El proceso de retorno a lacomunidad se convierte a menudo en unaoportunidad de validar y afinar los resultados delanálisis.

7. El uso del instrumento dentro de unproceso

El instrumento de investigación-acción queproponemos es una herramienta de aprendizajeque se sitúa dentro de un contexto que va más

allá de los encuentros video-participativos. Esesencial no perder de vista que, más allá de la“recolección de información,” se inicia un procesocon la comunidad, de cuyo éxito dependerán lassiguientes fases del trabajo con ella. Durante lasvisitas a las comunidades hay una serie de tareasparalelas a realizar, que se complementan yrefuerzan entre sí:

Conducir los encuentros video-parti-cipativos con los diversos gruposCrear y desarrollar los contactos conorganizaciones de base, comités,organizaciones no gubernamentales, etc.activos en la comunidad.Elaborar estrategia de cómo estos gruposformados para los encuentros y laspersonas y grupos clave contactados en lacomunidad, pueden mantenerse involu-crados a lo largo del proyecto para seguirel trabajo.Proseguir, fuera de los encuentros, con el“mapeo comunitario” visitando lo queexiste.Aprovechar también para conversar conel resto de los miembros de la comunidady no sólo con aquéllos que han participadoen los encuentros.

Estas conversaciones girarán en torno,en un primer momento, a temas más

40



bien generales que nos darán una ideade la realidad y la trayectoria de lacomunidad, como por ejemplo: cómo seformó la comunidad, cómo es la vida enla comunidad, si hay muchos niños,cuáles son las fiestas, cómo las celebran,dónde está la escuela, dónde está laparroquia, quiénes son las autoridades(tradicionales y formales), dónde sereúne la gente, si la gente de losalrededores se conoce bien, cuáles sonlos principales problemas en la comu-nidad, si se ayudan entre ellos, etc.

Poco a poco, y en un segundo momento,podrán entrar al tema de: ¿qué hacencuando alguien se enferma?, ¿hastadónde tienen que ir para hacerse ver osi alguien viene a sus casas?; ¿si sabende alguna señora que haya tenidoproblemas con su embarazo o en el

momento de dar a luz?; ¿qué es lo quela gente hace en esos casos: dónde van?,¿a quién consultan?; ¿si acuden a losservicios?: ¿cuándo van?, ¿dónde?, ¿quéles parecen?, ¿qué tipo de cuidadoprefieren?; ¿si conocen gente u orga-nizaciones (redes formales e informales)que son importantes en la comunidady que deberíamos contactar?; etc.17

Fortalecer los lazos con la comunidad apartir, por ejemplo, de la participación(bajo invitación) a reuniones comuni-tarias.

Es fundamental en esta etapa establecer y / oconsolidar el trabajo en redes y desarrollar lazosde confianza y colaboración con los miembros dela comunidad. El éxito de la iniciativa podrámedirse en función de la continuidad y elfortalecimiento de estos lazos a lo largo del tiempo.

17 Toda esta información debe ser documentada usandolas herramientas para la sistematización de la experienciapropuestas más arriba.

41



No basta con tener una excelente materia prima yun instrumento adecuado para tejer los lazos. Esnecesario asegurarse de la calidad y de lacontinuidad de los lazos que se vayan tejiendo conla comunidad. Para hacerlo, lo más importante espropiciar el diálogo y la participación. El diálogo yla participación son, en efecto, los principalesingredientes a lo largo del proceso de creación delazos dentro de esta investigación-acción. Ellosatraviesan el trabajo de principio a fin. En estaparte ofreceremos pautas para dos aspectos de laparticipación que pueden presentar interrogantesprácticas durante el trabajo: la cuestión de losincentivos y el retorno de la información recogidaa la comunidad. Terminaremos con una reflexiónsobre el diálogo y la participación como procesos ycomo resultados que se quieren potencializar enla comunidad a través de la metodología de trabajoque proponemos.

1. Valoración e incentivos

A menudo, los miembros de la comunidad estáninteresados en participar. Están dispuestos no sólo

a participar en discusiones en grupo donde puedenexpresar sus opiniones sino, además, a realizarvoluntariamente algunas tareas específicas. Porejemplo, hay miembros de la comunidad que seprestan gustosos a hacer las dramatizaciones, locual nos permite reemplazar las imágenes de losvideos con imágenes “en vivo” cuando no hayenergía eléctrica en la comunidad. Otros sirvende intérpretes cuando hay personas de fuera queno entienden el idioma local en que se lleva a caboel encuentro.

La retribución a las personas que colaboran yparticipan a distintos niveles se presta al debate.Hay quienes consideran que es importante quelos miembros de la comunidad se involucrenvoluntariamente, sin esperar una compensaciónmaterial e inmediata a cambio. Hay tambiénquienes consideran que es importante retribuir alas personas, ya que es una forma de reconocersus esfuerzos y el tiempo que dedican a unaactividad. Entre las dos posturas, ¿cuál nosconviene adoptar? Una posición intermedia seríala que:

PARTE III:LOS LAZOS

42



Reconoce e incentiva la participación de lacomunidad yEvita, al mismo tiempo, dar la impresión deque se está “remunerando” a los que parti-cipan

Una manera de hacerlo es encontrar con lacomunidad un “símbolo” que a la vez:

Tome la forma de un objeto que se puedadistribuir como incentivo durante lasactividades, ySirva para reforzar el trabajo en saludmaterna y neonatal, sin dar la impresión quees una “remuneración” o compensaciónmaterial

El “listón blanco” es un ejemplo de “símbolo” quees a la vez un objeto que puede distribuirse a losparticipantes. Los listones se utilizan a nivelmundial para simbolizar distintas causas.18 Ellistón blanco representa, entre otros, la luchacontra la violencia hacia las mujeres; el rojorepresenta el apoyo al trabajo de educación sobreel sida; el amarillo representa el apoyo al trabajode defensa de los derechos humanos. Se podríapensar en introducir en las comunidades un listón,

u otro elemento elegido con la comunidad, comomedio de reconocimiento y como símbolo de loslazos para la mejora de la salud materna y delrecién nacido. Lo ideal sería que este objetosimbólico fuera pensado y fabricado con lacomunidad, adaptándolo a la cultura local. En estecaso, ese objeto representaría o sería un “símbolo”del trabajo a favor de la salud materna y del reciénnacido. A partir de este objeto podría desarrollarsetodo un sistema de incentivos con la finalidad dereforzar la participación de los miembros de lacomunidad a distintos niveles.

2. El retorno a la comunidad

El retorno de la información recogida durante losencuentros video-participativos es un aspectoesencial del proceso de investigación-acción ya quea través de él se va reforzando el proceso de diálogocon la comunidad y se va propiciando que lacomunidad misma tome un papel cada vez másactivo en la búsqueda de soluciones a losproblemas que la aquejan. Este retorno deinformación debería convertirse no en una“presentación de resultados” sino en un espaciode intercambio con la comunidad.

Al mismo tiempo que se devuelve a la comunidadlo que sus miembros opinan sobre el manejo delos casos de emergencia o la utilización de losservicios, se verifica con ellos si la información

18 En el sito www.sltrib.com se da información sobre loslistones de distintos colores y las causas que representana nivel mundial o en distintos países del mundo.

43



parece exacta y si hay otras opiniones que noaparecen y que deberían añadirse. Si no se haempezado todavía a trabajar con la comunidad enel desarrollo de planes locales de apoyo a la vida,esta reunión de intercambio puede ser unmomento adecuado para iniciar este trabajo. Estosplanes adoptarán un nombre diferente según loque decida la comunidad.

Dado que se trata de un espacio de intercambio,esta reunión con la comunidad debe organizarsede tal manera que facilite la presencia de los queparticiparon en los encuentros, así como de los queno tuvieron la oportunidad de participar en ellos.Esta reunión tomará probablemente la forma deuna asamblea comunal durante la cual semotivará a los asistentes a participar activamente.El personal de salud que trabaja de cerca con lacomunidad debe también ser invitado a la reunióny, si es posible, co-animar la reunión. Podría pueshaber uno o dos facilitadores durante la reuniónque se compartirían las tareas durante la discusiónen grupo. El o los facilitadores de la reunióndeberán utilizar técnicas participativas, así comodibujos, figuras e imágenes para lograr unintercambio dinámico con los participantes.

Los temas de la reunión podrían ser priorizadosteniendo en cuenta los intereses salientes de lacomunidad. Para facilitar la participación durantela reunión, los facilitadores pueden seguir los

consejos para la animación que se ofrecen en elAnexo #2 y asegurarse de verificar:

Si lo que dicen es claro y comprensiblepara los participantes¿Qué opinan los participantes sobre loque dicen?

Si hay algo que añadirSi hay algo que corregir

¿Qué les parece a los participantes laspropuestas hechas (de trabajo conjunto,por ejemplo)?¿Qué sugerencias tienen losparticipantes?

Es importante planificar cuidadosamente estareunión tanto a nivel de contenido como en lo quese refiere a la previsión de los recursos humanosy materiales necesarios para llevarla a cabo. Paraordenar lo que se discuta sobre el Seguimiento ala Reunión con la Comunidad es recomendableutilizar un cuadro que los facilitadores debenllenar con la ayuda de los participantes. Se debeprever para ello ya sea un pizarrón, marcadores ypapel de rotafolio, para que los facilitadorespuedan tomar nota de lo que se discute en grupo.En este proceso de diálogo con la comunidad, losfacilitadores no imponen un programa, sino quenegocian la mejor manera de incluir en la agendalocal la prevención de muertes maternas y derecién nacidos como una de las prioridades en la

44



comunidad. Esta es una oportunidad de estrecharlos lazos entre la comunidad y el personal de saludy de establecer las bases para un trabajo querequiere un compromiso a largo plazo de las dospartes.

3. Tejiendo lazos

Como señalamos al principio del manual, los lazosno son sólo producto sino también proceso. Loslazos se forman en diálogo con los miembros de lacomunidad, dentro de un proceso de participaciónque incluye a los grupos más vulnerables. Se debebuscar la participación de la comunidad a distintosniveles y en diferentes momentos dentro y fuerade las reuniones de discusión y de intercambio.Pero esta participación no se logra de maneraautomática. Lograrla requiere tiempo, esfuerzo yperseverancia. Por un lado, mucha gente no hatenido antes la oportunidad de participar y le tomatiempo darse cuenta de que puede hacerlo yaprender a hacerlo. Por otro lado, para establecerun diálogo abierto hay que desarrollar lazos deconfianza y sostenerlos a través del tiempo, cosaque no se hace de un día a otro. A veces, se tieneque empezar a desarrollar lazos de confianza encontextos en los que por motivos históricos ya haydesconfianza y resistencia hacia las propuestas quevienen de afuera o que representan instanciasgubernamentales.

La participación es:Un proceso largo y lentoUna meta a seguir, pero también unaserie de problemas para resolver

La participación:No se da de manera automáticaRequiere un “trabajo de hormiga”

A menudo la necesidad de respetar el ritmo deeste proceso a largo plazo se enfrenta con laurgencia de presentar resultados dentro decronogramas de trabajo precisos. ¿Cómo conciliarentonces los procesos y los productos? Nopretenderemos dar una respuesta absoluta a estainterrogante en el espacio limitado que nos quedadentro de este manual, ya que cada caso esdiferente y requeriría un tratamiento específico.Sin embargo, en términos generales, dentro delproceso de investigación-acción siempre hayresultados que se pueden y deben ir compartiendocon los interesados, en la medida que salen y estodentro de límites razonables de tiempo. Así, si sellevan a cabo los encuentros en una comunidad yse retornan los resultados después de un año, yano hay continuidad y el proceso se rompe. De igualmanera, hay información que puede ser útil paralos decisores y que se le debe transmitir en lamedida que se encuentra.

45



Es necesario trabajar con fechas límite yofrecer productos útiles a los actoresinvolucrados (comunidades y tomadoresde decisiones) en la medida que vayaavanzando la iniciativa.

Pero al mismo tiempo que se ofrecenproductos útiles, tanto a la comunidadcomo a los decidores, es importante teneren cuenta que el proceso instaurado tomatiempo y requiere un “trabajo de hormiga.”El éxito de este tipo de iniciativa, se midemás en relación a la calidad de laparticipación y los beneficios a largo plazo,que en función del número de personas ocomunidades cubiertas y el impacto de lasactividades a corto plazo.

Es necesario sensibilizar a los involu-crados y a los tomadores de decisiones, enespecial a aquéllos que están máshabituados a trabajar en función deproductos concretos, sobre la naturalezay las implicaciones de un trabajoparticipativo dentro de procesos de cambioa largo plazo.

Los lazos son tanto productos comoprocesos. Es importante pues, lograr unequilibrio entre productos a corto plazo yprocesos a largo plazo.

No cabe duda de que el diálogo y la participación,como los lazos, tienen una utilidad y un propósitoque se traducen—y deben traducirse—enresultados concretos. Las comunidades mismasinsisten una y otra vez en ver estos resultados yen que su participación no sea “en vano.”19 Almismo tiempo, el valor del diálogo y laparticipación es que se trata de procesos querepresentan continuidad y que favorecen lasostenibilidad de las iniciativas a largo plazo. Es,en efecto, a través del diálogo y la participaciónque los miembros de la comunidad se apropian deiniciativas y adquieren las herramientas que lespermiten asegurar su continuidad a lo largo deltiempo.

Los lazos tienen pasado, presente y futuro. Eldiálogo y la participación, al igual que los lazos,se convierten en parte de la historia de lacomunidad ayudándola a rescatar su pasado,analizar su presente y desarrollar una visiónconjunta hacia un mejor futuro. El propósito deeste manual ha sido no sólo familiarizar al lectorcon la metodología de investigación-acción a travésde los encuentros video-participativos, sinocompartir algunas pistas de reflexión para su usoen el contexto más amplio del trabajo participativocon las comunidades.

19 De acuerdo a los resultados de los encuentros realizadosen Momostenango y en la Zona Reina.

46



PRESENTACIÓN DEL PROYECTO Y DEL EQUIPO

El facilitadorexplica, de forma general, el objetivo delencuentro y agradece la participación de lospresentes.explica a los participantes el carácterconfidencial y anónimo de sus intervenciones.les explica la necesidad de grabar la reuniónpara tener una “memoria” del encuentro (se lespuede ofrecer, en la medida de lo posible, el verla grabación posteriormente).20 Si es posible,pedirles su consentimiento para la grabación,reasegurándolos una vez más el anonimato yla confidencialidad.

PARTE IV. ANEXOSANEXO 1

GUIA DE DISCUSIÓN

EL INSTRUMENTO DE RECOLECCIÓN DE DATOSPARA LOS ENCUENTROS VIDEO-PARTICIPATIVOS

les explica que verán juntos un par de videoscortos preparados para la reunión y queconversarán informalmente de lo que cada unopiensa.les pide que lo interrumpan en cualquiermomento si hay algo que no esté claro.presenta a los demás miembros del equipo porsu nombre y función (durante la reunión). Sesugiere no mencionar sus cargos en el sector desalud, para evitar sesgos.les explica que van a empezar con un pequeñoejercicio para conocerse mejor.

20 Es muy importante asegurar confidencialidad y anonimato de los participantes. Para reasegurarlos de manera concreta, loideal sería que los de una región encuentren a usuarios/as de OTRA región y no de la suya. O, como hemos acordado, que lagente que facilite sea gente del exterior con buenas habilidades de animación. Tener cuidado de que el personal de salud quehaga las veces de observador participante en su propia comunidad no afecte con su propia presencia los resultados.

47



DINÁMICA ROMPE-HIELO:A elegir teniendo en cuenta las características delos participantes.

PARTE IPresentación del video 1, seguida de discusiónEl facilitador explica el procedimiento a losparticipantes: se les presentará una parte de unapelícula de la cual se discutirá después de verla.Observación: ver si los participantes estánsiguiendo con atención el video. Pasarlo unasegunda vez para asegurarse de que todos lo hanvisto y entendido de principio a fin.

Video 1: Situación—emergenciaDramatización: mujer enferma en casa, lapersona que está con ella le explica a otra lossíntomas que tiene la mujer, pero ninguna deellas sabe que se trata de señales de riesgo.La comadrona llega y le dice que en ese casoella ya no puede hacer nada. Al mismo tiempollega un proveedor de servicios de salud queinsiste en que lleven a la mujer al servicio desalud más cercano. El esposo no está y lasuegra no quiere que se lleven a la mujer alServicio de salud. Empieza una discusiónacalorada entre los que están alrededor de lamujer sobre qué deben hacer. Ésta se ve cadavez más débil, va desfalleciendo. Se corta lafilmación.

Video 1, preguntas para la discusión:1. ¿Qué les recuerda lo que acaban de ver? ¿han

vivido algo igual? ¿han escuchado de un casocomo éste en su comunidad?

2. ¿Qué es lo que sucede en la película? ¿quéproblema tiene la mujer que está mal?¿quiénes discuten? ¿por qué están discutiendo?

3. En casos como éste, ¿qué hace la gente de lacomunidad? ¿qué se hace con la mujer?

4. (Si es necesario, retomar el hilo de la historiapara que los participantes se acuerden). Segúnustedes, ¿qué pasaría después? ¿en quémomento y cómo se da cuenta la familia de quela mujer está grave? ¿quiénes deciden lo quese va hacer? ¿qué hacen? (aceptar que se va amorir, llamar a un curandero, llevarla a unservicio de salud: de religiosos, institucional,prestadoras) ¿Qué pasa con la enferma al final(muere, sobrevive)?

5. ¿Qué problemas tienen que pasar para tratarde salvar la vida de esta señora? ¿qué necesitanpara resolver esos problemas? ¿quién losayuda? ¿quién no los ayuda? (a distintosniveles: familia, comunidad, redes fuera de lacomunidad) ¿qué tan difícil resulta resolverestos problemas?

6. Si estuvieran ustedes en esa situación, ¿quéharían?

7. ¿Qué sucede cuando una mujer muere en lacomunidad? ¿Con quién se quedan los niños?¿Quién se ocupa de ellos? ¿Qué pasa con elesposo?

48



PARTE IIPresentación de video 2, seguida de discusiónEl facilitador explica a los participantes que van aver una parte de otra película y que después ladiscutirán juntos como la anterior.Observación: ver si los participantes estánsiguiendo con atención el video. Pasarlo unasegunda vez para asegurarse de que todos hanprestado atención.

Video 2: supuesto caso en el que se decidió llevara la señora a un servicio de salud (red financiadacon fondos estatales)

Dramatización: llegan al Servicio de Salud yun proveedor de servicios los recibe diciendoque cómo esperaron tanto. Está molesto conla familia y con la comadrona. Llega elproveedor de salud médico de turno (joven) queno habla el idioma y explica, con buenavoluntad, lo que la paciente tiene. El intérpretetiene dificultad para traducir porque el médicoha utilizado términos técnicos que no existenen la lengua del lugar. El médico se pone abuscar el instrumental que necesita paraintervenir y todos alrededor se empiezan amovilizar, y se corta.

Clip 2, preguntas para la discusión:1. ¿Qué es lo que vieron en la película?

(expliquen qué es lo que está pasando en lapelícula: ¿Qué está pasando?

2. ¿Les ha pasado a ustedes o a alguien queconozcan algo parecido? ¿qué sucedió?

3. ¿Qué es lo que más les llama la atención deesta segunda película? ¿qué otras cosas ven?¿es así en los servicios de salud que ustedesconocen?

4. (Si es necesario, retomar el hilo de la historiapara que los participantes se acuerden). ¿Seacuerdan que les mostramos sólo una partede la película?

5. ¿Qué creen ustedes que pasó al inicio (en laparte de la película que no les hemosmostrado: cuando la familia llega al serviciode salud)?5.1 (Si el tema no fue abordado en la

proyección anterior) ¿cómo hizo lafamilia para llegar al servicio de salud?

5.2 ¿Cómo recibieron a la familia en elservicio de salud? ¿Cómo piensanustedes que el personal de salud tratóa la familia, a la señora, a la comadrona? ¿Les dejaron hacer preguntas? ¿Cómoles contestaron?

5.3 ¿Qué le dijo el personal de salud a lacomadrona?

6. Y en el pedazo de película que hemos visto,¿Cómo piensan ustedes que se siente laseñora y la familia en el lugar donde la estánatendiendo? ¿Qué les parece el lugar dondeatienden a la señora? ¿Cómo ven ese lugar?

49



¿Qué es lo que hay y qué es lo que falta en elservicio de salud? ¿Qué es lo que les gusta yqué es lo que no les gusta?

7. Si estuvieran ustedes. en esa situación, ¿quéharían?

8. Al final de la película (que tampoco hemosvisto porque la cortamos antes) ¿qué creenustedes que pasa con la señora? (¿la señorasobrevive o muere?)

9. ¿Cuál sería un final feliz para esta segundapelícula? Para llegar a ese final feliz, ¿qué senecesitaría?

10. ¿Cómo les gustaría a ustedes que lostrataran en los servicios de salud?

PARTE IIIDramatización seguida de priorizaciónSe pide a los participantes que se dividan en dos otres grupos (dependiendo del número de personas).Cada grupo va a representar cómo le gustaría queterminara la primera historia que acabamos dever: desde el momento en que llega la señora a unservicio de salud hasta que se le salva la vida.OJO: Empezamos con la dramatización del finalfeliz relacionado al video 2 que acabamos deproyectar.

Dramatización de mujer grave en los serviciosde salud: final feliz.Cada grupo presenta su dramatización (quees a su vez grabada, como el resto delencuentro).Dramatización 1, discusión: priorizaciónSe pide a los participantes que comenten ladramatización del otro grupo y la de su propiogrupo:Preguntas del facilitador: ¿cómo se sintieronen el servicio de salud?, ¿qué encontraron queles gustó?, ¿cómo los trataron?, ¿cómo se logrosalvar a la mujer enferma?El facilitador va dibujando imágenes en elpapelógrafo de lo que la gente va diciendo (estolo puede hacer otro miembro del equipo quetenga aptitudes para el dibujo).21 Facilitadory observador van tomando nota de loselementos mencionados por los participantespara completar las imágenes en el papelógrafo.Una vez que los dos grupos han hecho suscomentarios, el facilitador hace la siguientepregunta (priorización):1. Si tuvieran que poner en orden de

importancia todo lo que han mencionado,

21 Otra posibilidad sería utilizar un flanelógrafo con imágenes preparadas de antemano. Para esto lo que se podría hacer es veren las primeras reuniones cuáles son los elementos que salen en el discurso de los participantes. Se podría entoncescomenzar a fabricar este flanelógrafo que quedaría como herramienta de animación para reuniones posteriores durante lainvestigación y en otras fases del proyecto; ya que se trata de una investigación-acción.

50



¿qué vendría primero? ¿y después?Explorar por qué ese orden de prioridad.Se ordenan los elementos en el orden deprioridad señalado por los participantes(poner número 1, 2, etc. en la lista delpapelógrafo).

PARTE IVDramatización seguida de mapeo comunitarioSe pide a los participantes que se dividan en dos otres grupos (dependiendo del número de personas).Cada grupo va a representar cómo le gustaría queterminara la primera historia que vimos juntos(video 1): desde el momento en que la señora seenferma hasta que se decide qué hacer. Se lesexplica que la dramatización o representacióntiene que mostrar cómo se organiza la comunidadpara un caso grave (emergencia en la comunidad):¿qué deciden hacer?, ¿en qué momento toman ladecisión?, ¿cómo logran sacar a la mujer de su casapara salvarla?, ¿qué los ayuda?, ¿quiénes losayudan?

Dramatización de emergencia en lacomunidad: final feliz.Cada grupo presenta su dramatización (quees a su vez grabada, como el resto delencuentro).

Dramatización 2, discusión: mapeoSe pide a los participantes que comenten ladramatización del otro grupo y la de su propiogrupo.

Preguntas del facilitador:1. ¿Quiénes pueden ayudar para lograr estos

finales felices? ¿por ejemplo, para llevara la mujer a un servicio de salud donde lapuedan salvar? ¿quién puede ayudar atomar la decisión a tiempo? ¿quién puedeayudar con el transporte? ¿quién puedeavisar de la emergencia a los otrosmiembros de la comunidad y al serviciode salud?

El facilitador dibuja en el papelógrafo figurasque representen a estos actores.22

2. ¿Dónde están estas personas en sucomunidad? ¿cerca de la casa? ¿lejos de lacasa? ¿cómo se puede hacer paraubicarlos? ¿se puede hablar con ellos?

El facilitador, mediante la información que losparticipantes aportan, va dibujando un mapade la comunidad en el cual se pueda ubicarlas personas claves que pueden ayudar a lasfamilias en caso de emergencia: poder localinstitucional, poder local tradicional, redtradicional de salud, vecinos, etc. Mostrandoel mapa a los participantes, el facilitador

22 Se puede pensar también en la fabricación de un flanelógrafo como en el caso anterior.

51



verifica que su representación corresponde alo que ellos están diciendo y lanza la siguientepregunta final al grupo:

3. ¿Qué puede hacer la comunidad paraayudar en casos de emergencia? ¿nospodremos movilizar todos juntos parasalvar vidas?

Para terminar la reunión:Explicar que el objetivo es justamente trabajar conla comunidad para mejorar los servicios de salud,para ayudarlos a prevenir problemas de salud, yapoyarlos a enfrentar casos de emergencia paralograr así salvar vidas. Recalcar que se trata deun proceso a largo plazo y que éste es sólo el inicio.Se les agradece por su participación y se les invita

a hacer sus últimos comentarios (si tienen algoque añadir). Luego se concluye la charlaexplicando cuál será el seguimiento. En estesentido, se sugiere recalcar que éste es el iniciode un trabajo conjunto; que regresaremos alas comunidades para dar un seguimiento aeste proceso.

NOTA: El seguimiento a esta recolección dedatos podría resultar en una retroalimentaciónde los resultados de la investigación-acción ala comunidad, en forma de desarrollo de planeslocales de emergencia (el nombre que se daráa este tipo de iniciativa saldrá de los gruposmismos). No debemos olvidar involucrar (deuna manera o de otra) a las personas queaceptaron participar en la discusión en las otrasetapas del proyecto.

52



ANEXO 2

ALGUNOS CONSEJOS

Reglas de base:

I. Practiquen la “escucha activa”Es decir, escuchar de una manera quecomunique respeto, interés y empatía. Estasactitudes pueden transmitirse de maneraverbal y no-verbal.

¿Cómo puedo darle a entender a la personaverbalmente que la estoy escuchando?_______________________________________

_______________________________________

¿Cómo puedo darle a entender a la personade manera no verbal que la estoy escuchando?_______________________________________

_______________________________________

II. Utilicen un lenguaje simple y claroNada de jerga profesionalUtilizar términos que los participantesentiendenLenguaje apropiado culturalmente

Algunas técnicas para clarificar respuestas o paraprofundizar lo que la persona está diciendo:

1. Parafraseo: es decir, repetir con otras palabraslo que la persona acaba de decir

Ejemplo:_______________________________________

_______________________________________

2. Hacer preguntas complementarias o de“verificación”: ésta es una técnica CLAVE eneste tipo de investigación. Se utiliza para com-prender las razones de los comportamientos,actitudes o motivaciones de las personas. Esuna pregunta que CLARIFICA una respuestadada por alguien. Nos ayuda a PROFUNDI-ZAR algún punto que consideremos impor-tante.

Cómo hacerlo:Déle tiempo a la persona para que sigahablando (deje un pequeño silencio después dela respuesta de la persona)Repita con otras palabras lo que la personaacaba de decir

53



Repita lo que la persona acaba de decir, peroen forma de preguntaPídale a la persona que clarifique unaafirmación. Por ejemplo: “No entiendo muy

bien. Hace un momento dijo “tal cosa” y ahoradice “tal otra.”Utilice palabras claves como:

AFIRMACIÓN DEL PAFIRMACIÓN DEL PAFIRMACIÓN DEL PAFIRMACIÓN DEL PAFIRMACIÓN DEL PARTICIPARTICIPARTICIPARTICIPARTICIPANTEANTEANTEANTEANTE

“No estoy contenta con esa situación”“Me gusta en parte”“Sería conveniente”“Para mí funciona bien”

PREGUNTPREGUNTPREGUNTPREGUNTPREGUNTA DEL FA DEL FA DEL FA DEL FA DEL FACILITACILITACILITACILITACILITADORADORADORADORADOR

“¿qué hace que usted no esté contenta?” “¿porqué no está contenta?”

“¿qué es lo que le gusta?”“¿de qué manera sería conveniente?”“¿cómo sabe que funciona?”

Utilice la técnica de la tercera persona. Ejemplo:“Parece que está muy convencido de eso. ¿Cómopiensa que otros se sientan al respecto?”

Algunos ejemplos útiles:¿Me podría decir más al respecto?¿Qué es lo que le gusta o que le disgusta de eso?¿Me podría dar un ejemplo?Me gustaría saber más de lo que usted piensasobre ese temaNo estoy segura de que entendí lo que usted queríadecir cuando utilizó la palabra “...”¿Qué quiere decir por “tal cosa”?“¿Qué es lo que lo hace sentir así?”

¿Por qué necesitamos utilizar este tipo depreguntas?Porque:

A veces se le tiene que sacar la información ala gente “con cucharita”.A menudo es difícil para la gente hablar de loque SIENTENPodemos mal interpretar lo que nos dice lapersona

Así es que utilice este tipo de preguntascuando:

No haya entendido por completo lo que dijo lapersonaSi quiere más detalle o ejemplos específicos

54



Si está tratando de descubrir sentimientos omotivacionesSi no está familiarizado con términos que lapersona utilizaSi piensa que la persona está diciendo sóloparte de lo que piensa

3. De una “retroalimentación positiva”Es decir, hacer una alabanza o alentar a lapersona acerca de lo que dice haber hecho.Esto ayuda a que la gente se sienta máscómoda con el facilitador (que no emite juiciosde valor, no “critica” a la persona), y los alientaasí a dar más información. Esta técnica puedeayudar también a reforzar un comportamientodeseado. A veces es difícil hacerlo porque lapersona puede estar describiendo uncomportamiento que nosotros desaprobamoso que consideramos “malo”. Ejemplo: Unapersona decidió no llevar a su esposa al CS,pero luego se dio cuenta de que hubiera sidomejor llevarla. El facilitador puede decirle:“Está bien que se haya dado cuenta quehubiera sido mejor llevarla. ¿Qué lo hizocambiar de opinión? ¿qué haría ahora?

Otros consejos:4. Evite las preguntas que llevan a respuestas de

tipo “sí” o “no”; es decir, preguntas cerradas.

5. Reformule las preguntas cuando sea necesariopara asegurarse de la comprensión y de laadaptación cultural.

6. No de la impresión de estar pasando unexamen de conocimientos a los participantes.

7. Pónganse en el lugar de los participantes paraverificar si usted se sentiría amenazado poruna pregunta en particular o por la manerade formularla.

8. No adivine ninguna respuesta. Lo que piensausted puede no coincidir con lo que piensa lapersona.

9. No incluya RESPUESTAS en sus preguntas.

10. Si la gente habla de manera “neutra” sobreun tema, o si los participantes no hablan,puede hacer las veces de “abogado del diablo”,siempre teniendo cuidado de no obstaculizarel proceso de comunicación.

11. Acuérdese de que se trata de una discusión engrupo y no de entrevistas individuales.Devuelva al grupo los comentarios o lasrespuestas de un participante para motivar aotras intervenciones. Relacione las respuestasde distintos participantes para explorar másel tema.

55



ANEXO 3

CUADRO DE RECURSOS HUMANOS

Municipio:Municipio:Municipio:Municipio:Municipio:

Comunidad:Comunidad:Comunidad:Comunidad:Comunidad:

Equipo* Equipo* Equipo* Equipo* Equipo*GrupoGrupoGrupoGrupoGrupo

MujeresMujeresMujeresMujeresMujeres

ComadronasComadronasComadronasComadronasComadronas

LíderesLíderesLíderesLíderesLíderes

HombresHombresHombresHombresHombres

FacilitadorFacilitadorFacilitadorFacilitadorFacilitador ObservadorObservadorObservadorObservadorObservadorparticipanteparticipanteparticipanteparticipanteparticipante CamarógrafoCamarógrafoCamarógrafoCamarógrafoCamarógrafo

OtroOtroOtroOtroOtro(especificar)(especificar)(especificar)(especificar)(especificar)

FechaFechaFechaFechaFecha

* El piloto, encargado del traslado a la comunidad,es también un miembro clave del equipo. Si seconsidera necesario, se puede añadir unacolumna específica para incluirlo en el cuadro.

En algunos casos, el piloto puede ocuparsetambién de otras tareas durante los encuentros,como por ejemplo camarógrafo.

56



NÚMERO CONFIRMADO PORCONFIRMAR

ANEXO 4

LISTA DE VERIFICACIÓN DE MATERIALES E INSUMOS

MUNICIPALIDAD:_______________________________________________________________________COMUNIDAD:___________________________________________________________________________FECHA: ________________________________________

MATERIAL

1.-EQUIPOTelevisorVHSGrabadora audioCassettes de 90 mmAdaptadores Extensión Micrófonos (Baterías AAA, Rep. Batería)2.-MATERIAL DE APOYOA. Videos (Videoclips-películs cortas)B. Material Gráfico Flanelógrafo o figuras (si se decide utilizar estos elementos en lugar de dibujar)D. Identificación de Participantes Viñetas Cuadro con datos Socio-Demográficos Hoja para lista de participantes

57



NÚMERO CONFIRMADO PORCONFIRMAR

MATERIAL

E. OtrosMasking tapePapelógrafosMarcadores permanentesTijeraTachuelas

3.- REFRIGERIOListado de participantesRefaccionesJabón (*)Toalla (*)Palangana (*)

4.- OTROSPelotas o dulces para los niñas/as

(*)Estos son algunos elementos ideales para facilitar que los participantes se laven las manos antes decomer.

58



No. hijos/as Usario/a No usuario/a

ANEXO 5 (A)

FICHA DE DATOS SOCIO-DEMOGRAFICOSGRUPO: ________________________________________________________________________________COMUNIDAD:___________________________________________________________________________FECHA: ________________________________________

No.

1

2

3

4

5

6

7

8

9

Nombre completo Edad Comunidad

59



Grupo u organización

ANEXO 5 (B)

FICHA DE DATOS SOCIO-DEMOGRAFICOS (LIDERES)GRUPO: ________________________________________________________________________________COMUNIDAD:___________________________________________________________________________FECHA: ________________________________________

No.

1

2

3

4

5

6

7

8

9

Nombre Edad Comunidad

60



ANEXO 6

EJEMPLO DE GUION

Ejemplo de guión, preparado por los coordinadores del trabajo con las comunidades del Proyecto de SaludMaterno Neonatal/ JHPIEGO CORPORATION

Ejemplo para el Video No. 1 de los Encuentros Video Participativos

Lugar:Casa en la comunidad donde vive una mujer que acaba de dar a luz

Personajes:1. Mujer Post-Parto ( está en el cuarto)2. Vecina ( está en el cuarto)3. Comadrona ( llega)4. Auxiliar de enfermería ( llega)5. Suegra ( está en el cuarto)

Momento: Post-PartoComplicación: Hemorragia Post-Parto

Aparece la mujer en su casa, se nota que está muy enferma (se está quejando)

Comadrona: ( dirigiéndose a la vecina y a la suegra)María está muy mal, yo ya no puedo hacer nadaEn ese momento, la Auxiliar de Enfermería dice: (muy preocupada y apresurada)

61



Auxiliar deEnfermería: Doña Juana deje que llevemos a María al hospital, está grave, se puede morir. Necesitamos

buscar ayuda para que se cure.

Suegra: Es que Juan no está, no sé cuando regresa y yo no puedo dejar que la lleven al hospital, ellos novan a dejarnos entrar con ella y se nos va a morir ( preocupada, pero convencida que no va a dejarque se la lleven)

En ese momento, la discusión aumenta entre todos (el tono y los gestos de unos a favor de llevarla y otros que noestán de acuerdo, menos la mujer).(Pueden hablar al mismo tiempo)

SE CORTA LA FILMACION.

62



ANEXO 7

TRANSCRIPCIONES — ALGUNOS CONSEJOS

El formato que la persona utilice para vaciar lainformación, dependerá del uso que se quierahacer de la transcripción. Así, si se ha grabado lareunión en video y se quiere después editar lofilmado, se le proporcionará un formato en el sepuedan plasmar tanto las imágenes como el texto.

Si se piensa utilizar la transcripción para unanálisis del discurso (verbal) de los participantes,bastará con transcribir las intervenciones oralesde los participantes.

Algunas instrucciones para las transcripciones

Indicar quién habla en cada caso.

Traducir lo que la persona dice tal como lo dice.

No hacer resúmenes ni sintetizar lo que la persona dice.

Cuando resulte difícil o imposible traducir palabras al castellano (porque no existen en nuestrovocabulario), escribirlas en la lengua local y explicar entre paréntesis lo que significan, aunqueeso implique una explicación detallada de su significado

Cuando la traducción literal de la palabra ilustra maneras de pensar o de ver el mundo,ceñirse a la traducción “literal” y explicar entre paréntesis lo que la palabra significa en elcontexto (por ejemplo, si la persona usa el término “suciedad” para referirse a la menstruación,escribir “suciedad” y explicar entre paréntesis lo que significa).

“TYING KNOTS” FOR HEALTHY MOTHERHOOD A Method of Participatory Research and Action Using Video Discussion Meetings Practical Guide

2

Thank you for your support!

Educational Producers and Evaluators

Marcela Tapia, Patricia Poppe, Robert Ainslie

Adaptation for Guatemala

Human Resources Responsible for the Investigation

Technical Reviewers Ministry of Public Health and Social Welfare of Guatemala

National Program for Reproductive Health, Executive Board,

USAID

Collaborators

Technical and Administrative Personnel of the Maternal and

Neonatal Health Project

Regional Health Offices:

Groups of women, men, leaders, midwives, providers

(purpose of the investigation)

Photographs

Graphic Design and Diagrams

Note: It is important to indicate that in this document the masculine gender has been used on most occasions in which the text might

refer to either men or women. This measure has been adopted with the sole intention of simplifying the text, without any suggestion of

preference.

This publication was made possible with the support of the Agency for International Development (AID), under Contract No. C.A.

HRN-A-0098-00043-00. The opinions expressed are those of the authors and do not necessarily reflect the point of view of AID.

Guatemala, January 2004

3

TABLE OF CONTENTS

INTRODUCTION

I. Human Resources or Raw Material for the

Participatory Research A. Potential Partners

B. Visions of the World and of Health

C. Basis in Reality

D. The Gender Lens

E. The Process of Changing from Soliciting Help to

Taking Power

II. Participatory Video Discussion Meeting A. Necessary Characteristics

B. Objectives of This Tool

C. Components of the Methodology

1. Discussion Guide

2. Introduction and Development

3. Prioritization of the Subject Matter

4. Community Mapping

D. Production of the Videos

E. Human Resources

F. Advance Planning and Logistics

G. Resource Management (the things you need)

H. Time Management

I. Space Management

J. Systematizing (documenting) the Experiment

III. Creating Bonds of Trust

IV. Appendices

1. Discussion Guide: The data collection

instrument for participatory video discussion

meetings

2. A few tips

3. Table of human resources

4. Checklist of materials and supplies

5. (A) Socio-demographic information sheet

5. (B) Socio-demographic information sheet

(leaders)

6. Sample script

7. Some tips on transcribing

8. Possible formats for organizing the discussion

meetings

4

INTRODUCTION The purpose of this guide is to lead you step by step

through the application of a “methodology” of

participatory research in a health project.

The subjects of the videos presented in this guide are

related to maternal and neonatal health, since that is

the focus of the Maternal and Neonatal Health Project

of the JHPIEGO Corporation. However, the end

result is to provide a tool that can support us in

resolving any health problem, and which can be

adapted to the needs of the community and of

organizations desiring to carry out participatory

research (or participatory investigation).

We will call this “method (instrument or tool)”

participatory video discussion meeting, consisting

of a meeting in which video taped images (short film)

from a real situation are used to stimulate dialogue

and discussion among the participants.

This guide consists of three parts and a section of

appendices at the end.

The first part examines the essential and most

important resource for this work, that is, the human

element or raw material of the participatory

research.

The second part, entitled The Tool or Participatory

Video Discussion Meetings, contains instructions for

carrying out these discussion meetings, presents the

objectives of the “videoclips” (videos or short films)

and basic principles of production. It provides general

information on the organization of these discussion

meetings and how to document the experience.

The third, entitled Creating Bonds of Trust, refers to

the process of dialogue and participation that goes

beyond the methodology and supports its use.

WELCOME!

5

I. Human resources or raw material for the participatory research

Every process of participatory research should

validate the human potential existing in the

communities. Five factors are described below which

we suggest be taken into consideration when

planning to work within a community.

A. Potential Partners In every community, we will find two kinds of agents:

Change agents

People who have influence over others and who

are capable of generating change in the

community, such as some community leaders and

deputy mayors.

External collaborating agents People from outside the community who

“facilitate” the change, such as people from

projects, NGOs, the Ministry of Health, etc.

Other players Women of reproductive age, midwives, heads of

families, and groups that are usually absent from

community decision-making. Other key players in

the participatory research process are health

service staff members. Ideally they should

participate in the process.

It is important at the beginning to secure the

authorization of health authorities, municipal

authorities, etc., to conduct the investigation.

There is no single model for initiating the process of

change within a community supported by

participatory research. The important thing is to

change the focus of the endeavor from being centered

on “what we don’t have” to one centered on the

“strengths” of the community and of the players

involved, that is, an effort centered on “what we do

have.”

6

B. Visions of the World and of Health

Many development projects and programs have

learned that it is necessary to take into account the

point of view of those who have an interest in a

specific problem or theme, and that it is not

appropriate to try to impose patterns of behavior that

are foreign to the local culture.

To reach the objectives of an investigation, project or

program, we recommend that you:

Recognize and respect the cultural differences

between the external collaborating agents and the

community

Understand how “the other” sees his own problems

and reality

Know what health means to the community, for

example, its values, priorities and traditions

Know what the community thinks of the health

services, that is, the “attributes of quality.”

C. Basis in Reality

The participatory research needs to be integrated with

existing organizational initiatives, and take into

account the priorities the community establishes to

resolve its problems. For example, the project of

building a community maternity center could be the

engine that drives the participatory research process

with the community.

D. The Gender Lens

Remember that within the vulnerable groups, women

must be included in making decisions about matters

that directly affect them.

E. The Process of Changing from Soliciting Help to Taking Power

It is important not to fall into the paternalism or

“aidism” that consists of doing things for the

community instead of doing them with the

community. Empowerment is the process by which

people develop skills, make decisions, increase their

self-confidence, and take ownership of the situation.

7

II. Participatory Video Discussion Meeting

A. Necessary Characteristics

Must respond to precise objectives;

Must be in harmony with the goal of the

participatory research;

Must reinforce community participation in caring

for the health of the mother and the newborn;

Must be culturally appropriate (adapted as much as

possible to the customs and needs of the

community).

B. Objectives of This Tool To learn the community’s perception of its health

services;

To facilitate active community participation in the

evaluation of those services; and

To walk the community through the process of

implementing and executing Community

Emergency Plans.

This participatory research tool should start with the

reality of the community motivate it to discuss

subjects that directly affect it by using videos as

discussion starters.

C. Components of the Methodology

1. Discussion Guide Includes the description of the videos, exercises and

the questions that will be asked during the

participatory video discussion meetings. It is a guide

for

8

facilitating dialogue, and should not be used as a

questionnaire.

(This discussion guide can be found in Appendix

1.)

2. Introduction and Development The way the project, program, organization,

institution and team of facilitators are introduced will

motivate those present to participate and express their

viewpoints freely.

One of the people responsible for making this happen

will be the facilitator, who will:

Explain in simple terms and in the language of the

majority the objective of the project he/she

represents. In addition, he will indicate that the

health and municipal authorities have given their

endorsement so that the activity may take place. It

is best if the introduction of the activity can be

done in conjunction with the mayor or deputy

mayor and a local representative of the Ministry of

Health as members of the team, who will say a few

words to the group.

Briefly explain the objective of the meeting.

Explain that this methodology is different from the

traditional approach; it is not “like school,” that is,

lecturing, but is “participatory.”

Thank the participants for coming.

Mention that the subject of discussion is the health

of pregnant women, mothers and their newborns.

State that the group of facilitators wishes to learn

with the community and get to know the points of

view of its members regarding health issues.

NOT offer money or create false expectations

among the participants.

Explain that the team wants to support them by

facilitating a brainstorming session on how to

organize to “save the lives” of people who are in a

health crisis and getting worse by the minute.

Assure them that what they say will be kept private

and only used for the purpose of the investigation.

Explain the need to record the session so that what

they say may be taken into account. In addition,

promote respect for what each one says, and

respect the decision of the group if it does not wish

the meeting to be recorded.

Explain the procedure that will be followed during

the discussion meeting. Example: “We are going

to watch a short film together that has been

prepared for this meeting, and afterwards we will

talk about what each one thinks of what we have

seen in the film.”

Invite them to interrupt him at any time if he says

anything that is unclear.

9

Introduce the members of the team or have them

introduce themselves to the participants.

State how long the session will last.

If staff members from the health services are

present, it is recommended that they not give their

titles when introducing themselves, as this may

intimidate the participants.

Explain that the meeting will start with a small

exercise or game to help them “get to know each

other better.”

Choose an exercise that is active, that allows

participants to interact with each other, that involves

the entire group and contains some humor.

3. Prioritization of the Subject Matter

The objective of a prioritization exercise is to probe a

subject that has been presented in the video, for

example, identifying which indicators of quality are

most important from the community’s point of view.

Note:

An example of prioritization is presented

subsequently in the content and objectives of two

videos.

10

a. Video 1 Objectives

To explore what the community does in case of an

emergency during childbirth or immediately after

childbirth.

To identify customs and traditions relating to care

of the mother and of the newborn.

To explore, “What prevents a woman from being

taken to a health center or hospital?”

To explore what could facilitate the transportation

of a woman to a health center or hospital.

To explore who the decision-makers are in the

community.

To explore what the community knows about the

danger signs of pregnancy and childbirth.

11

b. Video 2 Objectives

To explore what the community likes and does not

like about its health services and how it would like

the health services to be (“quality attributes or

indicators”).

To explore what the barriers are to using the health

services.

To explore what might facilitate greater use of

health services.

c. Rationale for conducting the prioritization exercise

For example, the participants might have mentioned

in the discussion of the video that they do not like

being treated badly or being yelled at when they bring

a pregnant woman with complications to the hospital,

but that they appreciate the fact that the doctor helps

them find a solution to the woman’s complication.

Therefore: What is most important to the participants?

The treatment given to the people accompanying

the woman to the hospital, or

The competence of the attending physician?

That is, they are pointing to a problem, but they are

also sharing “something positive” (opportunity) that

could be shared with the personnel in the health

centers to build up their self esteem and improve care.

d. Procedure for conducting the prioritization exercise

Ask participants to divide into two or three groups

(depending on the number of people), and say the

following: “Each group is going to act out how

they would like the story we have just seen to end

(video 2) from the moment the lady arrives at the

health center until they save her life.”

Each group presents its dramatization. The

facilitator asks the participants to comment on the

dramatizations of the other group and of their own

group, using questions such as these:

How did you feel in the health center?

What did you like and what didn’t you like?

How did they treat you?

How was the sick woman’s life saved?

12

The facilitator or observer draws pictures on a flip

chart of what the people are saying. As an

alternative, it is recommended to bring to the

meeting cutouts prepared in advance representing

the figures that might possibly be used, for

example, a man, a woman, a nurse, an injection,

money, transportation, etc.

When all comments have been made and all the

pictures are on the flip chart, the facilitator asks

questions to help the participants arrange the

components mentioned in order of priority:

- If you had to put everything that you have

mentioned in order of importance, what would

you put first? What next?

- The facilitator arranges the figures following

the order of priority indicated by the

participants (write number 1, 2, 3, etc. in a list

going down the side of the flip chart), letting

them know that their contributions have been

very important, since the information will be

used to design community emergency plans,

moreover, it will help in the development of

projects and interventions to improve the

quality of care in the health centers.

4. Community Mapping

The objective of this exercise is for the members of

the community to draw a map showing the location of

people who can help families in emergency cases,

including representatives of: the local institutional

authority, the local traditional authority, the traditional

health care system, the social network (for example,

neighbors and relatives), etc.

a. Procedure for Community Mapping

Ask participants to divide up into two or three

groups (depending on the number of people).

Say the following: “Each group is going to act out

how they would like the first story to end (Video

1) from the moment the lady’s condition becomes

critical until a decision is made about what to do.”

13

Explain to the participants that this dramatization

or representation needs to show what should

happen next:

- How the community can organize itself to bring

a successful outcome to a critical case like this

one.

- What do they decide to do? When do they

make the decision? How do they manage to get

the woman out of her house to save her life?

Who helps them?

Each group presents its dramatization.

The facilitator asks the participants to comment on

the dramatizations of the other group and of their

own group.

Following the discussion guide in Appendix 1, the

facilitator brings out who the key people are and

what resources are available in the community for

emergency cases, drawing figures on a flip chart to

represent these characters, or uses cutouts prepared

ahead of time.

Next, to identify the people and resources available

in the community for emergency cases, the

facilitator poses the questions suggested in the

guide.

The facilitator draws a map of the community with

the help of the participants and verifies that the

illustration matches what they are saying. If

possible, he may ask one of the participants to

come up front to help him make the map of

community resources. When this is done, the

facilitator poses the following questions to the

group:

1. What can the community do to help in cases of

emergency?

2. Is it possible for all of us to mobilize to save a

person’s life?

(These questions conclude the exchange on the central

theme of discussion.)

14

To conclude the meeting a. As a follow-up to the last question posed to the

participants, the facilitator explains the

objective of the team facilitating the meeting.

b. He/she thanks the group for participating and

invites participants to offer any final comments.

c. He/she concludes the session and explains what

the next steps will be. He/she indicates that this

is the beginning of a joint effort, and that the

team will return to the communities to follow

up and to share the results of the investigation.

After the meeting The facilitating team should get together immediately

after each session to:

Go over the strengths and weaknesses of the

team’s performance;

Determine whether or not the subject matter was

adequately covered;

Determine whether or not the information sought

was gathered from the discussion;

Ask, What themes were the most difficult to

address?

Did new themes come out of the discussion?

Discuss how to plan for the next meeting and how

to correct any mistakes or make any changes that

might improve the process.

D. Production of the Videos

The videos should be produced in advance and should

follow an established script. Each team can prepare

its own script, and should be sure to have the elements

necessary for filming: actors, costumes, materials,

camera, video cassette, etc.

The script is a proposal that can be adapted to the

context and needs of the community.

There are teams that prefer to go into the field and

have the resources to travel to a community and

videotape the local people, and in the best case

scenario, that is the ideal.

Others prefer to bring the actors to a neutral location

where they act out scenes that are taped and edited

into a video.

Before holding the meetings, you should make sure

there is electricity to be able to show “a video;”

however, if there is none, you can organize a group of

volunteers to act out “a social drama or

dramatization.” You will need to explain the

objectives and who should make the presentation with

each group that participates in the meetings.

15

An example of the script for video 1 is presented in

Appendix 6.

E. Human Resources The necessary members and their functions:

a. A facilitator: This is (ideally) a person from

the community who speaks the language of the

place, and who guides the group discussion.

b. A participating observer: This is the person

who takes notes during the meeting and helps

the facilitator, indicating, for example:

That there is someone in the meeting who

has something to say;

That it is necessary to bring into the

discussion a participant who is sleeping or

not participating;

That it would be good to return to a theme

that one of the participants mentioned, to

complete it, etc.

c. A camera operator: This is the person who

will record images of the discussion meeting

for the purpose of sharing them. This is part of

the learning process with the people and can be

used as a medium for promoting community

mobilization to develop Emergency Plans.

F. Advance Planning and Logistics

Conducting meetings in the country’s remote

communities requires a considerable amount of

organization and coordination. The port of entry into

the community is formal local authorities.

Steps to follow:

Visit the selected community ahead of time to

confirm its interest and the possibility of

conducting meetings in the area.

If this is confirmed, plan the visit and make

arrangements for the necessary human and

material resources.

16

G. Resource Management (the things you need)

Set up a table of human resources with names of

specific members of the facilitating team for each

locality. An example of the Table of Human

Resources can be found in Appendix 3.

Set up a table of the material resources with the list

of supplies that will be needed for the meeting, and

use it as a checklist a day before going out to the

community. And example of a Table of Material


Prepare a socio-demographic information sheet for

recording the data (most important) concerning the

participants. See the example in Appendices 5A

and 5B.

Other preparatory tasks such as the translation of

the research guide or instrument into another local

language, should be performed ahead of time, and

the translation should respect the formulation and

the order of the questions in the original

instrument.

Make preparations for the work of transcription:

before going into the field, the team should locate

and contact with sufficient lead time the people

who will be doing the transcriptions, to ensure that

they will be completed as soon as possible.

Preferably, the facilitating team should also be

responsible for this task. These people should

speak the language of the place where the meeting

will take place, be fast typists, and, if possible, be

experienced in this type of work. They should be

given a sheet of instructions on how to do the

transcriptions. A model of instructions on how to

do transcription is presented in Appendix 7.

H. Time Management Calculating time is important at specific moments:

before, during, and after the meetings.

Before the meetings

Plan the meetings in advance and, as much as

possible, send a reminder one or two days before

the date of the meeting, in conjunction with health

personnel and/or local authorities.

Arrive at the location sufficiently ahead of time so

that the team can meet and iron out the final details

for each discussion meeting.

17

Plan the transcription of the sessions in advance,

taking into account the fact that it takes at least 8

hours to transcribe one hour of audio tape.

Anticipate follow-up activities and the outputs to

be presented as a result of the process.

Prepare a detailed workplan, taking into account

the points mentioned above.

During the meetings Plan each meeting taking into account the

characteristics of the community and the time

available to the participants. Keep in mind that the

participants’ time is valuable. You need to explain to

them the timeframe and process selected for the

discussion meeting and then keep to the times that you

have set. A table with the pattern for organizing

these meetings is presented in Appendix 8.

After the meetings Plan ahead of time the tasks of consolidation and

analysis of the information so that you can, in a

reasonable amount of time, transfer the information to

the stakeholders: the community itself and the

decision makers.

Refer to the workplan and respect the deadlines that

have been set. If this is not possible, communicate the

changes to the individuals involved (that is, those who

are waiting for the results from the team).

I. Space Management

You will need to take into account the physical

conditions in which you will be working, for example,

whether there is electricity or not (and if it is possible

to use an electric generator).

See to it that the room is as spacious as possible, but

not so large that it becomes a distraction. See to the

arrangement of the chairs, making sure that the

facilitator and his team are not positioned before the

audience as if in a lecture hall.

18

J. Systematizing (documenting) the experience

You can develop a journal of the most outstanding

moments, events and actions and, in this way, build a

vivid record of the process with the community. This

brief document of reflection and self examination

should be filled out at each meeting, including

everything having to do with preparation, invitations,

logistics and organization, facilitation, the use and

understanding of the instrument, the content of the

discussions, and the process with the community.

You can also keep a travelogue in which you can

document the formal and informal interviews and

observations of the facilitating team during their time

of residence in or visits to the community.

You can make tables summarizing the data

concerning the resources identified in the

communities, such as traditional and technical

communication media, sources of information,

networks, etc.

19

III. Creating Bonds of Trust To establish an open dialogue, you have to develop

bonds of trust and maintain them over time—

something that is not done from one day to the next.

Many times, the need to respect the rhythm of this

long term process runs up against the urgent need to

present results within precise workplans. So, how to

reconcile processes and outcomes? Within the

process of participatory research there are always

results that can and should be shared with the

stakeholders as they appear, and shared within

reasonable timeframes.

As the initiative progresses, it is necessary to work

within deadlines and offer useful outputs to the

stakeholders (communities and decision makers). The

success of this initiative has more to do with the

quality of the participation and the long term benefits

than with the number of people or communities

covered and the short term impact of the activities.

Bonds of trust are as much outputs as processes. It is

important to achieve a balance between short term

outputs and long term processes.

Important note It is recommended that on the day of the meeting you:

Try to create a good relationship with the

participants;

Arrive early at the meeting place;

Converse informally with everyone;

Invite the participants to share their information

(socio-demographic) with the person responsible

for collecting it and explain to them how the

information will be used. For example, get an idea

of the age of each person, how many children they

have, etc.

Make sure that the lunch break is free and that no

one lacks for anything.

20

THE COMMUNITY SHARES ITS IDEAS DURING PARTICIPATORY VIDEO DISCUSSION MEETINGS

“In practice, the one who has the last word is the lady’s husband; even if her brothers and sisters

would like for her to go to the health center, that depends on the husband. Although we might be in

the woman’s house, that is by choice; it must be the husband who gives the last word.” (Group of

Leaders, Totnicapán)

“…there are families that do want to, and there are others that don’t, even when the midwife insists

that they take her patient to the hospital; but if those involved don’t want to, it doesn’t happen.”

(Group of women, Totnicapán)

“…they came to look for me, since I have a car…” “…the husband came to tell us, but only when

his wife was at the point of death. And he said, do me a favor, take my wife to the hospital. We left

at 11 at night and arrived at 1 in the morning. And the doctor said, it is by the pure grace of God that

your wife did not die. Why did you wait until now to bring her in?” (Group of midwives, Zona

Reina, La Parroquia, Uspantán, Quiché)

“…what I saw in the film happened to me, because our husbands don’t stay home and you can’t

decide on your own.” (Group of women, Zona Reina, La Parroquia, Uspantán, Quiché)

21

IV. Appendices

APPENDIX 1

DISCUSSION GUIDE

THE DATA COLLECTION INSTRUMENT FOR PARTICIPATORY VIDEO DISCUSSION MEETINGS

INTRODUCING THE PROJECT AND THE TEAM The facilitator

Explains, in general terms, the objective of the

meeting and thanks the participants for coming.

Explains to the participants that the information

they share will be confidential and anonymous.

Explains the need to record the session to have a

“souvenir” of the meeting (he can offer, where

possible, to let them see the tape later).1 If possible,

he should ask their permission to make the tape,

assuring them once again of their anonymity and

confidentiality.

Explains to them that they will watch together a

couple of short videos that have been prepared for

the meeting, and that they will converse informally

about what each person thinks.

Asks them to interrupt him at any time if there is

anything that is not clear.

Introduces the other members of the team by name

and function (during the meeting). It is suggested

that their positions in the health care system not be

mentioned, to avoid bias.

Explains to them that they are going to begin with

a short exercise to get to know each other better.

1

It is very important to ensure the confidentiality and anonymity of the participants. To reassure them more concretely, the ideal would be for those of one region to meet with users of ANOTHER region than their own. Or, as we have agreed, that those who facilitate be people from the outside with good facilitation skills. Take care that the health workers who sometimes play the role of participating observers do not affect the outcome by their very presence.

22

ICE-BREAKER: To be chosen based on the characteristics of the

participants.

PART 1 Presentation of Video 1, followed by discussion.

The facilitator explains the process to the participants:

that he will show them part of a film which they will

discuss after seeing it.

Observation: watch whether the participants are

following the video attentively. Play it a second time

to make sure that all have seen and understood it from

beginning to end.

Video 1: Situation—emergency

Dramatization: a woman lies ill at home; the

person who is with her explains the woman’s

symptoms to another person, but none of them

know that these are warning signs. The midwife

arrives and states that in this case she can no

longer do anything. At the same time, a health

care provider arrives and insists that they take the

woman to the nearest health center. The husband

is not there, and the mother-in-law does not want

the woman to be taken to the health center. A

heated argument ensues among those who are

around the woman about what should be done.

You see the woman becoming weaker the whole

time, beginning to faint. The film cuts off here.

Video 1, discussion questions:

1. What does what you have just seen remind you of?

Have you experienced anything like this? Have

you heard of a case like this in your community?

2. What happens in the film? What problem does the

sick woman have? Who are the people arguing?

Why are they arguing?

3. In cases like this, what do people of your

community do? What does the woman do?

4. (If necessary, pick up the thread of the story to

help the participants remember). In your opinion,

what would happen next? When and how does the

family realize that the woman’s condition is

serious? Who are the ones who decide what to do?

What do they do (accept that she is going to die,

call in a traditional healer, take her to a health

center: church based, institutional, women’s

practice)? What happens to the sick woman at the

end (dies, survives)?

5. What problems will they have to face in trying to

save this lady’s life? What do they need to resolve

these problems? Who helps them? Who does not

help them (at various levels: family, community,

networks outside the community)? How hard is it

to resolve these problems?

6. If you were in this situation, what would you do?

7. What happens when a woman dies in the

community? Who are the children left with? Who

takes care of them? What happens to the husband?

23

PART II Presentation of Video 2, followed by discussion.

The facilitator explains to the participants that they

are going to see part of another film and discuss it

afterwards as before.



to make sure that all have paid attention.

Video 2: hypothetical case in which it was decided to

take the lady to a health center (system financed with

state funds)

Dramatization: they arrive at the Health Service

and a service provider receives them saying why

did they wait so long. He is rude to the family and

to the midwife. The medical health care provider

on duty arrives (a young man). He does not speak

the language, and willingly explains what is wrong

with the patient. The interpreter has difficulty

translating because the doctor has used technical

terms that do not exist in the local language. The

doctor starts gathering the instruments needed for

the intervention, and everyone around begins to

mobilize—and the film cuts off.

Clip 2, discussion questions:

1. What did you see in the film? (have them explain

what is happening in the film: “What is

happening?”)

2. Has anything like this happened to you or to

someone you know? What happened?

3. What is it that most draws your attention in this

second film? What else do you see? Is it like this

in the health services that you know?


help the participants remember). Do you

remember that we showed you only one part of the

film?

What do you think happened at the beginning (in

the part of the film that we did not show: when the

family arrives at the health center)?

4.1 (If the subject was not addressed in the

previous section) What did the family do to

get to the health center?

4.2 How was the family received at the health

center? How do you think that the health

workers treated the family, the lady, the

midwife? Did they let them ask questions?

How did they answer?

4.3 What did the health workers say to the

midwife?

5. And in the film clip that we saw, how do you think

the lady and her family feel in the place where she

is being treated? How does the place where the

lady is being treated seem to you? How do you

see this place? What is present and what is lacking

in the health center? What do you like and what

don’t you like?

24

6. If it were you in this situation, what would you do?

7. At the end of the film (which we haven’t seen

either because we cut it off before it got there)

what do you think happens to the lady (does the

lady live or die)?

8. What would be a happy ending to this second

film? What would be needed to get to this happy

ending?

9. How would you like to be treated in the health

centers?

PART III Dramatization followed by prioritization

Ask participants to divide up into two or three groups

(depending on the number of people). Each group

will act out how they would like the first story that we

just saw to end: from the moment the lady arrives at

the health center until her life is saved.

ATTENTION: We will begin with a dramatization of

the happy ending related to video 2 that we just

finished showing.

Dramatization of the gravely ill woman in the

health center: happy ending.

Each group presents its dramatization (taped as

they occur, like the rest of the meeting).

Dramatization 1, discussion, prioritization

Ask the participants to comment on the

dramatizations of the other group and their own

group:

Facilitator’s questions: How did you feel in the

health center? What did you find that you liked?

How did they treat you? How was the life of the

sick woman saved?

The facilitator draws pictures on the flipchart of

what the people are saying (this can also be done

by another member of the team who has an

aptitude for drawing).2 Facilitator and observer

write down the points mentioned by the

participants to complete the pictures on the

flipchart.

Once the two groups have completed their

comments, the facilitator poses the following

question (prioritization):

1. If you had to arrange everything you mentioned

in order of importance, what would come first?

2 Another possibility would be to use

a flannel board with figures prepared ahead of time. For this, you could see in the first meetings what

elements came out of the discussion with the participants and, on that basis, start making the flannel board, which would serve as a tool for discussion in subsequent meetings throughout the investigation and in other phases of the project, to the extent that they related to participatory research.

25

What next? Explore the reasons for this order of

priority. Arrange the components in the order of

priority indicated by the participants (write

numbers 1, 2, etc. on the list on the flipchart).

PART IV Dramatization followed by community mapping



will act out how they would like the first story that

theyjust saw together to end (Video 1): from the time

the lady falls ill until it is decided what to do. Explain

to them that the dramatization or presentation must

show how the community is organized to deal with a

serious case (emergency in the community): What do

they decide to do? When do they make the decision?

How do they manage to get the woman out of her

house to save her life? What helps them? Who helps

them?

Dramatization of an emergency in the community:

happy ending.



Dramatization 2, discussion: mapping



group.

Facilitator’s questions:

1. Who can help bring about these happy endings?

For example, to take the woman to a health center

where they can save her life? Who can help make

the decision in time? Who can help with

transportation? Who can inform other members of

the community and the health service of the

emergency?

The facilitator draws figures on the flipchart

representing these players.

2. Where are these people in the community? Near

the home? Far from the home? What can be done

to locate them? Is it possible to speak with them?

The facilitator, using the information supplied by the

participants, draws a map of the community on which

can be placed the key people who can help families in

case of emergency: local institutional authority, local

traditional authority, traditional health care system,

neighbors, etc. Showing the map to participants, the

facilitator verifies that his drawing corresponds to

3 You might also consider making a flannel board, as in the previous exercise.

26

what they said, and poses a final question to the

group:

3. What can the community do to help in emergency

cases? Can we all work together to save lives?

Conclude the meeting by:

Explaining that the objective is really to work with the

community to improve health services, to help them

prevent health problems, and support them in dealing

with emergencies in order to save lives. Reiterate that

we are engaged in a long term process, and this is

only the beginning. Thank them for their participation

and invite them to make their final comments (if they

have anything to add). Then conclude the

conversation by explaining what the follow-up will

be. In doing this, it is suggested that you reiterate that

this is the beginning of a common endeavor; that we

will be returning to the communities to continue the

process.

NOTE: As follow-up to this investigation, you might

hold a debriefing session with the community on the

results of the participatory research, in the form of

developing local emergency plans (the name to be

given to this type of initiative will come out of the

groups themselves). We should not forget to involve

(in one way or another) the people who agreed to

participate in the discussion and in the other phases of

the project.

27

APPENDIX 2

A FEW TIPS

Basic Rules: I. Practice “active listening”

That means, listen in a way that communicates

respect, interest, and empathy. These attitudes

can be conveyed verbally and non verbally.

How can I verbally communicate to the person

that I am listening to him/her?

How can I non verbally communicate to the

person that I am listening to him/her?

II. Use language that is simple and clear No professional jargon

Use terms that the participants understand

Culturally appropriate language

Some techniques for clarifying answers or probing into what a person is saying:

1. Paraphrasing: that is, repeating in other words

what the person has just said

Example:

2. Posing follow-up or “checking” questions: this

is a KEY technique in this kind of

investigation. It is used to understand the

reasons for people’s behaviors, attitudes, or

motivations. It is a question that CLARIFIES

an answer given by someone. It helps us to

PROBE a point that we consider important.

How to do it:

Give the person time to keep on talking (wait in

silence for a short time after the person has

answered).

28

Repeat in other words what the person has just

said.

Repeat what the person has just said, but in the

form of a question.

Ask the person to clarify a declaration, for

example: “I don’t understand very well. A while

ago you said ‘one thing,’ and now you are saying

‘another thing.’”

Use key words, such as

PARTICIPANT’S DECLARATION FACILITATOR’S QUESTION

“I’m not happy with this situation” “I like some of it” “It would be convenient” “It works well for me”

“What causes you not to be happy?” “Why aren’t you happy?” “What is it that you like?” “How would it be convenient?” “How do you know that it works?”

Use the third person technique. Example: “You

seem to be very convinced about this. How do you

think that others feel about it?”

Some useful examples: Could you tell me more about that?

What do you like or not like about it?

Could you give me an example?

I would like to know more about what you think about

this subject.

I’m not sure I understood what you meant when you

used the word “…”

What does “such and such” mean?

What makes you feel that way?

Why do we need to use these kinds of questions? Because:

Sometimes it is necessary to get information out of

people “with a teaspoon.”

It is often difficult for people to talk about what

they FEEL.

We can misinterpret what a person says to us.

Thus, you will use this type of question when:

You have not completely understood what the

person said;

29

You want more details or specific examples;

You are trying to uncover feelings and

motivations;

You are not familiar with the terms that the person

is using;

You think the person is saying only part of what he

is thinking.

3. Giving “positive feedback”

That is, praise or encourage the person

concerning what he says he has done. This

helps people feel more comfortable with the

facilitator (who is not making value judgments

and not “criticizing” the person), and thus

encourages them to give more information.

This technique can also help reinforce a desired

behavior. Sometimes this is difficult to do

because the person could be describing a

behavior we disapprove of or consider “bad.”

Example: a man decided not to take his wife to

the health center but then realized that it would

have been better to have taken her. The

facilitator can say to him, “It’s good that you

have realized it would have been better to take

her. What made you change your mind? What

would you do now?”

Other advice:

4. Avoid questions that lead to “yes” or “no”

answers, that is, closed questions.

5. Rephrase questions when necessary to ensure

understanding and cultural adaptation.

6. Don’t give the impression that you are testing the

participants’ knowledge.

7. Put yourself in the participants’ place to see if you

would feel threatened by a particular question or

the way it is formulated.

8. Don’t guess any answer. What you think might

not coincide with what the other person is

thinking.

9. Don’t include ANSWERS in your questions.

10. If people are speaking in a “neutral” manner about

a subject, or if the participants are not talking, you

can sometimes play the “devil’s advocate,” always

being careful not to obstruct the process of

communication.

11. Remember that you are leading a group discussion

and not individual interviews. Refer the comments

and answers of one participant to the group to

encourage other comments. Connect the answers

of different participants to further explore a

subject.

30

APPENDIX 3

TABLE OF HUMAN RESOURCES

Municipality:

Community:

Team* Group

Facilitator Participating

Observer Camera

Operator Other

(specify) Date

Women

Midwives

Leaders

Men

*The pilot, responsible for transportation into the

community, is also a key member of the team. If it

is considered necessary, a specific column can be

added to include him in the table.

In some cases, the pilot might also attend to other

tasks during the discussion meetings, such as camera

operator, for example.

31

APPENDIX 4

CHECKLIST FOR MATERIALS AND SUPPLIES

MUNICIPALITY:

COMMUNITY:

DATE:

MATERIAL NUMBER CONFIRMED TO BE CONFIRMED

1. -TEAM

Television

VHS

Audio tape recorder

90 min. cassettes

Adaptors

Extension

Microphones (AAA batteries, recharge. battery)

2. –SUPPORT MATERIAL

A. Videos (video clips-short films)

B. Graphic material

C. Flannel board or figures (if it is decided to use these materials instead of drawing)

D. Participant identification

Name tags

Table with socio-demographic information Sheet with list of participants

32


E. Other supplies

Masking tape

Flip charts

Permanent markers

Scissors

Tacks

3. -REFRESHMENTS

List of participants

Refreshments

Soap(*)

Towels(*)

Basin(*)

4. –OTHER ITEMS

Balls or candy for the children

(*) These are some ideal materials to make it easy for the participants to wash their hands before eating.

33

APPENDIX 5 (A)

SOCIO-DEMOGRAPHIC INFORMATION SHEET

GROUP:

COMMUNITY:

DATE:

No. Full name Age Community No. children User Non user

1

2

3

4

5

6

7

8

9

34

APPENDIX 5 (B)

SOCIO-DEMOGRAPHIC INFORMATION SHEET (LEADERS)

GROUP:

COMMUNITY:

DATE:

No. Name Age Community Group or organization

1

2

3

4

5

6

7

8

9

35

APPENDIX 6

SAMPLE SCRIPT

Sample script, prepared by coordinators of the community component of the Maternal and Neonatal Health Project/JHPIEGO CORPORATION. Example for Video No. 1 of Participatory Video Discussion Meetings Place: House in the community, the home of a woman who has just given birth Characters: 1. Post partum woman (in the room) 2. Neighbor woman (in the room) 3. Midwife (arrives later) 4. Nurse’s aide (arrives later) 5. Mother-in-law (in the room) Time: Post partum Complication: Post partum hemorrhage As the scene opens, the woman is in her house, it is clear that she is very ill (she is complaining) Neighbor woman:

(Very calmly) (She turns and speaks to the mother-in-law) Doña Juana… look… Maria has a fever, she has a headache, her stomach hurts, look, she is losing a lot of blood (she looks at the woman) (in a normal tone of voice, as if she thinks that what is happening is not dangerous)

At this point, the midwife arrives with the nurse’s aide.

36

Midwife: (speaking to the neighbor woman and the mother-in-law)

Maria is very ill, I can do nothing more. At this point, the nurse’s aide says (very worried and hurried)

Nurse’s Aide:

Doña Juana, let us take Maria to the hospital. She is very ill; she could die. We need to get help so that she can be healed.

Mother-in-law:

The problem is that Juan is not here. I don’t know when he will be back and I can’t let them take her to the hospital, they’re not going to let us go in with her and she will die (worried, but determined not to let them take her).

At this point, the argument intensifies among all players (the tone of voice and gestures of some showing that they are in favor of taking her, while the tone and gestures of others show that they do not agree, minus the woman). (They may all speak at once.) THE FILM CUTS OFF HERE.

37

APPENDIX 7

SOME TIPS ON TRANSCRIBING

The format that the person uses to transcribe the

information will depend on how the transcript will be

used. Thus, if the meeting has been video taped and

the intention is to edit the tape, a format will be used

that will allow the images to be matched with the text.

If the intention is to use the transcript for an analysis

of the discourse (verbal) of the participants, it will

suffice to transcribe the verbal statements of the

participants.

Some instructions for transcribing

Indicate who is speaking in each case.

Translate what the person says as he says it.

Do not summarize or synthesize what the person is saying.

When it is difficult or impossible to translate words into Spanish (because they do not exist in our

vocabulary), write them in the local language and explain in parentheses what they mean, even if that means

giving a detailed explanation of the meaning.

When the literal translation of the word illustrates ways of thinking or looking at the world, stick to the

“literal” translation and explain in parentheses what the word means in context (for example, if the person

uses the term “filthiness” to refer to menstruation, write “filthiness” and explain in parentheses what it

means).

38

APPENDIX 8

POSSIBLE FORMATS FOR ORGANIZING THE DISCUSSION MEETINGS

To be discussed with key people who know the community well, including health care providers who are to

support this process.

FORMAT

ADVANTAGES

DISADVANTAGES

A 2-hour meeting

Very dynamic We can be sure of covering all the subjects with the same people (“captive audience”)

Sometimes does not fit the rhythm of the participants Is difficult to control the time, particularly if the facilitator does not have much experience

3-hour meeting with an intermission

Allows more time for discussion Everything can end on the same day

Risk of some participants leaving during the intermission

Divide the activity into 2 sessions of an hour and a half each, within a reasonable timeframe

Easier to cover all subjects thoroughly while respecting the rhythm of the discussions and without tiring the participants

More chances of losing people from one meeting to another

“TYING KNOTS” FOR HEALTHY MOTHERHOOD A Method of Participatory Research and Action Using Video Discussion Meetings User’s Manual

“TYING KNOTS” FOR HEALTHY MOTHERHOOD A Participatory Method of Participatory Research through Participatory Video Encounters

User’s manual

Thank you for your support!

Educational Producers and Evaluators Marcela Tapia, Patricia Poppe, Robert Ainslie

Adaptation for Guatemala

Human Resources Responsible for the Investigation

Technical Reviewers Ministry of Public Health and Social Welfare of Guatemala

National Program for Reproductive Health, Executive

Board, USAID

Collaborators Technical and Administrative Personnel of the Maternal and

Neonatal Health Project

Regional Health Offices: El Quiché, Totonicapán and Sololá

Midwives of Cantel, Quetzaltenango

Midwives of Santa Catarina Palopó

Groups of women, men, leaders, midwives, providers

(purpose of the investigation)

Photographs

Graphic Design and Diagrams

Note: It is important to indicate that in this document the masculine gender has been used on most occasions in which the text might refer to either

men or women. This measure has been adopted with the sole intention of simplifying the text, without any suggestion of preference.

This publication was made possible with the support of the Agency for International Development (AID), under Contract No. C.A. HRN-A-0098-

00043-00. The opinions expressed are those of the authors and do not necessarily reflect the point of view of AID.

Guatemala, January 2004


User’s manual

TABLE OF CONTENTS

INTRODUCTION

PART I:

THE RAW MATERIAL 1. The various change agents as resources

2. Visions of the world and visions of health

3. Starting from reality: working with existing organizations and

initiatives

4. Towards gender inclusion

5. From soliciting help to empowerment

PART II:

THE INSTRUMENT

PARTICIPATORY VIDEO DISCUSSION MEETINGS

1. Objectives of participatory research

2. The instrument: Participatory video discussion meetings and how to use them

Step #1. Creating a good relationship

Step #2. Introducing the facilitating team and the participants and

presenting the project

Step #3. Creating a friendly atmosphere: Ice-breaking exercise

Step #4. Presenting stories from life: Videos 1 and 2

Step #5. Prioritizing the attributes of quality that a health center

should have from the community’s perspective

Step #6. Conducting community mapping

Step #7. Wrapping up the meeting and continuing the collective

action

3. The facilitating team for participatory video discussion meetings 3.1 The facilitating team

3.2 The qualities and skills of the facilitating team

3.3 Practical tips for leading group discussions

4. The participants from the community invited to the participatory

video encounters

4.1 The process of inviting the participants

4.2 Criteria for selecting participants

5. Planning ahead and logistics 5.1 Resource management

5.2 Time management

5.3 Space management


User’s manual

6. Processing the information

6.1 Processing the experience

6.2 Analyzing the discussion meetings

7. Use of the instrument within the process

PART III:

THE “KNOTS”

1. Recognition and incentives

2. Giving back to the community

3. Tying the knots

PART IV:

APPENDICES


User’s manual

INTRODUCTION

This manual has been designed to lead the reader step by

step through the application of a participatory research tool

in a maternal and neonatal health project. This method of

investigation (instrument or tool) is called the “participatory

video discussion meeting.” A participatory video discussion

meeting is a meeting for discussion in which testimonies,

stories and images on video are used to stimulate dialogue.

The “tapestry of knots” we know today reflects the

components and characteristics of the participatory research

process that includes this particular method of investigation.

We have chosen this analogy because the “tapestry of knots”

is an “indigenous” cultural element, that is, it is created from

the community itself and represents it. The knots represent

at once permanence and change, since every tradition has a

past (has history), and at the same time has a future and

evolves with time. The knots are, therefore, not only outputs

but also processes since they are continually created and

recreated over time. Moreover, the knots symbolize

community, mutual support, the formation of networks, and

solidarity.

This manual proposes to “tie knots” for healthy motherhood

through a process that involves learning, reflection and

action. The first part of the manual, “The Raw Material,”

highlights the essential and most valuable resource for this

work—the human element, that is, the community, health

care providers, and external agents working together to

create and strengthen the “knots” for improved health. The

second part, entitled “The Instrument,” contains a detailed

description with precise instructions for using “participatory

video discussion meetings” as a method/tool of participatory

research. The third part, “The Knots,” presents in detail the

process of dialogue and community participation that is the

very essence of the process of participatory research.

Parts II and III are the most condensed sections of the

manual, but essential to contextualize and help the reader

understand the principles that guide the use of the

instrument. Part II of the manual is the most extensive,

since it contains detailed instructions that will allow the

reader to take ownership of the instrument step by step, and

use it to forge bonds with the community. To complete the

manual, we have included in the appendices section various

documents that the reader can photocopy when needed.

To gain a more complete vision of the participatory research

process, and to use the instrument in harmony with the

objectives of mutual learning established within the

framework of this project, it is recommended to read this

manual as a whole. Although each part of the manual

addresses different themes and provides elements for


User’s manual

reflection that can be used separately, the three parts

complement each other and represent, in effect, a whole

within the process of participatory research.

The commitment of this manual corresponds to the ultimate

goal that inspired the development of the instrument, that is,

to “tie ever stronger knots” to support life and the need to

take action within the community when it and its families

are confronted with cases of obstetrical emergency. It is one

attempt to contribute to social change, to make long term

commitments and actions, and to strengthen existing social

networks in the community.


User’s manual

PART I: THE RAW MATERIAL

Every process of participatory research for social change

should focus on the potential existing in the communities.

Without denying the lack of resources and infrastructure that

afflict communities, it is essential to recognize existing

resources as a point of departure for working in the

community. Along these lines, beyond the material

resources available, we need to highlight the great human

potential existing in each community. Added to this are the

working groups and external agents committed to supporting

the community in its own process of social change. The

different paragraphs in this first part of the manual suggest

themes to guide your thinking regarding the valuable “raw

material” existing in communities, and the necessity and

relevance of building on what is there, on the strengths and

potential of each community. Farther along, some models

are proposed to guide the reader in the use and adaptation of

this manual, taking into account the need to include the

community’s most vulnerable groups in the process of

participatory research. We will look at:

1. The various change agents as resources A project or collective endeavor does not get started by

spontaneous generation. Thus, the role of community

“change agents” and of external catalysts is fundamental

during the startup of any project. Community “change

agents” are people who have influence over others and who

are capable of generating change within the community. It

is often they who become aware of the existence of a

problem and begin to mobilize the community in search of a

solution. Those who come from outside to support the

community are called “external catalysts.” Their role is to

facilitate the process of change in the community, using

tools such as those suggested in this manual. Sometimes

they are the ones who suggest that the community work on a

specific problem that has been identified, through research

studies, for example. Their role as facilitators is not to

impose an agenda on the community, but rather to work with

the community to help it:

identify and become aware of the problem, and

decide what should be done to resolve it.


User’s manual

The facilitator orients the community and enters into a

dialogue with it in order to take appropriate action, without

unilaterally imposing his point of view. Together, the

community change agents and the external catalysts can help

the community identify a problem and establish common

goals for solving it.

There are sectors of the community particularly affected by

the problem that is being addressed, and it is essential to

involve them in the process: in this case, maternal and

neonatal health issues directly affect women of reproductive

age and their midwives. The heads of families are another

key group, since the actions taken in cases of emergency

often depend on them. When conducting participatory

research, it is important to take into account the real or

potential role that each of these figures plays in the

community. Special consideration should be paid to the

question of how to involve groups that are usually absent

from the arena of decision making in the community.

There is no one, predetermined model for initiating the

process of change within a community with the help of

participatory research. The characteristics that the

experiment assumes will depend on the people involved, the

existing means of organization, and the surroundings. In

every case, what is important in the process is to turn the

focus of the endeavor away from the deficiencies and

shortcomings of the community. Instead, we propose to

focus the intervention on the strengths of the community

and the specific players involved. It is important to be

aware that the role of each of the following:

women

husbands

midwives

leaders

community change agents

external catalysts

authorities

is essential, and that what each one brings from his/her

position to the participatory research should be appreciated

and respected.

Using the strengths of the players involved as a

starting point helps to strengthen the bonds

between the community and the external catalysts.

Both parties will be joined by the conviction that

they can move forward together:

reappropriating the past

focusing on the present, and

incorporating in their actions a vision of the

future.


User’s manual

2. Visions of the world and visions of health

Many development projects have failed in the past because

they did not take into account the point of view of the

interested parties and tried to impose patterns of behavior

that were foreign to the local culture. The focus on

community strengths goes hand in hand with the recognition

of the cultural differences between the external catalysts and

the community. The recognition of these differences also

implies the need to understand how “the Other,” the one

who is different from me, conceives his own problems and

his reality. Without needing to blindly accept traditions that

might be harmful to the people’s health, it is important to

know what health means to the community, and what are its

priorities, values, and traditions. An open exchange with the

community about its customs and beliefs can lead us to

discover traditional practices that will need to be modified as

well as customs that should be reinforced and integrated into

the practice of western medicine.

In the context of this participatory research activity, it is

particularly important to know the community’s point of

view concerning health services, or what we call “the

attributes of quality” with regard to health care. The

“attributes of quality” are the characteristics of health care

services that determine whether or not the users appreciate

them. For example, a person might complain that she is

made to wait a long time before being seen at the health

center. In this case, the quality attribute is “rapid attention.”

Another person may say that she is going to the health center

because she knows that the staff who see her there will treat

her well. In this case, the quality attribute is “good

treatment.” In the first case, the service lacked the attribute

in question, while in the second, the service possessed the

attribute or characteristic that was important to the user. The

fact that a health center does or does not have a certain

attribute may lead the user to choose one service over

another, or simply not use any services. This is why it is

important to know the attributes of quality from the

community’s point of view.

The process of participatory research proposes a perspective

from within, that is, that starts with the community’s point of

view. Listening to the community’s point of view will help

to better understand the community’s ways of being and

doing. This means that we are going to listen to what people

are telling us and learn from them and with them. We are

not going to be empowerers, but rather facilitators who go to

the communities to learn the point of view of their members

concerning health and health services. This perspective

from within will help, for example, in the case we are

looking at, to better understand what people like about their

services and what could be improved to make the people

satisfied with them. The perspective from within will also

help better understand how members of the community deal

with obstetric emergencies and what causes them to act in

one way or another. This will make it possible to develop

activities adapted to the context, that take into account the


User’s manual

point of view and the reality (psychosocial, socio-economic

and cultural) of those involved.

In holding conversations with members of the community,

the most important thing is to clearly distinguish between

what “I” think and what “they” think. We must strive to put

aside all the ideas we have about the community in order to

listen to the people with fresh ears and be able to understand

what they are telling us.

In an intercultural exchange, the act of opening your eyes to

the community’s vision of the world goes hand in hand with

an awareness of your own prejudices, values and cultural

norms.

3. Starting from reality: working with existing initiatives and organizations

The approach used in this manual implies starting from the

reality that exists instead of trying to impose an agenda or

program that is not relevant to the community. To the extent

possible, you should try to integrate participatory research

into the initiatives and areas of intervention of the

organizations already working in the community.

For example, the project of building a birthing center or

community maternity clinic might be the motor that drives

the process of participatory research in the community. In

the same way, you must be aware at all times that the

process begun in the community should be given back to the

community to which it belongs, and that the best ways to do

this are often through the health committees or groups

already working in the community. On many occasions,

when it comes to maternal and neonatal health, you may

consider expanding and/or strengthening the fundraising

activities that are already carried out in a particular way in

the community. For example, there are communities in

which funds are collected for cases of death or emergency.

Instead of proposing something new, you can improve the

organization, planning and management of these activities as

part of a “Community Emergency Plan,” a name that could

The community’s experiences in:

Project development

Community organizations

Collective management (e.g.,

fundraising)

are part of the community’s baggage that should

be taken into account during the participatory

research.


User’s manual

well be changed according to what the community decides.

When you start with what is already there, you are better

adapted to your surroundings. The process of participatory

research can help to both identify and improve on

experiments already taking place in the community. This is

important because:

You need to be attentive to the opportunities for

mobilization and participation existing in the community

You need to get involved in the existing nuclei of

community organization

You need to improve what already exists instead of

“reinventing the wheel”

It is also important to take into consideration the calendar

of agricultural activities and the agendas particular to

each community in order to collaborate more effectively

with them. For example, it is no use to try to organize

meetings with men at harvest time when everyone is

outside the community. Nor would it be useful to

organize meetings to talk about the health of the mother

and the newborn when the community is in a week of

celebration or has some other urgent problem to deal with

(for example, a flood).

It must not be forgotten that the other key players in the

process of participatory research are the health care

providers. The same thing that we advocate for the

community also applies to the service providers involved in

this intervention. For example, it would not be realistic to

think that the nurses or social workers could put aside their

work in the clinics to dedicate themselves completely to

facilitating “participatory video discussion meetings.”

Those who might be interested in doing it will need to: 1)

plan their work in such a way that these discussion meetings

complement it; 2) analyze to what extent they can assume

the functions of the facilitating team for the discussion

meetings and have the participants feel free to “tell it like it

is” and not how it “ought to be.” At the same time, we

know that some of the activities planned within the

participatory research can reinforce the operations of the

health care providers. For example, the “community

mapping” to take place during and after the participatory

video encounters is a tool for locating the resources

available in cases of emergency in the community, which

reinforces one of the functions of the community facilitators

in the emergency rooms. Since we know that community

facilitators need to make maps of the communities, the tool

of community mapping within the context of participatory

research will necessarily help them in this task. It is a matter

of identifying in the field the best way to involve health care

workers in participatory research activities from where they

are.

The use of participatory video discussion meetings as a tool

of participatory research must be adapted to the reality of the

community and of the service providers, starting with what

is already there in order to strengthen it. The very process of


User’s manual

reflection and action will lead to the collective formulation

of proposals for effecting changes that will benefit everyone.

4. Towards gender inclusion

Starting from reality does not mean accepting the status quo

(things as they are) and the unequal power relationships that

might exist in a community. It is about including and not

excluding and, within vulnerable groups, women are often

excluded from decision making, even in matters that directly

affect them, such as death in childbirth. Despite the

preponderant role that women play in the community as a

whole and in health matters in particular, they are often

absent from the health committees, the pro-maternity

committees, and other nuclei of community organization.

However, when given the opportunity to participate, they are

capable of articulating their ideas and making suggestions

that can benefit the committees as well as the community as

a whole.1 It is necessary to support the participation of

women at every level and at specific times in the

participatory research, including active participation in the

health and pro-maternity committees. This can be achieved

through specific measures, such as:

1 We were able to confirm this during participatory video discussion meetings

that were carried out in Zona Reina.

Providing incentives for participation in the participatory

video discussion meetings by women in the community

who are not used to participating

Discussing with the community how women leaders,

midwives, and community women in general might be

included in the committees that make important health

decisions.

The external catalysts in the participatory research can play

an important role in this regard, since they bring a different

point of view (that is, that women can and should

participate), and are able to influence the opinions of

members and leaders in the community.

5. From soliciting help to empowerment It may happen that, when a team comes into a community,

its members and representatives ask the team to solve the

problems that afflict it. The community may also express:

Its feeling of impotence when faced with the conditions

that confront it.

Its feeling of helplessness to solve its problems.

Its belief that only the people coming in from outside are

capable of changing the situation.

Often the members of the community lose sight of what they

are doing day by day to improve their situation and that of


User’s manual

their children. They have an image of themselves centered

more on what they lack than on their strengths. And the

same thing often happens with some of the people from

outside the community, who see above all its shortcomings

and not its strengths. Participatory research seeks precisely

to reverse this situation and bring to light the strengths and

the worth of the community’s own initiatives.

We should not deny the community’s concrete need for

help; on the contrary, we should be attentive to it. The thing

to avoid is falling into “paternalism” or “aidism” that

consists of doing things for the community instead of doing

them with it. We must remember that the mutual learning

process we have begun should help develop in individuals

and in the community:

Confidence in themselves;

The sense of being able to do things;

The skills required to complete projects.

It is a matter, for example, of showing the community the

steps to follow in formalizing an agreement, not to take the

steps for it. You need to bring to light past and present

successes to encourage people to continue on. In other

words, you need to try to emphasize at all times the

community’s own capacity for transformation. In this way,

a request for help can be converted into an opportunity for

empowerment. Starting with community dialogue, you can

promote a process of social change, in which the community

takes the reins and feels capable of finding solutions to its

problems—a guarantee of sustainability and of long term

actions. The use of the instrument, as described in the

following section of the manual, is embedded within this

context of social change and empowerment.


User’s manual

PART II: THE INSTRUMENT Participatory Video Discussion Meetings

Once we have a clear view of the potential existing in the

community and the value of the “raw material,” it is

necessary to find the right instrument and methodological

process for working with community groups, based on the

ultimate goal of the project, which is to promote healthy

motherhood through:

The next step is to analyze the potential of video as a

generator of ideas and discussion, of reflection and

internalization of health issues. Of equal importance, the

active participation of the community analyzing its problems

and empowering itself to identify solutions and mobilizing

collectively leads to the objective of making room for

dialogue, collaboration and collective action at the

community level. Thus, this manual proposes “participatory

video discussion meetings” as an instrument and process for

reaching the above mentioned goal. Further on, it explains

in detail the objectives of participatory research, the

characteristics of the instrument of the participatory video

discussion meeting, the methodology and process for using

it, the facilitating role to be fulfilled by the team, the active

participation of the community in the “discussion meetings,”

and the logistical work that will ensure that the “discussion

meetings” flow with confidence, and the analytical capacity

and desire for action on the part of the community to arrive

at a commitment to saving lives.

1. The objectives of participatory research

The central theme of participatory research is to investigate

in partnership with the community the causes of maternal

and neonatal deaths, as well as the availability of health

services to assist in the presence of a case of obstetric

emergency. Our objectives are:

Enhancing and strengthening community participation

in the different components, caring for maternal and

neonatal health, and continual improvement of life

saving services.


User’s manual

To get the community’s point of view on health services,

specifically as they relate to maternal and neonatal

health.2

To facilitate the active participation of the community in

analyzing its own reaction to an obstetric emergency,

observing the decisions and actions taken.

To support the community in its process of buying into a

program aimed at developing Community Emergency

Plans3 to save the lives of mothers and children.

In general terms then, the instrument and process of

“participatory video discussion meetings” serve to bring us

closer to the community, to “tie knots” with it, and learn

together:

What the community thinks and feels about health

services and the causes of maternal and neonatal deaths.

The real and potential barriers to and facilitators of use of

services.

2 To address other subjects using the same method, it would be necessary to

adapt both the content of the videos and the discussion guide. 3 The development of Community Emergency Plans implies, among other

things, the creation or consolidation of community networks for treating emergency cases.

The beliefs, attitudes and practices that influence

decisions on health in the community.

The aspirations of the community concerning: (a)

organizing to handle emergency cases; and (b) the

treatment and care provided in health care facilities.

The resources existing in the community that offer, or

could offer organizational opportunities for the

formulation of Community Emergency Plans.

2. The instrument: participatory video discussion meetings and how to use them

As mentioned earlier, the instrument developed to move

forward the process of participatory research has been called

“participatory video discussion meetings.” One of its key

approaches is the use of pictures to record testimonials and

life stories related to a particular health topic. When these

life stories are presented, especially when they are

developed and produced in partnership with the community,

the participants in the meetings or “discussion groups”

identify with the characters and situations portrayed and

relate it to what they experience in their own community. A

very fruitful discussion follows, in which the participants are

encouraged to tell their own stories, offer different and/or

complementary points of view, think about what they have

seen and heard and, in many cases, negotiate proposals for


User’s manual

taking action. Hence the use of what we call “participatory

video discussion meetings” with the communities, as

opposed to the use of techniques for collecting data on the

community. In effect, it is an instrument of mutual learning

more than a technique, a tool for encouraging and

maintaining social change in the community.

Since the organization of the “discussion meetings” takes

place in the community, an implementation and discussion

guide is available to help us move through the process of

“participatory video discussion meetings.” The “discussion

meeting” is organized around the following seven key steps:

1. Creating a good relationship

2. Presenting the project and introducting the facilitating

team and the participants

3. Creating a friendly atmosphere: ice breaking exercise

4. Presentation of short life stories: videos 1 and 2

5. Prioritization of the attributes of quality from the

community’s perspective

6. Community mapping

7. Wrapping up the discussion and continuing collective

action

Step #1. Creating a good relationship

This is the first contact of the facilitating team with the

participants in the handling of the working sessions and

the “participatory video discussion meetings.” The

facilitating team4, although not in its own community,

plays the role of host and, and such, is in a position to

welcome the participants from the moment they arrive at

the meeting place. To successfully play the role of host,

the facilitating team should:

Get set up ahead of time in the room where the

discussion meeting will take place, so that they can

greet the participants as they arrive.

Converse informally with the participants and give

them a respectful and friendly welcome.

Invite them to give their information (socio-

demographic) to the person responsible for

collecting it, who can explain to them that this

information is only being asked to get an idea of

their ages, the number of children they have, and if

they are already using health services.

The team should take advantage of the refreshment break

to continue developing a good relationship with the

community. At this time, whether it is in the middle or at

the end of the discussion meeting, the facilitating team

serves the refreshments and interacts with the

participants. Just as if they were entertaining a friend at

home, they wait on the participants as graciously as

possible, making sure that no one wants for anything and

conversing with them.

4The composition of this team will be explained in the next section.


User’s manual

One barrier to interaction between the facilitating team and

the participants might be the fact that they do not all speak

the same language. In this case, the members of the

facilitating team who speak the participants’ language will

act as a bridge between them and the rest of the team. It is

also important to remember that, more than verbal

communication, the non verbal communication, the attitude,

the care that is taken to ensure that no one lacks anything are

signs that the participants notice, and that contribute to

creating a good relationship with them.

Step #2. Introducing the facilitating team and the participants, and presenting the project

The presentation of the project, the facilitating team and the

assembled participants is essential. How this presentation is

done will motivate “spectators” to become “real

participants” and to feel free to express their points of view.

During the presentation of the project and of the facilitating

team, the facilitator should:

Explain the objectives of the discussion meeting and

thank the participants for coming: Mention that the

subject of particular interest is the health of mothers

and newborns. The participants may be used to

participating in skills building sessions or in

discussion groups in which an outside team comes in

to impart or obtain information from the community.

During the presentation of the project, the facilitator

can clarify that this is not a skills building session and

that what the group of facilitators wants is to learn

with the community and gain a better understanding of

its points of view concerning health. Nor is the team

going to gather information and leave. What it wants

is to see how it can support the community. In this

regard it is also important not to create false

expectations in the community: the facilitator should

clarify, if necessary, the type of support that the team

can provide and the parameters within which they

have to operate. For example, it must be made clear

that the team does not have any funding to offer the

community. The one thing it can do is support them

with ideas on how to organize to save the lives of

people who may be confronted with an emergency

from one moment to the next in the community.

Explain to the participants the confidential nature

and anonymity of its interventions: It is very

important to assure the participants that no one will

be quoted by first and last name, and that the

opinions shared during the discussions will not be

repeated or used without their consent.

Explain the need to record the meeting in order to

have a “souvenir” of the discussion: The

facilitating team should see to it that each

discussion meeting is recorded. Each tape is


User’s manual

transcribed to facilitate the analysis of the

information gathered later on. The participants

might ask why they are being taped, and feel

intimidated by the tape recorder placed in the

middle of the room. It is recommended to ask the

participants’ permission to record the session,

assuring them once more of their anonymity and

confidentiality. In some circumstances, not asking

permission to record can create mistrust among the

participants. In such cases, it is best to limit

yourself to explaining as clearly as possible the

need for a document that will help to remember

what was discussed: it is also a way to respect

what the people have said, since we cannot trust

our memory alone. If, in addition to the audio

recording, the meeting is being videotaped, you

can offer to let the participants see the tape

afterwards. People generally like to see their

picture on the screen, and it is a way to share with

them what we share during the discussion

meetings.

Explain the process that will be followed during

the discussion meeting: The facilitator explains to

the participants that they are going to watch

together a couple of short films prepared for the

meeting and that they will converse informally

about what each one thinks. He also explains to

them that afterwards they will also make a couple

of presentations as a group.5


anything that is not clear: What we want is for

everyone to participate, and for that, we need to

understand each other well. He can use the

opportunity to ask the participants if they have any

questions or if they would like some clarification

before going on.

Introduces the other members of the team and asks

the participants to join in the introductions: The

facilitator can introduce the members of the team

or, better still, the other members of the team can

stand in front of the participants and introduce

themselves briefly. Each one can give his name

and mention what his role will be during the

meeting. If they are health workers (HW), they

should not mention their responsibilities in that

area, since that could, on the one hand, intimidate

the participants, and on the other, create an

atmosphere more like that of a skills building

session than of an informal exchange. In the same

way, those present at the meeting should also

5 Note that we are using the words “short film or video” instead of “video clip,”

and “presentation” instead of “dramatization.” It is necessary to simplify the language and avoid new or complicated words with which the participants might not be familiar.


User’s manual

introduce themselves, adding a few words if they

so choose. The facilitating team can also

participate in the ice breaking exercise, as one

more member of the group, to encourage trust and

enable people to communicate with one another as

equals.

Explain that they are going to begin with a little

exercise to get to know each other better: At which

point the ice breaking exercise takes place.

Step #3. Creating a friendly atmosphere: Ice breaking exercise

There are various techniques for leading a group with the

main objective of creating a friendly and participatory

atmosphere. An ice breaking technique is one that helps the

participants and the facilitating team get to know each other

and thus begins to create a friendly and relaxed atmosphere

for conversation. Taking into account the characteristics of

the participants and the context, a technique6 should be

chosen for the discussion meetings that:

Is active;

6 A useful reference for selecting a participatory and ice breaking technique is

the book edited by the Alforja Center for Studies and Publications entitled, “Participatory Techniques for Popular Education” (Volumes I and II, San José, Costa Rica: Alforja Center for Studies and Publications, 1988).

Helps the participants relax;

Involves the participation of the participants; and

Includes humor.

Step #4. Presenting stories from life: Videos 1 and 2

The videos show the participants short stories from life,

“slices of real life” that reflect what is happening in the

community. We will describe later the objectives and

content of the videos and the discussion guide used to

stimulate dialogue and discussion for the purpose of learning

and investigating together with the community how it acts

when faced with an emergency case involving a pregnant

woman and what the community thinks of the quality of

services offered in the health facilities for cases of

obstetrical emergency.

Video #1: Story of a mother in crisis set in the community

Objectives:

Explore what the community usually does when an

emergency arises during or immediately after delivery.

Find out what the customs and traditions are regarding

the care of the mother and the newborn.


User’s manual

Investigate what might prevent a woman from being

taken to the appropriate health center.

Investigate what might facilitate the transportation of the

woman to the appropriate health center.

Synopsis of the Story:

A woman lies ill at home. The person who is with her

explains to another the woman’s symptoms, but neither

of them knows that these are danger signs. The midwife

arrives and says that in this case she can no longer do

anything for the patient. At the same time, a health

professional (or provider) arrives and insists that the

woman be taken to the nearest health center. The

husband is not there, and the mother-in-law does not

want the woman to be taken to the health center. A

heated argument ensues among those who are around the

woman about what should be done. You see the woman

becoming weaker the whole time, beginning to faint.

The film cuts off here.

Screening of Video 1:

The facilitator explains to the participants that he is going to

show them a film,7 after which they will discuss what they

have seen. While the video is playing, the facilitating team

7 The words “film” or “video” are used instead of “video clip,” which is a term

the participants are probably not familiar with.

checks to see if the participants are following it attentively.

In remote rural areas, it may be that the people are not used

to watching television, and at first may not pay enough

attention to the content, but rather focus on the form. It is

recommended to show the video a second time to make sure

that all have seen and understood it from beginning to end.

You should also ask the participants if they want to see the

film from beginning to end.

Dialogue and Discussion8:

After watching the video, proceed to group work using the

following discussion guide:

1. What do you remember of what you have just seen?

Have you experienced anything like this? Have you

heard of a case like this in your community?

2. What happens in the film? What is wrong with the

woman who feels ill? Who is arguing? Why are they

arguing?

3. In cases like this, what do the people in the community

do? What is done with the woman?

4. (If necessary, pick up the thread of the story to help the

participants remember). In your opinion, what would

happen next? When and how does the family realize that

the woman’s condition is serious? Who decides what to

8 The discussion guide for the dialogue and discussion following the video

screening can be found in Appendix #1.


User’s manual

do? What do they do? (accept that she is going to die,

call in a traditional healer, take her to a health center:

church based, institutional, women’s practice)? What

happens to the sick woman at the end (dies, survives)?

5. What problems will they have to face in trying to save

this lady’s life? What do they need to resolve these

problems? Who helps them? Who does not help them

(at various levels: family, community, networks outside

the community)? How hard is it to resolve these

problems?


7. What happens when a woman dies in the community?

Who are the children left with? Who takes care of them?

What happens to the husband?

Video #2: Story of a pregnant woman who goes to a health center in an emergency

Objectives:

To explore what the community likes and does not like

about its health services and how it would like the health

services to be (quality attributes).

To explore what the barriers are to using the health

services.

To explore what might facilitate greater use of health

services.

Content:

They arrive at the Health Service and a service provider

receives them saying why did they wait so long. He is rude

to the family and to the midwife. The medical health care

provider on duty arrives (a young man). He does not speak

the language, and willingly explains what is wrong with the

patient. The interpreter has difficulty translating because the

doctor has used technical terms that do not exist in the local

language. The doctor starts gathering the instruments

needed for the intervention, and everyone around begins to


Screening of Video 2:

The facilitator explains to the participants that they are going

to see part of another film and discuss it afterwards.

Dialogue and Discussion9

1. What did you see in the film? What is happening?

2. Has anything like this happened to you or to someone

you know? What happened?

3. What is it that most draws your attention in this second

film? What else do you see? Is it like this in the health

services that you know?

9 The discussion guide for the dialogue and discussion following the

screening of Video 2 can be found in Appendix #1.


User’s manual

4. (If necessary, pick up the thread of the story to help the

participants remember). Do you remember that we

showed you only one part of the film? What do you

think happened at the beginning (in the part of the film

that we did not show: when the family arrives at the

health center)?

(If the subject was not addressed in the previous

section) What did the family do to get to the health

center?

How was the family received at the health center?

How do you think that the health workers treated the

family, the lady, the midwife? Did they let them ask

questions? How did they answer?

What did the health workers say to the midwife?

5. And in the film clip that we saw, how do you think the

lady and her family feel in the place where she is being

treated? How does the place where the lady is being

treated seem to them? How do they see this place? What

is present and what is lacking in the health center? What

do they like and what don’t they like?


7. At the end of the film (which we haven’t seen either

because we cut it off before it got there) what do you

think happens to the lady (does the lady live or die)?

8. What would be a happy ending to this second film?

What would be needed to get to this happy ending?

9. How would you like to be treated in the health centers?

Step #5. Prioritizing the attributes of quality that a health center should have from the community’s perspective

During the dialogue and discussion generated by Video 2,

explore the attributes of quality and satisfaction regarding

the health center from the perspective of the participants.

The objective of this exercise is precisely to prioritize in

order of importance the attributes or characteristics that a

good health center should practice and/or demonstrate. For

example, the participants might have mentioned in the

discussion of the video that they do not like being treated

badly or being yelled at when they bring a pregnant woman

with complications to the hospital, but that they appreciate

the fact that the doctor who treats the woman cures her: what

is most important to the participants, the treatment given to

the people accompanying the woman to the hospital, or the

technical competence of the attending physician?

Procedure:

1. Ask participants to divide into two or three groups

(depending on the number of people). Each group is

going to act out how it would like the story they just saw


User’s manual

to end (video 2) from the moment the lady arrives at the

health center until they save her life.10

2. Each group presents its dramatization. The facilitator

asks the participants to comment on the dramatizations of

the other group and of their own group, using questions

such as:

How did you feel in the health center?

What did you find in the health center that you liked?

How did they treat you there?

How was the sick woman’s life saved?

3. The facilitator or observer draws pictures on a flip chart

of what the people are saying. This can be done by a

member of the facilitating team who has a talent for

drawing.11

10

It is appropriate to mention here that in the first version of the instrument,

the participants were asked to act out the “happy ending” of the story they had just seen. We realized that those words had no meaning to the people in some communities, so we decided to ask them to act out how they would like the story to end.

11 Another possibility is to use

a flannel board with figures prepared ahead of

time. If you decide to make one, you can pull out from the first meetings the elements of the discussion with the participants that come up the most often. On that basis, a flannel board could be made which would serve as a tool for discussion in this and other phases of the project with the communities. You can also choose to conduct this exercise with figures, chosen in advance, that can be attached to a flipchart during the discussion.

4. Once all the comments have been made and all the

images have been placed on the flipchart, the facilitator

poses questions that will help them arrange the elements

mentioned in order of priority:

If you had to arrange everything you mentioned in

order of importance, what would come first? What

next?

The facilitator explores where the points of view

diverge and converge and the reason for the order of

priority selected by the participants.

He reorders, simultaneously, the elements following

the order of priority indicated by the participants

(numbering the elements in a list on the flip chart).

5. He checks the final list of priorities to make sure the

order reflects what the group thinks.

Step #6. Community mapping

The objective of the community mapping exercise is locate

the key people and resources that can help families in

emergency cases, including representatives of: the local

institutional authority, the local traditional authority, the

traditional health care system, the social network (for

example, neighbors and relatives). One of the

characteristics of community mapping is that the map is

drawn with the active participation of community members


User’s manual

to identify existing resources and networks that can be

mobilized in the case of maternal and neonatal emergency.

Procedure:

1. Ask participants to divide up into two or three groups

(depending on the number of people). Each group is

going to act out how they would like the first story to end

(Video 1) from the moment the lady’s condition becomes

critical until a decision is made about what to do.

Explain to the participants that this dramatization or

representation needs to show how the community can

organize itself to bring a successful outcome to a critical

case (emergency). What do they decide to do? When do

they make the decision? How do they manage to get the

woman out of her house to save her life? What helps

them? Who helps them?

2. Each group presents its dramatization. The facilitator

asks the participants to comment on the dramatizations of

the other group and of their own group. The facilitator

then explores:

Who can help ensure that the mother or the child are

saved?


where they can save her life

Who can help make the decision in time?

Who can help with transportation?

Who can inform other members of the community and

the health service of the emergency?

The facilitator draws figures on the flipchart representing

these players.12

Where are these people in the community? Near the

home? Far from the home? What can be done to

locate them? Is it possible to speak with them?

The facilitator, using the opinions of the participants,

draws a map of community resources on which can be

placed the key people who can help families in case of

emergency. If possible, he may ask one of the

participants to come up front to help him make this little

map. Showing the map to the participants, the facilitator

checks that his representation corresponds to what they

are saying, and poses the following final questions to the

group:

What can the community do to help in cases of

emergency?

Is it possible for all of us to mobilize to lives?

Who are the key people in the community for

emergency cases?

What resources exist in the community? 12

You might also consider making a flannel board as in the previous case.


User’s manual

The facilitator draws figures on a flipchart that represent

these persons or identified players, as well as resources

available in emergency cases within the geographic space

of the community.13

Once the map has been completed, the discussion leader

poses the following question to the group, with which the

dialogue on the central theme concludes:

What can the community do to help in emergency

cases?

Can we all work together to save lives?

Step #7. Wrapping up the meeting and continuing the collective action Following the last question posed to the participants, the

facilitator explains that the objective is really to work with

the community to improve health services, to help them

prevent health problems, and support them in dealing with

emergencies in order to save lives. At the same time, he

emphasizes that we are engaged in a long term process, and

this is only the beginning. He thanks them for their

participation and invites them to make their final comments,

if they have anything to add.

13

As in the previous exercise of prioritization, you might also consider

making a flannel board or using figures chosen ahead of time.

He then explains what the follow-up will be, that is, an effort

to “devolve” the joint discussion for participatory research

into the community. He outlines how, with all the findings

coming out of this process, it will be possible to follow

through by taking collective action with some initiatives that

have already been developed in many other communities

through their local authorities and their community

assembly, such as the development of a Community

Emergency Plan14

and the Family Emergency Plan15

to

protect the lives of mothers and children.

3. The facilitating team for participatory video discussion meetings

In this section, we specify the composition of the team

responsible for moving forward the process of “participatory

video discussion meetings,” and the functions of each of its

members. Here we will explain in detail some of the

characteristics and qualities that the facilitating team should

14

This is the expression of an organized community working together to

solve a health problem: an emergency that places at risk the life of a mother or a child. The Community Emergency Plan is the instrument that gives concrete expression to the community’s empowerment to save lives.

15 The Family Emergency Plan is worked out by the pregnant woman with

her husband, within the family, making in advance decisions such as the following on what to do if confronted with an obstetric emergency, then going to the community health committee for help: Where to go? How to go? Who will go with me? Who will look after my house and my other children? How much money do I have saved up?


User’s manual

display, and finally, we will address the subject of

moderating group discussions, giving helpful tips for

conducting participatory video discussion meetings. We

invite you to review Appendix #2, which further develops

the practical tips for conducting participatory video

discussion meetings presented in this section.

3.1 The facilitating team

The facilitating team for the participatory video discussion

meetings is composed of:

(a) A facilitator (or moderator), the person who leads the

group discussion

(b) A participating observer who takes notes during the

meeting and supports the moderator (or facilitator),

indicating, for example:

That there is someone in the meeting who has

something to say;

That it is necessary to bring into the discussion a

participant who is sleeping or not participating;

That it would be good to return to a theme that one

of the participants mentioned, to complete it, etc.

The participating observer also looks after the tape

recorder to make sure the meeting is being properly

recorded, and changing the cassettes in time.

(c) A camera operator (if necessary). In some cases, a

person is needed to video tape the discussion meeting.

Sharing the video taped images with the participants

can be part of their process of learning and mobilizing

to develop emergency plans.

In this first phase, it may be appropriate for the team that

is facilitating the discussion meetings to not be the same

as the institutional health care providers working in the

same locality or community. This has a dual purpose: (i)

to avoid the label of “capacity builders” that the health

workers already have because of the work they do, and

that would lead the participants to confuse the discussion

meeting with a capacity building session; (ii) to ensure

that the people feel completely free to express their

opinions. One possibility is that the health care workers

in one locality could meet with communities in a region

other than their own. The other possibility is that the

facilitating team could be made up of people from the

outside, not necessarily health care providers, who are

skilled as moderators and co-moderators. In cases in

which the health professional or health care provider acts

as moderator or participating observer in the community

where he works, it is important to make sure that his

presence does not affect the results of the process.

3.2 The qualities and skills of the facilitating team


User’s manual

The facilitating team will need to do detailed work that is

rigorous and requires organizational ability, but that is also

fun. To do this successfully, it is important to practice

certain qualities, such as:

Knowing how to listen

Acting with modesty

Keeping open

Having a sense of humor

The basic, guiding principles of this activity are:

Respect (including respect for differences)

Equity

Veracity

The golden rules to follow are:

Punctuality

Fulfillment (of promises, offers, etc.)

Always keep in mind that it takes years to cultivate bonds of

trust with the community, but only seconds to destroy them.

The community can tell whether the relationship that the

team is establishing with it is authentic or not, and confirms

it, for example, when it sees that the team:

Is not creating false expectations in the community

Respects the confidentiality of the participants

The facilitating team must be:

Participatory and structured at the same time.

What does that mean? It means that participation

does not happen spontaneously, but is the result of

a conscious and deliberate effort to create the

necessary conditions for people to participate.

To be successful, participation must:

Be structured and organized

Respect the time available for the discussion

meetings

Be flexible enough to adapt to circumstances

and to the environment

Be creative in finding the best way to adapt

to the environment without losing sight of

the objectives that have been set

Be disciplined in documenting

systematically the results of the discussion

meetings, so as to be able to give them back

to the community and transmit them to

decision makers in a reliable manner.

Finally, it is important that the facilitating team:

Know how to develop empathy with the

community, while at the same time maintaining

an objective distance that will enable it to

document things the way they are.

To the extent that the team is aware of its own subjectivity,

of its values and beliefs, it will be able to attain the


User’s manual

objectivity needed to complete the work proposed in this

manual.

3.3 Practical tips for leading group discussions During the discussion meetings, the facilitator plays many

roles, acting at times as a “journalist” who:

is “at the center of the action”;

is seeking the opinion of the “experts” who are

the members of the community;

wants to know the truth;

at times as an “anthropologist”:

who is learning with the community

is always ready to discover new things;

and is, at the same time, a “craftsman”:

who works with great detail and

who is patient and persevering.

4. The participants from the community invited to the participatory video discussion meetings

The participants in the participatory video discussion

meetings are chosen using specific criteria within a process

of selection that includes all the community.

4.1 The process of inviting the participants

The external agents, in this case the facilitating team, often

go through the formal local authorities to conduct meetings

in the communities. It is important that these key people,

who are going to convene the meetings, have a copy of the

list of criteria for selecting the participants in each meeting.

But beyond these criteria, it is essential to make clear that

we want to invite to the discussion meetings members of the

most vulnerable groups within the community.

Every community and society is a complex universe, in

which can be found distinct social strata. Taking into

account the limitations that the environment may impose, it

is important to try to promote the participation of those who

may have been marginalized because:

It is believed that they are not able to or interested

in participating,

They belong to marginalized groups (for example,

the poorest) within the community,

They do not belong to the group of voters who

elected the reigning authorities.

Experience has taught us that a restricted and biased

invitation can cause resentment and mistrust in the

community. At the same time, the presence of external

agents, who come with a point of view that is foreign to the

community, can sometimes contribute to the inclusion of

groups that have traditionally been left behind, and open


User’s manual

areas of dialogue in which those particularly vulnerable

groups may participate.

4.2 Criteria for selecting participants

In the case in question, we have identified at least four

groups of people that we are interested in meeting with in

separate groups, since each of them brings a different

perspective to maternal and neonatal health and dealing with

emergency cases in the community. These are: women,

midwives, leaders, and men. It is important that each group

be homogeneous to facilitate a free exchange among the

participants. For example, if we invite a midwife who is a

traditional leader in her community to participate in a

discussion meeting with mothers of families, we will find

that her discourse is different from theirs; she will probably

talk more than the other women, and may influence their

opinions. Hence the importance of meeting with these

groups separately.

The criteria for selecting the participants are, in each case:

GROUP OF WOMEN

Should be pregnant or have been pregnant (may

have lost children). You might want to also

include women in union of reproductive age who

have not yet become pregnant.

It is important to include young future mothers and

women who have borne many children.

Users and non users of health services.

Should speak the local language.

GROUP OF MIDWIVES

Should represent different levels of experience as

midwives.

With and without formal training (in traditional health

services).


GROUP OF LEADERS

Institutional leaders (deputy mayor, president of the

church committee, evangelical pastor, school

committee, etc.) and traditional leaders (midwife,

Mayan priest, traditional healer).

Men and women (gender balance), but taking into

account the actual make-up of the community.

Diversity in type of leadership (religious, political,

etc.).


Invite influential midwifes to participate in the

leaders’ discussions (or they could lead the discussion

in the groups of less influential midwives).

GROUP OF MEN


User’s manual

Husbands or partners. They may or may not be the

partners of the participants in the women’s group.

Users or non users of health services.


Concerning the selection criteria: In no case is age

considered a criterion of selection. Especially in the

women’s group, the highest rate of mortality occurs at the

beginning of reproductive life; and therefore it is important

to also include young future mothers. On the other hand, it

is also important to invite the participation of women who

have borne many children, who are also a group at risk.

5. Planning ahead and logistics

Conducting meetings in the country’s remote

communities requires a considerable amount of

organization and coordination. The port of entry into the

community, as we have just mentioned, is formal local

authorities. A visit to the selected community ahead of

time will allow the members of the facilitating team

tomake an initial contact with the community and

confirm its interest and the feasibility of conducting

meetings in the area. Once the possibility of conducting

them in the given community is confirmed, you should

proceed to carefully plan the visit and make

arrangements for the human and material resources

needed for the meetings.

5.1 Resource management

It is recommended to use checklists for the purpose of

providing for the human and material resources needed for

each discussion meeting. The preparation ahead of time of

other documents, such as the socio-demographic information

sheet for each discussion meeting, or the guides for dialogue

and debate translated into the local language, will also

contribute to the successful realization of the activities.

Table of human resources

Prepare a table on which you can write the names of the

members of the facilitating team for each locality. This

table will serve to check whether enough team members

are available on the dates scheduled, and for each

discussion meeting. An example of the Table of Human


Table of material resources

Set up a table of the material resources with the list of

supplies that will be needed for the meeting, and use it as

a checklist before going out to the field. An example of a

Table of Material Resources can be found in Appendix 4.

The socio-demographic information sheet

Do not forget to prepare, for each meeting, a sheet on

which you can record the data (most important)

concerning the participants. Examples of socio-

demographic information sheets can be found in

Appendices 5A and 5B.


User’s manual

Translation of the instrument

The instrument should be translated, preferably ahead of

time, for use in meetings conducted in languages other

than Spanish. This translation should respect the

formulation and the order of the questions in the original

instrument.

It is important not to rely on the facilitator’s memory for

the translation, nor on his ability to make simultaneous

translations. It should not be forgotten that the work of

simultaneous translation and interpretation requires

specific training and experience that the majority of

moderators do not have.

Transcribing the discussion meetings

The team should make preparations for the work of

transcription before going into the field. The team

should locate and contact with sufficient lead time the

people who will be doing the transcriptions, to ensure

that they will be completed as soon as possible. These

people should speak the language of the place where the

meeting will take place, be fast typists, and, if possible,

be experienced in this type of work.

They should be given a written sheet of precise

instructions on how to do the transcriptions. (This can be

found in Appendix 7).

Some instructions for transcribing:



Do not summarize or synthesize what the person is

saying.

When it is difficult or impossible to translate words into

Spanish (because they do not exist in our vocabulary),

write them in the local language and explain in

parentheses what they mean.

When the literal translation of the word illustrates ways

of thinking or looking at the world, stick to the “literal”

translation and explain in parentheses what the word

means in context (for example, if the person uses the

term “filthiness” to refer to menstruation, write

“filthiness” and explain in parentheses what it means).

The format that the person uses to transcribe the information

will depend on how the transcript will be used. Thus, if the

meeting has been video taped and the intention is to edit the

tape, a format will be used that will allow the images to be

matched with the text. If the intention is to use the transcript

for an analysis of the discourse (verbal) of the participants, it


User’s manual

will suffice to transcribe the verbal statements of the

participants.16

5.2 Time management

Managing time is important at specific moments: before,

during, and after the meetings.

Before the meetings:

Plan the meetings in advance and, as much as

possible, send a reminder one or two days before the

date of the meeting, in conjunction with health

personnel and/or local authorities.

In consultation with key people who know the

community well, including the health care providers

who work in the area, select the appropriate

organizational model for each case. Table 1

summarizes three formats for organizing the

discussion meetings from which the facilitating team

may choose. It is important that once the most

appropriate format has been chosen, you plan for the

specific resources and time required for each one.

16

In some cases, in which the researchers have opted to analyze the

information with the help of computer programs, precise instructions must be given so that the format of the transcriptions is compatible with the program.

Arrive at the location sufficiently ahead of time so

that the team can meet and iron out the final details

for each discussion meeting.

Plan the transcription of the sessions in advance,

taking into account the fact that it takes at least 8

hours to transcribe one hour of audio tape.

Anticipate follow-up activities and the outputs to be

presented as a result of the process and prepare a

detailed workplan, taking into account the points

mentioned above.


User’s manual

TABLE 1 POSSIBLE FORMATS FOR ORGANIZING THE DISCUSSION MEETINGS

FORMAT

ADVANTAGES

DISADVANTAGES

A 2-hour meeting Very dynamic We can be sure of covering all the subjects with the same people (“captive audience”)

Sometimes does not fit the rhythm of the participants Is difficult to control the time, particularly if the facilitator does not have much experience

3-hour meeting with an intermission

Allows more time for discussion Everything can end on the same day

Risk of some participants leaving during the intermission

Divide the activity into 2 sessions of an hour and a half each, within a reasonable timeframe (morning and afternoon of the same day or two consecutive half days)

Easier to cover all subjects thoroughly while respecting the rhythm of the discussions and without tiring the participants

More chances of losing people from one meeting to another

During the meetings:

Plan each meeting taking into account the

characteristics of the community and the time

available to the participants.

Keep in mind that the participants’ time is

valuable. You need to explain to them the

timeframe and process selected for the

discussion meeting and then keep to the times

that you have set.


User’s manual

After the meetings:

Plan ahead of time the tasks of

consolidation and analysis of the

information so that you can, in a reasonable

amount of time, transfer the information to

the stakeholders: the community itself and

the decision makers.

Refer to the workplan and respect the

deadlines that have been set. If this is not

possible, communicate the changes to the

individuals involved (that is, those who are

waiting for the results from the team).

5.3 Space management

You will also need to take into account during the

organization of the discussion meetings the physical

conditions in which you will be working, for example:

Electricity. Find out if there is electricity in

the community. If there is no electricity,

find an electric generator in the community

that you can borrow. If this is not possible,

contact a group of volunteers who will be

willing to do a dramatization or social drama

at each of the discussion meetings.

Location of the meeting. The location where

the discussion meetings will be carried out is

critical to ensure availability. The

characteristics of the site to be considered

include:

That it be sufficiently spacious to hold

the group and, if possible, not so large

that it echoes or the participants scatter.

That it not be so close to a point of sale

or a noisy environment. This can be

distracting during the discussions and

make recording difficult.

The physical arrangement of the chairs or

benches for the participants is also

important: Form a semi-circle or circle

that includes the facilitating team.

Having the participants close to each

other will create a more intimate

atmosphere that will promote

conversation and at the same time

facilitate recording.


User’s manual

Position of the facilitating team in relation

to the participants. Make sure that the

facilitator and his team are not positioned in

front of the audience as if in a lecture hall.

This arrangement gives the impression that

those on one side (those who are in front)

“know” (are coming to teach) and the others

(those who are listening) “don’t know” (and

are coming to learn). On the contrary, what

we want to promote in this case is an equal

exchange between the facilitating team and

the participants.

Arrange lodging for the facilitating team. If

the facilitating team needs to spend a few

days in the community, you will need to find

a place where they can sleep. As we will

see later, the visit or stay in the community

is in itself an opportunity to forge bonds

with the community and meet informally

with people who are not participating in the

discussion meetings.

6. Processing the Information

It is not enough to gather information and interact

with the community. If you want to use the

information to support a process of change in the

community, it is necessary to process it and analyze it

to pass it on to the community, so that the latter can

share it with decision makers. This is necessary so

that, on the one hand, you can process the experience,

and on the other, you can complete an analysis of the

discussion to find useful proposals that come from the

participants themselves, and in which they can see

themselves reflected.

6.1 Processing the experience

Processing is a separate methodological subject in

itself, which we will not attempt to cover in this

manual. Here we are only suggesting a couple of

basic tools that can be used to process the experience

for the facilitating team and the community. We are

talking here about developing tools for recording the

most outstanding moments, events and actions and, in

this way, building a vivid record of the process with

the community.

The document of reflection and self-

examination should be filled out at each

meeting, and should mention the outstanding

points (barriers, facilitators, findings,

surprises) regarding:

Preparation

Invitations

Organization/logistics

Facilitation and instrument

Content of the discussions


User’s manual

The process with the community

A travelogue can document the formal and

informal interviews and observations of the

facilitating team during their time of

residence in or visits to the community:

Date

Description

Outstanding elements

Follow-up planned

Glossary of terminology used in the

community

Tables for compiling and organizing data

concerning:

the resources identified in the

communities, such as the commonly used

traditional and technical communication

media, principal communication

channels and sources of information and

formal and informal communication, key

people and groups, existing networks,

etc. This data serves to develop

strategies for social participation and IEC

(information, education and

communication), as well as the creation

or consolidation of life support systems.

Periodic processing meetings planned

ahead of time for:

The interaction and socialization with

the community and with the health

care providers working at various

levels.

These meeting are neither

spontaneous nor casual. They should

be organized ahead of time following

a precise agenda and a participatory

methodological framework that is

coherent with the process of

participatory research.

6.2 Analyzing the discussion meetings

Data analysis is a complex subject that goes beyond

the limits of this manual. Suffice it to say that a

detailed analysis of the discussion meetings will make

it possible to better understand the psycho-social and

socio-cultural dynamics that influence the ways of

doing and being in a community. This understanding

will, at the same time, allow the development of

strategies appropriate to the context and the

identification and planning for potential problems that

might be encountered in the communities having to do

with the health of mothers and newborns. In addition

to its usefulness from the point of view of external


User’s manual

agents who want to improve the way they work with

the community, data analysis in this context starts

from the community’s point of view, and seeks to

give back the results so as to reinforce the process of

community empowerment.

To complete this type of analysis, you should take

into account certain steps that require planning and

organization, such as:

Preparing the transcripts;

Arranging data in matrices;

Analyzing the information;

Disseminating the results.

It is recommended to rely on experts in qualitative

analysis to jointly carry out this task. The

contribution of those involved—both the facilitating

team and the participants from the community—is

essential during the analysis phase. The process of

giving back to the community often becomes an

opportunity to validate and refine the results of the

analysis.

7. Use of the Instrument within the Process

The participatory research instrument that we suggest

is a learning tool placed within a context that goes

beyond participatory video discussion meetings. It is

essential to not lose sight of the fact that, beyond the

“collection of information” there is the process that is

started with the community, whose success will

depend on completing the following steps in the

partnership. During the visits to the community, there

is a series of parallel tasks to be carried out, that

complement and reinforce each other:

Conducting participatory video dis-

cussion meetings with various groups

Creating and developing contacts with

grassroots organizations, committees,

non governmental organizations, etc. that

are active in the community.

Developing a strategy for how these

groups formed by the discussion

meetings and the people and key groups

contacted in the community can remain

involved throughout the life of the

project to carry on the work.

Continue with the “community mapping

outside the discussion meetings, going to

see what is there.

Taking the opportunity to converse with

the other members of the community as

well, and not only with those who

participated in the meetings.


User’s manual

These conversations will revolve

initially around more general themes

that will give us an idea of the reality

and the trajectory of the community,

as for example: how the community

was formed, what life in the

community is like, if there are many

children, what the holidays are, how

they celebrate them, where the school

is, where the parish church is, who the

authorities are (traditional and

formal), where people gather, if

people in the surrounding areas know

each other well, what the main

problems in the community are, if

they help each other, etc.

Little by little, in a second phase, you

can address themes such as: What do

you do when someone is sick? How

far do you have to go to be treated, or

does someone come to your homes?

Do you know any woman who has

had problems with her pregnancy or

at childbirth? What do people do in

such cases: Where do they go?

Whom do they see? Do they go to a

health center? When do they go?

Where? How is it for you? What

type of care do you prefer? Do you

know of people or organizations

(formal or informal networks) that are

important in the community and that

we should be contacting? Etc.17

Strengthening the bonds with the

community based, for example, on

participation (by invitation) in community

meetings.

It is essential in this phase to establish and/or

consolidate the work with networks and develop

bonds of trust and collaboration with members of the

community. The success of the initiative can be

measured in terms of the continuity and strengthening

of these bonds over the long term.

17

All of this information should be documented using the tools

suggested above for processing the experience.


User’s manual

PART III: THE “KNOTS”

It is not enough to have excellent raw material and an

appropriate instrument to “tie the knots.” You must

ensure the quality and continuity of the bonds being

forged with the community. To do this, the most

important thing is to promote dialogue and

participation. Dialogue and participation are, in

effect, the main ingredients in the process of creating

bonds within this participatory research. These

elements carry the work from beginning to end. In

this section, we will offer guidelines for two practical

issues regarding participation that may come up

during the work: the issue of incentives and giving

back the information collected from the community.

We will conclude with a reflection on dialogue and

participation as processes and as results to be

actualized in the community through the methodology

that we propose.

1. Recognition and Incentives

Often, the members of the community are interested

in participating. They are inclined not only to

participate in group discussions in which they can

express their opinions, but also to voluntarily carry

out a few specific tasks. For example, there are

members of the community who throw themselves

enthusiastically into doing dramatizations, which

allows us to replace the video images with “real life”

images when there is no electricity in the community.

Others act as interpreters when there are people from

outside who do not understand the local language in

which the meeting is being conducted.

The question of compensation for individuals who

collaborate and participate at various levels is a matter

of debate. There are those who think that it is

important for members of the community to get

involved voluntarily, without expecting immediate

material compensation in return. There are also those

who think that it is important to compensate people,

that it is a way to recognize their efforts and the time

they dedicate to an activity. Between those two

positions, which one is best for us to adopt? An

intermediate position would be one that:

Recognizes and provides incentives for

community participation and

Avoids, at the same time, giving the

impression that people are being “paid” to

participate.


User’s manual

One way to do this is to find within the community a

“symbol” that at once:

Takes the form of an object that can be

distributed as an incentive during the

activities, and

Serves to reinforce the work in maternal and

neonatal health, without giving the

impression that it is a “remuneration” or

material compensation.

The “white ribbon” is an example of a “symbol” that

is also an object that can be distributed to the

participants. Ribbons are used all over the world to

symbolize various causes.18

The white ribbon

represents, among other things, the struggle against

violence towards women; the red represents support

for the cause of AIDS education, the yellow

represents support for the cause of defending human

rights. You might consider introducing into the

communities a ribbon or other object chosen with the

community as a sign of recognition and as a symbol

of the bonds of collaboration for improving maternal

and neo natal health. The ideal would be for this

18

The site www.sltrib.com gives information on ribbons of various

colors and the causes they represent at the world level or in various countries of the world.

symbolic object to be designed and fabricated with the

community, adapting it to the local culture. In this

case, the object would represent or would be a

“symbol” of the cause of maternal and neo natal

health. Based on this object a whole system of

incentives can be developed aimed at reinforcing the

participation of members of the community at

different levels.

2. Giving Back to the Community

Giving back the information gathered during the

participatory video discussion meetings is an essential

component of the participatory research process, since

through it the process of community dialogue is

strengthened and the community is encouraged to play

an ever more active role in seeking solutions to the

problems afflicting it. This giving back of

information should not take the form of a

“presentation of results” but rather as a basis of

interaction with the community.

At the same time that you are reporting back to the

community what its members think about the

handling of emergency cases or the use of services,

you are checking with them whether the information

seems correct and whether there are other opinions

that do not appear and which should be added. If you

have not yet begun to work with the community in

http://www.sltrib.com/


User’s manual

developing local life support plans, this meeting to

exchange opinions and information might be the right

time to begin this work. These plans will take on a

different name, according to what the community

decides.

Since the purpose is to create a space for sharing, this

meeting with the community should be organized in

such a way that it facilitates the presence of those who

participated in the discussion meetings, as well as

those who did not have the opportunity to participate

in them. This meeting will probably take the form of

a town meeting during which those attending will be

encouraged to actively participate. The health

workers that work closely with the community should

also be invited to the meeting and, if possible, co-

facilitate the meeting. There could then be one or two

facilitators during the meeting that would divide up

the work during the group discussion. The facilitator

or facilitators of the meeting should make use of

participatory techniques such as drawings, figures and

images to achieve a dynamic interchange with the

participants.

The themes of the meeting could be prioritized taking

into account the outstanding interests of the

community. To facilitate participation during the

meeting, the facilitators can follow the tips for leading

a group offered in Appendix #2 and be sure to check:

That what they are saying is clear and

comprehensible to the participants

What the participants think about what they

are saying:

If there is anything to add

If there is anything to correct

What the participants think of the proposals

made (for working together for example)

What suggestions the participants have.

It is important to plan this meeting carefully, both in

terms of content and in the provision of the human

and material resources to carry it out. To organize the

discussion on the Follow-up to the Meeting with the

Community it is recommended to use a table that the

facilitators can fill out with the help of the

participants. For this, you should plan on having

either a large chalk board or markers and flipchart

paper so that the facilitators can take notes on what is

discussed in the group. In this process of community

dialogue, the facilitators do not impose a program, but

rather negotiate the best way to include in the local

agenda the prevention of maternal and neonatal deaths

as one of the priorities in the community. This is an

opportunity to forge bonds between the community

and the health care staff, and to lay the foundation for


User’s manual

an endeavor that will require a long term commitment

from both parties.

3. “Tying the Knots”

As we indicated at the beginning of the manual, the

“knots” are not only an output but also a process. The

“knots,” or bonds of trust, are formed in dialogue with

members of the community, within a process of

participation that includes the most vulnerable groups.

Community participation should be sought at various

levels and at different times inside and outside the

meetings for discussion and interchange. But this

participation does not happen automatically.

Achieving it requires time, effort and perseverance.

On the one hand, many people have not yet had the

opportunity to participate, and it will take them time

to realize that they can do it and then learn how to do

it. On the other hand, to establish an open dialogue, it

is necessary to develop bonds of trust and maintain

them over time, something that is not accomplished

from one day to the next. At times, it is necessary to

begin developing bonds of trust in contexts in which,

for historical reasons, there is currently mistrust and

resistance to proposals the come from outside, or that

represent government interests.

Participation is:

A long and slow process

A goal to pursue, but also a series of problems

to solve

Participation:

Does not happen automatically

Requires “the work of ants” (one grain of sand

at a time)

Frequently, the need to respect the rhythm of this long

term process is confronted with the urgency of

delivering results within precise work plans. How,

then, to reconcile processes with outputs? We will

not presume to give an absolute answer to this

question within the limited space that remains within

this manual, since every case is different and would

require specific treatment. However, in general terms,

within the process of participatory research, there are

always results that can and should be shared with the

stakeholders--as they emerge, and within reasonable

time frames. For example, if discussion meetings are

conducted in a community and the results are returned

more than a year later, by that time, there is no

continuity and the process breaks down. In the same

way, there is information that can be useful to the

decision makers and should be passed on to them as it

is uncovered.


User’s manual

It is necessary to work within deadlines and

offer useful outputs to the players involved

(communities and decision makers) as the

initiative progresses.

Yet, at the same time that useful outputs are

offered, both to the community and to decision

makers, it is important to keep in mind that the

process we have begun takes time and requires

“the work of ants”—one grain of sand at a time.

The success of this type of initiative is

measured more in terms of the quality of

participation and the long range benefits than in

terms of numbers of people or communities

covered and the short term impact of the

activities.

It is necessary to educate those involved and the

decision makers, especially those most

accustomed to working to produce concrete

outputs, concerning the nature and implications

of a participatory activity within the processes

of long term change.

The “knots,” or bonds of trust and

collaboration, are both outputs and processes.

It is important, therefore, to achieve a balance

between short term outputs and long term

processes.

There is no doubt that dialogue and participation, like

the knots in the tapestry, have a usefulness and a

purpose that translate—and should be translated—into

concrete results. The communities themselves insist

time and again on seeing these results, and that their

participation not be “in vain.”19

At the same time, the

value of dialogue and participation is that they have to

do with processes that represent continuity and

promote the long term sustainability of initiatives. In

effect, it is through dialogue and participation that

community members take ownership of initiatives and

acquire the tools that will enable them to ensure their

continuity over time.

The “knots” have a past, a present, and a future.

Dialogue and participation, like the knots in a

tapestry, become part of the history of the community,

helping it to redeem its past, analyze its present, and

develop a common vision for a better future. The

purpose of this manual has been to not only

familiarize the reader with the methodology of

participatory research through participatory video

discussion meetings, but also to share some ideas to

think about concerning its use in the wider context of

working with communities in a participatory way.

19

According to the results of the discussion meetings conducted in

Momostenango and in Zona Reina.


User’s manual

PART IV. APPENDICES

APPENDIX 1

DISCUSSION GUIDE

THE DATA COLLECTION INSTRUMENT

FOR PARTICIPATORY VIDEO DISCUSSION MEETINGS INTRODUCING THE PROJECT AND THE TEAM The facilitator

Explains, in general terms, the objective of the

meeting and thanks the participants for coming.

Explains to the participants that the information

they share will be confidential and anonymous.

Explains the need to record the session to have a

“souvenir” of the meeting (he can offer, where

possible, to let them see the tape later).2O If

possible, he should ask their permission to make

the tape, assuring them once again of their

anonymity and confidentiality.

Explains to them that they will watch together a

couple of short videos that have been prepared for

the meeting, and that they will converse informally

about what each person thinks.


anything that is not clear.

Introduces the other members of the team by name

and function (during the meeting). It is suggested

that their positions in the health care system not be

mentioned, to avoid bias.

Explains to them that they are going to begin with

a short exercise to get to know each other better.

20

It is very important to ensure the confidentiality and anonymity of the participants. To reassure them more concretely, the ideal would be for those of one region to meet with users of ANOTHER region than their own. Or, as we have agreed, that those who facilitate be people from the outside with good facilitation skills. Take care that the health workers who sometimes play the role of participating observers do not affect the outcome by their very presence.


User’s manual

ICE-BREAKER: To be chosen based on the characteristics of the

participants.

PART 1 Presentation of Video 1, followed by discussion.

The facilitator explains the process to the participants:

that he will show them part of a film which they will

discuss after seeing it.



to make sure that all have seen and understood it from

beginning to end.

Video 1: Situation—emergency

Dramatization: a woman lies ill at home; the

person who is with her explains the woman’s

symptoms to another person, but none of them

know that these are warning signs. The midwife

arrives and states that in this case she can no

longer do anything. At the same time, a health

care provider arrives and insists that they take the

woman to the nearest health center. The husband

is not there, and the mother-in-law does not want

the woman to be taken to the health center. A

heated argument ensues among those who are

around the woman about what should be done.

You see the woman becoming weaker the whole

time, beginning to faint. The film cuts off here.

Video 1, discussion questions:

1. What does what you have just seen remind you of?

Have you experienced anything like this? Have

you heard of a case like this in your community?

2. What happens in the film? What problem does the

sick woman have? Who are the people arguing?

Why are they arguing?

3. In cases like this, what do people of your

community do? What does the woman do?


help the participants remember). In your opinion,

what would happen next? When and how does the

family realize that the woman’s condition is

serious? Who are the ones who decide what to do?

What do they do (accept that she is going to die,

call in a traditional healer, take her to a health

center: church based, institutional, women’s

practice)? What happens to the sick woman at the

end (dies, survives)?

5. What problems will they have to face in trying to

save this lady’s life? What do they need to resolve

these problems? Who helps them? Who does not

help them (at various levels: family, community,

networks outside the community)? How hard is it

to resolve these problems?


7. What happens when a woman dies in the

community? Who are the children left with? Who

takes care of them? What happens to the husband?


User’s manual

PART II Presentation of Video 2, followed by discussion.

The facilitator explains to the participants that they

are going to see part of another film and discuss it

afterwards as before.



to make sure that all have paid attention.

Video 2: hypothetical case in which it was decided to

take the lady to a health center (system financed with

state funds)

Dramatization: they arrive at the Health Service

and a service provider receives them saying why

did they wait so long. He is rude to the family and

to the midwife. The medical health care provider

on duty arrives (a young man). He does not speak

the language, and willingly explains what is wrong

with the patient. The interpreter has difficulty

translating because the doctor has used technical

terms that do not exist in the local language. The

doctor starts gathering the instruments needed for

the intervention, and everyone around begins to


Clip 2, discussion questions:

1. What did you see in the film? (have them explain

what is happening in the film: “What is

happening?”)

2. Has anything like this happened to you or to

someone you know? What happened?

3. What is it that most draws your attention in this

second film? What else do you see? Is it like this

in the health services that you know?


help the participants remember). Do you

remember that we showed you only one part of the

film?

5. What do you think happened at the beginning (in

the part of the film that we did not show: when the

family arrives at the health center)?

5.1 (If the subject was not addressed in the previous

section) What did the family do to get to the

health center?

5.2 How was the family received at the health

center? How do you think that the health

workers treated the family, the lady, the

midwife? Did they let them ask questions?

How did they answer?

5.3 What did the health workers say to the

midwife?

6. And in the film clip that we saw, how do you think

the lady and her family feel in the place where she

is being treated? How does the place where the

lady is being treated seem to you? How do you

see this place? What is present and what is lacking

in the health center? What do you like and what

don’t you like?


User’s manual


8. At the end of the film (which we haven’t seen

either because we cut it off before it got there)

what do you think happens to the lady (does the

lady live or die)?

9. What would be a happy ending to this second

film? What would be needed to get to this happy

ending?

10. How would you like to be treated in the health

centers?

PART III Dramatization followed by prioritization



will act out how they would like the first story that we

just saw to end: from the moment the lady arrives at

the health center until her life is saved.

ATTENTION: We will begin with a dramatization of

the happy ending related to video 2 that we just

finished showing.

Dramatization of the gravely ill woman in the

health center: happy ending.



Dramatization 1, discussion, prioritization



group:

Facilitator’s questions: How did you feel in the

health center? What did you find that you liked?

How did they treat you? How was the life of the

sick woman saved?

The facilitator draws pictures on the flipchart of

what the people are saying (this can also be done

by another member of the team who has an

aptitude for drawing).21 Facilitator and observer

write down the points mentioned by the

participants to complete the pictures on the

flipchart.

Once the two groups have completed their

comments, the facilitator poses the following

question (prioritization):

1. If you had to arrange everything you mentioned

in order of importance, what would come first?

21

Another possibility would be to use a flannel board with figures prepared ahead of time. For this, you could see in the first meetings what

elements came out of the discussion with the participants and, on that basis, start making the flannel board, which would serve as a tool for discussion in subsequent meetings throughout the investigation and in other phases of the project, to the extent that they related to participatory research.


User’s manual

What next? Explore the reasons for this order of

priority. Arrange the components in the order of

priority indicated by the participants (write

numbers 1, 2, etc. on the list on the flipchart).

PART IV Dramatization followed by community mapping



will act out how they would like the first story that

they just saw together to end (Video 1): from the time

the lady falls ill until it is decided what to do. Explain

to them that the dramatization or presentation must

show how the community is organized to deal with a

serious case (emergency in the community): What do

they decide to do? When do they make the decision?

How do they manage to get the woman out of her

house to save her life? What helps them? Who helps

them?

Dramatization of an emergency in the community:

happy ending.



Dramatization 2, discussion: mapping



group.

Facilitator’s questions:

1. Who can help bring about these happy endings?


where they can save her life? Who can help make

the decision in time? Who can help with

transportation? Who can inform other members of

the community and the health service of the

emergency?

The facilitator draws figures on the flipchart

representing these players.22

2. Where are these people in the community? Near

the home? Far from the home? What can be done

to locate them? Is it possible to speak with them?

The facilitator, using the information supplied by the

participants, draws a map of the community on which

can be placed the key people who can help families in

case of emergency: local institutional authority, local

traditional authority, traditional health care system,

neighbors, etc. Showing the map to participants, the

facilitator verifies that his drawing corresponds to

22

You might also consider making a flannel board, as in the previous exercise.


User’s manual

what they said, and poses a final question to the

group:

3. What can the community do to help in emergency

cases? Can we all work together to save lives?

Conclude the meeting by:

Explaining that the objective is really to work with the

community to improve health services, to help them

prevent health problems, and support them in dealing

with emergencies in order to save lives. Reiterate that

we are engaged in a long term process, and this is

only the beginning. Thank them for their participation

and invite them to make their final comments (if they

have anything to add). Then conclude the

conversation by explaining what the follow-up will

be. In doing this, it is suggested that you reiterate that

this is the beginning of a common endeavor; that we

will be returning to the communities to continue the

process.

NOTE: As follow-up to this investigation, you might

hold a debriefing session with the community on the

results of the participatory research, in the form of

developing local emergency plans (the name to be

given to this type of initiative will come out of the

groups themselves). We should not forget to involve

(in one way or another) the people who agreed to

participate in the discussion and in the other phases of

the project.


User’s manual

APPENDIX 2

A FEW TIPS

Basic Rules:

I. Practice “active listening” That means, listen in a way that communicates

respect, interest, and empathy. These attitudes

can be conveyed verbally and non verbally.

How can I verbally communicate to the person

that I am listening to him/her?

How can I non verbally communicate to the

person that I am listening to him/her?

II. Use language that is simple and clear

No professional jargon

Use terms that the participants understand

Culturally appropriate language

Some techniques for clarifying answers or probing into what a person is saying:

1. Paraphrasing: that is, repeating in other words

what the person has just said

Example:

2. Posing follow-up or “checking” questions: this

is a KEY technique in this kind of

investigation. It is used to understand the

reasons for people’s behaviors, attitudes, or

motivations. It is a question that CLARIFIES

an answer given by someone. It helps us to

PROBE a point that we consider important.


User’s manual

How to do it:

Give the person time to keep on talking (wait in

silence for a short time after the person has

answered).

Repeat in other words what the person has just

said.

Repeat what the person has just said, but in the

form of a question.

Ask the person to clarify a declaration, for

example: “I don’t understand very well. A while

ago you said ‘one thing,’ and now you are saying

‘another thing.’”

Use key words, such as

PARTICIPANT’S DECLARATION FACILITATOR’S QUESTION

“I’m not happy with this situation” “I like some of it” “It would be convenient” “It works well for me”

“What causes you not to be happy?” “Why aren’t you happy?” “What is it that you like?” “How would it be convenient?” “How do you know that it works?”

Use the third person technique. Example: “You

seem to be very convinced about this. How do you

think that others feel about it?”

Some useful examples: Could you tell me more about that?

What do you like or not like about it?

Could you give me an example?

I would like to know more about what you think about

this subject.

I’m not sure I understood what you meant when you

used the word “…”

What does “such and such” mean?

What makes you feel that way?


User’s manual

Why do we need to use these kinds of questions? Because:

Sometimes it is necessary to get information out of

people “with a teaspoon.”

It is often difficult for people to talk about what

they FEEL.

We can misinterpret what a person says to us.

Thus, you will use this type of question when:

You have not completely understood what the

person said;

You want more details or specific examples;

You are trying to uncover feelings and

motivations;

You are not familiar with the terms that the person

is using;

You think the person is saying only part of what he

is thinking.

3. Giving “positive feedback”

That is, praise or encourage the person concerning

what he says he has done. This helps people feel

more comfortable with the facilitator (who is not

making value judgments and not “criticizing” the

person), and thus encourages them to give more

information. This technique can also help

reinforce a desired behavior. Sometimes this is

difficult to do because the person could be

describing a behavior we disapprove of or consider

“bad.” Example: a man decided not to take his

wife to the health center but then realized that it

would have been better to have taken her. The

facilitator can say to him, “It’s good that you have

realized it would have been better to take her.

What made you change your mind? What would

you do now?”

Other advice:

4. Avoid questions that lead to “yes” or “no”

answers, that is, closed questions.

5. Rephrase questions when necessary to ensure

understanding and cultural adaptation.

6. Don’t give the impression that you are testing the

participants’ knowledge.

7. Put yourself in the participants’ place to see if you

would feel threatened by a particular question or

the way it is formulated.

8. Don’t guess any answer. What you think might

not coincide with what the other person is

thinking.

9. Don’t include ANSWERS in your questions.

10. If people are speaking in a “neutral” manner about

a subject, or if the participants are not talking, you

can sometimes play the “devil’s advocate,” always


User’s manual

being careful not to obstruct the process of

communication.

11. Remember that you are leading a group discussion

and not individual interviews. Refer the comments

and answers of one participant to the group to

encourage other comments. Connect the answers

of different participants to further explore a

subject.


User’s manual

APPENDIX 3

TABLE OF HUMAN RESOURCES

Municipality:

Community:

Team* Group

Facilitator Participating

Observer Camera

Operator Other

(specify) Date

Women

Midwives

Leaders

Men

*The pilot, responsible for transportation into the

community, is also a key member of the team. If it

is considered necessary, a specific column can be

added to include him in the table.

In some cases, the pilot might also attend to other

tasks during the discussion meetings, such as camera

operator, for example.


User’s manual

APPENDIX 4

CHECKLIST FOR MATERIALS AND SUPPLIES

MUNICIPALITY:

COMMUNITY:

DATE:


1. -TEAM

Television

VHS

Audio tape recorder

90 min. cassettes

Adaptors

Extension

Microphones (AAA batteries, recharge. battery)

2. –SUPPORT MATERIAL

A. Videos (video clips-short films)

B. Graphic material

C. Flannel board or figures (if it is decided to use these materials instead of drawing)

D. Participant identification

Name tags

Table with socio-demographic information Sheet with list of participants


User’s manual


E. Other supplies

Masking tape

Flip charts

Permanent markers

Scissors

Tacks

3. -REFRESHMENTS

List of participants

Refreshments

Soap(*)

Towels(*)

Basin(*)

4. –OTHER ITEMS

Balls or candy for the children

(*) These are some ideal materials to make it easy for the participants to wash their hands before eating.


User’s manual

APPENDIX 5 (A)

SOCIO-DEMOGRAPHIC INFORMATION SHEET

GROUP:

COMMUNITY:

DATE:

No. Full name Age Community No. children User Non user

1

2

3

4

5

6

7

8

9


User’s manual

APPENDIX 5 (B)

SOCIO-DEMOGRAPHIC INFORMATION SHEET (LEADERS)

GROUP:

COMMUNITY:

DATE:

No. Name Age Community Group or organization

1

2

3

4

5

6

7

8

9


User’s manual

APPENDIX 6

SAMPLE SCRIPT

Sample script, prepared by coordinators of the community component of the Maternal and Neonatal Health Project/JHPIEGO CORPORATION. Example for Video No. 1 of Participatory Video Discussion Meetings Place: House in the community, the home of a woman who has just given birth Characters: 1. Post partum woman (in the room) 2. Neighbor woman (in the room) 3. Midwife (arrives later) 4. Nurse’s aide (arrives later) 5. Mother-in-law (in the room) Time: Post partum Complication: Post partum hemorrhage As the scene opens, the woman is in her house, it is clear that she is very ill (she is complaining) Midwife:

(speaking to the neighbor and to the mother-in-law) Maria is very ill, I can do nothing anymore. At this point, the Nurse’s Aide says: (very worried and hurried)


User’s manual

Nurse’s Aide:

Doña Juana, let us take Maria to the hospital. She is very ill; she could die. We need to get help so that she can be healed.

Mother-in-law:

The problem is that Juan is not here. I don’t know when he will be back and I can’t let them take her to the hospital, they’re not going to let us go in with her and she will die (worried, but determined not to let them take her).

At this point, the argument intensifies among all players (the tone of voice and gestures of some showing that they are in favor of taking her, while the tone and gestures of others show that they do not agree, minus the woman). (They may all speak at once.) THE FILM CUTS OFF HERE.


User’s manual

APPENDIX 7

SOME TIPS ON TRANSCRIBING

The format that the person uses to transcribe the

information will depend on how the transcript will be

used. Thus, if the meeting has been video taped and

the intention is to edit the tape, a format will be used

that will allow the images to be matched with the text.

If the intention is to use the transcript for an analysis

of the discourse (verbal) of the participants, it will

suffice to transcribe the verbal statements of the

participants.

Some instructions for transcribing



Do not summarize or synthesize what the person is saying.

When it is difficult or impossible to translate words into Spanish (because they do not exist in our

vocabulary), write them in the local language and explain in parentheses what they mean, even if that means

giving a detailed explanation of the meaning.

When the literal translation of the word illustrates ways of thinking or looking at the world, stick to the

“literal” translation and explain in parentheses what the word means in context (for example, if the person

uses the term “filthiness” to refer to menstruation, write “filthiness” and explain in parentheses what it

means).


User’s manual

TEJIENDO LAZOS PARA UNA MATERNIDAD … · Marcela Tapia, Patricia Poppe, Robert Ainslie Adaptación...

Documents

Transcript of TEJIENDO LAZOS PARA UNA MATERNIDAD … · Marcela Tapia, Patricia Poppe, Robert Ainslie Adaptación...