Reducing stigma: Multifaceted approach - Communication

One of the important steps in the fight against stigmatisation is communication targeting both the stigmatizers and the stigmatised. The communication targeting the stigmatizers should aim at creating awareness, sensitizing and educating the public on the real issues in terms of the causes of Covid-19 and for that matter, any other condition that triggers stigma. The education must be carried out through multiple medium such as radio, television, the various social media platforms, newspapers, billboards, flyers, mobile information van and drama. In addition, the information must be succinct, factual and in the different major Ghanaian languages to ensure that it reaches all the various strata of the population and clearly understood irrespective of educational background or demographic characteristics. The information for the stigmatised must among others, aimed at encouraging them to remain strong, where and how to seek social and professional support, where to report name calling and other forms of attack and discrimination. 

Community mobilisation and participation

Community mobilization is the next important step in the efforts to diffuse, manage and reduce stigmatisation. This involves education and sensitization of community leaders in particular to champion the fight against the scourge of stigmatisation. Community leaders in this context refers to chiefs and queen-mothers, assemblymen/women, unit committee members, neighbourhood leaders, market queens, kings and the respective sub-groups within the communities and the markets. A significant number of the population in the country has high respect for their Chiefs and Queen-mothers hence the involvement of these two groups will be very helpful in reducing the canker of stigmatisation. Due to the fact that assemblymen and women and other community leaders live and interact with, and are therefore in close contact with the citizens, they are another group who are well placed to impact change of attitudes in the area of stigma. In addition, almost all traders, artisans, beauticians, and other business groups in the county have associations and leaders who can also be educated and sensitized to help in the crusade against stigmatisation. The drivers unions are another important group that must be targeted. Teachers, especially those in the rural and peri-urban communities are also well positioned to assist in de-stigmatisation process.

Involvement of faith-based organizations

Ghana has two major faith based organization (Christians and Moslems) and other minor ones most of which have branches and members in almost every corner of the country. Taking cognizance of the large numbers involved in religious programs and activities in the country, as well as the strong trust and respect most members have for their leaders (Rev. Fathers, Pastors, Bishops and Imam/Ulamaas), and therefore tend to pay more attention to what they say, it is very important that the faith based leaders are engaged at the forefront to play significant roles in the battle against stigmatisation. If these leaders devote at least five minutes of their sermons and other programs to educate their members on the facts and effects of stigma with possible support from the Bible and Quran in terms of the need to be each other’s keeper, it might go a long way to win the fight against stigmatisation. In simple language, faith-based leaders are very good allies not only for the combat against stigma, but in mobilizing support for strict adherence to the recommended/prescribed protocols aimed at reducing the spread of COVID-19.

Person with face and name recognition

Another effective means of combating stigma and other forms of conditions that induces stigma is the involvement of influential and public figures or persons on stage. Persons on stage in this context refers to individuals known by a significant percentage of the population because of their contributions society, position or roles they play. Almost invariably, public figures and influential persons in every society already have face and name recognition. In addition, persons on stage are usually like, admired and trusted by a cross-section of the population, Furthermore, such persons tend to have a larger following of persons who identify with them and even want to be like them and therefore perceive such public figures as role models.  As a result of these, influential and public figures especially those perceived to have integrity stand a better chance of influencing a segment of the citizens to their side when they appeal to them to do or desist from certain habits including stigmatisation. This concept of identification, admiration and trust of some persons with face and name recognition is the main reason why persons on stage (popular footballers, athletes, golfers, comedians, actors/actresses, artists, etc.,) are mostly engaged as communicators in advertisement and attitude change programs.

There is a large pool of such personalities in academia, the business community, among traditional rulers (chiefs and queen-mothers), the clergy/Imams and Ulamaas, political leadership, the media and many other fields of endeavour in the country who can be selected to support the campaign against stigmatisation. In the case of CVID-19, the involvement of those who have recovered from the disease to share their experiences and thus demonstrate to the public that they remain fit and strong as before the illness and are therefore capable of doing everything they were used to before is of critical importance. This is an aspect of what is mostly referred to as hero/heroine campaign or program - to feature those who have recovered to tell their stories as an inspiration to others also as a means to change negative attitudes towards the stigmatised. On the basis of this I humbly appeal to His Excellency the President, Nana Addo Dankwa Akufo-Addo, to kindly make a passionate statement on stigmatisation as he did on how to improve our nutrition status and for that matter, boost our immune system. According to market women interviewed on television and radio who sell nkontomire, dawadawa, etc., their sales have quadrupled since the President made that statement. Similar effects are likely to be derived if he speaks on stigma...

Enhanced civic education at all levels

For both the short and the long term, the National Commission for Civic Education (NCCE) should mount a vigorous campaign aimed at educating the citizens against stigmatisation. Fortunately, the NCCE has offices and staff in all the district capitals in the country. As the main constitutional body mandated to provide mass education and sensitization in all subject areas, the institution is well positioned to play a key role in this respect given the necessary training, logistical and financial support. The civic education component in the course syllabus for social studies and other subjects taught at the basic schools and other levels must be enhanced and taught with practical illustrations, analogies, role play and videos as it is the case with the blue and brown eye and the true colours videos which demonstrate how such issues play out in real life. For the long term, more emphasis must be placed at the basic school level as they remain one of the critical segments of the population whose values are still being formed. They are usually referred to as the window of opportunity or hope because if equipped with the necessary information, knowledge, skills and attitudes, they are likely to live up to expectation as compared to adults whose values may have already concretized and difficult to break through.

Laws, work place policies and enforcement

Fortunately, the supreme law of our land - the constitutional - anticipated broader instances of discrimination and therefore made it a prohibition. It is therefore important that the laws on discrimination is evoked and enforced to deal with those who engage in any form of discrimination against those on quarantine awaiting test result, those tested positive or have recovered from COVID-19. In addition, all state and private institutions should be compelled to have inclusive policies with special emphasis on non-discrimination and anti-stigmatisation. The staff of the respective institutions should be taken through orientation aimed at educating and creating awareness on stigma to ensure that any staff who recovers from COVID-19 feels welcome, safe, secured and comfortable at the workplace. To ensure the effectiveness of such a policy and compliance, there must be dedicated complaint desk/officer to report such occurrence to for prompt investigation and actions at the workplace and even in the communities. The community complaints may be dealt with by trained staff from the NCCE, or the Domestic Violence and Victim Support Unit of the Ghana Police service. The workplace sanctions for violating any aspect of the policy must be made known and available to all staff. 

Reporting protocols and diction

In all these, the critical role of the media is immeasurable. Indeed, without the media a lot of issues would have gone unreported or unknown to the public. In this particular instance, the role of the media is even more critical as they feature prominently in awareness creation, sensitization and attitudinal change in specific areas such as misinformation, misconception, faked news and unrealistic beliefs specific to COVIS-19. In spite of these, there are also instances where the media itself inadvertently contributes to the problem they are helping to resolve. This happens when a section of the media engage in what could be referred to as sensationalism or use certain words and phrases which infringe on cultural sensitivities or even reinforce stigma.  For instance, in the case of media houses which predominantly use the English language as the main medium of communication, the constant use of the word isolation in reference to COVID-19 is somewhat problematic as least psychologically.

In everyday medical language and in the hospital setting, the word isolation is very apt for patients with conditions that are highly communicable and which must be blocked to prevent spread. In addition, isolation in such cases ensures special attention for the patients and in the case of barrier nursing, it is also to protect patients who are prone to infection from communicable diseases. Unfortunately, to the ordinary person, isolation gives the impression of cases declared as almost impossible to deal with - terminal - a near death case. To my mother, Maame Serwaa, her age groupand many laypersons (non-medical professionals) of different age bracket and educational background I have interacted with, an isolation block within health facilities is synonymous with condemnation to the other side of the world. Even though as indicated above, isolation is an integral part of the health system and plays a critical role in the prevention of spread of certain diseases, ensure special attention to patients and enhances recovered, in normal times isolation cases are few and only the family and close friends of the patients may be privy to it.However, in this period of the dreaded COVID-19, psychologically, the use of the word isolation is not very appropriate diction on air because it evokes fear and gives the impression that those involved are ‘condemned’ hence must be kept apart. This has the tendency to increase the levels of anxiety and add to the already existing burden of stigmatisation. In the light of this, may I humbly suggest to my friends of the inky-fraternity a more friendly term of ‘separated for special attention’ or ‘separated for special care’. Similarly, what about the phrase ‘tested positive to COVID-19’ instead of infected with or victims of COVID-19.

For the Radio and Television stations which predominantly broadcast in the Akan/Twi language two psychologically inappropriate terminologies heard so far in reference to COVID-19 and quarantined are; yamantan no (translated literally as tied to a tree, a pole or a wall) and ye de no ato prisan (translated as he has been imprisoned). The yamantam no ascribes animal qualities to humans. In simple language, it means the person has been dehumanized and that alone can be too much to bear. Mantam also suggests that the animal may be transported elsewhere or may be slaughtered anytime soon to prepare meals hence it must be handy for the purpose. Since no psychologically sound person wishes to be treated like an animal, this word alone may prevent some persons who experience any of the known COVID-19 symptoms from seeking help. The import of my position which is grounded on human information processing, interpretation and analogies is that, the phrase/sentence yamantam no is likely to be counter-productive to the fight against COVID-19 especially in the area of quarantine.

Though the use of the term prison does not inanimate a person, it however implies incarceration and thus reinforces the use of the word yeaanatam no. Since we all love our freedom and dignity and do not want to be ‘locked in somewhere’ and forgo our freedom or to be referred to, and treated like animals, the use of these two Twi words are problematic and must be substituted fora phrase like ‘yedeno asie eboneho ban’ ‘yedeno asie emano ayeresa’ literally translated as ‘separated for special attention’ or ‘separated for special care’. I also like to highly commend all the officials who have since the March 12 been involved providing the public with information on the disease especially during the press briefings. I further like to appeal to them to continue be extremely careful and couch their language in such ways that their statements will not be subject to several interpretations by the public. You are not under obligation to answer any question if you are not adequately briefed or sufficient equipped to respond. Do not give the public (especially those who may decode scientific language upside down) the ammunitions to shoot at you. Use probability language and statement; on the basis of, given this and that, no sufficient basis to conclude, etc. The economists are BEST at it with their usual caveat ‘all things being equal’    

Good intention with negative unintended consequences

Ambulance services all over the world is meant to save lives especially those in critical condition. Unfortunately, in this period of COVID-19, ambulance services in the country is gradually gaining notoriety for something the service has NEVER intended - unintended consequences. On this basis I have a humble appeal to the Ghana Ambulance Services; based on the learning principles of conditioning, it may be very useful to mute the siren of the ambulance when the vehicle is about 300 metres to the house of the person who called for help or the person under contract tracing. The reason is that some persons now associate the siren of the ambulances with COVID-19 cases only and on that basis, stigmatize the person involved, the family, the house and even the neighbourhood irrespective of the type of condition or reason that necessitated the arrival of the ambulance team. Very unfortunate! Whereas elsewhere the arrival of an ambulance especially with short response time is highly appreciated, in our current situation the case is different. Societal and cultural context are very important so the appeal is that in order not to exacerbate the state of stigmatisation, the siren of the ambulance should only be used when far away from their destination and also in traffic to pave way for fast movement and quick service delivery. Continuous use of the siren at the premises of the person in need of support will not only draw crowd, but may increase stigma (at least now) and prevent some persons from seeking ambulance support even if they need it urgently.

Personal responsibility

As an individual what can you do to reduce stigmatisation? Make a personal commitment not to ever stigmatize anyone on any grounds or circumstance. Personal commitment is important because as humans we are prone to stigmatize others in the same way as we sometime stereotype and make prejudicial statements about others. This is more so about individuals who were born in their respective home region (home town in particular), grew up there or spent a greater part of their childhood (up to mid teenage years or more) in the same region/town/village. For such persons, the probability that they may still hold certain stereotypical and prejudicial views about others from different ethnic, racial and social groups is high. Even those who were born and/or grey up outside their home region, if the suburb they grew up was made up of persons who are predominantly of the same ethnic and/or social groups; they may also nurture similar prejudicial views about others.

This happens because our parents and other around us who socialized us may hold such views themselves so on regular basis - deliberately or inadvertently - they conveyed to us and even acted some of them. Consequently, we were likely to have picked and stored most of these as part of our knowledge base and worldview and as we navigate our world, we carry them as part of our compass. Having grown up in an environment where direct and indirectly stereotypes, prejudice and discrimination (SPDs) of others was part of the socialization, we all have to make more conscious efforts not to spite anyone and treat them in ways we would not wished to be treated. The Islamic version of ‘Love thou neighbour…….’ has been my favourite since I learned about it. It says something to the effect that ‘Do not do unto others, things when done to you, will cause you pain’. Individually, we have the responsibility to make conscious efforts to avoid STIGMATISATION and also to educate others to refrain from it.

Conclusion

Stigma is a social construct which affects a lot of people in almost every country and society. The sources of stigma include physique or physical looks, social group membership, cognitive and neurological, health condition and personal choices and preferences. These arise as a result of perceived deviation from societal standards, lack of relevant knowledge and information, ignorance and misconceptions. Other factors are traditional, religious and superstitious beliefs and difficulty in understanding and appreciating certain life events and occurrences. Stigma has negative connotations including shame, disgrace, scorn, hatred, disgust, aversion, dishonour and despise.

The effects include labelling, differential treatment, development of socio-phobia, anxiety and emotional discomfort, self-fulfilling prophesy and internalization of stigma labels. The fight against stigmatisation requires a multi-faceted approach including awareness creation, community mobilization, protest and hero’s campaign. The other strategies are the involvement of influential persons and public figures, laws and work place policies with strict enforcement and sanctions; strengthening of civic education at all levels, complaint desk for prompt action and reporting protocols of COVID-19 cases by the media.

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This is the final part (3) of an article on stigmatisation. In the first and second parts, the target, sources and effects of stigmatisation with emphasis on Ghana specific cases were discussed. This final part deliberates on the way forward to stigma reduction through awareness creation and sensitization. Other means suggested are community involvement and the role of faith-based institutions as well as workplace policies and the role of the media as a key stakeholder.

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About the author

Wiafe-Akenten, C. Brenya, PhD is Social Psychologist and a Senior Lecturer, Department of Psychology, University of Ghana.