海角大神

Moumini Niaon茅, a doctor and public health specialist, bounds into a radio studio in Ouagadougou and takes position behind a microphone, 6 feet from the show鈥檚 host. He draws down his white mask accented with gray stripes, matching his African tunic, to make himself more audible. He鈥檚 ready to field coronavirus questions from the public.

The host fires off a true-or-false, aimed at the false information circulating the city.

鈥淎fter the lifting of the curfew and restrictions people can cuddle and kiss,鈥� she says.

Dr. Niaon茅 smiles. 鈥淔alse,鈥� he says. 鈥淲e must beware of a second wave that could worsen the epidemic.鈥�

Two translators conveying his words into Fulfude and Gourmantch茅, two of the nation鈥檚 many languages, struggle to find a word for 鈥渒iss,鈥� for which there is no literal translation. They settle on 鈥渟aying hello with your mouth.鈥�

For Dr. Niaon茅, a former Fulbright scholar who completed his master鈥檚 at the University of Indiana, his own work is not dissimilar to translation: It involves searching for a way of speaking about health and illness with people who may have limited literacy, scientific knowledge, and financial means. 鈥淚 will come to the community and look at the problem from their eyes. When I know where they stand, it鈥檚 easier to design the intervention,鈥� he says.

While training in Ouagadougou, the capital of Burkina Faso, Dr. Niaon茅 remembers seeing the high cost of patients鈥� poverty and lack of basic medical knowledge, as he witnessed deaths from preventable or easily treatable diseases. Watching a patient come back 鈥渢wo weeks or two months or one year later with the same disease or with another sickness, related to the same risk factor,鈥� he recalls, 鈥渋t鈥檚 like no, you are doing nothing.鈥�

He saw the role that careful listening and public messaging could play in saving people鈥檚 lives聽鈥� and the novel coronavirus is no exception.

鈥淎ll么 Docteur鈥�

Since March 9, when the first cases were detected in Burkina Faso 鈥� a West African nation battling a jihadist insurgency, where literacy rates are low 鈥� Dr. Niaon茅 knew that citizens would have to go door to door to outpace the misinformation circulating on social media. He put out a call for volunteers on his Facebook page and WhatsApp, made an announcement on the radio, and soon gathered hundreds of volunteers across the country, among them his own medical students at the University of Ouagadougou.

Next, he took to the airwaves in a popular show called 鈥淎ll么 Docteur,鈥� where ordinary Burkinab茅s would call in and ask questions about the virus: from whether it was invented by the government or a laboratory, to how someone could be asymptomatic. In many Burkinab茅s鈥� understanding, 鈥渟omeone is only sick when they are in a bed,鈥� Dr. Niaon茅 explains.

He and his volunteers set out to places where the virus could easily spread, like the Grand March茅, the city鈥檚 largest market: a two-storied African futurist brick structure, made up of alleyways choked with electronic goods, glittering with imitation gold rings and chains, and crammed with stacks of batik and indigo fabrics, plastic buckets, and chairs.

His teams stood at entrances in fluorescent orange vests, making sure customers and sellers washed their hands and put on masks, before taking their temperature. They wore handmade masks of bright-patterned, hand-woven fabrics that tied at the back 鈥� based on Dr. Niaon茅鈥檚 many conversations with people who said they found the elastic bands that hooked onto their ears uncomfortable.

The doctor carefully wove through the alleyways of the Grand March茅, and in a soft-spoken voice advised marketeers to put their masks on and stay behind social distancing lines. They obliged, but he complained of the lax enforcement around him, and offered a cynical explanation: 鈥淚t is an election year.鈥� Although the doctor serves on the government鈥檚 departments of medical emergencies and logistics, he is of a younger generation of professionals unafraid to criticize leaders, though public dissent remains limited.

Partners in prevention

A few weeks later they moved on to a rapidly growing, low-income community on the outskirts of Ouagadougou known as Nioko II, where their work is especially key. The local chief聽鈥� or naaba, in the culture of the Mossi, the largest ethnic group in Burkina Faso聽鈥� met Dr. Niaon茅 in a palaver hut outside his walled house, adorned with a large faded painting of himself surrounded by key advisers. As community members wheeled in heavy metal barrels and clustered around a local water depot a short distance away, Dr. Niaon茅 knelt, as is custom, and presented the naaba with a plastic jerrycan full of handmade soap.

Here and everywhere, Dr. Niaon茅 says, his strategy is simple: listening to people鈥檚 concerns, documenting and analyzing their understandings, and working out how they can protect themselves, in a way that makes sense for their everyday lives. Then comes identifying and mobilizing leaders, like the naaba. Those include 鈥渓egal鈥� leaders and, as he calls them, 鈥渓egitimate鈥� ones: people who have earned trust and recognition, regardless of official status, and could be trained to form their own groups and continue the work.

鈥淲e need to get communities involved from the beginning. When we saw people fighting to open the mosques, it鈥檚 because the religious leaders weren鈥檛 involved in the response,鈥� he says.

For Dr. Niaon茅, it soon became clear that residents in Nioko II felt only wealthy people were affected. 鈥淭hey said, 鈥業鈥檓 not going to wear [masks] because I don鈥檛 go to Ouaga 2000,鈥欌�� he says, referring to a suburb where embassy staff and the Burkinab茅 elite live. And with high levels of distrust toward the political establishment, many thought the pandemic was a government ploy to make money.

The team mapped the community and identified potential hot spots: water depots, bars, marketplaces, churches, mosques, and places men gathered to play cards and drink tea. Student volunteers聽鈥� studying everything from economics and sociology to law and medicine聽鈥� visited four hours a day, three times a week, working out who leaders were and educating them about the virus.

After a long Saturday morning out on the field, Dr. Niaon茅鈥檚 team members come back to the tree where they鈥檝e parked their scooters. Dr. Niaon茅 speaks to a woman selling a fried doughnut-like snack called bourmassa and asks her why she isn鈥檛 wearing a mask. 鈥淚t鈥檚 too hot; I can鈥檛 breathe,鈥� she says. A man sitting outside a health clinic said he wouldn鈥檛 wear a mask because the pandemic was brought about by the 鈥渨ill of God,鈥� and high infection rates in the U.S. and Europe.

Rashida Ou茅draogo, a pharmacy student working with Dr. Niaon茅鈥檚 team, says their work 鈥渉as helped people understand,鈥� though 鈥渢here are people who will never believe because they haven鈥檛 seen cases with their own eyes.鈥� But there is still a long way to go. The government and other groups needed to give soap and masks to people without means to purchase them themselves, she adds.

As West African nations prepare to open their borders, Dr. Niaon茅 is nervous that people have become too relaxed. Government measures have decreased, but for him the fight against COVID-19 has only just begun. With a presidential election in November, he is concerned health measures will be sidelined.

鈥淚t is like in the United States 鈥� if the leadership doesn鈥檛 show the right behavior, people will not take the right measures,鈥� he says. 鈥淲e need to give communities finances and support so that they can work to prevent the disease themselves. We need stronger civil society actors doing what I鈥檓 doing. We need people who trust what we tell them.鈥�