Health care needs are complex, particularly in diverse communities within developing countries. Practitioners need to have the ability to function in unfamiliar contexts yet be competent in their duties. Innovative teaching methods are required to promote these skills. Inserting arts into a health science curriculum have shown to inculcate critical thinking, problem solving skills and improve teaching and learning (Haffejee, 2021). The author previously used a photovoice assignment, where students, situated in their own societies, photographed environmental conditions involved in causing disease. At an oral presentation, students clearly depicted how adverse environmental conditions affected health (Haffejee, 2021). The students depicted slum development, overcrowding, pollution, lack of piped water and sanitation as social determinants of health.  

Teaching also needs to have a broader societal impact which incorporates community engagement in the career path. This will provide a more holistic view of the problems faced by society (Morin et al., 2016). Low socio-economic societies have higher morbidity and mortality rates than high socio-economic societies as the former may be disempowered and unable to access health care for various economic and other societal reasons (Srivarathan et al., 2020). Hence student’s working within these marginalized communities could potentially be exposed to a larger variety of health care problems compared to working within the general population

It is however, unknown whether placing students in unfamiliar marginalized environments would enhance their learning. It is also unknown whether adding a compulsory community engagement component to an assignment in a public health module would augment their knowledge. The objective of this study was to explore the experiences of students in a community engagement project, as a medium of learning. 

Students (n=37) enrolled in the module Epidemiology: Public Health formed part of the study population. They were presented with an assignment which required them to identify environmental factors that were involved in causing disease. The study area was the Warwick Avenue market, in Durban, South Africa, which is within walking distance from the municipality. An initial guided tour of the market was provided by myself and a non-governmental organization working in the area. During this initial guided tour, the students observed the environmental, living and health conditions within the market and were required to reflect upon the lived realities that caused disease. They subsequently conducted a needs analysis for the improvement of health in the area. Thereafter, the students (working in groups of 3-5) were tasked to engage in a social justice programme in the market. This required an improvement of the environment, whilst clearly documenting how this would improve the health of the affected people. Photographic evidence documenting conditions before, during and after the intervention were essential. Each group was allocated 20 minutes to present their work orally in class. They were assessed on their engagement with the community, their interpretation of the public health issues, the photographic evidence and the quality of the presentations. Following the assessment, all students were invited to participate in focus group discussions to explore their experiences of this new teaching pedagogy. Participation was voluntary and there was no coercion to participate. Those who did not wish to participate were not penalized in any way. A total of 6 number of focus group discussions, comprising of 36 students, were held to gain an in-depth understanding of the students’ experience. Ethical clearance (IREC108/19) was obtained prior to commencing the study. All focus group discussions were audio-recorded and conducted in a closed room to ensure privacy. The recordings were subsequently transcribed by a research assistant and verified for accuracy. The data was subsequently analysed using Tsech’s 8 steps of data analysis for qualitative research.

Students observed traders selling wares in the open sun, a risk for sun stroke and skin cancer. The sale of fruit and vegetable in the hot sun, resulted in the food rotting quickly and the potential for salmonellosis. Additionally, many traders slept in the market in very uncomfortable conditions, resulting in musculo-skeletal disorders. Traders who cooked take-away meals prepared the food on cement structures, which were difficult to clean, with the concomitant accumulation of bacteria and subsequent food poisoning. Food storage containers were non-existent, attracting rodents and cockroaches, which the market had become a breeding ground for. Furthermore, lack of municipal services resulted in the accumulation of waste in large areas of the market. Interventions to improve the environmental conditions included the provision of: gazebos to those trading in the open sun, mattresses to traders who slept on the market floor, food storage containers, tablecloths, insecticides and rodent control pellets. Initiatives to clean the area and educate people about pollution also ensued. Teaching and learning was enhanced, as students learnt skills such as problem solving and critical-thinking. The students expressed that this novel way of teaching, enhanced their learning skills since they put into practice what they had learnt in theory. They strongly believed that they would not forget aspects of the curriculum that they learnt whilst embarking on this assignment. This was mirrored by the assignment scores (80.1%  6.4%), which were substantially higher than those of the theory based test (56.9%  14.0%). Additionally, the number of distinctions obtained increased from 4 in the theoretical assessment to 23 in the assignment. Students also expressed an eagerness to continue with community engagement in the future. The steps taken to renovate the environment, improved health of the population and augmented learning. Such partnerships are thus mutually beneficial and should continue.

Haffejee, F. 2021. The use of photovoice to transform health science students into critical thinkers. Medical Education. 21(237): 1-10 https://doi.org/10.1186/s12909-021-02656-1 Morin, S.M., Jaeger, A.J. and O’Meara, K, 2016. The State of Community Engagement in Graduate Education: Reflecting on 10 Years of Progress. Journal of Higher Education Outreach and Engagement. 20(1): 151-156 Srivarathan, A. , Lund,R. , Christensen, U. and Kristiansen, M. 2020. Social Relations, Community Engagement and Potentials: A Qualitative Study Exploring Resident Engagement in a Community-Based Health Promotion Intervention in a Deprived Social Housing Area. International Journal of Environmental Research and Public Health. 17: 2341; doi:10.3390/ijerph17072341