THROUGHOUT SUB-SAHARAN Africa, children serve as the primary caregivers for parents living with AIDS,1,2 providing invaluable nursing and palliative care. In many cases, they also play a key role in sustaining their households.3,4 To think of ways to support this group of children, staff from a local nongovernmental organization (WVP [World Voices Positive] Kenya) in Western Kenya made use of Photovoice, a participatory methodology that encourages people to reflect and develop perspectives on their life challenges through producing and reflecting on images.5,6 Photovoice has traditionally been used to involve lay people in identifying challenges to their health and well-being and increasing policymakers’ awareness of these issues. Our WVP Kenya experience suggests it can also play a key role in highlighting coping strategies and thereby facilitate action plans through which excluded groups tackle such challenges.
WVP Kenya provided 48 caregiving children aged 12 to 17 years with disposable cameras. The children were selected by community health workers for participation in the project on the basis of their above-average care and support for ailing household members; they hailed from two rural communities in the Bondo district of Western Kenya. In workshops given in the local Dholuo language, children were informed that the purpose of this exercise was to explore and strengthen their coping strategies. During the workshops they were taught how to take photos and were sensitized to some of the ethical issues7 regarding photography. The children were given two weeks to take photos guided by four questions: (1) What is good about your life? (2) Who helps you? (3) What keeps you strong? and (4) What needs to change? After the two weeks, children selected their six favorite photos and wrote reflections on the images. This exercise generated 240 images and accompanying reflections, which have contributed to the academic understanding of the coping strategies of caregiving children in Africa4,8,9; they have also been used by participating children to develop action plans for social change.10
A key theme arising from the images was that food and income generation were key to their nursing and care of sick adults as well as to sustaining their livelihoods (see images by Edith and Debora). Although the children already engaged in some food-and income-generating activities that contributed to the health and survival of their households, discussions of their photographs suggested that improving their skills and knowledge and the provision of minimal resources could greatly improve their coping strategies and the health of their dependent adults.
Drawing on the child-generated images and perspectives, WVP Kenya facilitated group discussions and ranking exercises to help the children develop social action plans around activities they could implement to strengthen their coping strategies. The children were divided into two youth clubs that submitted two action plans to WVP Kenya, one involving maize-selling and one involving growing and selling kale, poultry-keeping, and purchasing school uniforms. WVP Kenya provided the clubs with the financial resources (US $70 per child) needed to implement these activities and facilitated their progress. Details of this project are provided elsewhere,10 but our experiences emphasize the productive role Photovoice can play in highlighting the health-related needs and challenges facing traditionally excluded groups. In addition, images can also be used to highlight coping strategies, providing participants and service users with a powerful platform to generate action that can address the health-related needs of the children and those for whom they care.
This study and intervention was supported by the generous contribution of a private individual and the London School of Economics Research Studentship Scheme and Postgraduate Travel Fund.
Thanks to Catherine Campbell for support and advice in this work and to Vincent Onyango Ogutu and Cellestine Aoro from WVP Kenya for data collection, running workshops, and offering ongoing support to participating children. Greatest thanks to participating children for sharing their photographs and insights.
Human Participation Protection
Permission to conduct this study and intervention was granted by the Research Ethics Committee at the London School of Economics and Political Science and the Department of Gender and Social Services in Kenya.