For the Embera, Wounaan and Kuna Tule peoples of the Choco region in Colombia, the COVID-19 pandemic is just one of the many threats they face. Like many other Indigenous communities around the world, they witnessed little in the way of a response from their government. Effectively they were left on their own to make sense of this new disease spreading across the world.

For Indigenous people this was yet another disease to battle without recourse to Western medicine, along with frequent outbreaks of yellow fever, malaria and tuberculosis. Indigenous people have felt the impact of the coronavirus pandemic more than other communities. With limited access to Western medicine to treat conditions that are entirely curable, and little trust in white people after centuries of colonial oppression, they have relied on their own traditional ancestral medicine as their only response to the pandemic.

Through our research, we attempted to bridge the gap between traditional ancestral knowledge and Western understanding of the pandemic by introducing strategies to reduce the risk of transmitting the disease while being respectful of local traditions.

We did this by exploring people’s perception of coronavirus and employing a gamification process (using games to explore issues and find solutions) to build common ground for reducing risks that were then conveyed on an illustrated poster.

Traditional beliefs

One member of the team had been researching how to bridge traditional and Western medicine in the region over the past 10 years, and had already gained the trust of the communities. This helped the rest of the team understand how important ancestral knowledge is to Indigenous people and how it would influence how they viewed and responded to the virus.

We had to find a way to be sensitive to their traditional beliefs while helping them to understand that there were things they could do to lessen the risk of transmission. The community had already traced the spread of the new virus throug the village back to the first case. They noted that it didn’t affect children very much, but this led them to think that the virus must be travelling around one metre above the ground.

They were also convinced the virus was caused by man because they lived in nature, and if it had originated from bats, they would have encountered it already. They observed that older people were disproportionately affected, concluding that the virus was designed specifically to destroy ancestral knowledge, which older people possess.

We wanted to reconcile the two views, rather than confront their beliefs. In the poster we suggested that the virus originated in an animal market where animals were not stored safely, while also emphasising that the whole world had been affected by the pandemic.

These communities had developed their own ways that they believed would protect them. Local spiritual leaders and herbal healers held that the virus would not stick to bitter blood. So they recommended drinking herbal tea with lemon, ginger and elderflower, and bathing with the leaves from the gliricidia tree. They also developed ritual ceremonies, during which spiritual leaders spat on people, believing it offered protection from the virus. Initially it was believed that as COVID-19 affected old people more, it had been designed to destroy ancestral knowledge. Agnessa Spanellis, Author provided

Reducing the COVID-19 risk

It was important that any imagery used on the poster reflected and represented Indigenous people. Things like washing hands with tap water had to be adapted to the local context of communities bringing their water from the river in plastic containers. Local practices such as drinking herbal tea had to be respected, and only those practices that were potentially harmful (such as spitting during the ceremony) had to be subtly addressed without causing offence or confrontation.

The COVID-19 poster was translated into six Indigenous languages and placed in communal areas. Community members showed more trust and interest in the information on the poster, in contrast with their attitude towards the materials they had previously received. The poster recreated their local and domestic life showing everyday scenes and items rather than the standardised Western-looking figures and contexts normally seen in infographics. Seeing themselves in the poster helped them relate to it.

Within the poster we created a puzzle with hidden local animals, a sort of local Choco version of Where’s Wally?. Children were the first to engage with the animals and spent a long time in front of the poster trying to find them. Soon adults would join them and start a discussion about what the poster was communicating. The puzzle engaged adults indirectly through the initial excitement of the children, and so both groups paid more attention to the information provided on the poster. Children’s interest in the game aspect of the poster led adults to engage with them about its content and message. Agnessa Spanellis, Author provided

The medical part of the team ran a seroprevalence survey, which uses antibody tests to estimate the percentage of the population with COVID-19 antibodies. Interviews with the community and the results of this rapid testing were used to evaluate the effectiveness of the strategy during our limited stay, when we observed changes in behaviour. Of the 148 people who took part, 73% reported they had experienced at least one COVID-19 symptom. Of the 19 people who had clinical symptoms at the actual time of the survey, eight tested positive.

During our time with the community we observed that at the beginning, for example, teenagers were quite careless, but after testing positive they started self-isolating and following the advice on the community poster. In many villages, people showed appreciation for the messaging written in their own language which reflected their environment and made them more attentive to the poster. In some villages mothers asked for copies to teach children in their native language.

It might seem unusual to use such a playful approach among Indigenous communities, but they have been using games to share their knowledge and traditions for generations.

Sensitive and careful attention to Indigenous people’s lives and culture combined with elements of gamification helped us to successfully develop common understanding about COVID-19, and could help spread health messages in other parts of the world. But one size does not fit all, and using gamification principles can help make health initiatives relevant, relatable and inclusive.