To expand the conceptual framework for people-centered community practice in our work, we include ideas from Paulo Freire, Robert Chambers, David Korten and Max Neef. This article explores Paulo Freire’s view of people. Paulo Freire was a Brazilian pedagogue who revolutionized ideas about poor and oppressed people. This article provides an overview of the “culture of silence” described by Freire, and how we are applying this in our work to understand communities better. It is important to note that we do not work intuitively, but we utilize theoretical frameworks that assist us to think about and understand a phenomenon that may exist, guiding our actions to be ethical, non-biased and professional.   

Why should clinical research sites be concerned about the culture of silence that may exist in our communities? A culture of silence manifests in our settings when communities accept what we say all the time, without questioning things presented by researchers, and when communities feel obliged to always agree with the researchers. People may also miss asking critical questions during the informed consent process, becoming passive participants in the research process who will look at research sites as owning the research. As a result, communities will feel that they have no ownership in the research process. This defeats our aim for communities to co-own the process.

Our research usually focusses on communities and people who are disproportionately impacted by a disease. For this reason, HIV/TB studies focus on communities who are impacted by HIV/TB.  In most cases these communities are also dealing with multi-dimensional poverty and other social issues. A person is considered “multi-dimensional poor” when they are living in households where they are deprived of at least three of the seven dimensions of poverty which are health, housing, nutrition, protection, education, information, water, and sanitation (Stats SA, 2017). The report also revealed that Black women, children, and youth are disproportionally impacted by poverty. Black women, and persons considered multidimensional poor, are also most impacted by long term unemployment (unemployed for 12 months or more) (Stats SA, 2017). Women, children and youth, especially adolescent girls and women, suffer the brunt of many social and economic factors. South Africa is also challenged with Gender Base Violence and Femicide. It is on this background that our engagements with communities should always aim to empower and break the culture of silence.   

In South Africa we are recovering from a history of oppression.  The apartheid regime (1948-1994) was oppressive for Blacks, Colored and Indians. One may argue that apartheid ended 29 years ago, so why are we still talking about apartheid? Apartheid and colonization are conducive to the development of the culture of silence which is passed on from one generation to the next. 29 years later, these communities are still living in poverty. The legacy left by apartheid is an unequal society. A World Bank Report indicated that South Africa is the most unequal country in the world, with race playing a determining factor, in a society where 10% of the population owns more than 80% of the wealth (World Bank, 2022).

Another reason why breaking the culture of silence is important is due to the principle of autonomy. When a person or a community is autonomous, it is believed that the person can make their own decisions about what to do and what to agree to do. To what extent are participants or communities exercising their autonomy when a culture of silence exists? When a culture of silence exists, participants may struggle to assert themselves when they are unhappy about the way they are treated at the study site. For example, participants may struggle to raise concerns about long waiting hours, or raising other issues that they are unhappy about. Instead, participants may decide to stop coming for visits, becoming lost to follow-up instead of addressing their concerns.  It is for this reason that sites should be intentional about breaking the culture of silence.

Our entry into the community is always negotiated according to the cultural norms and requirements of the community. We don’t enter the community with the aim to teach or to impose our believes onto the community. When entry is not negotiated in the correct way the people of the community will feel invaded and view us as invaders.  We may also unintentionally reproduce oppression when we invade communities. We thus adopt the view that people can think critically about their situation. People don’t have to be taught and can learn through self-reflected learning and they do this within their frame of references, experiences, realities, values, and culture.  Allow people to take control of their lives, to take control of their lives people engage in a collective process of conscientization on their situation. Conscientization is a process for raising the self-reflected awareness of people rather than educating. We create spaces where people have the power to assert their voice to transform their reality. We show empathy by listening attentively as people talk spontaneously. We listen to understand and convey this understanding. When we convey understanding people can see that they have been heard and understood and that they are valued.  Use dialogue to discover, through dialogue people develop their capacity to think critically about themselves and their context.

We always strive towards real participation where people and community share fully and have equal voice in any decision making and efforts directed towards change (Schenck, Nel & Louw, 2010).  In closing it is important for research sites to be aware of the culture of silence that may exist and not feel that we don’t have a role to play in empowering our communities, During the process of doing this we are building trust and building sustainable relationships with our communities. 

References:

Freire, P. (1998). Pedagogy of the freedom: Ethics, Democracy, and Civic Courage. Lanham: Rowman and Littlefield.

Korten, D. & Klaus, R. (1984). People-centred development. West Hartford, CT: Kumanian Press

Schenk, R., Nel, H. & Louw, H. (2010). Introduction to participatory community practice. Pretoria: University of Pretoria

Statistics South Africa. (2017). Poverty trends in South Africa- An examination of absolute poverty between 2006 and 2015. Pretoria: South Africa

World Bank (2022). New World Bank: Inequality in Southern Africa: An assessment of the Southern African Customs Union.

Blossom is the Community Engagement Manager for the Aurum Institute CRS in Klerksdorp, South Africa.