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Edited by Mohan Jyoti Dutta and Dazzelyn Baltazar Zapata Communicating for Social Change Meaning, Power, and Resistance Communicating for Social Change Mohan Jyoti Dutta Dazzelyn Baltazar Zapata Editors Communicating for Social Change

Meaning, Power, and Resistance Editors Mohan Jyoti Dutta Dazzelyn Baltazar Zapata Center for Culture-Centered Approach Department of Communications and to Research and Evaluation (CARE) New Media Massey University National University of Singapore Palmerston North, New Zealand Singapore, Singapore

ISBN 978-981-13-2004-0 ISBN 978-981-13-2005-7 (eBook) https://doi.org/10.1007/978-981-13-2005-7

Library of Congress Control Number: 2018959219

© The Editor(s) (if applicable) and The Author(s) 2019 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Cover Image by the Editors Cover Design by Tom Howey

This Palgrave Macmillan imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Dedicated to Willie, June, Daniel, Lily Advisory board members of the “Singaporeans left behind” campaign Launched by CARE Your voices Emerging from your soul From the depths of your worn out bodies From the truth Of your everyday struggles Raise their clarion call For change. Mohan Dutta, Singapore, May 1, 2016 Acknowledgments

Although the academic study of social change and the intersecting communicative processes that generate spaces of social change are inherently situated within the ambit of institutional powers, legitimized by the state- market nexus, the rupturing of discursive spaces in the status quo is enabled when academics reach out to activists, community organizers, and social movements. This book is therefore dedicated to the activists Samarendra Das, Jolovan Wham, P. Satheesh, Vanessa Ho, and Braema Mathi, and community organizers Indranil Mandal, Ramprasad Das, Tony Gillespie, and Tracy Robinson, who have collaborated with the multiple projects of Center for Culture-Centered Approach to Research and Evaluation (CARE) that seek to embody the spirit of academic-activist-community collaborations. These collaborations and conversations, when powerfully embedded in meaningful action, emerge as sites of precarity and embodied risks. The advisory group members at the forefront of change, Uncle Willie, Auntie June, Daniel, and Auntie Lily, who led our advisory group with the “Voices of Hunger” advocacy project in Singapore, and created the “Singaporeans Left Behind” advocacy campaign, you embody the spirit and ethic of social change, bearing the many risks and costs that come with believing in your voices. Your indomitable courage in being the voices of truth forms the foundation of communication for social change, rupturing the propaganda that circulates in the mainstream. This book was conceptualised at one of the weekly meetings of CARE, Department of Communications and New Media (CNM), National University of Singapore (NUS) in 2015, where the research team felt the urgency of intervening in the theoretical production of social change

ix x ACKNOWLEDGMENTS

communication knowledge from outside of the colonial tropes of social change communication, rooted in the U.S. With the hope of sharing and reaching a wider audience, especially in the global South, engaged in the everyday practice of communicating for social change, the Conference for Social Change: Intersections of Theory and Praxis was held in early 2016 in Singapore. Each of the chapters in this book has been part of that inaugural Conference for Social Change brought by CARE, Department of Communications and New Media, National University of Singapore. We wish to thank all of those who made this possible. We most especially thank our community partners who have served not just as inspiration but as a source of strength. We also thank our NGO partners: Deccan Development Society, India; Jolovan Wham and the Humanitarian Organisation for Migrant Economics (HOME); Sherry Sherqueshaa, Vanessa Ho and Project X, Dialita Performance from Indonesia, Healthserv, Mohsin bhai and Banglar Kantha, and Food from the Heart. We also wish to thank our distinguished keynote speaker Collins O. Airhihenbuwa, and our plenary speakers Ambar Basu, Barbara Sharf, and Raka Shome. We also had the pleasure of witnessing a lecture demonstration by Rachmi Diyah Larasati, poetography by Julio Etchart and Mohan Dutta, a documentary screening of Learning 65 by Dyah Pitaloka and Mohan Dutta, and preconference film documentary workshops by Deccan Development Society and independent documentary filmmaker Nakul Singh Sawhney, who worked through elements of his film Muzzafarnagar baqi hai. We thank all the conference secretariats who worked hard and pushed through to make the conference possible, Satveer Kaur, Naomi Tan, Pauline Luk, Abdul Rahman Bin Abdol Rahim, and Asha Rathina Pandi, as well as the other members of the conference committee: Dyah Pitaloka, Munirah Bashir, Ashwini Falnikar, Somrita Ganchoudhuri, Li Lijun, Monishankar Prasad, and Julio Etchart. We thank the CNM administrative staff who assisted us throughout the planning, implementation, and conclusion of the conference, especially Gayathri Dorairaju and Norizan Binti Abdul Majid. We also thank Palgrave, especially Vishal Daryanomel and Anushangi Weerakoon for their patience and help in putting this book together. Our families hold the anchors to our ongoing work. Mohan would like to thank his parents, siblings, wife, and children, Shloke, Trisha, and Soham, for their strength, fortitude, and support on the journey of social ACKNOWLEDGMENTS xi change. Dazzie would like to thank her family and her daughter Zab for the love and inspiration. We thank all the chapter authors for their contribution to social change in their respective parts of the world, depicting the plural and multitudinal ways in which social change communication is imagined and crystallized. These chapters offer inspirations for imagining social change outside of and in resistance to the colonialist agenda of the dominant social change communication literature. Contents

1 Introduction: Theory, Method, and Praxis of Social Change 1 Mohan Jyoti Dutta

Part I Theoretical Articulations of Social Change 9

2 Self-Reflexivity for Social Change: The Researcher, I, and the Researched, Female Street-Based Commercial Sex Workers,’ Gendered Contexts 13 Iccha Basnyat

3 Gaze as Embodied Ethics: Homelessness, the Other, and Humanity 33 Eric Kramer and Elaine Hsieh

4 Development Communication and the Dialogic Space: Finding the Voices Under the Mines 63 Christele J. Amoyan and Pamela A. Custodio

xiii xiv CONTENTS

5 The Kapwa in Compassion: Examining Compassionate Health Care for Violence Against Women (VAW) Victims Among PGH Health Care Providers 87 John Mervin Embate, Marie Carisa Ordinario, and Alyssa Batu

Part II Contexts of Social Change Communication 109

6 Mama, Home and Away: Philippine Cinema’s Discourse on the Feminization of Labor Migration 111 Arjay Arellano

7 “Long-Distance Parenting”: A Media Ecological Study on Values Communication Between Migrant Parents and Their Children in Paete, Laguna 133 Paoloregel Samonte

8 Harnessing the Potential of Communication for the Well-Being of Transnational Families 155 Rosel San Pascual

Part III Social Change Methodologies 173

9 The Health Communication Advocacy Tool: An Approach Toward Addressing Health Inequity 175 Chervin Lam and Marifran Mattson

10 Self-Reflexivity in DevCom Research: An Autoethnography 197 Rikki Lee B. Mendiola and Pamela A. Custodio CONTENTS xv

11 Participatory Communication and Extension for Indigenous Farmers: Empowering Local Paddy Rice Growers in East Java 213 Edi Dwi Cahyono

Part IV Examples of Communicating for Social Change 235

12 Going Viral: Online Goal Emergence and Adaptation in the Anti-human Trafficking Movement 239 Rachel Gong

13 Communication Platforms and Climate Change Adaptation of Rice Farmers in Lipa City, Batangas, Philippines 263 Benedict Omandap Medina

14 Integrative Medicine Focus Groups as a Source of Patient Agency and Social Change for Chinese Americans with Type 2 Diabetes 285 Evelyn Y. Ho, Genevieve Leung, Han-Lin Chi, Siyuan Huang, Hua Zhang, Isabelle Ting, Donald Chan, Yuqi Chen, Sonya Pritzker, Elaine Hsieh, and Hilary K. Seligman

Part V Culture-Centered Approach to Communication for Social Change 311

15 Culture-Centered Social Change: From Process to Evaluation 315 Mohan Jyoti Dutta

16 Embodied Memories and Spaces of Healing: Culturally- Centering Voices of the Survivors of 1965 Indonesian Mass Killings 333 Dyah Pitaloka and Mohan Jyoti Dutta xvi CONTENTS

17 Inequalities and Workplace Injuries: How Chinese Workers Cope with Serious Diseases Caused by Benzene Poisoning 359 Ee Lyn Tan and Mohan Jyoti Dutta

18 Media Portrayal Stigma Among Gender and Sexual Minorities 383 Jagadish Thaker, Mohan Jyoti Dutta, Vijay Nair, and Vishnu Prasad Rao

19 Epilogue 409 Mohan Jyoti Dutta

Index 411 List of Figures

Fig. 5.1 Conceptual framework of the study 92 Fig. 6.1 Sarah leaves a covenant with her son, assuring him that she will return to get him and be ultimately reunited in London 120 Fig. 6.2 Josie bids farewell to her family; this will only be the first of more airport goodbyes 121 Fig. 6.3 Josie can’t give up hugging a stuffed toy, imagining the warmth of her daughter’s embrace 122 Fig. 6.4 Josie tends to the needs of her employer’s child like a real responsible mother 124 Fig. 6.5 Sarah becomes Mr. Morgan’s trusted aide and a good friend whom he can share life stories with 124 Fig. 6.6 Josie is in a hurry to speak to her daughter, but she would be unsuccessful with the arrival of her employers 125 Fig. 6.7 Sarah expresses how much she misses her son by regularly calling home 126 Fig. 8.1 Harnessing the potential of communication at the micro level 158 Fig. 8.2 Harnessing the potential of communication at the macro level 163 Fig. 9.1 Health Communication Advocacy Tool 179 Fig. 15.1 CCA-based approach to designing community-placed solutions 319 Fig. 18.1 Experienced stigma mediates media stigma association with identity disclosure. Unstandardized coefficients, Sobel test: Z = 3.73, p<0.001, κ = 0.65, 95% CI for 10,000 bootstrap samples: 0.26, 1.07 401

xvii List of Tables

Table 5.1 Verbal, non-verbal and approach aspects of Asal 97 Table 12.1 Anti-trafficking activists interviewed 247 Table 13.1 Profile of rice farmers in terms of age 268 Table 13.2 Profile of rice farmers in terms of civil status 268 Table 13.3 Profile of rice farmers in terms of educational attainment 268 Table 13.4 Profile of rice farmers in terms of other source/s of income 269 Table 13.5 Profile of farmers in terms of number of years in rice farming 270 Table 13.6 Profile of farmers in terms of area or tract of land they cultivate 270 Table 13.7 Communication platforms utilized by rice farmers in sharing information on climate change 271 Table 13.8 Problems experienced by the rice farmers due to climate change 273 Table 13.9 Assessment on the rice farmers’ adaptation to climate change in terms of physical adaptive measures 274 Table 13.10 Assessment on the rice farmers’ adaptation to climate change in terms of existing agricultural practices 275 Table 13.11 Assessment on the rice farmers’ adaptation to climate change in terms of self-help programs and capacity building 276 Table 13.12 Difference on the physical adaptive measures of the farmers in terms of profile 277 Table 13.13 Difference on the existing agricultural practices of the farmers in terms of profile 278 Table 13.14 Differences in the self-help programs and capacity building of the farmers in terms of profile 279

xix xx LIST OF TABLES

Table 14.1 Details of participants divided by focus group 290 Excerpt 14.1 Focus group 1: Cannot control yourself 292 Excerpt 14.2 Focus group 4: A Chinese person would say, “What kind of food is this!” 293 Excerpt 14.3 Focus group 4: You must eat otherwise you will not have sufficient energy 294 Excerpt 14.4 Focus group 3: I tried all kinds of herbal medicine 295 Excerpt 14.5 Focus group 2: Our health insurance card does not cover CM 297 Excerpt 14.6 Focus group 2: I have diagnosed myself [but I don’t know...] 299 Excerpt 14.7 Focus group 3: Everyday I have to have soup otherwise I am not happy 300 Excerpt 14.8 Focus group 1: CM information sources 303 Excerpt 14.9 Focus group 1: Beef is very good for replenishing/nourishing the blood 305 Table 17.1 Job nature and length of exposure of Chinese workers 365 Table 18.1 Demographic characteristics of sexual and gender minorities in three south Indian cities 392 Table 18.2 Factor analysis of gender and sexual minority identity stigma scale 394 Table 18.3 Regression with media stigma as outcome variable 400 Table 18.4 Logistic regression model predicting identity disclosure 400 CHAPTER 1

Introduction: Theory, Method, and Praxis of Social Change

Mohan Jyoti Dutta

In January 2016, 57 social change communication scholars, communication practitioners, and activists from across the globe participated in a three-day conference hosted by the Center for Culture-centered Approach to Research and Evaluation (CARE) at the National University of Singapore. The location of the conference in Singapore, positioned in the interstices of Eurocentric capitalist democracy and practices of authoritarian governmentality that foreground values of communitarianism and col- lectivism as modes of organizing, offered an opportunity to critically engage with the foundational theoretical concepts of social change communication, explore the erasures constituted in dominant constructions of social change communication, and foster entry points for listening to the voices of the global margins. The articulation of social change and communication from outside of the circuits of knowledge production in the West/North created openings for contextually situated theorization of social change, closely intertwined with the practice of social change communication (Dutta, 2015). Simultaneously, the global concentration of power in the hands of the transnational capital-state-civil society nexus emerged as a consistent theme throughout the conference, therefore

M. J. Dutta (*) Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University, Palmerston North, New Zealand

calling for social change communication that interrogates the structures that constitute dominant notions of contemporary governmentality. The local as a site for occupying communicative spaces where change is imagined, created, and carried out articulates imaginaries of social, cultural, economic, and political organizing that directly challenge global neoliberal hegemony and simultaneously frameworks of reworking the local. The theorization of voice, spatially located at the global margins, and explicitly resistive of the structures of neoliberal governance, offers a counter to the market-driven imaginary of trickle-down development. The attention to geography as an anchor for theorizing communication and social justice also meant that our conference organizing committee particularly paid attention to the representation of academic-activist voices from across spaces in Asia, proximate to our own site of theory building at CARE in Singapore. Therefore, the large majority of voices celebrated in this edited collection emerge from Asia, taking seriously the task of what it means to theorize communication and social change from/in Asia. The concepts thus developed across the chapters demonstrate a deep commitment to context even as they seek to engage with the global trajectories of social change. Moreover, the conference emerged as a communicative infrastructure for a range of activist performances, including performances by the Dialita Choir, comprised of the survivors of the 1965 US-sponsored Indonesian genocide, performances by Lachmi Dyah Larasati remembering trauma to articulate health and healing through dance, and performances, activist workshops, and documentary screenings by dalit women farmers organized under the umbrella of the Deccan Development Society (DDS). For each of these activist performances, critically engaging and interrogating the logics of power and control that organize social systems offered the bases for theorizing social change communication from the margins of neoliberal capitalism. I co-performed a poetography with the photography and image artist Julio Etchart, who served as a research assistant at CARE for four years. The poetography sought to interrogate the organizing logic of the market that has colo- nized the Asian-global scape. In the backdrop of the consolidation of communicative spaces in the hands of the power elite, conference themes grappled with the role of communication in disrupting these processes of resource consolidation. The positioning of the conference at CARE was meant to bring together new and critical thinking about the interplays of culture and communication for social change, particularly drawing on the complex history of INTRODUCTION: THEORY, METHOD, AND PRAXIS OF SOCIAL CHANGE 3

Southeast Asia as a target of top-down social change communication interventions emerging from the West during the Cold War. This Cold War legacy was directly interrogated in the voices of the performers of the Dialita Choir who experienced physical, sexual, and cognitive violence and lost family members in the Indonesian anti-Communist purge, carried out with US sponsorship. The voices of the survivors of 1965 disrupt the communicative inversions that have been circulated in elite discourse. Particularly salient is the courage and tenacity of resistance that emerges in these voices amid various state-driven techniques of repression, which themselves are techniques learned and perfected by postcolonial elites in South and Southeast Asia from the colonial masters. The locally constituted narratives of resistance offer lessons for global principles of social change communication, building communication strategies and techniques that disrupt the now-perfected strategies of colonial expansion and capitalist exploitation. Also salient was the theoretical anchor for positioning social change communication amid neoliberal global transformations, reflected in the hegemonic position of the “free market” ideology in spite of the evidence that points to the failures of market-based organizing processes in addressing contemporary global challenges. The voices of activists, community organizers, and participants from the margins of global production of knowledge create different entry points for the conversations on social change, connecting the theorizing of change processes to the contingencies, challenges, and fragmentations in the practices of communication for social change. The opening keynote with Professor Collins Airhihenbuwa brought to the forefront the role of culture as an anchor to health and healing. Encouraging social change communication scholars to closely study the role of culture, Professor Airhihenbuwa opened up an invitational space for alternative imaginaries of social change communication.

Theorizing Communication for Social Change Theories of communication for social change conceptualize communication in specific logics. The dominant constructions of social change communication reproduce an overarching framework of liberal democracy, circulating the imaginary of civil society, working hand in hand with mechanisms of the state and the market in constituting communication for social change. In this backdrop, the chapters presented in this collection interrogate the notions of democracy and capitalism, inverting on its 4 M. J. DUTTA head the very notion that capitalism is a necessity for sustaining democratic processes and practices. The mostly US-generated body of scholarship on communication and social change that pushes the US imperial agenda on the global arena is interrupted by the voices from other geographic locales, disrupting the assumptions about neutral and universal social change communication. An emergent theme across the articles in this edited collection is one of voice in the backdrop of the increasing consolidation of communicative power in the hands of the power elite. Attending to the inequalities in the circulation of communicative processes and communicative resources, the essays in this collection point to the constitutive role of communication as voice.

Methodology of Communication for Social Change The question of methods for social change communication introduced in this edited collection deconstructs the very logic of what we understand as communication for social change. The naturalized notion of social change communication as planned social change projects driven from US/West- centric sites of expertise, in collaboration with local elites, is disrupted through the re-turning toward the many geographies of social change communication outside of the knowledge circuits of the West. What these many geographies reveal about communication for social change is at once the displacement of the key methodological tenets from the Cold War development logic, and the possibilities of a “politics of hope” that emerges from elsewhere, offering theoretical anchors for “polluting” the concepts of the mainstream. In the wide range of manuscripts that have been assembled here, the received concept of social change communication is disrupted by a plurivocality of methods for the study of communication for social change.

How Do We Evaluate Social Change Communication? The concept of evaluating social change communication is plurivocalized, creating anchors for depicting social change from diverse viewpoints, particularly attending to the creation of spaces for knowledge creation from the margins. What does social change mean for those at the margins? How do communities at the margins of global development understand the effectiveness of social change communication? From the largely quantitative focus on field-based experiments, with pre/post comparisons between experimental and control communities, that has served as the gold stan- INTRODUCTION: THEORY, METHOD, AND PRAXIS OF SOCIAL CHANGE 5 dard for the measurement of the effectiveness of social change communication, articulations of effectiveness of social change communication from the global margins are grounded in narratives that describe the social change process, its effects on the lives of community members, and the effects on societal and cultural processes.

Stories as Method The shift to the voices from the global margins interrupts the quantitative reproduction of knowledge on communication for social change, instead offering narratives as bases for building the evidence base for social change. For instance, in the voices of indigenous communities threatened to be displaced by an extraction project, putting a stop to the land grab is considered as evidence for effectiveness. Similarly, in the voices of communities of food-insecure households, having enough access to food is considered as a measure of effectiveness. In this sense, community member narratives depict the workings of the social change communication effort. Similarly, the stories of marginalized community members coming together in a collective and having their voices be heard in a discursive space that systematically erases them is an anchor to alternative definitions of social change communication.

The Scholar-as-Activist The scholar-as-activist interrupts the dominant location of the scholar within elite structures of grant-funded, public-private interventions achieved through partnerships between the state, global civil society, and transnational capital. The foundation of “academic tourism” where the scholar “goes in and out of the community” to push an expert-designed intervention into the community is inverted by the articulation of activism as the basis of social change communication scholarship, deeply intertwined with the struggles of the local communities scholars reside in, and committed to transforming the politics of the local as it enters into the global (Hartnett, 2007, 2010). Activism, by its very nature, identifies the structural conditions that reproduce injustices and the material contexts of marginalization, intervening into these marginalizing practices through communicative performances (Frey & Carragee, 2007). Where the social change communication scholar sits and how she/he is mobilized to work on social change communication are fundamentally 6 M. J. DUTTA inverted in articulations of communication for social change emerging from the global margins. In contrast to the invisible expert academic located in elite centers of expertise in the North/West, far removed from the everyday struggles of the subaltern margins, the body of the scholar is placed in the middle of struggles of subaltern communities, “intervening into discourses” (Frey & Carragee, 2007, p. 7). Rather than developing communication interventions from elite positions of privilege based on targets defined by funding agencies, private foundations, and corporations, the notion of the scholar-as-activist reorients its commitment to the voices of the margins, seeking to cocreate communicative infrastructures for subaltern participation. The turning of the scholar into an activist-participant is itself a resistive turn, retheorizing “academia as habitus” (Bourdieu, 1984).

Interrogating Power That social change is constituted in fields of power is a theme that works through many of the chapters. To examine and participate in social change communication therefore is to interrogate the organizing logics of power that constitute institutions, organizations, projects, and sites of social change communication (Dutta, 2015, 2017). The academic locus itself emerges as a site of interrogation, questioning the logics that constitute academic knowledge production and practice. The authoritarian regimes and totali- tarian structures of governance across Asia (and more specifically Singapore in the context of local projects carried out by CARE) therefore suggest critical anchors for interrogating power and its workings in relationship to universities as sites of knowledge production (see for instance Tan, Kaur-Gill, Dutta, & Venkataraman, 2017). For instance, after the conference ended, and during a time when CARE’s advocacy project on poverty (#nosingapor- eansleftbehind) in Singapore came under scrutiny, institutional- state structures pointed to the social change communication conference, placing it under surveillance and seeking to know the purpose of the conference. The notion of activism and its relationship with academia is interrogated through the question of the body. Claims to activism are grounded in interrogations of embodied relationships and risks to the body constituted in relationships with power. Radical chic articulations of activism that serve to posture market-friendly academic brands that sell the neoliberal model of education are juxtaposed amid questions of activism as a site for interrogating power. The suggestion that the location of social change communication within academia is out-of-the-ordinary or unacademic became the basis for much of the communication work of CARE, seeking to retain the space for legitimacy INTRODUCTION: THEORY, METHOD, AND PRAXIS OF SOCIAL CHANGE 7 for carrying out social change communication projects through academic- activist-community partnerships, mobilized toward generating knowledge of communicating for social change from the margins. Power, circulating within institutional structures, sought to delegitimize the communicative practices of social change by marking these practices as unacademic, disruptive, threatening. Communicative infrastructures among the poor for instance became threatening as they challenged the dominant narratives that erase poverty. The work of communicating social change then became one of reworking these sites of power, seeking to retain the communicative infrastructures for the participation of the margins. As reflected in many of the chapters, reflexivity as a methodological tool turns the lens inward, situating as its subject the power embedded in academic sites of knowledge production. The lessons emerging from the chapters offer important lessons regarding strategies for cocreating communicative infrastructures at the margins amid authoritarian strategies of state-market control.

Conclusion This edited collection of essays seeks to offer new ground for theorizing, empirically examining, and participating in communication for social change. That social change communication processes are complex, complicated, and messy suggests that academics studying and practicing social change communication continually explore invitational spaces for opening up the conversations. The very nature of space, rendered impure, through academic-activist-community partnerships is reconstituted in new ways through social change communication practices from the global margins. I hope as you read these chapters, you attend to the constitutive ways in which academe is interpellated through communication for social change from the margins. This continual orientation toward the margins of knowledge production is generative of an ethic that opens up to multiple plural stories.

References Bourdieu, P. (1984). Homo Academicus. Peter Collier, trans. Stanford, California: Stanford University Press. Dutta, M. J. (2015). Decolonizing communication for social change: A culture- centered approach. Communication Theory, 25(2), 123–143. Dutta, M. J. (2017). Migration and health in the construction industry: Culturally centering voices of Bangladeshi workers in Singapore. International Journal of Environmental Research and Public Health, 14(2), 132. 8 M. J. DUTTA

Frey, L. R., & Carragee, K. M. (2007). Communication activism volume one: Communication for social change. Hartnett, S. J. (2007). “You are fit for something better”: Communicating hope in antiwar activism. Communication activism, 1, 195–246. Hartnett, S. J. (2010). Communication, social justice, and joyful commitment. Western Journal of Communication, 74(1), 68–93. Tan, N., Kaur-Gill, S., Dutta, M. J., & Venkataraman, N. (2017). Food insecurity in Singapore: The communicative (dis)value of the lived experiences of the poor. Health communication, 32(8), 954–962. PART I

Theoretical Articulations of Social Change

Dazzelyn Baltazar Zapata

This part of the book explores theoretical articulations of social change. In particular, it looks at (1) how communication scholars theorize issues of social change, (2) make sense of what is considered social change to begin with, and (3) explore how emerging alternative theories and frameworks in communication address various kinds of disparities. The opening chapter titled Self-Reflexivity for Social Change: The Researcher, I, and the Researched, Female Street Based Commercial Sex Workers’, Gendered Contexts starts off with reflecting on the role of the researcher in social change. As social science scholars, we are always involved in research in more ways than what is revealed in our scholarship. Iccha Basnyat questions this valorization of objectivity that is abundant in communication research. She interrogates the prescribed top-down measures of social change that remove the researcher from the process and erase the voices of the communities in the name of “objectivity”. Basnyat eloquently argued how positioning the self in relation to those being “studied” enables the communication scholar to foster participatory coconstructive spaces for change. This becomes a transformative space that blurs the line between the researcher and the researched. Basnyat weaves the lived experience narratives of female commercial sex workers to her own voice—a co-constructive process of their gendered-selves as she links it to the broader context within which these stories transpire. The next chapter, Gaze as Embodied Ethics: Homelessness, the Other, and Humanity by Erik Kramer and Elaine Hsieh, engages ethics in relation to homelessness. The authors theorize gaze as they interrogate a culture that 10 Theoretical Articulations of Social Change justifies cruelty to this marginalized homeless population that is rendered invisible and disposable. They explore the larger sociocultural context that contributes to the complexity of homelessness in the United States. Kramer and Hsieh examine the issue of homelessness from the perspective of cultural phenomenology or the cultural conditions that facilitate such structures. Their chapter challenges us as they take us on a journey to view homelessness and our humanity as deeply intertwined and that social science needs to go beyond mere theorizing for it to really make a dent and foster social change. The third chapter, Development Communication and the Dialogic Space: Finding the Voices Under the Mines by Christele Jao Amoyan and Pamela A. Custodio, amplifies the voices of a small fisherfolk community in Calancan Bay, Sta. Cruz, Marinduque, Philippines. Through engaging the (un)heard voices of fisherfolk, who bore witness to how unsustainable mining transformed a local fishing village into an industrial wasteland. After decades of struggle for socioeconomic welfare, environmental rehabilitation, and social justice, the fisherfolk remain in unhealthy polluted living conditions. The authors listened to the people’s dialogues and everyday conversations and argued how this creates a new space for critical discourse. They operationalized dialogue using Freirean concepts of dialogue for desirable social change. Amoyan, first author and dominant voice of the chapter, accounts entering the field to listen and collate the silenced voices of the fisherfolk and from there, develop a sense of self-reflexivity as she journeys through the multitude of lifestories and her own. Chapter four, The Kapwa in Compassion: Examining Compassionate Healthcare for VAW Victims Among PGH Healthcare Providers by John Mervin Embate, Marie Carisa Ordinario and Alyssa Batu, talks about compassion through the lens of kapwa. They investigated the ways and means through which compassionate healthcare was extended through communicative behaviours of healthcare providers in a public-funded hospital to Violence Against Women (VAW) patients. The Philippine General Hospital (PGH) caters to about 600,000 patients every year, most of whom come from poor economic backgrounds and among the few which has a working Women’s Desk. The authors used a locally developed theory on the Filipino psyche called Sikolohiyang Pilipino (Filipino psychology) to engage the concept of compassion. The authors found that healthcare providers are able to deliver compassionate healthcare to VAW victims through recognizing, relating, (re)acting and empowerment. The Theoretical Articulations of Social Change 11 providers also view compassion as Kapwa (kindred), Pakikiramdam (shared inner perceptions), Kagandahang-Loob (shared humanity), Asal (attitude). A dichotomy between call of duty and social responsibility. Embate and colleagues discussed how health workers are affected by various factors and are inhibited by different organizational/structural and sociocultural factors. They discussed how compassionate healthcare is restricted by structures. They argued that amendment in government policies, proper budget allocation, and a rehabilitation of sociocultural influences that marginalize women are called for to empower women and bring about social justice to those who have been violated by the system. CHAPTER 2

Self-Reflexivity for Social Change: The Researcher, I, and the Researched, Female Street-Based Commercial Sex Workers,’ Gendered Contexts

Iccha Basnyat

In this chapter, I argue that positioning the self, that is, researcher, in relation to those “researched” through self-reflexivity enables the communication scholar to foster participatory spaces for social change. I use social change, as noted by Waisbord (2015), “to refer to the activation of institutional and social networks to promote transformations at individual, community and structural levels toward social justice” (p. 146). It is important to define social change, because as Waisbord (2015) highlights communication for social change “grounded in studies on a vast range of health issues (e.g., family planning, HIV/AIDS, child health, malaria) reflects long-standing patterns in global aid, namely priorities and funding flows” (p. 147). Academic scholarship that “parallels international development” (Waisbord 2015, p. 147) positions only the researcher as the expert, and such designing and implementing social change projects remain at the discretion of the researcher. The consequence then is that voices of the communities are absent from this communication discourse.

I. Basnyat (*) School of Communication Studies, James Madison University, Harrisonburg, VA, USA

For instance, in health communication, scholars often refer to concepts such as communication strategies, communication campaigns, social marketing and mobilization, persuasive communication, and awareness raising where behavioral change is the dominant form of change (Lie1 & Servaes, 2015). These terminologies reflect more about the researcher than the community. Rather, I argue that a social change project needs to engage with the community, and to do so we must begin as a self-reflexive researcher. Self-reflexivity ensures that both the “researched” and the “researcher” engage in a coconstructive meaning-making process that produces culturally meaningful knowledge. “Engagement and co-constructive possibilities creates a dynamic space that is fragmented, contested, and continually revised on the basis of journeys of solidarity with marginalized communities” (Dutta, 2010, p. 538). The concept of reflexivity implies turning the lens inward to explore spaces of collaboration through dialogue (Dutta, 2010). Self-reflectivity is an important consideration because it allows the researcher to preserve their own subjectivity and to avoid becoming absent from the research process and the research context (Bott, 2010). Self- reflexivity is an ongoing conversation with oneself about what you are experiencing as you are experiencing it. Particularly, self-reflexivity highlights the choices one makes when deciding what to research, whom to research, and how the interpretations are situated. Nagata (2004) notes that “to be self-reflexive is to engage in this meta-level of feeling and thought while being in the moment. The strength of being reflexive is that we can make the quality of our relationships better at that time in that encounter” (p. 141). To be aware of yourself and to be present in the moment is to learn from one’s experience with the intention of improving the quality of one’s interactions with others (Nagata, 2004). Using a case study of the lived experiences of commercial sex workers and my self-reflexivity, I juxtapose our stories to illustrate the significance of the “researched” and the “researcher” as active participants in the research process. The way we imagine our research process, that is, researcher/expert or researcher-researched collaboration, is the way we enact our social change projects. First, I begin with theorizing self- reflexivity. The aim is to draw attention to the significance of coproducing culturally meaningful knowledge by the researcher and the participant. Next, I will use fragments of data from my field work to juxtapose my position as a researcher and as a woman of the same culture to the lived experiences of female commercial sex workers (FCSWs). I have two SELF-REFLEXIVITY FOR SOCIAL CHANGE: THE RESEARCHER, I… 15

objectives for this chapter: first is to illustrate the significance of self-reflexivity for social change project. For example, I argue that self-reflexivity is part of social change rooted in social justice—the reduction of social inequalities understood from a constructivist, agency-centered approach that underscores “strategic collective actions” (Waisbord, 2014); second is to demonstrate that self-reflexivity fosters participatory spaces for copro- duction of knowledge that are culturally situated.

Self-Reflexivity Reflexivity is part of the sense-making process in which both participants and the researcher are engaged, and through this interaction certain versions of knowledge are produced (Colombo, 2003). Self-reflexivity allows the researcher to examine the self while listening to and making sense of those stories being told, such that the outcome includes stories of both the participant and the researcher. Self-reflectivity begins with acknowledging that we are not only the researcher but also part of the research. Who we are is reflected in the work we do and the environment we end up studying. Self-reflexivity is where a researcher locates the self (i.e., position, experiences, and identities of the researcher) through which the role of the self can be examined (Bishop & Shepherd, 2011). Thus, self-reflexivity is a process—a process of critical reflection—on the kind of knowledge that is produced and how that knowledge is produced. Self-reflections become self-stories where “reflexive accounts provide opportunities to position the self in a particular way” (Bishop & Shepherd, 2011, p. 1286). For instance, if I were to share the following self-reflection, we can begin to see patterns of the researcher’s thoughts, feeling, and behavior, which in turn plays out during interactions.

I come from the same culture as the women I “study” yet I am not part of the same. We share language, religion, food, and traditions but I am not part of a marginalized group. I am located in a culture that has given me affordances in life. This privilege colors my understanding of the context of the women’s lives at the margins because my privilege has sheltered me from hardship, pain, and struggles in life. Our narratives of being a woman in the same culture reflect two different worlds.

Here, the viewer (i.e., the researcher) is part of what is viewed (i.e., the researched) rather than separate from it (Charmaz, 2000). Also, this positions me as a woman of the same culture but also highlights what I do 16 I. BASNYAT not know of my own culture. Self-reflexivity brings to the forefront the personal and professional experiences of the researcher as well as takes into account the researcher’s effect on the study context by addressing the subjective nature of research (Malterud, 2001). In self-reflexivity, both parties then become active participants in the meaning-making process coconstructed through their interaction, for the reason that self-reflexivity cultivates the ability to be self-aware of one’s feeling and its impact on thinking and then adjusting what one is doing and saying (Nagata, 2004), which in turn has profound impact on the interaction and the relationship. The interpretations we make as a researcher are inevitably affected by who we are, where we come from, and what we value. Dutta-Bergman (2004) argues that reflecting upon positions of privilege attunes you to the fact that it is impossible to represent the voices of the subaltern but rather the coconstructive process ensures stories of marginalized doesn’t go untold. In addition to positioning myself is the need to position the context within which the stories emerged.

I approached Community Action Center (CAC), a non-profit organization, and requested access to interview sex workers living/working in Kathmandu. CAC operates a drop-in center in Kathmandu and a Voluntary Testing and Counseling (VCT) clinic in Kathmandu and Bhaktapur, 15 kilometers (~9 miles) east of Kathmandu. The VCT clinic provides free STI treatment and free HIV testing for FCSWs. Gaining entry and access is often a challenge with marginalized populations. This is a hard-to-reach group of women who are highly mobile and I felt I needed to work with an established organization that the women trust. This research is confined to sex workers who access this service. During my time with CAC, I went to the clinic every day for an entire month and conducted an average of two interviews per day. This marks the beginning of our journey, our relationship. In this chapter, I present parts of the data from my interviews with the sex workers. I argue that both the researcher and the researched need to be part of the communicative process where both the roles are significant in the meaning-making process for social change. That begins with a dialogue and a dialogue is about listening and about being self-reflexive as we journey together.

Inherent in this positioning of self and of the story is to situate the location from which, I, the researcher speaks and is able to speak. A reflexive researcher is aware of the potential influences and is able to look at their own position in the research process. I am aware that my SELF-REFLEXIVITY FOR SOCIAL CHANGE: THE RESEARCHER, I… 17 research begins with me the moment I decide what/whom I want to study. This awareness is critical in a coconstructive process because it attunes the researcher to where the self is located in relation to the participants and the position from which we both communicate. Throughout the research process, the researcher needs to constantly locate and relocate themselves (Bott, 2010). Self-reflexivity allowed me to explore my own position in relation to the women. For instance, I noticed that I would react to the women’s stories with anger, frustration, joy, sorrow, and happiness, and this came with my identification with the culture and realizing my own expectations, and assumptions, about our culture and about the different experiences of women within our culture. “By concentrating on how personal interests and standpoints affect the research process, the researcher begins to emerge not as an individual creative scholar, a knowing subject who discovers, but more as a material body through whom a narrative structure unfolds” (Richardson, 1994, in Bott, 2010, p. 160). The true essence of self-reflexivity is the ability to show your vulnerability and your willingness to learn. When the coconstructive journey began, I was no longer just a researcher but part of the process through which alternative knowledge could emerge. In order to constantly engage in self-reflexivity, I wrote field journals, jotted down my thoughts after each interview, and reflected upon our interactions. I share my first journal entry.

Day 1: At 8:30 am, I close the door of the car behind me as I hurry across a crowded city street. As I make my way, I think about the stark difference between the lives of the women I am about to meet and myself. I am not sure what to expect when I actually meet the women. I feel anxious as I walk through the narrow alleyway. I walk hurriedly to a two-floor house tucked away from the main road. It bears no signage. I am greeted by a staff member at the door. She knows who I am (i.e., upper strata of social class, educated, a professor, living in Singapore) and hence uses language of formality and respect. I too use the same language in return out of respect. Looking around I immediately know that I am also different from the staff who work here. I am also aware that everyone at the center is watching my every move. I quietly follow the staff member to the director’s office. She is not in but I am asked to wait. I am offered tea, which I graciously accept. An hour goes by, and another. Neither the director nor the participants arrive. I am unsure what to do but I wait. While I wait I try to soak myself in my surrounding by observing and listening. At some point the staff member comes in and apologizes for keeping me waiting. I smile and assure her that I am fine to 18 I. BASNYAT

wait and am not inconvenienced at all and I ask if it’s ok if I continue to wait. I think about the irony. I should apologize for occupying their space and time. Around noon, she pops her head in the room and asks if I would like her to order lunch for me. I ask her what the staff normally do and whether I can join in. I meet all the staff who eagerly ask questions about me throughout lunch. I get in a few questions about the organization and my potential participants. After lunch, I make myself comfortable back in the room and wait. The director arrives. It’s 2 pm. We chat about the study. She calls in her staff member and asks her to arrange someone to take me and set me up at their VCT tomorrow, 15 km outside of Kathmandu, to begin my fieldwork. The staff member, herself, will meet me next day at the center to help me set up and to introduce me to the clinic staff. At this point, I thank them both and take my leave for the day. As I walk out I ponder about tomorrow.

Journaling allowed me to stay engaged throughout the process as an active process of self-reflection. Guillemin and Gillam note that active self- reflection means to (i) interrogate the data, the researcher, and the participants who come together to construct knowledge; and (ii) engage in reflexivity at every stage, from research design to the questions being asked, and to the analysis and interpretations that show the coconstructed knowledge production. Engaging in self-reflexivity during this process ensured that I was able to identify and separate my voice and the voices of the participants even as they interpenetrated and coconstructed the discursive space.

Situated Retelling: My Society, Your Society, Is It the Same? Retelling of stories is fragmented and situated. In retelling the participants’ and my story, we construct certain knowledge through our interactions. Narratives are personal and are also social because people understand themselves through the stories they tell and the stories they feel part of such that how the individual narrates is just as important as the meanings they communicate though their stories (Chase, 2008). How we narrate signifies the position from which we narrate, and, through the stories we share, the meanings we want to convey through our stories. Through the process of narration, social phenomena take on meanings of social context (Daya & Lau, 2007; De Fina, 2009). In other words, with different interactions with different people, we produce different meanings of the SELF-REFLEXIVITY FOR SOCIAL CHANGE: THE RESEARCHER, I… 19 same phenomenon. In this situated retelling of our stories, I ensure that the (i) voices of the participants and the researcher are represented and (ii) my subjectivity in the research process is engaged and its possible impact on the interpretation explored.

The Researcher, I I share my self-reflections to contextualize what I mean by “my society, your society, is it the same.” This begins to highlight our differences in not only the research process but also where we, as women, are located in our lives, in our society such that the interpretations we make are meaningful to us. I share a self-reflection to illustrate this:

I am fully aware that I am very different from the women. I also know that I do not want to pretend we are the same, despite our cultural similarities. To me this is about respect and respect is about acknowledging our differences. I know even if visually I look like the women, as soon as I speak it will be obvious that I am not. The way I speak will indicate my background to the women. With this on my mind, I dress like I normally do as I ready myself for my first encounter. Jeans and kurti-top, a simple red tika, a few glass bangles, a string of glass beads around my neck, and simple sandals.1 As I dress, I am acutely aware that this will indicate to the women that I am married but clearly come from a “modern” family, not dressing in traditional attire of either sari or kurta. At the same time, this is me.

In self-reflexivity, I separate my voice from those of the participants to show how we have come together to produce knowledge about the marginalized space. Particularly, I locate myself in this research process to show how that influences the interpretations I make. My self-reflections are interspersed with field notes and journaling.

Day 2: 9:00 am. The drive takes me outside of Kathmandu city limits. As I watch out the window through the morning drive, I can’t recall the last time I was here. The car stops on the shoulder of a busy main road. From the window, I see the staff member from yesterday waiting for me by the road.

1 Red tika (on the forehead), glass bangles, and a string of glass beads around the neck are cultural markers of being married. A sari is a five- to nine-yard length of fabric that drapes around the body, often worn daily by married women. Although kurta, a long, loose-fitting, knee-length top with a matching pant bottom, is also regularly worn by unmarried as well as by more and more married women. A kurti is a short top without the matching bottom. 20 I. BASNYAT

I get out and greet her. I follow her across a small muddy made-up pathway through a rice paddy toward a two-floor house well hidden from the streets. We arrive and she proceeds to introduce me to the center staff. I greet everyone in the same formal language as yesterday and like yesterday I am very aware of the difference in me and everyone around me. I am, however, certain that yesterday’s interaction has already been relayed to the clinic staff based on the warm greetings I received. I chat briefly with the center staff and we decide that I will occupy a room on the top floor of the house for privacy. The staff will tell the potential participants about me and if they so wish they can make their way to the room. I am ok with this arrangement given the sensitive nature. I walk into the room, which is practically empty. In one corner I sit on the floor across from a low square table. As I ready myself, I hear a knock on the door.

I am aware that as a researcher, I create the conversational space where participants are willing to share their lived experiences. It’s not a matter of question and answer but of a dialogue which meant sometimes I talked about everything but the intended questions with the women. Sometimes I was a counselor listening to stories about children, about family, about friends and neighbors, about the pain and suffering, about what happened yesterday. None of it sometimes was about what was at hand, but about being present in the moment, and to listen. These were all learning opportunities for me, as I am not part of the same story as the women. Time and relationship are an important aspect. I share a reflection:

Often I go home filled with emotion at the end of the day. Anger is what I feel mostly. I am not angry at the world for the women nor do I feel anger toward our society. What angers me I have finally realized is my own insensitivity toward the performance of our gendered identities. I know what patriarchy is but never have I stopped for a moment and thought about what that really amounts to in the lives of so many because I have never had to think about it. When I let the anger pass through me I do feel hopeful. I feel the strength of the women, the determination of the women to survive, to fulfill their identity as mothers.

Through my self-reflexivity I position the researcher in relation to the researched. As I retell the fragmented stories of how gender roles are exacerbated at the margins, I will highlight gendered context in both personal and social relations for the women and myself. In the situated retelling of our gendered contexts, we begin to capture the significance of self- reflexivity in research that moves toward dialogue. Dialogue then becomes SELF-REFLEXIVITY FOR SOCIAL CHANGE: THE RESEARCHER, I… 21 the root of social change project that allows problems and solutions to emerge organically and with equal inputs from the researcher and the community.

Personal Relations All the participants are married yet none of them live with their husbands. Even in separation, the role of husbands has great implications for the women as Kali explains:

I started this line of work because my budha [referring to husband] was abusive. He took my citizenship and wouldn’t give it to me. I am not educated, I didn’t know how to write my name and I was afraid to look for jobs because my budha had my citizenship card. He kept it so he wouldn’t have to give me any land or inheritance for my children. I cannot use my parents name because I am married so for a long time I only used my first name and had no last name. To get a permanent job, I need my citizenship. I work in this line to educate my children, take care of them. I work, I survive and I live. I just wish that no one has to go through the struggles and hardships, the suffering I have been through.

Kali’s story reveals that because she is married her future is tied to his willingness to support her. The power embedded in this relationship reveals the gender inequalities of those who are poor, uneducated, and thus dependent on the husband for their livelihood. Kali also expresses her will to survive for her children. Sex work is stigmatized but of greater concern is the future of her children. Similarly, Putali shares her story:

I was arranged to marry when I was 15 years but my budha brought another wife in [“brought in” is reference to eloping rather than socially family- accepted marriage]. At first it was not looked upon well when he ran away as a married man with another woman but eventually it comes to be that you are the one who is not treated well for being left by your husband. I had to leave.

Putali highlights another layer of gender inequality: the power of her husband to control her future such that she is either accepted into the family or thrown out. “I had to leave” is a reference to the lack of support from the husband’s family as well as the lack of acceptance to move back with one’s parents and/or siblings. In Nepal, women move in with the 22 I. BASNYAT husband and his family such that when a husband shuns her she often lacks the social support to live in the same household or the community. Similarly, Hari Maya explains:

My husband sold all our land and left with another women. It’s been almost 10 years I do not know his whereabouts. I have four children and I have to take care of all of them. I don’t have a home so I have left my children in my gaun [village] with my parents. They all think I am in the city for labor work. I tried to look for jobs but I haven’t found any work. I have no education and I have no other support, so when a friend told me this is how she raises her children, well I am here now.

Hari Maya’s story further captures the power relationship between husband and wife. The power that lies within the husband and his family is exemplified by the fact that both Putali and Hari Maya bear the burden as outcasts after their husbands left them for another woman. Furthermore, “this is how” is reference to sex work as the ability to raise children and earn a living. Sita captures this sentiment when she said:

I have four children, 4 girls and 1 boy. The oldest is sixteen and the youngest is ten. I am the sole person that takes cares of them, pays for them to go to school. I pay doing this work. I have no idea where my husband is. He doesn’t take care of them, I do. I haven’t seen him almost ten years. Maybe he has already found someone else to take care of him [referring to another wife].

The women are mothers seeking foremost to support a family, to ensure their children have a better future. Without an education, without any job skills, without the ability to take on physical labor work, without any support, the women find themselves in this line of work. Furthermore, Sita’s story highlights the agency of the women to manage their lives, despite the fact that husbands may hold the power in the relationship. Sex work then becomes a way to earn a living, a way to survive. Listening to the stories of these women, I share my own position and reflection of my gendered position in my personal relationship:

I know I am part of a patriarchal society but I never questioned how that gets performed because I have never had to confront a situation where that has limited me in becoming who I am. In fact, I was raised in a family where equality is assumed between boys and girls, men and women. I perhaps do SELF-REFLEXIVITY FOR SOCIAL CHANGE: THE RESEARCHER, I… 23

not question this as much as I should; I have become complicit in furthering this gender inequality. This equality continues in my life. I am well-educated, I have not taken on my husband’s name though we live with his family, and I work but he is a stay-at-home dad, the caregiver in the family. We have reversed the traditional norms around gender roles; I am even more removed from how patriarchy is performed in the lives of these women I have been listening to. I have never claimed to challenge patriarchy though we operate outside of the traditional gender expectations. In fact, what I have come to realize through the stories is that I can do what I am doing because my privilege allows me.

In accepting my position in relation to the women, my interpretation becomes situated in meanings that are relevant to us both. Without self- reflexivity and without engaged listening, I, the researcher may suggest that social change ought to begin with the women. I may become an advocate for providing individual rehabilitation for sex workers to reinte- grate them into society without asking whether society will accept them back as “full-functioning” members. In reality, what social change means and would look like for the women may be different than what I imagine from my position of privilege such that self-reflexivity becomes key for a coconstructive journey. The stories then become an opportunity for dialogue that opens up participatory spaces of change that is relevant and meaningful to the women. The next step for my project is to have a continued dialogue with the women, a continuation of the field work, a move that allows both parties to participate in the social change that is defined and derived within the community. What this means is that there are no one-size-fits-all solutions and solving social problems becomes contextual- ized and situated, as does the knowledge that is produced through our interactions, even within the same group of women. The next section discusses gendered context for FCSWs in relation to their jobs.

Social Relations Exposure to violence and exploitation is an everyday reality in the lives of the women. Clients on one hand provide the income and on the other hand may abuse and exploit the women. Nirmala shares her recent experience. She said:

I recently went with what I thought was a client. He seemed decent but after we finished when I asked for payment he showed me a knife, threatened me by saying are you going to give me what you have or should I stick 24 I. BASNYAT

this in you and so robbed me of my day’s earning, took my mobile and left me there with nothing. I didn’t even have any money left to get home on the bus. I started worrying about what I will feed the children tonight.

When faced with a life-threatening situation, Nirmala’s only concern was her children. Being a mother comes first for the women, and as a mother, I can share this understanding of the need to provide and protect our children. Here, I share my self-reflection entry upon hearing Nirmala’s story:

Every day the women struggle for children, yet I wonder will their children accept them when they learn what she does for a living. While the women struggle to educate their children and help them to integrate into mainstream society, I feel society will turn these children against the women. That is, these children to be part of the mainstream society, for their education to have value and to find a place an accepted place within our society, they must in turn accept the societal norms which will reinforce the marginalization of the very woman who has struggled for their future. I think how my mother struggled to balance home and work so that her children could also have a better future but never can I imagine turning my back on the very women who endured and struggled for us. Yes, hers was a privileged struggle in comparison and such is mine for my children. Perhaps, I will never understand this juxtaposition.

For a social change project what that then means is that the voices and participation of the women are critical. Self-reflexivity allows us to ensure the suggestions we make for social change are located in a dialogue that allows the solutions to be driven by both the researcher and the participant rather than being prescribed by the researcher/expert. Self-reflexivity reveals that even I, who come from the same culture, wouldn’t be able to create a solution that reflects the realities of the women and truly address their needs. Furthermore, Ruma discusses the hidden relationship with clients—the public versus the private relationship. In private, service is sought but in public because of the stigma and discrimination the women themselves do not expect to be treated with respect. She explained:

Sure they call us because they want something. Maybe they even want to relax with us but tomorrow if we need something, need some help they will hang up the phone. They use us but from the inside there is hatred because SELF-REFLEXIVITY FOR SOCIAL CHANGE: THE RESEARCHER, I… 25

we do this kind of work so they would never accept or acknowledge us. They want to hide, want to relax with us where no one can see us but tomorrow if we ask for help they will call us sluts and whores. There will be none who will show you love or care when you need it.

Ruma’s reference of “they” she tells me includes men of all social position and strata of society. In private these men seek the women, and in public the same men will shun them. The duality of private-personal relationship keeps them an invisible, voiceless, and marginalized segment of society. Meaning we know the women exist and so do their clients who demand and utilize their service, yet due to the stigma associated with sex work we blame and shun the women for the service they provide. Ruma further illustrates how women are exploited. She explains:

A: I only started doing this [referring to sex work] a year ago. Q: So you were working someplace else before? A: Before this I went to Arab [referring to being a labor migrant]. I was in jail for five months. Sahu [in Nepali refers to business owners, in everyday language is a reference to the boss, whoever is the employer] kept my passport, wouldn’t give it back to me. They took my honor [referring to rape], I lost my respect. It was a big business. I wanted to get out of it. I was jailed because I tried to escape. I finally managed to get back to Nepal. My husband was gone when I returned. He sold all our land, took my children and moved. I have no idea where he is. But now what? I had already lost my honor. I have no home. So you tell me what’s left for me to do?

Vulnerability, abuse, exploitation, and risk are all part of sex workers’ lives, but what Ruma highlights is the notion of “honor.” Society may consider sex work dishonorable but for the women there is integrity and self- respect in their work. Similarly, Kumari shares her experience. She said:

We’re selling our body so why give to others [referring to bribes to policemen] but if we don’t do that then we will meet with more policemen hassle, arrest and trouble all the time. Sometimes they arrest you and take all your money and so when you get to jail you have no money to get out. Other times they may just ask if we will give them money and sex or whether they should take you to jail and lock you up instead.

This doesn’t mean the entire system is corrupt but often the policemen the women encounter are foot soldiers patrolling the streets. Nevertheless, it raises concerns about how the entire security system is functioning 26 I. BASNYAT where certain segments of the society will be protected while the rest fear the very system meant to protect them. The women highlight the difference between selling their body as a service and being taken advantage of because they are sex workers. This challenges the very notion of how one views the women: as victims or as active participants, as one who needs saving or one who has agency. Radha further echoes this sentiment. She explains:

You know sometimes we have to rent rooms with our client. So people may notice you. Some may harass you. Sometimes they may call the policemen to come and arrest you. When that happens what should we do? I am a little troubled by this harassment because when they arrest you, they sometimes take your money and they will try to take your honor or demand you give them free service. That’s why I feel troubled by the policemen and oppressed by them.

Her reference to “take your honor” implies how sex workers view what they do with respect, a way to earn a living, as a form of occupation, even if society stigmatizes and discriminates against them. To them there is a distinction between the service they provide and the exploitation because of what they do. Similarly, Rupa shared her experience:

I was standing at the bus terminal/park. Suddenly someone pulled me. Then that person called the police van over. Along with me there were others that were pushed inside the van. We told them, we have children; we don’t have husbands, or homes. We begged for them to let us go to our children. Then, one of them pulled another girls hand and dragged her “to take her honor.” I think I was left alone because I am an old lady. But you see they take girls like that by threatening them of arrest and jail time. I had hundred rupees [~ 1 USD] with me and they took that from me. All of this was happening in the middle of the road. Other men are watching this as well. There is no one to protect us, you see.

Stories of the women reveal that they enter sex work due to failure in their marriage, which makes them outcasts from their kinship and community. All are mothers who continue this line of work with the hope of economic gain. Failure in personal relations leads them to engage in social relations with two major categories of men: clients and policemen. This leaves the vulnerable to risk, abuse, violence, and exploitation because they are a stigmatized and marginalized group of women. The stories of SELF-REFLEXIVITY FOR SOCIAL CHANGE: THE RESEARCHER, I… 27 relationships with men reveal a complex cultural, social, and institutional environment within which the women become and remain sex workers. In such a context what would social change look like? From an objective perspective, it seems rational to remove the women from becoming sex workers by ensuring they have skills, education, and jobs. This leaves out two things: (i) rehabilitation is after the fact and it doesn’t address the root cause, and (ii) reintegration into society is often a challenge for the women because she returns to a society that has shunned her in the first place. Participatory social change based on dialogue begins with including the women in defining, designing, and implementing change that truly connects and reflects her realties and her needs. I share my concluding self-reflection:

At this stage I have no suggestions to make to address the conditions at the margins. I do not even know where to begin explaining what this journey has been for me. The stories that were shared provided insights into the lives of women, and simultaneously into my own life, its constructions, politics, and privileges. Through their stories, I see my own place within the same society we are part of yet have experienced so differently. Through this process, I have come to respect the resilience of human agency in the midst of struggle. I am left asking: Why do the women need to accept the injustices a system, a culture, has imposed on them? And why don’t we talk about material shifts that could bring about changes in the lives of these women? Then I am left wondering what my role is in this change?

Storied Culture Narratives of lived experiences come to life through how I, the researcher, make sense of them as well as how I, the researcher, illustrate the stories’ connection to the lives of the women. Therefore, positioning the researcher is critical because it highlights the position from which interpretations are being made. When I position myself in relation to the women, our narratives reveal different microcultural contexts, and together we are able to connect our gendered contexts to the broader macrocultural within which our lived experiences transpire. This coconstructive journey is based on time, space, and relationship such that self-reflexivity becomes critical in creating spaces for dialogue between the “researched” and the “researcher.” Dialogue ensures voices of the marginalized are foregrounded in the interpretations 28 I. BASNYAT the researcher makes and this opens up possibilities for coconstructed solutions to emerge. Self-reflexivity reveals much more than just stories; it reveals the life of the storyteller as well as reveals the position of the researcher. The participants and the researcher are intertwined in this process of sharing, listening, and reflecting. Through this coconstructive journey, a bigger narrative about a culture emerges: a culture of inequality, a culture of patriarchy, a culture of limitations, and a culture of social boundaries for women. This is unlike the culture I know of, a culture of equality and culture of opportunities that has given me the affordances in life. The significance of a coconstructive journey is to foreground voices of the participants such that alternative meanings begin to emerge. The alternative meanings reveal a culture of resilience, of survival, of the women becoming active participants in negotiating and making sense of their lives at the margins, of the need to reconstruct our social change efforts to the macro material shifts and policy platforms that disadvantage women. This differs from the grand narrative that shuns, isolates, and discriminates sex workers. Sex work is stigmatizing, often exposed to violence, abuse, and health risk, yet the women endure to survive by renegotiating the marginalized space as honorable and respectful occupation for survival. Here, I want to draw attention to the need to reconceptualize dominant communication scholarship to embody social change as a journey, as a relationship. Moving away from social change as Waisbord (2015) noted traditionally as “inseparable from the particular architecture of global aid” (p. 147), through social change focused on social justice, we can focus on the marginality of women within macrostructural discriminations (i.e., education, access, income, class) which operate within gender discrimination. “Change,” in this instance, cannot be simply a focus on women’s sexuality but moves us toward discussing the influences of cultural, societal, and institutional oppressions. Through listening and self-reflexivity, we are able to see how power relations in family (e.g., abuse, throwing the women out) as well as patriarchy (e.g., women move in with the husband’s family, citizenship is tied to the husband; husband can take in second wife) coupled with lack of access to education, resources, and jobs influence their choices. Gender and gendered contexts are intertwined such that the women’s condition of subordination is constituted in the realm of culture. Through listening and self-reflexivity, we can make sense of and understand how culture of patriarchy and limited access to structures has created conditions at the margins. Through my self-reflexivity, I can rethink how communication can contribute to social change that promotes social justice SELF-REFLEXIVITY FOR SOCIAL CHANGE: THE RESEARCHER, I… 29 informed by the participants. Thus, a self-reflexive researcher committed to a coconstructed process needs to engage in a dialogue with the marginalized community to understand and locate choices within broader macrocultural and microcultural and structural limitations. In doing so, voices of these traditionally unheard populations allow us to rethink development interventions from a bottom-up participatory approach, rather than remain simply parallel to international development agenda. Through the stories of the female street-based commercial sex workers, a complex social process that embodies gendered context is revealed. Sex work is a manifestation of gender power relations in both personal and social relations and is sustained by those gender relations. In a patriarchal society, women are discriminated and pushed to the margins, and are further marginalized for living at the margins of what a society deems to be immoral. Through self-reflexivity and dialogue, we make sense of the lived experiences and locate the interpretation within a culture of violence, limited access, unprotected from the law, and exposed to social stigma. I have grown up in the same culture but have no shared experience with my participants. However, through a dialogue I am able to understand how the participant’s lived experiences can be viewed as both enabling and constraining (Chase, 2008). Enabling because women make a living through sex work for their day-to-day survival, to provide for their families, yet constraining because of the limited opportunities to access mainstream society while living at the margins of society. Despite sharing cultural markers with my participants, I am located in spaces that have enabled me opportunities and access. Listening to the stories and engaging in self-reflexivity, I am able to understand the lived experiences of my participants which have helped me question my own position and identity. What this highlights is the importance of self-reflexivity, which then takes us down a different path when imagining a social change project. Through this process of self-reflexivity, we move away from the behavior change model to social change. Much of health promotion targeted at sex workers has relied on individual behavior change interventions such as peer educators, condom promotion, provision of sexual health services, and management of sexually transmitted infections (STIs) (Beattie et al., 2014; Kerrigan et al., 2006). However, Basnyat (2017) argues that in addition to paying attention to the socio-cultural, political, economic, and historical contexts, social change projects must be understood in relation to gendered social context (i.e., patriarchy, policies, and oppression) intersected with social identity 30 I. BASNYAT

(i.e., woman-mother-sex worker) and social locations (i.e., poverty, marginalization) of FCSWs. Through a self-reflective process we open up spaces for sex workers’ narratives which are indicative of broader socio- cultural, political, economic, and historical contexts that affect their lives. In turn, this creates spaces for participatory social change that reflects and resonates with the lived experiences, needs, and realties of the marginalized. This moves away from prescribing interventions based solely on the researcher’s position and agenda—interpretations that reveal nothing about the interpreter and their politics. Rather, self-reflexivity presents an understanding of our lives (i.e., the researcher and the researched), and how we have come to become who we are in the same context, such that any biases in the interpretations I make are also situated but also create space for the participants in that process. Articulations of the lived experiences and self-reflexivity are how the participants and I became active in this process of meaning-making and shared knowledge production. Locating the stories of the commercial sex workers reflected through my fragmented retelling demonstrates the relationship between the researched and the researcher and their respective location in this process. At the end of this self-reflexive journey, rather than proposing a solution that focuses on individual behavior change of sex workers, we open up spaces for social change project that achieves social justice.

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Sage Handbook of Qualitative Research (pp. 507–536). Thousand Oaks, CA: Sage Publications. Chase, S.E. (2008). Narrative Inquiry: Multiple Lenses, Approaches, Voices. In N.K. Denzin & Y.S. Lincoln (Eds.), Collecting and Interpreting Qualitative Materials (pp. 57–94). Thousand Oaks, CA: Sage Publications. Colombo, M. (2003). Reflexivity and Narratives in Action Research: A Discursive Approach. Forum: Qualitative Social Research, 4, retrieved from: http://www. qualitative-research.net/index.php/fqs/article/view/718 Daya, S., & Lau, L. (2007). Introduction: Power and Narrative. Narrative Inquiry, 17, 1–11. De Fina, A. (2009). Narratives in interview – The case of account. For an interactional approach to narrative genres. Narrative Inquiry, 19 (2): 233–258. Dutta-Bergman, M. (2004). The unheard voices of Santalis: Communicating about health from the margins of India. Communication Theory, 14, 237–263. Dutta, M.J. (2010). The Critical Cultural Turn in Health Communication: Reflexivity, Solidarity, and Praxis,Health Communication, 25, 534–539. Kerrigan, D., Moreno, L., Rosario, S., Gomez, B., Jerez, H., Barrington, C., … Sweat, M. (2006). Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic. American Journal of Public Health, 96(1), 120–125. doi:https://doi.org/10.2105/ajph.2004. 042200. Malterud, K. (2001). Qualitative research: standards, challenges and guidelines. The Lancet, 358, 483–488. Nagata, A. L. (2004). Promoting self-reflexivity in intercultural education.Journal of Intercultural Communication, 8, 139–167. Lie, R., & Servaes, J. (2015). Disciplines in the field of communication for development and social change. Communication Theory, 25(2), 244–258. Waisbord, S. (2014). The strategic politics of participatory communication: Where strategic communication and communication for social change (should) meet. In R. Obregon, T. Tufte & K. Wilkins (Eds.), Handbook of development communication and social change. Malden, MA: Wiley. Waisbord, S. (2015). Three challenges for communication and global social change. Communication Theory, 25(2), 144–165. CHAPTER 3

Gaze as Embodied Ethics: Homelessness, the Other, and Humanity

Eric Kramer and Elaine Hsieh

In this chapter, our goal is to critically examine the social phenomenon of homelessness by questioning our own presumptions and humanity as well as the social theories developed to explain homelessness. We want to start our discussion with a childhood story of the first author:

In 1964, when I was seven years old, my family traveled from our suburban home in Ohio to the New York World’s Fair. We took a tour of the city and at some point we were on the edge of the Bowery neighborhood filled with flophouses and disaffected people. According to my father, I got separated from the group and when they found me I was squatting down next to and chatting with a “bum.” I don’t recall any of my conversation with the “bum” but I do recall the extraordinary machinations of my father and the very peculiar look on his face as he pulled me away from the homeless man, apologetically but urgently. The situation was for me, and I think my father too, totally dissonant. It seemed clear that I was being both good and bad at the same time. The man had caught my eye and waved at me. So I waved back and went over to talk to him. My father’s look of concern mixed with anxiety and an urgency to get me away (to… safety?) yet politely, apologetically, with a fake smile is something I never forgot.

E. Kramer (*) • E. Hsieh University of Oklahoma, Norman, OK, USA e-mail: [email protected]; [email protected]

I recall my relieved mother and father laughing at my naiveté with each retelling of the story. So far as I recall it was the first time I’d heard the word “wino.” They are dirty and may be sick, even perverted. So I had unwit- tingly treated this abnormal man normally and that was wrong. Yes, I had done the right thing. He was old and kind (he had waved to me) and I should respect my elders but … My parents seemed both relieved when they saw what I was doing and yet eager to terminate the interaction. That was the essence of the dissonance I now believe. How can someone be both harmless yet repulsive? I had violated norms and expectations because, for the first time, I had encountered a different kind of person and I did not understand. I needed to learn, to be socialized to fear the Other, even if they were harmless even friendly, indeed perhaps worthy of pity.

How we react to things exhibits our courage, our cowardice, our empathy, our narcissism, our sensitivity and empathy, our idiocy or dumb sense- lessness—our humanity. In the slightest hesitation to return a hug or smile, to reach out and take the hand offered, we are exposed. We cannot avoid responsibility. Ethics, along with its moral obligations, is embodied through our existence (Honneth, 1996). Lévinas (1978/1978, 1979/1987) argues that we as human beings summon each other as moral beings and that this organic way of communicating with the Other pre- empts what may become competitive or instrumental communication. When we see each other, we are beheld as an Other. The event of encountering is a summons to respond—to reciprocate, to communicate. When we refuse, when we feign ignorance and innocence, when we avert our eyes, step away, or neglect to complete our side of a greeting, we are offending (Honneth, 2000/2014). Such understanding of ethics, our moral obligations to one another as fellow human beings, is universal because it transcends any individual culture. It calls out the shared embodiment of human existence. In the following sections, we aim to explore the cultural conditions that make the existence of the homeless possible. In particular, we adopt the approaches of cultural phenomenology, a subfield of phenomenology. Building on the phenomenological investigations of Husserl (1962) that aim to seek authentic meaning in the primordial world of daily existence, cultural phenomenologists are interested in the reciprocal constitution of cultural arti- facts (e.g., communication and public discourse) and constituted subjectivities (i.e., human consciousness) in everyday life (Clucas, 2000; Gebser, 1949–1953/1985). For example, Geertz (1973) attributed Paul Ricoeur for GAZE AS EMBODIED ETHICS: HOMELESSNESS, THE OTHER, AND HUMANITY 35 his notion of ethnography and Gilbert Ryle for his approach to thick description, equating examination of humanness with doing semiotics and herme- neutics. He explained: “The concept of culture I espouse, and whose utility [I] attempt to demonstrate, is essentially a semiotic one” (Geertz, 1973, p. 5). He argued that the aim of anthropology is “[A]n aim to which a semiotic concept of culture is peculiarly well adapted. As interworked systems of con- struable signs, culture is not a power, something to which social events, behaviors, institutions, or processes can be causally attributed; it is a context, something within which they can be intelligibly – that is, thickly – described” (p. 14). We follow the traditions and approaches of these theorists. By critically questioning the cultural conditions that make the existence of the homeless possible, we reflect on the lack of sentimentality to this vulnerable population. We hasten to emphasize that sentiment and sentience share the same root. By incorporating narratives from homeless people in a Southwest college town in the United States,1 we will demonstrate that our arguments are supported not just by the theoretical basis and ethics of the primordial obligations that govern us all but also by the subjective, empirical, and lived experiences of the homeless. By highlighting the fragmentation of cultural consciousness and the desire to develop a universal, context-free understanding of the marginalized, we use the homeless phenomenon in the United States2 to extrapolate the cultural conditions that facilitate such structures of human consciousness (i.e., a cultural phenomenology approach).

1 All procedures and data reported here have been approved by the Institutional Review Board of the University of Oklahoma. Details of research methods and participants have been reported elsewhere (Hsieh, 2016; Terui & Hsieh, in press). The narratives were excerpts of interviews with people who rely on a local homeless shelter for resources to cope with everyday challenges. The excerpts were chosen as they best reflect and embody the central themes of our arguments in each section. The participants have been given pseudonyms that starts with H (e.g., Helen and Hank). 2 While the term “homeless” implies a unified definition of the population (i.e., those without homes), the reality of the homeless are far more complicated (Lee, Tyler, & Wright, 2010). For example, researchers have argued that how “home” is defined and understood may create differences in whether one is considered homeless or not (Gowan, 2010; Somerville, 1992; Tipple & Speak, 2005). Tipple and Speak (2005, p. 350) noted, “[T]he margin between homeless and inadequately housed is much more vague and can be set very low, excluding squatters, or very high, including all who are not owners or renters of formally approved dwellings.” As a result, estimates of the prevalence of homelessness often vary significantly due to differences in how homelessness is defined. As a result, rather than discussing the issue of homelessness at a global level, which is complicated by the varied definitions of homelessness, we have limited our discussion to the homelessness in the United States. 36 E. KRAMER AND E. HSIEH

Gaze as Embodied Ethics I’ve run into it a lot of times, where people, they see somebody carrying a backpack or bag of clothes and they go, “Oh, that’s a homeless person. Stay away.” And they avoid ‘em like the plague. And for a lot of [the homeless], just saying hi to them makes their day. Don’t, don’t, don’t make ‘em invisible. They’re not invisible. They are here. You know, treat them as people. And that’s where they struggle because this is how they’re getting treated. You get treated like dirt. Eventually, you’re gonna believe you’re dirt. – Hannie

We are beheld as we behold. The homeless person who looks back at us captures us in their gaze. We are caught in the act of choice. Choice is fundamental in our conceptualization of ethics. Without choice, there is no free will; thus, no place for discussion of ethics (van Inwagen, 1983). Ethical dilemma comes as we are faced with difficult choices. Sentience summons reciprocity (Greene & Haidt, 2002; Honneth, 1996). When we are confronted with the sight of the homeless, we are forced into making choices. This moment exposes us to judgment about how we will react when confronted with the vulnerability of a fellow human being (Honneth, 2000/2014). This exposure, this inescapable judgment is made mostly by our own conscience. There is no way to avoid assessment. We know, as positively as we know anything, what is the right thing to do. Such moral judgment is best understood as affect-laden intuitions that “appear suddenly and effortlessly in consciousness [….] without any feeling of having gone through steps of searching, weighing evidence, or inferring a conclusion” (Greene & Haidt, 2002, p. 517). Our conscience threatens our view of ourselves as good and moral beings. Their presence, their sentience, weighs on us. We try to eliminate not only them as a specter but to escape ourselves as we look away to avoid eye contact or to remove the homeless’ presence in public space (Amster, 2003; National Law Center on Homelessness and Poverty, 2014a, b). If we can remove the homeless from our gaze, we remove the chance of ourselves being beheld with moral imperative (Honneth, 1996, 2000/2014).

Primordial Obligation I’m out here and they get scared cause whenever you’re homeless, they just make a wide turn around you. Cause they think we’re gonna do something. – Hank GAZE AS EMBODIED ETHICS: HOMELESSNESS, THE OTHER, AND HUMANITY 37

If you bring a bag walking on the road, and they are looking at you and realize that you are a homeless, they’ll make a big… walking around you and avoid contacting with you. – Hadley

Most of us aren’t bad people or nasty people or crazy people or anything like that. We’re just trying to live life each day like everyone else. – Hugo

The major issue discussed in this chapter is our ethical obligation to one another as fellow human beings (see also Honneth, 1996; Honneth, 2000/2014). Globalization of modern dissociation has accelerated two great extinctions: cultures and languages are disappearing rapidly, and diversity of life is collapsing (Kramer, Adkins, Kim, & Miller, 2014). In the animistic world, everything was aware of us. In that consciousness, awareness was concern—care (Gebser, 1949–1953/1985, 1997). We were not alone. So we followed elaborate forms of etiquette that guided our behavior lest we trespass against some spirit, god, ancestor, or specter. Everything was to be respected. Everything was sacred. According the theory of dimensional accrual and dissociation (Kramer, 1997, 2013), a human history of increasing dissociation or alienation from each other corresponds with the history of increasing fragmentation and individualism. It is important not to simplify this as a process of Westernization. Rather, the increasing fragmentation and individualism transcend across cultures (Gebser, 1949–1953/1985; Kramer, 1992). The history of humanity can be seen as a process of individual ego-identity emerging from the larger world. At first we were part of nature. Before Homo Sapien Sapien emerged, our ancestors lived in extended groups, mostly blood relatives. We knew each other from birth to death. This was the world we evolved in as highly social beings who cared deeply about each other and our environment. Ritual, which emotionally bound us, along with language and tool making stretches far back into our prehis- toric past (Alexander, 2004; Bourdieu, 1990). Then we began to see ourselves as separate from nature and created complex systems in attempts to confront and control nature (Kramer, 1992). As time passed further fragmentation occurred. “The people,” broke into tribes, then the tribes broke down into extended clans, then those split into extended families, and those into nuclear families. Slowly we settled into Mesolithic and Neolithic hamlets followed later by villages that were self-sustaining (Otte, 2009). The last Mesolithic peoples exist in tiny pockets deep in the Amazon (Gross, 2015). And Neolithic hamlets are disappearing from our 38 E. KRAMER AND E. HSIEH world (McCarter, 2012). The modern city must colonize surrounding land and peoples because it cannot feed itself (Kramer et al., 2014). With each fragmentation, ego-identity separated a bit more from the rest of existence. Eventually the modern individual with all his/her self-interests, from privacy to civil liberties, created to protect the individual from the collective was established. Ego-identity fragmented into id, ego, superego, and then was in danger of being lost entirely (Kramer, 1992, 1997). The great delusion of wealth is that the Self is self-sustaining. Alienation is the plague of modernity (Kramer, 1997). The world we evolved in over millions of years is rapidly being replaced by modern urban environments. Over the course of time, the universe which was previously animistic, meaning alive with spirits everywhere, full and finite, has been replaced by a universe that is largely a dead and infinite void of vibrating bits of matter (e.g., atoms). The modern universe, being constituted of dead “building blocks,” does not know we are here or care and inversely, we are free to move mountains, dam rivers, even reengineer life itself with only our own self-interests guiding us. This means that the way we interact with, communicate with everything, including each other, has changed fundamentally (Kramer et al., 2014). This change in social relations is rooted in a deeper shift in human existence, in human consciousness (Gebser, 1949–1953/1985; Kramer, 2013; Kramer et al., 2014). The evaporation of sentimentality and care becomes inevitable. It is a consequence of material reductionism (Kramer, 2013; Kramer et al., 2014). Care and aid have been shifted onto institutions of the modern mass society such as government agencies, schools, churches, hospitals, daycares, and nursing homes. With commodification of care, we increasingly see each other as customers for services that were not long ago rooted in thick emotional networks. Care has vanished.3 As the community (and Self) becomes smaller, the Others increase in number. Others are no longer what the Self is connected (emotionally or spiritually) to but are reduced in quantifiable, measurable “values” (Marx,1935 ). In this world, if a marginalized population is numerically small, they are deemed insignificant—ignorable—or correctable, meaning that they can

3 It is important not to simplify such understanding as an East vs. West dichotomy. Such consequence is not a simple result of “Westernization” either. Rather, this world emerges in response to the increasing fragmentation of our construction of the Self, our cultural consciousness. GAZE AS EMBODIED ETHICS: HOMELESSNESS, THE OTHER, AND HUMANITY 39 be assimilated and disappear into and as identical with the larger population. If they are not quantifiably productive—exploitable, they are seen as having no value (Filho, 2002). Before we know it, we begin to avoid the undesirable Others. The first move to avoid the Other and their gaze is to abstract the Other and objectify them (Kramer & Lee, 1999). Homeless people, who lack value reduced to a function within a structure, are ignored and considered irrelevant as they are constructed as the Other. By associating homelessness with disorder and criminality, local authorities justify their strategies to harass, punish, or restrict the homeless’ presence in public space (Amster, 2003; National Law Center on Homelessness and Poverty, 2014a, b). Mitchell (1997, p. 307) concluded: “The intent is clear: to control behavior and space such that homeless people simply cannot do what they must do in order to survive without breaking laws. Survival itself is criminalized.” This is the move of transcen- dence, to construct the Other as a concept as opposed to a living, feeling human being, which evokes our primordial obligation through embodied ethics. The homeless is reduced to some quantifiable variable categorized through economic, sociologic, psychologic, or some other quantity— “ratio”nal perspective. They become an issue of budgets, political calculus, and/or public health.

Authentic Communication and the Struggle to Remain Inherently Meaningful They think we’re all drunks, but we’re not. I’m an engineer. Then I had seven heart attacks and five surgeries. – Harris

The biggest struggle I face is forgiving people and any of the struggles I face. Ignoring people calling me a bum, looking at me as homeless. They think I’m homeless, or a druggie or an alcoholic, or a sexual deviant or anything like that. That’s a big struggle: When people look at you like that and you’re not that. And you can’t react! Or you would be that. – Homer

Buber (1937/1958) argued that authentic communication between two who see each other as equally alive and aware, be it another human or a totem animal, has an inherent moral dimension which he called reciprocity, which is fundamental to our embodied experiences of ethics. When we behold each other as merely objects with extension, statistical values, we are not communicating. Lévinas (1978/1978, 1979/1987) has argued 40 E. KRAMER AND E. HSIEH that when we are fixed by the gaze of the Other, each sensing the Other as alive and aware, a shared dimension of mortality, fear, and responsibility prevails. Being so captured by the gaze of the Other looking back at us, be it an animal in a trap or an enemy in the crosshairs, we cannot escape moral obligation. Sentiment prevents us from discarding and ruining things, including and especially relationships (Greene & Haidt, 2002; Honneth, 1996, 2000/2014). Even for the disillusioned Modern, when another sentient being looks back at us and sees us as sentient, the gaze is essentially different from glancing at a random rock, mountain, cloud, or some other dead, name- less object (this is why naming is so powerful). When gazing at another person who looks back, we feel a mutual recognition of life (Honneth, 1996), which is different from the fetish we might have for a dead object. Objectifying other animals or humans is thus a dangerous way to regard Others (Kramer et al., 2014), a dangerous attitude because such a mode of regard or way of seeing them is care-less. It excludes them from mutuality, equality, and as such moral obligation. The city is filled with a vast aggregate of individuals who are largely anonymous to each other. The dimension of care that used to be the emotional cohesion of “we” has evaporated, replaced by modern functional structural patterns of instrumental interaction (see also Honneth, 2000/2014). As Morris (1996), has observed, competition has displaced cooperation. Measurable productivity is all that matters in the modern context. Society has thus fragmented moving unproductive people out of sight, and at least temporarily out of mind. They get in our way as we pursue “progress.” The homeless live in a parallel time and space (van Doorn, 2010). We see them “around.” They skirt our scheduled time, showing up behind fast food places at closing for food and at shelters “in time” for a bed. The homeless belong nowhere, and have no place to be. They have no appoint- ments to keep. We see them, but they are not part of our spatio-temporal manifold. They exist in Paleolithic modality on the fringe of our space, time, and economy. As such, they are not physically but psychosocially and culturally isolated. By associating homelessness with images of filth, decay, and disease, the public perpetuate the stereotypes, marginalization, and stigmatization of the homeless (Amster, 2003; Hsieh, in press), demanding social distance between the homeless and the community. While media coverage traditionally has provided sympathetic and positive views toward the homeless, it often centers on the deficits and deviant characteristics of homeless people (Buck, Toro, & Ramos, 2004). By blurring GAZE AS EMBODIED ETHICS: HOMELESSNESS, THE OTHER, AND HUMANITY 41 the boundaries between homeless people and individuals with mental illness, and attributing the increase of the homeless population to the closing of mental health care facilities in the 1980s, governments and media have reinforced negative stereotypes of the homeless and treated homelessness as a medical problem (Mathieu, 1993). By constructing homelessness as a “disease” or deviancy to be avoided by self-awareness and responsible behaviors, shelter staff encourage the homeless to look into themselves to identify causes of their homelessness, a practice that transforms the homeless into self-blaming and self-governing persons (Lyon-Callo, 2000). In other words, homeless people can only find redemption through submission to the regime of surveillance, discipline, and personal enhancement (Farrugia, Smyth, & Harrison, 2016; Wasserman & Clair, 2012, 2013). Trait psychology and forced assimilation is the dominant official discourse (Kramer, 2003). Such public discourse reinforces our understanding of the Other. The routinized separation legitimizes “me”/“my” space and time. The homeless person who crosses “my” path violates my expectations, my dogmatic slumber but in a particularly valued way. Unlike seeing and recognizing a famous face or an exceptionally beautiful person that may excite me, the homeless challenges me (Honneth, 1996). They may even “ruin my day” by their mere appearance.

The Dilemma of the All-Too-Visible Otherness of the Homeless Just the looks you get when people are driving their kids to school in the morning. Just the looks you get because they see you carrying a bed roll. It goes from a happy good morning to an “ugh” in disgust. – Helen

Although many have called the homeless invisible people, we argue that the homeless are not invisible people. Very much to the contrary, they are not only visible to us but we are to them. This inconvenient reciprocity takes away our ability to control the moral dimension of the face-to-face encounter (Buber, 1937/1958; Lévinas, 1978/1978, 1979/1987). Insofar as we recognize the homeless as human, we cannot avoid the fact that they are not an Other but the same. To deny them is to deny ourselves in a hypocritically absurd effort to avoid responsibility. They look back at us as we look at them and in that act, we cannot avoid judgment. 42 E. KRAMER AND E. HSIEH

My attitude toward the Other is what Scheler (1913–1916/1973) calls my moral disposition. It exists only in the act, not as a formal rule or value. Our moral judgments are largely driven by social intuitions (i.e., emotions; Greene & Haidt, 2002). Walking away from an Other in need thus demands reflection on who we are (Honneth, 2000/2014). We will be judged by what we do. This is the experiential origin of value (Scheler, 1913–1916/1973). Value is not logically derived. It is given immediately in experience (Greene & Haidt, 2002).

A Failing Culture Being homeless is the most challenging thing I have ever faced. It is the worst thing ever. My mind started to drift in ways – I don’t mind telling you – I had thoughts that I didn’t go through with. But it was no different than what any homeless person’s thoughts are. – Haiden

There is another way to look at culture, which does not presume any transcultural standards of behavior or beliefs. It is more fundamental. Becker (2010) suggested that culture has a function: to provide a stable set of social conditions that allow its members to fulfill meaningful roles and to thus experience a sense of belonging and self-esteem. Cultures that fail to do this for their members may be judged dysfunctional (Kramer & Hsieh, 2012). For individuals who have no place within the socio-cultural system where they live, they are perceived as eyesores, visible blemishes on the social landscape. In the modern world, social relationships with a broad network of people is tenuous. If something happens to them, good or bad, few if anyone else within the established community knows or cares. Such a condition where individuals can live in the same physical spaces where established social activity takes place day in and day out but do not participate is most acute to modern urban life. It is a product of acute individualism and social dissociation (Kramer, 1997, in press). The study of poverty by government agencies and social scientists is extensive. A few realities need to be recognized. Rossi (1989, p. 8) notes in his landmark book: “The more I looked into homelessness the more it appeared to be misstated as merely a problem of being without shelter: homelessness is more properly viewed as the most aggravated state of a more prevalent problem, extreme poverty.” Rossi (1989, p. 9) concludes that being homeless is the result of “extreme deprivation” and that “a life GAZE AS EMBODIED ETHICS: HOMELESSNESS, THE OTHER, AND HUMANITY 43 of extreme poverty is one of extreme vulnerability.” There is an important psychological cost to being vulnerable. Being homeless is a constant threat to millions of Americans who are not currently homeless but precariously close to it (National Health Care for the Homeless Council, 2015; Rossi, 1989). This means that the larger issue of extreme poverty, of which being literally homeless is but a result, has a much broader effect on millions of people who live in chronic fear of being literally out on the street. This includes millions of children and elderly who cannot fend for themselves (Henry, Cortes, & Morris, 2013; Kushel, 2012). Very few choose to be homeless (Terui & Hsieh, in press). Most end up in such a state due to forces such as addiction, illness, or age- related unemployment that are largely beyond their control (Gowan, 2010; Wasserman & Clair, 2010). For the homeless population, homelessness, mental illness, and substance abuse are often confounding realities (Hsieh, 2016, in press). A meta-analysis found that among homeless people in Western countries, there is a pooled prevalence of 12.7% for psychotic illnesses, 11.4% for major depressions, 23.1% for personality disorder, 37.9% for alcohol dependence, and 24.4% for drug dependence (Fazel, Khosla, Doll, & Geddes, 2008). Rather than portraying a linear causal relationship between homelessness, mental illnesses, and substance abuse, many researchers have suggested a complex interrelationship between these factors. For example, a review found that people with schizophrenia and other psychotic disorders use substances to reduce general dysphoria, and possibly negative symptoms (Phillips & Johnson, 2001). Homeless and runaway youths may resort to substance abuse as a coping strategy to manage depressive systems, sexual minority status, street victimization, and problematic home life, including child abuse and parental drug use (Moskowitz, Stein, & Lightfoot, 2013; Tyler & Melander, 2013). As individuals exhaust their supportive prosocial networks, they may begin to seek support from individuals in the drug subculture, which can increase their own drug use behaviors (Galaif, Nyamathi, & Stein, 1999). The notion that it is homeless peoples’ own fault that they find themselves in such dire straits is inaccurate.

A Culture of Modern Dissonance There ain’t nothing to really say about myself. I just existing basically [laughs]. I know that- that ain’t what you want to hear. I’m sorry. – Hayden 44 E. KRAMER AND E. HSIEH

We are in the midst of one of the most connected, technologically advanced periods of human history. Yet, we are more disconnected from fellow human beings than ever (Kramer et al., 2014). Families are fragmented and collegial relationships are encouraged to remain purely professional. In this culture of modern dissociation, we argue that we are faced with the following conditions:

Axiom 1: Responsibility, culpability requires free will. Axiom 2: Behavior cannot be ethical or moral unless it is based in choice, which presumes Axiom 1. Axiom 3: Universal laws of nature operate autonomously from human choice. Axiom 4: Economic behavior exhibits choice. Conclusion: The universal algorithmic laws of economics assure predict- ability and deny the possibility of choice. Economics is therefore fatalistic.

Aristotle long ago asked a very simple question. He believed everyone knows basically the right thing to do. So why don’t we? Reaching out to those in need is more constructive than simply stating the obvious that homelessness is bad and the homeless are weak/vulnerable. Stating the obvious without intervention is simply noise, if not immoral (Honneth, 2000/2014).

The Law of Laws: Reducing Choice and Morality Out of the Equation Ah! This is always a choice. There is no formula. They never figure that out because everybody has a different story. There is absolutely no formula to get out of this position. – Hadley

Make no mistake. Being homeless is an economic condition. Political economy was the original name of a discipline that studied production and trade as behaviors which manifest cultural values, law, politics, and most important to this chapter, morality. For instance, scholars who study comparative wealth of nations note that where there is no political will to enact and enforce contract law, business flounders (Birks,2005 ; Fried, 1981). Lack of meritocracy, uncertainty due to incoherent, inconsistent, and corrupt practices prevents modern economies from reaching their full GAZE AS EMBODIED ETHICS: HOMELESSNESS, THE OTHER, AND HUMANITY 45 potential of wealth creation. Political economy was part and parcel of moral philosophy because it was clear that not all groups’ and nations’ economic behavior was the same and as such they did not exhibit identical success. How does one explain the fact that Japan, with practically no natural resources, has been a world economic power while parts of Africa abundant in valuable natural resources have languished in poverty without taking into account culture, politics, history, and geography? The only way to explain this variance is to examine the different factors that impact economic behavior and institutions. This is how Adam Smith, John Stuart Mill, David Ricardo, and other founders of the field understood their subject matter. Political economics understood economic behavior to be rooted in everyday life, beliefs, customs, and values. However, during the late nineteenth century and expanding during the twentieth century, the understanding and examination of economic behavior changed. In an effort to make social studies appear more “scientific,” mathematical modeling became all the rage (and still is). Researchers began to separate the understanding of economic behavior from its cultural, legal, political, and moral contexts—to create “objective” universal laws of economic behavior that aim to rival Newton’s laws of physics. Alfred Marshall (1895) severed the term economics from the moniker “political economics” in an attempt to appear more scientific, more objective, and to simplify the subject matter. This move followed on the heels of the scientism applied to the development and application of statistics to human beings by Francis Galton (1870), the person who coined the term “social Darwinism” and who initiated the field of eugenics along with Karl (originally spelled with a C) Pearson, the founding occupant, and only holder of the eugenics professorship sponsored by Galton at the University College London.4 The effort to make economics into a social physics had more to do with an academic inferiority complex as science and engineering surged forward with success, while social and moral studies showed little gains. Although new machines and technologies solved old material problems, social issues such as war, poverty, and injustice seemed, and continue to seem, intractable. This trend to objectify and dissociate social status from human beings (separating poverty as a number from the poor) via quantification has had

4 With the rise of Nazism, the endowed chair was unceremoniously eliminated after Pearson’s death in 1936. Galton and Pearson founded the journal Biometrika thus promoting the reduction of human behavior to biological precursors, especially correlating intelligence scores with much more complex phenomena such as income and criminality. 46 E. KRAMER AND E. HSIEH many consequences. One has been to claim that economics has no political, or more critically, no moral dimension. The mathematical models that aim to construct a context-free understanding of economic behaviors face fatal error in results and explanations. Many European economists have labeled the neoliberal laissez-faire approach to understanding economic behavior while ignoring historical, cultural, and political context to be misguided, narrow-minded, “autistic” (Fulbrook, 2007). Examples are the devastating austerity policies imposed by the World Bank and International Monetary Fund on various parts of the world. Another was the massive failure of Long-Term Capital Management (LTCM) run by John W. Meriwether and two Nobel Prize winners in mathematical economics, Myron Scholes and Robert Merton. They literally programmed a computer with a set of equations (the Black-Scholes model to dynamically hedge against risk and volatility), turned it on and went golfing (Dunbar, 2000; Stein, 2003). Initially it made money for its elite investors but then the real world happened, which they did not expect. A year into operation, in 1997 the Asian housing bubble burst, in part due to IMF-imposed austerity policies, and then in 1998 Boris Yeltsin devalued the ruble and allowed Russia to default on its domestic debt (Jacque, 2010). As the world’s investors in Russia and Asia scrambled, the computer at LTCM just kept blindly, irrationally running only now it was compound- ing massive losses (Stein, 2003). The level of arrogance and narcissism exhibited by the mathematical financial experts and bankers was astound- ing (Jacque, 2010; Stein, 2003). The failure started a chain reaction, a global crisis throughout financial markets (Dunbar, 2000; Stein, 2003). The US government turned off the computer and the Federal Reserve Bank of New York rushed in to organize a bailout of $3.625 billion to prevent total collapse of the world’s financial markets (Lowenstein,2000 ). Trust was reestablished when the adults came into the room and imposed rational regulation. The total loss was about $4.6 billion (Weiner, 2007). The LTCM disaster is a perfect example of autistic economics in action, what Jacque (2010) has called the malpractice of pure theory. The human element had been removed and LTCM’s computer could not read the newspaper to see what was happening in the real world or regulate itself. Computers are neither conscious nor intelligent. They cannot step outside of their own programming and reflect on the rationality of what they are doing. Computers do not and cannot care about process or results. To a computer there is no such thing as a “mistake” or immorality. It cannot judge its own operation, stop and rewrite its own programming. GAZE AS EMBODIED ETHICS: HOMELESSNESS, THE OTHER, AND HUMANITY 47

When economies are seen as self-operating systems driven by universal laws, then finance appears to have no free will, no ideology, no choice. Given this paradigm, morals and ethics are not eliminated but ignored and left to deteriorate (van Inwagen, 1983). Denial of realities in favor of a mathematical fantasy has had profound consequences. Austerity may hurt someone, somewhere, but such finite contingencies are irrelevant to the larger logic of economic movement. The “wizards” of global economic policy thus appear to not care, which enrages populations that suddenly see food subsidies slashed resulting in the price of cooking oil (Brazil in 2010) or bread (Egypt in 1977) rising 1000% overnight, sparking riots (Trostle, Marti, Rosen, & Westcott, 2011; Westall & Perry, 2013). More recently, many have moved the field of economics back toward more complex efforts to understand economic behavior by taking into account aspects of that behavior which are cultural, legal, historical, and moral. Free market, neoclassical, and neoliberal forms are all essentially euphemisms for the disastrous laissez-faire economics of the late nineteenth century (Krugman, 2011). Stiglitz (2003, 2013) has been pointing out for years that what we have is global governance by financialinstitutions without a global government. It’s an engine with no regulation. It will run more and more aggressively until it blows up.

Homelessness: Being Among the Wolves What’s really challenging is finding stability. You know, and I can find that internally, within. But it’s really hard when you don’t have a job. – Hanna

That’s why I’m just like, pardon my French, fuck the corporate world, the government, and all that stuff, ‘cause if you truly go research and stuff, they’re actually fucking us more than they’re helping us. – Haile

The old adage about the “wolf at the door,” presumes that one has a house with a door. If you don’t, you are among them. Being homeless is a tipping point within a process of destitution. And millions of Americans are dangerously close to that point (Henry et al., 2013). It is not a permanent condition but a transient identity, one that many assume sometime during their lives. As many as 90% of homeless people suffer transitional or episodic homelessness (Bassuk, DeCandia, Beach, & Berman, 2014). That means that many Americans have been homeless for short periods of time. It also 48 E. KRAMER AND E. HSIEH means that for this reason it is impossible to determine precisely how many people are homeless in America by means of point-in-time counts. On any given night in America, about 600,000 people are counted in shelters including children and families (Bassuk et al., 2014). Homeless youth is one of the fastest growing and most vulnerable segments of the US homeless population, with over 1,258,182 homeless students, including 62,890 unaccompanied youth, enrolled in public schools in the 2012–2013 academic year (National Center for Homeless Education, 2014; Rahman, Turner, & Elbedour, 2015). About one in 30 children in America or 2.5 million were homeless at some point during 2013 (Bassuk et al., 2014; Pergamit et al., 2013). Because of the high turnover of homeless people and the fact that many experience homelessness a few nights a year, the number of Americans experiencing homelessness is much higher than any single point-in-time measure. According to the US census, 14.8% of the US population, or 46.7 million people, are in poverty (DeNavas-Walt & Proctor, 2015). In most cases, homelessness is not due to lack of work but largely due to low- income wages (National Coalition for the Homeless, 2009). Burt et al. (1999) found that 44% of the homeless reported paid work in the past month, including 20% who worked in a job lasting or expected to last at least three months.5 Homelessness is not due to a lack of shelter either. There are about six times as many vacant homes in America as there are homeless people (Bronson, 2011). Since 2007, banks have foreclosed on and shut- tered about 18.5 million homes while about 3.5 million homeless “shiver in the cold” (Loha, 2011). The cause is not material but socio-culturally determined economics. We say socio-culturally determined because a person or nation may have money but what they decide to do with it is a matter of values, motives, beliefs, and expectations (culture). Being poor and homeless is not a matter of fatalistic laws of physics. It is a matter of choices people make. Consequently, it is a matter of ethics and morality (van Inwagen, 1983). The wolf, it seems, is always at our door. Increasingly in the modern world, we are on our own. Dire poverty and destitution exists literally right beside massive, excess wealth. When living in Boston many years ago, we marveled at a society that would heat and light giant, largely empty skyscrapers all night long but lock the doors to people literally

5 Despite the advanced age of the data, which was collected in 1996, in Burt et al.’s (1999) study, this is the most recent data available on employment rate of the homeless (Jacobson, 2013). GAZE AS EMBODIED ETHICS: HOMELESSNESS, THE OTHER, AND HUMANITY 49 freezing to death huddled up against the granite and marble facades at the bases of these megalithic towers. How is this acceptable? Clearly such people are seeking to survive and need help. This is not a natural disaster. It is a human-made one. We don’t like to acknowledge it, but every large city in America either has municipal- operated crews or subcontracts crews that are responsible for picking up the dead from the streets. Ron Gospodarski and Juan Osteguin, owners of a biorecovery business, noted it takes a “strong stomach” to stay in their business as they often clean up “atrocities” (Sahadi, 2005).

Legitimizing Suffering: Natural Selection and Darwinian Economics I’m like, “Oh look at what they all have that I don’t have.” “Oh, look, normal people. Ohh.” [laughs] Yeah, I I’ve been getting a little bit bitter, I mean. I’ve already been excluded most of my life and now this is just one more stack against me that makes me even more excluded. You know, I’m just so sick of it. [laughs]. It’s like I’m not a real person. – Hilary

The destitute [is the most challenging thing], I guess. Because there’s nothing you can do. You can’t work. You’re waiting. In my position, I’m just waiting day after day after day after day. You don’t know whether you’re going to make it. You don’t know anything. And in my particular case, I hadn’t taken any of my medications in six months, so I’m not sure if I’m going to make it anyway, you know? – Harris

How do we stomach the fact that millions of people experience homelessness in the United States every year? One way is to justify it to ourselves by means of a social Darwinian philosophy (Cronley, 2010; Kramer, 2003; Kramer & Kim, 2009). People are homeless because they are lazy or stupid. Yet we find no homeless in the premodern world. In the Mesolithic and Neolithic hamlet and village, the collective protected even the “village idiot.” Homelessness among the homed is a modern consequence of impersonal mass social structures that allow us to avoid personal responsibility (Honneth, 1996; Ikeda & Kramer, 1999; Kramer & Lee, 1999). Nothing is more impersonal than the laws of nature, which have been used as a convenient excuse for oppression. Natural law is objective and beyond human control. So if something like homelessness is “naturalized,” put into the mythology of being natural, it is no longer debatable (Barthes, 50 E. KRAMER AND E. HSIEH

1957/2013). It becomes inevitable, fatalistically certain, predictable. It is fruitless to try to regulate natural forces. There is no freedom between cause and inevitable effect. Therefore, as the logic goes, there is no moral dimension to such issues. Nature simply takes its course. Perhaps the greatest example of this legitimation of irresponsible leadership was the Great Hunger in Ireland during the 1840s. Being homeless, like the Irish of the great starvation who scrambled to escape chronic destitution, were described as “landless cabin dwellers” (Clark, 1982, p. 44).6 During the great Irish Famine, Assistant Secretary to Her Majesty’s Treasury, Sir Charles Trevelyan (1848) officially forbade any and all efforts to assist the starving people of Ireland. Even churches were officially barred from aiding the poor. Trevelyan did so because in his opinion it was nature’s transcending way to eliminate the weak and unwor- thy of life. He wrote at the time: “Our measures must proceed with as little disturbance as possible of the ordinary course of private trade, which must ever be the chief resource for the subsistence of the people…” (Trevelyan quoted by Bourke, 1977). While millions of Irish peasants starved, Trevelyan made a show of publicly blaming the landed gentry for not improving their estates by instruct- ing the peasants to plant a variety of crops. However, even as he criticized the gentry he knew that Ireland was exporting tons of wheat, barley, and other “cash crops.” People who tended the fields were starving in the midst of plenty. Trevelyan’s public letters to newspapers castigating the gentry for expecting the government to help correct the situation justified the failure of the British government to act (Trevelyan quoted in Gray, 1995, pp. 154–155). As the potato blight spread to the western highlands of Scotland peasants there too began to starve, so thousands were deported by official decree to Australia. Transcendental essentialism and universalism presume naturalistic innocence (Husserl, 1962). Laws of nature, thus, dictate who is worth helping and who is not. Those who are worth helping conveniently

6 But these “cabins” were not what one might think of as a nice little lakeside abode. Rather the Earl of Devon, writing for a Royal Commission in 1845 described the living conditions of the Irish peasants thus: “It would be impossible adequately to describe the privations which they [the Irish labourer and his family] habitually and silently endure … in many districts their only food is the potato, their only beverage water … their cabins are seldom a protection against the weather … a bed or a blanket is a rare luxury … and nearly in all their pig and a manure heap constitute their only property” (Devon quoted by Woodham-Smith, 1962/1992, p. 24). GAZE AS EMBODIED ETHICS: HOMELESSNESS, THE OTHER, AND HUMANITY 51 don’t need help because they have already exhibited rapacious vigor by voraciously helping themselves. Trevelyan who was in charge of government relief for the Irish claimed: “The judgment of God sent the calamity to teach the Irish a lesson” and whosoever contradicts “an all-wise and all-merciful Providence in its sharp but effectual remedy” for “social evil would prove evil himself” (quoted in Woodham-Smith, 1962/1992, pp. 87, 106–108). Thus ideological choices are naturalized or spiritualized and made to seem fatalistically beyond human volition. To be poor in modern capitalism is finally identified with personal sin, or inherently bad personality traits. The poor deserve to be poor. And those who try to help them are evil. Hence, we see the eugenic solution to breed in desirable traits and breed out undesirable ones. Today’s homeless in America are even worse off. They are powerless but without even a cabin. A vast number of Americans are “upside down” regarding money owed, meaning that they owe more on their house and car, and perhaps their college degree, than they are worth. Two Princeton University economists, Greg Kaplan and Justin Weidner, and their coauthor Giovanni Violante of New York University estimated that about one-third of all American households, more than 100 million Americans, lived paycheck-to-paycheck in 2014, and that for the poor and lower working class, this is a long-term, chronically stressful, life condition (Ingraham, 2014; Kaplan, Violante, & Weidner, 2014). This means they have little or no savings and carry chronic debt: Counting all households including ones with no debt, the average US household owes $7281. For those with credit card debt, which is about half of all American households, the average balance owed is $15,609. All households average $156,706 in mortgage debt. Student debt averages $32,956 (Federal Reserve Statistical Release 2015). Failure to service so much debt keeps millions of families, including many that falsely believe they are middle class or even upper middle class, at risk (Federal Reserve Statistical Release, 2015; Kaplan et al., 2014). One might like to think that modern capitalism eliminated the inhu- mane institutions of slavery and debt peonage. But such practices as well as the most predatory forms of capitalism have been justified by alluding to and distorting old notions of IQ and the new science of genetics. Some of the representative work in this new Darwinian genre include The Bell Curve (Herrnstein & Murray, 1994) and The Global Bell Curve 52 E. KRAMER AND E. HSIEH

(Lynn, 2008).7 Under the shadow of the social Darwinian defense of, and the pseudo-scientific justification for inequality, even Christian altruism came to be seen as a myth—as the misplaced sentimentality of “bleed- ing heart” liberals. Care and aid, according to this ideology, is useless. Caring about poor (and dumb) people is a waste of resources. According to this philosophy, all human interaction can be explained in terms of self-interested competition and exchange (Homans, 1958). But Homans (1958) was not an original thinker. Two hundred years earlier, during the English Enlightenment, Jeremy Bentham (1789/2007) methodized his philosophy as “hedonic calculus.” Thus the very British notion of equating utilitarian self-interest with rationality itself was consecrated. John Stuart Mill, the son of Bentham’s closest colleague and collaborator (James Mill) would later clarify the notion of self-interest as sacred right in his essay On Liberty (Mill, 1859/2002) which would inspire the quint- essentially modern individualistic virtue of the “pursuit of happiness” as an inalienable God-given universal right.8 In this essay, Mill clearly pits the authority of government against the right of individual freedom. Yet he also makes an argument that upheld colonial power and racism by stating that “Despotism is a legitimate mode of government in dealing with barbarians” and children (Mill, 1859/2002, pp. 18–19). Thus, British utilitarianism, including the very notion of individual liberty itself, supported the moral principles that justified suppression of poor people—a point not lost on many critics of neoliberalism such as Losurdo (2011) and Goldberg (2000). Modern morality came to be steeped in colonial self-righteousness and justified via reductionism to economic advantage (Cronley,2010 ). In the end, poor people do not serve the ultimate modern demand for utility and

7 Rooted in such ideologically charged “pseudo-science” (and statistical confusion) is the unfounded proposition that a particular form of competition as understood by a specific culture at a specific time is universal, a matter of natural law, and that inherent intelligence is reducible to racial membership (see the Nobel Prize-winning economist Heckman’s (1995) systematic dismantling of the statistical mess that is The Bell Curve’s argument). 8 Conrad and Muccino (2006) wrote a screenplay entitled The Pursuit of Happyness depicting the rags-to-riches story of Chris Gardner. The film, starring Will Smith as Gardner, a homeless salesman, captures the irony of modern economic reality, underscored by the pur- poseful misspelling of happiness as “happyness.” What is wrong with the story, as with the spelling, is that, like all Horatio Alger stories of the American Dream, it functions to camou- flage the truth that most never make it out of rags. In fact, they die still owing money. As LeRoy came to understand, in post-Vietnam America upward mobility has increasingly become a violated expectation. GAZE AS EMBODIED ETHICS: HOMELESSNESS, THE OTHER, AND HUMANITY 53 efficiency. The opposite of utility (fitness, usefulness, value) is to be unfit, useless, of no value, which is exactly how those who do not “work right” are defined in assimilationist, neo-Darwinian “adaptation” terms (Kramer, 1997, 2003). The maladapted are unfit. Similarly, the opposite of efficient is deficient, defective, flawed, a form of unwanted waste that should be discarded. This is what occurs when people are seen as mere resource base by an industrial mind-set. The unproductive are not worthy of dignity or care. They are a liability rather than an asset, and there is no other way to view people. The great irony here is that this mind-set that sees people strictly from this narrow valuation claims this attitude to be objective. This is the case because with modern mass anonymity, measured productivity does not assess who the worker is, only how much they produce. Thus it seems objective and even quantifiable, but in fact the modern world is harshly judgmental of those who are slow, less productive, or who harbor unique interests and talents that cannot be readily exploited. In the modern world, unless a person or thing such as a river or forest can be converted into a commodity and thusly exploited, it has no value (Marx, 1935). Value is realized only at the moment of exchange. This appears “objective,” and “disinterested,” but in fact it is highly motivated by the ambition for profit. If I cannot exploit you for my own utility, you have no meaning to me. Bentham (1789/2007) equated the pursuit of self-interest as rationality in itself, and the only utilitarian, or common-sensical path of action. Utility was literally introduced by Bentham (1789/2007) as a simple measure based on a balance sheet between pain and pleasure. Thus, reason became equated with the most base of motives rooted in individualism. To not be selfish was to be unreasonable and the opposite of genius. It was to be stupid. Essential to Darwinism generally and the English colonial pseudo- science of social Darwinism as expounded by Galton (1870) in his famous work Hereditary Genius (in which he coined the term “eugenics”) is the idea of survival of the fittest in endless conflict. Fundamental axioms of social Darwinism were championed more recently by Rand (1964) who dichotomized the world into what she claimed to be irrational social support found in collectivistic cultures and modern rationality manifested as pure self-interest, an ideology that inspires many to this day. She attacked communism not because it espoused atheism, for she herself was an avowed atheist, and distrusted the central Christian tenets of love, sacrifice, and comradeship within a church community. Instead she attacked 54 E. KRAMER AND E. HSIEH communism because she fervently promoted the “virtue of selfishness,” and vehemently disapproved of notions of assistance, aid, altruism, or self- sacrifice for another or for a “greater good,” as being utterly unnatural, dishonest, and simply stupid (Rand, 1964). Social Darwinists see no grace in empathizing or sympathizing with others. Social Darwinism came to justify slavery in the Americas and the structural starvation of millions in Great Britain while authorities stood by and did nothing. This abominable ideology still influences the debate about poverty today, and it is reinforced by the modern concept of the individualism. The two ideologies, social Darwinism and hypertrophic individualism, form a two-pronged justification for not helping the poor (Cronley, 2010; Kramer et al., 2014; Kramer & Lee, 1999). On one hand, it is useless to try to help them because they are genetically predisposed to fail and no amount of aid can change the laws of nature. On the other hand, the poor’s failure to be self-sufficient is due to personal character flaws that may or may not be rooted in inherent personality traits. Strategic ambiguity exists within debates about poverty regarding the idea that character is inherent but yet also learned. According to modern understanding, prior cause for the effect of poverty must be identified. The state of poverty is merely a result. The true target of inquiry is the cause. Two transcending justifications exist for why the poor are poor: moral “bankruptcy” and biological predetermination. While the argument that poor people are poor because of genetic predis- position is completely different from the argument that poor people are poor due to choices they freely make, those arguing against assistance commonly use both (Lyon-Callo, 2000; Tyler & Melander, 2013). Either way, helping the destitute is a waste of time akin to denying the laws of physics, or equally futile, resisting divine judgment. Consequently, withdrawal of help and resources is rational, justified, evenmoral (Honneth, 2000/2014; Lyon-Callo, 2000). Bottom line, those who argue that they are not their brother’s keeper have all bases covered. In the modern world, the emotion that drives immediate aid to those in need is displaced by analysis and systematic reasons (hedonic calculus) for not helping them rooted in transcendental principles stated as objective, qua unquestionable, premises (Greene & Haidt, 2002; Kramer, 1997). Such arguments proceed as truisms—which are rhetorical rather than scientific or rational. Hence, rationalization is the opposite of actually being rational or objective. Rather it is an excuse for protecting self- interest by denying responsibility to and for others. GAZE AS EMBODIED ETHICS: HOMELESSNESS, THE OTHER, AND HUMANITY 55

Conclusion People have no idea. They think we’re just a bunch of bums sitting around, getting drunk. But it’s hard. Nowhere to sleep and no one wants to hire you. You can’t have good hygiene and they don’t want to be around that and they don’t want to hire you. They think we’re stupid and lazy. And they don’t know what it’s like until they’ve slept on this shit right here [pounds on concrete]. Until they do that, they have no idea what it’s like. The people sleeping in their beds, they have no idea what it’s like to wake up on the concrete [laughs] with a pair of shoes for a pillow, if you have that. – Hank

The basic facts about the relationship between destitution and homelessness have not changed. However, the number of Americans who are acutely vulnerable has. When we see a homeless person, perhaps we are gazing at a living flesh and blood periscope.9 Gadamer (1960/2005) characterized communication as a risk. Whenever we are exposed to something new (purposefully or accidentally) our horizon is affected. Freedom is how we respond to what happens to us and how we respond changes with experience (van Inwagen, 1983). Overt, organized social movements are nearly always reactionary— responding to perceived injustice and/or aggression. The new makes the previous old as such, and so dependent cocreation results in change. If communication occurs this is unavoidable (Honneth, 1996). But building relationships, coalitions, organizations, and communication takes time. Those with temporal resources have advantages on directing change. Sadly, more often than not, the homeless are out of resources, including time. They are at the mercy of Others. The point of this chapter was to directly engage the issue of ethics and a culture that justifies cruelty to its own members. Our path was not to propose laws or moral rules. It is not about a rational self-management of “freedom” (deontology), or the modern utilitarian calculation of happiness (hedonic calculus ala Jeremy Bentham), or the romantic ideal of cultivating instituted virtues (virtue ethics). Rather this is about encountering ourselves in the Other (see also Honneth, 1996, 2000/2014). It is about intersubjectivity and the possibility of being “good,” as in good actions and good motives linked to the good life here and now. It is about the

9 We use periscope in this context to mean a slice of the sacred. The word technically means a cut-and-paste piece of a sacred text. A homeless person, any human is a fragment of the sacred, worthy of respect. A child is more valuable than the rarest Bible. Burn the sutras because the sacred is all around us. 56 E. KRAMER AND E. HSIEH ethical gravity of the embodied encounter, of standing in the presence of a homeless person. In this world we share, the homeless and the Others live parallel lives. Do any of us recognize the loss or gain of humanity in the moments we gaze upon one another? In life, we often do not realize when important moments have passed. It may be when we are in our late teens and we say goodbye to someone who had been a life-long friend for us, thinking we would meet again but we never did. It is only later that we realize what happened and reidentify that person as a “childhood friend.” We may think we will always see them again, but with the passage of time, we realize that a friendship or even an era in our lives slipped away unnoticed. What is happening to our humanity? Being homeless is a process. People may be fired or laid off in an instant, divorced with the stroke of a pen, but being homeless is not an official title. It is an existential condition with infinite degrees of isolation. Of course the meaning of home usually implies a physical domicile where one can “get in” from the “outside.” It also has the sense of a retreat, a refuge where one can be at ease and receive social visitors. Home is a place known and understood. The outside, the not home, is filled with uncertainties and anxieties. Most importantly, home is the place where domestic affec- tions are centered. Without a home, affection and civility are at extreme risk and so too, therefore, is humanity.

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Development Communication and the Dialogic Space: Finding the Voices Under the Mines

Christele J. Amoyan and Pamela A. Custodio

Development Communication in Social Change Theorizing communication is a way of social change. It reflects how humans, as rational and creative beings, are capable of translating social reality into a form of discourse. Craig (2013) assumes that theorizing is ingrained in society. There may be different and contrasting traditions that divide the overall landscape of communication, but there is something that unifies every existing theory—and that is human aspiration. We want to make better sense of life, not only as an introspection of our individual selves but of the society we live in. This gives communication scholars and experts the mandate to bring communication theories closer to the people and involve them in the process of social change. Development communication (DevCom) as an evolving communication theory began as a Southeast Asian academic discipline. According to Nora C. Quebral (2012), DevCom’s ultimate goal is to empower individuals and communities to realize their full potentials. From its birth in

C. J. Amoyan • P. A. Custodio (*) College of Development Communication, The University of the Philippines Los Baños, Los Baños, Philippines e-mail: [email protected]

© The Author(s) 2019 63 M. J. Dutta, D. B. Zapata (eds.), Communicating for Social Change, https://doi.org/10.1007/978-981-13-2005-7_4 64 C. J. AMOYAN AND P. A. CUSTODIO the 1950s, DevCom initially took the role of communicating rural and agricultural agenda. It continued to become more and more involved in socio-economic discourse, then soon transitioned with the coming of the new age of information and communication technology (Librero, 2005). DevCom used different approaches to development, keeping up with the time of varying development trends. From an integrated rural development perspective, DevCom places people at the centre of social transformation, by their collective human capacity. In the process, Quebral emphasized that development should be achieved without sacrificing the environment and scarce natural resources, following the twenty-first- century buzzword “sustainable development.” DevCom largely spent its early years on research work. Librero (2005) was convinced that the literature would keep on adding up as new research interests develop. Note, however, that the more critical aspect of DevCom is not purely theoretical. As communicators for social change, we should concentrate on the application of theories into painstaking action that would lift people from all forms of poverty. If we look at the map of global development, we would very likely see that most of the pervasive societal conflicts are pinned in the developing countries. Quebral views the situation from a DevCom perspective and asks: How do we engage the majority of the marginalized population in dialogue, especially when attention is centralized in the urban districts and cities? Unfortunately, these people in the countryside seldom make it into public discourse, with limited space to express their voices. This is the same problem that countries in Latin America and Africa have had to struggle with. However, before we arrive at a valid answer, and propose a viable solution, we need to first critique Quebral’s inquiry on “How to give voice to the voiceless?” The authors raise two assumptions. First, we probe on voicelessness. It is important to note here that being silenced is not the absence of response; rather, this proposition con- veys that voicelessness was the lack of critical content from those who suffer injustice (Freire, 1985). In the Philippine context, underprivileged people from the rural outskirts are capable to resist oppression, and to speak of their rights. However, their voices are frequently muted in the actual dialogue. In the crisis of voicelessness, in one’s repression to speak of the world, human life is reduced to a lost struggle, whereas the culture of silence wins over the oppressed. Second, we assume that “giving voice” does not encourage genuine participation especially in the grassroots. This fails to hear the authentic DEVELOPMENT COMMUNICATION AND THE DIALOGIC SPACE: FINDING… 65 voices, and therefore amplifies oppression. Take the relationship of a ven- triloquist and a puppet, for instance, wherein someone changes voice to play a dummy in a performance act. DevCom scholars and practitioners do not deal with puppets. We deal with real people with real life stories to tell and share. Society is not a puppet stage but a dialogic space for these people—their voices—to be heard.

A Note on Voice This chapter opens the space for a “negotiated dialogue” between a student and advisor. The “I” is the student speaking as a novice qualitative researcher who wants an exotic milieu as location for an undergraduate research. Perhaps, there seemed to be a messianic vision for most DevCom students and practitioners to walk into an unfamiliar community to prove themselves worthy as catalysts for social change. With this pursuit, the student initially planned to study a community “out there”—somewhere away from her place of origin. Indeed, it would be a brave attempt to practise DevCom as a social outreach, but eventually, the authors arrived at a critical moment of self-reflexivity:Who are we to speak on their behalf? Why not go home and inquire into our own backyard? From here, let the novice researcher speak.

The I’s Reflexivity I started my personal reflexivity as a novice qualitative researcher with a keen intention to make sense of Development Communication. This was a critical point for me to reflect on my chosen academic field: Is it DevCom that defines its working towards social change? Or, is it the working of DevCom that defines itself being both a discipline and a practice for society’s desired transformation? DevCom is built on two complex concepts—development and communication—working together symbiotically to share and serve underprivileged societies in the Third World (Quebral, 2012). They are the landless farmers who can barely supply food for their families; the fishers who depend their day-to-day survival on a meagre fish catch; the indigenous people deprived of their ancestral domains, and the social minorities dispos- sessed of their rights. They are dejected of their voices, and it’s DevCom’s commitment to these marginalized sectors to join their advocacy and struggle. They are “denied of their communicative capacity” in a dysfunctional 66 C. J. AMOYAN AND P. A. CUSTODIO top-down communication (Dutta, 2014, p. 67). However, the problem of marginalization could not simply be resolved by trampling a vertical communication pattern, but through confronting the power interplay in the communication processes in their respective societies.

Dialogue at the Heart of Development Communication Dialogue holds the central element in Paulo Freire’s theory of development and communication (Richard, Thomas, & Nain, 2001). For Freire (1970, 1993), dialogue is a way of knowing and learning in an “encounter between men, mediated by the world, in order to name the world” (p. 88). This epistemological relationship suggests that individual actors engaging in dialogue should first situate themselves within the realm of social reality established on common historical and cultural roots (McLaren & Leonard (Eds.), 1993). Aronowitz (1993) clarified that Freire envisioned his critical pedagogy to transcend into a more radical power relationship that goes beyond the classrooms. Dialogue is a political communicative interaction and should not be confined within the boundaries of the academe. In 1995, the World Summit for Social Development in Copenhagen explored dialogue as the central mechanism for the promotion of peace, development, and human rights. The United Nations have already seen the powerful dynamics of dialogue for social change. However, the UN cautioned that dialogue in participatory communication should not be taken blithely as an antidote to every social problem. The UN has emphasized that

Dialogue is not a panacea: It does not replace justice, equity policies, inclusive education or any other key interventions towards social integration. Rather, it should be understood, and used, as one component of a comprehensive strategy towards inclusive and just societies. Within a social integration strategy, dialogue complements, enables, and enhances other interventions. It helps to weave a stronger fabric of social relations, thus building social capital. (United Nations 2007, p. xv)

There are already many existing policies and projects that international organizations have been working on to offer funds and to improve human resources (Dagron & Tufte, 2006). However, very seldom do these initiatives address the real problem of communication. It was only during the World Congress of Communication for Development (WCCD) in 2007 DEVELOPMENT COMMUNICATION AND THE DIALOGIC SPACE: FINDING… 67 that Dagron first recognized the shifting communication perspective to genuine people’s participation. He highlighted that “For the first time, decision makers and officials from development organisations had the opportunity to have dialogue around communication approaches that are different from what they are used to” (Communication for Social Change Consortium, 2010, para. 15). What concerns the communication consortium was the fact that international and local organizations were still being misled that the right to information cannot be referred interchangeably with the right to communication. Participatory approach in development allows people to engage in decision making which can only be possible through communication. In this process, however, people should need first to acknowledge themselves as free individuals with a genuine voice of their own (Dagron, 2009). Participatory communication research opens a new dimension for the “citizen voice” to engage in critical discourse (Pettit, Salazar, & Dagron, 2009, p. 450). This recognizes the role of researchers as communication actors in echoing the interest of their respective societies. However, there are three main problems that interfere with dialogue between the developed and the developing worlds (Du Plessis, 2010). These include the elitist nature of the problems, the certain sense of superiority of the developed world over its lesser counterpart, and the insufficient funds for researchers in the developing world to establishing the ethos of development and its implementation.

Dialogue and Love: A Connection Freire’s pedagogy invited me to study dialogue as an experiential manifestation of love. This may seem superficial to the uncritical eye, and hence it is imperative to read Freire with a postcolonial understanding of the word:

Dialogue cannot exist, however, in the absence of a profound love for the world and for people … Love is at the same time the foundation of dialogue and the dialogue itself … Because love is an act of courage, not of fear, love is commitment to others. No matter where the oppressed are found, the act of love is commitment to their cause–the cause of liberation … If I do not love the world—if I do not love life—if I do not love people—I cannot enter into dialogue. (Freire, 1970, 1993, p. 89)

The love described here is refined in Freire’s political view of injustice and oppression in Third World nations. It is a seemingly endless confrontation, interrogation even, of the oppressor-oppressed dichotomy. 68 C. J. AMOYAN AND P. A. CUSTODIO

According to Freire, the presence of oppression defies love, and prevents people from entering into dialogue. Dialogue grew out from the philosophical and theoretical principles of communication and often sought common linkages to Buberian dialogue of “reciprocity, mutuality, involvement, and openness” (Kent & Taylor, 2002, p. 22). Likewise, in Martin Buber’s prose, he would refer to love in dialogue as “Feelings dwell in man; but man dwells in his love … That is no metaphor, but the actual truth” (p. 14). Here, Buber (1958) implied the dialogic expression of love in terms of the I and Thou relationship between and among humans. In order to understand his work in depth, it is requisite to any communicators to engage themselves in dialogue with the text (Morgan & Guilherme, 2010). Morgan and Guilherme (2010) wrote that Buber’s dialogic principles and its thrust on learning is also a way of conflict resolution. Thus, for Buber, dialogue is a communicative tool used to translate theory into practice in unresolved communities. Buber refers to a true dialogue, one that is authentic communication which takes place between and among equals. Unlike the I-It, the I-Thou embraces the spirit of conscience and consciousness-seeking inherent in Freire’s dialogue, whereas the I-It signifies the oppressor-oppressed dichotomy putting humans at a reduced level of things, a derivative of antidialogue. Buber sees this I-It objectification as barrier to entering a relationship among humankind. Love unites individuals as equal human beings, and lets them “be equal without being the same” (Fromm 1956; as cited in van Arendonk, 1985, p. 146). Based on Fromm’s assertion (as cited in van Arendonk, 1985) love could be the answer to human’s “eternal quest for union with the world” (p. 156). This coincides with Freire’s position of a utopia of freedom (Freire & Macedo, 1993). Freire claims that “True solidarity is found only in the plentitude of this act of love, in its existentiality, in its praxis,” and love as the dwelling compassion of the human soul—as a strategy to be free (Freire, 1970, 1993, p. 50). Dialogue arises from a critical consciousness grown from love, humility, faith, hope, and critical thinking (Freire, 1970, 1993). These values transpire a sympathetic mutual trust and participation among dialoguers. But before entering the dialogic process, both dialoguers should need to coex- ist in the world through shared realities. This, according to Mefalopulos (2008), follows a “two-way horizontal model” of communication influenced by the Latin American school of thought that spread between the 1970s and 1980 as a new perspective in development communication. DEVELOPMENT COMMUNICATION AND THE DIALOGIC SPACE: FINDING… 69

However, there is a counter argument raised by Theunissen and Wan Noordin (2012) that a two-way horizontal model “has not done justice to the nature of dialogue, and has effectively stifled concrete development of a dialogic theory” especially in public relations (p. 5). Apparently, public relations emanating in the real world is not constructed according to a horizontal appropriation but a vertical hierarchy of socio-political power. It serves as a birthright to a few people, while a scarcity to those living in the bottom billion of highly stratified societies of the Third World. Superiority of one class over the other is counterproductive in dialogue for it succumb to the whims of the more powerful communication actors. It manifests in many forms and agencies “not exhausted in those public and private spheres where governments, ruling classes, and other dominant group operate” (Freire, 1985, p. xix). Freire (in McLaren & Leonard (Eds.), 1993) states that oppression has multiple and contradictory forms grounded on a concrete situation. He did not discredit the existing plural- ity of power relations and the subjectivity of inequality. For Freire, it is ideal for every society to move out of oppression through reflection and action about their context, because only then is communicative struggle for freedom possible. Freire did not disregard criticisms on dialogue, and instead positioned his pedagogy in the specificities of human oppression. In defence, Freire explained that the fundamental transformation of the oppressed is to realize that, they too, have power to denounce the “greater enemy” (Freire & Macedo, 1993, p. 174). Macedo’s dialogue with Freire now poses another critical frame, from the oppressor-oppressed dichotomy, to the grander, vertical power structure in society.

Dialogue and Praxis Dialogic praxis determines the reflection and action of humans in order to transform the world (Freire, 1970, 1993). It resolves oppression by acknowledging and reflecting on the realities of the oppressor and oppressed, and consequently denouncing the dichotomy through action. However, before concentrating on the depth of praxis, one must first value the importance of the authenticity of the word. Freire explains:

As we attempt to analyze dialogue as a human phenomenon, we discover something which is the essence of dialogue itself: the word. But the word is more than just an instrument which makes dialogue possible; accordingly, 70 C. J. AMOYAN AND P. A. CUSTODIO

we must seek its reflection and action, in such radical interaction that if one is sacrificed—even in part—the other immediately suffers. There is no true word that is not at the same time a praxis. Thus, to speak a true word is to transform the world. (Freire, 1970, 1993, p. 87)

Freire links praxis to human liberation. Here, he addresses humaniza- tion as an equivalent of the orientation to the world, and praxis, on one hand, is the way to transform it. Praxis carries the blueprint of human existence by which one can continuously name and rename the world. Freire made it clear that the ultimate way of learning is through lived experiences that needs to be viewed in terms of historical and normative dimensions. So, reflection and action, for that matter, always follow the same order because without deep understanding and critical thinking, action becomes a futile attempt for social change. Likewise, Aronowitz (1993) recognizes the value of dialogue being a condition towards human emancipation and not just a communicative process. Essentially, it opens up a space for the oppressed voices to be heard in public discourse, and so it requires a great effort for listening (Aronowitz, 1993). In Dutta and Pal’s (2010) approach to subaltern voices, they asserted that listening rests at the core of theorizing dialogue which demands dialoguers to listen to the other. Listening also demonstrates the process of social change by providing opportunity for the local communities to raise their cultural voices (Dutta, 2014). This strengthens a culture-centred approach by way of challenging the status quo wherein marginalized voices are erased in dialogue.

Borderlands and Border-Crossers: Freire in Postcolonial Discourse It is the moral obligation of Freire’s critical readers to discover the importance of his critical pedagogy in our own present milieu. Henry Giroux (1993), a close colleague and friend of Freire, identifies this kind of character known as a border-crosser. Giroux says that a border-crosser is someone who follows the philosophy of Freire and engages in a dialogic relationship with others. This, too, means “producing a space in which those dominant social relations, ideologies, and practices that erase the specificity of the voice of the other must be challenged and overcome” (Giroux, 1993, p. 178). Intellectuals and scholars who wish to become border-crossers should be willing to break the traditional form of discourse that is submissive and repetitive of universal truth, and rather enter DEVELOPMENT COMMUNICATION AND THE DIALOGIC SPACE: FINDING… 71 a postcolonial discourse of reinvention and construction. After all, what we need now is to read Freire in a postcolonial sense and deviate our thinking from the inorganic Western doctrines. Before coming up with a radical transformation, we should start first at the theoretical basis of change. Thirdspace, a postcolonial approach to social geography, grew out of Edward Soja’s concern for human welfare entrapped in oppressive human conditions (Dixon, 1999). In an interview with Borch (2002), Soja explained that his conception of thirdspace refers to the social production and interpretation of space. Moreover, another study on the hybridization of space was further explained in Sorrells (2013) being “the intersection intercultural communication practices that construct meanings in, through, and about particular places within a context of relations to power” (p. 93). This hybrid space, in Giroux’s (1993) text, refers to “home”—one that resembles the “cultural, social, and political boundaries that demarcate varying spaces of comfort, suffering, abuse, and security that define an individual or group’s location and positionality” (p. 179). Compared to Soja’s concept of thirdspace, home is built on cultural spaces where social resistance exists. In the presence of power struggle in cultural spaces, there emerges another category. Low and Zuñiga (2003; as cited in Sorrells, 2013) refer to this as a contested cultural space, a geographic location inflicted with hegemony over natural resources, and thus confronted with a strong desire of the oppressed to challenge the status quo.

Dialogue on Mining: The Calancan Bay Tragedy The Calancan Bay mining discourse has already been existent far beyond my time. This chapter is just a continuation, where we come to revisit one of the worst Philippine industrial tragedies through a dialogic encounter with the oppressed. The transformation that a human wants to affect to the world is communicated through dialogue. Thus, transformation happens through the very fundamental role of being able speak of freedom. Massey (2012) claims that social change is the totality of peoples’ individual change founded on similar social milieu, thus, motivated by a common social cir- cumstance. In the context of the Calancan Bay fisherfolk, their freedom is taken over by social and environmental injustice brought about by unsustainable mining industry in Marinduque, the Philippines. 72 C. J. AMOYAN AND P. A. CUSTODIO

Among the six town municipalities consisting the island, Sta. Cruz alone produces 13 per cent copper, 10 per cent silver, and 2 per cent gold of the national mineral yield (Muhi, Rivera, De Los Reyes, Lopez, & Tayag, 2012). Its geographic location was considered part of the Circum- Pacific Orogenic Zone where most of the porphyry copper deposits of the world can be found (Asuncion, 2004). Even earlier, foreign mining corporations had already seen the potential of Marinduque’s mineral resources. In 1964, Marcopper Mining Corporation (Marcopper) started its mining activity in Marinduque under the supervision of Placer Dome Inc., (then Placer Development Limited), a major transnational Canadian mining company (Coumans, 2002). Placer Dome claim their presence in mineral-rich countries like Canada, Australia, Chile, Papua New Guinea, South Africa, and the United States (Coumans, 2003). Besides the Philippines, Placer Dome’s exploration in Southeast Asia also include Indonesia where there are large deposits of copper, nickel, and tin (United Nations Environmental Program [UNEP], 2000). The United Nations Environmental Program (2000) is aware that every stage in mining activity has an adverse impact on the environment, causing air and water pollution, solid waste production, and mine tailings disposal. The local and national impacts of mining on the society were highlighted from 2005 to 2012. New norms and discussion have been formed as mining agenda gains momentum (Hart & Coumans, 2013). The harmful effects of mining industries, according to Hart and Coumans (2013), raised resistance and conflict in communities across the globe, and at the same time increased peoples’ awareness and resistance on mining issues. According to Coumans (1999), the village leaders’ resistance towards Marcopper began as early as 1974, a year prior to the submarine waste disposal in Calancan Bay. However, their petition did not stop the mining company from its operations. In 1975, at the height of martial law dicta- torship in the Philippines, Marcopper started to dump mine wastes into Calancan Bay at a rate of 2.5 tons per second which lasted for 16 years (Coumans, 2002). There is an estimate that about 80 sq km of coral reefs, sea grasses, and other marine biota had been covered by at least 200 million tons of mine tailings. The submarine tailings disposal runs through huge pipelines every day (Coumans, 1999, March 26). Marcopper temporarily stopped its operation in 1981 due to massive protest from the fishing community and civil society (Lowe & Vettori, 2005). Though, it did not last long because President Ferdinand Marcos, DEVELOPMENT COMMUNICATION AND THE DIALOGIC SPACE: FINDING… 73 who, by that time, had 50 per cent ownership of Marcopper, repealed the cease-and-desist order filed by the National Pollution Control Commission (NPCC). Marcos allowed Marcopper to resume operations without any government intervention (Coumans, 1999, March 26). Marcopper created jobs to some 800 employees (Coumans, 2002). But that number is nothing compared to the 20,000 villagers affected by their mining operations in Calancan Bay (Lowe & Vettori, 2005). According to Coumans, “Calancan Bay villagers were never asked for their permission for this dumping and never compensated for their losses. They protested the dumping vehemently for 16 years” (n.p.). Until now, the fisherfolk continue to appeal their case in court for their desired environmental justice. Coumans (1999, March 26) sees that this industrial catastrophe and the long story of struggle for justice illustrates that the government was not able to conduct its duty to protect both its citizens and the environment from such a mining stronghold like Marcopper. In 1998, the Philippine government under former President Fidel V. Ramos raised a national state of calamity for health reasons in the villages near Calancan Bay due to heavy metal poisoning and lead contamination (Coumans, 1999, March 26). In a study conducted by Carr, Nipper, and Plumlee (2003) on porewater toxicity from the tailings, the result revealed that the contamination of heavy metals such as cadmium, cobalt, copper, nickel, lead, and zinc was highest near Calancan Bay causeway. Due to extreme copper concentration, the effect of the toxic would persist long term and continue to impact nearby villages (Carr, Nipper, & Plumlee, 2003). According to Social Watch Philippines (2005), the Marcopper mine tailings severely destabilized the marine ecosystem of Calancan Bay. More than that, the livelihood of the community villagers who depend primarily on fishing suffered at great cost. Nearby residents were reported with heavy metal contamination (Fellizar, Velo, & Bernardo, 2002). “We thought that Marcopper could help the people and bring us livelihood, and yet what they brought us is poison in exchange,” said Amang Pagi, a fisher in Calancan Bay (Amang Pagi, 2015, January 5, personal communication). Amang Pagi’s daughter was among the victims of Marcopper. She was confined in the Philippine General Hospital (PGH) in 1999 with other villagers. Medical findings show that the young girl’s severe headache was caused by the tailings. Amang Pagi suspected that when the wind blows, it carries particles of sandy mine wastes from tambak to an open deep well where they fetch water. 74 C. J. AMOYAN AND P. A. CUSTODIO

Even the air they breathe is not safe as the toxic chemicals were diffused into the atmosphere (Social Watch Philippines, 2005). The fisherfolk, too, have been experiencing small fish catches since then. From 10 kilos, today they barely have 2 kilos per day. Indeed, the villagers were still suffering from the aftermath of this “world-class tragedy” (personal communication, August 8, 2015). Despite all the inconvenience, Placer Dome continuously deny any responsibility for the people of Calancan Bay. Even the company spokes- person sent a letter to the Calancan Bay supporters emphasizing that “Placer Dome rejects allegations that it is also responsible for alleged damage to fishing in Calancan Bay” (as cited in Lowe & Vettori, 2005, p. 20). In the end, Placer Dome has declined their compliance and social account- ability to the villagers. Hart and Coumans (2013) said that the contamination of the bay was only a part of the inconvenient story. Immersion in a community along the coast of Calancan Bay revealed the narratives of the villagers whose struggle for justice remains to this day.

Dialogue and Kapwa: Towards Indigenizing Methodology Kapwa is inherent of Filipino culture, and it sets Filipinos’ core values unique as a form of human interaction. The concept emerged from the new movement in Filipino psychology introduced by Virgilio Enriquez in the 1970s. Sikolohiyang Pilipino (SP) embraces the Philippine indigenous perspective towards liberation. SP thinkers like Enriquez believe that genuine Filipino identity and personhood should first be the duty of Filipinos themselves, and not be based on the Eurocentric impressions implanted by the Western colonizers. Kapwa is sharing oneself with others—a unifying consciousness that transcends the Buberian dialogue of I-Thou into a word unique of the Filipinos. At the same time, kapwa carries a value system, that is, for De Guia (2005) the core in genuinely acknowledging Filipino identity. Kapwa begets a moral obligation by treating other human beings as mortal equals (De Guia, 2005). In recognizing others as kapwa, I commit to a more convenient way of dialogic communication with the fisherfolk. Through pakikipagkapwa, we (I and my participants) talk about our own familiarities and differences of realities. We laugh at jokes together because we get each other’s language. According to Enriquez (1986), “the native language is a rich source of DEVELOPMENT COMMUNICATION AND THE DIALOGIC SPACE: FINDING… 75 concepts meaningful for and significant to the local culture” and “it is a good starting point” (p. 7). We make stories together, some drawn and narrated from their old experiences. I talked to men, women, and elders. I come to witness them in their own language and niche. Consequently, in the presence of social injustice—the suppression of freedom—the concept of kapwa suffers. The same consequence happens with mutual trust and understanding between the Self and the Other. I perceived this when I first came to the community, and met Amang Habagat. I told him about my intention to conduct my study in their barangay, but there is a hint of distrust as he expressed his preconceived notion of outsiders: Honestly speaking, what is hurting our feelings, is when people interview us, take our side, just to make money! (Amang Habagat, 2014, October 25, personal communication). Amang Habagat speaks on behalf of the small fisherfolk whose voices are struggling to be heard, and yet, often disregarded in exchange for personal gain and profit of the interviewer, or in my case, the researcher. As a reflection, I felt disheartened since the initial phase of my research is just starting, and here I am, faced with a dilemma: How can I speak for the small fisherfolk? How can I give justice for these voices? I am not even a fisherfolk like them. In fact, I don’t even know how to fish. I take this as a challenge, in spirit of kapwa, to gain back the trust of the people, and retell the oppressed voices as authentic as possible. My sense of kapwa evolved from my own sentiment as a Marinduqueño. At first, I may seem as the intruding stranger coming to the community barely knowing anyone. As I negotiate with them my purpose for this study, then, I take the image of a researcher. Yet, whenever I introduce myself and speak of where I come from, it gives the people more chance of expressing themselves like we have known each other in a hypothetical world. Filipinos have this innate hospitality, but it is a different story to live and share a common geography. Santiago and Enriquez (1976; as cited in Pe-Pua, 1982) pointed out the misdirection of studies on Filipino personhood and identity which is influenced and explained by the dominant Western colonial impressions. Santiago and Enriquez suggest that in order to resolve this socially inflicted crisis of Filipino identity an indigenous methodology is necessary. This is somewhat supported by Shor (1993) taking Freire’s viewpoint. Shor asserts that “Our specific settings and conditions teach us the limits and openings for making change. These specific situations are the first and final arbiters of the methods we choose, the language we speak, and the ways we organize for change” (p. 35). From here, I come now to listen to the 76 C. J. AMOYAN AND P. A. CUSTODIO voices under the mines in Barangay Botilao, Sta. Cruz, Marinduque, a small, secluded coastal community along Calancan Bay.

Finding the Silenced Voices

I, Going to the Barrio There is no definite itinerary in entering the field. The voices became the map leading to where the oppressed are. Van Maanen (2011) says it truth- fully that “fieldwork apparently requires some of the instincts of an exile, for the fieldworker typically arrives at the place of study without much of an introduction and knowing few people” (p. 2). Likewise, Freire himself experienced this kind of exile not only as a victim of a military coup in Brazil but also as an educator who braved the path to human liberation (Giroux, 1993). I have realized early on that this research is not only the struggle of the voices in silence but also a struggle of my own. I went to Barangay Botilao with the idea of an exile. My first visit to the barrio was on October 25, 2014. I always look back to this day as my brave attempt at finding the silenced voices in Calancan Bay—the very day I began tracing my journey of exile. Steep, rock-strewn road welcomed me going to the community. As I was rid- ing on a tricycle, I saw a sparkling white-sand beach across the bright blue sea. I asked the driver to stop so I could get a better view of the beautiful landscape. I took a picture and after that we immediately went ahead. It was not until later that I learned that the spot I viewed from above the mountain ridge would be the praxis of my research. It was the Calancan tailings causeway known as tambak. I learned from the villagers that for almost two decades of irresponsible mining activity, Marcopper left Calancan Bay a wasteland of mine tailings and a poisoned environment. Amang Habagat told me stories, tragic stories, about children and relatives who were affected by the tailings. Some of them were dead, while others are still suffering. I was standing still before him, baffled at every blow of anger, grief, and resentment he threw at Marcopper. Right there and then, I realized that this journey was not just about finding the voices, but also finding justice for these voices. My first encounter with the word “ahon” was in a conversation with a catechist. There was a patrol boat blessing during the morning that day, and the family of Amang Bakawan hosted a small celebration at their house. We were gathered at a kitchen table when suddenly the woman seated beside me DEVELOPMENT COMMUNICATION AND THE DIALOGIC SPACE: FINDING… 77 asked: “Kailan ka umahon sa Botilao?” which can be roughly translated to “Since when have you been to Botilao?” I was confused at how she used the word ahon because I interpreted it differently. Being a Tagalog-speaking Marinduqueño myself, I could say that there are still some meaning varia- tions in our native language. To me, ahon signifies “to rise” or “to emerge from the water.” So I asked the catechist what ahon or umahon means to them. According to her, ahon signifies to go or to visit. It applies to the lexi- cal meaning of going to the barrio—the isolated rural community in the Philippines (Almario, 2010, p. 21). Finding the voices is a journey of finding home. It took me series of going back and forth to the community for two weeks. Every ahon allowed me to talk and walk with the people of Botilao. I have no interview schedule with me, no list of people to go to, but what I have is my camera, a pen, a journal notebook, and sympathetic ears and mind to listen to them. I seize every opportunity to talk with the fishing villagers. Oftentimes, I listen to their conversations at the pier. I sit by them and laugh. Sometimes, I go with them to fish in the sea. I eat and celebrate with them during special occasions. I attend to their assemblies and gatherings in the barangay. In all these encounters, I realize that dialogue in the presence of sympathy and mutual trust allowed me to become one with the fisherfolk and side with them in their long-sought struggle for justice.

Research Findings

(Re)creating Tambak as Praxis Tambak is a metaphor for mine tailings. At the same time, it is a praxis told through the lived stories and narratives of the small fisherfolk in Calancan Bay. As I immerse myself in conversation with fishers along the pier, they would point to a long stretching causeway that is the tambak, often associated with a mound of sandy artefacts, mine tailings, and rocks drilled from the mountain which were later on dumped into the reefs. The recollection of the past meets the present life stories of the small fisherfolk through moments of reflection. It is in comparing their experiences that they construct among themselves the tambak as praxis. Yet, it is also through embracing this critical consciousness and understanding this social praxis that human engages society for transformative action (Groves, 2011). I used tambak not just as a word, but a password to open a space for dialogue with the small fisherfolk. The voice being operationalized here is rather 78 C. J. AMOYAN AND P. A. CUSTODIO grounded in the nature of human struggle, unlike in speech communication in which the main concern is articulation and phonetics or in musical arts where the voice synchronizes with beats and rhythm. Voice is not just the ability to say something orally, but rather it is speaking of something that is reflective of reality among humans. I noticed that it is a way of reality among the villagers to speak of their own mining catastrophe, where they identified themselves as victims. The voices of tambak are categorized in four emerging categories: (1) voice of solidarity; (2) voice of resistance; (3) voice of doble cara, and (4) voice of praxis.

Voice of Solidarity as ‘Pakikiisa’ Then, if you are alone, and you have no companion, what can you do if you’re just one? There needs to be a group.—Amang Tabsing

Amang Tabsing emphasized the value of solidarity or the Filipino concept of “pakikiisa.” Pakikiisa is merged with the root word isa which means “one,” affixed withpakiki , denoting a certain Filipino attitude or values. It has grown from the indigenous concept of solidarity. The voice of solidarity is strengthened on the collective power of the fisherfolk to join force and unite towards a common advocacy. This recognizes the marginalized voices to acquire their own power to muffle their oppressor. Yet, in a more profound understanding of the word, solidarity also manifests the Filipino value of kapwa. As previously mentioned, kapwa is the prevailing psychology that binds the self with the other, both as fellow human beings. Therefore, the self (or the I) has a social account- ability towards his or her fellow citizen under a specific socio-cultural environment. The task of the researcher may be confined on his or her set objectives. But for me, my task extends to the essence of helping my kapwa achieve their objectives as well. I may have succeeded in fulfilling my research, but there remains the guilty feeling: Is this paper even worthy to capture the voices? Or am I giving these voices false hope? Is participation enough, or should I extend this participation as being one with the people? Will I ever reach to the point of pakikiisa or being one with them? At the end of the day, I am still the student-researcher whose primary purpose of conducting this study was to contribute something to the so-called body of knowledge and finally, finish a college undergraduate degree. Even though I’ve tried to involve myself in dialogue with the people, I cannot fight their DEVELOPMENT COMMUNICATION AND THE DIALOGIC SPACE: FINDING… 79 battle. But the concept of sympathy, of kapwa, of being with the people, that makes me on their side.

Voice of Resistance as ‘Pakikibaka’ We formed barricades, we have many people! I served as guide to the pupils, I stand as the team leader. We joined rallies back then…We, the fisherfolk fought, all of us affected… Until now, it is still an ongoing discussion. Still, nothing happens… If they only listened to me during the rally, “Stop mining.” I was angry, the Mayor will run over me with his vehicle.—Amang Habagat

Voice manifests resistance acted upon by a social group or class that is purposively united together in a shared interest for social change. One way of finding this voice is through listening from the ground where conten- tions and conflicts arise, since authentic voice can be influenced by social injustice. It also means that voice is not neutral. There is something special to the voice of resistance, and it is a matter of keen and critical understanding of the social context that we tend to codify this voice. Pakikibaka or “resistance” (Pe-Pua & Marcelino, 2000, p. 56) ema- nates only in the presence of injustice. This complements the voice of solidarity to resist an exploitative condition, such that pakikipagkapwa turns inconsistent and suffers. It is through Filipinos’ resistance that they fight whenever they are deprived of freedom. Personally, it is my persistent inquiry: How far can I go with this research given that this struggle finds its way as my own struggle, too. Will I cross the boundaries of being a researcher, to an activist fighting for the same advocacy as the small fisherfolk? At this point, I have no definite answer yet. But writing this paper, I know, I have something to contribute by offering these voices some space, that is, by means of listening and retelling.

Voice of Doble-Cara Our village captain before do not want Marcopper to dump into Calancan Bay. What Marcopper did was hire the captain’s children, and relatives as employees to the company. So now, he sided with Marcopper and said that there is no poison [in Calancan Bay], because his family was offered jobs. Shameless! He doesn’t think of the livelihood of his people. Even the [former] mayor, they are all the same!—Amang Habagat 80 C. J. AMOYAN AND P. A. CUSTODIO

Amang Habagat strongly denounced the decision of their barangay captain at that time for allowing Marcopper to dump mine wastes into the sea. He speaks with anger and distrust of their barangay leader and to the mining company. Up until now, he still blames them for the misfortunes that affected the villagers of Calancan Bay for decades. The peoples’ struggle motivates me to listen to them more. Like Amang Habagat, Inkong Tagak, a community elder, speaks the same indignation towards the government. He said:

I hope that we get the compensation. I hope that the government won’t no longer intervene because they [the government] have their own interest to receive share with the money.—Ingkong Tagak

Doble cara is a Spanish word for double face. It is a word that has been incorporated into mainstream Tagalog that can be understood by most Filipinos. This meaning translation implies that voice portrays no singular identity. Other than the multiplicity of voices, the oppressed exhibits an alter ego apart from being the result of violence and oppression. As Freire (1970, 1993) put it: “The oppressed suffer from the duality which has established itself in their innermost being. They discover that without freedom they cannot exist authentically. Yet, although they desire authentic existence, they fear it” (p. 48). However, this doble cara voice does not necessarily exclude the double-voicedness of those people in power as they speak of unauthentic words. The doble cara voice resounds from the mouth of those in the political sphere. They are those people who hold positions, previously denying the voice of the poor, but resorted to acknowledging these voices later when the victims finally solicited the attention and sympathy from the public sphere. The question now lies on how authentic is the doble cara voice: Does this intend to create the space for genuine dialogue, or only aggravate, even double, the oppression of the already marginalized voices? Still, it will remain as a battle of forces, serving for the socio-political power—the greater enemy—to serve their own voice.

Voice of Praxis as Reflection and Action Praxis, the confluence of reflection and action, resonates in the lived experiences of the fishers with tambak through spoken narratives and stories. Thus, tambak for them is in itself a praxis—a password to enter an authentic dialogue. DEVELOPMENT COMMUNICATION AND THE DIALOGIC SPACE: FINDING… 81

I met Mamimingwit along the Calancan causeway one morning as I was walking the length of the tailings. I asked him of his insights about tambak and a series of metaphors crossed his mouth on how Marcopper exploited the people of Calancan.

You know…back to the day that Marcopper was dumping tailings here, our fish catch went meagre because of the toxic chemicals they are releasing. Marcopper has been blinded to the villagers’ situation. They were deaf to the complaints of the people trying to stop the company. You know Marcopper is influential. They still continue operations not minding the ill effects of their mining activity to the fishermen and to the environment.—Mamimingwit

Nonetheless, tambak as praxis also involves tensions and conflict.

Since this area was already closed, it’s better now to develop this into a beach resort. The government should focus on how to improve the tambak, the mine wastes that Marcopper dumped into our waters.—Amang Salungo

Recently, the provincial government is prospecting on the development of the Calancan Bay causeway into a beach resort. Amang Salungo is one of the barangay officials I talked with during my preliminary interviews, and he approves the creation of a beach resort in tambak. He agrees to this proposal since it will attract tourists, and provide jobs for some villagers. However, there are other voices that disagree with this idea:

…[I] told them to blow up that tambak so the people of Calancan Bay can have easy access to fishing. Perhaps we can gain back our natural resources like before…The toxic stagnates inside the bay, the water does not flow free.—Amang Habagat

I think, if we can open the mine tailings causeway again, open the entryway for the fishers, and maintain the sea from illegal activities, then probably Botilao would be rich in fish again.—Amang Tabsing

The emerging tension between the reflection and action of tambak is a critical issue for the fishing community. Essentially,tambak is a cultural space where the villagers depend their livelihood and daily needs. Making it a beach resort might somehow improve tourism in the area, but tambak will remain an obstruction to fishing. The toxic chemicals will continuously 82 C. J. AMOYAN AND P. A. CUSTODIO contaminate their waters as long as the tailings remain submerged in the sea. On the other hand, if they blow up tambak as Amang Habagat is suggesting, it would not be long before the passageway close due to the strong water current pushing the tailings back again to the causeway. I realized that praxis making will not be actualized as a dialogue unless the tension between reflection and action is resolved. The struggle is not only the people of Calancan Bay fighting against Marcopper, but the oppression is being aggravated by government. Reflection and action have to come from the fishing villagers themselves. Now, I wonder: To whom are these fisherfolk going to entrust their voice since they cannot fully depend on the government? Besides, the government, too, have their own interest over the issue, that is, in contrast with the peoples’ view of tambak.

Conclusion In my quest for dialogue, my participants and I negotiate a coconstructed reality. We form among ourselves solidarity, and resistance towards power that silences the voice of the oppressed. Unlike in value-free research, dialogic communication requires me to interrogate the value system I live by, the beliefs and cultural capital I subscribe to, as I portray myself as kapwa to the small fisherfolk. As a DevCom researcher, I attempted to make sense and meaning of their world, with the assumption that research, in its core, is a preexisting dialogue which is a collaborative process of meaning making. As a researcher, it is a daunting task to find where the marginalized voices reside. Four years in as an undergraduate student, I was trained to engage with various subgroups of people, from small farmers to people with disabilities, from street children to out-of-school youth. I come to them, listen to their stories, and realize later on that communication grown from sympathy and mutual trust is possible, if only driven by the principles of dialogue, authenticity of voice, and praxis. As we go back to Quebral’s question “How to give voice to the voiceless?” we come to this final reflection that it is not really the voice they need, for voice in itself is not the real struggle of oppression but the venue to speak for this voice. So now, the question turns to how to give space for these voices to be heard in the social and political arena. Essentially, the task of every communication practitioner and researcher who desires for social change is to become the provider of this dialogic space, and simultaneously bridge the oppressed-oppressor gap. This dialogic space could possibly be the missing space in development communication to thrive for social change. DEVELOPMENT COMMUNICATION AND THE DIALOGIC SPACE: FINDING… 83

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The Kapwa in Compassion: Examining Compassionate Health Care for Violence Against Women (VAW) Victims Among PGH Health Care Providers

John Mervin Embate, Marie Carisa Ordinario, and Alyssa Batu

Introduction In 2016, the Philippines ranked seventh worldwide in gender equality and was the only Asian country included in the top 10 (World Economic Forum, Hausmann & Tyson, 2016). While it seems that Filipinas enjoy equal opportunities as men, many of them have been victims of physical and sexual abuse. Results of the Philippine Statistics Authority (PSA) National Demographic Household Survey (NDHS) indicate that 20 percent of women aged 15–49 had experienced physical violence at the age of 15 (PSA, 2013). Additionally, 42 percent of “divorced, separated or wid- owed women report having experienced physical violence since age 15”

J. M. Embate (*) College of Development Communication, University of the Philippines Los Baños, Los Baños, Philippines e-mail: [email protected] M. C. Ordinario • A. Batu University of the Philippines Diliman, Quezon City, Philippines

(PSA, 2013, p. 188). This is higher than the percentage of women who are married or those with common law partners, and the number of women who have never been married. Further, around 6 percent of women aged 15–49 have been sexually abused (PSA, 2013). In 1998, the Rape Victim Assistance and Protection Act was passed. The law sought to establish rape crisis centers nationwide to address the needs of women survivors of violence. The law is supported by an earlier administrative order mandating the Department of Health (DOH) and Local Government Unit (LGU) hospitals to establish women and child protection units (WCPUs). This enabled the DOH to set up WCPUs in 25 provinces nationwide (DOH, n.d.). The DOH also noted that between 2004 and 2010, these WCPUs handled an average of 6,224 new abuse cases, representing an increase of 156 percent (DOH, n.d.). The Philippine General Hospital (PGH), a government-funded public hospital and designated as the National University Hospital, is administered and operated by the University of the Philippines Manila (UPM), catering to about 600,000 patients every year, most of whom come from poor economic backgrounds. PGH established a women’s desk in 1998, right after the passing of RA 8505. According to a general staff of the PGH, between 1998 and 2003, the unit had already served 2,980 cases of women survivors of violence, the highest number of which was in 2,000 with a total of 686 cases. However, there was no mention of health care professionals dedicated to the Women’s Desk of PGH. Based on the website of the Women’s Desk, their services are focused on medical management, particularly in the “training of residents, fellows, nurses, social workers of PGH and those of other centers/institutions on gender sensitivity and violence against women”. This study aimed to map out and evaluate how health care providers at PGH extend compassionate services to VAW victims. Specifically, it aimed to (1) describe the health care services given by health care professionals to patients who suffered from abuse; (2) determine the dimensions of compassion in the Philippine health care setting; (3) explore the subjective meanings and experiences attached by health care professionals to compassion; (4) determine the factors that affect health care providers in delivering compassionate health care to VAW patients; and (5) assess the protocols used by PGH in treating women victims of physical and sexual violence. THE KAPWA IN COMPASSION: EXAMINING COMPASSIONATE HEALTH CARE… 89

Compassionate Health care Despite the developments in health care equipment and innovations, care and compassion still have to be at the core of the care delivery (The NHS confederation, 2008). In a paper, Taylor (1997) even called for the “resus- citation of the Personal Doctor,” believing that doctors who practice their profession without compassion are “as therapeutic as air without oxygen” (p. 521). In literature, health care professionals or “experts” often use a very “clinical” lens that tends to neglect the social and economic dimensions of domestic violence. The use of such lens can be limiting in providing health care assistance to physically and sexually abused women (Tower, Rowe & Wallis, 2012). This “clinical” lens brought about by the biomedical paradigm in treatment at times undermine the crucial role played by culture in healing. In many indigenous and native communities all over the world, illness is not only a domain of the body but also of the mind and soul. Hence, healing is a function not only of the individual or of the modern “doctor” and “patient,” but of the entire community (Stacey, 1988). In precolonial Philippines, the religious shamans called babaylans communicated with the spirits that could cure the sickness or those who have caused it (Villero, 2011). In literature, several possible debilitating effects on the physical and mental state of victims, as well as their ability to relate with others have been identified. Hence, attending to VAW victims requires more sensitivity and special attention. Djikanovic et al. (2011) argued that the needs and requirements of physically or sexually abused female patients is highly contextual. Interaction with health care professionals in itself may potentially cause women to experience further abuse. It is then imperative for health care professionals to be equipped with contextual knowledge and understanding of domestic violence (Tower et al., 2012).

Dimensions of Compassion in the Health Care Setting It is important to look into how compassion is communicated to patients to examine a doctor-patient relationship. With the belief that compassion is “a process of intuition and communication” (p. 1255), Van der Cingel (2014) identified seven dimensions of compassion: (1)attentiveness , 90 J. M. EMBATE ET AL. showing one’s interest in the important issues of another person; (2) active listening, the “indispensable component of compassion” characterized by “stimulating the person to tell his/her story” (p. 1255); (3) naming of suffering, in which the suffering experienced by the other person is acknowledged and confronted through dialogue; (4) involvement, in which the health care provider becomes involved with his/her patient and where mutuality is established as produced by the previous dimensions; (5) helping, which is the “practical component of compassion” (p. 1255); (6) being present, which involves both physical and emotional presence, and most especially a sense of sensitivity to know what the patient needs and be there when it is actually needed; and lastly, (7) understanding, which involves being cognizant of the pain, hardship and the emotions that go with suffering and loss. While van der Cingel situated these dimensions in the nurses’ point of view, Fernando III and Consedine (2014) developed the transactional model of compassion from the physician’s end. They presented a perspective in which dynamic and interrelated factors like physician factors (the health care provider’s ability and motivation to empathize, gender, background, etc.), clinical factors (condition of the patient which affects the ability of the doctor to respond with compassion), and patient and family factors (cooperation of the patient and his/her family), all in the context of environmental and institutional factors, affect the compassion that a physician delivers. Similarly, Way and Tracy (2012) reconceptualized compassion as recognizing (“understanding and applying meaning to others’ verbal and non-verbal communicative cue”), relating (“identifying with another to enable sharing of emotions, values, and decisions”), and (re)acting (“engaging in behaviors that could be seen as compassionate by the provider, recipient or another individual”). These two models differ in perspectives and in classification but have similar conceptualization. To highlight their points of convergence in this study, Van der Cingel’s seven dimensions of compassion are integrated into Way and Tracy’s reconceptualization of compassion. The dimensions of attentiveness, active listening, naming of suffering, and understanding are classified under “recognizing”, while the dimension of involvement is categorized under “relating”. The dimensions of helping and being present fall under “(re)acting”. THE KAPWA IN COMPASSION: EXAMINING COMPASSIONATE HEALTH CARE… 91

Nonetheless, there is a need to ground these Western notions in the local context. As practice and virtue, compassion is ingrained in oriental cultures, particularly those influenced by Hinduism and Buddhism. The work of Dr. Virgilio Enriquez on Sikolohiyang Pilipino (Filipino psychology), as articulated by other researchers, particularly de Guia (2005), sheds light on how Filipinos express and interact with compassion in a health care setting and even in daily life.

Pakikipagkapwa, Pag-aruga, and Pagkalinga in Philippine Health Care Several studies have highlighted the difference between Western and Oriental constructions of reality. In the Philippines, Virgilio Enriquez (1978) proposed that the core value of Filipino personhood is Kapwa or the Shared Self which is different from the Western notion of Other. Kapwa, according to Enriquez, is the “recognition of a shared identity, an inner self shared with others” (de Guia, 2005, p. 28). Kapwa is one of the three core values of the Filipino personality theory, along with Pakiramdam and Kagandahang Loob. Pakiramdam, the piv- otal interpersonal value, is the “emotional a priori inherent in Filipino personhood…[and] operates all Filipino surface values” (de Guia, 2005, p. 29). Enriquez claimed that without pakiramdam, a person would find no sense of time and kalooban (perception). Kagandahang Loob or Shared Nobility is the linking socio-personal value demonstrated through an act of goodwill that stems from kindness or purity of heart (Aguiling-Dalisay, 2013). Stemming from the work of F. Landa Jocano on the Filipino value system, Manauat (2005) argues that caring is also a Filipino value. In Filipino, caring is synonymous with any (or all) of the following: pag- aaruga, the care given to the sick or the young; pagsasaalang-alang, where one thinks about the welfare of the other; pagtangkilik, which is being hospitable to another person; pakialam, which means being involved; and pagkalinga, which she describes as “benevolence, compassionate caring” (Manauat, 2005, p. 137). Other related terms are pakikiramay (sympathy) and pagkahabag (pity). The UP Diskiyonaryong Filipino’s translation for compassion is pagkahabag, while other dictionar- ies use pakikiramay. While the concept “pity” indicates a hierarchy of 92 J. M. EMBATE ET AL. superiority and inferiority, running counter to the concept of Kapwa, and pakikiramay connotes death or loss, we opted to use the terms pag- aaruga and pagkalinga in localizing compassionate care. This research aims to expand, if not pioneer, a study on localized health care compassion that is extended to survivors of VAW. This research on compassionate health care used Filipino core values, particularly Kapwa, based on the respective works of Enriquez and Jocano. It also utilized the Transactional Model of Compassion developed by Fernando III and Consedine (2014) and the integrated conceptualizations of compassion by Way and Tracy (2012) and Van der Cingel (2014). Figure 5.1 presents the conceptual framework of this research.

Methods and Procedures To study the communicative aspect of compassion as delivered by PGH health workers to VAW patients, in-depth face-to-face interviews were conducted among six health care providers: two are male surgeons (S1

Healthcare Patient Factors Provider Factors Clinical Factors

Sikolohiyang Pilipino

Dimensions of Compassion

Organizational/ Structural/ Institutional Factors Socio-Cultural Factors

Fig. 5.1 Conceptual framework of the study THE KAPWA IN COMPASSION: EXAMINING COMPASSIONATE HEALTH CARE… 93 and S2) at the Emergency Room, two are female obstetrician-gynecologists (OB1 and OB2), and the last pair are female social workers (Staff 1 and Staff 2) at the Women’s Desk. Snowball-convenience sampling was used to determine the participants of the study. All of them are Filipino citizens and have been affiliated with PGH for more than five years. While the sample size is relatively small, the informants were able to provide substantial breadth and depth of narratives and personal views on the situation at PGH. After all, the health workers interviewed were the ones who had personal and constant encounters with VAW victims, particularly the two social workers at the Women’s Desk whose job description specifically mandates them to deal with VAW patients. Questions were asked using a semistructured interview and were conducted at PGH, particularly the Emergency Room (ER), the Obstetrician ER (OB ER), and the Women’s Desk (WD) office, a small office located across the Emergency Room complex. Through this, we were able to observe them in an ambient surrounding. However, we decided against closely observing health worker-patient conversations or any of their specific interactions as these are highly sensitive, private, and confidential. The interviews were recorded upon the verbal consent of the informants. The transcripts were then analyzed through a thematic analysis to facilitate a hermeneutic going back and forth of open, axial, and selective coding. Personal observation and document reviews were also employed to verify and support our findings. Exemplars cited in the discussion below are lifted from the transcript that was translated into English by the researchers.

Results and Discussion

Health Care Services Provided to VAW Patients Based on the interviews and document reviews, we found that PGH- Women’s Desk and two ERs (surgery ER and OB ER) provide holistic services to VAW patients, covering medical assistance (immediate medical treatment, medico-legal examination, prophylaxis/emergency contracep- tion, among others); psychological counseling through the PGH psychiatry department; documentation (medical diagnosis filled out by the OB and surgeon, rape kit, narrative or record of the abuse); social services (temporary shelter, referral to non-governmental organizations [NGOs] 94 J. M. EMBATE ET AL. and government agencies like DSWD for further assistance); and “Extra Mile Services”—tasks that are beyond the health care providers’ job description which they still perform out of concern for their patients (i.e. out of pocket contribution to patients’ expenses for medications and laboratory tests).

Subjective Meanings and Experiences on Compassion

Compassion as Pakikipag-Kapwa Enriquez proposed that the core value of the Filipino personhood is Kapwa, or the shared self, in which one “opens up the heart-doors of the I to include the Other” (de Guia, 2005). Pakikipag-kapwa requires a person to treat another as a human being, and hence, as an equal. Results, however, showed that the interviewed physicians consciously distance themselves from the patient. As S1 shared, “there’s a level of empathy… [But], you have to be professional… You must not get too attached with your patients.” Yet, despite the distance this “professionalism” entails, these physicians are still cognizant of the troubles and suffering their patients experienced. Naturally, despite the professional detachment, it is inevitable for these practitioners to feel exhausted given the unceasing volume of patients that flock to PGH on a daily basis. S1 admits, “Of course, the hospital is limited. We are not robots, we also feel exhausted.” He added:

There are ways to be efficient in attending to [the patients], but at times, we can’t help but act as if we were like robots. Of course, it suddenly comes to us that we’re actually talking to a real person.

People who practice pakikipag-kapwa are supposed to demonstrate sin- cere pagkamakatao (people-centered orientation), pagkamatulungin (service to people around them), and pamathalaan (commitment to their communities) (de Guia, 2005). It is without a doubt that the physicians interviewed demonstrate genuine service and commitment to their patients and institution as most of them were trained at the UP College of Medicine which has a mantra to serve the people. However, compared to the social workers who employ a more people-centered approach in handling VAW patients, physicians tend to be task-oriented, reasoning that the compassion they provide is more of a product of their training and duties as medical practitioners. Nonetheless, this does not mean that they THE KAPWA IN COMPASSION: EXAMINING COMPASSIONATE HEALTH CARE… 95 are not makatao. Viewed in a larger context, the doctor’s professional approach is a strategy to optimize the time they have at the hospital to cater to the needs of other patients arriving and waiting to be attended. Their strategy to be efficient is not a form of abandonment or neglect, but rather a means to deliver care to a greater number of patients.

Compassion as Pakikiramdam Pakikiramdam is an “act of sensing the situation, including the feelings and thoughts of others and an anticipation of action” (Rungduin & Rungduin, 2013, p. 19). The word pakiramdam and its variants were present in almost all interviews, making it the ultimate strategy these health care providers use in interviewing the patients. VAW patients under trauma will most likely find a difficult time narrating orally their experience and tend to resort to non-verbal language in communicating pain and suffering. The sensitivity of the topics shared by the patients and their very delicate condition require health care providers to facilitate compassionate health care operated by pakikiramdam. These providers are able to use health communication approaches strategically by making sure that no line is crossed, and that the well-being of the patient is protected at all times. OB1 was being accurate when she said:

We need to be sensitive…we don’t touch [the patient] if she’s still hysterical. We talk to them first, we calm them down. We need to comfort them and dig deeper to understand what happened to them, because at times they feel shy to speak out.

Compassion as Kagandahang-Loob The last core value in Enriquez’ Sikolohiyang Pilipino is Kagandahang- Loob or “shared nobility”. Jocano definedkalooban , a related term for loob, as the place where reason and emotions merge. Physicians experience an intrapersonal debate on whether to maintain a distant kind of professionalism or to let their emotions dictate their approach toward their patients. This is not surprising as Kagandahang-Loob is also translated to English as “shared humanity”, implying that one’s generosity is first and foremost a product of one’s inherent human trait. Despite their resolve to distance themselves from their patients, the health care providers could not simply detach themselves from the emotional suffering of the victims. It can be inferred that the health care providers act out their duties and responsibilities not only because they 96 J. M. EMBATE ET AL. were trained or mandated to do so, but also because of their genuine feeling for their kapwa. Both social workers emphasized the value of sincerity in handling a VAW patient. This sincerity, however, is not just an outward manifestation, but also an inward conviction.

Compassion as Asal Jocano identifies asal as the “expressive aspect of a person’s behavior” (Manauat, 2005). Consequently, he argued that asal consists of three standards, namely kapwa (relational), damdamin (emotional), and dangal (moral). Asal is illustrated through the communicative behavior of health workers. With communication at the center of compassion as asal, this is categorized in the study into verbal, non-verbal, and approach. The verbal component involves actual utterances during conversations or consultations with the VAW victims. The medical and paramedical practitioners have different perspectives on how to start conversations with their patients. To illustrate, the quite straightforward S1 immediately proceeds to asking about the details of the case, while both social workers believe that the details of abuse are rather delicate and not to be explored right away. Staff 1 relates encouraging patients to disclose by giving them more space and the liberty to choose where to start their narrative. The different practices between the medical and paramedical practitioners (i.e. social workers), however, may be attributed to the respective natures of their jobs. For medical practitioners, there is immediacy in exploring the physiological details of abuse to come up with the corresponding medical intervention. On the other hand, staff from the Women’s Desk explore and deal with the psychological aspects of abuse, in which healing, according to Staff 1, is allowing patients to “take [their] time…at [their] own pace” in telling their narrative. These differences also determine the degree of directness in their verbal communication. Specific to the practice of counseling, Staff 1 further elaborated that she has developed her personal verbal communication strategy through her years of stay at the Women’s Desk. Part of her strategy is to refrain from asking “Why?” and from offering a consoling “I understand”. Another aspect of the theme compassion as asal is non-verbal communication. This involves gestures, tone of voice, haptics, and proxemics. A health care provider must instinctively know where and when to display them; otherwise, it would elicit distrust from the patient and might even violate her personal space. THE KAPWA IN COMPASSION: EXAMINING COMPASSIONATE HEALTH CARE… 97

While the informants have been quite specific on how the verbal and non-verbal aspects of compassion as asal may be illustrated, approach was related in a more abstract manner. Approach may be considered as an aspect which shapes the “climate” of the interaction or interpersonal relationship between a medical or paramedical practitioner and a patient. It may be inferred that the informants’ responses show patterns such as a patient-centered interaction and sensitivity or cautiousness. Using Jocano’s standards for asal, namely kapwa, damdamin, and dangal, compassion as asal in this study may be primarily perceived on the basis of damdamin (emotions), and more importantly, kapwa (relationships) by the health care practitioners. This confirms Maggay’s (2002) observation that Filipino communication is more high-context than low, which means that the way Filipinos communicate with one another may rest more on the context or what is internal to the person in conversation, than on the explicit or direct transmission of coded information. In other words, Filipinos communicate without necessarily using words. Table 5.1 summarizes how the verbal, non-verbal, and approach aspects of compassion as asal illustrate this. These behaviors can be categorized either as Pakikitungo or “transaction/civitlity with” (Pe-Pua & Marcelino, 2000, p. 56), Pakikiramay or sympathizing, or Pakikisama or “being along with” (Pe-Pua & Marcelino, 2000, p. 56).

Compassion as a Virtue Excellence has been traditionally considered as the essence of virtue. Rooted in the Greek word arête, virtue pertains to an individual’s excellence in theory, practice, as well as “moral virtue” or “excellence in character” (Begley, 2008). In particular, virtues found as themes in this study are the practitioners’ acts of going the “extra mile” for their patients or self-sacrifice and unbiased attitude and behavior toward patients.

Table 5.1 Verbal, non-verbal and approach aspects of Asal

Compassion as asal Element of asal: kapwa

Verbal Direct or immediate probing of case details Pakikitungo Indirect or non-immediate probing of case details Pakikitungo Non-use of “Bakit?” (“Why?”) Pakikiramay Non-verbal Tone of voice Pakikitungo Haptics and proxemics Pakikisama Facial expression Pakikitungo Approach Sensitivity or cautiousness Pakikisama Patient-centricity or personalization Pakikitungo 98 J. M. EMBATE ET AL.

From the medical standpoint, going the extra mile at PGH involves mobilizing personal, financial, and human resources. S1, for instance, related that on several occasions, colleagues (physicians) personally financed laboratory tests, medicines, and other medical expenses of some of their patients. Further, self-sacrifice also involves rendering extra hours of duty despite their physical exhaustion. Another virtue among the health care practitioners which emerged from the interviews is the unbiased attitude and behavior toward the patients. Other informants also noted their conscious efforts to avoid blaming the victim. OB2 shared:

Of course, you shouldn’t judge them even if you feel like they’ve put themselves into that situation… The patient is judged because you don’t share the same belief as them. For example, you’re annoyed at her because she chose to stay with her husband and declines any medical assistance. It’s her choice! She’s of age and has the right to decide for herself. But it doesn’t mean you have to abandon her.

It may then be argued that these virtues of going the extra mile and being understanding become parameters of “excellence” for health care practitioners. Though these are not part of their medical obligations to their patients, and may be considered as agent (practitioner)-specific, upholding these characteristics helps medical and paramedical practitioners navigate the interaction with patients that require sensitivity and good interpersonal relationships to positively influence the interventions they administer.

Compassion as Dichotomy Between Call of Duty and Social Responsibility Based on the research findings, extending compassion can sometimes cause dissonance, particularly on the part of medical workers. Following their medical training, doctors are expected to maintain a professional distance with their patients. S1, S2, and OB2 confirm the need to be detached from their patients and maintain zero or minimal emotional involvement. According to S1, doctors cannot get too attached to their patients, while S2 said:

As much as possible, we need to detach ourselves emotionally from any patient. But that does not hinder us from attending to their needs with utmost care and compassion. When we need to do something, we need to do it because of our profession; we do it with utmost compassion. THE KAPWA IN COMPASSION: EXAMINING COMPASSIONATE HEALTH CARE… 99

OB2, meanwhile, admitted that being emotionally detached prevents clouding her medical judgment. This means that maintaining their distance from patients is a way of self-preservation and a means to perform their duty to help other patients in need of medical attention. Despite these considerations, doctors know that they have a social responsibility to fulfill. This means the call of duty does not prevent them from going the extra mile for their patients.

Dimensions of Compassion Using the integrated works of Way and Tracy (2012) and van der Cingel (2014), the section below enumerates how the health care providers demonstrate compassion to their VAW patients.

Recognizing Attentiveness The health care providers show attentiveness by giving the patient full attention, avoiding taking down notes, respecting the patient’s pace when sharing her narrative, establishing rapport, and showing interest.

Active Listening The communication strategy of both social workers are patient-centered and are focused on the content. The pace of the entire conversation is determined by the patient. By doing so, social workers show patients respect. Active listening also involves a lot of patience and avoids rendering any judgment. Additionally, social workers shared the importance of showing “signs of life” (e.g. nodding) on the part of the interviewer to assure that the patient is understood.

Understanding When interviewing or treating a victim of abuse, Staff 1 noted that she cannot simply tell or respond to the patient, “I understand”, because no one can truly understand a victim of abuse unless one has gone through the exact same ordeal. Small gestures such as giving the patient tissue to wipe her tears may be enough to express empathy. Further, the word dadamahin (to feel or approximate the disposition or mood of another) and its variants were a recurring theme in the interviews. For instance, social workers approximate the disposition of their patients (dadamahin) by adjusting the lineup of questions, beginning with basic or 100 J. M. EMBATE ET AL.

“benign” information before delving into the more sensitive areas of the narrative.

Recognizing Naming of Suffering This is the act of recognizing that the patient has suffered from violence. Suffering is named through the documents (e.g. hospital forms) that ask information about their physical, psychological, and/or sexual abuses. These documents later become evidence of the assault they experienced.

Relating Involvement The main focus of relating is involvement, which, according to social workers, is inevitable since they feel very much attached to the concerns of their patients. However, medical personnel shy away from too much involvement with patients, stressing that their duty demands a professional relationship with them.

(Re)Acting Helping This refers to actions done by health care providers to help their patients, such as walking them through the treatment and legal processes. The Women’s Desk is focused on this dimension, given that it has forged significant partnerships with intra-PGH and government line agencies such as the Department of Social Work and Development (DSWD), as well as non-governmental organizations that provide free legal and social services. Apart from these services, medical doctors also extend medical and psychological treatment among patients to enable healing and recuperation.

Being present This means being able to anticipate the needs of patients. For doctors, this stems from their medical education and training, while for social workers, from their years of experience doing social work.

Empowering This research aims to propose another dimension of compassion, “empowering”. This is evident in the narratives and statements of the health care providers. One way by which doctors and social workers empower their VAW patients is by taking part in patient education. Apart from this, the Women’s Desk has already set up a small support group for VAW patients. THE KAPWA IN COMPASSION: EXAMINING COMPASSIONATE HEALTH CARE… 101

The support group consists of former VAW patients who are now in the middle of various stages of the legal process that will bring their perpetrators to justice. The group started with only four members but has doubled to include eight former VAW patients. Social workers and medical practitioners also empower victims of abuse by helping them escape their abusers. Staff 2 recalled an instance when the nurses of PGH referred a victim of abuse to the Women’s Desk. It turned out the victim was made a “sex slave” by a person she met when she arrived in Manila to find work. The stranger took her in, and they started a relationship. Eventually, he beat and raped her, and forbade her to leave his house. The abuse continued even when the aggressor’s mother was confined at PGH. Her supposed “husband” would beat her inside a toilet in the hospital so that nurses, doctors, and other patients would not notice. But one day, when the aggressor left the hospital, she decided to escape. That was when the nurses and the staff of the Women’s Desk took action. They had her examined by a surgeon and confined her under an alias “Miss X” to hide her from her abuser. The ruse worked despite the incessant badgering by the abuser on the where abouts of “his wife”. Once the victim was cleared to leave the hospital, the social workers turned her over to a local Non-governmental organization (NGO) that facilitated her return back to her province. The wide network of the Women’s Desk also allows it to help VAW patients get what they need including the economic and financial support should they decide to leave their abusers. Staff 2 said they link VAW survivors to NGOs or other institutions that can help them get into livelihood programs. This gives VAW survivors the means to support themselves, free of their abusers, and in charge of their own lives. Lastly, the documentation accomplished by both doctors and social workers become additional support to the victims, particularly on the legal front. These documents are used to bolster their case against their abusers.

Factors Affecting Compassion

Health Care Provider Factors Based on the interviews, health care compassion roots from either field experience or formal training. The surgeons, for example, claim that compassionate health care in general (but not specific to VAW cases) is part of 102 J. M. EMBATE ET AL. their curriculum in medical school, through a subject called the Art of Medicine. On the other hand, for Staff 2, it was her 12 years of experience at the Women’s Desk that equipped her with the skills to deal with VAW patients who have sensitive stories to share. For OB2, compassion is something not taught but is part of one’s humanity:

[Compassion]… can’t be taught. It’s something you develop on your own. We were taught [in medical school], we have lectures on VAW…[It’s] theoretical; [it teachers you] what to do if your patient is [a VAW victim]. But compassion isn’t taught; it’s already in you.

Patient and Family Factors Staff 1 shared that there have been instances when she lost her patience with the patient and the patient’s family. One time, she even thought of withdrawing a case and referring it to another staff member since her difficult relationship with the patient’s mother had somehow affected her willingness to exercise her duty. Additionally, all health care providers interviewed also shared the same notion of the Filipina woman—matiisin (enduring), selfless, religious, and submissive to men. It seems to imply that their understanding of a Filipina, especially that of a mother, is someone who is willing to tolerate abuses for the sake of her family, or is someone who remains mum and endures violence because religious and cultural reasons render them silent or compel them to stay docile to the whims of men. Part of the patient factors is the trust that victims are willing to give to the health care providers, most especially if the attending physician is a man. Aware of this consideration, both male surgeons interviewed admitted asking assistance from their female interns when interviewing and examining a VAW victim.

Clinical Factors These factors include “cases in which the patient is consciously or unconsciously deemed ‘responsible’” (Fernando III & Consedine, 2014). The health care provider’s perception of the victim and their relationship with each other shape his/her attitude and behavior toward the patient. VAW health care providers, too, may fall prey to victim blaming. OB2 is conscious of this, believing that real compassionate health care should be impartial and free of judgment even if one thinks that the victim may also be to blame for her suffering. OB2 added that despite the differences between her and the victim, the physician must not, in any way, judge the patient. THE KAPWA IN COMPASSION: EXAMINING COMPASSIONATE HEALTH CARE… 103

Environmental and Institutional Factors Lastly, Fernando III and Consedine (2014) suggest that physicians may find it difficult to demonstrate compassion in a crowded and noisy ward devoid of privacy. Unfortunately, the ideal place envisioned by Fernando III and Consedine is the opposite of what PGH has. The Emergency Room, for instance, is filled with too many sick patients waiting for medical staff to assist them. The problem is not with the physicians, who do their job the best way they could, but with patient congestion and the lack of facilities and areas where the patients could stay and wait comfortably. VAW victims, for one, have to endure the crowded place and tell their sensitive narratives with the fear that other people might overhear them. At the same time, results from the interviews reveal that there are no issued guidelines on handling VAW patients from the PGH administration. If there is one, the interviewed medical practitioners were not aware of it. One surgeon, however, noted that there is a gender sensitivity training conducted for interns and residents upon their entry to PGH.

Socio-Cultural Factors Our study found an additional factor that affects health care providers in delivering compassionate health care to their patients: preconceived and preconditioned notions that oppress women, most especially the belief that women are inferior and that women victims of violence deserved the abuse. This factor stems from the view that healing should be holistic and a communal effort, and not just confined to a patient- physician relationship. Hence, people that VAW patients interact outside this relationship have an effect on their recovery and claim for justice. For example, Staff 1 reported that some VAW patients who have been referred to outside institutions, including the police or the prosecutor, were treated with insensitivity. In fact, the social workers shared that a patient of theirs was made fun of by the prosecutors; instead of nurturing the victim that PGH had served and protected, some people outside even rubbed more salt into the victim’s gaping wound.

Problems Encountered in Providing Compassionate Health Care The problems health care providers experience in delivering compassion to VAW victims may be categorized into two: organizational or structural and socio-cultural. Addressing these factors may be considered as reactive (for organizational or structural) and reactive-proactive (for socio-cultural). The primary 104 J. M. EMBATE ET AL. issues and challenges to the provision of compassionate health care to patients, including those of VAW cases, are brought about by organizational or structural factors—both at the level of PGH and the Philippine health care system. Among the organizational/structural problems that need to be addressed are the facilities or physical setup for Women’s Desk and its patients, budget, and efficiency of process. Paramedical and medical practitioners agree that the physical setup is an immediate need in providing health care to VAW victims. This consists of a larger Women’s Desk office space (as its current office is only about 2 × 2 meters in size), a proper storage area for rape kits, and a dedicated examination room, or possibly even a one-stop facility for VAW victims, especially for sexual assault cases. It is the dedicated examination room that can provide an immediate significant difference to the health care provided to VAW patients, as the current setup (i.e. treated in ER where any and every other hospital case is received) further abuses patients and even strips them of their dignity because even strangers can hear their stories. Related to this issue is the rather inefficient process of providing health care to victims of VAW. Currently, seeking and receiving treatment is quite a tedious process for the patient, partly due to the lack of a “one-stop facility”, but also due to the hospital’s discouraging and repetitive documentary requirements. More than these PGH-based problems, there is a need to make Philippine health care more responsive to the need for a dedicated hospital unit for women. It may be noted that the limited capacity of PGH as a fully operating Women’s Desk in the country is stretched even more as other hospitals that do not accommodate VAW cases send their patients to PGH. While health care practitioners may be considered to provide compassionate health care to VAW patients, it is the condition in the hospital (PGH) and the situation of the Philippine health care system that limit them. Furthermore, at the macro level, it may be argued that socio-cultural factors pose problems not only in the provision of compassionate health care to women, but also to the quality of their lives in general. It is argued that abuse happens and continues in part due to existing traditional views about the place of Filipino women in society. Beyond the actual abuse that a patient receives from the perpetrator, she may again be subjected to abuse by the same people involved in providing her assistance. THE KAPWA IN COMPASSION: EXAMINING COMPASSIONATE HEALTH CARE… 105

It may be argued then that the values and judgments of other members of society—from those in the legal system to law enforcement—may also be a means to void the compassionate health care already extended to VAW patients at PGH.

Conclusion and Recommendations The findings of the study showed health care services received by VAW patients at PGH include immediate medical treatment, counseling, documentation, social services, and what the researchers call “extra mile services.” The study affirms there is compassionate health care at PGH for VAW victims in the form of recognizing, relating, (re)acting, and empowering. Health care professionals also view compassion as Kapwa, Pakikiramdam, Kagandahang loob, Asal, virtue, and a dichotomy between call of duty and social responsibility. Factors that affect health care provider’s ability to deliver compassionate health care to VAW patients include clinical factors, patient factors, organizational/structural factors, and socio-cultural factors. While the expertise and knowledge of the health care practitioners at PGH are com- mendable, the health care system for VAW patients is plagued by issues and challenges that constrain health care providers’ ability to deliver compassionate health care. Compassion is one of the most important aspects in the treatment of victims of sexual and physical abuse, as their condition is characterized and must be addressed not only at the physiological but also at the psychological level. This is the reason why delivering compassionate health care is not simply a physician or patient concern; it is after all an organizational and more importantly a political and socio-cultural issue. We recommend the amendment of government policies and enhanced budget allocation to address the serious lack of facilities at the ER Compound, and transform the Women’s Desk into a one-stop facility, complete with a lawyer, psychiatrist, social worker, a surgeon, and an Ob-Gyn specialist on standby to conduct the interview and save the patient the humiliation of going all over PGH to narrate the details of her abuse over and over again. The DOH and the national government must also strive to protect the health and welfare of abused women so they may be empowered to take back their lives. This includes improving other private and public hospitals to help ease the patient congestion at PGH. After all, illness and healing are not sole concerns of a single person 106 J. M. EMBATE ET AL. nor is it exclusive between the patient and the doctor. As this study finds and asserts, healing is a social, cultural, and political concern. Additional training on compassion and proper treatment of VAW victims, such as those provided to social workers, will also go a long way in making medical practitioners more sensitive to the needs of physically and sexually abused women. While we do not necessarily dismiss the critique to the industrial production model of health care that is brought upon by the biomedical health system, the technological advancement it entails, and the political economy that made it possible (Stacey, 1988), we still believe that in the current system, improvement in facilities, equipment, and the overall institutional setup of the PGH’s Women’s Desk would also encompass improvement in the service it extends to those in need. Making the health care system more accommodating, efficient, and technologically advanced will not only enable more compassionate service, but will also entail a more holistic approach to healing, covering physical, mental, socio-cultural, and even spiritual domains that have long been present in many indigenous cultures. This study also argued and has found out that indigenous Filipino values, especially that of kapwa, have been at the core in the delivery of compassion among PGH health care providers. Sadly, these values are often limited by different factors. Future research endeavors might even take interest in confirming if the so-called industrialization of health care is partisan to the suffocation of these Filipino values in the health care setting. We believe extending compassionate health care is one clear step toward achieving gender equality. But it cannot be done by any single person. It takes a community—an entire institution—to deliver this kind of health care. If health workers are enabled by their very institution to be more compassionate and caring, we would not only change the lives we touch but also our world.

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http://www3.weforum.org/docs/GGGR16/WEF_Global_Gender_Gap_ Report_2016.pdf Way, D. & Tracy, S. (2012). Conceptualizing Compassion as Recognizing, Relating and (Re)acting: A Qualitative Study of Compassionate Communication at Hospice. Communication Monographs, 79(3), pp. 292–315. PART II

Contexts of Social Change Communication

Dazzelyn Baltazar Zapata

This part of the book explores contemporary examples of social change. All three chapters are related to the migration of primarily low income workers coming from the Philippines, a country which has among the highest number of migrant workers and has overseas labor as its number one ‘export product’. The first chapter of this part of the book titledMama, Home and Away: Philippine Cinema’s Discourse on the Feminization of Labor Migration by Arjay Arellano offers a take on communicating social change through popular media. He discusses domestic work overseas and how this influences the Philippines’ psyche. Arellano talks about how the Filipino diaspora has manifested its presence in the collective consciousness of the country’s psyche through its representation in the media. He examines the discourse on the feminization of labor migration in Philippine cinema. Popular films, Anak and Caregiver, presented the stories of mothers leaving their country and the effect of this modern-day exodus on their families. The film texts revealed a great ordeal experienced by Overseas Filipino Worker (OFW) mothers: a crisis in identity and worth. Such dilemma is resultant of the gender politics experienced by women both in the domestic (home) and economic (labor) spheres. Long-Distance Parenting: A Media Ecological Study on Values Communication Between Migrant Parents and Their Children in Paete, Laguna by Paoloregel Samonte delved into the dynamic interactions of communication technologies and communication practices of migrant parents and their left-behind children in the Philippines as they struggle to keep their families intact in the face of the socio-economic and cultural 110 Contexts of Social Change Communication realities of international migration. Specifically, the study sought to describe and interrogate how the communication of values, from the perspective of left-behind children, is shaped by the choice and use of various communication media in a transnational family setting. Pagpapakuwento (in-depth interviews) and pakikipagkwentuhan (local storytelling techniques) were employed in gathering the stories from the left-behind children. Migrant parents and their children mostly communicate via telephone, mobile phone, and video calls and subsume three values highly emphasized by migrant parents in communicating with their children: Love for the family; value for education; and love for the self. The quality of values communication between migrant parents and their children relied on their choice of medium. Telephone and mobile calls enable the presence of emotions and voice. Video calls enable real time surveillance, and allow for the presence of voice and facial expressions. The study calls for government institutions to craft policies for a more accessible mode of communication among migrant parents and their children. The last chapter, Harnessing the Potential of Communication for the Well-Being of Transnational Families by Rosel San Pascual, discusses the micro- and macro-level challenges of transnational separation of OFW parents and their left-behind children which consequently beget psychosocial distresses among transnational family members. San Pascual drew evidence from her interviews with Singapore-based Filipino mothers who left their children and family in the Philippines to pursue overseas work, as well as existing literature on Filipino transnational parents and families. She highlights the critical role of communication and argues how communication policy advocacy can play a major role in advocating for social justice related to facilitating a better life for transnational families. The listed advocacy objectives emphasize how communication may be harnessed at the micro- and macro-level for the well-being of transnational families. CHAPTER 6

Mama, Home and Away: Philippine Cinema’s Discourse on the Feminization of Labor Migration

Arjay Arellano

This chapter aims to focus on the issue of the feminization of labor migration in the country, particularly on overseas Filipino workers (OFWs)-mothers and their performance of motherhood. But I am specifically situating this discussion in the realm of the cinema, where, ever since the hanging of Flor Contemplacion, whose travails were made public through intense news reportage and media reenactments of her life story, OFW issues are significantly drummed into the collective consciousness of the country’s psyche, according to Lejano (2003). Film as a communication medium can be an effective form of social commentary particularly with the power of drama. As Francis Bacon noted, drama is a moving, effective means by which philosophical and moral principles could be set “before the eyes” of rich and poor, educated and uneducated alike (Simmons, 2008). I chose to textually analyze two popular Filipino drama films that tackle the plight of OFW mothers, Anak (2000) by Rory B. Quintos and Caregiver (2009) by Chito S. Roño, both films produced by Star Cinema,

A. Arellano (*) Adventist Development and Relief Agency (ADRA) International, Washington, DC, USA

© The Author(s) 2019 111 M. J. Dutta, D. B. Zapata (eds.), Communicating for Social Change, https://doi.org/10.1007/978-981-13-2005-7_6 112 A. ARELLANO to point out how the concept/performance of “mothering from a distance,” as phrased by sociologist Parreñas (2001), is imagined through cinematic representation. By focusing on the mutuality of form (film) and content (message), I intend to know how our social constructions of motherhood are articulated (defied or upheld) by these portrayals against a backdrop of ongoing labor migration. To give my inquiry a proper background, I am surveying first the history of women migration in the country. The persistence of globalization as a phenomenon in both economic and cultural terms has resulted in the increased movement of people within and across national borders, and cemented in our consciousness the term “migration” to refer to “individuals moving as part of their effort to improve their lives and the lives of their families, to learn new skills, to gain new experiences, to find a job or to flee insecurity, disaster or famine. Migration is an economic, social and political process that affects those who move, those who stay behind, and the places where they go.” Zlotnick (2003) notes that the entry of women into migration streams that had heretofore been primarily male has been one of the most significant trends in migration. About half of the migrants in the world today are women, approximately 95 million (International Labor Organization, 2005). This mobility of women has been noted to have significant impacts on the roles of both female and male migrants, the families left behind in the migration process, and the state of the source and destination communities and countries of migrants. In particular, migration of women within and from developing countries affects the development process itself for those countries. It also raises a number of challenges to immigration and refugee policies that address such issues as family reunification and formation, labor migration, trafficking and smuggling, and forced migration (Martin, 2003). Historically, migration was largely a male undertaking. The prevailing pattern of international migration was the lone, rugged male who left his family behind in the homeland as he ventured across seas to seek his for- tune, hoping to return to them after achieving success (Pessar and Mahler, 2003, p. 822). However, particularly in the last 30 years, Asis (2003) wrote that journeying in Asia has meant international labor migration, initially to the Gulf countries in the 1970s, and to the dragon economies in Asia from the 1980s, and men were not the only ones taking part in the diaspora: MAMA, HOME AND AWAY: PHILIPPINE CINEMA’S DISCOURSE… 113

In the 1970s, Filipino men began availing themselves of job opportunities in the Gulf countries. The slowing down of infrastructure projects, the second oil crisis in 1979, and the changing labor needs of the Gulf countries resulted in a lower demand for male workers and an emerging need for female workers to fill the demand for medical personnel, maintenance workers, and domestic workers. (Asis, 2003)

The Philippines was among the poorer countries where most female migrants have come from, along Indonesia and Sri Lanka for the past three decades (Reyes, 2009). The percentage of legally deployed female migrants in these countries is estimated at 60–80 percent every year. Legal migration from Indonesia and Sri Lanka is dominated by women who take up domestic work in Middle Eastern countries, with Malaysia, Singapore, Hong Kong, and Taiwan as other secondary destinations (Asis, 2003). In terms of interracial marriages in the Asia-Pacific Region, particularly Australia, “This group is dominated by women from the Philippines, although women also figure strongly amongst the recent migrants from Thailand. The Filipinos were one of the fastest-growing groups of the foreign-born in Australia throughout the 1980s and virtually two thirds of the entrants were women, or over 48,000 people by 1991” (Hugo, 2005). Overall, San Juan (2006) claims that Filipinos are “now the largest cohort in the Asian American group” and have become “the newest dia- sporic community in the whole world.” He estimates seven million Filipino migrant workers, mostly female domestic help, are working in the Middle East, Asia, Europe, North America, and elsewhere (San Juan, 2006). The Democratic Socialist Women of the Philippines (2008) pegs the number of Filipinos working abroad at 10 percent of the population or at present, about 9–10 million. What is more readily obvious however, is the amount of remittances that they collectively send annually. The Philippine Daily Inquirer (2008) reported that remittances coursed through banks were estimated to have reached $14.3 billion in 2007. For 2008, the Bangko Sentral ng Pilipinas expects a growth of 10 percent, which translates to $15.7 billion. For all its touted economic contributions, migration is not without its social costs. “About 3.5 cadavers of Overseas Filipinos (now an entry in the Wikipedia), or OFWs, land at the Manila International Airport—not as famous as Flor Contemplacion or Maricris Sioson, but scandalous enough to merit attention” (San Juan, 2006). In a report by GMANews.TV, top-notch psychiatrists of the country have pointed out that “the continuing 114 A. ARELLANO exodus of mothers for jobs overseas affect the behavioral development of children they leave behind… [and] that the feminization of labor migration where fathers take the role of mothers is causing a negative effect on children’s behavior.” Dr. Grace Macapagal, in-house psychiatrist of the Department of Social Welfare and Development (DSWD) for crisis intervention rehabilitation, said the trend is also causing a reversal of roles where fathers are left to care for children and are normally not prepared to do so. “I don’t think Filipino men are ready to evolve to that next phase,” she said, noting that based on her clinical exposure, there are more OFW children who experience sexual and physical abuse by their male relatives. In fact, the myopic view about the OFW phenomenon as simply an economic issue is already passé. The significant entry of women in labor migration have raised important questions regarding the plight of our women overseas workers, vis-à-vis the efficacy of our government’s policies and interventions, the state of the global labor market, and the security conditions in the receiving and settling countries. Asis (2003) lamented on the prospects and pains of the participation of women in migration:

The fact that women are migrating on their own rather than as part of family migration seems to suggest greater freedom and choice. However, their concentration in vulnerable sectors has generated much debate on how migration can have a positive impact on women’s lives. Both domestic work and entertainment are not covered by labor laws in many countries, hence women’s working and living conditions are very much dependent on the “charity” of their employers. In the case of entertainers, the dangers include being pushed into prostitution, violence, and run-ins with criminal elements. (Asis, 2003)

It is believed that with the continuing dependence of some countries of destination on foreign domestic workers, government policies to limit the hiring of domestic workers will fail to make a dent, according to studies. “Prospects of declining and aging populations in the advanced economies foreshadow continuing demand for migrants,” according to Asis (2003). She stresses that this demand for more foreign workers will include caregivers whose primary clients are the sick and elderly. But despite their contributions to their host countries, women migrants are not generally assured of basic protection. There are countries with rigid policies that do not allow women migrants to change employers even if their conditions are already far from satisfactory and life-threatening. MAMA, HOME AND AWAY: PHILIPPINE CINEMA’S DISCOURSE… 115

Nor can they move to a different job outside of domestic work. This is part of the efforts of some countries to ensure that migration is temporary (Rodriguez, 2005):

In some countries, there is a perception that migrant women childcare workers could have a negative cultural impact on their wards. This includes the concern that children could become closer to their nannies than they are to their own parents. At best, women migrants receive an ambivalent welcome. (Asis, 2003)

Sociologist Rhacel Parreñas stressed that there are other costs that are shouldered by families in the countries of origin, such as in the Philippines. She has noted that, as “servants of globalization,” women migrants, in turn, transfer their caregiving responsibilities to other female family members or other less-privileged women in the countries of origin. In the process, while migrant women contribute to making family life more comfortable and easier for their employers, they are separated from their own families, who have to fend for themselves.

OFW Mothers in the Films Anak and Caregiver The naturalizing effect of cinema cannot be disregarded in that what gets to be shown on screen can easily be interpreted as “naturally” occurring in real life. We know and interpret what we see in films as stories, the same kind of stories we know from everyday life. The filmic text then lends itself effectively in conveying complex messages that have socio-cultural reso- nance (Lejano, 2003). Majority of films about the OFW experience are in the narrative cinema form. Narrative cinema refers to the strategies of codes and conventions (including mise en scene and lighting) employed to organize a story. Primarily narrative cinema is one that uses these strategies as a means of producing the “real world,” one that the spectator can either identify with or consider to be within the realm of possibility (Hayward, 1996). Moving images effectively employ sign systems that communicate non-verbally where signs are used to stand for experiential knowledge as well as ideas (Lejano, 2003). The popularity of the OFW as a subject in film portrayals is evident in the past decade. Following the commercial successes of “based-on-true- to-life” movies such The Flor Contemplacion Story and The Sarah Balabagan 116 A. ARELLANO

Story, there have been quite a number of movies with direct or indirect portrayal of the overseas workers. What is noticeable, too, is the “female face” of these representations, or the trend of using storylines about female protagonists and the constant use of melodrama. Some of these notable films areAmerican Adobo, Dubai, Milan, I.T.A.L.Y, Homecoming, and Emir. In 2000, Star Cinema released Anak in theaters, and it was a huge hit. It was top billed by Vilma Santos (Josie) and Claudine Barretto (Carla) and was directed by Rory B. Quintos, with screenplay by Ricardo Lee and Raymond Lee. The story revolves around Josie, one of the many residents of the archipelago, who is forced to leave her family and take a higher paying job in Hong Kong, a more prosperous Asian country. Like the plight of other maltreated domestic helpers, her employers refuse to let her take a vacation, nor do they deliver her mail to her. She is unaware, therefore, that her husband has died. When she finally returns to the Philippines she is met with resentment and hatred by her children, more particularly her eldest daughter. The movie focuses on how she overcomes these feelings and rebuilds the relationship with her family (IMDB, 2000). Meanwhile, Caregiver was a huge commercial OFW movie released in theaters in 2009, starring Sharon Cuneta (Sarah) and John Estrada (Teddy). Chito S. Roño directed it, and Chris Martinez wrote the screenplay. Sarah is a mother who left her son in the Philippines and also a teacher who relinquished her profession in lieu of caregiving in London, in hopes of augmenting her salary. More than just a chronicle of the Filipino experience working as nurses and caregivers in the UK, this story also charts Sarah’s journey to self-discovery—from a submissive wife who makes sacrifices to make way for her husband’s aspirations to an empowered woman who finds dignity and pride in a humbling job as a caregiver in London (Wikipedia, 2008). I am focusing my analysis on the representation of the characters of Josie and Sarah as OFW mothers. First, I recognize that it is vital to read them as three-tiered texts—them being women, (absentee) mothers, and exported laborers—within the context of our social constructions of gender and the ongoing labor migration. I situated my inquiry in the three stages of their migration experience: their departure, integration in their countries of destination, and finally, homecoming. My aim is to critique the effectiveness of these films as forms of social commentary on the issue of feminization of the OFW phenomenon in the country, and how this reshapes the performance of motherhood amidst economic and gender factors. MAMA, HOME AND AWAY: PHILIPPINE CINEMA’S DISCOURSE… 117

Departure Blues Before the OFW phenomenon came to impact the gender roles of men and women in the country, Filipina mothers were traditionally confined in the homes. Some of their main functions are attending to the children, housekeeping, and at best, performing the position of “pursekeeping,” which Alvarez and Alvarez (in Aguilar, 1989) sanctify by saying, “Proverbially, the person who holds the purse strings rules the house. In the Philippines, it is the woman who does so and who therefore runs the home as in matriarchal societies” (p. 534). But given the sparse employment opportunities in the Philippines, most mothers are convinced to leave their families behind and join the growing number of overseas workers. In this sense, they challenge “pursekeeping” as a sign of matriarchy in Filipinos’ family; for indeed, what good is a purse, as Aguilar (1989) implies, if it does not have money in it? The very first essential question that I ask in my analysis of the films is what convinced Josie and Sarah to leave their homes and work abroad? At a first glance, economics indeed proved to be their primary motivation. Josie’s husband had no job, she had no income as well, and they had three children to feed, while Sarah, despite earning a living as an elementary teacher and having a husband who, himself, was an OFW, felt she could augment her income by becoming a caregiver. Poverty as a “push” factor is widely resonated by millions of other Filipinos who leave the country in the hope of finding greener pastures abroad. Though the government is not direct in pronouncing the OFW phenomenon as a policy in poverty reduction, it cannot be denied that working overseas has been the solution for many poor families in the country. As the International Organization for Migration explains: “Migration is an important livelihood strategy for poor groups across the world and not just a response to shocks” (2005). However, it helps not to simply rest our reason on pure economics to understand why women, especially mothers, are forced to leave their families to take jobs abroad. Our social constructions of gendered domestic roles also interplay with economic factors. First, I looked at how our society constructs the husband and wife/father and mother gendered division of labor. Wives and mothers are traditionally relegated to the domestic sphere where they are burdened with the responsibility of “looking after” the family, while husbands and fathers are conventionally assigned with the breadwinning role. The woman of the house is expected to ensure that 118 A. ARELLANO the children are healthy, the house is clean and organized, and that the family eats good food. If she fails to seamlessly perform these roles, the husband can easily call her an irresponsible wife and mother. In our iniq- uitous patriarchal society, the norm is that it takes a man to measure a woman’s worth. But what happens when the father/husband is not a good provider? In Josie’s situation, her husband initially went to Taiwan as an OFW. But after only four months he returned home because he could not overcome his longing for his family. He was a loving father, but it proved he could not reconcile his emotional vulnerability with his breadwinning duties. Consequentially, the family ended up selling their possessions just so they could meet their bare necessities. Josie’s husband found work at a construction site, but it was really not enough to improve the family’s financial condition, and hence she had to leave for Hong Kong to work as a domestic helper. Meanwhile, in Sarah’s case, her husband was already an OFW in London working as a “nurse,” or so she was told. Unlike Josie, she had a decent job as an elementary teacher prior to being a caregiver in London, and, in fact, was a candidate for promotion in her department. With just one child to raise, and given the fact that they both had stable sources of income, there was really no pressing need for Sarah to be a caregiver. Though she was convinced she could have a better income abroad, it was entirely her husband’s idea for her to resign from her job and join him there. As the typecast of a dutiful wife, she obeyed and honored her husband’s decision. It would soon be revealed that her husband was actually having a hard time being alone, especially that he was experiencing his own troubles at work, and he needed Sarah’s presence and support. In both cases, their decisions to become OFWs were not solely based on economic reasons but were also resultant of the power asymmetry in their respective husband-wife relationship. I observed that Josie and Sarah, as women of the household and the society in general, suffered a two-fold kind of subordination. One is relational subordination in which wives are constrained to surrender to their husbands in order to become honorable women. And the other is economic subordination in which women are treated outsiders of the production sphere and therefore are conditioned to be dependent on the breadwinning capabilities of men. The lack of agency in these women was indeed evident in that Josie only opted to leave because her husband was incapable and unwilling to go the distance of providing for the family, and Sarah abandoned her personal MAMA, HOME AND AWAY: PHILIPPINE CINEMA’S DISCOURSE… 119 career growth in the Philippines mainly because she wanted to support her husband’s dream for the family to relocate to London. These women denied themselves their own will to choose their lives, and consented instead to their husbands’ action/inaction. They resonated the social construction of women as male property, which makes it impossible for many women to disentangle their individual rights from the needs and demands of their families (Bennet and Manderson, 2003). Now shifting my attention to Josie’s and Sarah’s husbands, I also observed that the rigid imposition of the breadwinning role on men can prove to be delimiting. To say that men are essentially built as providers is already evoking a myth. I say it is delimiting because, obviously as in the case of the two husbands, not all men can withstand being away from their families, as opposed to the traditional representation of men in, for instance, war movies depicting strong, unemotional cavaliers leaving their homes to defend their country. Because men are not trained to express their emotions, both husbands fail to address their longings and reconcile them with their breadwinning duties. As a result, Josie and Sarah suffered from the emotional insecurities of their husbands. But instead of correcting their men, they stood as the typecast of supportive wives created by patriarchal imaginations. Sociologist Randy David (2002) explains that most Filipino women “negotiate” the terms of their subjugation within the family.

They realize that the world in unfair: it has conferred upon men the right to be the rulers of their families. But even when their husbands show themselves to be unfit to rule, they somehow feel obliged to maintain the fiction of their men’s supremacy, while they take on the daily functions of providing for, managing, and keeping the family together. (p.83)

David cites a study by the Woman Health Philippines, which revealed that women actually manage to “strategically accommodate traditional practices or expectations they find demeaning in order to secure reproductive, familial, or economic needs” (2002, p. 84). And the value premise for Filipino women, according to the study, is always the welfare of the children. Further in my analysis, I noticed that the OFW phenomenon has caught women such as Josie and Sarah in emotional and psychological labyrinths wherein they had to deal with contradicting but equally destructive feelings of shame and guilt in their psyche: shame, if they allow poverty to continue creeping in, and guilt, if they choose to abandon their children in search for work opportunities abroad. 120 A. ARELLANO

Indeed, women go through painful coming to terms with becoming absentee-mothers and migrant workers. Abandoning their children and loved ones may have meant, on one end, economic emancipation, but overall, the OFW journey is a great emotional ordeal for them. In several scenes, Josie and Sarah engaged in sentimental rituals of goodbye representing the ways through which they purge their guilt. In a defining moment (see Fig. 6.1), Sarah took her son to a flea market to buy herself a coat for the cold. She took it as an opportunity to explain to the child their family’s predicament and tell him about their future plans. She promised to come back for her son and take him to London to be ultimately reunited with her. Then she bought him a large winter coat as a symbol of her covenant with the child. In between sobs she told him, “I want you to wear it when I come back to get you.” Meanwhile, Josie had a very emotional parting moment with her family, too. At the airport, she painfully bid goodbye to her sobbing children. It would be the first time in a series of goodbyes (as she would be returning to Hong Kong a few more times as a domestic helper). She tells her eldest daughter, Carla, to write her letters all the time, but only those bearing good news. This was her way of purging her guilt for abandoning them. The letters would symbolically represent their good ties as mother and daughter (Fig. 6.2).

Fig. 6.1 Sarah leaves a covenant with her son, assuring him that she will return to get him and be ultimately reunited in London MAMA, HOME AND AWAY: PHILIPPINE CINEMA’S DISCOURSE… 121

Fig. 6.2 Josie bids farewell to her family; this will only be the first of more airport goodbyes

The nostalgia that these mothers had to bear is easily dismissed as a reflection of the “innate” sentimentality in women, and such strong show of emotions is unfairly equated with vulnerability and weakness. But it should be understood that whenever mothers leave their homes, they battle with the thought of being physically and emotionally away from their families mainly because of the deep level of attachment women are able to establish with their children from being traditionally confined in the homes.

Mothers from a Distance The second part of my analysis looks at how Josie and Sarah perform their mothering duties while far from their children. Parreñas (2001) notes that

Everyday Filipina domestic workers… are overwhelmed by feelings of helplessness: they are trapped in the painful contradiction of feeling from a distance from their families and having to depend on the material benefits of their separation. They may long to reunite with their children but cannot, because they need their earnings to sustain their families. (p. 371) 122 A. ARELLANO

These findings by Parreñas from a study she conducted with OFW mothers in Los Angeles, California and Rome, Italy were resonated in the cases of Josie and Sarah. Longing for their children was a central emotional strain in the portrayal of these characters. Parreñas (2001) cited three ways through which mothers negotiate these emotional strains: the commodification of love; the repression of emotional strains; and the rationalization of distance, that is, they use regulation communication to ease distance (p.371). How were these coping mechanisms articulated in the movies? First, the commodification of love is indeed evident in the efforts of both mothers to send material gifts to their children when possible. In the following scene, Josie was cuddling a stuffed toy that she planned on sending to her youngest daughter. When asked by her friends why she had not sent it, she said she wanted it to stay in her arms for one more week, hoping the toy could transfer the warmth of her embrace to her child and make her daughter realize how greatly her mother longed for her (Fig. 6.3). But I would like to point out that, in Josie’s case, she did not have that much financial freedom to substitute her love for her children with toys and gadgets. In general, she had a hard time compensating her absence

Fig. 6.3 Josie can’t give up hugging a stuffed toy, imagining the warmth of her daughter’s embrace MAMA, HOME AND AWAY: PHILIPPINE CINEMA’S DISCOURSE… 123 with material gifts for her children. Being a domestic helper with a low salary, she could not afford to regularly shower her children with gifts as she wished. In fact, in the movie, it was only when she came back home that she was able to bring plenty of “pasalubongs.” Unlike Josie, Sarah, whose earnings are considerably higher than Josie’s, can ensure her son receives some material compensations. But the reality is that not all OFWs earn big. Unfortunately for those low-paid jobs like domestic work, mothers are unable to compensate for their absence through material benefits. This proves that commodifying love as a coping mechanism is largely dependent on economic rewards, which not all OFW mothers experience equitably. Another coping mechanism that is widely resorted to by OFW mothers, notes Parreñas (2001), is the repression of emotional strains. Both Josie and Sarah manifested this in several occasions, but one major way is by channeling their longing and love to the people they were assigned to take care. Josie earnestly attended to her “alaga” and even cooked her special Filipino dish for the child. Despite receiving maltreatment from her employers, she continued to pour her love on the young boy as if he were her own (Fig. 6.4). Sarah, meanwhile, was an indefatigable and hardworking caregiver. Even when her patient, Mr. Morgan, was always grumpy and unapprecia- tive of her, she continued to be loyal to her duties. Eventually she won the admiration of her patient’s family because of the unwavering devotion she had been showing to their old man. She was even invited by Mr. Morgan’s son to accompany his father on his return to their huge estate and spend the weekend with the family (Fig. 6.5). Sarah also found herself sincerely concerned about the condition of a young Filipino boy she encountered stealing at a grocery store. Though, at first, he was rude and insolent toward her, she knew the child was experiencing trouble at home. She succeeded in winning the boy’s approval who later on became Sarah’s youngest confidant. It was through the young boy that she tried to share her mothering instincts. Finally, the third coping mechanism that Parreñas (2001) observes is the rationalization of distance through technological management of distance. Again, like commodifying love, this is not experienced equitably by all OFW mothers. In Josie’s case, she does not have enough savings to regularly phone home. In one particular scene, Josie snuck into her employer’s bedroom to use the phone and call home. It was Carla’s birthday and she wanted to greet her and make her feel special since she was not 124 A. ARELLANO

Fig. 6.4 Josie tends to the needs of her employer’s child like a real responsible mother

Fig. 6.5 Sarah becomes Mr. Morgan’s trusted aide and a good friend whom he can share life stories with MAMA, HOME AND AWAY: PHILIPPINE CINEMA’S DISCOURSE… 125 able to send enough money to give her daughter a celebration. But before she could even speak to her daughter, her employers arrived and she had to promptly put the phone down. This left both mother and daughter very disappointed (Fig. 6.6). Sarah, on the other hand, proved to be more fortunate than Josie because she could afford to maximize the use of communication in bridg- ing the distance between herself and her son. She was even given a raise for her excellent performance, which meant more financial capabilities to maintain long-distance communication (Fig. 6.7). What is common in both cases is that, despite being in two very different societies and working conditions, Josie and Sarah managed to gain strong emotional support from other OFW women. Josie was able to establish loyal friendship with Bing and Mercy, fellow domestic helpers in Hong Kong whose struggles as wives and mother are not different from hers. They came to each other’s rescue and looked after each other even when they settled back in the Philippines. Sarah, on the other hand, got her encouragement from Filipina coworkers at the nursing home. She discussed her worries with them and they helped her deal with cultural discrimination they received from British workers.

Fig. 6.6 Josie is in a hurry to speak to her daughter, but she would be unsuccessful with the arrival of her employers 126 A. ARELLANO

Fig. 6.7 Sarah expresses how much she misses her son by regularly calling home

However, despite their commonalities in having experienced the emotional ordeals of being absentee-mothers, Josie and Sarah represent two different cases of OFW women, whose powers to overcome their condition were greatly shaped and constrained by the nature of their jobs as well as the kind of society they had settled in. Josie represents the plight of the unfortunate domestic helpers who are marginalized by an industrialized modern society like Hong Kong that looks down on Filipina women as domestic helpers. She represents the uneducated women of the country whose only escape from poverty is to become modern-day slaves. Unfortunately for these women, they do not have the self-esteem or courage to stand up against their oppressive employers and claim their rights as women. They would bear all insults and maltreatment just so they could send money back home to feed their children. On the other hand, Sarah represents the intellectual women who, despite their good education, become disillusioned with the country’s elusive progress and instead try on lowly but high-paying jobs such as caregiving in progressive societies like London. She constitutes the continuing exodus of Filipino professionals who could not stand the sparseness of jobs here and the inadequacy of the government policies to address the situation. But overall, Josie and Sarah are positive portrayals of the Filipina workers manifesting hard work, dedication, and integrity, which are counter representations to the Western image of our women as sex workers, entertainers, and gold-diggers who only marry for money. MAMA, HOME AND AWAY: PHILIPPINE CINEMA’S DISCOURSE… 127

Welcome Home? At the end of every OFW mother’s journey is the challenge of reuniting with her loved ones and reclaiming her space in the family. Unfortunately, some OFW women return home as victims of abuses by their male employers while others cope with massive depression, and of course there are those who end up in caskets whose death causes remain mysterious—15 of which remain unsolved since 2002 according to Migrante International (San Juan, 2006). Asis (2003) notes that when “journeying was traditionally a masculine preserve, a returning [male] could expect not only a warm welcome but also an esteemed place in the community, as the completion of a journey gave them a badge of honor.” But for Josie and Sarah, there is no similar homage. They were instead confronted by a greater emotional ordeal, and that was how to build their family anew and regain the love and respect of their children. Such is very evident in Josie’s case, whose return home was greeted by animosity from her eldest daughter, Carla. She felt that Josie had been selfish for leaving them as they were growing up. Her mother’s periodic and brief homecomings gave her an impression that Josie was no longer prioritizing them and was just engrossed with earning a living. It did not help that they were receiving material gifts from mom, which came but very seldom due to Josie’s condition in Hong Kong. Carla’s resentment toward their mother was furthered when the latter failed to come home for the wake and burial of their father. She thought her mom was simply not exerting effort to return and face the situation. The truth, of course, would reveal that Josie was not aware of her husband’s death mainly because her employers locked her away, and it was too late when she received the letter from home. While Josie was away assuming the role of the provider, her husband was doing the domestic care work for their children before he met an untimely death. This reversal of roles, however, did not receive equitable appreciation from their children. Josie was viewed as a selfish absentee- mother, while her husband was treated with unabated love and respect by her children. Despite her own sacrifices, and no matter how hardworking and selfless she had proven to be in assuming the role of the provider, she is still undervalued as a member of the family. Perhaps this is because the society has put a premium on mothering as the main role of a woman through which we measure her worth, and her absence in the family for 128 A. ARELLANO years had taken its toll on the kind of maternal expectations our patriarchal society demands from her. The social construction on women as properties of the home has apparently blinded Josie’s children from seeing the wider picture of her juggling her responsibilities as an absentee-mother, provider, and exported laborer. But there is more to the travails of a returning OFW mother than just coping with the emotional estrangement of her children. Josie also had to face the awful realities of their financial condition. Being the only provider for the family, she had to make do with her two years’ worth of earnings to provide the basic needs of the family and pay their household bills and her children’s tuition. But one major problem surfaced when Josie found out that her son, who used to be an academic scholar, failed to maintain his scholastic standing and was disqualified from the scholarship. Now she had to pay the full tuition. In the hope of augmenting her remaining savings she invested a huge sum of it in a taxi business together with her two fellow OFW returnees and close friends. But the venture would eventually fail due to mismanagement. Josie’s return home was supposedly for good, but as poverty seeped back in, it became clear to Josie that she had to return to Hong Kong and find work again. At that point, Josie found herself once again at a crossroad where she was confronted by a crisis of roles: as a provider in the absence of her husband and as a mother who yearns to stay and make up for the years lost. In Sarah’s case, meanwhile, homecoming was more of an issue of finding her “real” home, and eventually her self than just going back to her old domestic life in the Philippines. Unlike Josie, Sarah had a better option: she could leave her husband, take their son with her, and build a new life in London. Her decision apparently surprised and disappointed her husband. Sarah’s character started as a patriarchal fantasy: she was understanding of and dutiful to her husband. Despite her own faculties—a good education, decent profession, and strong emotional support from her sisters and relatives—she did not have a mind of her own and was merely submitting to her man’s desires. But while in London, she realized she was discovering a new self: a smart, hardworking, and economically empowered woman against a deteriorating husband, who was struggling to maintain himself as an authoritative and productive man. Her transformation in the end as an independent wife and mother became a counter representation to her old self, which, for years had been defined by her husband. This liberation of the self from patriarchal expectations was in itself a homecoming. MAMA, HOME AND AWAY: PHILIPPINE CINEMA’S DISCOURSE… 129

Mothers in Crisis In conclusion, the characters of Josie and Sarah as filmic texts surfaced a great ordeal experienced by OFW mothers: a crisis in identity and worth. Such dilemma is resultant of the gender politics experienced by women both in the domestic (home) and economic (labor) spheres. The crisis in identity begins when mothers assume the breadwinning role that is traditionally a male’s as poverty affects the family. Mothers’ entry in labor migration may have challenged the traditional roles of women—from merely being household properties to becoming active participants in economic production—but this does not mean that they are being liberated from the patriarchal expectations of motherhood. They end up negotiating their identities by wearing three hats as women, migrant workers and mothers. But it will prove in the end that they cannot serve multiple masters at the same time; they would fail as mothers in the eyes of their children. Consequentially they suffer a crisis of worth because even though they sacrificially toil overseas to provide for their family, as well as significantly contribute to the economic well-being of the country, their capabilities are still restricted to low-paid household-related work such as housekeeping and caregiving. Compared to men who receive higher pay due to the kind of work assigned to them, women’s breadwinning efforts are largely undervalued.

References Aguilar, D. (1989) “The Social Construction of the Filipino Woman”, International Journal of Intercultural Relations, Vol. 13, pp. 527–551. Asis, M. (2003) “Asian Women Migrants: Going the Distance, But Not Far Enough”, retrieved from http://www.migrationinformation.org/feature/display.cfm?ID=103 on March 12, 2011. Bennett, L. and Manderson, L. (2003) “Introduction: Gender Inequality and Technologies of Violence”, in Manderson L. and Benett L. (eds) Violence Against Women in Asian Societies, London, Routledge Curzon, pp. 1–13. Commission on Filipinos Overseas (2009) “Number of Registered Filipino Emigrants By Sex: 1981–2009”, retrieved from http://www.cfo.gov.ph/pdf/ statistics/BY_SEX.pdf on March 10, 2011. David, R. (2002) “Terms of Survival”, in David R. (ed) Nation, Self and Citizenship: An Invitation to Philippine Sociology, UP Press, pp. 82–84. 130 A. ARELLANO

Democratic Socialist Women of the Philippines (2008) “Women and migration: Trends and Implications on the Filipino Youth”, retrieved from http://www. dswp.org.ph/index2.php?option=com_content&do_pdf=1&id=59 on March 12, 2011. Hugo, G. (2005) “Migration in the Asia-Pacific Region”, Global Commission on International Migration, retrieved from http://www.gcim.org/mm/File/ Regional%20Study%202.pdf on March 11. 2011. Hayward, S. (1996) Key Concepts in Cinema Studies, London: Routledge. International Labor Organization (2005) International Labour Organization, Preventing Discrimination, Exploitation and Abuse of Women Migrant Workers, Information Guide, Gender Promotion Programme, retrieved from http://www.migrationdrc.org/publications/other_publications/Moving_ Out_of_Poverty.pdf. International Organization for Migration (2005) “Gender and Migration Fact Sheet” retrieved from http://www.iom.int/jahia/webdav/site/myjahiasite/ shared/shared/mainsite/published_docs/brochures_and_info_sheets/gen- der_factsheet_en.pdf on March 2, 2011. IMDB (2000) “Anak” retrieved from http://www.imdb.com/title/tt0246425/ on March 9, 2011. Lejano, E. (2003) “(Un)packing the Balikbayan Box: Images of the Returnee in Three Contemporary Filipino Movies”, Masteral Dissertation, UP College of Mass Communication. Pessar, P. and Mahler, S. (2003) “Transnational Migration: Bringing Gender in”, International Migration Review, Vol. 37, No. 3, pp. 812–846. Martin, S. (2003) “Women and Migration”, paper presented at the United Nations Division for the Advancement of Women (DAW) Consultative Meeting on “Migration and Mobility and how this movement affects Women”, Malmö, Sweden 2 to 4 December 2003 retrieved from http://www.un.org/womenwatch/daw/meetings/consult/CM-Dec03-WP1.pdf on March 12, 2011. Parreñas, R. (2001) “Mothering from a Distance: Emotions, Gender, and Intergenerational Relations in Filipino Transnational Families”, Feminist Studies, Vol. 27, No. 2, pp. 361–90, and Servants of Globalization: Women, Migration and Domestic Work. Stanford, CA: Stanford University Press. Reyes, M. (2009) “Migration and Filipino Children Left-Behind: A Literature Review”, Miriam College Women and Gender Institute (WAGI) for the United Nations Children’s Fund (UNICEF), retrieved from http://www.unicef.org/ philippines/Synthesis_StudyJuly12008.pdf on March 2, 2011. Rodriguez, R. (2005) “Domestic Insecurities: Female Migration from the Philippines, Development and National Subject-Status”, Working Paper 114, Center for Comparative Immigration Studies, University of California, San Diego. MAMA, HOME AND AWAY: PHILIPPINE CINEMA’S DISCOURSE… 131

San Juan, E. (2006) “Trajectories of the Filipino Diaspora”, retrieved from http:// philcsc.wordpress.com/globalization-and-the-emergent-filipino-diaspora/ on March 12, 2011. Simmon, R. (2008) “The Power and Drama of A Good PlayRead more: http:// www.articlesbase.com/writing-articles/the-power-and-drama-of-a-good- play-4389829.html#ixzz1Gkz5LvI3 Wikipedia (2008). “Caregiver” retrieved from http://en.wikipedia.org/wiki/ Caregiver_%28film%29 on March 1, 2011. Zlotnick, H. (2003) “Global Dimensions of Female Migration” retrieved from http://www.un.org/womenwatch/daw/meetings/consult/ CM-Dec03-WP1.pdf on March 4, 2011. CHAPTER 7

“Long-Distance Parenting”: A Media Ecological Study on Values Communication Between Migrant Parents and Their Children in Paete, Laguna

Paoloregel Samonte

When I was young, my teachers used to tell me I was a bright boy. I would fascinate my classmates and friends with knowledge fit for people above my age, and the elders watching us would be in awe. I told good stories, and they all seemed pretty impressed. The stories were not really mine, though. They were my dad’s. I and my brothers and sisters used to sit on the stairs, always two steps below him, and hear him tell stories and lessons of science, fiction, and great humor, among others. He would go on all afternoon—from Biblical stories to the truth behind Cleopatra and Alexander, from Nostradamus and his famous prophesies to tricky mathematical questions, down to values and life lessons. I remember I was very fond of his stories; it was like getting lost in the world. Then I would take all these stories up like a sponge soaked in water, and I would remember.

P. Samonte (*) United Nations University Institute for the Advanced Study of Sustainability (UNU-IAS), Tokyo, Japan

It is through this that I learned. It is through these simple stories that my young mind was honed, that my values were formed, that my life was guided. After all, I was quite a bright child. All I needed was someone to lead me. Ironically, my dad was seldom home. He worked as a seaman, and was abroad 10 months in a year. We were very lucky to have him. But sometimes I wondered how much different it would have been if he had been there all along as we grew up. This got me thinking how communication within the family inevitably affects the development of an individual.

ICTs and Transnational Families I have always been fascinated with the idea of family. This may be attributed to the fact that my family is very close to my heart. Growing up, I was raised to believe that the family is the most important set of people in anyone’s life. Placed in the context of the Filipino culture, the family becomes even more relevant and influential. Jocano 1998( , p. 11) supported this statement by asserting that close family ties is a unique feature of the typical Filipino family. This is common since the majority of Filipino families follow the extended family structure, wherein the children still live with their parents even after marriage. However, the Filipino family is put to many challenges in these changing times. These socio-economic and political challenges are a threat to Filipino values, particularly the close family ties. Parreñas (2005, p. 317) asserted that many families around the world, including in the Philippines, are continually facing relationship strains. Because of the Overseas Filipino Workers (OFW) phenomenon, many children are growing up without the care and guidance of their parents (Parreñas, 2005, p. 317). The worsening case of poverty and inequality in the country motivated many Filipinos to go and find their luck abroad. For many years, the Philippines has been among the top countries of origin of migrants around the world. There are an estimated five million OFWs today; many of them are located in the Middle East and the United States, while a significant number can also be found in some European cities and Asian countries including London, Milan, Singapore, and Hong Kong. Overall, there are an estimated 7.38 million overseas Filipinos around the world (International Organization for Migration, 2013, p. 52). “LONG-DISTANCE PARENTING”: A MEDIA ECOLOGICAL STUDY ON VALUES… 135

Migration in the Philippines, in fact, is such a prevalent reality that more than a million citizens migrate every year to work or reside abroad (Philippine Overseas Employment Administration, 2008, p. 1). According to Mangahas (2004, p. 1), amid growing concerns about the social costs of this diaspora, the Philippine government promotes overseas employment as one of the primary means of keeping the national economy afloat. So inescapable is Filipino migration that almost every Filipino in the Philippines has a loved one living abroad. A national survey conducted by the independent research group Social Weather Stations revealed that 52 percent of Filipino families have relatives located in various countries (Mangahas, 2004, p. 1). Family ties between Filipino migrant parents and their children are maintained over great distances through, among other tools, the Internet and the cell phone (Parreñas, 2005, p. 330). In other words, Filipinos anywhere in the world keep in touch through new Information and Communication Technologies (ICTs). Because of this, most of the relationships of the migrant Filipino families nowadays are shaped by technology. This is what Filipino anthropologist Raul Pertierra described in his paper “Mobile Phones, Identity, and Discursive Intimacy” (2005) as “absent presence”—being there yet not really there (p. 24). This concept argues that ICTs do not only connect but mediate and shape relationships. Pertierra (2005, p. 26) further argues that through the use of ICTs, Filipinos living overseas can now enjoy an “absent presence” in their homes. The notion of “absent presence” implies a new form of relationship in the evolving context of Filipino families. To compensate for the lack of physical presence and emotional warmth provided by the parents to their children, families with one or both parents abroad, or what could be termed as transnational families, utilize ICTs to bridge the distance (Mangahas, 2004, p. 1). Along with this dependence on technology comes a concern for the quality of such relationships. According to Aguila (2011), “the continuous and fast-paced evolution of ICTs has redefined the concept of self, human relationships, and the community. These changes are apparent in modern Filipino relationships which are unavoid- ably affected by the use of communication technology,” (p.84). Such is the case of OFWs and their children. The use of ICTs among families with migrant members, hence, shapes their overall experience of migration. In the assumption that migrant parents continuously attempt to communicate with their children at home, 136 P. SAMONTE

ICTs become an important parcel of the whole diaspora phenomenon (Hamel, 2009, p. 9). As so concisely put by Marshall McLuhan (1964, p. 7) in his famous quote, “the medium is the message,” the communication channel used has inevitably come to shape the relationship formed between the children and the migrants abroad. Therefore, studying and understanding the media used by the migrant parents and their children to keep connected becomes a necessitous aspect of migration and communication research.

Situating the Family in Development Communication Research Communication as an integral part of family life is an area of scholarship that can be further developed within the development communication discourse. The concept of family is so rich and important in the Philippine context that it is quite alarming how little of it is studied in the field of development communication. Going through previous development communication studies, it is very seldom, if not at all, that the link between family and communication is discussed as a vital aspect of development. The family, being the basic unit of community, can affect the overall growth and progress of a nation. Communities whose families, as an individual unit, are enjoying a happy and close relationship are more likely to succeed socio-economically than a community with broken families. According to Alesina and Giuliano (2007, p. 5), it was found out that strong family ties are correlated positively with happiness and self-esteem. Moreover, according to a study conducted by Fleischer (2002, p. 78), children who spend most of their growing years in an intact family structure generally receive more and better guidance and attention. This protects them from engaging in socially unwanted and negative behaviors, such as smoking, drug use, drinking, or engaging in commercial or premarital sex, thus having better chances to succeed in life (Fleischer, 2002, p. 78). Aiming to introduce family relationships and mediated communication in the development communication discourse, and filling the research gap about children of migrants and their experience of migration, this study looks at how values communication occurs between migrant parents and their children via telephone, mobile, and video calls in Paete, Laguna. This answers the strong recommendations of past researchers on the need to use more qualitative methods—such as life histories, in-depth interviews, “LONG-DISTANCE PARENTING”: A MEDIA ECOLOGICAL STUDY ON VALUES… 137 and focus group discussions—on studying family and migration (Aguila, 2011, p. 84). There have likewise been changes as to how families with migrant members communicate with each other throughout the years, which is tied with the changing ICTs. This study is an attempt to look at these changes closely through a case study involving five children of migrants. Overall, this study is an attempt to understand the interrelation between migration, family relationships, and ICTs viewed in a development communication perspective.

Understanding Long-Distance Parenting My research interest started with the idea that communication within the family is an important and viable aspect of communication for social change. Realizing the plausibility of this argument, I began focusing on migration and the role of ICTs in family communication due mainly to my experiences as a child of a migrant, and the belief that the changing nature of communication media invariably affects relationships within transnational families. As my research inquiry progressed, and as my literature review about ICTs and migration deepened, I was able to define the scope of my study. I began focusing on a specific message, which is values communication, shared in a specific locale, which is Paete, Laguna. In this study, the word “values” is defined as “a person’s principles or standards of behavior; one’s judgment of what is important in life” (Merriam Webster, n.d.). The choice of topic and locale has something to do with my personal orientation as a Paeteño and the town’s increasing OFW population. With Marshall McLuhan’s media ecology as a guide, my study sought to better understand how migrant parents communicate values to their children in my hometown Paete, Laguna province in the Philippines, through the use of various information and communication technologies (ICTs). According to Scolari (2012, p. 206), media ecology tries to “find out what roles media force us to play, how media structure what we are seeing or thinking, and why media make us feel and act as we do.” It is in this context that Postman (1970, as cited by Scolari, 2012, p. 206) affirmed that media ecology is “the study of media as environments.” Specifically, the study (1) described how migrant parents and their children in Paete, Laguna in the Philippines choose a medium through which to communicate; (2) identified the most significant values communicated 138 P. SAMONTE by these migrant parents to their children; and (3) described how the communication of values by migrant parents to their children is shaped by their use of various ICTs. According to Camacho (2006, p. 11), children of migrants are found at the periphery of interest of migration researchers. Hence, this study hoped to contribute to a better understanding of the impact of migration on children of migrants, as well as the importance of family- mediated communication as a timely research area in the field of communication for social change. Accordingly, various institutions dealing with social welfare issues will find this research beneficial in understanding juvenile delinquency brought about by parental migration. The understanding of the effects of migration on children and the role of ICTs in migration would help government institutions craft policies for welfare protection of children of migrants, as well as form provisions that would institutionalize cheaper and more accessible medium of communication.

Interrogating Values Communication from a Distance: The Case of Paete, Laguna This study aims to understand how values are communicated by migrant parents to their children through the use of ICTs, particularly telephone, mobile phone, and video calls. The recognized lack of literature in development communication focusing on communication within the family, as well as the use of ICTs and its implications to development, fuels the drive to pursue this inquiry. In the belief that experiences are best captured and understood through the narratives of the migrant children themselves, I deem it necessary to use qualitative methods in achieving the objectives of this study. As cited by Balarabe Kura (2012, p. 9) Denzin and Lincoln defined qualitative research as

…a situated activity that locates the observer in the world. It consists of a set of interpretive, material practices that makes the world visible. These practices transform the world. They turn the world into a series of representation, including fieldnotes, interviews, photographs, recordings, and memos to the self. At this level, qualitative research involves an interpretive, naturalistic approach to the world. This means that qualitative researchers study things in their natural settings, attempting to make sense of, or to interpret, phenomena in terms of the meanings people bring to them. “LONG-DISTANCE PARENTING”: A MEDIA ECOLOGICAL STUDY ON VALUES… 139

I began the pursuit for this research inquiry with a simple idea in mind: to situate the place of communication within the family in the development communication discourse. I wanted to prove that communication within the family is a viable but untapped aspect of development research. During my initial research, I found out that the term “family communication” is usually associated with psychology, sociology, and family therapy, among other fields. But in fact, studies also show that communication within the family has huge implications to the development of the individual and the society. Thus, I conceptualized this research with the aim to introduce communication within the family in development communication. As my inquiry progressed, I began taking interest on the study of migration, which is mainly due to my personal background as a son of a migrant father. My research, then, took a more specific focus: to understand how parental migration affects communication within the family. But to differentiate this research from migration studies in other fields such as psychology, sociology, and economics, I considered the possibility of focusing on the transnational families’ media use. Going through a bulk of literature about migration, I found out that the diaspora phenomenon is often linked with the use of ICTs such as the telephone, cell phone, social media, and webcam, among others. In keeping families bound together despite physical distance, the use of ICTs becomes embedded in the lives of migrants and their left-behind families. Furthermore, literature shows that while migration studies are abundant, children of migrants are found at the periphery of these studies. This realization contributed to the further narrowing of my research endeavor. My research topic then focused on ICTs and its impact on values communication between migrant parents and their children, mostly told through the children of migrants’ point of view.

Methodology In order to better understand this phenomenon as it takes shape in the context of Paete, Laguna, I deem it appropriate to use the case study method. Becker (1970, p. 75; as cited by Fidel, 1984, p. 274) stated that case study refers to the detailed analysis of an individual case wherein one can (1) adequately gain knowledge of the phenomenon from the rigorous exploration of a single case, (2) arrive at a complete understanding of the 140 P. SAMONTE event, and (3) develop more universal theoretical statements about regu- larities in the said phenomenon. According to Johansson (2003, p. 2), it is called a case study simply because it requires a case that should be the object of the study. Moreover, the case should be a complex functioning unit, must be investigated in its natural context with multitude of methods, and should be contemporary (Johansson, 2003, p. 2). Robert Stake (1998; as cited by Johansson, 2003, p. 2) further stated that what is critical about case studies are not the methods of investigation but the objects or the cases. The case may be a relatively bounded object, or a process which may be theoretical, empirical, or both (Ragin and Becker 1992; as cited by Johansson, 2003, p. 5). For my research locale, I chose Paete, Laguna primarily for two reasons: (1) I was born and raised in this small town, therefore giving me more authority to talk about it; and (2) I seek to understand how this place has been changed by the migration phenomenon. Dubbed as “The Carving Capital of the Philippines,” Paete is a fourth- class municipality in the province of Laguna. According to the 2010 census of the Department of Trade and Industry, it has a population of 23,523 people. Jimeno, in her article entitled How not to carve a future (2008, p. 1), explained that even before the arrival of the Spaniards and the beginning of the twentieth century, carving already formed part of Paete’s industry. According to Jimeno (2008, p. 1), by the 1970s, Paete was solidifying its reputation in woodcarving. Aside from its mass-produced household items and decors, Paete’s famous artists became the first choice of both Filipinos and foreigners who were looking for creative and reliable artisans to render religious images and other works of art in wood. But due to unethical business tactics, the rising cost of wood, and a local environmental resolution prohibiting the cutting down of trees, Paete’s woodcarving industry slowly started to die and residents began seeking for opportunities abroad (Jimeno, 2008, p. 1). With their town’s traditional sources of income threatened and weakened, more and more of Paete’s youth are seeking their fortunes elsewhere. According to Jimeno (2008, p. 1), one local official estimates that over 1000 woodcarvers have sought employment in hotels and on luxury cruise ships as ice and fruit carvers. The woodcarving era started to disappear as the town’s young people are lured by the high income that comes with cruise ships and five-star “LONG-DISTANCE PARENTING”: A MEDIA ECOLOGICAL STUDY ON VALUES… 141 hotels (Jimeno, 2008, p. 1). Hence, Paete, a once culturally rooted town known for its artistic people and woodcarvings, started to become a nest of OFWs.

Identifying the Research Participants For the purpose of this study, I chose five children of migrants in Paete, Laguna as research participants, who were selected using theoretical sampling. According to Charmaz (2006, p. 96), theoretical sampling is a way of “seeking pertinent data to develop your emerging theory. The main purpose of theoretical sampling is to elaborate and refine the categories constituting your theory.” She likewise stated that theoretical sampling can be considered emergent as it follows tentative categories that are developed during the research process (p. 104). Hence, theoretical sampling provides that “the criteria for sampling emerge along with the study itself” (Koerber and McMichael, 2008, p. 465). This quality of a theoretic sampling was realized on this study. While gaining access to a number of literature and through preliminary data gathering, the criteria for choosing research participants were gradually developed. The first participant, the OFW-daughter of an OFW, was specifically chosen due to the assumption that the person’s choice of being an OFW is heavily influenced by her migrant parent. This is where the value of sacrifice and love for the family may be exhibited. Furthermore, she may have a better understanding of the features of various ICTs and its significance in migration, as she herself has used them as a migrant. The second participant, the Iglesia ni Kristo devotee, on the other hand, was chosen mainly because of my interest on how strict religious beliefs are upheld and passed on. Meanwhile, the aspiring teacher, who is also financially handicapped, was included in the list because of the assumption that people living below the poverty line ascribe higher importance to certain values, such as the value of education. Moreover, their financial capacity will limit their choice of ICTs in communicating with migrant parents, which would also be important to look at in this study. The fourth participant, the good girl, was chosen so as to understand how a migrant’s child can exhibit good values despite the distance of one of her parents. Finally, the overachiever was included in the list to further 142 P. SAMONTE understand how a child of a migrant gives importance to the value of education, as well as the web of values to which it is ascribed to. The research respondents took their human form in the personas of Betty, the 33-year-old OFW daughter of an OFW; Nick, the 19-year-old son of Iglesia ni Kristo parents; Bea, 19 years old and an aspiring teacher; Eunice, the 21-year-old good daughter of a migrant father; and Kian, 19, who has always been an overachiever. It should be noted that I am not using the participants’ real names. Although in the initial interview the respondents gave their consent to use their complete names, I used pseudonyms in this article to protect their privacy. Furthermore, it is important to note that I have explained the nature of my research to my participants well enough before I proceeded to the interviews. Because the questions probed during the interviews necessi- tated highly personal answers, I explained to my participants the details of my research study and its objectives. They were not, in any way, coerced to give information they considered private.

Collecting and Analyzing Data I carefully selected in-depth interviews, pagpapakuwento and pakikipagkuwentuhan as my method of gathering data for this study. Each interview lasted for about 30 minutes to one hour, depending on my participants’ capacity to answer the interview questions, and my discretion as to whether the data gathered could be deemed sufficient. Other factors that contributed to the length of the interviews included kamustahan or small talk, as well as the respondents’ willingness to share stories and ask questions. For the whole duration of the data-gathering process, I was able to interview a total of 14 research participants, including nine children of migrants, four migrant parents, and one left-behind parent. All interviews are then transcribed, from which I chose the five key participants I highlighted in my study. However, some of the accounts of migrant parents, as well as one of the other research participants, were also included as part of the results and discussion and data analysis. Before the interview sessions, I drafted an interview questionnaire that would serve as my guide for the whole data-gathering procedure. However, during the actual field work, I just let the conversations take its natural course. I let my participants tell their own stories the way they wanted to, “LONG-DISTANCE PARENTING”: A MEDIA ECOLOGICAL STUDY ON VALUES… 143 while I provided reassurance and asked more questions. Keeping my research interest in mind, I only sought to probe questions that moved the conversation slightly in the direction of my study. All of my interviews were conducted in the comfort of my participants’ own homes. I personally went to their houses for my participants’ own convenience, as well as to observe their actual home settings. I wanted to somehow have a glimpse of their situation at home, where most of the children’s communication with their migrant parents takes place. Moreover, some of my respondents were given prior notice before the actual interviews, while others were interviewed spontaneously. I can do this mainly because most of them are people I have known for a long time—people who are very close to me. Since my research participants are people who are close to my heart, or di-ibang tao in the context of Filipino psychology, I deem it necessary to use pagpapakuwento and pakikipagkuwentuhan as my data-gathering methods. Pagpapakuwento and pakikipagkwentuhan or “story telling” are local research methods (Pe-Papua and Marcelino, 2000, p. 18). These methods are more applicable when the researcher and the research respondents themselves are no stranger to each other. In this case, rapport need not be established, as the participants are willingly open to share their stories. As a researcher who is also a child of a migrant, it became easier for me to understand the plight of my participants. I was able to sympathize with them and provide them with genuine insights during the interview, as I myself have been through what they have, in one way or another. Thus, the nature of pakikipagkwentuhan became very true in conducting this field work. Because of a large common field of experience, it became easier for me to likewise share my story with them. According to Gadamer (2004), “the search for understanding requires the interpreter’s awareness of their own bias and preconceptions affecting the habit of projecting a meaning for the text as a whole as soon as initial meaning is grasped” (p. 269). Thus, researchers should bracket their biases and own them fully, becoming self-aware that these biases would color their interpretation of the text (Gadamer, 2004, p. 269). This assertion became true in the course of my data gathering, as instead of taking the point of view of an outsider, I embraced my own experience as a child of a migrant and used it to my advantage. My understanding of the participants heavily relied on my understanding of my own experience, thus making me, as a researcher, inseparable from the data. 144 P. SAMONTE

Interview transcriptions and field observations were the two main sources of the analytical themes resulting from this study. My prior knowledge of my research participants were likewise used in analyzing the data I gathered.

Findings Within the course of my data analysis arose several recurring themes. For instance, the use of a combination of various media in parenting and the role of gender in values communication are very much evident. These, among others, are discussed briefly in the proceeding text.

The Role of Left-Behind Parent in Instilling Values While migrant parents still strive to communicate values to their children, of equal importance is the role of left-behind parents in instilling values. The results of my data analysis showed that non-migrant parents carry the heavier responsibility of communicating values to their children. Because values need to be modeled, parents who are present at home are the ones better expected to perform this role. Limited by distance in performing their parenting responsibilities, migrant parents would mostly act as to reinforce these values. This assertion could be gleaned from the experiences of my research participants, who recognized the importance of the parent who is left behind in teaching good values to them. Even when not explicitly asked about their non-migrant parent, my research participants would often share a bit about how certain values were reinforced by them. Betty, an OFW whose mom is also an OFW, for example, would be reprimanded by her dad whenever she failed to come home on weekends. Betty’s dad was usually a quiet and very reserved man, but with the absence of her mom, he took on the responsibility of reminding Betty her role as a daughter. Her migrant mother, on the other hand, would go more in depth about the issue and discuss it further, as they are more comfortable talking to each other. Conversely, Nick explained how his religiosity is more rooted in his mother’s teaching than that of his migrant father’s. In his case, his mother was originally from Iglesia in Kristo, and his father converted to Iglesia before they got married. So when it comes to religion, his mother’s advice weighed heavier than that of his father. “LONG-DISTANCE PARENTING”: A MEDIA ECOLOGICAL STUDY ON VALUES… 145

When it comes to issues about pregnancy and marriage, Eunice, the good girl, shares that it is mostly her mother, not her father abroad, who reminds her not to enter into relationships at a young age. Parallel with the importance of left-behind parents in instilling values, the role of extended relatives is an equally critical issue. In the case of Bea, our aspiring teacher, it was her grandmother who stands as the head of the family due to the absence of both parents. It is also worth noting that it is not always the non-migrant parent who takes care of the children in the absence of the other. Sometimes, the inability of the non-migrant parent to take on the responsibility of parenting renders the importance of close family relatives in taking care of the children. This is especially true for non-migrant fathers, who often cannot perform the “caring” work in the family (Parreñas, 2006, p. 224). As explained by Asis (2000, p. 266), when a mother migrates, the father does not automatically assume the roles previously undertaken by women; hence, it becomes a burden on the girls in the family who assume the roles of the migrant mothers. This gives rise to the issue of gender differences in migration and values communication.

Gender, Migration, and Values Communication Perhaps one of the most highly discussed issues in migration is the role of gender differences. As is so clearly evident in my data, gender dictates who takes the place of the absentee parents when they migrate. This validates the studies conducted by Parreñas (2005, p. 330; 2006, p. 224), Pingol (2001, p. 8), and Cortes (2011, p. 17). A mother’s migration means that the eldest daughter shall take her place, whereas a father’s migration means it should be the eldest son. The absence of both, on the other hand, implies that an extended family member takes on the vacated parent’s role, which in most cases is still a female member of the family. For instance, after her mom migrated, Betty found herself filling in the role her mother left. Kian, on the other hand, took on the role of his migrant father. In Bea’s case, it was her grandmother who took on the role of the parents after both of them left. Another factor that could be gleaned from the research data is the role of gender in the parenting of values. Gender dictates which kinds of values are communicated by a migrant parent to their children. There are certain issues that are more comfortably discussed by a daughter and a mother, 146 P. SAMONTE and a father and a son. Female children, in general, are comfortable talking about sensitive issues such as pregnancy and romantic relationships with their mothers.

Convergence of Communication Media My research data reveals that the convergence of varying communication media, each with its own features, strengths, and limitations, proves to be an effective way of parenting. Telephone and mobile calls were commonly used for longer and more important conversations, while texts, being a cheaper and faster medium, enabled the quicker exchange of messages. Social media and Facebook, on the other hand, would serve as a form of surveillance for migrant parents. This finding is consistent with Madianou and Miller’s (2012, pp. 113–115) study of the use of social media in parenting. Aunt Tina, Bea’s migrant mother, for example, would use Facebook as a form of surveillance, or knowing what Bea is doing back home. When she discovers something on Bea’s Facebook account she deemed inappropriate, she would not directly reprimand Bea on Facebook. She would send her a direct message, which implies that Facebook would solely be used for surveillance, whereas parenting still happens over text messages, calls, and chat. Facebook as a form of surveillance also goes the same way in situations when Bea was in trouble. Her mother would discover via Facebook posts and statuses whenever Bea was in a fight, which would lead to her probing questions on text and private message. In the case of Kian, our overachiever, a combination of texts and telephone calls composed his long-distance communication with his father. Kian’s father, Uncle Tano, would wait for his children’s texts every day to get bits of updates about their lives. The longer conversations, however, still happen once a week when he gets to land on a port and access a telephone. My data results further show that the use of varying media becomes a result of the convergence of different factors such as financial capability, location, convenience, and the features of the particular media. Because of these factors, migrant parents and their children attach particular meanings to a certain media when it comes to parenting. This gives way for my next discussion. “LONG-DISTANCE PARENTING”: A MEDIA ECOLOGICAL STUDY ON VALUES… 147

Communication Media and the Attachment of Meanings Because of different media’s varying enabling and disabling features, as well as the convergence of factors that dictate when they could be used, migrant parents and their left-behind children attach certain meanings to a particular medium. The attachment of meanings to a medium is on the basis of (1) its convenience of use; (2) perceived importance of the message; (3) cost of the medium; (4) medium’s conceived reach; and (5) location of the migrant parent, among others. This is where the concept of media ecology comes in. Because of varying environments formed as a result of the particular use of a medium, the medium itself earns meaning and transforms itself into the message. And because people are the ones who attach meanings based on their individual contexts and fields of experience, people themselves become the content (cf. McLuhan, 1964). For Bea, whose mother in Lebanon was forbidden from calling her family back home, a cell phone call from her mom would mean a more important matter. Aunt Tina had to hide just so she could call back home. But a Facebook chat, on the other hand, would mean a lighter conversation—a form of “quality time,” as Bea would call it. This implies the different roles that various communication media play in the individual context. Each communication medium has its own affordances that dictate when and in what situations it could be used. A cell phone, for instance, being a handy device, could be used to call any time; it could likewise be hidden easily, so one can keep it even in situations it is not supposed to be allowed. While Bea’s primary choice of communication with her mom is still SMS, she would still prefer calling her mother on special occasions or conflicts. This could imply that a call is still deemed more special than a text or a chat; a mobile phone call from Bea’s mother means a more important event or a serious problem. This indication of importance has likewise something to do with the cost of the media use—since a telephone or mobile call is more expensive, it must be used for a more special occasion. This attachment of meaning and importance, however, changes depending on personal situations. In Eunice’s case, a text signifies a rather more important event than a video call, her primary mode of communication. A video call would only cost her the bill of a whole month’s Internet subscription, while a single text costs her one peso, or even more. 148 P. SAMONTE

Eunice’s father would call them via Skype every day, but a text from Eunice to her father would mean something else. As she describes, it could mean that she needs money, or she wants to greet her father on a special occasion. Not being a really showy person, Eunice would communicate her care with a different medium—a text—rather than their usual video call conversations. Another meaning attached to a medium is its conceived reach. For Betty, a telephone call from the mother abroad meant that it was a family matter—a conversation which could be shared by the whole family. A cell phone call and text, on the other hand, meant it was solely for Betty. Telephone, perceived as owned by the whole family, was used more often in group communication, whereas cell phone, which is seen as something personal, was used primarily for interpersonal communication. Additionally, an important consideration in the use of media is the location where the migrant parent stays. In the case of Aunt Tina, her workplace does not allow the use of cell phones. This resulted in the seldom and often hidden use of phone calls and texts, which further reinforces the importance of occasions when she can use such media. In Kian’s case, his father works on a cruise ship, which means that telephone calls can only be made when they have landed on a port. This resulted in his use of cell phones and text as a complement to the telephone calls he and his family are already used to. As realized in the interviews and the data gathered, the choice of media to be used, as well as the meaning attached to it, is largely dependent on varying factors. These factors, then, lend themselves crucial on the core message of this study—the communication of values.

Values Communication as Rendered in Various Media In the age of information technology, migrant parents and their children can have easier access to a wide array of communication media. Their choice of media, as mentioned earlier, is based on several factors. However, it could be gleaned that it is not the values communicated that dictate the choice of the medium; rather, it is the media that shapes how the values are communicated.

Video Call’s Features as Effective Tools in Parenting Because of video call’s ability to enable surveillance and allow for the presence of both voice and the face, it becomes a viable medium for parenting. “LONG-DISTANCE PARENTING”: A MEDIA ECOLOGICAL STUDY ON VALUES… 149

As my research participants suggest, its effectiveness as a medium for communicating values lies in (1) the enabling of direct observation of children’s behavior and situation; (2) the more accurate rendering of emotions as evident in the combination of voice and facial expressions; and (3) the preventing of false listening due to face-to-face interaction. For instance, in Nick’s situation, the value of being respectful to the elderly would be reminded by his father during their video call conversation. This is because his father would notice directly via the webcam how he retaliates to his mom, or to the other elders in the house. This again implies the positive effects of real-time surveillance via video call when it comes to parenting. Moreover, because of video calls, parents abroad are able to track the physical changes happening to their children. This, in turn, would lead to giving further reminders about taking care of one’s self. Furthermore, according to Nick, webcam prevents false listening. Because of the presence of the face, parents abroad can directly monitor if their children are truly listening or not. On the other hand, because the children know they are being watched, they, in turn, exert extra effort to listen.

Education as a Primary Value Communicated via ICTs In the course of the interviews with each participant, the emergence of education as an important value is very evident. While other values such as love for the family and love for the self may be reminded by left-behind parents and guardians more vividly, it seems like the value of education is more often communicated by migrant parents. As the findings of my study suggests, this may be attributed to three factors, which are as follows: (1) education of children as the primary cause of parents’ migration; (2) education as a means to escape poverty; and (3) education as a key to prevent the possibility of further migration in the family. Betty, for instance, would often be reminded that the reason why her mom and her dad could not be together is her education, so she had to repay this sacrifice by doing well in school. As could be gleaned from this, the decision of parents to migrate would mostly be for the education of their children. Because of their efforts, parents deem it only apt and necessary to constantly remind their children to value their education—the fruit of their hard work and sacrifices. It is important to note that both Betty’s parents have not finished college. Her mother, therefore, sees education as a means to escape poverty and the cruel situation they are in right now—a kind of reasoning also 150 P. SAMONTE evident in Aunt Tina’s case. A good education means a better future for Betty and her future family as well. Just like Betty’s mom, Uncle Tano would remind Kian how education ensures a good future. Additionally, he would constantly tell him that if he does not want to experience being a migrant himself, he should study well. The communication of the value of education, then, is rooted from the parent’s past experiences. Uncle Tano does not want Kian to experience how hard it is to be an OFW; that’s why he has to constantly remind Kian to study hard. Finally, the thought that a good education likewise secures a good life for the children’s future families further reinforces the importance ascribed to education.

Interpersonal Relationships Determine Quality of Values Communication While the medium affects the environment to which the communication of values occurs, findings of this study show that perhaps of greater importance to the medium in communicating values is the prior relationship the children have with their parents. The level of disclosure that children have and the effectiveness of values communication, it turns out, are still largely dependent on their interpersonal relationship with their parents rather than the media used. Eunice’s interpersonal relationship with her dad, for instance, is only limited to “joking around.” So even though the two use video call, a medium arguably most conducive to parenting, the level of interpersonal relationship they have and kind of values communicated between the two is still relatively shallow. This scenario also rings true for Kian, who had already established a sense of fear when communicating with his father, which is also apparent when they talk via the telephone. Varying personali- ties and type of parent-child relationship that exists, as shown in Eunice’s and Kian’s cases, deeply affects the extent of values communication. Betty, on the other hand, had already established a deep, open relationship with her mom even before she migrated. The level of disclosure she has with her mom, as well as the effectiveness of values communicated, in turn, are still high regardless of the medium they use. This is apparent when Betty narrated how she is able to visualize her mom’s facial expressions whenever she scolds her via the telephone, which leads her to obey her mother. “LONG-DISTANCE PARENTING”: A MEDIA ECOLOGICAL STUDY ON VALUES… 151

As could be gleaned from the findings of this research, values communicated from a distance by a parent to a child are likewise values passed on to the rest of the family members. This is apparent on how children of migrants communicate to their younger siblings the values taught to them by their parents abroad, or how these values are passed from one generation to the next.

Conclusion: ICTs in Social Transformation The arrival of new ICTs has come to reshape various human experiences, and the migration phenomenon is no exception. Such changes, when applied to a specific locale upholding a particular set of values and culture, become a powerful tool in enabling social transformation. This study sought to understand how the use of various ICTs affects values communication between migrant parents and their children. With this study, I therefore conclude that Marshall McLuhan’s media ecology is indeed true in the context of migration—that the medium comes to shape the message—but only to a certain extent. While the choice of medium does affect the sharing of values, there are a host of other factors that affect how well values are communicated. It is first and foremost important that the child had already established a deep interpersonal bond with his or her parent for values communication via the use of ICTs to effectively take place. Again, telephones, mobile phones, and video calls are only media— objects that only serve to bridge the gap and maintain the relationship already present in the first place.

Recommendations: Mainstreaming Migratory Experiences Since government organizations have the power to craft policies and programs catering to children of migrants, I recommend that they design programs that aim to secure the welfare of left-behind children. Along with this, a more accessible mechanism for migrant parents and their children to communicate with each other (i.e. government-subsidized international phone calls, free video call usage for children of migrants in public computer centers) could be imposed as a local or national policy. Human development organizations, on the other hand, can create awareness as to how parental migrations’ social costs could be lessened. It could be a communication campaign, or a series of ads, that shows how parenting should be done at a distance. 152 P. SAMONTE

Meanwhile, academics should not stop interrogating and theorizing human experiences of migration in the quest for social change. Social science researchers, in particular, play an important role in making sense of Filipino transnational families’ experiences and weaving them into palpa- ble narratives—stories which are otherwise unheard and devoid of meaning, studies which solidify social transformations.

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Harnessing the Potential of Communication for the Well-Being of Transnational Families

Rosel San Pascual

Transnational Labor Migration and the Filipino Family Year after year, more and more Filipinos leave the country to seek better employment opportunities and career prospects abroad. In 2015 alone, the Philippine Overseas Employment Administration (POEA) documented that a total of 1,844,406 Filipinos left the country for overseas land-based and sea-based work. This means that in 2015, the country supplied the global labor market with an addition of about 5053 Filipino migrant workers a day (Official Website of POEA, accessed on 22 July 2017). Overseas Filipino Workers (OFWs) primarily headed to Saudi Arabia, United Arab Emirates, Singapore, Qatar, Kuwait, Hong Kong, Taiwan, Malaysia, Oman, and Bahrain (Official Website of POEA, accessed on 22 July 2016). An econometric analysis conducted by Pernia et al. (2014) reveals that, ceteris paribus, OFW remittances considerably improve family incomes and savings, increase household per capita expenditure on education and health care, and facilitate the move of poor families out

R. S. Pascual (*) College of Mass Communication, University of the Philippines Diliman, Quezon City, Philippines

© The Author(s) 2019 155 M. J. Dutta, D. B. Zapata (eds.), Communicating for Social Change, https://doi.org/10.1007/978-981-13-2005-7_8 156 R. S. PASCUAL of poverty. However, the continuously increasing number of Filipinos who are leaving their homes and families for overseas employment is consequently generating a growing number of Filipino families that are separated by itinerant work for prolonged periods of time. Given that parents comprise a substantial number of Filipino migrant workers, a significant volume of Filipino children are left at home without one or both parents because of off-country employment (Madianou and Miller 2012). According to Madianou and Miller (2012), official statistics report that over 10 million Filipino children are left behind because of their parents’ overseas work. While international labor migration serves as a relatively lucrative solution for families who need the comparatively higher wage of overseas employment, extant literature documents that international migration generates psychosocial strains on transnational family members (Aguilar 2009; Añonuevo 2002; Madianou and Miller 2012; Parreñas 2005a, 2008; Pernia et al. 2014; San Pascual 2016; Uy-Tioco 2007). For instance, OFWs experience psychosocial distresses as absentee spouses and parents while family members back home experience psychosocial burdens as left-behind spouses, children, and caregivers (Aguilar 2009; Alunan-Melgar and Borromeo 2002; Añonuevo 2002; Añonuevo and Estopace 2002; Battistella and Conaco 1998; Parreñas 2005a, 2008; Pernia et al. 2014; San Pascual 2016; Sobritchea 2007; Uy-Tioco 2007). As such, there has been a growing concern on how labor migration-led family separation has been affecting Filipino transnational families. In this chapter, I will present my analysis of the micro- and macro- level challenges of transnational separation of OFW parents and their left-behind children, which consequently beget psychosocial distresses among transnational family members. In doing so, I have drawn evidence from my October 2010 to March 2011 interview of 32 Singapore- based Filipino mothers who left their family in the Philippines to pursue overseas employment as well as evidence from existing literature on Filipino transnational parents and families. Furthermore, I will put forward some broad communication policy advocacy objectives that highlight the critical role of communication in facilitating a better life for transnational families. The list of advocacy objectives emphasizes how communication may be harnessed at the micro and macro levels for the well-being of transnational families. HARNESSING THE POTENTIAL OF COMMUNICATION… 157

Harnessing the Potential of Communication to Address the Micro-Level Challenges of Transnational Separation of Parents and Children Filipinos place unequivocal value on their family (Medina 2001). Even during migration, Filipino transnational families endeavor to maintain and sustain family ties (San Pascual 2016). Though transnational migration continues to change the dynamics of the Filipino family, the importance of being a family remains the same (Asis et al. 2004; San Pascual 2016).

Micro-Level Concern: Family’s Temporal and Spatial Separation Philippine society ideally sets that family members should experience the daily routines of family life together. Logically, the daily routines of family intimacy are easier carried out when family members spend time together and share space (San Pascual 2016). Parreñas (2005a) explained,

In terms of experience, “family” refers to the daily lives of men, women, and children who share material resources and in cooperation and sometimes conflict provide one another with material, physical, and emotional care. In this view, the family is rooted in patterns of shared activities. If large doses of temporal and spatial proximity are necessary ingredients to a family, one could easily wonder how transnational families could possibly function as a family without the intimacy and familiarity gained only from the routine of daily interactions. (p. 33)

At the micro level (Fig. 8.1), the psychosocial cost of migration ema- nates from the spatial and temporal separation inherent in transnational migration, as family members deal with the dissonance of their transnational situation (San Pascual 2016). On the one hand, they know that their transnational separation is a consequence of addressing the economic needs of the family (Go 2009; Parreñas 2001; San Pascual 2014a, 2014b, 2016; Sobritchea 2007). In my interview of Singapore-based Filipino working mothers, one mother explained her decision to work abroad: “It’s my responsibility as a mother to provide for their needs” (Office/ Production Administrator, 34 years old, two kids). In fact, providing for their children’s education is a significant motivating factor for parents’ labor migration. Another mother expressed: “If I 158 R. S. PASCUAL

Fig. 8.1 Harnessing the potential of communication at the micro level stayed home, I will just be planting rice or selling vegetables to earn money. That is not enough. If I didn’t leave, I won’t be able to pay for my children’s education” (Household worker, 37 years old, three kids). Then again, another mother, who was employed in corporate work back in the Philippines voiced out: “I didn’t earn enough back home even as a Manager” (Manager, 39 years old, two kids). Other mothers expressed that apart from securing their children’s education, they also want their children to enjoy the material things that they were not able to enjoy when they were kids themselves. A mother narrated that when she was a child, she recycled and transformed old bottles to dolls because her parents did not have spare income to purchase toys. She said, “I wanted my daughters to play with real Barbie dolls” and further recounted that she brought home a couple of Barbie dolls for each of her two daughters during her first vacation leave from her overseas employment (Household worker, 39 years old, two kids). On the other hand, as the experience of family stems from togetherness and collective actions, family members bear the spatial and temporal constraints that transnational separation brings to family intimacy (Parreñas 2005a, 2005b; San Pascual 2016). The migrant mothers I interviewed lamented that while overseas employment enable them to financially provide for their family, it also hinders them to personally care for and be there for them.

Micro-Level Plan: Compress Time and Space Fortunately, the growth in the number of transnational families transpired alongside groundbreaking developments in communication media and technologies, which made overseas communication more accessible and HARNESSING THE POTENTIAL OF COMMUNICATION… 159 affordable to transnational family members. Contemporary communication media and technologies compress space and time, allowing “perpetual contact” (Katz and Aakhus 2002) among family members anytime and anywhere. As we live in a time wherein communication is no longer bound by physical proximity and spatial immobility, the current generation of transnational families has greater opportunities to manage their family intimacy through mediated family communication. A Singapore-based migrant mother articulated, “It’s like I’m there” (Sales and Service Worker, 42 years old, three kids), which echoes the findings of Hondagneu-Sotelo and Avila’s (1997) study of Latina transnational mothers. Wilding (2006) remarked, “The use of ICTs is important for some transnational families in constructing or imagining a ‘connected relationship’, and enabling them to overlook their physical separation by time and space – even if only temporarily” (p. 132). The newer forms of communication media and technologies allow transnational family members to sustain family life and maintain affective ties anytime, anywhere, at more affordable rates. The advent of mobile phones, in particular, changed the communication landscape of transnational families (Aguilar 2009; Paragas 2008; San Pascual 2014a, 2014b, 2016; Uy-Tioco 2007). Aguilar (2009) wrote:

Moving from the era of the postal system, mobile phone technologies have radically transformed the ways by which physically separated couples and families stay in touch and maintain their relationships. Through voice calls and text messages, the cellphone has become a potent device to recreate the absent partner’s presence and conjure transnational togetherness. Special events, and everyday life in general, can be configured in support of conju- gal, kin, and community togetherness. (p. 221)

Micro-Level Strategy: Managing Family Intimacy Through Mediated Family Communication Based on my review of extant literature and my own study of transnational mothers, there appears to be a marked contrast in the transnational parenting that migrant fathers and mothers carry out. This is mainly because, even during migration, Filipino transnational fathers and mothers enact their culturally prescribed roles (Medina 2001; Parreñas 2008). Because of the culturally prescribed role of fathers, when they leave their family to work abroad, the daily routines of the household are not severely disrupted since the mothers are left to perform their culturally 160 R. S. PASCUAL prescribed role at home and in the family. When mothers are left behind with the rest of the family, the household is able to run as if the father is just out of the home to earn for the family. Thus, fathers’ migration is akin to an extended period of performance of productive responsibilities, where fathers work outside the home and mothers do reproductive tasks at home (Parreñas 2005a, 2008). Even from a distance, fathers need not redefine gendered norms associated with their parenting roles. Moreover, going away in order to provide for the family even reinforces the norm of fathers being the family’s breadwinner. Parreñas (2008) expounded that

the transnational families of migrant men usually mirror modern nuclear households. For instance, unlike those of migrant women, their families hardly rely on the assistance of extended kin. Instead, their families resemble conventional nuclear families. The only difference is the temporal and spatial rearrangement brought by the father’s work: instead of the father routinely getting back home to his family at suppertime, he comes back home from work every ten months. (Parreñas 2008, p. 1061)

Financially providing for the family gives fathers the ostensible freedom from the burden of emotional work. Parreñas also wrote:

Perhaps because no social expectation to do so is imposed on them, migrant fathers rarely communicated with their children. Moreover, they usually enforce discipline during the few times that they do so. To remind children of their authority in the household, migrant fathers typically take on the habit of reprimanding their children from a distance for having low grades, selecting the “wrong” major, or not performing adequately in other school activities. (p. 69)

While society places relatively lesser attention on the importance of fathers’ nurturing presence in their children’s lives, society piquantly imposes a mother’s constant nurturing presence (Parreñas 2008). To fulfill this expectation, migrant mothers shell out a large sum of money to communicate their presence in the lives of their children (Añonuevo 2002). Thus, while transnational labor migration enables migrant mothers to provide for their family, their frequent long-distance communication with them allows them to manage their prolonged physical absence and to parent their children beyond economic provision. HARNESSING THE POTENTIAL OF COMMUNICATION… 161

The Singapore-based Filipino migrant mothers recounted that they typically get in touch with their children once a day. Depending on their socio-economic status, mothers employed in white-collared jobs are able to communicate with their family through daily Internet voice and video call while mothers employed in blue-collared jobs are able to communicate with their family through daily SMS. Conversations with their family revolve around productive functions such as remittances and remittance- allocation, reproductive functions such as household management and child care, as well as affective functions such as reaffirmation of love, concern, and support. According to Singapore-based migrant mothers, kamustahan (a Filipino term for asking about a person’s state of affairs) questions jumpstart their daily mediated conversations such as Kamusta ka? (How are you?), Kamusta ang araw mo? (How was your day?), Kumain ka na ba? (Have you eaten?), Ano kinain mo? (What have you eaten?), Nasa bahay na ba ang mga kapatid mo? (Are your siblings home already?), and Tapos na ba ang homework mo? (Are you done with your homework?). Conversations about the family’s well-being, safety, and the children’s schooling take off from these seemingly mundane questions. Kamustahan also ensues after the migrant mother sends remittances by asking Nakuha niyo na ba ang padala? (Have you received the remittance?), which then serves as a pre- lude to conversations about managing household finances. Apart from these discussions, some mothers observed that their exchanges have become more affective. A mother noticed that her children have become more expressive: “We’re sweeter with each other now. Perhaps the distance drew us together, ironic isn’t it? We’re now more expressive of our feelings than before” (Operations Executive, 35 years old, two kids). Another mother shared how she typically concludes her daily conversation with her daughter: “Before we end our phone call, we keep on saying “I love you,” “I miss you” repeatedly without us knowing that we have already spent 2 to 3 minutes just doing so” (Administrative Executive, 32 years old, 1 kid). Apart from oral affective expressions, Aguilar (2009) added that a broad range of emotions is expressed and communicated over long distances through forms of nonverbal communication such as “tone, velocity, cadence, accent, pauses, and other aspects of speech acts” (p. 219). Then again, the Singapore-based Filipino migrant mothers acknowledged that being physically around to see, care for, and be there for their children is the ideal setting for families. In spite of this, these mothers 162 R. S. PASCUAL recognized that long-distance communication gives them the opportunity to address the visual and tactile dimensions of parenting which are being challenged by their migration-led separation. As one mother uttered, “It’s hard, but through communication, I can still be a mother to them” (Household worker, 43 years old, two kids). While these mothers are cognizant of the parameters of parenting that long-distance communication allows them to carry out, they regard that it is the limitation imposed by their migration-led separation, not the shortcomings of existing communication technology, which encumbers them from fully parenting their children (San Pascual 2016). As such, despite their awareness of the inad- equacies of overseas communication, they emphatically expressed their satisfaction and sometimes, even amazement, with how mediated communication permits them to maintain and sustain their ties with their children (San Pascual 2016). My conversations with migrant mothers and my review of studies on Filipino transnational parents confirmed that communication is an integral part of long-distance parenting. Through mediated parenting, these migrant parents are given the opportunity to function beyond financial provision and be providers of care, concern, and affection as well. Through transnational communication, migrant parents are able to reach out to their children, maintain their relationship with them, and practice their parenting responsibilities. As one mother expressed, “Even if I’m living apart from my children, it’s like I’m still there” (Household worker, 37 years old, two kids). While mediated parenting has limitations, it is the best response to the situation imposed by transnational labor migration.

Harnessing the Potential of Communication to Address the Macro-Level Challenges of Transnational Separation of Parents and Children Parenting norms in the country follow traditional gender-role expectations. While contemporary Philippine society and the younger generation of Filipinos are more welcoming of fluid parenting roles and responsibilities, the gendered dichotomy of parenting roles and responsibilities still remains to be the dominant parenting frame. HARNESSING THE POTENTIAL OF COMMUNICATION… 163

Macro-Level Concern: Society’s Prescription of the “Right” Kind of Family At the macro level (Fig. 8.2), the psychosocial cost of migration arises from society’s prescription of the “right kind of family” (Parreñas 2005a, p. 30), which is rooted on its steadfast adherence to traditional gendered norms. Medina (2001) noted that Philippine society prescribes different parenting norms for fathers and mothers. Filipino fathers are socially constructed as the pillar of the home or haligi ng tahanan, a metaphor that reinforces their stereotypical image of power and asserts their so-called masculinity (Asis et al. 2004; Medina 2001; Parreñas 2005a, 2008). The haligi ng tahanan metaphor perpetuates traditional notions of men’s dominance in the political economy of the modern household. Fathers are generally regarded as the family’s authority figure, are expected to perform productive work, and are supposed to maintain order and discipline in the household (Parreñas 2005a, 2008). As the primary provider, they are not expected to perform reproductive work in the household. Medina (2001) wrote:

The Filipino father has to devote much of his time and effort in making a living that child-caring is left practically to the mother. Furthermore, the traditional “male image” which has to be maintained keeps the father from involving himself in tasks like feeding, dressing, and toilet-training of children. (p. 223)

Filipino mothers, on the other hand, are socially constructed as the light of the home or ilaw ng tahanan, a metaphor that reaffirms their stereotypical image of warmth and supports their so-called femininity

Fig. 8.2 Harnessing the potential of communication at the macro level 164 R. S. PASCUAL

(Asis et al. 2004; Medina 2001; Parreñas 2005a, 2008). The ilaw ng tahanan metaphor maintains traditional notions of women’s reproductive responsibilities in the modern household. As mothers are the primary caregivers in the family, they are culturally expected to prioritize caring for the home and the well-being of the family (Medina 2001; Sobritchea 2007). Then again, while mothers are encouraged to augment the income of the family, they are expected to be able to do so without neglecting their primary responsibility (Medina 2001; Sobritchea 2007). Thus, even when society has embraced working mothers, it is still circumspect when it comes to the mothers’ ability to juggle their responsibilities at home and at work (San Pascual 2016). As such, women carry the so-called multiple burden, wherein they are expected to successfully balance reproductive and productive work. As society expects transnational parents to follow conventional gendered parenting norms, operationalizing transnational parenting within the gendered parenting framework consequently leads to psychosocial distresses among members of transnational families (Parreñas 2005a; Pernia et al. 2014). These families are not only coping with the anxiety of separation but they also have to deal with their dissonance with the culturally prescribed notion of the “right” kind of family (Asis et al. 2004; Parreñas 2005a; Pernia et al. 2014; San Pascual 2016). Moreover, migrant parents carry the burden of functioning within the mold of the “right” kind of fathering and the “right” kind of mothering. However, extant literature documents that, compared to transnational mothers, it is relatively easier for migrant fathers to enact these expectations and to be judged favorably when they do so (Parreñas 2008). Even for children, the image of a perfect family is that of a stay-at-home mother and a breadwinning father, a reflection of culturally constructed gendered roles in the family (Parreñas 2005a). Thus, based on culturally held notions of a mother’s role in the family, migrant mothers defy not only society’s prescriptions but their children’s expectations as well given that they are physically away from their family (Parreñas 2005a). Hence, there are children in mother-away families who tend to be ambivalent with respect to their mother’s overseas employment (Añonuevo 2002; Madianou and Miller 2012). Although these children appreciate their mother’s sacrifice, they harbor hard feelings against their mother’s absence and view family togetherness as much more important than acquiring financial security (Añonuevo2002 ; Madianou and Miller 2012; Parreñas 2001). Parreñas (2001) remarked: HARNESSING THE POTENTIAL OF COMMUNICATION… 165

The binary construction of “money or family” suggests that children consider these two to be mutually exclusive decision for mothers. Moreover, an underlying suggestion is the wrongful decision of mothers for having chosen money instead of family. This line of reasoning disregards the fact that mothers migrate to provide money to the family. (p. 133)

Macro-Level Plan: Expand the Concept of Family Even with the progressively increasing occurrence of transnational families and even with the advancements in postmodern communication that enable family members to maintain family life and sustain affective ties, Parreñas (2005a) observed that society remains wary of transnational families:

Yet, despite their [transnational families] ubiquity, the public still maintains quite a dismal view of these families, because transnational families, especially those of migrant women, contest the normative nuclear family with a nurturing (that is, physically nearby) mother and a breadwinning father and conflict with dominant cultural notions of the right kind of family. (p. 30)

On a basic level, this view may be attributed to the daily routines of intimacy that transnational family members are not able to carry out because of their spatial and temporal distance (Parreñas 2005a; San Pascual 2016). On a deeper level, this view may be ascribed to the gendered parenting prescriptions that are challenging to carry out when parents, especially mothers, live spatially and temporally apart from their children (Parreñas 2005a; San Pascual 2016). A mother vented, “That’s the curse of a mother working abroad, you are a mother financially but you are not a mother physically” (Household worker, 37 years old, two kids). Indeed, performance of care is difficult when mothers are not around to take care of the home and their family (San Pascual 2014a, 2014b, 2016). Given that transnational families do not adhere to society’s mold of the “right” kind of family, transnational family members do not only deal with the uncertainty and anxiety of transnational separation but they also have to deal with their dissonance to society’s prescription of the “right” kind of family (Parreñas 2005a; Pernia et al. 2014; San Pascual 2016). While in general, transnational families transgress society’s notion of the “right” kind of family, mother-away transnational families defy the mold more than father-away transnational families do (Asis et al. 2004; Parreñas 2001, 2005a). While transnational mothers attempt to reconfigure on-site 166 R. S. PASCUAL parenting to offsite parenting as they carry out their traditionally prescribed reproductive role alongside their productive work, migrant mothers still feel their dissonance against society’s standards of the “right” kind of mothering (Parreñas 2001, 2005a; San Pascual 2014a, 2014b, 2016). One mother expressed, “A perfect mother should always be there for her children, 24/7” (Household worker, 37 years old, two kids). Then again, even when migrant fathers enact society’s gendered prescription of the “right” kind of fathering, this enactment breeds emotional distance between them and their left-behind children (Parreñas 2005a, 2008). Thus, in order to help ease the psychosocial distresses of transnational families, there is a pressing need for society to expand its concept of family to better embrace the reality of transnational families. There is also a critical need for society to reconfigure its prescribed family roles and responsibilities not only for the sake of transnational families but for the well-being of Filipino families who will be better served by a more gender- fluid construction of family roles and responsibilities. It is therefore necessary to reorient society through societal-level discourse.

Macro-Level Strategy: Reconfigure Prescribed Family Roles and Responsibilities Through Societal Discourse Transnational parents perform their parenting responsibilities even during migration. However, these responsibilities are enacted within the framework of culturally ascribed gendered parenting norms. In the case of migrant fathers, notions of the “right” kind of fathering creates artificial boundaries between what they can actually do as parents and what society deems as gender appropriate (Parreñas 2005a, 2008). Their operationalization of socially approved ideals of the “right” kind of fathering limits their parenting to acts consistent with traditional gendered norms of breadwinning and authoritarianism (Parreñas 2005a, 2008). This consequently generates a psychosocial gap between migrant fathers and their left-behind children (Parreñas 2005a, 2008). When migrant fathers parent from a distance, they essentially attempt to perform the culturally approved notion of being a “good” father, which chiefly rests on their ability to be “good providers” for the family (Medina 2001; Parreñas 2008). Furthermore, as haligi ng tahanan, transnational Filipino fathers are still expected to be the authority in the family and to maintain order and discipline in the household (Parreñas 2005a, 2008). However, when migrant fathers attempt to be “good” fathers as they HARNESSING THE POTENTIAL OF COMMUNICATION… 167 carry out their culturally sanctioned role of being the authority and keeper of order and discipline, they tend to neglect the more emotional aspect of parenting (Parreñas 2008). Based on her interviews of children left-behind by migrant fathers, Parreñas (2008) observed that many of them shared that distant disciplining characterizes their childhood experience with their migrant fathers. Parreñas (2008) attempted to explain such behavior of transnational fathers:

Why do fathers impose their authority as the head of the household? We can speculate that, coupled with the awkwardness of not knowing how to act around their children, fathers may also feel the pressure to act with authority, as that is what they think they ought to be doing to be good fathers. In other words, they assume that they must discipline their children to fulfill their parental duties. (p. 1069)

As a result, Parreñas (2008) found that left-behind children tend to feel emotionally distant from their migrant fathers. The limited amount of time spent by fathers with their children exacerbated by the fathers’ role as disciplinarians leads to an emotional gap between fathers and children (Parreñas 2008). Thus, Parreñas (2005a) strongly cautioned that because of the gender roles ascribed to fathers, men are deprived of the chance to be nurturing fathers. She encouraged migrant fathers to cross socially constructed gender boundaries to “ease the emotional tensions” that their transnational separation generates (Parreñas 2008, p. 1070). Furthermore, she noted that “efforts of migrant fathers to nurture from a distance, communicate regularly with their children, and reconstitute fathering to not center on disciplining could enhance intergenerational relationships in transnational families” (Parreñas 2008, p. 1070). Contrary to fathers who enact their culturally prescribed productive role when they leave their family to work abroad, mothers who leave their family for overseas employment are not able to perform their reproductive role in a way that society deems appropriate (Parreñas 2005a; Uy-Tioco 2007). A Singapore-based migrant mother tearfully bemoaned, “Sometimes I feel like I’m a failure as a mother because I’m not with them. But what choice do I have?” (Office/Production Administrator, 34 years old, two kids). Because “good” mothers are defined by their performance of society-stipulated nurturing role, working overseas, even if to provide the much-needed finances for the family, is seen as a dereliction of their society-prescribed duty to care for their children (Gustafson 2005). 168 R. S. PASCUAL

While notions of the “right” kind of fathering imposes artificial limits on migrant fathers’ parenting, notions of the “right” kind of mothering constructs “good” mothering as a balancing act between a migrant mother’s traditionally ascribed reproductive functions and her recently expanded productive function (Medina 2001; Sobritchea 2007). Thus, in the case of migrant mothers, their operationalization of socially approved ideals of the “right” kind of mothering generates psychosocial distresses among them since they have to carry out their reproductive duties offsite alongside their productive contribution to the household (Pernia et al. 2014; San Pascual 2016). Besides, their left-behind children also expect them to successfully perform this balancing act (Parreñas 2005a). Otherwise, left-behind children tend to experience psychosocial distresses when they perceive that their migrant mother fails to be the “right” kind of mother (Parreñas 2005a). Thus, even in parent-away migrant families, left-behind children still expect their parents to perform conventional parenting and follow gendered parenting protocols (Parreñas 2005a, 2008). However, there are also accounts of children’s ambivalence with regard to their migrant mothers’ frequent attempts to parent them across borders (Madianou and Miller 2012). Madianou and Miller (2012) wrote:

While for the mothers new communication technologies represent welcome opportunities to perform intensive mothering at a distance and to ‘feel like mothers again’, for their young adult children such frequent communication can be experienced as intrusive and unwanted, although this often depends on specific issues such as the age of the children at the time the mothers left and the nature of the media available to them. (pp. 2–3)

Then again, even if there are left-behind children who are ambivalent regarding their mothers’ migration and their mothers’ constant attempts at long-distance communication, Parreñas (2005a) found that children are able to perceive their mothers’ migration-led separation more favorably if their mother is able to show attention, express her love and concern, and parent them from a distance. In other words, just as long as it is not too much remote parenting, mothers’ migration-led separation is more acceptable when migrant mothers continue to perform their reproductive role on top of their productive responsibilities. As such, mothers are nonetheless expected to perform multiple functions and, consequently, the multiple burden of women is extended over the migration sphere. HARNESSING THE POTENTIAL OF COMMUNICATION… 169

Thus, gendered parenting norms do not only create artificial gender- based boundaries on what fathers and mothers ought to do. These norms also generate actual psychosocial burdens among transnational family members when they perceive their family to be non-conforming to society’s gendered prescriptions (Parreñas 2005a; Pernia et al. 2014; San Pascual 2016). While it is imperative to break gendered family role expectations, it is now even more urgent and critical as more and more families experience migration-led family separation.

Conclusion: Communication Policy Advocacy Proposal While exporting Filipino labor has been a long-standing response of the Philippine government to the growing labor surplus in the country, the government should aggressively pursue policy reforms that would put the domestic economy on a rapid and sustained growth trajectory (Pernia et al. 2014). According to Pernia et al. (2014),

On the whole, while international remittances are associated with beneficial effects at the household, regional, and macro levels, they cannot be relied upon as a principal instrument for reducing poverty, redressing income inequality, and for that matter, fostering the country’s long-run growth and inclusive development. (p. 39)

Undeniably, a strong local economy would generate a wide variety of lucrative domestic jobs that would then recast overseas work as an option instead of a necessity (Pernia et al. 2014). But in the interim that the local economy is fighting to shape up, overseas employment continues to be a viable solution especially for families struggling to cope with the ever- increasing cost of domestic living. Thus, in order to help transnational parents and families manage the micro-level and macro-level challenges of transnational family separation, I am putting forward some broad communication policy advocacy objectives that highlight the critical role of communication in facilitating a better life for transnational families. At the micro level, a policy advocacy could harness communication as a means for managing family intimacy, which could help address the psychosocial challenges of transnational families’ spatial and temporal separation. Policy advocacy objectives at the micro level may focus on spreading 170 R. S. PASCUAL awareness and appreciation of the importance of family communication, especially among transnational family members; developing skills in utilizing communication to maintain and sustain family life across borders; and widening access to affordable media and technologies for long-distance contact. At the macro level, a policy advocacy proposal could harness communication as a means to expand the concept of family, which could better embrace the reality of transnational families, and to reconfigure prescribed family roles and responsibilities, which could help address the psychosocial challenges of society’s prescription of the “right” kind of family. Policy advocacy objectives at the macro level may focus on stimulating sensitivity toward transnational families and engendering family values that transcend gendered definition of family roles and responsibilities.

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Social Change Methodologies

Dazzelyn Baltrazar Zapata

This part explores various social change methodologies. It looks at (1) how communication scholars approach social change; (2) how the widening health disparities are addressed communicatively; and (3) the role of self-reflexivity for communication scholars. The chapters in this part of the book further interrogate the roles of the researcher in the process of knowledge generation and actual social change on the ground. The first chapter of this part of the book, entitled The Health Communication Advocacy Tool: An Approach Toward Addressing Health Inequity by Chervin Lam and Marifran Mattson, proposes a health communication advocacy tool to address health inequality. The tool consists of three phases: (1) assembling an advocacy team, (2) conducting formative research and designing advocacy messages, and (3) implementing and evaluating the team’s strategy. Given the pervasiveness of health inequity, it is imperative that more health advocacy efforts are initiated. According to Lam and Mattson, the Health Communication Advocacy Tool offers advocates structure and confidence going forward in pursuing such efforts. In a similar light and in a more grounded and community-centered approach to social change, the concluding part of the book talks about exemplars of using the culture-centered approach to social change. The next chapter on methodology, Self-Reflexivity in DevCom Research: An Autoethnography by Rikki Lee B. Mendiola and Pamela A. Custodio, focuses on Mendiola’s retelling of her fieldwork with the indigenous Alangan Mangyan community and their struggle to articulate their voices in the mining discourse in the province. With the failures of modernization, Development Communication (DevCom) has pivoted its development 174 Social Change Methodologies paradigm from simply achieving economic well-being as the end-all and be- all to a complex inclusive, long-term sustainable development. Mendiola and Custodio explore the indigenous presence of the Alangan Mangyan in the mining discourse, and examine these episodes through critical self- reflection. Through self-reflexivity as method, this chapter reevaluates the role of dialogue as an embodiment of participation in DevCom praxis, places reflexivity in its theory and praxis, and explores critical studies as a potential tradition in its predominantly post-positivist research. The third chapter on methodology, Participatory Communication and Extension for Indigenous Farmers: Empowering Local Paddy Rice Growers In East Java by Edi Dwi Cahyono, argues against the top-down communication approach of development agencies and how such top-down communication fails to stimulate capacities of marginal communities and further worsens social inequality. Cahyono’s chapter talks about a participatory communication approach with strong culture-centered perspectives. The chapter includes the documentation of a series of interactive extension or facilitation activities which were aimed to conserve rare rice varieties and the unique farming practices in indigenous community’s areas in the eastern region of Java Island. As a result, the farmers were more aware of the values of, and committed to conserve the endangered seed varieties, and the related indigenous knowledge and practices; they were also willing to employ their indigenous institution as a medium for information exchange regarding the farming system. This is significant since the local public administration has been paying close attention to indigenous lifestyles for agro-eco tourism attractions recently. The project results suggest that the building of participatory processes creates social change at various levels. CHAPTER 9

The Health Communication Advocacy Tool: An Approach Toward Addressing Health Inequity

Chervin Lam and Marifran Mattson

Health inequity is a global concern, prevalent in every part of the world such as Asia, Africa, and the United States. However, health inequity is a problem that may be mitigated, and many international organizations, such as the International Society for Health Equity and the World Health Organization, are already working toward addressing this issue (Casas- Zamora & Ibrahim, 2004). Social change via health advocacy campaigns is necessary to alleviate health inequity. For example, in 2004, the National African American Tobacco Prevention Network succeeded in abolishing Kool, a flavored cigarette that targeted African American youth (Freudenberg, Bradley, & Serrano, 2009). Given the positive track record of health advocacy campaigns in achieving social change and given the pervasiveness of health inequity across the globe (see Marmot, Allen, Bell,

C. Lam (*) Department of Communications & New Media (CNM), National University of Singapore, Singapore, Singapore M. Mattson Brian Lamb School of Communication, Purdue University, West Lafayette, IN, USA e-mail: [email protected]

& Goldblatt, 2012), it is imperative that more campaigns are initiated to address health inequity. This chapter presents a brief overview of health inequity and health advocacy and advances a tool (i.e., Health Communication Advocacy Tool) that organizations or individuals may utilize as a guide to addressing health inequity.

Health Inequity Inequity is the potentially remediable differences between different groups of people (Starfield,2011 ). Inequity may involve people having similar needs but dissimilar access to resources, or people having greater needs but not given greater resources. For example, when a certain minority group is as susceptible to illnesses as the general populace but are not afforded equal or greater treatment options, health inequity would exist for that minority group. According to Kawachi, Subramanian, and Almeida-Filho (2002), health inequity refers to health differences that are considered unfair or a result of injustice. Such differences may be perceived as unjust because of genetic predispositions or uneven distribution of social determinants of health. These social determinants of health may include early childhood conditions, educational opportunities, health behaviors, and environmental exposure (Kawachi et al.). For example, individuals who do not have access to education may not learn about disease prevention or the detrimental effects of habits such as smoking. Inequity is prevalent in the area of health and is a burgeoning problem in society today. For example, black children have more emergency department visits, hospital visits, and higher mortality rates for health conditions such as asthma when compared with white children (Berry, Bloom, Foley, & Palfrey, 2010). Besides health inequity between races, health inequity also is prevalent between other types of groups, such as between genders. For example, Wells, Marphatia, Cole, and McCoy (2012) found in their study that there are three obese women for every two obese men. Other types of groups include those that differ in income, education, and location, among others. Health inequity is a global issue, with the poorest countries bearing the greatest burden of health risks and diseases. For example, approximately 842 million people globally are chronically hun- gry although global food production is sufficient to cover 120 percent of global dietary needs (Ottersen et al., 2014). Health inequity may have its roots in socio-economic inequality, and socio-economic problems may THE HEALTH COMMUNICATION ADVOCACY TOOL: AN APPROACH… 177 potentially be remedied with advocacy efforts. Policies can have consequences to health outcomes (Ottersen et al.) and therefore health advocacy—an initiated effort toward policy change—may be instrumental to addressing health inequity.

Health Advocacy Health advocacy is the act of championing for changes in public policies so that better health outcomes may be achieved (Lupton, 1994). The aim of health advocacy campaigns is to persuade policymakers—who are vital in influencing health issues (Woolf & Braveman, 2011)—to make policy changes that can benefit the health of people. Such campaigns can be conducted by organizations, professionals, or any individuals with adequate skills in health advocacy. For example, individuals can push for equitable health care by staging a rally outside a statehouse. Health advocacy has had significant success in altering policies. For instance, the smoke-free flights today are a result of numerous campaigns against smoking in airplanes (Holm & Davis, 2004). Since movements can result in improved health outcomes, health advocacy may be an effective approach for curbing health inequity. There are evidences for such optimism; for example, the Indiana Amputee Insurance Protection Coalition (IAIPC) initiated an advocacy campaign in 2010 with the aim of making prosthetic limbs more affordable and succeeded in doing so (Mattson, 2010). Before IAIPC launched its movement, health insurance coverage for prosthetic care was not on par with other critical medical services, and because of this inequity many of the almost two million amputees in the United States could not afford prosthetics. IAIPC’s health advocacy effort overturned this inequity by successfully persuading legislature to pass and sign into law HB1140, a bill that championed for prosthetic parity across health insurance plans in Indiana. Because of IAIPC’s advocacy initiative, the inequity in health insurance coverage for prosthetic care in Indiana was resolved, and many amputees were able to acquire prosthetic limbs. Currently, recommended approaches to health advocacy are found mostly within public policy and public health disciplines (see, e.g., Okonofua, Lambo, Okeibunor, & Agholor, 2011; Sato, 1999). Within the communication literature, health advocacy is mostly examined as theory or as part of a qualitative inquiry (Zoller, 2005). A practical approach to advocacy is thus yet advanced within the communication discipline. 178 C. LAM AND M. MATTSON

Mattson’s (2010) Health Communication Advocacy Tool addresses this gap by forwarding a tool in praxis, focusing on communication processes and recommending phase-by-phase procedures to which one may effectively navigate through an advocacy campaign. This chapter presents this tool in the context of addressing health inequity, and as a structured guide with strategies and processes aimed at persuading target audiences to support an advocacy cause.

Health Communication Advocacy Tool The Health Communication Advocacy Tool (see Fig. 9.1) guides its users through an advocacy process and consists of three phases.1 In the first phase, an advocacy team is assembled. The second phase involves conducting formative research and designing advocacy messages, and in the third phase the team’s strategy is implemented and evaluated.

Phase 1: Assemble Team In the first phase, an advocacy team is assembled. The team should consist of health issue experts, community partners, public health and communication specialists, and a lobbyist. Health issue experts may include professionals with specialized knowledge in a particular health issue or patients who have experience with the health issue. Health issue experts are important for the team because they may help enhance the credibility of the team. Furthermore, health issue experts may use their insight to contribute to an advocacy team’s decision making (see, for e.g., Fick et al., 2003). For example, an amputee may recommend ways for amputee supporters to participate in advocacy while accommodating to mobility concerns. Community partners are people or organizations within the community who are willing to collaborate in initiatives, and may include universities, unions, clinics, and hospitals, among others. Community partners contribute to the team with their extensive network and experience with a community. Public health specialists are experts in community health concerns, and communication specialists are experts in message development and dissemination. Such specialists are vital to the team because they may help develop and disseminate advocacy messages effectively. A lobbyist is a

1 This section draws from the work of Marifran Mattson (2010) and is an exposition of her Health Communication Advocacy Tool. THE HEALTH COMMUNICATION ADVOCACY TOOL: AN APPROACH… 179

Fig. 9.1 Health Communication Advocacy Tool 180 C. LAM AND M. MATTSON person hired to help facilitate in influencing public policy by contacting public officials, observing political and government movement, and advising on political strategies (Thomas & Hrebenar, 2009). A lobbyist is important for the team because he or she has considerable political knowledge and connection with the policy community (Kersh, 2000). When the team is assembled, members will determine the team’s position in regard to the health issue. For example, if the issue is inequity in health insurance for amputees, the team’s position may be “insurance parity.” When the team has ascertained its position on the health issue, the team will proceed to the second phase.

Phase 2: Formative Research and Message Development The second phase involves formative research and message development. Formative research includes collecting evidences of health inequity and evidences that policy change is necessary to reduce the inequity. For example, if the health inequity concern is about unequal health insurance coverage for amputees, an advocacy team would need to gather evidences that such inequity exists for amputees and that policy change is required to help amputees gain fairer health insurance coverage. There are multiple ways to conduct formative research. For example, an advocacy team may conduct key informant interviews to assess the extent of health inequity and the need for advocacy. Key informant interviews involve identifying and interviewing key individuals within a community (Marshall, 1996; Mattson & Hall, 2011). For example, the director of an amputee organization may be a key informant who may be able to provide expert opinion regarding health insurance coverage for amputees. The interview responses from a key informant may be included in advocacy messages to enhance persuasiveness and credibility of messages. Also, interviewing a few key informants may be a time-saving approach to assessing the extent of health inequity and need for advocacy. Although a key informant may provide expert opinions, add to the persuasiveness of advocacy messages, and help an advocacy team save time, an advocacy team should not heavily rely on key informants because informants may have biases or opinions that are not reflective of the opinions held by members within a community. Therefore, the key informant interview approach should be used with caution and in conjunction with interviews with patients or individuals affected by the advocated health issue (Mattson & Lam, 2015). THE HEALTH COMMUNICATION ADVOCACY TOOL: AN APPROACH… 181

Formative research also includes identifying target audiences. These audiences are people who may influence policy change and are thus people that an advocacy team needs to communicate with. There are usually three target audiences—legislators, relevant populations, and the media. Legislators are politicians in charge of specific states or districts and have a role in implementing policy (Bernheim, Rangel, & Rayo, 2006). The support of legislators is crucial because legislators are influential in making policy changes. Relevant populations refer to people who are affected directly or indirectly by the health inequity. For instance, if the health inequity is unequal health insurance coverage for amputees, the people directly affected are amputees and the people indirectly affected may be their caregivers. The support of relevant populations may help amplify the voice of an advocacy campaign. The media are organizations specializing in mass communication of news through platforms such as the radio, television, and the Internet. Having the support of the media may be beneficial because the media may help disseminate campaign information to a wide audience effectively. After identifying target audiences, the team will need to assess the position of these target audiences in regard to the advocated health issue. For example, if the health issue is inequitable insurance coverage, an advocacy team would need to ascertain the extent to which legislators, relevant populations, and the media understand and support (or do not support) the inequitable insurance coverage. An advocacy team may assess the position of target audiences through surveys (see, e.g., Cobanoglu, Warde, & Moreo, 2001), interviews, or focus groups (see, e.g., Lindlof & Taylor, 2011). After establishing the position of target audiences, an advocacy team will proceed to strategize and develop advocacy messages to persuade those audiences to support their campaign.

Messaging Process The messaging process involves using communication theories and concepts to craft effective and persuasive advocacy messages. Although not necessarily exhaustive, messages should be stimulating, motivational, eliminating barriers, culturally consistent, and resource contingent.

Stimulating Messages can be stimulating by incorporating emotional appeals, such as guilt (O’Keefe, 2002), fear (Ruiter, Abraham, & Kok, 2001), or anger appeals (Turner, 2007). Anger, for example, generates 182 C. LAM AND M. MATTSON high levels of energy for defending oneself or one’s loved ones, or for resolving something deemed to be wrong (Nabi, 1999). Thus anger appeals may be relevant and appropriate for advocacy purposes. According to Turner (2007), anger appeals are particularly useful for efforts to change health policies or regulations because anger and strong efficacy can motivate audiences in supporting those efforts. Although emotional appeals may be useful for crafting effective messages, such appeals must be applied tactfully; excessive or inappropriate use of emotional appeals may offend audiences or lead audiences to ignore the message (Coulter, Cotte, & Moore, 1999; Guttman & Salmon, 2004; Witte, 1994).

Besides the use of emotional appeals, messages also may be stimulating by incorporating visual and audio techniques. The use of stimulating imagery and sounds may add to the effectiveness of advocacy messages. For example, according to Bradley, Greenwald, Petry, and Lang (1992), pictures that are perceived as highly arousing may be remembered better than pictures that are less arousing. Also, vivid imagery that is congruent with the theme of a message can assist audiences in processing the message (Smith & Shaffer, 2000). Similar to imagery, stimulating sounds also are remembered better than less stimulating sounds (Bradley & Lang, 2000). Although imagery and sounds may be useful for designing advocacy messages, inappropriate use may compromise messages; for example, the addition of irrelevant sounds may interfere with memory (Banbury, Macken, Tremblay, & Jones, 2001). Thus, like emotional appeals, stimulating imagery and sounds must be tactfully applied.

Motivational Messages that are motivational may spur audiences to take action. Messages can be motivational by emphasizing how the advocated health issue is pertinent to audiences. In contrast, messages that do not convey the threat of a health issue may not motivate audiences to respond to those messages or to further process those messages (Witte, 1994). Messages also may be motivational by including self-disclosure, such as in testimonials. According to Han (2009), self-disclosure may motivate people to participate in a political appeal.

Eliminate Barriers Advocacy messages should eliminate any barriers that may prevent audiences from adopting the recommended course of action embedded in advocacy messages. If audiences do not feel confident in their ability to carry out the recommended course of action, those audiences likely will not THE HEALTH COMMUNICATION ADVOCACY TOOL: AN APPROACH… 183 take action (see Witte, 1992). An advocacy team needs to consider two forms of barriers—internal and external barriers (Allison, Dwyer, & Makin, 1999). Internal barriers refer to disturbances experienced within the individual, such as discomfort, stress, fear, and so on. On the other hand, external barriers refer to environmental circumstances that impede an individual from achieving a certain objective or goal, such as high monetary costs, inaccessible infrastructure, lack of access to technology, and so on. Advocacy messages would need to anticipate and address these potential barriers so that audiences would feel confident adopting a recommended action.

Culturally Consistent Messages also should be culturally consistent so that the messages may capture attention and stimulate information processing (Kreuter & Haughton, 2006). Cultural consistency may be achieved through tailoring, which involves crafting of messages specifically for the needs and preferences of the receiver (Hawkins, Kreuter, Resnicow, Fishbein, & Dijkstra, 2008). Besides tailoring, Kreuter, Lukwago, Bucholtz, Clark, and Sanders-Thompson (2003) posited five other ways through which culture may be incorporated into messages: using peripheral cues, evidence, linguistics, involvement of a constituent, and socioculturally appropriate elements.

Peripheral cues are outside the content of a message see (Petty & Cacioppo, 1984). An example of peripheral cues includes color, which may be perceived differently across different cultural groups (see Chan & Courtney, 2001; Ou, Luo, Woodcock, & Wright, 2004). Culturally consistent evidence involves making specific references to a cultural group (e.g., evidences of inequitable care for a specific ethnic group). Such evidences may compel relevant audiences to contemplate about the issue, decide to take preventive action, and make plans to act (Kreuter et al., 2003). Linguistics refers to the use of language most familiar to a specific cultural group (e.g., Mandarin with Chinese audiences). Involvement of a constituent refers to the direct involvement of a member belonging to a cultural group (e.g., a testimonial from a Malay individual). Socioculturally appropriate elements refer to aspects of social structure that a culture is constructed upon. For example, when communicating with a Hispanic audience, a message should integrate core Hispanic values such as “simpatia,” which is the need for smooth interpersonal relationships as opposed to confrontation (Huerta & Macario, 1999). An advocacy team should be careful not to stereotype when integrating sociocultural elements in messages (see, e.g., Verhaeghen, Aikman, & Van Gulick, 2011). 184 C. LAM AND M. MATTSON

Resource Contingent Advocacy messages should be resource contingent; messages must be developed within the ambit of resources available, such as time, money, and skilled labor (Brady, Verba, & Schlozman, 1995). For example, an advocacy team that has modest financial resources should not splurge extravagantly on promoting issue awareness. As another example, a team without a video editing specialist should consider alternative platforms to video for message dissemination.

Marketing Mix According to Kotler and Zaltman (1971), social marketing refers to the use of marketing skills to generate responses to calls for social action. For example, promoting awareness regarding a health inequity issue may generate support for a health advocacy campaign. The marketing mix comprises elements vital to successful social marketing, and should be taken into account during the development of messages. The marketing mix includes product, promotion, place, and price.

Product Product in the marketing mix refers to the recommended social action and how it is presented to target audiences. In the context of health advocacy, the product would be the notion of supporting an advocacy cause. For example, an advocacy team’s product may be “support insurance parity.” Like tangible products that businesses sell, an advocacy team would need to anticipate audiences’ reactions and market their call to action in a way that would be appealing and persuasive to audiences (Mattson & Lam, 2015). In order to achieve this, an advocacy team may conduct focus group interviews (see Lindlof & Taylor, 2011) to gauge how audiences might react to calls to action in advocacy messages.

Price Price in the marketing mix refers to the cost involved in supporting a social action, including psychological, monetary, energy, and opportunity costs (Kotler & Zaltman, 1971). There are a variety of price concerns that audiences might have; for example, audiences may have psychological concerns such as uncertainty, anxiety, or fear regarding confidentiality. If a call to action involves money (e.g., donations), audiences may be uncertain how the money would be managed and spent. Audiences may be concerned about the physical effort required in supporting a call to action (e.g., rallying). Audiences also may be concerned about the sacrifice of alternative plans (e.g., fun day at the beach) in order to support a call to action (e.g., rallying outside a statehouse). An advocacy team would need to anticipate such price concerns and reassure audiences that the price is minimal or that the advocacy cause is worth the price (Mattson & Lam, 2015). THE HEALTH COMMUNICATION ADVOCACY TOOL: AN APPROACH… 185

Place Place in the marketing mix refers to the channel in which audiences can perform the recommended social action (Kotler & Zaltman, 1971). The channel can be a physical location, such as a petition booth or a rally site, or a nonphysical platform, such as an online petition or social media. Although a physical location is a straightforward channel, there may be some concerns to take into consideration. For example, some audiences may regard the location as too far or inconvenient to go to. Also, a physical location is susceptible to bad weather which can compromise support turnout. Unlike a physical location, a nonphysical platform such as the Internet does not have concerns of travel and weather. Although the Internet is a convenient platform, it has potential concerns too. For example, certain individuals may not favor the use of the Internet for political participation (see, e.g., Xie & Jaeger, 2008) or lack access to the Internet. The use of social media, in particular, may pose a serious concern to advocacy success; “slacktivism,” which is to the willingness to perform a token display of support for a social cause accompanied by a lack of willingness to invest significant effort for meaningful change (Kristofferson, White, & Peloza, 2014), may compromise advocacy success. Slacktivism is prevalent in social media applications such as Facebook. For example, Saving the Children of Africa, a popular cause on Facebook, had over 1.7 million members but only raised about $12,000 (Morozov, 2012). There is also little connection found between Facebook support and online petition signatures (Panagiotopoulos, Sams, Elliman, & Fitzgerald, 2011). In fact, the problem of slacktivism is so pressing that UNICEF Sweden launched a “Likes Don’t Save Lives” campaign to remind people that financial contributions, and not token displays of support, are necessary for helping children in developing nations combat disease (Kristofferson et al., 2014). Given such concerns, an advocacy team may consider limiting the use of social media only for promoting awareness, and use other Internet platforms (e.g., online petition site) as the “place” in the marketing mix.

Promotion Promotion in the marketing mix refers to the way that the product is brought to the attention of audiences (Kotler & Zaltman, 1971). In the context of health advocacy, promotion involves raising awareness about an advocacy effort (Mattson & Lam, 2015). There are various ways that an advocacy team may promote its campaign, including through traditional media (e.g., television, radio, newspaper, pamphlets), new media (e.g., social media, the Internet), or rallying. 186 C. LAM AND M. MATTSON

Pre-test Draft Messages Advocacy messages that are developed should undergo a pre-test. Pre-testing involves an appraisal of advocacy messages and finding out which aspects of the messages work and which do not (Mattson & Lam, 2015). Pre-testing usually is conducted in a focus group setting (see Guest, Namey, & Mitchell, 2013). The feedback from focus group participants allows an advocacy team to anticipate potential responses to its advocacy messages. Accordingly, the team may revise content and stylistic issues in those messages before disseminating those messages to target audiences. Pre-testing is important because it may prevent costly errors (Brown, Lindenberger, & Bryant, 2008; see also McKenna & Williams, 1993). With pre-testing, an advocacy team may circumvent the unnecessarily laborious task of correcting messages after bad or unexpected responses from target audiences (Mattson & Lam, 2015).

Phase 3: Implementation and Evaluation The third phase involves implementing the team’s strategy and disseminating the advocacy messages to target audiences. During this phase, the team will keep track of progress and evaluate the outcome of the campaign. If the team determines that the campaign was successful, the team will end the campaign and inform individuals who may benefit from the policy change. An advocacy team may inform relevant individuals through various means, such as social media, which allows rapid dissemination and exchange of large amounts of information (Lovejoy, Waters, & Saxton, 2012). An advocacy team also may decide to withdraw from further advocacy efforts. This may occur for several reasons, including lacking resources to continue (e.g., Pless, 2007), deciding that a stalemate has been reached and no further action is possible or necessary, deciding that it is not possible to change a policy, or simply withdrawing because they prefer to withdraw. In the event that an advocacy team decides to withdraw from further advocacy efforts, the team also should inform individuals regarding any progress made. It should be stressed that there is always progress to report, even in the face of ostensible loss. For example, the advocacy efforts may have brought about awareness regarding the advocated health issue (e.g., Freudenberg et al., 2009) or the advocacy efforts may be documented for scholars and future advocates to learn from (e.g., Pless, 2007). An advocacy team may determine that their campaign was unsuccessful but decides to continue advocating. In such a scenario, the team will proceed to the Correction Loop. The Correction Loop involves the team THE HEALTH COMMUNICATION ADVOCACY TOOL: AN APPROACH… 187 assessing aspects of the strategy that did not work well. The team will discuss the flaws of the strategy and revise it accordingly. The team will have to return back to the second phase and conduct additional formative research and develop better advocacy messages in line with the revised strategy. The team will continue through the third and fourth phases until the team’s campaign is successful.

Exemplar The following exemplar is based on the personal account of the author of the Health Communication Advocacy Tool (Mattson, 2010). Mattson, whose leg was severed in a motorcycle crash, led an advocacy campaign for prosthetic parity when she realized that access to and affordability of prosthetic limbs was problematic for many amputees. Each phase of the tool is illustrated through the events of her account.

Assemble Team Motivated by two prosthetists, Mattson began her advocacy campaign by assembling a team. Because Mattson is a communication scholar, she intuitively took on the role of the communication specialist. In addition to the two prosthetists, another prosthetist and two amputees were recruited to take on the roles of health issue experts. For community partners, organizations such as Amputees in Action and prosthetic firms were recruited to be involved. Lastly, a lobbyist who had valuable networks and experience in traversing the state legislature was recruited. The team formed the Indiana Amputee Insurance Protection Coalition, and they met once a week for approximately two hours a session to discuss their progress on the campaign as they worked through the Health Communication Advocacy Tool. One of the main responsibilities of the team members was to tap into their networks. For example, the prosthetists were assigned to contact relevant prosthetic organizations to network with their colleagues. This networking was for advocacy and credibility enhancement purposes (Johansen & LeRoux, 2013; e.g., Shaw & Carter, 2007). The networks provided written statements that supported the team’s campaign to implement a law regarding prosthetic access. Also, fundraising was necessary for the team to pay for the services of the lobbyist. The team approached prosthetic firms to solicit funds via letters and telephone calls which 188 C. LAM AND M. MATTSON addressed three fundamental concerns: why the team needed funding; what the team would do with the funding; and how their campaign would benefit the firms (i.e., their clients may be able to afford prosthetic limbs). Although the advocacy team suggested that the prosthetic firms could advertise through the campaigns in exchange for funding, none of the firms wanted to advertise. Through persistent following up with approximately 15 firms, the team collected more than $10,000, which was sufficient for hiring the lobbyist. The donations varied from $100 to $1200. Eventually the team was fully equipped with human resources, financial investment, and a credible campaign strategy.

Formative Research and Message Development The target audiences for the team’s advocacy effort were state legislators, amputees and their caregivers, prosthetic firms, and the local media, which included radio, television, and newspaper organizations. It was through e-mail, phone, and face-to-face communication that the team ascertained the needs of the target audiences. The team determined that legislators knew little about concerns regarding prosthetic access, and therefore addressed this need for information when the lobbyist arranged meetings with the legislators. Through networking with prosthetic firms and prosthetists, the team was able to contact local amputees and their caregivers, who had a need to know how to be involved in the advocacy effort. Accordingly, the team provided instructions on how to sign petitions and details regarding rallying at the statehouse, which were instrumental methods that advanced their campaign (see also Madestam, Shoag, Veuger, & Yanagizawa-Drott, 2013). The local media was reached throughout the state by networking. Interestingly, the media was eager to provide coverage, and there was no need for the advocacy team to pay for publicity. The media was largely unaware of prosthetic access issues which required the team to elucidate the problem concerning prosthetic access and affordability. Additionally, the media wanted visuals, and requested to videotape and interview amputees with serious conditions, such as a boy who is a bilateral (i.e., double) amputee. Though sensationalistic, the advocacy team realized the necessity of such exposure to advance the cause. In addition to media coverage, the primary modes of communication used by the team were phone calls, e-mails, and face-to-face interactions. THE HEALTH COMMUNICATION ADVOCACY TOOL: AN APPROACH… 189

Implementation and Evaluation The advocacy team implemented its campaign strategy and closely moni- tored progress, such as tracking the number of media hits and legislative votes. After a period of time and several votes, the bill requiring insurance companies to cover prosthetics was passed and prosthetic parity became law in Indiana. Since then, the Federal Prosthetic and Custom Orthotic Parity Act (S. 3223) has been introduced in the US Senate. The advocacy effort was thus successful and achieved the team’s objective of addressing the health inequity that amputees faced.

Discussion Health inequity is a global problem that is prevalent between people of different race, gender, socio-economic status, and education, among others. Health advocacy is an approach that may bring about the necessary social changes to address health inequity. The Health Communication Advocacy Tool provides a systematic approach to navigating through an advocacy process. One may consider other tools or models to guide one through an advocacy process, but the Health Communication Advocacy Tool stands out because it has been effective in practice (see, e.g., Mattson, 2010). However, the Health Communication Advocacy Tool has some limitations. Thus far, the tool’s effectiveness has been limited to advocacy for prosthetic parity. Therefore, its effectiveness for other health inequity issues is yet to be tested, and may be an avenue for future studies to explore. However, since the tool is not issue specific, it should be effective for other health inequity issues as well. Another possible limitation of the tool is in the measurement of “success.” Whether an advocacy campaign is successful or not depends largely on subjective interpretation (Mattson & Lam, 2015). For example, in 1972, advocacy groups campaigned against smoking in airplanes, resulting in an implementation of separate sections for smokers and nonsmokers (Holm & Davies, 2004); while this implementation could have been considered a success, the advocacy groups could have interpreted it as not yet successful and push for more changes (which they did). Therefore, there is no one fixed concept of “success.” That is not to say, however, that there is no way to gauge how successful a campaign is; one useful approach would be to compare an advocacy result with the team’s initial position statement. If the advocacy result is similar to the position statement, the 190 C. LAM AND M. MATTSON campaign was successful, and vice versa. To illustrate, the National African American Tobacco Prevention Network initiated an effort in 2004 to abolish Kool (i.e., position statement), a flavored cigarette that targeted African American youth. Eventually, the network abolished Kool and was awarded $1.4 million in a legal settlement (i.e., advocacy result) (Freudenberg, Bradley, & Serrano, 2009). In this illustration, the result was consistent with the position statement, and therefore the campaign was successful. While measuring success across campaigns may be difficult because there is no fixed concept of success, ascertaining the success of an individual campaign is relatively straightforward. Given that health inequity still is a pervasive problem in society, it behooves organizations and individuals to work toward addressing health inequity. Health advocacy is one approach that may bring about the necessary social changes to address health inequity. The Health Communication Advocacy Tool offers advocates structure and confidence going forward in advancing change to health inequity concerns that—as can be observed globally—are increasingly pressing.

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Self-Reflexivity in DevCom Research: An Autoethnography

Rikki Lee B. Mendiola and Pamela A. Custodio

Two years ago, we attempted to surface an indigenous presence in the public sphere of the mining discourse in the context of the Alangan Mangyan tribe. Using Habermas’ concept of public sphere as lens, it assumes that its presence is communicatively constructed in the Mangyan community’s participation in the mining discourse (Mendiola, 2013).

Rikki Lee B. Mendiola is University Extension Specialist I at the College of Development Communication, UPLB. Graduated from the University of the Philippines Los Baños (UPLB) with a degree of Bachelor of Science in Development Communication in 2014, currently pursuing her Masters in Information Technology in UPLB. The author specializes in the production of Information, Education, and Communication materials, with research interests in qualitative research and critical studies. Pamela A. Custodio is Assistant Professor at the College of Development Communication. She finished Bachelor of Science in Agriculture then pursued MS and PhD in Development Communication in UPLB. She teaches participatory community journalism, communication theory, and qualitative communication research.

R. L. B. Mendiola • P. A. Custodio (*) College of Development Communication, The University of the Philippines Los Baños, Los Baños, Philippines e-mail: [email protected]; [email protected]

This article relives the research moments and reflects upon them by looking back from a distance of two years ago, through the autoethnographic voice of the first author. This is a recounting of a field experience while collecting data for an undergraduate study. This time, we attempt to reflect upon the research process in the hopes of gaining theoretical understanding in DevCom— the value of dialogue in the field as an embodiment of participation, the place of reflexivity in its theory and praxis, and critical studies as a potential branch in its research arena. From the practical experience of a qualitative researcher in the field, we attempt to draw theoretical and methodological implications in DevCom research. Though this is a product of dialogic encounters between co-equals, the mentor and mentee, from here on, the voice of the first author is privileged, represented in italics when she directly speaks of her experiences. This reflection began when our research, which this chapter came out of, was presented in a national communication research conference. The research made it to the competition and was shortlisted for final presentation. Given 12 minutes to present, I recounted the essence of this research—as an observer-participant, I narrated the indigenous people’s (IP) community engagements in the mining discourse. I ended with the tentative nature of my inquiry: that development is a continuous struggle to be recognized in the public arena, and the meaning of development as an iterative conversation. In the intensive eight-minute question and answer portion, one question led me to start my reflection on the discipline of development communication. The head of the panel asked, as I take another deep calming breath, “Development communication is very beautiful, especially how you presented it. I saw the importance. However, aren’t you afraid DevCom will be a homogenizing agent?” I smiled as I remembered the conversation I had with a research buddy on the bus ride home from our first field work—back to the moment I realized we were never going to save the world. Quebral (1988) claims that development communication, given its definition,1 is uniquely a Third World phenomenon. Further, Quebral (1988) mentioned that “development communication is no transplant”

1 Development communication is “the art and science of human communication applied to the speedy transformation of a country and the mass of its people from poverty to a dynamic state of economic growth that makes possible greater social equality and the larger fulfillment of human potential” (Quebral,1971 as cited in Quebral, 1988). SELF-REFLEXIVITY IN DEVCOM RESEARCH: AN AUTOETHNOGRAPHY 199 and emphasizes the responsibility of a development communicator to explore its dimensions, cultivate it, and use it (p.148). Thirty years after, this chapter is a long-overdue answer to her call. This is a reflection incited by uncomfortable realities that permeated the discipline we study and practice, however careful I was that these did not become just solipsistic musings brought about by the follies of my youth. To learn the other through the self and consequently the self through the other is a crucial part of reflexivity in qualitative research; to consciously observe ourselves observing, think beyond the reasons of our actions, words, and thoughts, and analyze our complex relationship with ourselves (Ellis and Bochner 2000, 2003; Finlay, 2002). This chapter aims to reconstruct the research moments in our 2013 inquiry on the Alangan Mangyan public sphere and critically reflect upon the role of self-reflexivity in the research process, guided by the principles of Gabriel Marcel’s (n.d.) primary and secondary reflection (Dy,1991 ). Through autoethnography, we shall attempt to reverberate the defining moments of our development communication research and how critical self-examination redefined us as communication scholars. The autoethnographic accounting was done by the first author, the analyses and tentative conclusions were derived through dialogic encounters between authors, invoking a mentor-mentee relationship and a conversation between equals. Development Communication (DevCom) started with economic growth as the ideal state to achieve social equality and fulfillment of individual potential. However, the failed promises of modernization caused shifts in paradigms of development and have continuously evolved to an “integrated participatory development” for an inclusive long-term sustainable development, and other considerations in-between (Quebral, 2012).

Confronting the Self Through the Other: Reflecting on Vulnerability Reflective research has two basic characteristics according to Alvesson and Skoldberg (2000): careful interpretation and reflection. According to Marcel (Dy, 1991, p. 3), reflection is a personal act linked to personal experience, called for because something valuable is at stake, and only comes after a certain break in the daily routine of life. In the context of empirical research, Alvesson and Skoldberg (2009) define reflection as 200 R. L. B. MENDIOLA AND P. A. CUSTODIO

“the interpretation of interpretation and the launching of critical self- exploration of one’s own interpretation of empirical material” (p. 6); various basic dimensions behind and in the work of interpretation, by means of which this can be qualified, are always considered. Knowledge and the knower are one and therefore cannot be separated (Steedman, in Alvesson and Skoldberg, 2000). Dy (1991) emphasized the oneness of reflection and experience as an active participation in the other. In the context of qualitative research, the researcher is an instrument of the inquiry; however, continuous reflection is needed to protect the danger in privileging one’s own voice—“the precondition of any objectivity, of all scientific knowledge of the body” (Dy,1991 , p. 21).

Autoethnography Autoethnography can “radically alter an individual’s perception of the past, inform their present, and reshape their future if they are aware and open to the transformative effects. Much of the process of autoethnography revolves around the idea of time and space” (Custer, 2014, p. 2). Custer (2014) identifies seven lenses in autoethnography: (1) changes time, (2) requires vulnerability, (3) fosters empathy, (4) embodies creativity and innovation, (5) eliminates boundaries, (6) invites and honors subjectivity, and (7) provides therapeutic benefits. Exercising reflection means “interpreting one’s own interpretations, looking at one’s own perspectives from other perspectives, and turning a self-critical eye onto one’s own authority as interpreter and author” (Alvesson and Skoldberg, 2000, p. vii). Marcel (Dy, 1991) differentiates primary and secondary reflection through reflecting on our identity: primary reflection “dissolves the unity of original experience” (p. 9) like inputting your identification details in a form (e.g. name, birthday, gender, etc.), while secondary reflection “recuperates the unity of the original experience” (p. 9) like questioning the self being identified in several incoherent haphazard categories. Autoethnography is “the embodiment of ‘the human intertextuality of existence’ because someone had the courage to be vulnerable – first with themselves and eventually with others” (Custer, 2014). I had to confront a two- years-ago version of myself as a researcher, opening up myself to scrutiny and uncomfortable musings. SELF-REFLEXIVITY IN DEVCOM RESEARCH: AN AUTOETHNOGRAPHY 201

Development Communication Praxis Through the Years: The Los Baños School From a simple economic utopia as the basis for development in the 1950s, it became a complex play of multiple factors and yardsticks that constitutes development. In this paradigm shift, the practice of DevCom evolved through the years. Waisbord (2001) cites two broad approaches in development communication in the 1960s: diffusion theories mainly based on the premises of modernization and a participatory view of communication. DevCom is a convergence of two key concepts in any given environment: development and communication. Development is considered the more important concept, communication being the vehicle to forward development progress (Quebral, 2012). DevCom plays a key role in my foundation as a communication scholar. I rooted my study in the 2012 definition of DevCom by Nora C. Quebral, considered the pioneer of development communication: “the science of human communication linked to the transitioning of communities from poverty in all its forms to a dynamic, overall growth that fosters equity and the unfolding of individual potential” (Quebral, 2012, p. 3). I constantly reflect upon its definition as I try to find my way in the analysis of 2013 inquiry— rediscovering its meaning, as a development communication student and researcher, in my own research journey was an essential part of my inquiry. DevCom research finds its beginning in the cybernetics and socio- psychological communication traditions—analyzing systems, behavioral correlations, and measuring knowledge attitudes and practices. Quebral (1988) mentioned the two dominant schools of thought in DevCom research: information transfer and socio-political view of development. As a relatively young field of communication, DevCom has a predominantly quantitative research practice focused on behavioral change—qualitative research is a rare pursuit of inquiry. However, there is an increasing number of students, both graduate and undergraduate, who are exploring qualitative research in the socio-cultural, critical, and phenomenological traditions.

Problematizing Public Sphere: The Alangan Mangyan Enclaved Public Habermas (1989) first coined the term public sphere, defined as “conceived above all as the sphere of private people come together as a public; they soon claimed the public sphere regulated from above against the public 202 R. L. B. MENDIOLA AND P. A. CUSTODIO authorities themselves, to engage them in a debate over the general rules governing relations in the basically privatized but publicly relevant sphere of commodity exchange and social labor” (p.27). The conception of the public sphere clearly marks a separation between private and public—the affairs of the households and work (where private interests are of priority) and the state (which is assumed to be a structure of power and exerts domination) come together and are mediated in the public sphere. However, as years come by, the corporations were increasing its influence in the decision making of the issues of public concern; it was no longer just a demarcation between the public and private. Dalhberg enumerates six Habermasian conditions that constitute a public sphere: (1) thematization and reasoned critique of problematic validity claims Argumentation, (2) reflexivity, (3) ideal role-taking, (4) sincerity, (5) formal and discursive equality, and (6) autonomy from state and corporate power. The public sphere, then, should be a venue for a rational debate on the concerns of the public and the one that can direct its force and influence to the state and corporations. It is also a venue of freedom of speech— every actor has an equal chance to engage in expression and debate. The six Habermasian conditions, however, are met with criticism for their too ideal conception: the question of their existence in reality. Habermas also emphasized it as the public sphere—excluding the idea of multiple public spheres. This calls into question the difference between its theoretical conception and the actual representation that may be far from existing participatory involvement and freedom from power—thus Keane’s (1995) proposed theory of multiple subaltern public spheres consisting of three components: space, communication structure, and public opinion.

(Re)evaluating the Role of Dialogue in Participation Bochner (in Ellis and Bochner, 2000) said in his lecture, “So it’s important to get exposed to local stories that bring us into worlds of experience that are unknown to us, show us the concrete details of people whose lives have been underrepresented or not represented at all, help us reduce their marginalization, show us how partial and situated our understanding of the world is.” These stories represent the various instances where dialogue instilled fear, relied on trust in authority, and fostered silence. SELF-REFLEXIVITY IN DEVCOM RESEARCH: AN AUTOETHNOGRAPHY 203

Fear in Association: The Story of Kap Malakas He was the first person we needed to meet to start our study. Kap Malakas2 was the barangay captain, part of the group of contemporary leaders in the area. He is very soft spoken, oftentimes he is unintelligible. He is meek but he does not shy away from speaking his mind when asked. He gave us permission to conduct our interviews around the community. His house was near the center of the community—beside the community hall, basketball court, and the paved road. We talked outside his house. There was a makeshift bench outside the hut meant for entertaining visitors. In the middle of our conversation, he worked up the courage to ask the question that seemed to bother him since we started talking about mining. “Madam, may I just ask, those questions about mining, is it really part of your interview?” “Yes, it is included,” I answered. I was caught unaware of his inquiry. He stared at me intently and said, “Every time mining is mentioned… we become afraid whenever we hear it.” “Oh no, it is really included in my study. I’m not one of them,” I said trying to assure him that I am not a minion of the mining corporations. His fears were justified. According to his recollection, Mapinsala3 Corporation tried to invade the community two times—each time trying to forge a friendship and offering the community members jobs and scholarships for their children. Each time, the community presented a united front not to let the invaders in. They said they were defending the future of their children. He tried to share the collective fear the community has on mining. “Because here… in our minds, almost every one of us. If mining is just mentioned, it seems there is an intention to go on with the mining operations,” he said. It took me over a second to wrap my head around his sentiment. I was at loss of what to say. I have no idea what to say to convince him of my innocence. All throughout our conversation, he did not mention his concern over my alleged association with Mapinsala. At the end of our first encounter, he asked us if we could share something with the community—clothes, food, and other basic needs. We left his house with a promise of bringing them the best we can procure in a span of two days.

2 A pseudonym. Malakas, in Tagalog, means strong. 3 A pseudonym. Mapinsala, in Tagalog, means dangerous. 204 R. L. B. MENDIOLA AND P. A. CUSTODIO

With a few extra hundred pesos in our pockets, we agonized on what we could give the community that suited our means. Throughout my data gathering session, I tried to reconstruct the community meeting they had with Mapinsala Corporation, the mining company that tried to invade their community. Kap Malakas’ rendition is one of the most detailed. His fearful question came after my insistent questions on the happenings in the community meetings involving the mining company. In their previous associations with others through dialogue, the relation of causa- tion on the biophysical aspect was continuously discussed and established as the dominant reason to resist the mining exploitation. Through interactions with external actors beyond the tribal community, the community members were exposed to the biophysical discourse of the mining industry. In their experience in the Mapinsala meeting and their knowledge on the matter, my very presence triggered a fearful response—my alleged association may bring about change. This led me to ask myself—even with the detailed recollection he has shared with me, did he disclose himself fully with me?

On Authority and “Learned Helplessness:” The Story of Lider Palay I met him when we were being introduced around the community. Lider Palay4 welcomed us with a smile. He is in his early 40s, a farmer, and leader of the farmer cooperative. He asked us to come by his house late in the afternoon. He welcomed us warmly in his house. Of all the tribe members I have spoken with, Lider Palay was the most accommodating of all. He told stories beyond what we asked for. He would smile, joke, and laugh with us. We did not feel like outsiders. Like all my participants, I asked him of his participation in community gatherings. “In the assembly, do you speak up?” His answer was not I expected it to be. “No I don’t. The governing body is already there, they will speak for us,” he said. I followed up on it. “They will be the one in charge?” “Yes, for what should be said and what is right and just,” telling us that they rely on authority to voice out concerns of the community. His answer baffled me. As a leader, I thought he was passionate in expressing what he thinks in any venue he was in. I was expecting an answer, a proactive one different from other participants. Before we left, he said some-

4 A pseudonym. Palay, in Tagalog, means rice. SELF-REFLEXIVITY IN DEVCOM RESEARCH: AN AUTOETHNOGRAPHY 205 thing that tickled my mind to think about marginalized communities, if I may classify them as one. “Come back here when you graduate and become successful. We need help. The community needs help. You are intelligent and I know you will be successful someday. We need people like you. Do not forget us.” Two years have passed. I have not visited the community since then. Guilt overcomes my whole being as I retell this moment with Lider Palay. It takes me back to another moment, more than a year after this request has been made, when a student asked me what my undergraduate thesis did to help my Alangan Mangyan community. Lider Palay surprised me the most—despite being a leader, he surrendered his place in the conversation by entrusting the leaders on the authority of what is right and just for the whole tribe. Even with their shared experiences on “engaging” community consultation, if I may describe it as one, they have varying levels of public membership: visibility, presence, and action. Lider Palay, however, did not transcend to the highest level of public membership— he is aware of the issues, but refuses to speak out for himself. This led me to question how open the dialogue is for the communities—does the indigenous presence of the public sphere (barely a member of the mainstream public sphere) foster the spirit of participation or unconsciously impose silence on mere members?

Resistance in Silence: The Story of Makahiya We found her on the last day of our data gathering session. Makahiya,5 as we dubbed her because of her meekness, was sitting on her front porch with her family. We approached her and introduced ourselves. She is in her late 40s, a barangay nutrition scholar, and a maid. She was kind enough to entertain us. As we talked to her, I noticed she fumbles with her hand and stares down as she answers her questions. Makahiya is reserved, hence her pseudonym—she shies away from us when we probe deeper to her answers. But behind her constant short answers and reservations in elaborating her thoughts, she seems to express her beliefs in a firm manner. Maybe the reason she is not willing to reveal more was because I was an outsider, an unfamiliar presence in the community. Fighting my assump-

5 A pseudonym. Makahiya, in Tagalog, is a plant has that leaves fold inward or droop when touched. 206 R. L. B. MENDIOLA AND P. A. CUSTODIO tions, I wanted to ask if she participates in community meetings through expressing what she thinks. “If there is a public assembly, do you speak your mind there?” “No.” She refuses to tell more voluntarily. “No?” as I tried to explore the reason without pushing it. “No. I just listen.” “Why is that?” Silence met my follow-up question. She continues to fumble with her hands as she tries to phrase her answer. “I just say the things I want to happen to the barangay captain.” “Why not in the assembly?” I noticed that every time I tried to ask her questions, she would muster up courage to express herself. “I’m shy,” she finally said. “You’re shy? Do you think you are heard when you speak?” “I think that’s why I’m shy, they will not…” her voice trails away, trying to find the right words. I tried to help her get there. “Listen to you?” “Mmm mmm,” while she nods yes. Her timidness frustrated me. She sheltered more of herself than what she revealed. Our gap was evident. For a novice qualitative researcher, my first reaction to this lack of response is a “dry” data. I was afraid it will get me nowhere. By the time I confronted my data countless times, my frustration at Makahiya’s silence faded away—I began to celebrate it. I began to reflect on the meaning of her reservation and silence. Her lack of response constantly haunts and frustrates me as a researcher. After constant reflections, I realized a change in the shift of focus—instead of just being frustrated about her silence, I began to ask why. It led me to consciously think about who I am—not only in the context of how I knew myself, but as how they are affected by my identity.

(Re)building the Self: Situating the “I” Who are “we”? Who am I? This was the question dwelled on as I completed the study. Before this, I never consciously criticized my own being in the context of someone else’s environment. I never inquired in defining “I” in varied relationships with myself, and “I” in the context of a distant self. Through my journey in this inquiry, I began to wonder who am I to myself and who am I to them in the context of my dialogue with them. In our con- SELF-REFLEXIVITY IN DEVCOM RESEARCH: AN AUTOETHNOGRAPHY 207 versations, I was able to discover and reflect upon the self—broken down into categories, and unified again. I am a Tagalog. This was the most important piece of my identity that I dwelt on. A history of discrimination and degradation has been experienced by the Mangyan tribes from the Tagalog community. They were ridiculed for being different, poor, and physical characteristics deemed unappealing. This cycle of discrimination was distant from me until I realized I was part of the group that endlessly put them down. It was the first time I paused and thought, reflected upon my regional identity. I was a foreigner on their territory; I was not a resident of Mindoro. This already gave me a fear of the possibility that I might have difficulties in establishing rapport with the community members. As a Tagalog, I might be unconsciously hindering my participants in expressing themselves freely— “My mere presence could render them fearful, offended, angry or uneasy” (Mendiola, 2013). I fear that my participants will find it hard to be comfortable with me and disclose what they really had in mind. I am a novice qualitative researcher. It was the first time I was going to conduct a qualitative research. Even with countless warnings I was given when I was still making up my mind, I went through with the road less traveled—they were right, the qualitative jungle swallowed me up, but I emerged a survivor. At times, I became frustrated at my data that seemed so bland and unappealing—I was already having a hard time finding the right questions, the right follow-ups to surface the concept I was studying. Oftentimes, I am close to pulling out my hair in making sense of the data at hand. I struggled at the concepts—balancing between keeping myself at bay against my own biases, my own anticipations, my preconceived notions, and being guided by theoretical assumptions and the qualitative practice. I experienced intense internal struggle in trying to make sense of everything I had at hand—a thousand tiny little pieces of an unknown picture. I am a development communicator. And for that, I will always be biased. I will always be on the side of development—but what development means is an endless journey of discovering its purpose. Who does it serve? What is its end game? I always thought that I was more logical and knowledgeable in telling the beneficiaries, “This is what you need.” Maybe I am just a facilitator trying to surface what they really need. They are the only ones who can exactly say what they need. I realized that each piece of my identity corresponds to my reflection on power and dialogue. I was not aware of it before I went to the field, I never noticed that my identity may be exuding and imposing an order that I am not aware of. 208 R. L. B. MENDIOLA AND P. A. CUSTODIO

The Place of Reflexivity in DevCom Research When I was in college, I used to pass by this bulletin board that says, “the voice of the voiceless.” I remember feeling proud of being that voice, it gave me a higher sense of purpose. I remember being elated because of the recognition given to seemingly defenders of the poor and marginalized. Privileging the self as the overall orchestrator seems to overestimate the importance of the researcher in the process of the inquiry—a pitfall any qualitative researcher may have. As the research went on, I began to question the role of DevCom in marginalized communities—did we set the box to categorize someone as marginalized, and who are we to set such standards and qualification? How do we now deal with multiple worldviews? Traveling to our research site takes at least two hours from the town proper. Taking a jeep first with a designated time of departure, then arriving at the shed where we should start on foot. Walking under the scorching heat to reach our site carrying heavy bags, I always thought it was the hardest part of my research I ever had to endure. While surpassing physical limitations of carrying kilos of bags on foot to reach a community is hard, confronting my position as an outsider and a researcher was an internal struggle I had to reconcile. I was there, as a researcher, on my own accord because I needed to achieve something: a thesis for a college degree. For all development projects, interventions, and inquiries, the question “why I am here?” is an important point of reflection. Claiming the authority on a particular inquiry can lead to a danger of forgetting our situatedness in the inquiry. The innate Messiah complex triggered by a deep concern with helping others can be a double-edged sword—while it fosters sincerity to help the needy, to declare what they need without consultation and open dialogue might lead to a solution that they do not really need, to place authority on us as “experts” of development to prescribe the cure to their problem. In an untold story of an elder in the community, he told us in a brief encounter how, after a “development intervention,” they realized they were poor and started dreaming of the Tagalog utopia. Because of this untold story in my manuscript, it kicked off my introspection of the purpose of DevCom in different situations and worldviews. In 2012, Manyozo wrote, “This postcolonist autoethnographic orality uses personal experiences as a theoretical tool for explaining that in development thinking” (p. 225). Acknowledging we, as development experts, are SELF-REFLEXIVITY IN DEVCOM RESEARCH: AN AUTOETHNOGRAPHY 209 illegitimate representatives of the community because we are “ideologically distant from local people, knowledge, and places” (Manyozo, 2012). It calls into question our legitimacy as authorities of development. Reflexivity in DevCom research is being vulnerable by laying down your arms and rethinking our places in this community—do they a need a voice to speak for them, or do they need to be heard?

Exploring Critical Studies in DevCom Research In 1988, Quebral warned against the uncritical acceptance of foreign con- ceptions of development and replicating it without context. Going back to the basics: Quebral said, “Development literature has had the answer for quite a while now: people.” The heart of development is always with the people. To commune with them as we communicate is being vulnerable and humbled by their plight, to acknowledge that we do not always know better. We, as development communicators, should always be wary that development is a conflict over representation, over the instruments and discourses of that representation. Representation is a conflict of power. To empower means there is someone who will be disempowered in the process, and choosing the voice we privilege. Koivisto and Valiverronnen (1997) said, “The distinctions between ‘public’ and ‘private’ are not natural but socially and culturally constructed; what counts as a public matter is always a question of political negotiation and struggle” (p.24). Development is deeply embedded in political and economic conflicts, not simply a linear process to one definite goal.

Conclusion I was invited to share my research in an undergraduate communication theory class. There was one question I would never forget: “What is the direct effect of your thesis to your participants? Did it help them?” It was a very simple and practical question, one that I had a hard time to even think of an answer. “No, there is no direct effect on the participants. I was hoping it would indirectly affect them in the long run. My thesis was not meant to help them directly, it was meant to contribute to the understanding of devcom. It was meant to be part of a greater understanding and make a theoretical contribution in our field.” 210 R. L. B. MENDIOLA AND P. A. CUSTODIO

Her question provoked me to reflect on the purpose of this research. Was it really enough to contribute theoretical understanding, or was it too much to ask to have both purposes? In the end, when does the story of an inquiry stop? We find solace in revisiting Quebral’s work (1988): the discipline is “falling behind in letting research inform practice and in transmuting knowledge from knowledge” (p. 11). In pursuit of extending theoretical contributions to the field of DevCom, we lay down a work in progress, a tentative reflection on the role of self-reflexivity in DevCom research. Over time, as we engage in more discussion and unstructured encounters, we come to reveal more of ourselves as we learn with the other. In the murky waters in which the DevCom theory stands, we invite you to join us to (re)construct the potential of reflexivity in the field. Going back to the question the head of the panel in research conference asked, my answer is, and always will be, a work in progress. As a researcher, development communication is a tentative, on-going project. “I remember this analogy I told my research buddy about a fictional character contracting a disease after being vaccinated. It turns out, his immune system was already weak because of a cancer in remission. Instead of protecting him from the disease, it killed him. Maybe DevCom should be wary about that, in a way, we may be spreading the poverty disease. We should always be critical to the dangers of our own self-deception, to not just be critical of others, but also ourselves. To always question where we stand, and who we are now. Because of this research, I learned to be reflective, to not always take things as it is, but look deeper and ask uncomfortable questions. Maybe what we insist they need is not what is really necessary for them. The only guard to homogeneity that can be perpetuated by DevCom is continuous critical reflection on the dangers of its self-deception.” For the question will always be a reminder—as a development communicator, have we forgotten where we are situated?

References Alvesson, M. & K. Skoldberg (2000). Reflexive Methodology: New Vistas for Qualitative Research. London: Sage Publications, Inc. Alvesson, M., & Skoldberg, K. (2009). Reflexive methodology: New vistas for qualitative research (Second Ed.). London: Sage Publications, Inc. Custer, D. (2014). Autoethnography as a Transformative Research Method. The Qualitative Report, 19, 1–13. SELF-REFLEXIVITY IN DEVCOM RESEARCH: AN AUTOETHNOGRAPHY 211

Dy, M. B. (ed.) (1991). Phenomenological Papers: A Supplement to Philosophy of Man, Selected Readings. Office of Research and Publications, Ateneo De Manila University. Ellis, C. and A. Bochner. (2000). ‘Autoethnography, Personal Narrative, Reflexivity: Researcher as Subject’.Handbook Of Qualitative Research. N. Denzin and Y. Lincoln. 2nd ed. Thousand Oaks, California: SAGE Publications, 2000. 733–768. Ellis, C., & Bochner, A. P. (2003). Autoethnography, personal narratives, reflexivity: Researcher as subject. Collecting and Interpreting Qualitative Materials, (July 2015), 199–258. Finlay, L. (2002). Negotiating the swamp: The opportunity and challenge of reflexivity in research practice.Qualitative Research, 2(2), 209–230. doi:https://doi.org/10.1177/146879410200200205 Habermas, J. (1989). The Structural Transformation of the Public Sphere: An Inquiry into a Category of Bourgeois Society, translated by T Burger with F Lawrence. Cambridge: Polity Press. Keane, J. (1995). Structural transformations of the public sphere. The Communication Review Vol 1(1). Malaysia: Overseas Publishers Association. Koivisto, J., & Väliverronen, E. (1997). Resurgence of the critical theories of public sphere. Journal of Communication Inquiry (1996), 20(2). Manyozo, L. (2012). Media, Communication, and Development: Three Approaches. New Delhi: SAGE Publications India Pvt. Ltd. Mendiola, R (2013). ‘Exploring the Notions of an Indigenous Presence in the Public Sphere of Mining Discourse: The Alangan Mangyan’s Enclaved Public’. Undergraduate. University of the Philippines Los Baños. Quebral, N. C. (1971). Development Communication in the Agricultural Context. Lecture delivered at the “In Search of Breakthroughs in Agricultural Development”, Los Baños, December 1971. Quebral, NC. (1988). Development Communication. Los Baños, Laguna: University of the Philippines Los Baños. Quebral, NC. (2012). Development Communication Primer. Southbound Sdn. Bhd: Penang, Malaysia. Waisbord, S. (2001). Family Tree of Theories, Methodologies and Strategies in Development Communication. The Rockefeller Foundation. CHAPTER 11

Participatory Communication and Extension for Indigenous Farmers: Empowering Local Paddy Rice Growers in East Java

Edi Dwi Cahyono

Participatory Communication/Extension for Social Change Communication is seen as a “key in human development” (UNDP, 1994), and it binds individuals for executing development programs (Fraser, & Villet, 1994) or a social change. For this reason, communication must be the center of development, as stated in the 2004 plenary session of the 9th UN Roundtable on Communication for Sustainable Development in Rome (The Communication Initiative, 2007). Specifically, communication is a process “to develop awareness and trust, to coordinate dialogue and information, to inform and empower, and to stimulate citizen action” (p. 75). For agricultural development, communication is central to exchange information and provide meaningful relation between agents or facilitators of development, farmers, and other stakeholders. Different communication approaches would lead to different effects on people. Two different communication approaches—diffusion and participation-based communication—were discussed in the 2004 Rome

E. D. Cahyono (*) Socio-Economic Department, Faculty of Agriculture, University of Brawijaya, Malang, Indonesia

Round Table (United Nations Educational, Cultural and Scientific Organization [UNESCO], 2007). Diffusion of innovations theory assumes that innovations are always good, which is known as pro- innovation bias. In the case of a rejection, it is presumed the problems are in the users and not the innovation agencies (such as governments or private companies); the users are often labeled as passive, incompetent, or less innovative (Rogers, 2003). In the diffusion approach, communication is seen as a linear way to change people. It is a “tool for generating and disseminating content of development messages” (UNESCO, 2007, p. 25), suggesting passive activities of the information receivers. The communication is also perceived as in the “outside of the design and implementation of project” (p. 25), indicating that communication is not embedded in each step of development processes. For these reasons, mass media is assumed to be a powerful channel to convey messages (United Nations Development Programme [UNDP], 2011), reflecting a top-down approach. This approach is criticized because individuals’ needs are often ignored and it causes gaps among communication participants (FAO Expert Consultation on Communication for Rural Development [FAO ECCRD], 2011). Other criticisms are: bias toward elites (Boon, 2009); the innovation is impractical/irrelevant (Van Clay & Lawrence, 1995) and may put local community at the risk of loss of security and meaning (Fougère & Harding, 2012, p. 26); and it may ignore social consequences (Vanclay & Lawrence, 1995). Linear communication approaches led to the alienation of indigenous communities from the ideas of development agencies; the community does not have control over the planning of development programs; and the approach undermines indigenous wisdom (beliefs, knowledge, practices, social life). These critiques are in line with the MacBride Report (MacBride, 1980) and the World Report Towards Knowledge Societies (UNESCO, 2005). Therefore, the linear communication approach may have limited impacts on community empowerment. In community development, as social change efforts, the communication approach needs to be two-way (interactive); it is commonly called participatory communication. This is an anticlimax of the approach to diffusion of communication that is top-down (linear). In participatory communication, individuals are seen “as the nucleus of development” (Servaes & Malikhao, 2005, p. 98). Through a participatory communication approach, someone has power to participate fully in the process of social changes. As stated by the Fogo Process activist, Donald Snowden: PARTICIPATORY COMMUNICATION AND EXTENSION FOR INDIGENOUS… 215

“The core of all development is empowerment, and the key to empowerment is communication” (The Communication Initiative, 2007, Executive Summary, p. xxix; UNDP, 2011, p. 2). Accordingly, two-way communication leads to empowerment, and empowerment of individuals causes participation in development programs. In other words, two-way communication and participation is like “two sides of the same coin” (FAO ECCRD, 2011, p. 2). To review, the idea of participatory communication is rooted in the report on the 1980 Commission on the Study of Communication Problems (MacBride Report):

Communication is basic individual and collective right… should be decen- tralized to provide greater direct participation, there should be greater attention to the needs and rights of minorities and less powerful groups. (UNESCO, 1980; White, 1999, p. 253)

Thus, the report urges the need to distribute power in the process of communication. Participatory communication enables individuals, as the participants of development, to be aware of rights and duties; it is a fundamental way for “conscientization,” to release them from outsiders’ domination (Freire, 2005). In another discourse, the 1980 UNESCO meeting in Belgrade proposed that participatory communication deals with wider access to media, participation (higher level of involvement in communication systems), and self-management (ability to decide, formulate plans and policies) (Servaes & Malikhao, 2005). Other institutions suggest the role of participatory communication to enable individuals to share knowledge (FAO ECCRD, 2011); increase their ability to identify and analyze problems; plan and implement projects based on their needs and context (such as knowledge, values, and culture) (The Communication Initiative, 2007; Ninth UN C4D Roundtable, 2004; UNESCO, 2007); stimulate dialogue (UNDP, 2011) or “cocreation of knowledge and empowerment” (Ninth UN C4D Roundtable, 2004, p. 48). In addition, it leads to “openness, diversity, and flexibility” of methods/techniques of communication (The Communication Initiative, 2007, p. 222). In short, participatory communication provides empowerment for individuals as proclaimed by Donald Snowden. In participatory communication for social change, local people must interpret messages from outside of their social system in the context of their situation. Moreover, dialogue should be the heart of communication 216 E. D. CAHYONO process to make them able to share perceived challenges and aspirations to outsiders. They need to achieve “liberation, freedom, justice, and egalitar- ian ideologies” (Nair & White, 1994, p. 168). The idea of participatory communication is in line with the experiential learning theory: direct experience is the foundation of the creation of meaning (Itin, 1999). For this reason, individuals must be active in processing information, and not remain passive receivers; they need to be aware of their circumstances and discuss intensively with their peers (Kolb, 1984). In the case of an indigenous community, which is often overlooked by development agents (Boon, 2009), they must be able to voice out their concerns, needs, and issuing their situation to become equal partners with their acquaintances (Kroma, 2006; Malahayatin, & Cahyono, 2017; Siwalette, Hidayat, Cahyono, & Purnomo, 2018). For indigenous community, their culture—especially agriculture—is unique. Besides, they are the experts on practicing and valuing the local resources; they have knowledge transmitted from the previous generation; they also have indigenous social networks. Through social interaction within their networks, then collective norms, values, knowledge, and practices can easily be exchanged. In another perspective, these are their social capital (Putnam, 1993; Putnam, 2000; Inggrida, Sukesi, & Cahyono, 2017) that must be taken into account by development agents or facilitators for sustainable change or development of the community. For these reasons, a culture-centered perspective is crucial to be incorporated into participatory communication, particularly when working with indigenous community. The community needs to share their capital with outsiders; on the other hand, outsiders share scientific information related to the capital. Thus, it becomes a bridge of communication to empower the community (Dutta, Ban, & Pal, 2012). This chapter aims to describe the process of our facilitation project to empower an indigenous community through participatory extension approaches to conserve paddy rice varieties and the related knowledge and practices. The aims of the project are to: (1) make local farmers aware of the value of conserving the local rice varieties and the related farming knowledge, practices, and customs; and (2) enable them to negotiate their concerns and interests to stakeholders. Participatory extension “is a non-formal educational setting that highlights farmers’ participation and partnership of stakeholders. It covers the process of information sharing, the ability to negotiate, and make joint decisions, in which farmers’ opinions, knowledge, and initiatives are regarded as equal to those of extension agents or researchers (Cahyono, 2014).The participatory extension of this chapter is essentially the same as participatory communication, but the stress is on indigenous farmers in a less formal learning situation. PARTICIPATORY COMMUNICATION AND EXTENSION FOR INDIGENOUS… 217

Biodiversity and Indigenous Community The preamble of the Convention on Biological Diversity (United Nations, 1992) highlights the inherent values of biological diversity, of having a tight bond with indigenous community livelihoods. Such a community has specific wisdom that is embedded in their culture, that is, the knowledge and practices that enable them to preserve the biological diversity. The convention assumes that this wisdom is necessary to be shared, for the sake of the biological diversity protection and the sustained uses of its elements. It has been a concern, however, that modernization threatens the indigenous wisdom. As a result, biological diversity is decreased at various levels (van Heerwaarden, Hellin, Visser, & Van Eeuwijk, 2009; Dyer, López-Feldman, Yúnez-Naude, & Taylor, 2014). A study shows that genetic erosion of wild traditional crops may be caused by alteration of land use; eating habits; urbanization; infrastructure availability (Keller, Mndiga, & Maass, 2005); and the replacement with modern varieties that will be described later. Meanwhile, the convention was aware of having limited information about such wisdom. For this reason, they urge the need to manage the risks at the source areas. As a strategy, the UN notes that “the fundamental requirement for the conservation of biological diversity is the in-situ conservation of ecosystems and natural habitats and the maintenance and recovery of viable populations of species in their natural surroundings” (p.1, para. 10). In the preamble, the UN recognizes that in situ strategy is vital because of “close and traditional dependence of” (para 12) the indigenous community in utilizing indigenous wisdom, that is, traditional knowledge, practices, or innovations, for the conservation and sustainable use of biodiversity components. In the agricultural sector, such wisdom is marginalized because of agricultural modernization. It causes elimination of the diversity of local seed varieties and the related indigenous wisdom. To put into practice, the convention suggests assessing the indigenous wisdom. Moreover, the technical and institutional capacity of the indigenous people needs to be enhanced. Through these steps, an appropriate action can be accomplished to conserve the local biological diversity as well as the related indigenous wisdom. It is assumed that an appropriate communication intervention can help improve this situation. In accordance with the convention, this chapter focuses on the participatory agricultural extension/communication efforts to conserve the diversity of the seeds and the related knowledge and practices through the strengthening of indigenous farmers. 218 E. D. CAHYONO

Local Rice Seed Diversity The diversity of agricultural seeds is an important indicator of biological diversity. In this case, local paddy rice seeds developed by the indigenous community are one such example. Farmers value these seeds for their survival. For this reason, they develop local knowledge of rice genetic resources. They also manage the resources carefully to meet their needs (Saad, Sperling, & Ashby, 2009). For instance, they produce diversity of rice seeds through their cultivation and saving practices. As a consequence, the use of these diverse seeds provides an advantage for the sustainability of the local ecosystem, economy, and socio-culture. Local seeds are part of germ plasm that serves as a system to enrich the pool of rice genetic diversity of the area; part from the food chain; food security; food sources; and the symbol of the history and pride in local culture (Timsina & Tributes, 2005); local seeds are even regarded as public property (Seboka & Deressa, 1999). However, the elimination of local seeds occurs systematically, because of the selection process and the need for the use of uniform varieties, and strict control over the quality of seeds (Almekinders et al., 1994) to increase production. As a result, local seeds gradually began to be ignored, including agricultural practices associated with the local seeds. Previous studies have proved that procedures and criteria for the selection of seeds developed by indigenous people are valid; for example, selection procedures and indicators for the use of seeds and seed supply (Purnamaningsih, Cahyono, & Tyasmoro, 2008). In addition, traditional seed supplies and saving systems still exist to some degree. This can be seen from the supply of seeds by farmers themselves. In addition, there are traditional networks for the sale or exchange of seeds (farmer-to-farmer seed exchange) (Garforth, 2001). These networks exhibit relationships between relatives or other informal sources (not the official institutions from government or the private sector) (Rajasekaran, 1993; Haile, Verkuijl, Mwangi, M., & Yallew, 1998; Pandey, Bisht, Bhat, & Mehta, 2011). Moreover, farmer networks of circulating seeds are considered efficient, open, and selective (Coomes et al., 2015). For seed provision, many farming communities around the world depend on local seed systems (Bentley & Vasques., 1998). It was reported that before the year 2000, approximately 25% of crops had been used for the purposes of supply seeds, which is released into the network of local farmers (Seboka & Deressa, 1999). A recent study shows that 90.2% of seeds for farming are accessed by farmers from informal systems, in which 50.9% of the seeds are from local markets (McGuire, & Sperling, 2016). PARTICIPATORY COMMUNICATION AND EXTENSION FOR INDIGENOUS… 219

Several studies suggest the benefits of using local rice varieties. For example, the taste is good (Susilowati & Cahyono, 2004; Purnamaningsih, Cahyono, & Tyasmoro, 2008) and they have a fragrant smell (Shinta & Cahyono, 2006); the maintenance is relatively easy, they need low input, and are resistant to disease (Purnamaningsih, Cahyono, & Tyasmoro, 2007), and the price is relatively low (Rohrbach, & Kiala, 2000). However, the problems are: it is difficult to get the seeds, they require much energy to harvest, and the marketing is difficult (Purnamaningsih, Cahyono, & Tyasmoro, 2007).

The Roles of Indigenous Knowledge and Practices Indigenous wisdom, in the form of native farmers’ knowledge and practices, is very special but often neglected. Such wisdom is often ignored because it is perceived as primitive, low-tech, low production, and less scientific (Zamora,2000 ). In fact, indigenous knowledge and practices are valuable (Flora, 1992). In contrast to the modern knowledge, traditional knowledge is unique, traditional, and locally-specific; special; cumulative (across generations). The knowledge has been proven through careful observation and trial-and-error experiments by local experts that are the indigenous people (Grenier, 1998). The specificity of the use of local seeds, for instance, found on how to select and preserve seed, and in the process of cultivation (Shinta & Cahyono, 2006). Cahyono (2007) concluded that farmers’ indigenous knowledge and practices needs to be con- served, and should be integrated with modern knowledge. Previous studies show that farmers that grow local paddy rice are often marginalized. The indicators are: limited number of farmers; concentrated only in certain regions (particularly in the traditional areas); small acreage of rice fields; endangered varieties; some favorite seeds are extinct (Purnamaningsih, Cahyono, & Tyasmoro, 2007). In addition, local seed supply systems are relatively fragile. When a seed supplier dies, then the supply seed chain might be interrupted because of failure of regeneration; young farmers are not enthusiastic in continuing the indigenous farming system; and low education level. Moreover, the government’s concerns for the local rice cultivation are also low (Purnamaningsih, Cahyono, & Tyasmoro, 2008). In such conditions, what efforts can be made to conserve the diversity of the seeds and the sustainability of the indigenous farming? Although, over the past decades, genetic variation has been recognized as an important factor for maintaining biodiversity, concrete conservation 220 E. D. CAHYONO efforts are still limited. There is global insistence that scientists need to engage in the establishment of practical conservation policies and practices (Laikre, 2010). It has been recommended that active participation of the indigenous community is the key to the continuous supply of local rice seeds and the cultivation system; the reason is that the community not only has the relevant skills but also lives in the local area (Purnamaningsih, Cahyono, & Tyasmoro, 2007). Thus, this is in accordance with the expectations of the Convention on Biological Diversity, in which capacity building (empowerment) for such a community and in situ strategy needs to be prioritized. The question is how to execute it and what methods to be employed. It is assumed that the key to solve this problem is through the comprehension of the roles and appropriate use of communication approach.

Methods of Implementation In the context of applying the participatory extension approach, a cultured- centered approach is relevant to be incorporated because it deals with an indigenous community. The participants of extension were 25 Osing farmers that live at eight villages near the city of Banyuwangi in East Java Province of Indonesia; local key farmers, formal village leaders; representatives of the regional Agricultural Agency; one farmer who grew local rice from another region as a resource person. Gender and age factors were considered, so that the composition of the participants was balanced and diverse. The farmer participants were part of the indigenous Osing community that had socio-cultural differences (such as language, way of life, customs, etc.) compared to the dominant-modern Javanese society. They were selected as extension participants because of their unique cultivation practices in using rare paddy rice varieties (commonly known as “padi Jawa” or Java rice), in which the varieties were local specific. The main mission of this extension activity was to strengthen local communities on the importance of maintaining cultivation using these extraordinary varieties. The extension activities were conducted in 2008. At the time of extension/facilitation, there were 17 rice and sticky rice varieties employed by the Osing; once nearly 40 varieties existed in the local area, indicating that some varieties had become extinct. The concerns about local paddy rice farming were limited cultivation areas (only found in exclusive areas); old growers; limited number of growers; unpopular for young farmers; invisible to local public administration and agricultural extension PARTICIPATORY COMMUNICATION AND EXTENSION FOR INDIGENOUS… 221 service (Purnamaningsih, Cahyono, & Tyasmoro, 2007). The slightly outdated nature of the project activities helps to assess the impacts on the project after some years (Bessette & Rajasunderam, 1996), such as the persistence of the extension participants, and the changes of policies and conditions. To validate the data, the authors visited and re-inter viewed a key leader, using in-depth interview techniques, as well as asked opinions about the recent development issues in the region where the community live. The composition of the extension team was two researchers (from agronomic and socio-economic departments) and members of an NGO who acted as facilitators; some students of the Faculty of Agriculture were also involved. The team composition that was interorganizational and interdisciplinary was to address the problems of institutional linkage that were common in extension activities (Maarthen, Cahyono, & Wahyuni, 2006; Cahyono, 2014; Cahyono, & Agunga, 2016). The author of this chapter, working in the discipline of agricultural communication and extension, acted as the team leader. The researchers had conducted two- year research in the community before the facilitation. The team was interdisciplinary, covering the researchers who had expertise in agricultural communication/extension, and agronomy. Meanwhile, the NGO members had technical abilities to empower communities, particularly the marginal ones. Thus, these two groups were complementing each other in their expertise and skills. In the context of communication for marginal community, the fundamental questions were “How do we (can we) facilitate a grassroots, participatory approach and work with gatekeepers?” (Bessette & Rajasunderam, 1996, p. 104). To respond to these questions, some steps of participatory extension techniques need to be considered. Commonly, the techniques stress: interpersonal attempts; small scale or community- based; covering conversation; traditional media; and group activities. In this regard, Yoon (1996; 2004) suggests the following stages: (1) entering the community; (2) preparing to plan action; (3) planning what to do; (4) supporting action; (5) iterating the process; (6) withdrawing from the community; (7) working at a regional level (involving local people through communication media usage); (8) audience research (to report local community’s interests); and (9) people in charge (involving local people in decision making via broadcasting and professional assistance). The extension team highlighted steps one to six, considering limited time and finance for this project. 222 E. D. CAHYONO

Project Implementation

Pre-Facilitation Because of the preceding research activities in the project area, the extension team had crucial scientific knowledge on the topic, that is, names of existing local paddy rice varieties and the perceived and actual characteristics (local perceptions and scientific findings), cultural aspects, and valida- tion of the related indigenous farming practices (Purnamaningsih, Cahyono, & Tyasmoro, 2007, 2008). Other advantages were that the facilitation team had stayed in the community to conduct participatory experiment (on-farm trials with farmers) on the local paddy rice that makes farmers familiar with the team members. As a reflection, the pre-facilitation stage helps the facilitators to know deeply about the local context and conditions: the farming system, community, culture, etc. Moreover, local people welcome the facilitators, creating a favorable social atmosphere that makes the facilitators feel confident to accomplish their tasks.

Stage 1: Entering the Community The facilitation team was able to identify a middle-age indigenous community leader. The team hired this person as a bridge to communicate with the indigenous farmers. One of the facilitators had already known the local leader sometime before the project initiation and that made easy for other facilitators to collaborate with this leader. Moreover, data from the previous research helped facilitators to recognize the socio-economic problems of the indigenous community (e.g. old farmers and poor economic performance.) and their strengths (e.g. having valuable local farming knowledge and practices, strong indigenous group association, excellent environment, valuable cultures, and specific communication behaviors such as regular meeting). To reflect, most of the team’s successful works rely on the elected indigenous leader. This leader acts as a liaison that bridges the socio-economic difference between the facilitators and the indigenous people. This is crucial, considering that the facilitators lived at a distance from the project area and did not understand the local language. By inserting the leader into the project, the potential risks of a failure of the facilitation process are minimized. His involvement was also a cross-cut that the project could be initiated as early as possible. This stage shows that collaboration with a PARTICIPATORY COMMUNICATION AND EXTENSION FOR INDIGENOUS… 223 key local person is crucial for empowering the local community beyond the boundary of the team’s capacities and resources, let alone the language obstacles.

Stage 2: Preparing to Plan Action Next, the team discussed face-to-face with the indigenous leader at his home along with other leading farmers to negotiate a plan and methods of conducting facilitation. The plan was to gather with the indigenous farmers and stakeholders. The methods used were individual visits and group meetings. To contemplate, preparation for action with local representatives is necessary to ensure that local people are ready for facilitation, such as the meeting location. The team prepared everything needed, for instance, materials for presentation, video equipment, and food and drinks.

Stage 3: Planning What to Do The team prepared materials for extension/facilitation activities: samples of various varieties of local rice and a video. The samples were collected during the previous research. One member of the team prepared the samples in such a way to attract the audience by creating a book and displaying the actual harvested local rice. Meanwhile, the video contains activities and issues related to local rice farming and the indigenous community in the area. Made by professionals, the video contents attracted farmers because the farmers recognized the actors and issues. We hired professionals to ensure the video quality and availability at the time of facilitation. To assess, the facilitation activities was benefited by our previous research project because we can exhibit the research data and confirm any issues regarding the findings.

Stage 4: Supporting Action The activities in this stage were: (a) Group meeting 1: the facilitators conducted group discussion sessions to discussed farmers’ problems in their farming and in getting local rice seeds; (b) Group meeting 2: the video was projected on a large screen during a special meeting with the farmers and the stakeholders. The meeting was conducted at a village facility, attended by the indigenous farmers and stakeholders. While watching the video, the team provided food and drink for the audience as part of local 224 E. D. CAHYONO custom. The attendees were encouraged to reflect on the issues conveyed in the video, provide comments, and discuss their aspirations. As an evaluation, this is the chance to do interactive communication between indigenous people, facilitators, local formal leaders, and representative of agricultural department in informal settings. The strategy of using local content in the video is very effective; it makes the attendees relax and become enthusiastic in following the video presentation and discussing the materials which are relevant in their daily life.

Stage 5: Iterating the Process In the beginning, the facilitators met the local community through personal visitation; the team discussed individually or with their family regarding problems and expectations of local rice farming. The facilitators also strengthened the farmers individually or with their family by raising awareness about the values of conserving local paddy rice seeds and the farming system. In addition, the local leader helped to translate information conveyed between facilitators and farmers because they used local language that could not be understood by the facilitators. In the next step, the team through the local leader facilitated focus- group discussions. The facilitators presented the local rice varieties found in the previous research through discovery in the farmlands and individual interviews. It came up with the verification of the varieties by the audience, such as the local names, availability, taste, potential productivity, price, originality, and perceived novelty (some people had never seen certain varieties); and seed management (selection procedures, indicators, supply). Before leaving the site, our team visited other farmers who were not aware of the facilitation activities, especially those living in relatively distant places; we also encourage local leaders to use indigenous assembly as a communication medium to discuss any issues about the endangered local rice seeds and the related farming customs. Finally, we issued certificates for the farmers in recognition of outstanding service for conserving the endangered seeds and indigenous farming methods. As an assessment, so far the facilitation process is manageable. The facilitation team started the process by hiring the indigenous leader as the bridge between the team and the indigenous farmers; in the beginning, the team only needs to communicate with him rather than with farmers individually, and later he coordinates with the farmers. Through this PARTICIPATORY COMMUNICATION AND EXTENSION FOR INDIGENOUS… 225 leader, the facilitators could directly meet farmers who grew local paddy rice personally or with their family. They welcome the team to discuss the proposed topic for hours in their home. It was followed by individual visits, video presentation, group gathering, and discussions, and closed with presentation of certificates. The incorporation of traditional assembly in the strategy of facilitation, as highlighted by Smith (2013), is extremely urgent because it is not only enabling farmers to raise their voice, but also energizes them when the facilitators leave the site. The stages suggest that participatory extension needs gradual steps and has to be holistically accomplished.

Stage 6: Withdrawing from the Community The team withdrew from the community after applying all of the mentioned facilitation processes. On occasion, we contacted them and asked for the progress of the facilitation. During that time, it was a hard time for the local community, because the public administration officers have little concern of their activities. We believe, however, that the farmers were ready to continue their struggle with their own capacities and resources.

Further Stage The team did not facilitate the farmers to negotiate with stakeholders at the regional level. Nevertheless, by incorporating the indigenous institution as a communication medium for discussing their farming system, the team believed that they had voices to express their concerns. This is a step of distributing power from outsiders to the local community as a condition for participatory extension. Yet, this is not an easy task to accomplish; recently, the local informal leader has accentuated that the local community might need volunteers to assist the community in developing their unique capabilities. Here are his concerns:

I feel there is no party that defends the interests of farmers. If the farmers want to protest, only grow rice in one season and not for sale, it will give a tremendous impact. But farmers accept it without expecting more (in local terms: ‘nerimo ing pandum’). They do not want complicated, they are grassroots.

Regardless of their worries, the leader highlighted the capacities of farmers for caring for the local resources, by articulating: “they [farmers] are very 226 E. D. CAHYONO familiar with nature. In it, lies the key of preserving nature and the environment, I think it is!” Admitting to not lobbying intensively, the local leader is keen on the public administration’s active role:

The government should seek a breakthrough, look for the steps to improve creativity of farmers to grow paddy rice. Escort and provide training to help small farmers increase production. Advice farmers to produce maximum yields, I think so!

As time passes by, eventually the favorable social atmosphere will come. Recently, the public administration in the regency level has been paying more attention to the indigenous people and promotes them as parts of community-based ecotourism under a slogan: “Sunrise in Java.” As a result, the beauty of the local environment and cultural properties, including indigenous architectural styles, lifestyles, music and dances, and the local cuisine, are becoming popular tourist attractions. The indigenous leader describes:

I am not so intensively lobbying the government, I just foster the public about how the social and cultural side can contribute to the government. Now, in conjunction with the government’s efforts to promote tourism programs … suddenly [the initiative of the government and local communities] are connected, just like that!

Though the unique agricultural systems are less visible compared to those of the sightseeing attractions, more and more tourists seek agricultural- based activities (such as coffee-based agrotourism, and traditional music and dances related to agriculture). This trend may make the local farming systems visible to tourists that might encourage farmers, let alone the young ones to conserve local paddy varieties and the related activities. Moreover, in 2017, the Internet network integrates more or less 50 villages in the region, and it is targeted to double by the end of the year, which means half of all villages in the regency. As a consequence, social media becomes popular for villagers to market their handicraft items, agricultural products, and promote their area, and lifestyle to attract tourists. These trends show that they have access and control over social media usage, indicating that local people are in charge of using communication media. To speculate, the local community, including the indigenous farmers, has a chance to report their interests and aspirations. PARTICIPATORY COMMUNICATION AND EXTENSION FOR INDIGENOUS… 227

Implication This chapter set out to describe extension efforts to empower the indigenous people of Osing to conserve local rice varieties and the related agricultural practice to respond with the UN convention on biodiversity. A participatory extension approach was administered to strengthen the farmers to conserve their prominent knowledge and practices. This chapter demonstrates that the approach is able to make social change at various social levels: raising awareness, naming local seed varieties, exchange seeds, and negotiation with outsiders. The main part of the facilitation activities is to raise public awareness about the importance of conserving the local seeds for the sustainability of their traditional farms. Some farmers live separately and some are not connected to exchange certain seeds. Participatory extension activities (whether through on-farm experiments, video playback, meetings, and dialogue, certification, etc.) have helped connect one farmer to another. Moreover, facilitation enables farmers to recall their traditional knowledge. The valuable results are identifying and verifying some local rice varieties and naming unfamiliar varieties. This is an authentic proof that they have local knowledge and technology. Furthermore, the facilitation assists farmers to get to know each other and later exchange information (cf. Alawiyah, & Cahyono, 2018) or buy certain rare seeds through farmer-to-farmer mechanism. Thus, farmers can plant the seeds on their respective local land (as in situ strategy). Each particular local rice cultivation will function as a “seed bank,” in which the seeds are very useful for cultivation in subsequent seasons. This means that the seeds will remain sustainable as long as they are planted continuously. Moreover, to some degree, the farmers can negotiate with the government in setting up community-based tourism events. In this case, farmers can introduce a variety of local uniqueness. In the context of the Osing community, they have unique local food supply systems and customs, which can reinforce their cultural identity as one of the original indigenous communities in Java. Cultural sensitivity proves to be useful in participatory extensions. The facilitation team involves an indigenous leader, which helps to make social change. Studies show that such a leader has a function to bridge outsiders and the community (Melkianus, Sugiyanto, Sukesi, & Cahyono, 2018; Noviyanti & Cahyono, 2016). The community is even willing to use their traditional assembly to discuss local rice issues. This is consistent with other studies showing that the use of indigenous 228 E. D. CAHYONO communications media is effective for the process of exchanging information (Kurniasari, Cahyono & Yuliati, 2018; Swari & Cahyono, 2016). Gradually the government began to incorporate the local wisdom as part of tourist attractions. These findings show that through participatory extension social changes occur, in which farmers are more aware of their strategic and exceptional position and are able to negotiate with outsiders to initiate a program. Participatory extension is evident to empower farmers as the core of development as proposed by some authors (Servaes & Malikhao, 2005). It allows farmers to promote awareness and exchange knowledge among farmers; dialogue with stakeholders; and eventually, collaborative actions with the public administration. This social change is in line with the UN’s expectation to pursue sustainable development through participatory communication approach. That is, at various societal levels, participatory communication has empowered farmers to create change as echoed by Donald Sweden, the Fogo Process activist (The Communication Initiative, 2007). It can be seen that farmers (at least the indigenous leader) have a level of confidence to become a key partner of government (Kroma, 2006) to promote local culture, including agriculture, for agro-ecotourism package. The extension also benefited from participatory field experiments using local rice seeds that were executed prior to the facilitation process. This demonstrates that the in situ strategy urged by UN convention can support participatory extension. This is because farmers have chances to use their own agricultural resources and local wisdom to take part in the process of social change. We hope that the farmers have power to conserve the diversity of local rice seeds in the future, regardless of the challenges, including the non-human obstacles that they may face. Participatory extension is not only to enrich biodiversity, but also to strengthen local cultural identity (Timsina & Tributes, 2005), as evident in the Osing community. To sum up, participatory extension/communication approaches are effective to energize the community in preserving their invaluable local knowledge, practices, and the related cultural systems. Albeit, the macro factors, mainly governmental policy alteration might contribute to wider levels of societal and possibly economic changes.

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Examples of Communicating for Social Change

Dazzelyn Baltazar Zapata

This part of the book provides examples of communication projects on social change. In particular, this part of the book looks at: (1) How culture, community engagement, and communication intersect for social change; (2) how theory and praxis intersect in social change communication; and (3) explores the roles of academics and activists within this paradigm. Chapters include a range of topics including digital activism, climate change adaptation of farmers, and coping with Type 2 diabetes. Culture and context emerge as two key concepts in practices of social change communication, informing the principles of communication and social change. The first example talks about the anti-human trafficking movement. Going Viral: Online Goal Emergence and Adaptation in the Anti-human Trafficking Movement by Rachel Gong contributes to the fields of social movement studies and digital activism by identifying three types of online goals that are well-suited to digital activism, namely user engagement, fundraising, and individual changes of behavior such as ethical purchasing decisions. These goals have emerged and been adapted organically through continued use of different types of web tools and social media. Activists believe their web presence is important in achieving these goals, and remain committed to investing resources in digital activism. Using data from interviews with activists involved in the anti-human trafficking movement, this paper examines the relationship between “going viral” and a movement’s online goals. Goal emergence and adaptation online is driven by two types of uncertainty—an initial lack of expectations and norms online, and a reduction in control on the part of activists. The identification 236 Examples of Communicating for Social Change of online movement goals lays the groundwork for systemic means of measuring and evaluating digital activism outcomes. The second example, Communication Platforms and Climate Change Adaptation of Rice Farmers in Lipa City, Batangas, Philippines by Benedict Omandap Medina, talks about how communication plays a fundamental role in sharing information on climate change and organizing and sustaining initiatives on climate change adaptation. In the area of agricultural development, it is essential to determine the community communication platforms they utilize and the problems they encounter to conceptualize adaptive measures to climate change. This study profiles rice farmers and the communication platforms they utilize. Medina also profiles and com- pares adaptation practices, and discusses what can help promote better adaptation to climate change. Medina provides insight on how communication plays a role in climate change mitigation in farming communities. The majority of the rice farmers are in the middle and late stages of adulthood, married, have low educational attainment, do not have other sources of income, have been in rice production for about 6–15 years, and cultivate small hectares of land. They utilize interpersonal and small group communication, and mass media in sharing information on climate change. Most of them agreed that their physical adaptive measures, existing agricultural practices, and self-help programs and capacity building help them adapt to climate change. The third example, Integrative Medicine Focus Groups as a Source of Patient Agency and Social Change for Chinese Americans with Type 2 Diabetes by Evelyn Y. Ho, Genevieve Leung, Han-Lin Chi, Siyuan Huang, Hua Zhang, Isabelle Ting, Donald Chan, Yuqi Chen, Sonya Pritzker, Elaine Hsieh and Hilary K. Seligman, takes social justice on an interpersonal level. The authors discuss how Chinese Americans (CAs) are at higher risk for developing type 2 diabetes mellitus (T2DM) compared to White Americans at the same BMI. Ho et al. used a Culture-Centered Approach to investigate patient agency as it intersects with structure and culture in the talk during focus group interviews. The interviewees were CAs with T2DM discussing their diet and eating practices to manage this chronic condition. These interviews were conducted as part of a larger study to create an integrative diabetes diet that uses Chinese medicine- based diet suggestions for diabetes that are also nutritionally acceptable from a biomedical perspective. CAs both use and are seeking ways to use Chinese medicine as a culturally informed way of asserting agency in how they manage their diabetes. CAs are often challenged in fully using Chinese Examples of Communicating for Social Change 237 medicine because of a variety of structural constraints including lack of access to information for determining the legitimacy of health practices. However, the participants were also quick to share information with one another to help others be more self-reliant and thus demonstrate how complementary and integrative healthcare can be a form of social justice. CHAPTER 12

Going Viral: Online Goal Emergence and Adaptation in the Anti-human Trafficking Movement

Rachel Gong

The impact of the internet on effecting social change has been a subject of increasing attention in recent years. Scholarly debate has considered whether use of the web facilitates a new form of organization and action (Bennett et al. 2013; Joyce 2010; Shirky 2008; Weinberger 2007) or is simply a new form of self-indulgence (Gladwell 2010; Keen 2007; Morozov 2010). The debate is complicated by the breadth and diversity of both, the ways in which the internet is used and how social change is pursued. This complication is compounded by the fact that, up to this point, scholars and practitioners alike lack a systematic means of evaluating digital tactics and their outcomes. One school of thought stands squarely behind the affordances of the web in terms of organizing and mobilizing action. It points to the influential role that the web played in political campaigns such as the US presidential elections of 2008 and 2012, and in the series of demonstrations and protests comprising the Arab Spring of 2011, and highlights the advantages of expanding networks of individuals to achieve common goals. While recognizing the implications of the Pareto distribution on

R. Gong (*) Khazanah Research Institute, Kuala Lumpur, Malaysia e-mail: [email protected]

© The Author(s) 2019 239 M. J. Dutta, D. B. Zapata (eds.), Communicating for Social Change, https://doi.org/10.1007/978-981-13-2005-7_12 240 R. GONG social movement actors within the population of web content consumers, this perspective argues that extremely large networks disperse (and thus minimize) the cost of participation, increasing the likelihood of actual participation, and requiring smaller contributions from each individual in order to succeed, as can be seen in crowd-funding campaigns. On the other hand, a more skeptical critique takes the position that the web’s influence may be useful for publicity and even for occasionally mobilizing voters and protestors, but that the web plays a much less significant role in actually accomplishing tangible, long-term movement goals, such as legalizing marijuana or making healthcare more affordable. This perspective dismisses the low-cost, symbolic, individual actions advocated online as being ineffectual compared to more traditional, cost- and commitment-heavy actions that lend weight to a movement’s claims. What both sides of this debate have not clearly addressed is the possibility that traditional social movement theories on tactics and outcomes that are rooted in resource mobilization and political opportunity may not always apply to digital activism. Digital technologies have greatly reduced cost, increased reach, and enfranchised marginal players such that new online tactics can accomplish traditional movement aims (Earl and Kimport 2011). Similarly, these technologies have resulted in the emergence and adaptation of movement goals to suit digital activism. Without first understanding these online goals, I believe that it would be difficult (and impru- dent) to authoritatively comment on the impact of the internet on effecting social change. To that end, I have undertaken a systematic empirical investigation of the online presence of a single social movement, namely the anti-human trafficking movement. In this chapter, I examine how anti- trafficking activists using the web develop and transform their online goals and use the participatory and networking affordances of the web to accomplish those goals. Interviews with activists suggest that initial forays into digital activism were not organized, strategic efforts. (I use the term digital activism in its broadest sense, referring to any social movement effort on the web, whether on the part of organizers to provoke action or on the part of end users to respond.) According to activists, they began setting up online profiles and websites for two main reasons. First, some activists felt an institutional pressure to create a web presence with simple aims, even if they did not have the resources to take advantage of the web and were not entirely sure how to do so. Second, some activists were aware that the web was an easily accessible, available tool and they were experimenting with it GOING VIRAL: ONLINE GOAL EMERGENCE AND ADAPTATION… 241 to discover how it would best supplement their offline efforts. In both cases, activists discovered that there were certain goals for which the web was well-suited, and they have begun to be more systematic and structured in their use of it. As they continue their efforts, activists are realizing that online tactics (or campaigns) that had previously succeeded are not guaranteed repeated success. Nonetheless, they express their commitment to digital activism, and are turning their attention toward measuring outcomes in efforts to fine-tune their web strategy. Due to the variety of measurement outcomes, bases for comparison, and tracking systems available online, I reiterate that there is not yet a systematic method for measuring and comparing online outcomes across social movement organizations (SMOs), let alone across social movements. While activists are aware of the need for such a method, those interviewed also place high value on an online campaign “going viral” (defined below) as a goal and key indicator of success. This presents a challenge, as viral campaigns are difficult to predict and reproduce. Nonetheless, activists prize such campaigns as a means of generating attention, interest, and engagement in a movement, all of which are especially important for young and small SMOs. Understanding what they are trying to accomplish by means of such campaigns is the first step toward identifying online goals and connecting them to broader movement goals. This chapter begins with an examination of extant literature on goal transformation within social movements, how this process occurs online, and why digital activists prize viral campaigns. Next, I outline the methods by which data were collected. Then I use these data to show how activists’ online goals have been transformed over time. The chapter concludes with a discussion of the relevance of these online goals to organizational and movement growth and success.

Goal Transformation Weberian and institutional theories predict that as SMOs gain legitimacy, goal displacement occurs, pushing the social movement toward homogeneity and self-conservatism to the detriment of its original goals of social change (DiMaggio and Powell 1983; Zald and Garner 1987). Two factors that can affect goal displacement are the environment in which SMOs are acting (Zald and Garner 1987) and the results of their efforts to attain their goals (Warner and Havens 1968; Zald and Garner 1987). 242 R. GONG

Environment can influence goal displacement in several ways. Changes in media attention, resource flow, and political opportunity can make movement goals more or less attainable. If movement goals are seen as less attainable, public support is more likely to drop, leading to corresponding decreases in membership and financial support, which in turn can force an SMO to shift its original goals and focus instead on organizational maintenance. On the other hand, goal attainment can lead to (1) goal succession where original goals that have been met are replaced by new goals, and/or (2) goal expansion where original goals that have been met are diffused to other similar fields or targets. An example of goal succession might be moving from legislating against human traffickers to providing aftercare programs for human trafficking survivors, while an example of goal expansion might be enforcing such laws and programs at state, national, and international levels. Goal displacement, goal succession, and goal expansion are three forms of goal transformation that occur more or less independently of tactical strategy. A fourth form of goal transformation, which I call goal adaptation, can occur when digital activists, confronted by the limitations and opportunities of the web as a resource and space for social action, adjust their goals to maximize the chances of success of their online strategies. As stated above, goal adaptation is driven by two factors—first, an initial lack of expectations by actors working in an emerging social space whose norms have not yet been codified, thus resulting in much “trial and error,” and second, the flattened (though not completely so) network structure that allows a critical mass of users to enhance and sometimes redirect activists’ efforts (Shirky 2008; Weinberger 2007). Activists using digital technologies, initially as a straightforward communications tool, soon realized its potential for not only organizing and recruiting, but also for new forms of collective action. However, they found it difficult to consistently and predictably generate collective action, even small symbolic displays of solidarity. Even though they had a much wider audience and pool of recruits to draw from, online mobilization remained a challenge. Faced with this challenge, activists had to reevaluate their goals in using digital technologies and adapt them to justify the continued use of the web without detracting from their overall movement goals. This does not mean they did so in a rational, organized fashion. Based on interviews with activists in the anti-human trafficking movement, much of the development of their web strategy came slowly and iteratively. Occasional flashes GOING VIRAL: ONLINE GOAL EMERGENCE AND ADAPTATION… 243 of inspiration and innovation resulted in temporary success that was often hard to replicate. Over time, recognizing that digital activism, that is, collective action that takes place online, reduces the need for people to physically gather together (Earl and Kimport 2011), activists began focusing on online movement goals that encouraged action at the individual level (Bennett 2012). They recognized that network effects could result in these individual actions translating into collective change (Shirky 2008). These online goals include user engagement, fundraising, and changes in individual behavior, for example buying fair trade products. I turn now to an explanation of how an online campaign “going viral” facilitates these goals.

The Value of Going Viral The term “going viral” describes the way in which media content, usually in the form of a video, gains a very large audience by very quickly spreading through an online network (Burgess 2008). While the minimum audience size and dispersion rate that define “going viral” remain unspecified, a viral video can be expected to be viewed millions of times in a matter of days. The Kony 2012 video, for example, accumulated over 212 million views, 100 million of those views occurring in just six days (Visible Measures 2012a, 2012b) and resulting in over two million Facebook followers for Invisible Children (interview data from 2012, as of March 2014 3.3 million). Going viral is, in short, the epitome of an online WUNC display. WUNC stands for worthiness, unity, numbers, and commitment, displays of which are considered indicators of a social movement’s viability and effectiveness concurrent with widespread democratization (Tilly 2004a, 2004b, 2006). These displays take many forms, from banners to uniforms, hand-holding to chanting, and signatures on a petition to marching through the streets. What matters is that they demonstrate a social movement’s ability to have gained the support of a large and respect- able public. According to Tilly, “WUNC matters politically because it con- veys crucial political messages [and political claims, i.e. identity claims, standing claims, and program claims, which reinforce one another and say]: pay attention to us; we matter.” (2006, pp. 184–185)

While WUNC displays can be disruptive, they need not be so. As Anderson puts it, ‘the power of WUNC is due to the fact that we count these factors as evidence of the moral authority of the claims made by a social movement…in demonstrating WUNC, democratic social movements express 244 R. GONG

their commitment to demonstrating the legitimacy of their claims to those whom they hold accountable for respecting them’. Claim-making, account- ability, and normative inquiry – not only arguments, but compelling narratives and dramas highlighting the normative force of claims – go hand in hand. (2010, p. 101)

The widespread use of the web has made such claim-making, especially by means of audiovisual storytelling, a popular tactic. In addition to the dissemination of a video, frequent use of hashtags that succinctly represent an issue, whether the cause itself, for example #antitrafficking, or a catch- phrase, for example #enditmovement, can also be indicators of a campaign’s virality. This means that a campaign can go viral in two overlapping ways—first, the campaign’s content; second, the response to the content. In the absence of physical gatherings, a viral campaign is analogous to a mass demonstration. Reaching a critical mass online is an indicator to activists, the state, and the public that the movement’s claims are at least of interest, if not also value. When online content goes viral, it is a clear display of unity and numbers, although levels of worthiness and commitment remain somewhat questionable. While worthiness offline might be visible by the presence of persons of respectability and authority, for example clergy, worthiness online tends to be associated with large numbers of subscribers or followers, lacking a qualitative definition. Furthermore, internet skeptics might argue that viewing and sharing videos require very little commitment to a movement’s cause. However, it could be countered that these actions require at least a time commitment and a willingness to be identified publicly as supporters of the movement. It should be noted that, when asked, activists equate going viral with success and express admiration for campaigns that have done so, but are unable to formulate a recipe for similar success. (Even scholars and social media providers, for example Facebook, who are currently studying algo- rithms and trends behind viral campaigns, have yet to produce a replicable method for running one.) Activists acknowledge that there is a large element of uncertainty in how much end users will respond to a campaign, but they persist in their attempts to develop viral campaigns. What is significant for scholars of social movements in a digital age is that activists, especially those involved in online activism, recognize the importance of going viral, even if they do not explain it in terms of WUNC displays. Going viral is becoming a tactical objective of digital activists in GOING VIRAL: ONLINE GOAL EMERGENCE AND ADAPTATION… 245 pursuit of their movement goals, be they online-specific goals such as educating supporters, or general movement goals such as policy change. Whether as an end in and of itself, for example for awareness campaigns, or as a means to an end, for example for fundraising campaigns, it can be safely assumed that much web strategy is aimed at making a campaign go viral.

Data and Methods

Case Selection As I have discussed elsewhere, human trafficking, sometimes also called modern slavery, has been criminalized since the Slavery Convention of 1926 (Bales 2005), but the modern anti-trafficking movement itself is relatively young. Kevin Bales and David Batstone, both anti-trafficking activists with academic backgrounds, describe Anti-Slavery International, which was founded in the early nineteenth century, as the oldest organization working on this issue (Bales 2004; Batstone 2007). However, the movement did not receive much media publicity or political attention until the 1990s. Legal and policy efforts led to two milestones in 2000. The United States Congress passed the Victims of Trafficking and Violence Protection Act (TVPA), while the United Nations ratified the Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children (also called the Palermo Protocol). Since then, the movement has received much more international attention and support from governments, non-profit organizations, and news media. Numerous activists have set up organizations with varying goals. Some organizations take a comprehensive approach, such as the Polaris Project, which describes its strategy as “holistic, [serving both U.S. citizens and foreign national victims], taking what we learn from our work with survivors and using it to guide the creation of long-term solutions [by] advocating for stronger federal and state laws, operating the National Human Trafficking Resource Center, and providing services to help our clients and all victims of human trafficking” (Polaris Project website 2011). Others are more specialized, such as the Bal Vikas Ashram in India, a rehabilitation center run by the Diocesan Development and Welfare Society for children aged 8–14 who were sold or forced into labor (Batstone 2007). One key reason for the selection of the anti-trafficking movement is the diversity of tactics employed by activists involved in the movement. These 246 R. GONG tactics range from forming partnerships with government law enforcement to demanding corporate responsibility with respect to supply chains, from making fair trade consumer purchasing decisions to volunteering at rehabilitation centers for rescued trafficking victims. Not only do offline tactics range from policy to fieldwork, but online tactics range from fundraising to engaging users. While it may not be possible to accurately use one social movement’s web presence and tactics to generalize across all movements, the variety present within the anti-trafficking movement allows me to undertake as broad a scope of study as possible within a specific movement. This is especially relevant when considering the link between tactics, goals, and goal adaptation.

Interview Data As part of a larger research project, I adapted the primary method used by Earl (2006) and Earl and Kimport (2011) to obtain a quasi-random sample of websites hosting a specific set of social movement tactics. In her research, Earl used a Google Search application programming interface to locate keywords (e.g. petition) in its public database of websites. By con- catenating multiple search results of similar keywords, she generated a sample of approximately 10,000 websites from which she took a random 10% sample for coding. Earl’s web search for tactics instead of causes enabled her to uncover the diffusion of traditionally political tactics for other causes and targets, such as business corporations and entertainment media. Adapting this method to search for the anti-trafficking movement allowed the search results not to be limited to SMOs. It also turned up websites managed by individuals, informal collectives, and non-traditional SMOs. The keywords I used were “human trafficking,” “anti human trafficking,” “human trafficking movement,” “anti human trafficking movement,” “modern abolitionist movement,” “modern slavery,” “stop modern slavery,” “end modern slavery,” “modern anti slavery movement,” and “trafficking in persons.” An initial search using each term with and without quotes yielded 2487 unique URLs over 1742 unique domains. I then eliminated results that only appeared once in the 20 searches, leaving 332 unique domains that appeared 2–32 times in the search results. Interview subjects were recruited from these unique domains using three methods: first, using contact information provided at matching websites in the search results; second, via snowball sampling using contacts provided by subjects recruited using the GOING VIRAL: ONLINE GOAL EMERGENCE AND ADAPTATION… 247 first method; and third, in-person recruitment at two anti-trafficking con- ferences. A research assistant and I then conducted 37 semi-structured interviews with anti-trafficking activists. Interviews averaged 75 minutes, and were conducted in person or by phone/Skype, with any follow-up questions addressed via email. Of the 37 activists, 24 are female. All but seven are located in North America; the remaining seven are located in Cambodia (3), Malaysia (2), New Zealand (1), and South Korea (1). Interview subjects fell into two broad categories: 11 individual activists who operate online without organizational oversight and 26 affiliated activists who administer/manage websites on behalf of anti-trafficking organizations. Many affiliated activists also maintain their own personal websites with similar interests and/or goals, but were interviewed with respect to their roles within anti-trafficking organizations. Of the 26 activists affiliated with organizations, 19 represented non-government/non- profit organizations and were the persons responsible for the day-to-day content management of either their organization’s website or social media profiles, or both. They were all also involved in their organization’s decision-making process around web strategy, with some subjects playing a more central role than others. Table 12.1 summarizes the distribution of interview subjects. These activists represent five of the seven types of non-governmental actors within the anti-trafficking movement (Foot2010 ): (1). businesses; (2). individuals; (3). non-governmental organizations; (4). professional associations; and (5). universities/research institutes. Actor types that are not represented in the interview sample are labor unions, as they were not part of my coding schema, and United Nations organizations, as I was unable to recruit interview subjects. While the selection of specific organizations is a convenience

Table 12.1 Anti-trafficking activists interviewed

Social networking sites Count

Organizations Individuals

Non-governmental organizations 19 Businesses 3 Professional associations 2 Universities/research institutions 2 Individuals 11 Total 26 11

Data source: Anti-Trafficking Online Search Results 2012 N( = 332) 248 R. GONG sample, quota sampling of the web search results produced a distribution of organization types from which to recruit interview subjects. The variation across interview subjects occurred in two ways: first, variation in terms of organization type and size. By interviewing individuals, business employees, activists in the non-profit sector, academic researchers, and professionals with field experience (e.g. lawyers working with trafficking survivors), I obtained multiple perspectives on the usefulness of the web and learned about the varying degrees to which each actor was able to develop a web presence (by comparing individuals and organizations). I was also able to interview multiple actors within two organizations, some of whom were involved in the day-to-day administration of their organization’s web presence, while others were only involved in strategy and decision-making. These different perspectives provided very useful insight in understanding how goal adaptation occurs, especially when considering access to resources at the individual versus the organizational level. Second, variation occurred in terms of movement goals. Some organizations focused on developing anti-trafficking policies and laws; others focused on survivor aftercare. Some developed web strategies directed at raising awareness and educating their followers; others were innovating digital platforms to get their followers to take concrete action, for example change their consumer habits, donate to the organization, or participate in a campaign. The interviews present a snapshot of digital activism within the movement around and prior to early 2013, during which time most activists shared a strategy of “trial and error,” but expressed their commitment to building and maintaining their web presence. The variation in movement goals is important in demonstrating that goal adaptation occurs across movement goals. Coding the interview data for keywords related to purpose, goals, and outcomes revealed three common themes: activists hoped that their web strategies would increase user engagement, user donations, that is, fundraising, and individual changes in user behavior. In the following discussion, I examine each of these goals as a product of goal adaptation by considering likely original goals and suggesting tangible outcomes by which attainment of these new goals can be evaluated.

Initial Digital Activism “Trial and error” was the most common phrase used by activists to describe their initial efforts at digital activism. Some activists built their websites before the rise of social media; others built a Facebook profile before GOING VIRAL: ONLINE GOAL EMERGENCE AND ADAPTATION… 249 developing a more comprehensive web presence. But almost all their first attempts revealed a lack of specific intent or strategy:

We had the website first. Right from the start [in 2007]. It was in place before we kicked off the organization [but] we rebuilt it [several times]. We try to do a [design] makeover every six months so we can stay fresh. That’s independent of content, of course; our content is updated daily, sometimes more than that. General information, news, that sort of thing. (Activist with an anti-trafficking organization in New York)

When we started with social media [in 2010], we had an intern do it for us. One of the local universities has a program, they send an upper level student (sic), usually a marketing student, to a paid internship at a non-profit, and she set it up for us. Just the basic stuff, you know, Facebook and all that. (Activist with an anti-trafficking organization in Ohio)

I started the Facebook group [in 2011] to see who was interested [in join- ing a student group]. It’s super easy to set up, but I don’t really do a lot with it. I’ll share a couple of articles, but that’s about it. […] I’m going to Causes [an online campaigning platform with a Facebook application] to get training for online activism. (Activist with an anti-trafficking student group in California)

Despite their lack of experience, these activists believed that they needed a web presence, possibly due to institutional pressures and brand building practiced by for-profit companies. While SMOs recognized the need for a web presence to demonstrate legitimacy within the movement, individual activists (including the student activist quoted above) saw the web as a low-barrier entry point to activism.

My focus is my personal blog. I write about the latest in the fight to stop child trafficking. That allows me to reach beyond my own audience as posts get forwarded and liked. […] Also, Twitter. I had no idea [what it was initially], but Twitter has been invaluable. It really levels the playing field. (Individual activist blogging in California)

[My blog] is how I got into the anti-trafficking world. I felt like there was so much information, and it’s very overwhelming, so [my blog] was my way of making sense of it. All I can do is try to help advocates think more critically about what they are really asking for and the implications this will have. It wasn’t strategic or anything. (Individual activist blogging in Connecticut) 250 R. GONG

At both the organization and individual level, these initial attempts at digital activism reveal a lack of purpose besides communicating information. As activists gained experience with the web, they found themselves rethinking and expanding their original online goals.

I think it’s less important to have a purpose in advance. We’ve found that people don’t always do what we expect them to do [online]. They’ll use [the web] as they see fit. It’s been good for us, though. We’re moving towards apps and mobile web now. (Activist with an anti-trafficking organization in New York)

We figured out that it’s better when [our content] is organic. People can tell when it’s authentic and when it’s manufactured. [Our strategy] changed, yeah, when we figured out social media. We could do a lot more with social media [than with a website]. (Activist with an anti-trafficking organization in Colorado)

[We’re] definitely making it up as we go along. But we try different things, and we learn from each other, and we pay attention to the numbers to see what’s working and what’s not. (Activist with an anti-trafficking organization in Washington, D.C.)

The evolution of web strategy is important to activists engaged in prolonged efforts aimed at social change. Those committed to digital activism express an understanding of the need to stay “fresh” and “relevant” while trying different approaches to activism. A spirit of experimentation and innovation remains, including a willingness to define goals in collaboration with their audience. However, interview evidence also suggests that there are specific online goals to which activists have gravitated, three of which are user engagement, fundraising, and individual changes of behavior.

From Communication to Collaboration Scholars who have studied the use of the web by social and political activists have found that the most common (and obvious) benefit of digital technologies is an improvement in communication (e.g. Beck et al. 2002; Delli Carpini 2000; Kanter 2010; Lievrouw 2011; Mesch and Talmud 2010). Online communication has the advantages of lower costs and a wider audience that greatly improve the ability of SMOs to recruit and GOING VIRAL: ONLINE GOAL EMERGENCE AND ADAPTATION… 251 communicate with supporters. As alluded to above, activists who were interviewed all acknowledged this benefit:

We send out email updates every quarter, and we put the PDFs on our website, so if someone wants to print them out they can do that. We don’t need envelope stuffers and postage, which is great for us, less overhead, so more money can go to our programs. (Activist with an anti-trafficking organization in New York)

I am one woman sending an email to 30,000 people when there’s important news. (Activist with an anti-trafficking organization in Washington, D.C.)

The internet allows us to reach millions of people with just a series of clicks on a keyboard. We’re able to communicate with our supporters in a more personal way; not to mention the speed at which we’re able to do it. (Activist with an anti-trafficking organization in California)

As they developed their web presence, including websites, blogs, and social media profiles, and became more familiar with the tools available to them, activists began to realize that online communication was not unidirectional. The web allowed their audience to talk back, and many activists, recognizing that these interactions held the potential for greater engagement and action began to adapt their web strategies to encourage and solicit responses.

Facebook is not just about communicating with people; it’s about connecting with them, giving them a chance to engage with us. It’s not like sending out [updates] every month, you know? It’s more like a conversation, and that makes them a part of it, […] partners, not just donors. (Activist with an anti-trafficking organization in California)

It’s all about making connections and [my blog] connects me with not only others who are passionate about making a difference but also those who don’t even know they are passionate about it yet. […] I have connected individuals with the right people and organizations so they can get involved with the cause. (Individual activist blogging in Texas)

Quite early on, we learned that we shouldn’t just post links. We got a much better response when we said, like, “Hey, we re-did our online store, check it out and let us know what you think” than if we just posted the link. (Activist with an anti-trafficking organization in California) 252 R. GONG

We set goals for all our [online] campaigns. Clickthroughs, RTs [retweets], shares, and then we do analysis on [our posts] for timing, style, medium. We don’t just want to put stuff out there; we want people to engage with us. We try to keep to the 80:20 rule […] 80% [of our content] is giving, like updates, or statistics, information-type posts, and 20% is an ask, like, become a donor, join the movement. (Activist with an anti-trafficking organization in Washington, D.C.)

When activists realized that their supporters could respond to and interact with them, they began to actively seek such connections. A shift occurred from the use of the web as a unidirectional communications tool for educating and exhorting supporters to its use as a multidirectional networking tool that could also be used to build a supporter base and increase resources available to an SMO for subsequent campaigns. This shift emphasizes user responses and actions, however small, such as clicking on a link or sharing it with their own social networks. It results in a measureable outcome that allows activists to evaluate whether or not their web strategies are useful and worth continuing. The ultimate indicator of success is a viral campaign, measured not just in terms of numbers of hits or shares, but in high-ranking trends (such as hashtags on Twitter) that indicate active discussion on an issue. Individual activists, especially, express satisfaction that they are raising awareness of an issue and facilitating conversations among people who might otherwise have remained ignorant and uninterested. Furthermore, increasing online followers enables SMOs to extend their reach. The power of weak ties and a large network for purposes of publicity and education are evident, and recent studies (e.g. Aaker and Smith 2010; Hall 2012) suggest that people are more likely to click on links shared by individual members of their network, especially when shared by multiple individuals, rather than organizations, even organizations that they follow. Shifting their online goals from communication to collaboration by seeking to engage users, instead of just inform them, allows activists to expand their networks and provides end users a low-cost, low-risk way of getting involved with a cause.

From Fame to Fundraising In addition to communicating with their existing support network, activists used the web to publicize their efforts to those who were less, or not at all, familiar with the movement. One of the immediate benefits of using the web for publicity as opposed to relying on corporate media is that GOING VIRAL: ONLINE GOAL EMERGENCE AND ADAPTATION… 253 activists retained control of their message and were able to publicize issues that corporate media might have ignored. In some cases, news media became aware of an issue because of the publicity it generated online.

It’s real, you know, the stories we post, because we’re the ones who know what really happens, and [on our blog] we can tell our stories, the ones we want to tell. The ones nobody else wants to tell. (Activist with an anti- trafficking organization in California)

This activist was commenting on how the media had a tendency to sensa- tionalize cases of sex trafficking, and gloss over domestic servitude as a form of human trafficking. She used the organization’s blog to promote a video telling survivor stories of African women trafficked into the United States as domestic servants, who were then threatened and abused by their supposed employers.

I think it’s important that [the issue of human trafficking] doesn’t just become another political hashtag. It’s not just a checkbox. It’s more complicated than that, and that’s what I’m trying to get people to understand [on my blog]. (Individual activist blogging in California)

This anti-trafficking activist, formerly a law enforcement officer, explained why he blogged extensively opposing Proposition 351 in the 2012 California general election. Despite his efforts, the “Californians Against Sexual Exploitation Act” Initiative, whose primary intent was to increase criminal penalties for human trafficking, was approved by a large margin. Opposition to the initiative argued that its poor wording would misclassify sex workers as victims and/or perpetrators of human trafficking.

We didn’t even have to contact the press. They heard about us [and our event] from social media and called us for interviews. We had radio stations, newspapers; they came, they contacted us, we didn’t initiate [contact]. (Activist with an anti-trafficking organization in Malaysia)

This activist described how a local anti-trafficking conference organized by students gained regional publicity and the attention of news media in South East Asia through the use of a hashtag (#LNxHT). This in turn brought in individuals and organizations that wanted to sponsor or otherwise support the conference.

1 For more information, see http://www.voterguide.sos.ca.gov/past/2012/general/ propositions/35/ 254 R. GONG

When web-users hear about specific campaigns and/or events that interest them, they can be mobilized to action if they are given an opportunity to do something simple and straightforward. For the anti-trafficking movement—and presumably many others as well—the easiest way to contribute is to make a financial donation. Combined with offline efforts, online fundraising can be an effective means of digital activism. Appeals for donations are more likely to be successful when made by an individual to his or her social network on behalf of an organization, likely due to the persuasive effects of existing social ties (McAdam and Paulsen 1993). They also have network ties that organizations do not, as these activists can attest:

I emailed a bunch of people, plus I spammed all the mailing lists [at my college]. I also asked my church for permission to speak, and they let me make an announcement. Most people hadn’t heard of [the anti-trafficking organization] so there was a lot of explaining what they’re about, but people were super supportive. [Yes,] I met the [fundraising] target; passed it, actually. (Individual activist fundraising in Hawaii for an anti-trafficking organization in Cambodia)

The [fundraising] campaigns work better when [our supporters] take the lead. It’s a way for them to get more involved. [It’s] more personal, not this unseen organization asking for money all the time. We don’t want to be only about money. […] We do contact our donors regularly, not too frequently, maybe once a quarter. But we’re seeing good things with the campaigns, and we get new donors that way. (Activist with an anti-trafficking organization in Washington, D.C.)

Fundraising websites such as Crowdrise, YouCaring, and GiveForward provide easy-to-use and secure methods for transferring funds to both verified organizations and personal causes. Given that these websites are globally accessible, location is no longer a barrier to financial support and small donations can very quickly add up across a large network. Publicity and fame also contribute directly to successful online fundraising. In 2011, activist and actress Serinda Swan organized a fundraising campaign, 18For18 (so named because the original goal was to have fundraisers skydive from 18,000 feet with the goal of raising $1 for each foot), to benefit the Somaly Mam Foundation, which rescues and rehabilitates victims of sex trafficking in South East Asia. She has organized the jump every year since, saying of the 2012 campaign, “that was a Twitter campaign; [we GOING VIRAL: ONLINE GOAL EMERGENCE AND ADAPTATION… 255 raised] $72,000 in 13 days. [Social media] has the potential to be such a game changer, for better or for worse.” In 2011, the campaign raised $38,000; $73,000 in 20122; $103,000 in 2013; and $106,000 in 2014 (personal communication). According to Swan, the first two campaigns were run at the grassroots level, relying on social media and word-of-mouth for publicity. Since then, the campaign has received organizational support from non-profit organizations, marketing companies, and other corporate sponsors, building on its capacity for WUNC displays, both online and offline. In light of the success of online fundraising campaigns, it is not surprising that activists who were interviewed did not bring up the donation link on their website unless the interviewer asked specifically about it. Instead, when discussing online fundraising, they discussed specific fundraising campaigns or periodic donation appeals via email, especially around the holiday season. In terms of goal adaptation, fundraising is an actionable goal that takes a publicity or awareness campaign one step further, and it is apparent from campaigns such as the ALS Ice Bucket Challenge3 that activists are well aware of the potential of the web to accomplish these goals. Online fundraising presents another opportunity for researchers to measure outcomes of digital activism, provided there is a means of distin- guishing the use of the web as a means of raising funds, for example the way social media was used for publicity and persuasion in the 18for18 campaigns, from the use of the web simply as a means of transferring funds, for example the way an activist might make a church announcement directing potential donors to a fundraising website. This distinction is key in understanding if the use of the web reflects an actual change in the way activism is conducted, or if it is simply another tool. One option might be the inclusion of a survey question at the point of transaction, but while technically easy to implement, this would require the cooperation of numerous SMOs. As it stands, even activists who track whether donations are made online or offline have no way of making this distinction.

2 This discrepancy reflects the known amount of money raised at the time of the interview (as quoted), and the final amount provided in a subsequent inquiry (cited as personal communication). 3 The ALS Ice Bucket Challenge was a viral fundraiser in the summer of 2014 that involved users pouring ice water over themselves and making a donation to the ALS Association, then challenging a few other people to do the same. The ALS Association reports that during the time of the campaign, it received donations surpassing $100 million. For more information, see http://www.alsa.org/fight-als/ice-bucket-challenge.html 256 R. GONG

From Protests to Purchases A third shift in online goals reflects a broader shift in social movement tactics more generally, namely from a focus on the state to a focus on the market. Political consumerism operates on the principle that for social movements with non-contentious goals, for example the anti-human trafficking movement, individual choices and actions—typically in a consumer market—can reach a critical mass that results in political change (Micheletti 2003). The question of individual actions constituting collection action is also addressed by Earl and Kimport as part of their theory of digitally enabled social change (2011). Given the affordances of digital technologies, they question the need for people to physically gather together, that is, co-presence, in order to accomplish the goals of a social movement. When first trying to develop web strategies, activists typically used the web as a means of organizing offline collective action such as protests and rallies (e.g. Lievrouw 2011; Rheingold 2002; Shah et al. 2005) or digitiz- ing tactics such as petitions and letter-writing (e.g. Earl and Schussman 2003; Earl 2006; Van Laer and Van Aelst 2010). These were subsequently replaced by tactics with a consumerist bent, such as educating users on supply chains and suggesting alternative fair trade products. These consumerist tactics are common within the anti-trafficking movement, which encourages supporters to be educated consumers and to make responsible purchasing choices. Numerous fair trade-oriented activists say they marry their activist goals and their business ethics:

We care about the people whose products we’re selling and [our website] make[s] it clear that when you buy from us, you’re having a direct impact on someone’s life. Your decision, your purchase keeps someone in business, and out of being trafficked, and that’s how we’re all connected. (Activist with a fairtrade business in California)

We believe change has to happen from the ground up. What we’ve created so far [with our website and online store] has helped grow the movement and strengthen the demand for slave-free products. (Activist with an anti- trafficking coalition in California)

Our site is a one-stop shop, especially for moms who don’t have time or freedom to do all the research [on human trafficking or slave-free products]. We want to provide them everything they need, all the information, in one place. We have the shop, we review products, we do book club discussions. It’s all about convenience for moms. (Activist with an anti-trafficking organization/ethical business in California) GOING VIRAL: ONLINE GOAL EMERGENCE AND ADAPTATION… 257

The failure of the KONY 2012 campaign—although deemed successful in other respects by virtue of going viral—to mobilize anti-trafficking supporters to take to the streets is unlikely to be the direct cause for goal adaptation away from protests, if indeed that was ever an online goal for anti-trafficking activists. Nonetheless, the push toward ethical purchasing is undeniably present in anti-trafficking activists’ online efforts. Anti- trafficking activists also encourage other forms of individual action including donating to or fundraising for anti-trafficking organizations, voting on issues related to human trafficking, and participating in symbolic actions demonstrating opposition to human trafficking. The End It Movement asks users to draw a red X on the back of their hands, take a photo, and upload it to social media. Even though this sort of symbolic action draws the expected criticism that it is simply “slacktivism” to no real end, it can be a useful WUNC display, especially if it goes viral. Such symbolic action is meaningful to the movement’s target demographic of college students. Said two such students, one of whom also founded a student group to educate people about human trafficking:

It was cool to see how we’re part of this big movement, all of us. All my [social media] feeds were red Xes. It’s inspiring; it makes me want to do more. (Activist with an anti-trafficking student group in California)

It’s a way of telling people without telling them. I don’t want to be the one always bringing up slavery and sex trafficking, but I post the photo, and people can go check it out if they want. (Individual student activist in California)

By encouraging action that does not require co-presence, digital activism broadens the tactical repertoire of SMOs. Online goal adaptation from protests to purchases demonstrates how offline social movement ten- dencies are able to effectively leverage digital technology. Although some other types of individual action promoted within digital activism may be considered too symbolic to generate tangible change, they nonetheless serve as forms of inspiration and gateway activism for potential recruits.

Conclusion This chapter examines the process of goal adaptation online, through which activists are learning to improve their web strategies and make better use of their digital resources. In doing so, it raises important questions for social movement and digital activism scholars interested in the role that 258 R. GONG the use of the web plays in accomplishing broader movement goals. As with all attempts to evaluate movement outcomes, the difficulty of identifying measureable outcomes and correlating them to movement goals remains a challenge. However, the findings of this chapter make it at least possible to address the question of the impacts of digital activism by defining online goals and providing a starting point in identifying measureable outcomes that SMOs consider meaningful. By analyzing how activists describe their online goals and efforts to accomplish them, I identify three types of online goals that are well-suited to social activism, namely user engagement, fundraising, and individual changes of behavior such as ethical consumer decisions. The data show that activists are taking note of the suitability of these goals to an online environment. These online goals suggest that sustainable digital activism would be most useful for social movements with non-contentious goals. Movements that are able to achieve their goals within the system as opposed to from outside it should be better able to take advantage of the affordances of digital technologies, especially if SMOs turn their attention to the market instead of the state. Additionally, fledgling SMOs that can develop effective web strategies stand to gain the most from involving their web audience in online collaboration and fundraising. Given the way in which activists have embraced the web and remain committed to its incorporation into movement tactics as a whole, attention should be given to how digital activism impacts social change. The ideal empirical model would have researchers examining evidence to connect successful online campaigns to tangible offline outcomes, such as improved legislature or a change in statistical measures. But should such correlations not be found, as for example, in the case of a viral Kony 2012 campaign not resulting in US involvement in the hunt for Joseph Kony, researchers attempting to evaluate digital activism will have to decide if the outcomes of online campaigns can stand on their own, for example if increased awareness of an issue is enough to be considered a successful movement outcome.

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Communication Platforms and Climate Change Adaptation of Rice Farmers in Lipa City, Batangas, Philippines

Benedict Omandap Medina

Introduction Climate is the primary factor of agricultural productivity. Given the vital role of agriculture in human welfare, concerns have been expressed by national agencies and others regarding the potential effects of climate change on agricultural productivity. Interest in this issue has motivated an extensive body of research on climate change and agriculture over the past decade. Climate change is expected to influence crop and livestock production, hydrologic balances, input supplies, and other components of agricultural systems. However, the nature of these biophysical effects and the human responses to them are complicated and tentative. For example, crop and livestock yields are directly affected by changes in climatic factors such as temperature and precipitation and the frequency and harshness of extreme events like droughts, floods, and wind storms. In addition, carbon dioxide is fundamental for plant production; rising concentrations have the potential to enhance the productivity of agro-ecosystems. Climate change may

B. O. Medina (*) College of Arts and Sciences, Batangas State University, Batangas City, Philippines

© The Author(s) 2019 263 M. J. Dutta, D. B. Zapata (eds.), Communicating for Social Change, https://doi.org/10.1007/978-981-13-2005-7_13 264 B. O. MEDINA also change the types, frequencies, and number of various crop and livestock pests; the availability and timing of irrigation water supplies; and the severity of soil erosion. Climate change is now globally recognized as one of the most pressing environmental issues of the twenty-first century that can significantly impact all aspects of life. According to the successive reports of the Intergovernmental Panel on Climate Change (IPCC, 2007), climate has changed over the past century and is expected to continue changing in the future. The Fourth Assessment Report of the IPCC projected further increase in the atmospheric temperature, rising sea level, disappearance of artic summer sea ice, and likely occurrences of heat waves and intense tropical storms in the twenty-first century. These can lead to: increased risk of extinction of 20–30% of all plant and animal species; reduced availability of water supplied by melted glaciers and snow cover; large regional variability in crop yield changes; and decline in agricultural output in rain- fed areas (IPCC, 2007). These events can affect human lives—their means of livelihood due to loss of habitable areas, increased food insecurity, and reduced access to drinking water. Unfortunately, the impacts of climate change have more severe effects on the developing world where adaptive capacity is wanting. The Philippines is one of the most vulnerable countries in Southeast Asia (Yusuf & Francisco, 2009). Unlike other countries in the region, the Philippines is exposed to multiple hazards such as tropical cyclones, floods, landslides, and droughts. These natural hazards affect agricultural output. Since 34% of the country’s labor force is involved in agriculture, the livelihood of a large share of the population is at risk due to climate changes. In particular, rice is one of the crops that can be extremely affected by changing weather patterns brought about by climate change. Rice growth and production are affected by extreme weather events such as warmer nights, more rainy days, and prolonged period of drought (Centeno & Wassmann, 2010). These extreme weather events can cause spikelet steril- ity, flower abortion, higher transpiration, leaf holding, root rotting, less energy for photosynthesis, submerged crop stand, and higher incidence of pests and diseases— these all lead to lower yield. In addition, flood and drought can cause reduction in area harvested of rice. Since rice contributes 28% of agriculture’s gross value added, policymakers must be provided with information about the extent of the impacts of climate change on the rice sector. COMMUNICATION PLATFORMS AND CLIMATE CHANGE ADAPTATION… 265

Communication Relevance to Climate Change Communication plays an essential role in mobilizing and sustaining civic action. It expresses and supports the fundamental work of civic engagement in a democracy. Interestingly, communication and community share the same etymological root. “To communicate” derives from a Latin word that means “to impart,” “to share,” and “to make common”; in turn, the word “common” derives from the two roots com “together” and munia “public duties” (Harper & Benton, 2001). This etymology links communication closely to the ideal of civic action. Practically, communication and community can also mutually foster each other, whereas unsuccessful communication can alienate individuals from acting in the public sphere and hence completely fail to be an instrument of citizenship. Thus, creatively designed and skillfully executed communication can be declared effective if it serves as a tool for building and sustaining the community that acts on a res publica (a matter of public interest) such as climate change, and in helping individuals create, and feel part of, a civic community. The civic movement literature distinguishes “being a citizen,” that is, in a narrow sense merely being an individual member of a city, country, or otherwise defined community, from “participating in civic action.” The former may be quite divorced from public and political life, relegated to being a self-interested individual acting on his or her own needs and wants, consuming goods and services, and otherwise ensuring that these personal desires are met (through complaints, advocacy, volunteering, or voting). In this capacity, people can help reduce their energy use and reduce the use of those technologies that produce large amounts of greenhouse gas emissions. The role of communication in this case would be to foster individual behavioral changes. Individuals engaging in civic action, by contrast, use their actions to express commitment to, and awareness and support of, a larger common goal. The role of communication in such “public work” focuses on how the issue of concern is framed; how its causes, implications, and solutions are explained; how dialogue occurs; and how it draws on and feeds social capital (Daniel, Schwier, & McCalla, 2003). As a means to create common cause and understanding, communication makes connections across issues and thus helps build a public that is engaged on climate change. Lipa City, one of the municipalities of Batangas, Philippines, is afflicted by the raging effects of climate change according to the City Agriculture 266 B. O. MEDINA

Office. Many of its barangays, or villages, suffer from the pitfalls this calamity brings. Some of them include San Guillermo, Rizal, and Pinagkawitan. The local government has begun to realize the need to immediately address the issue by disseminating adaptation knowledge and practices to help in combatting the effects of this catastrophe. Furthermore, different sectors of the government on agriculture and environment have united to come up and implement solutions for the disaster. Yet, an apparent burden is still at hand for the local government: How effective are these projects for agriculture and the environment in the face of climate change? Communicators need to support individuals and communities by creating a sense of feasibility, collectivity, and urgency arising from fact, experience, common sense, and moral sense of responsibility (Kaplan, 2000). The researcher conducted this study to identify the communication platforms utilized by the rice farmers in sharing information on climate change, to address the endeavors faced by farmers of Lipa City due to climate change and their adaptation practices to counter them. Moreover, as communicators and catalysts of change, the researchers believed that there was a prevalent insufficiency or partiality in social and moral responsibility and action toward the environment and its branching areas. Thus, they came up with this research aimed at emphasizing the importance of rice, a major agricultural crop and food for consumption in the Philippines; unraveling the problems experienced by rice farmers due to climate change, a currently growing issue; and conceptualizing ideas on how communication could help motivate individual action in mitigating the effects of this phenomenon and protecting the environment and hopefully result in adaptive rice farming practices to climate change, leading to an improved or greater yield among rice farmers.

Research Objectives This study aimed to determine the communication platforms utilized by rice farmers in sharing information and their adaptation practices to climate change. Specifically, it sought to: (1) Present the profile of the rice farmer-farmers in terms of age, civil status, educational attainment, other source of income, number of years in rice farming; and area or tract of land they cultivate; (2) determine the communication platforms used by the rice farmer-farmers in sharing information on climate change; (3) identify problems experienced by the rice farmers due to climate change; (4) COMMUNICATION PLATFORMS AND CLIMATE CHANGE ADAPTATION… 267 describe the farmers’ adaptation to climate change in terms of physical adaptive measures, existing agricultural practices; and self-help programs and capacity building; and (5) show the comparison of responses.

Methodology Lipa City is located at Batangas province, situated 80 kilometers south of Metro Manila, Philippines. The city is composed of 72 barangays and has a population of 308,888 (NSO, 2014). It has a land area of 20, 940 hectares and an agricultural area of 15, 546 hectares. The barangays included in this research were San Guillermo, Rizal, and Pinagkawitan. These barangays, according to the City Agriculture Office, are the rice farms in the Lipa City as of February 2014. The descriptive research design and quantitative approach were employed. The data were gathered through a semi-structured survey questionnaire among 50 rice farmers. They were chosen through random sampling from the list of members from the rice farming barangays provided by the City Agriculture Office. These farmers are focused on rice production and are limited only to the official list of the government office. In order to answer the objectives, the statistical tools such as percentage, weighted mean, one-way analysis of variance (ANOVA) and F-test were used.

Results and Discussion

The Farmers from Lipa City, Batangas, Philippines Table 13.1 shows the age bracket of the rice farmers in Barangays San Guillermo, Rizal, and Pinagkawitan. The age range was 18 to 60 and above. The age group that gained the highest score was 40–59 and 60 and above which shows that majority of the rice farmers in Lipa City are in the middle and late stages of adulthood. This is followed by ages 18–39, which shows that 10 or 20% of all the rice farmers in Lipa City were in the early stage of their adulthood. Table 13.2 shows the civil status of the rice farmers. The findings signi- fied that 33 or 66% of the rice farmers in Lipa City were married. Meanwhile, 10 or 20% of the rice farmers said that they are still single. Four or 8% of the rice farmers answered that they are in a live-in relationship or living-in with their partner while 2 or 4% answered that they are widowers. Only one or 2% out of fifty said that he is separated from his partner. 268 B. O. MEDINA

Table 13.1 Profile of Age F % rice farmers in terms of age 18–39 10 20 40–59 20 40 60 and above 20 40

Table 13.2 Profile of Civil status F% rice farmers in terms of civil status Single 10 20 Married 33 66 Widow 2 4 Separated 1 2 Live-in-partner 4 8

Table 13.3 Profile of Educational attainment F% rice farmers in terms of educational attainment College graduate 0 0 College dropout 2 4 Vocational graduate 1 2 Vocational dropout 0 0 High school graduate 18 36 High school dropout 10 20 Elementary graduate 13 26 Elementary dropout 6 12

Table 13.3 shows the findings on the rice farmers’ educational attainment. The majority of the rice farmers have low educational attainment: 18 (36%) are high school graduates, 13 (26%) have graduated from their primary education, 10 (20%) are high school dropouts, 6 (12%) were elementary dropouts, 2 (4%) are college dropouts, and only 1 (2%) took a vocational course. None (0%) graduated from ter- tiary education. Table 13.4 shows the assessment of the rice farmers’ other source/s of income aside from rice farming. A great majority (40 or 80%) of the rice farmers do not have any other source/s of income and depend on rice farming alone as their occupation and source of income. However, seven (14%) answered that they raise animals as another source of income. Some of these livestock that they raise are mostly pig or swine, hens, and COMMUNICATION PLATFORMS AND CLIMATE CHANGE ADAPTATION… 269

Table 13.4 Profile of Rice farmers’ other source/s of income F % rice farmers in terms of other source/s of Livestock 7 14 income Vegetables crops 2 4 Fruit crops 1 2 None 40 80 ducks. Since they are working in a farm and in rural areas, they tend to raise livestock as other source of income because of the clean and healthy environment suitable for the animals. Also, their crops can be fed to the animals they raise and the animals’ excretions can be used as organic fertilizer for their soil and crops. Moreover, ducks help the farmers avoid kohol (golden snail) pests in their farms because ducks feed on them. And, eggs that hens produce can be consumed by the rice farmers and their families for daily living and they can sell them for extra income. On the other hand, two (4%) of rice farmers answered that they grow vegetable crops which are pechay. They plant pechay perhaps because of the availability of space in their farms for cultivating other crops. Lastly, one (2%) answered that he produces fruit crops, specifically tangerine orange or sinturis as his other source of income. The rice farmers grow fruits and vegetables because of the suitability of these crops to the topography of their farms. Table 13.5 shows the number of years that the rice farmers have been engaged in rice farming. It was found out that most of the rice farmers were in the range of 6–15 years in rice farming but still, some were in the 1–5 and 16–20 years range. And only a few have more than 20 years in this field. In terms of the span of years, 16 (32%) of the rice farmers in Lipa City have been cultivating rice for about 11–15 years. On the other hand, 11 (22%) of the rice farmers have been cultivating rice for about 6–10 years. Furthermore, only nine (18%) of them are in the 1–5 years in rice farming and another nine (18%) are for about 16–20 years. Lastly, only five (10%) of these rice farmers have been cultivating rice for more than 21 years. Table 13.6 shows the tract of land where the rice farmers cultivate rice. Statistics show that the area or tract of land to have the highest score was one hectare which entails that 14 (28%) of the rice farmers in Lipa City cultivate rice on one hectare of land. This is followed by 0.5 hectare of land where 12 (24%) of the rice farmers cultivate 0.5 hectare of land for rice production. Then, 11 (22%) of the rice farmers cultivate 2–3 hectares 270 B. O. MEDINA

Table 13.5 Profile of Number of years in farming F % farmers in terms of number of years in rice 1–5 9 18 farming 6–10 11 22 11–15 16 32 16–20 9 18 21 years and above 5 10

Table 13.6 Profile of Area/tract of land they cultivate F % farmers in terms of area or tract of land they ¼ hectare 9 18 cultivate ½ hectare 12 24 1 hectare 14 28 2–3 hectares 11 22 More than 3 hectares 4 8 of farm lands, while nine (18%) cultivate 0.25 hectares. On the other hand, only four (8%) of the rice farmers cultivate more than 3 hectares of land.

Communication Platforms Rice Farmers Use in Sharing Information on Climate Change Table 13.7 shows the findings on the communication platforms utilized by the rice farmers in sharing and exchanging information on climate change. All (50 or 100%) the rice farmers utilize interpersonal communications such as face-to-face conversation, conversation with family members, peers, neighbors, co-farmers, etc., conversation with other members of the group or organizations, and informal conversation with other residents. Unmediated interpersonal communication is a usual activity for people living in rural areas because they do not have much activities and advance technology to spend their time with and to entertain themselves. Besides, such interactions do not require so much effort and expenses of any kind to gain and share information on climate change. Moreover, the farmers utilize small group communications such as meetings (50 or 100%), trainings, and demonstrations (both 48 or 96%) that are relevant to climate change for them to acquire knowledge from agricultural and environmental agencies for free. The rice farmers also use COMMUNICATION PLATFORMS AND CLIMATE CHANGE ADAPTATION… 271

Table 13.7 Communication platforms utilized by rice farmers in sharing information on climate change

Communication platforms F % Rank

1. Face-to-face conversation 50 100 2.5 2. Conversation with family members, peers, neighbors, co-farmers, etc. 50 100 2.5 3. Conversation with other members of group or associations 50 100 2.5 4. Informal conversation with the residents 48 96 7 5. Demonstration 48 96 7 6. Meeting 50 100 2.5 7. Training 48 96 7 8. Seminar 46 92 9 9. Magazine 17 34 14 10. Newspaper 28 56 12 11. Radio 39 78 10.5 12. Television 49 98 5 13. Cellphone messaging 39 78 10.5 14. Telephone or cellphone calling 24 48 13 15. Internet 4 8 15 television (49 or 98%) as a medium in gaining knowledge on climate change because television offers both visual and sound elements simultaneously which enables them to gain knowledge at ease even if they live in remote areas. The farmers use radio and text messaging (both 39 or 78%) that are communication platforms utilized in gaining and sharing knowledge on climate change. The rice farmers have access to radio because they are cheap, and informative radio stations are abundant in the city of Lipa and it can reach remote areas where these rice farmers reside. Moreover, text messaging is also employed by rice farmers because through this medium, they could gain information on the schedule of training, seminars, and any other programs offered by environmental and agricultural agencies on matters regarding climate change information and adaptation. Moreover, 28 (56%) said that they have been using the newspaper as a tool in garnering knowledge on climate change. This is quite reasonable because they live in remote areas where newspapers are hard to transport and distribute. Next in the rank is telephone or cellphone (24 or 48%) as a medium for calling and communicating with others. Results show that almost half of all the rice farmers in Lipa City employ telephones and cellphones in disseminating information on climate change. Given the fact 272 B. O. MEDINA that these farmers came from poor families, it is quite hard for them to afford and have access to modern communication tools such as telephones and cellphones. Also, they are not very knowledgeable in using these kinds of communication tools. Moreover, magazines have one of the lowest levels of utilization as communication medium in receiving information about climate change because it is a sophisticated type of print media and not readily available in the rural areas. Typically, it is a bit costly, which is why these rice farmers do not actually invest in magazines as a source of information on climate change. Lastly, the Internet received the lowest score in communication media utilization. Although it is the most in-demand and one of the most effective sources of information, these rice farmers do not have the chance to have access to this type of communication tool due to several factors— having an Internet connection is expensive and having a computer or laptop itself is costly. Farmers tend to prioritize their daily needs instead of investing in the Internet because of poverty and low income. Lastly, since most of the rice farmers are in the middle and late stages of adulthood, they did not get the chance to be educated in using computers or the Internet when they were young adults. The farmers are usually exposed to various forms of communication media to collect information. Different research studies show that farmers prefer interpersonal information sources, group approach, and mass media to receive information. Halim and Miah (1992) found that the small and medium farmers preferred interpersonal communication sources only to get their necessary information, while the rich farmers preferred interpersonal and mass media sources of information. However, these findings are in contrast to the study of Celis (2010), Saulan (2011) and Vega (2012), which revealed that rice farmers in Pila, Laguna, Ormoc, Liloan, and Leyte were highly knowledgeable on climate change and their common sources of information were mass media communications.

Problems and Struggles of Rice Farmers Due to Climate Change Table 13.8 shows the assessment on the problems experienced by rice farmers due to climate change. All of these problems gained high scores, but some stood out as the worst problems they encounter due to climate change. COMMUNICATION PLATFORMS AND CLIMATE CHANGE ADAPTATION… 273

Table 13.8 Problems experienced by the rice farmers due to climate change

Problems F % Rank

1. Inability to distribute water for crops due to extreme heat or El Niño 48 96 5 2. Destruction of crops due to typhoon and other natural calamities 49 98 3.5 3. Destruction of water irrigations or dam and other sources of water 50 100 1.5 due to typhoon and other natural calamities 4. Insufficient knowledge on the next accurate period of the farming 40 80 6 5. Decrease in crop production due to drought and flood 50 100 1.5 6. Spread of diseases and pests affecting crops 49 98 3.5

Items number 3 and 5 gained 1.5 in the ranking because the farmers are greatly affected by these problems. Climate change brings heavy rains, strong winds, and great storms which destroy the irrigations or dams which are the only sources of the rice farms’ water supply. Water is one of the major factors for a productive yield of rice besides air, sunlight, and soil with nutrients and minerals. If their only source of water is destroyed, the growth of the crops will fail due to drought. Moreover, due to heavy rains which lead to flood, the crops will drown and eventually die. This entails that water irrigation systems or dams are the only source of water of the rice farms. Hence, their rice production mainly depends on the availability of water from these water irrigation systems. Moreover, item number 3 requires money on repairing these damaged irrigation systems, while item number 5 affects the income of the rice farmers. Next in rank on the problems they encounter due to climate change are item numbers 2 and 6. Statistics show that 49 (98%) of the rice farmers in Lipa City are stressed by the destruction of crops due to typhoon and other natural calamities. This is likely because of the experiences they had that even though natural calamities destroy most of the rice crops, they damage some parts of the farms only and not entirely. On the other hand, they also worry about the spread of diseases and pests affecting the crops, but they already have solutions in countering this problem such as light trapping and metarhizium. Item number 5 ranked 3rd in the table because the problem of the inability to distribute water for the crops has already been experienced by the rice farmers a long time ago. And as a solution, they schedule the distribution of water among the different parts of the rice farms. Item number 6 was ranked last. And this is perhaps because they know that they are able to have sufficient knowledge through the free trainings and seminars conducted by the concerned agencies. 274 B. O. MEDINA

How do Rice Farmers Adapt to Climate Change? The following tables and interpretations are to assess the adaptation of rice farmers to climate change. It presents how much the rice farmers agree on the effectiveness of the following physical adaptive measures, existing agricultural practices, and self-help programs and capacity building in adapting to climate change (Table 13.9). The rice farmers agreed that the physical adaptive measures they practice are effective based on the composite mean of 3.42. They strongly agreed that using organic fertilizers and biological pest controls is one of the most effective physical adaptive measures in adapting to climate change. This is because they noticed the good benefits that organic farming brings instead of using synthetic fertilizers. They began to be aware that organic farming produces food that is safe to eat, safe on the farmers’ health, and is good for the environment. As for item number 1, the rice farmers only agreed on getting water from the river as a physical adaptive measure in adapting to climate change, perhaps because it is quite hard for them to practice this. Although the river is near them, it requires effort to transport the water from the river to their farms. Furthermore, they only agreed to raise ducks to prevent kohol pests in crops because it is only an option in the prevention of kohol pests, since they are already using various methods of pest control. Not all of the rice farmers agreed on the effectivity of item num-

Table 13.9 Assessment on the rice farmers’ adaptation to climate change in terms of physical adaptive measures

Item WM VI

1. Getting water from the river 3.28 Agree 2. Utilizing modern farming machineries such as drum seeder, 3.56 Strongly thresher, dryer, and tractors agree 3. Constructing water irrigation systems or dam in rice farms 3.84 Strongly agree 4. Using organic fertilizers and biological pest controls 3.62 Strongly agree 5. Raising ducks to prevent kohol pests in crops 2.98 Agree 6. Using organic pesticides such as kohol amino acid to prevent 3.44 Agree kohol pests 7. Mechanizing alternative technology and water irrigation systems 3.22 Agree COMPOSITE MEAN 3.42 Agree COMMUNICATION PLATFORMS AND CLIMATE CHANGE ADAPTATION… 275 ber 6 because it is not yet accepted by some of them. Some of them use organic pesticides such as kohol amino acid to prevent kohol pests, while some do not. They also agreed only on mechanizing alternative technology and water irrigation systems because they already have irrigation systems. One alternative source of water is the windmill as suggested by the City Agriculture Office, but they do not have enough funds to provide this kind of water system. According to an agriculture engineer, their farms require three wind- mills, but one windmill costs Php 350,000 (around USD 6,600). This may explain why the rice farmers agreed only in this physical adaptive measure. Among the given physical adaptive measures, majority of the rice farmers strongly agreed that utilizing modern farming machineries, constructing water irrigation systems, and using organic fertilizers and biological pest controls are most effective in adapting to climate change. Table 13.10 presents the rice farmers’ existing agricultural practices in adapting to climate change. With a composite mean of 3.52, it signifies that the majority of the rice farmers strongly agreed that their existing agricultural practices are effective on climate change adaptation. Among the given existing agricultural practices, the rice farmers strongly agreed that scheduling of water distribution on different parts of the rice fields and choosing the variety of rice to plant are effective measures in adapting to climate change. Since water is scarce in their farms and water irrigation

Table 13.10 Assessment on the rice farmers’ adaptation to climate change in terms of existing agricultural practices

Item WM VI

1. Scheduling water distribution on the different parts of the rice 3.76 Strongly fields agree 2. Choosing the variety of rice to plant based on the topography of 3.82 Strongly the rice fields agree 3. Practicing double or triple monoculture in planting rice 3.20 Agree 4. Alter nate planting of rice and vegetable to avoid the production of 3.44 Agree pests 5. Using crop rotation such as planting vegetable during dry season 3.44 Agree as an adaptation strategy 6. Practicing farming systems that are compatible with the season or 3.44 Agree climate COMPOSITE MEAN 3.52 Strongly agree 276 B. O. MEDINA systems are sometimes destroyed by storms, they cannot continue planting, and hence their income is intermittent. If only their farming is continuous throughout the year, they will also acquire income continuously. Meanwhile, on item number 2, rice farmers know the best varieties of rice to plant in their farms that are suitable for the changing climate. But, since the climate and weather is unpredictable, they cannot determine the variety of rice that they should plant. Sometimes, rice farmers tend to plant different varieties of rice at the same time so that they can produce in whatever climate might occur. They agreed on item number 3 because not all of them plant vegetables. They wanted to plant rice because it generates more income and their topography is compatible for rice crops. Meanwhile, items number 4, 5, and 6 are agreed to be effective by the rice farmers in adapting to climate change because they are certain that these agricultural practices are proven effective based on their experiences. Further, they gained the same scores in the assessment on their effectiveness according to the rice farmers. They also choose to plant rice because it is more expensive to sell and their farms are really suited for this crop. With a composite mean of 3.39, the rice farmers agreed that their self- help programs and capacity building are effective in adapting to climate change. The rice farmers strongly agreed that establishing associations or organizations will help them to be recognized and helped by the government and concerned agencies, and this will help them to adapt easier and better to climate change. Since they were not an organized group before, it was individually hard for them to ask help from the government and concerned agencies (Table 13.11).

Table 13.11 Assessment on the rice farmers’ adaptation to climate change in terms of self-help programs and capacity building

Item WM VI

1. Participating in activities about climate change adaptation 3.32 Agree 2. Attending trainings on using modern technology in rice farming 3.38 Agree 3. Employing modern technology in rice farming 3.48 Agree 4. Establishing small businesses of by-products from rice and rice grain 3.22 Agree such as making and selling sweet delicacies, producing paper and converting rice grains to fertilizer 5. Encouraging and teaching other rice farmers to practice organic 3.44 Agree ways of rice farming 6. Establishing associations or organizations to be easily recognized 3.52 Strongly and helped by the government and concerned agencies agree COMPOSITE MEAN 3.39 Agree COMMUNICATION PLATFORMS AND CLIMATE CHANGE ADAPTATION… 277

The City Agriculture Office helped organize the farmers and it is now easier to assemble and be helped by the local and national government by providing them agricultural aid such as machineries, irrigations, and free seeds. On the other hand, they only agreed on the effectiveness of items number 1 to 5 for climate change adaptation because anyone of the rice farmers is able to practice them individually. The results had verbal interpretations of “Agree” and “Strongly Agree,” but they are all perceived as effective in adapting to climate change since their scores are nearly close to one another, although some of them were highlighted and emphasized as the most effective among the other adaptation practices to climate change.

Climate Change Adaptation Practices versus Rice Farmers’ Profiles The following tables and interpretations assessed the comparison on the adaptation of rice farmers to climate change. It presents how the study found the significance of the farmers’ profile to their physical adaptive measures, existing agricultural practices, and self-help programs and capacity building in adapting to climate change. Table 13.12 indicates the difference in the physical adaptive measures of the farmers in terms of profile. The given profile variables are not significant and do not contribute to or affect, in any way, their physical adaptive measures in rice farming due to climate change. This is possible because the aforementioned measures were already known to the rice farmers. They pass this knowledge to their farmer constituents, regardless of their profile variables. There is no significant difference to, nor do they affect, each other in any way.

Table 13.12 Difference on the physical adaptive measures of the farmers in terms of profile

Profile variables p-values Computed f-values Decision on Ho Verbal interpretation

Age .18 1.76 Failed to reject Not significant Civil status .41 1.01 Failed to reject Not significant Educational .93 .26 Failed to reject Not significant attainment Other sources of .21 1.56 Failed to reject Not significant income Years in rice farming .87 .31 Failed to reject Not significant Area/tract of land .36 1.12 Failed to reject Not significant 278 B. O. MEDINA

Table 13.13 Difference on the existing agricultural practices of the farmers in terms of profile

Profile variables p-values Computed f-values Decision on Ho Verbal interpretation

Age .74 .31 Failed to reject Not significant Civil status .89 .27 Failed to reject Not significant Educational .82 .44 Failed to reject Not significant attainment Other sources of .02 3.84 Reject Significant income Years in rice farming .007 4.09 Reject Significant Area/tract of land .17 1.69 Failed to reject Not significant

The farmers’ age, civil status, educational attainment, and area or tract of land they cultivate are variables that are significant and do not affect their existing agricultural practices (see Table 13.13). Age was found not significant to the rice farmers’ adaptation to climate change. It entails that even though the rice farmers are in the early, middle, and late stages of adulthood, their physical adaptive measures to climate change are practically the same. This also suggests that the agricultural practices of rice farmers in the last 60 years remain unchanged. Their civil status was also found not significant to their climate change adaptation practices, it does not vary in any amount of uncertainty their physical adaptive measures to climate change. Civil status which was also found not significant on the rice farmers’ existing agricultural practices since being single or married do not affect them in employing agricultural experience in farming. Moreover, statistics show that the rice farmers’ educational attainment is also not significant to their adaptation to climate change. It indicates that whatever level of education they have attained, it would not alter their physical adaptive measures to climate change. In other words, though the rice farmers may come from different educational attainment, they employ the same agricultural practices in rice farming. Other source/s of income was found significant to the rice farmers’ existing agricultural practices. It entailed to show that having and not having other source/s of income varies the rice farmer’s agricultural practices in adapting to climate change. The findings revealed that some of the rice farmers raise livestock and produce fruit and vegetable crops. Since they have other priorities, they limit or change their existing agricultural practices in order to provide support for their other sources of income. Number of COMMUNICATION PLATFORMS AND CLIMATE CHANGE ADAPTATION… 279

Table 13.14 Differences in the self-help programs and capacity building of the farmers in terms of profile

Profile variables p-values Computed f-values Decision on Ho Verbal interpretation

Age .13 2.14 Failed to reject Not significant Civil status .22 1.51 Failed to reject Not significant Educational .12 1.89 Failed to reject Not significant attainment Other sources of .46 .88 Failed to reject Not significant income Years in rice farming .07 2.36 Failed to reject Not significant Area/tract of land .52 .83 Failed to reject Not significant

years in rice farming was also significant to the rice farmers’ existing agricultural practices. It indicates that having more years in rice farming may vary the rice farmers’ knowledge and agricultural practices because they have more time and experience in this area of work. Lastly, the area or tract of land they cultivate was found to be not significant in the rice farmers’ existing agricultural practices. This finding denotes that cultivating many or only a few hectares of land does not affect or change the rice farmers’ agricultural practices in adapting to climate change. Table 13.14 shows the difference in the rice farmers’ self-help programs and capacity building in terms of their profile. Findings revealed that all of the given profile variables of the rice farmers are not significant and do not contribute or affect, in any way, their self-help programs and capacity building for climate change adaptation. Similarly, age was again found not significant to the rice farmers’ adaptation to climate change. It entails that even though the rice farmers are in the early, middle, and late stages of adulthood, their self-help programs and capacity building to climate change is practically the same. Therefore, the farmers, whether young or old; single or married; highly or less educated; with other sources of income or focused solely on rice farming; new or seasoned rice farmer; cultivates small or large land area, they all do not vary in any amount of uncertainty their self-help programs and capacity building to climate change. Moreover, statistics again indicate that whatever level of education they have attained, it would not enable them to employ their self-help programs and capacity building to climate change. The table also presents 280 B. O. MEDINA that the rice farmers’ other sources of income is not significant to their climate change adaptation practices. Meaning to say, whether they have other sources of income or not, they can still manage to practice the self- help programs and capacity building to climate change. Furthermore, it was also found that the rice farmers’ number of years in rice farming is not significant to their climate change adaptation. It means that no matter how long or short the rice farmers may be in the rice farming industry, it will not alter their self-help programs and capacity building in adapting to climate change. Lastly, the area or tract of land cultivated by the rice farmers is not significant to their adaptation to climate change. This means that whether they cultivate few or many hectares of land, they could still practice their self-help programs and capacity building in adapting to climate change.

Conclusions The majority of all the rice farmers in Lipa City are in the middle and late stages of adulthood, married, have low educational attainment, do not have other sources of income, have been involved in rice production for about 6–15 years, and cultivate small areas of land. The rice farmers usually utilize interpersonal communication in sharing information on climate change. In addition, small group communication (i.e., demonstrations, meetings, trainings, and seminars) and broadcast media (i.e., television and radio) were the top communication platforms that they employ in gaining and disseminating knowledge on climate change. This is a manifestation of the fact that communication as a process and as a tool should always be taken into consideration because traditional media, more importantly interpersonal communication and media, are always relevant in everyday life. We should note that “one cannot not communicate,” according to one communication scholar. Communication in this sense plays a big role in sustaining the knowledge and awareness of the rice farmers in adapting to climate change, through various communication platforms. Enhancement, responsibility, and popularizing these communication platforms may be considered in order to sustain their utilization and information dissemination, which are helpful to the rice farmers. The rice farmers in Lipa City experience different agricultural problems. These phenomena could be naturally happening among them, but it is assumed that communication could be one possible solution to solve or COMMUNICATION PLATFORMS AND CLIMATE CHANGE ADAPTATION… 281 lessen these problems. Communication is deemed to be the bridge to the farmers’ knowledge. Through communication platforms, it could be possible to enhance the knowledge and awareness of the farmers, arming and preparing them to use the necessary measures once they experience such problems. Physical adaptive measures to climate change such as utilization of modern farming machinery, construction of irrigation systems or dams, and usage of organic fertilizers and biological pest controls were found to be very effective in adapting to climate change. Moreover, existing agricultural practices such as scheduling of water distribution in the different parts of the rice fields and choosing the variety of rice to plant based on the rice farm’s topography were also found to be very effective. Lastly, self-help programs and capacity building such as establishing associations or organizations were also found to be highly effective in adapting to climate change. These practices could be sustained and passed down the generations. The pathway to do this culturally could be communication platforms. The rice farmers were highly engaged in interpersonal communication platforms, highlighting communication as an avenue for passing general knowledge and awareness about climate change and particularly adaptation to it. The farmers’ profiles (i.e., age, civil status, educational attainment, other source/s of income, number of years in rice farming, and area or tract of land they cultivate) do not affect or vary their physical adaptive measures and self-help programs and capacity building. However, the farmers’ other source/s of income and number of years in rice farming vary their existing agricultural practices in adapting to climate change. However, their profile does not affect or vary their existing agricultural practices. The information above, if communicated properly, could be used as bases for further actions like community extension and involvement. Communication in this scenario serves as process in disseminating information among community stakeholders, particularly rice farmers. Since other sources of income and number of years in farming among rice farmers’ profile variables make a significant difference in terms of their agricultural practices, livelihood opportunities like trainings relative to rice farming could be carefully planned and conducted, and eventually sustained. These could also be introduced to those who do not practice other sources of income generation. 282 B. O. MEDINA

Recommendations The concerned office may conduct more training and seminars which would allow the rice farmers to learn farming practices that would help them adapt to climate change. Communicating knowledge is a relatively easy task but getting people to understand, accept, and apply is a difficult one. They shall conduct more frequent field visits and meetings about climate change adaptation for the farmers to adopt new varieties of farming techniques. To further enhance knowledge sharing, print materials such as leaflets/brochures may be distributed to supplement the knowledge shared through interpersonal communication. These materials could also serve as reference for the farmers if they encounter farming problems in case the concerned agencies are not around to help them. They shall also encourage the rice farmers to share knowledge. Through this, formulation of adaptation mechanisms in the locality will be improved. They may conceptualize and promote innovative mechanisms and adaptation practices for national agriculture. They shall always monitor rice crops and supply to avoid wasting them in warehouses. They shall provide more benefits for farmers in the Philippines for their hard work and great efforts in providing national food security. Partnership and collaboration shall be pursued, with the academe, local government unit, non-government organizations, and peoples’ organization, in order to push more extension services beneficial to the environment and agriculture. They may promote environmental and agricultural advocacies through their courses. They may also offer environmental and agricultural programs for aspiring students. The public shall cooperate and contribute in maintaining the cleanliness and health of the environment. They may put up a vegetable garden that is suited to the locale setting they are in to help and contribute to one of our government’s aims, which is food sufficiency and sustainability. Agriculture and environment shall be one of the city government’s priorities for the city’s development. They shall be available and help shall be visible to enable the farmers to apply the knowledge they gained after sharing with concerned agencies. Lastly, the Lipa City rice farmers shall always interact with the City Agriculture Office to seek information and help on agricultural aspects. The rice farmers shall always attend meetings, trainings, seminars and other rice farming-related agenda conducted by the City Agriculture Office and other agriculture sectors. COMMUNICATION PLATFORMS AND CLIMATE CHANGE ADAPTATION… 283

References Celis, Eva M. (2010). Knowledge, attitude, and practices (KAP) of rice farmers in Pila, Laguna on climate change. University of the Philippines Los Baños, Laguna, Philippines. Centeno, H.G.S and R. Wassmann. (2010). Reviewing the impacts of climate change and climate variability on rice production in the Philippines in adaptation to climate change and variability. Lansigan, F.P. (ed.). Asia Rice Foundation, College, Laguna, Philippines. pp. 120. Daniel, B., Schwier, R.A., and G. McCalla. (2003). Social Capital in Virtual Learning Communities and Distributed Communities of Practice. Canadian Journal of Learning and Technology. Volume 29(3). Available from: https:// www.cjlt.ca/index.php/cjlt/article/view/26539/19721 Halim, A and Miah, M. (1992). Flow of agricultural information in rural households. Available from: www.oecd.org/dataoecd/25/8/36562896.pdf. Accessed date: December 3, 2014. Harper, D.A.T. and M.J. Benton. (2001). Preface: History of Biodiversity. Geological Journal, Geol, J. 36: 185186 (2001). https://doi.org/10.1002/ gj.899. Intergovernmental Panel on Climate Change (IPCC). (2007). Climate change 2007: Impacts, adaptation and vulnerability. M.L. Parry, O.F. Canziani, J.P. Palutikof, P.J. van der Linden and C.E. Hanson, eds. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge: Cambridge University Press. Available from: www.ipcc.ch/.../publications_ipcc_fourth_assessment_report_wg2_ report_impacts_adaptation_an. Accessed date: February 7, 2014. Kaplan, D. (2000). Structural equation modeling: Foundations and extensions. Available from: https://www.researchgate.net/publication/233337570_ Book_review_of_D_Kaplan_2000_Structur. Accessed date: October 14, 2018. National Statistics Office. (2014). NSO releases 2014 Philippines in Figures. Available from: https://psa.gov.ph/content/nsoreleases2014philippinesfigures Saulan, Jonalyn G. (2011). Information environment and farmers’ responses to flooding and drought: The case of rice farmers in Ormoc. Visayas State University, Baybay, Leyte, Philippines. Vega, Jennifer M. (2012). Information environment, perceptions of vulnerability and responses to landslide of upland residents in Liloan, Southern Leyte. Visayas State University, Baybay, Leyte, Philippines. Yusuf, A and Francisco, A. (2009). Climate change vulnerability mapping for Southeast Asia. Available from: http://www.ccfsc.gov.vn/.../Climate%20 Change%20Vulnerability%20Mapping%20SE%20Asia%20(IDRC).pdf. Accessed date: February 7, 2014. CHAPTER 14

Integrative Medicine Focus Groups as a Source of Patient Agency and Social Change for Chinese Americans with Type 2 Diabetes

Evelyn Y. Ho, Genevieve Leung, Han-Lin Chi, Siyuan Huang, Hua Zhang, Isabelle Ting, Donald Chan, Yuqi Chen, Sonya Pritzker, Elaine Hsieh, and Hilary K. Seligman

In the U.S., over 29 million people (9.3% of the population) have diabetes and as many as one in three will develop type 2 diabetes (T2DM) in their lifetime (Centers for Disease Control and Prevention, 2014).

E. Y. Ho (*) • S. Huang • I. Ting • D. Chan • Y. Chen Department of Communication Studies, University of San Francisco, San Francisco, CA, USA e-mail: [email protected] G. Leung Department of Rhetoric and Language, University of San Francisco, San Francisco, CA, USA e-mail: [email protected] H.-L. Chi School of Nursing, University of California, San Francisco, San Francisco, CA, USA

The prevalence for ethnic minorities is even worse, ranging from 20% to 22% among Black, Asian, and Latino populations (Menke, Casagrande, Geiss, & Cowie, 2015). Chinese Americans (CAs) make up the largest Asian American ethnic group and are at higher risk for developing T2DM compared to White Americans at the same BMI (Hsu, Araneta, Kanaya, Chiang, & Fujimoto, 2015; Rajpathak & Wylie-Rosett, 2010). Asian Americans have one of the highest rates of undiagnosed diabetes (over 10%) compared to White and Black populations (Menke et al., 2015). Recent research has documented that CAs with T2DM often have difficulty following standard diabetes management diet recommendations that focus on food restriction and food measurement (Washington & Wang-Letzkus, 2009) and that many CAs use Chinese medicine (CM) in their healthcare and everyday food choices (Chun & Chesla, 2004). In this chapter, we use a Culture-Centered Approach (Dutta, 2007) to investigate patient agency in focus group interviews with CAs with T2DM discussing their diet and eating practices to manage this chronic condition. These interviews were conducted as part of a larger study to create an integrative diabetes diet that uses CM-based diet suggestions for diabetes that are also nutritionally acceptable from a biomedical perspective. Participants were recruited to give feedback on an early version of the diet and to share their stories of how they eat, and their

H. Zhang Wenzhou Medical University, Wenzhou, China S. Pritzker UCLA Center for East West Medicine, Santa Monica, CA, USA E. Hsieh Department of Nutrition and Public Health, University of Saint Joseph, West Hartford, CT, USA H. K. Seligman Division of General Internal Medicine and Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA INTEGRATIVE MEDICINE FOCUS GROUPS AS A SOURCE OF PATIENT… 287 successes and challenges with food, CM, and diabetes. As we will present, CAs both use and are seeking culturally-informed ways to use CM as a way to assert agency, despite structural constraints, in how they manage their diabetes.

Diabetes, Chinese Medicine and Chinese Americans There are a variety of reasons that could explain why T2DM affects CAs disproportionately. Between 2000 and 2010, Asian Americans were the fastest growing racial group in the U.S. largely due to immigration (U.S. Census Bureau News, 2015). This is particularly alarming as rates of diabetes (~11%) and pre-diabetes (~50%) in China have risen to epidemic proportions (Xu, Wang, He, & et al., 2013). Although compared to other Asian ethnic groups, CAs appear to have better prevalence numbers (Karter et al., 2013), these numbers may also obscure some of the actual experiences of different subgroups of CAs. For example, according to the 2010 U.S. Census, in San Francisco, where this research study took place, CAs constituted about 21% of the total population (U.S. Census Bureau, 2010). The CA population is made up predominantly of immigrants (over 80%) and half speak English “poorly” or “not at all” (NICOS-Chinese-Health-Coalition, 2004). Nationwide, 27.4% of CAs have low English proficiency (Sentell & Braun, 2012). Not sur- prisingly, low English proficiency has been associated with low health literacy. Research in this area has demonstrated that CAs with low English proficiency had far worse health literacy compared to Whites and other ethnic minority groups, and lower health status (Sentell & Braun, 2012). While statistical studies can overgeneralize about the prevalence of diabetes among CAs, a handful of studies are examining the actual health beliefs, practices, and culturally-specific diabetes self-management regimens created for CAs (cf., Chesla, Chun, & Kwan, 2009; Park, Nam, & Whittemore, 2015; Wang & Chan, 2005; Yin Xu, Pan, & Liu, 2010). For example, Ho, Chesla, and Chun (2012) concluded that for CAs, health messages about diabetes self-care should include the social and physical consequences of diabetes, as well as address cultural beliefs and food/eating practices. Although research finds that CM beliefs and practices are highly prevalent and deeply rooted in the CA community in San Francisco (Chesla et al., 2009; Chun & Chesla, 2004; Seligman et al., 2007; Sun, 288 E. Y. HO ET AL.

Tsoh, Saw, Chan, & Cheng, 2012), there are few interventions that actually seek to address this reality. Although there is a lack in literature on CAs with T2DM and their health practices, CM itself is not new. CM is a tradition that is thousands of years old consisting of various healing therapies including acupuncture, Chinese medicinal herbs, tuina (推拿, ‘massage’), acupressure, bone-setting, and other practices. In the 1940s, in an effort to standardize and bring CM to the masses, Mao Zedong codified some aspects of CM into what is now called Traditional CM (TCM) (Hsu, 2008; Ulett, Han, & Han, 1998). TCM is typically the standard form of CM used for licensing. For example, in the U.S., acupuncture and Chinese herbal medicine licensing is done state-by-state, but examinations are typically based on TCM therapy and typically cover either acupuncture or herbal medicine, or, in some cases (like in California), both. Dietary therapy and medicinal foods are not part of state licensure examinations. However, because many folk users and licensed practitioners incorporate dietary therapies as part of their practice (Baer, 2001), it is worth noting that what gets practiced is often broader than just TCM. Therefore, in this chapter, since we are interested in this broader practice of CM, we will use the term CM and not TCM.

Culture-Centered Approach and Social Justice Despite a clear recognition in medicine that health promotion and health education should be culturally-centered and/or culturally-appropriate, there is quite a bit of debate and disagreement about what that should entail (Betancourt, Green, Carrillo, & Ananeh-Firempong, 2003; Dutta, 2007). In this chapter, we use the Culture-Centered Approach, which focuses on understanding culture as a context as opposed to a variable to be manipulated (Dutta, 2007). The Culture-Centered Approach’s three main concerns are about agency, culture, and structure:

Agency refers to the capacity of cultural participants to participate in day-today actions in response to their contexts based on a deeper level of understanding of these contexts and the structures surrounding them. (Dutta, 2007, p. 321)

In other words, a Culture-Centered Approach project recognizes how individuals are embedded in larger cultural and structural contexts that INTEGRATIVE MEDICINE FOCUS GROUPS AS A SOURCE OF PATIENT… 289 affect people’s abilities to participate fully in health (Dutta, 2008). As a grounded approach, the Culture-Centered Approach also values and privileges dialogic spaces as a way for participants to be heard, to co-create, and to determine their own health solutions (Dutta, 2007) that might otherwise be erased in more top-down or biomedical-centric conversations. This approach acknowledges individual and cultural perceptions that may already be fostering positive health practices even if those practices are not commonly recognized as healthcare. It is especially important to listen to CA voices specifically talking about CM since research in the U.S. too often ignores traditional users of holistic therapies (Baer, 2001). Research about holistic medicine focuses too much on wealthy and White users of holistic medicine, which is often considered as a “treat” for the privileged (Bishop, Yardley, & Lewith, 2008). As a direct response to this inequality, our present project attempts to recover the voices of users who have an ethnic tradition and everyday practice tied to these therapies. Based on the above concepts of the Culture-Centered Approach and social justice, we asked the following research question: How do CAs use (and desire to use) CM as a form of agency in managing their T2DM?

Methods

Data Collection As part of a larger study with the goal of creating a diet guide and in- person course curriculum (Ho et al., 2015a, b), we conducted semi- structured focus group interviews with CAs with T2DM from the San Francisco Bay Area. Although the larger purpose of the focus groups was to assess a draft version of the diet guide, as part of the discussion, we also asked participants to share their eating/diet habits and experiences treating their T2DM with food, CM, and any other remedies or self- management practices. We used the focus groups as an opportunity for dialogue, to listen to the voices of CAs with T2DM, and to promote conversation among participants so that they might engage one another as well. The project was approved by the institutional review boards from the University of California, San Francisco and the University of San Francisco. Participants were recruited through purposive sampling via Chinese advertisements posted at the public safety net hospital for the county, through a local Asian health listserv, and a local Chinese newspaper. 290 E. Y. HO ET AL.

Recruitment and data collection began in April 2014 and were completed by May 2014. Participants were included if they: (1) were age 18 years or older, (2) had a diagnosis of T2DM, (3) were able to speak and read Chinese, and (4) had used CM or Chinese medicinal food principles in the previous 12 months. Informed consent was obtained from eligible participants prior to the focus groups. Fourteen participants were enrolled into four focus groups (see Table 14.1). Three groups were conducted in Cantonese, and one was conducted in Mandarin. Each focus group lasted approximately 90 minutes. Three bilingual/bicultural research assistants were trained to moderate the focus groups using a semi-structured interview guide. All of the participants received a $30 gift card upon the completion of the focus group. Focus group conversation was audio and video recorded. Some participants chose to not appear on the video, but consented to having their voices recorded.

Data Analysis Each of the four focus groups were transcribed from the audio/video recordings, verified, and translated into English by trained bilingual/

Table 14.1 Details of participants divided by focus group

Pseudonym Gender Years Preferred Meal General Insulin T2DM in US dialect preparation healtha pills

Hoi-Ying F 28 Cantonese Self Good Yes Yes William M 32 Chinese Others Fair No Yes Ming-Yi F 29 Cantonese Self Fair No Yes Annie F 10 Cantonese Self Fair No Yes Zhang M 18 Mandarin, Self Fair Yes No Cantonese Andy M 32 Cantonese Self Fair No Yes Lam M 2 Cantonese Self Fair No Yes Choi-Wah F 15 Cantonese Self Fair No No Priscilla F 34 Chinese Self Fair Yes Yes Yan F 29 Cantonese Self Fair No Yes Eric M 27 Cantonese Others Good Yes No Jingyu F 13 Mandarin Self Fair No Yes Yifeng M 18 Mandarin Self Fair No Yes Bing F 27 Cantonese, Self, others Good No No Mandarin aGeneral health was measured on a 1–5 scale with fair = 3 and good = 4 INTEGRATIVE MEDICINE FOCUS GROUPS AS A SOURCE OF PATIENT… 291 bicultural assessors who were native Cantonese or Mandarin speakers. The transcripts then went through a process of open coding, initial memos, and focused coding (Emerson, Fretz, & Shaw, 1995) by members of the research team. To facilitate the process, organizational qualitative research software, ATLAS.ti, was used to organize data to draw out patterns and locate examples throughout the corpus. It was through this process that we began to see how participants use and desire to use CM as a way to assert agency over their healthcare. As a group, we discussed the examples to reach consensus about whether and how participants demonstrated agency in their discussions of CM and then examined how these instances intersected with cultural and structural facilitators and barriers. In line with our research question of how CAs with T2DM envision agency for themselves in their diabetes self-management, we report the following themes based on our data.

Chinese Medicine as a Resource for Patient Agency In the following sections, we report findings from our four focus groups. First, we describe the various difficulties that CAs described when discussing how they attempt to control their diabetes on a daily basis. CM’s idea of balance is presented as a better way to manage diabetes than control. Second, despite a cultural preference for CM, participants discussed the barriers they encountered in trying to use CM to treat their diabetes. Finally, we present the ways in which CA participants use CM both as a resource for healthcare participation and as a communicative resource to assert patient agency and voice in health decision-making. CAs do culture through CM-related eating habits and they both seek and share culture through their information exchange regarding CM. In these instances, CM becomes both a resource for healthcare and for patient agency and voice in health decision-making.

The Daily Difficulty of Diabetes Self-Management Diabetes self-management can be extremely difficult and encompass many areas of everyday life. People with T2DM often have to take medicine and are told to do multiple times a day blood sugar checks, regularly examine their feet, exercise, and change their diets completely with strong emphasis on reducing carbohydrate intake. As previous studies of CAs have found, an over-emphasis on control and restriction runs counter to Chinese 292 E. Y. HO ET AL. ideas of proper balance (Chesla et al., 2009; Ho et al., 2012). Participants in this study talked about how this emphasis on control runs counter to both their culture and their abilities to work and take care of themselves, while CM’s emphasis on balance was a more humane and realistic metaphor for how they could manage their diabetes.

The Cultural and Structural Limits of Control In the next three excerpts, participants describe why it is so difficult for them to control their eating. The barrier to diabetes self-management is not knowledge of how to eat; rather, it is the practice of controlling one’s food intake that is challenging. Balancing blood sugar with or without medication can be very hard, and a diabetes diet can be quite unnatural in terms of amount and types of food restrictions in comparison to the average diet. These barriers occur on three levels: the individual, cultural, and structural.

In the following excerpt, participants describe how difficult it is for each of them to individually control their cravings for noodles. Because noodles are carbohydrates, most diabetes diets suggest eating less or almost none of them. In the following excerpt, Annie’s assertion about the difficulty of avoiding noodles leads to the rest of the group’s agreement (Excerpt 14.1).

Annie’s initial assertion about noodles, to “try a little bit to see what it’s like,” is taken up by William who upgrades the statement by saying that the taste (or how well it’s fried) is what makes it difficult to control. If it is tasty, there is not much he can do to control himself. Although Hoi-Ying seems to be able to better control herself by eating only a little, the point is that none of them completely avoid the tasty foods. Although the diet guidebook that we provided suggests eating fewer noodles, such a practice seems too undesirable and individual willpower is not strong enough to counter these cravings.

Excerpt 14.1 Focus group 1: Cannot control yourself

Annie: 忍唔住,食少少試吓啦! Cannot control yourself, just try a little bit to see what it’s like William: 尤其時好食呀! 有時 Especially if it’s tasty! Sometimes, I really cannot control 呢,你真係忍唔住呀, 想食多啲, myself. I eat a lot of those, like those, like those, eh, 好似哪,好似啲 eh 炒啲麵呢,炒 chow mein, if it’s fried very well, that’s when I really 得靚呢,咁就真係想食多啲 want to eat more of it Hoi-Ying: 食少少囉,通常係 I eat just a little of it [bad things], usually William: 有時呢,真係忍唔住呀 Sometimes though, I just can’t control myself INTEGRATIVE MEDICINE FOCUS GROUPS AS A SOURCE OF PATIENT… 293

Besides individual willpower, participants also talked about the difficulty of controlling their diet as a matter of culture. In the next excerpt, the participants use the designation of “Chinese people” in order to discuss why it is difficult to control their diet. Unlike Excerpt 14.1, it is not one’s willpower that makes it difficult, but rather that one’s Chinese palate makes diabetes self- management challenging.

In this excerpt, Jingyu and Bing are discussing a suggestion from the diet guide about avoiding extra salt or soy sauce. As this exchange demonstrates, this may be difficult for people because as Jingyu claims (using a hypothetical reasonable Chinese person), not having salt (or salty flavor) would be judged by Chinese people as tasteless and unrecognizable as Chinese food. Bing’s agreement then echoes Jingyu’s comment. While this excerpt is literally about the food itself, what is left unsaid but implied is that if one would eat such foods (without salt), it would be akin to being not fully Chinese. By using this construction, the barrier here is not one of willpower, but rather, a matter of being an authentic Chinese person (Excerpt 14.2). As both the previous excerpts and the next excerpt describe, food is not easily given up because it carries much more symbolic and practical weight than merely taste. In Excerpt 14.3, participants discuss the structural challenges of controlling diet. Although not everyone talked about this, for those who talked about having manual labor jobs in particular, food is a requisite part of having enough energy to maintain work productivity. These participants expressed how difficult it was to maintain enough strength while following a diabetes diet. Yifeng begins this excerpt by insisting on eating meals the way he always has, which could be harmful to his diabetes. Instead of maintaining a diabetic diet, Yifeng instead relies on insulin injections as a remedy for his (acknowledged) detrimental eating habits. He admits that this may undermine his health. However, as he states, he has no better options at hand if

Excerpt 14.2 Focus group 4: A Chinese person would say, “What kind of food is this!”

Jingyu: 沒有鹽一點,一點 We don’t add any salt into it 都沒有,菜都沒有鹽 Bing: 有啦有一點灑一點啦 It must at least have some Jingyu: 咱們咱們中國人就 [If this were eaten by] a Chinese person, a Chinese person 講, “這菜是什麼事啊!根本 would say, “What kind of food is this! There’s no taste at all” 就沒有味道” Bing: 是啊!是 Yes, yes 294 E. Y. HO ET AL.

Excerpt 14.3 Focus group 4: You must eat otherwise you will not have sufficient energy

Yifeng: 就吃歸吃,打歸打,就是 I still eat as usual and meanwhile take insulin injections, 這樣,否則你沒有精力的嘛,如果 this is how it has to be. Otherwise you will not have 是你,我有個工作, 要被 sufficient energy. If it were you, I have a job, you will supervisor講的, 對不對啊? be blamed by your supervisor, right? Interviewer: 沒有力氣做工作 Is it because you have no strength for work? Yifeng: 對! 沒有力氣做工作,你 Yes! If you don’t have sufficient strength to work, you 不要被他說的,肯定要被他說的 will get called out. For sure, you’re going to get called 對不對,沒有辦法的對不對?你像 out. There’s no choice, right? That’s your reality in the 美國這個社會本身就是這樣的 U.S., isn’t it! Yeah, I’ve been here so many years now, 嘛,對不對呢!我這麼多年了,單 changed so many jobs, I know it very well 位都換過幾個,都都很清楚的 he wants to maintain his job security. As he explains, the structure of the U.S. labor economy is one in which a productive worker cannot be too tired or weak for fear of being noticed as such and resulting in loss of employment. Others in the focus groups expressed similar concerns about the implications of following the dietary suggestions. For example, Annie mentioned that she has to stand the entire time at work. In responding to one of the diet guide’s suggestions to eat meals at regular times, Annie said that she often works very late and further explained, lamenting, “If you immediately go to sleep then it’s not good for your stomach/intes- tines…so if your work times are not stable, how are you supposed to arrange [your eating times]?” She then continued by drawing a stark comparison between herself and the other members of the focus group who did not work such rigid schedules (or were retired) and had more freedom to plan their meals. What these quotes from Annie and Yifeng demonstrate is that the burden of a diabetes diet does not fall equally on people with diabetes. For those with more labor-intensive work, the suggestions to cut back and eat less may not be realistic.

Chinese medicine’s Balance The previous section has established the difficulty CAs face when trying to control their diabetes with dietary changes. However, the focus groups also showcased instances where participants were able to successfully manage their diabetes using the CM concept of balance. As actors in a neoliberal healthcare environment, patients spoke about how they—as responsible individuals—shouldered much of the responsibility for their diabetes and health. The idea that patients should constantly be seeking out the next INTEGRATIVE MEDICINE FOCUS GROUPS AS A SOURCE OF PATIENT… 295 best therapy can be heard quite clearly in our focus group participants’ descriptions of their use of CM and other alternative therapies, especially as a way to balance out their use of western biomedicines. In the excerpt below, participants share that they have “tried everything,” including various types of CM herbal and food-based self-care (Excerpt 14.4).

Right before the above excerpt, Eric had said that he has tried everything, which then prompts two other focus group members, Priscilla and Yan, to agree that they have also tried everything with little success. Eric continues, repeating that “nothing works” and warning the other group members to avoid the over-the-counter drugs from advertisements because it is a waste of money and inefficacious. In Eric’s comment, one can hear frustration that despite his best attempts to be thorough and responsible for his health situation, nothing can be done. After this statement, the only positive response comes from Choi-Wah. She begins by framing her experience with diabetes as not only long (over 30 years) but also intergenerational (her mom also had diabetes). Like the others, she begins by explicitly stating, “I have tried everything” (giving the example of taking herbs once in a while). However, the statement that follows is not really about her use of occasional herbs that do or do not work. In fact, it is the daily practice of making and drinking soup (an important part of Chinese medicinal food practice to be discussed later) that she frames as her personal responsibility to counteract all the medicines she is taking. The soup (one form of Chinese medicinal therapy) is used so she can neutralize the negative effects of her twice-daily prescribed medicine. Her comments

Excerpt 14.4 Focus group 3: I tried all kinds of herbal medicine

Eric: 我乜嘢方,我都試過,人哋 I tried all kinds of herbal medicine. I tried everything 話呢個樣好好喎,我就走去試,唔 that people say is good but nothing works. Don’t even 得嘅。若果你食嗰啲成藥更加 try those over-the-counter drugs. It does not work. I 唔得,千祈唔好 ,睇嗰啲告白買 saw it on advertisement. They [over-the-counter drugs] 嗰啲,哂你呢銀紙 are a waste of money Choi-Wah: 我有咗糖尿病好耐 I had diabetes for a long time since I was in my 40s. I 啦,我四十幾歲有,宜家七十幾 am in my 70s now, because my mom had diabetes too. 歲,因為我媽媽有糖尿。我乜藥 I tried everything, once in a while, I will eat some herbs 都試過,耐不耐食中藥,即係要呢 to strengthen my kidney and liver. I take medicine 保腎,保肝嗰啲,仲每日都煲湯, daily, once in the morning and once at night. That is 每日食一次,早晚一次,所以我要 why I have to make soup all the time. I use nagaimo, 成日煲湯,就淮山, 杞子,瘦肉,噸 goji berries, lean pork, corn and corn silk to make soup 粟米,同埋粟米蘇煲湯 296 E. Y. HO ET AL. makes sense in light of other comments by focus group participants (“use Chinese medicine, the nutritional value, to patch back the western medicine’s insufficiencies,” from William) and previous studies that have found that CAs categorize biomedicine as effective for disease, but also disruptive to a person’s hot/cold balance (Chun & Chesla, 2004). Despite an overall feeling of frustration around diabetes self-management and even around CM as a treatment option, participants were able to carve out some spaces in which CM and/or its principles of balancing helped them achieve the type of health situation they desired.

Barriers to Using Chinese Medicine in the U.S. Although we began our research project on the assumption that CM could help CAs better manage their diabetes, what we heard in participants’ stories were descriptions of the structural challenges that CAs in the U.S. face in actually using CM. Not only can it be economically difficult to afford CM, but the biomedically dominant system of healthcare makes it difficult to find information about the legitimacy of CM providers and in having access to diagnostic information they could trust.

Structural Preferences for Western Medicine All focus group participants were receiving biomedical healthcare from a variety of local hospitals and clinics under various insurance or government subsidized insurance schemes. Even before the Patient Protection and Affordable Care Act (2010)1 was implemented, San Francisco had its own form of public health insurance, operated by the city’s public health department, which allowed all residents access to health insurance on a reasonable sliding scale. In addition, there are numerous Chinese-specific hospitals and clinics in the San Francisco Bay Area with bilingual and bicultural staff. Presumably because of these reasons, participants did not have trouble with access to biomedical care. Although some CAs might prefer CM, their primary choice, more often than not, is to see a western medicine doctor because that is what their health insurance covers. In

1 The Patient Protection and Affordable Care Act (2010) provided comprehensive health insurance reform including, but not limited to, a national health insurance marketplace, a new patient’s bill of rights, extending coverage to adult children under parental health insurance policies, and getting rid of exclusions for pre-existing conditions and lifetime payment maximums. See http://www.hhs.gov/healthcare/about-the-law/index.html for more information. INTEGRATIVE MEDICINE FOCUS GROUPS AS A SOURCE OF PATIENT… 297

Excerpt 14.5 Focus group 2: Our health insurance card does not cover CM

Zhang: 在美國嗰個環境兩方 In America, we need both (CM and Western medicine)… 面都要…er…因為我係打 er…because I inject insulin; I am insulin dependent and insulin嘅,咁都係依賴 my family doctor practices western medicine. As for insulin 啦,同埋我家庭醫生 Chinese doctors, if you ask me whether I trust them or 都係西醫。咁你至於話中醫 not. I’d say I believe in them. The problem is that in 我信唔信昵,我信。問題美國 America our health insurance card does not cover CM. 嘅醫療卡,無包中藥藥費。所 Even though I trust them, I cannot support CM. The 以我就係好信都唔能夠,我唔 herbal medicine is expensive and the consultation fee is 能夠去支持嗰個,因為藥費都 also expensive. Over ten dollars per visit plus you have to 好貴。睇醫生又貴,十幾蚊一 pay for the herbal medicine. When you compare CM with 次同埋藥費又好貴。同埋又 western medicine, it is more troublesome because you 比西藥麻煩啲,要煲就係好信 need to cook it 都唔夠

Excerpt 14.5, Zhang explains all the different reasons it is easier to use western medicine instead of CM. As Zhang mentions, because CM is not included in American health insurance, the $10 per visit plus additional fees for the herbal medicines can be quite difficult to afford given his income. The problem is not trust in CM, but rather access. In addition, as Zhang explains, there is also a practical aspect that can be an additional barrier. For patients who choose to use CM, they not only have to pay extra money but they also have to take the time to cook the herbs. As a result, personal preference gives way to economic and time constraints. Structural conditions act back on agency and influence participants’ selection of medical practice. As Zhang explains at the very beginning of this passage, this is not how he would choose the structure of medicine. In the U.S., he would prefer if he had access to both forms of medicine.

Inability to Assess Chinese Medicine Legitimacy As the previous excerpt described, CAs trust CM as a healthcare practice, but CAs also talked about how difficult it was to find an individual CM practitioner that they could trust. Although there were numerous options near and around them, it was often too expensive to try out multiple doctors and therefore it was difficult to know whom to trust. CAs expressed quite a bit of criticism for CM practitioners especially here in the U.S. As one participant explained, “Chinese doctors do not need a license. Everyone from the mainland can come here and say that they are Chinese doctors. But American doctors are licensed!” In California, CM doctors 298 E. Y. HO ET AL. are also supposed to have licenses in both acupuncture and herbal medicine. However, there is a gray area with some herbal medicine shops because providers there may not themselves be licensed providers but may still offer herbal advice. In heavily populated Chinese neighborhoods in San Francisco, one finds a variety of these shops often with employees with training and licensing obtained abroad, but not in the U.S. Many of these shops do have legitimate and well-trained providers, but the point is that it is hard for a layperson to know who is good and who is not.

Despite the variety and prevalence of these Chinese herbal medicine shops around San Francisco, our participants expressed reservations as to the standards and quality of care they might receive from a Chinese herb- alist, especially one from mainland China. This supports previous research with CAs about the difficulty of being able to find trustworthy CM in the U.S. (Kwan, Chun, Huang, & Chesla, 2013). It is also relevant to mention that all of our focus group participants were Chinese immigrants. In other words, finding a Chinese doctor with similar demographics was not as good as the security and legitimacy of a medical license. Eric’s comment from Excerpt 14.4 (about having tried everything and it being a waste of money) now takes on new meaning. There are many treatments and providers available over-the-counter in the neighborhood. However, these options are difficult to trust because there is a feeling that anything goes in terms of CM.

The Necessity of Legitimate Diagnostic Expertise Participants’ desires to seek alternatives to western medicine, even in a locale with linguistically and culturally relevant resources, are sometimes hampered by institutional and structural factors regarding licensing and legitimacy. This is especially apparent in considering how participants who do not have access to a legitimate CM provider might engage with something like our diet guide. In the following excerpt, Lam explains what is wrong with the diet guide that we have presented. It has nothing to do with the content of the guide, but rather the inability to use the guide without access to a CM diagnosis (Excerpt 14.6).

In this excerpt, a few points become salient. First, Lam is quite attentive to the content of the diet. When he states, “Onions are not supposed to be consumed by the warm body type but it is encouraged for the damp heat type. Is that right?” he demonstrates a high level of engagement with INTEGRATIVE MEDICINE FOCUS GROUPS AS A SOURCE OF PATIENT… 299

Excerpt 14.6 Focus group 2: I have diagnosed myself [but I don’t know...]

Lam: 嗰個第三頁,熱氣。第四 On page 3 is the Warm Dietary Guideline and page 4 is 頁,濕氣。我要嘅係呢都係我屬 the Damp Dietary Guideline. I don’t know which 於濕氣,定係熱氣,我唔知。今日 category I belong to. Today I wanted to find out whether 我想知我係濕嘅定係熱嘅。要 I am damp or warm. Then this Dietary Guideline will be 知道嗰個事物,你嗰張表有用 useful to me. As you turn the page, you see that onions 呀。你翻個來你睇洋蔥熱氣唔 are not supposed to be consumed by the warm body type 食得,濕氣就食得,係嗎? 我睇邊 but it is encouraged for the damp heat type. Is that right? 張表呀? 笫三頁或第四頁,唔知呀 I am looking at the list on page 3 or 4. I cannot decide. I 嗎。我自己就知道糖血高,食嘢 know my blood sugar is high so I eat very simple food. 已經好單一。係濕或係熱。 Am I damp or am I warm? I have diagnosed myself [but 診斷我自已。每個人個情況都 I don’t know what I actually am]. Everyone’s situation is 唔一樣。你話啱唔啱?否則我都 different. Is that right? Otherwise even if you give me the 無用呀,那本書我都無用。 eating recommendation pamphlet it will be useless. and comprehension of the specifics of the diet. In other words, it is not an individual or cultural attitudinal, belief, or knowledge problem that would prevent Lam from using our diet. The problem, as Lam presents it, is that he cannot use it because he does not have access to a key component needed to use the diet. He has to be diagnosed because “[e]veryone’s situation is different.” This is the second salient point. What Lam is expressing is an acknowledgement of a real structural constraint that prevents him from using CM as thoroughly as he would like. Without access to trustworthy, licensed providers, Lam cannot actually make smart decisions about his healthcare, including being able to use the guide that we are proposing. The importance of the diagnosis coming from a licensed “expert” becomes even more relevant later in the focus group conversation. Lam explains later, “Even if it [the prescribed treatment] does not work, he [his doctor] is still the doctor.” If a legitimate doctor gives a proper diagnosis, participants can at least be confident that it is the treatment and not the doctor that is the problem. Participants would like some guarantee of expertise before starting and investing in treatment. As Lam concludes, rather bluntly, our attempt to create a culturally-appr opriate diabetes guide that incorporates CM principles is “useless” without legitimate support in the form of a readily available CM diagnosis.2

2 Lam’s comment makes sense given the purpose of these initial focus group interviews (to receive feedback on the diet guide itself). Once the guide was made, the implementation and teaching of the diet included a diagnostic consultation with a licensed acupuncturist/CM doctor, followed by an in-person class where participants learn their specific diet (Ho et al.,2015a , b). However, this is a structural barrier that will still exist, and which we need to consider, if the guide is distributed more widely in biomedical practices or other community settings. 300 E. Y. HO ET AL.

Doing Culture: Chinese Medicine Food as Agency and Health Participation Despite the various barriers that CAs encountered, participants were also quite resilient in their efforts to use CM for their diabetes. In the absence of verified CM doctor’s diagnoses and in spite of the high cost of seeing CM providers, we found that participants often relied on themselves in treating and managing their diabetes with food as well as disseminating that knowledge to others. In these cases, CM itself often operated as an object and a cultural practice for patients to assert agency in their own healthcare and health decision-making. In the following sections, we describe how CAs used CM information seeking and sharing as a form of participation and voice in advancing their own and others’ health.

Doing Culture: Rituals/Practices As mentioned earlier in Excerpt 14.4, participants often made soup as a kind of medicinal food to address their diabetes and overall health. In other parts of the focus group interviews, other participants attributed this soup- making practice to being Cantonese. Many of the participants discussed their soup-making skills, like adding corn silk to pork soups, cooking bitter melon as a source of health, or adding yellow beans, red beans, or goji berries to increase the healthiness of soups. Participants described the perpetual or “slow-fire” soup (老火湯) with recipes passed down generationally. To make such a soup, one would usually boil soup over a big flame and then simmer it over a small flame for more than two hours. In Excerpt 14.7, the participants share some of the ways they make these soups healthier.

Excerpt 14.7 Focus group 3: Everyday I have to have soup otherwise I am not happy

Choi-Wah: 日日都有湯,無湯不歡, Every day I have to have soup otherwise I am not happy. 我有時煲椰子,椰子煲雞 Sometimes I use coconut and I cook it with chicken Priscilla: 椰子幾好 Coconut is pretty good Choi-Wah: 我煲好啲湯凍咗放入 After I finished cooking the soup, I let it cool down 雪櫃,聽日攞出嚟啲油晾晒,就撇哂 and put it in the refrigerator then I can take out all the 啲油,咁就煲番滾佢,咁就冇油係到 oil. I reheat it when I drink it so it won’t be so greasy Yan: 你即刻煲攞嗰油撇哂都得 You can still get rid of the oil right after you cook it Choi-Wah: 咁樣無咁清 That way it is not as clear Eric: 咁樣無咁清,係佢個方法好, That way is not as clear. Her way is better, put it in 係擺入雪櫃嗰到,佢晾晒,面嗰啲上 the refrigerator then the oil will solidify on top 咗去就得啦 Choi-Wah: 佢晾唒上面係唒嗰到 It solidifies on top and it is all there INTEGRATIVE MEDICINE FOCUS GROUPS AS A SOURCE OF PATIENT… 301

Right before this excerpt, one of the participants announced that she had heard a program about CM that said not to cook soups too long in the Cantonese style. In response, Choi-Wah pronounces, “Every day I have to have soup otherwise I am not happy.” As this statement explains, soup is not just a kind of food, but Choi-Wah actually regards having soup as a source of pleasure. As the rest of the excerpt demonstrates, although some might regard soups as unhealthy, the patients have a variety of strategies for how to make their soups healthy. As the conversation demonstrates, Choi-Wah, Yan, and Eric all build on one another’s description of how to get rid of the fat in soup. By refrigerating the soup after it cools down, Choi-Wah is able to get rid of the solid fat on top of the soup and as Eric confirms, this method gets rid of the most amount of fat as opposed to Yan’s suggestion of skimming the fat off immediately. Rigid self-control of diet is not easy for diabetic patients, but participants demonstrated that their concerns for health (in this case low-fat) could be integrated with their cultural food rituals with roots in CM.

As presented earlier in the section about CM balance, foods were also used as an important cultural practice for balancing out one’s constitution to restore health. Neutralizing and balancing body conditions by consuming specific food is at the heart of Chinese medicinal (or functional) foods theory and is a common practice among Chinese people (Weng & Chen, 1996). Food therapy is perceived as consuming specific types of food (i.e., cool, warm, or neutral) to patch back and eventually to neutralize or balance the conditions of the bodies. Many of the participants described the importance of bitter melon for helping with diabetes. Incidentally, bitter melon is also recognized from biomedicine as being one food source that can actually decrease blood sugar levels (Wang & Wylie-Rosett, 2008; Yin, Zhang, & Ye, 2008). The only problem that participants expressed with bitter melon is its bitter taste. In the focus group conversations, participants talked about how they ate bitter melon and traded cooking/eating tips with one another. For instance, Priscilla stated, “bitter melon soup tasted better than eating bitter melon…put some red beans (in the soup) to neutralize it.” Conversations around bitter melon are exemplary for understanding how CAs used CM to engage in healthcare decision-making and self-management. In another focus group, Annie uses the CM concepts of warm and cold to describe her current body state, and the use of bitter melon to balance her body. She explains, “Wow, today how does my body feel, how does my 302 E. Y. HO ET AL. tongue feel, how does my mouth feel. Well, let’s say today I feel very warm, so today I need to add more bitter melon so I immediately cook up some bitter melon, just like this.” What is important about this quote is the way Annie goes through her health decision-making and self-tr eatment. In this hypothetical situation, she describes how she identifies certain body symptoms (how her mouth and tongue feel) to come up with the diagnosis that she is too “warm” (a health condition that is understood in CM but not recognized in biomedicine). With this diagnosis, she then is able to assert her immediate plan to use bitter melon as a food-treatment for this condition. In this short quote, Annie illustrates how she can use Chinese medicinal foods as a source of agency to participate in her own health management and hopefully improve her health condition. The focus group interviews actually contained numerous other examples of CAs asserting their use of various foods to treat different health conditions, both those recognized by biomedicine (such as diabetes) and those not recognized by biomedicine (such as heat).

Seeking Culture: Health Participation Through Information Seeking As it should already be apparent, many of the CA participants were very knowledgeable about diabetes and Chinese medicinal foods and took extensive time to actively research CM on their own. When asked where they learned or found information about diabetes, participants stated that they regularly followed various Chinese-language media sources (radio, TV, and Internet) and read books on the topic. As illustrated below, Hoi- Ying and Ming-Yi explain to another participant the symptoms of xiaoke/ siuhot (消渴 “wasting thirsting [disease]”), a term that is often synonymous with the English word diabetes (Excerpt 14.8).

The above excerpt occurs after the focus group moderator asked if people had heard of the term siuhot, what it means to them, and where they learned this knowledge. To answer, Hoi-Ying explains that she follows mainland Chinese TV programs (regularly: every Thursday) that talk about not just siuhot, but various other health issues as well. Ming-Yi elaborates by explaining not just what siuhot feels like (constant thirst), but also about the different herbs that could be taken to lower one’s blood sugar levels. This knowledge was gained not through talking to western doctors, or through intergenerational transmission, but instead by “reading books” herself. It is noteworthy that she also uses the focus group time to ask the first author (Prof. Ho) who was INTEGRATIVE MEDICINE FOCUS GROUPS AS A SOURCE OF PATIENT… 303

Excerpt 14.8 Focus group 1: CM information sources

Hoi-Ying: 你可能冇睇電視 You might not have seen those [shows] on TV. I watched 嗰啲, 我喺, 喺到睇中央大陸 on Mainland China’s CCTV, oftentimes they will talk 電視臺好多時會講呢啲醫藥 about sicknesses/diseases, those things. So oftentimes I will 嘅嘢嘅, 所以好多時都會聽 see it [on TV], related to diabetes…every Thursday there 倒呢啲, 關於糖尿病呀…每 will be some 一個禮拜四都會有呢啲 Ming-Yi: 你不停飲水,成日 You can’t stop drinking water, your mouth is always, you 個口,到止唔倒喝. 嗰啲叫做 cannot quench your thirst. That is what’s called siuhot 消喝症呀嗎中醫。即係中 sickness in CM. That is CM, for example, if you want to 醫, 比如你話對降血糖嗰啲 lower your blood sugar, those herbs like ophiopogon 咁嘅麥冬呀,咩嗰啲天花粉 japonicus and those things like snakegourd root, those 呀,諸如此類嗰啲中藥呢,佢 types of things, in CM, the western doctors I haven’t talked 哋就冇啦。但係我自己睇書 to them about that but I have read books on the matter 呢,呢便方面我就睇,即係中 myself. So, from that perspective I’ve seen it, for CM, I 藥,我對中藥比較感興趣,所 have a big interest in CM, I sometimes will take a look at 以呢我就有時又睇一睇嗰啲 those CM books to see if there are medicines, besides 中藥書除咗食料以外藥料有 foods, that will help using CM method so I don’t have to 啲乜嘢,用中藥法食嘅唔使 take so many pills. Therefore, I think I wanted to ask 食 take 咁多嗰啲丸仔嘅,所 Professor Ho to see if she has done any research on this 以我想問一問呀何博士佢嗰 matter of CM 啲中藥方面有冇啲研究 sitting in on the focus group and was introduced as one of the profes- sors in charge of this study. Although Professor Ho is not a medical doctor or CM practitioner, there is still some legitimacy in the professor’s role as a University researcher and Ming-Yi’s question appears to be another form of self-study about CM treatment options. The CA participants involved in these focus groups were actively participating in their healthcare, and CM was an important part of their health treatment regimens.

Sharing Culture: Health Participation Through Information Sharing Participants were not only active in their health information seeking, but they were also active in sharing their knowledge with one another. Their extensive research, especially in an area with questions about legitimate professional expertise, gave many of the CAs a strong voice to speak about CM knowledge. Participants’ discussions concerning the nature of foods often blurred the lines between Chinese and western concepts of food qualities and health. In other words, participants sometimes moved seamlessly between talking about how food affects blood sugar to how it affects 304 E. Y. HO ET AL. internal heat. In these cases, participants demonstrated a very pragmatic form of what we are calling “integrative” healthcare. As lay experts on food knowledge, participants combined their knowledge to suit their needs and were eager to share that expertise with one another. In the following excerpt, the participants had been asked what foods are most difficult for them to give up or avoid. In one focus group, William says that it is beef that is hardest to avoid. The other participants then start to discuss the nature of beef from a CM perspective (nourishing the CM concept of blood which is tied to Qi or vital essence and is more than just the physical substance) and from a western medicine perspective (helpful for anemia because of the iron content of blood). In Excerpt 14.9, we see how participants construct their personal experiences with CM as a means to giving advice and being “experts” in what works toward their diabetes self-care and management.

In the beginning of this conversation, it is clear that William presents his desires to eat beef with claims that he knows he should control himself and not eat too much beef. In response, Hoi-Ying actually presents information about the health benefits of beef. The idea of nourishing blood comes from CM. The Chinese word for nourish (補) is the same word that William used earlier when talking about “patching back” western medicine’s insufficiencies. To clarify, the suggestion of beef in this instance is used in a CM understanding of patching back/nourishing all the components of blood that come with a CM understanding of blood. Hoi-Ying then follows this discussion with a more biomedical claim (of beef’s benefit for anemia). She uses her own health status (having anemia) to share her eating and cooking practices. Notice that these conversations move seamlessly between what we (in analyzing the conversation) are calling western and CM although the participants themselves are not drawing attention to any distinctions. Ming-Yi advances the conversation with the suggestion of adding goji berries (from CM) and the group continues (after the excerpt) discussing the health benefits of goji berries and red dates and sharing how they cook with these ingredients. The thread of the conversation ends as they discuss these foods and their effects on blood sugar. Importantly, this conversation among the participants, without any intervention from the focus group moderators, lasts for a full three minutes and has the characteristics of quick-fire reaction among the participants that is typically recognized by interaction scholars as being analytically important (Morgan, 2010; Robles & Ho, 2014). The animated nature of INTEGRATIVE MEDICINE FOCUS GROUPS AS A SOURCE OF PATIENT… 305

Excerpt 14.9 Focus group 1: Beef is very good for replenishing/nourishing the blood

William: 我,我好想食牛肉,但係我 I, I really want to eat beef, but I also am afraid of 又係唔敢食,唔敢食 eating it, afraid of eating it Ming-Yi: 但係耐耐都要食啲因為 But every so often I want to eat it because every so 我耐耐我都整一次羊肉至得 often I will have to make it at least once; (laughs) I (laughs) 都炆呀! 但係炆呢自己控 also stew it! But when I stew it I have to control 制自己呢。最多呢就食四舊我就唔 myself. At most I will eat four pieces and then stop, at 食架啦。最多最多。有時食兩舊咱 the very, very most. And sometimes only two pieces! Hoi-Ying: 牛肉又好補血嘅喎 Beef is very good for nourishing the blood though William: 係係 Yes, yes Hoi-Ying: 好多人呢,真係,好多糖 A lot of people, really, a lot of people with diabetes 尿病人都貧血架喎,唔好理一啲唔 are also anemic. You don’t need to just look at those 食牛 people who don’t eat beef Annie: 來來到美國唔食牛肉真係嘥 Coming to the U.S. and not eating beef that seems 嗮呀,何? like a big waste, doesn’t it? William: 係呀! Yes! Ming-Yi: 係呀, 咪,佢又對治療貧血 Yes, and it’s also good for anemia 好架 William: 我,我好想食牛肉,但係我 I, I really want to eat beef, but I also am afraid of 又係唔敢食,唔敢食 eating it, afraid of eating it Hoi-Ying: 喀,但係食少 Yes, but eat it less often Ming-Yi: 我呀至細到大都唔食牛 For me, ever since I was an young until I was adult I 肉架,所以對我冇乜關係呢樣嘢 never ate beef, so for me, this is not an issue (laughs) (laughs) 因為從細到大都唔食牛肉 because from when I was young until I was an adult, 架, 所以對我冇乜關係 I never eat meat, so this is not an issue to me Hoi-Ying: 唔係我又貧你所以我一 No but I am also anemic so I will crush a bit of beef 剁碎嗰啲牛肉嗰啲牛肉去焗飯,俾 [ground beef] like that, and bake the rice with it, 薑汁。 with ginger sauce Ming-Yi: 你貧血你咪比啲紅棗俾 If you are anemic you should put in some red dates 啲杞子咪得囉! and goji berries to take care of it! (William laughs very hard) (William laughs very hard) the dialogue, coupled with William’s laughter, exemplifies how this focus group space becomes a site for our participants to share, demonstrate expertise, and ultimately exert agency over their own healthcare management. In other words, despite the fact that the event – a focus group interview – may be a bit artificial, the participants used that forum to discuss with one another some important ways of improving health. Although the initial question is about what foods are difficult to avoid, what we see in the exchange that follows is not attention to the moderator’s question, but rather a communal sharing session of how one can still enjoy the foods deemed unhealthy through expert food knowledge that spans both Chinese and western medicine. 306 E. Y. HO ET AL.

Conclusion: Complementary and Integrative Medicine as Social Justice Through the conversations that occurred in these focus group sessions, participants engaged not only in important dialogue with the moderators, but perhaps, equally importantly with one another. In discussing their experiences with CM and diabetes, it was clear that a variety of barriers existed that prevented them from adequately controlling their diabetes and from fully using CM how they would have preferred, as a way to balance out their bodies. Despite having many options for CM, cost and an inability to judge legitimacy created real barriers. It is important to note, however, that participants did not let these barriers stop them from doing their own research, testing, and sharing of CM knowledge. Framed using language from a Culture-Centered Approach, participants were able to overcome structural barriers through personal agency grounded in their cultural knowledge about and interest in CM. Participants tried many different therapies paying close attention to what worked and what didn’t for themselves and their loved ones. They sought information through books, ethnic TV/radio/news, and once equipped with this knowledge, they were very open about sharing that expertise with one another. Similarly, the other focus group participants were eager to hear the advice. By giving participants a space to dialogue with one another and with us, CAs were able to share important information about how they had been able to successfully use everyday foods for their health. Participants were very open about wanting to assist in our research because they felt that more legitimate research needed to be conducted on CM to prove what worked and what did not. These focus group spaces became an open exchange of ideas that led to us creating a section of the guide called “I’ve heard this is good for diabetes,” to codify and legitimize certain cultural practices and rituals that seem to have the most evidence behind it. In this small example, the CA voices from our focus groups have made a real contribution to the science of diabetes self-management education. Through close discursive analysis of the actual words used and interactions about how they managed their diabetes, it is clear that these CAs were very pragmatic in their integration of Chinese and western medicine ideas. This form of “integrative” medicine, the everyday ways in which patients mix and combine medicine, can be an important avenue for witnessing patient agency in health participation. This study builds on other research that has examined how the medically underserved use comple- INTEGRATIVE MEDICINE FOCUS GROUPS AS A SOURCE OF PATIENT… 307 mentary medicines to assert agency over their difficult-to-control chronic health conditions (Ho & Robles, 2011). This research is limited in that each focus group was only one small snapshot in time. As a more extensive Culture-Centered Approach project, we likely would have interacted with these participants in more sessions over a longer period of time. We also acknowledge that our participants were on the more proactive end of the patient spectrum when it came to accessing and acquiring information about their T2DM management. In fact, their voluntary participation in our focus group is an example of this proactive attitude. Nonetheless, our participants’ proactive attitudes provide health providers, practitioners, and researchers an insightful window into the positive possibilities of patient agencies and the (re)imaging of complementary and integrative healthcare as a form of social justice.

Acknowledgments We wish to thank our research participants for generously sharing their time and their stories with us and UCSF’s Asian Health Institute and the University of San Francisco’s Faculty Development Fund for sponsoring this project.

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Culture-Centered Approach to Communication for Social Change

Dazzelyn Baltazar Zapata

The concluding part of this book demonstrates the practice of a culture- centered approach (CCA) to social change communication. Through the three chapters that use the culture-centered approach as theoretical and methodological compass, this part of the book raises the following important questions: (1) What are the emerging innovations in research using the culture-centered approach? and (2) How do communication scholars negotiate culture, structure and/or agency in envisioning social change and social justice? The first chapter authored by Mohan Dutta offers a methodological outline, drawing from applications that emerge from the culture-centered approach (CCA) to social change communication. In contrast to the dominant body of social change communication that conceptualizes social change as planned change directed by dominant global institutions (development agencies, foundations, global funding agencies) and directed at achieving specific pre-determined objectives, the CCA outlines a meta-theoretical framework of participatory communication for inverting the politics of communication for social change communication, theorizing communication as grassroots occupation of the communicative spaces and spheres where decisions are made, knowledge is produced and evaluations are carried out. In this section of the book, the chapters collectively offer a constitutive sense of what it means to conceptualize, design, implement and evaluate social change communication projects grounded in the tenets of the CCA. The second chapter by Mohan Dutta and Dyah Pitaloka works with the voices of the survivors of the 1965 Communist purge in Indonesia to co-create communicative infrastructures of healing. Stories shared by 312 Culture-Centered Approach to Communication for Social Change community members through their songs, dances and everyday performances emerge as sites for disrupting the silences that have been perpetuated by the state, continuing to reproduce the falsehoods of Cold War propaganda to construct an imaginary of a Communist threat. Amid the Cold War silences across Southeast Asia (including in Singapore, where certain stories are framed by the state, while others are systematically erased), the 1965 project foregrounds the critical role of the CCA in co- creating communication infrastructures that disrupt the erasures carried out by the state-civil society-market nexus. The third chapter is on Inequalities and Workplace Injuries: How Chinese Workers Cope with Serious Diseases Caused by Benzene Poisoning by Ee Lyn Tan and Mohan Dutta. They discuss at length how rampant benzene, a hazardous chemical, is used in various workplace in China and how it endangers the health of workers. In China, use of benzene in common raw materials like paints, thinners, solvents and glue in factories has been linked to diseases like leukemia, leukopenia (reduced white blood cell count), severe anemia and asthma in exposed workers. Apart from strain- ing the public healthcare system, benzene exposure causes untold suffering to victims and their families. Here, participants share how they negotiate access to treatment after they are clinically diagnosed with a serious benzene-related disease. Through the theoretical lens of the culture-centered approach, this paper explores the structures that constitute securing confirmation of an occupation-related illness, specifically examining what challenges workers face while negotiating access to this confirmation and treatment. It is hoped this information would provide insight to policy makers and advocacy groups so change may be pursued in tackling this hazardous pollutant and opening up access to treatment for victims. The last chapter on Media Portrayal Stigma Among Gender and Sexual Minorities by Jagadish Thaker, Mohan Dutta, Vijay Nair and Vishnu Prasad Rao discusses the important role of media in broadcasting stigmas. The authors fill the need for more studies that focus on how the stigmatized individuals and groups perceive and react to stereotyped media portrayals, specifically its effect on homosexual stigma. The chapter tackles stigma against gender and sexual minorities, targeted as “high-risk” groups in HIV/AIDS campaigns: men who have sex with men, transgender individuals and Hijras. The chapter talks about two new dimensions of stigma through a cross-sectional survey of gender and sexual minorities in three south Indian cities (n=225): HIV-related vicarious stigma or hearing stories Culture-Centered Approach to Communication for Social Change 313 about stigma and discrimination against HIV-positive individuals, and perceived media portrayal stigma. This goes hand in hand with three dimensions of stigma identified by previous studies—experienced or enacted stigma, internalized or self-stigma and felt-normative stigma. Regression models show that media use is positively associated with perceived media stigma, and that perceived media stigma is negatively associated with identity disclosure, but only through experiences of stigma and discrimination. More importantly, how minorities discursively manage media stigma carries important implications on reducing stigma and discrimination. CHAPTER 15

Culture-Centered Social Change: From Process to Evaluation

Mohan Jyoti Dutta

The culture-centered approach (CCA) to social change communication foregrounds the communicative inequalities underlying the dominant framework of social change communication constituted in global centers of power (Dutta, 2008, 2015), noting the marking of subaltern communities as passive target audiences to be incorporated into the global market, addressed through social change communication interventions designed at the centers of global power, far removed from the subaltern margins (Dutta, 2006; Dutta & Basnyat, 2008a, b). The global market of social change operates through the creation of new opportunities for subaltern participation, converting subaltern bodies into sites of profiteering (Dutta, 2006; Dutta & Basnyat, 2008a, b). These centers of global power that direct and disseminate development communication are increasingly constituted within neoliberal logics of privatization of public spaces and resources, enabling the global hegemony of the free market logic through the individualization of social change problems in the form of promotion of behavior change and empowerment of local communities. Integral to the hegemony of the neoliberal formulation is the depletion of the positive role of the state as an expression of popular demands for fundamental

M. J. Dutta (*) Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University, Palmerston North, New Zealand

© The Author(s) 2019 315 M. J. Dutta, D. B. Zapata (eds.), Communicating for Social Change, https://doi.org/10.1007/978-981-13-2005-7_15 316 M. J. DUTTA resources of human life and wellbeing, accompanied by the rise of private foundations and global civil society as sites of deploying social change communication solutions. The turning of the subaltern margins into the audience of social change communication interventions is inverted in the CCA, co-creating spaces through methodologies of solidarity that offer infrastructures for subaltern voices to be registered. The struggle for building communicative infrastructures is grounded in subaltern interpretations of what communication is, what the challenges to communication are, and how these challenges may be addressed through a wide range of communicative strategies that range from being dialogic to being antagonistic. The concept of the audience that is central to communication for social change is turned on its head in the CCA, noting that the marking of an audience as recipient, albeit an active meaning-making recipient under neoliberal formulations of social change communication, serves the pro- market agenda of transnational capital. Moreover, the marking of an audience is intrinsically tied to the persuasive agenda of social change communication frameworks in the mainstream, attempting to change the knowledge, belief, attitudes of the identified and categorized margins. The notions of culture and participation in this dominant framework of social change communication work toward disseminating the pre-configured agenda that serves the status quo, albeit co-opting participatory spaces to serve the elite agenda. In other words, through a plethora of strategies of communicative inversions, the deployment of communication to reverse the materialities of everyday life, terms such as voice, culture, participation, and democracy are deployed precisely toward achieving top-down expert-driven neoliberal agendas. The CCA interrupts this dominant framework of communication for social change by seeking to occupy the communicative spaces in the mainstream through solidarities with subaltern communities (Basu & Dutta, 2008, 2009; Dutta, 2008, 2016). Theorizing participation as radical democracy, the meta-theoretical framework of the CCA explores the communicative practices through which infrastructures for local participation and expression may be built. The foregrounding of the cultural contexts that constitute communicative spaces and processes suggests that the work of the culture-centered scholar becomes one of understanding community understandings of communicative infrastructures, attending to the margins within community spaces, and attempting to build through community-academic collaborations communicative infrastructures that CULTURE-CENTERED SOCIAL CHANGE: FROM PROCESS TO EVALUATION 317 are meaningful to community life. The sustainability of these infrastructures is driven by the cultural situatedness of the collaborative processes. The problem configuration, the research to be undertaken, the communicative processes to be put into place, and the frameworks of evaluation emerge from within the community framework. As a result, what counts as effective culture-centered intervention is tied to community-driven objectives.

Culturally-Centering Social Change To culturally-center social change is to foster communicative spaces for the voices of the margins that are systematically erased, often through the very tools of communication for social change that operationalize, categorize, and target the margins (Dutta, 2015). The framework of designing social change communication processes and messages from within dominant structures of local-national-global hegemony keep intact the very structures that perpetuate inequalities. The neoliberal regime of social change management constructs social change as a management function carried out by experts, and fine-tuned through the role of research in driving smart social change communication campaigns. These smart social change communication campaigns are hegemonic, co-opting culture and participation as tools for disseminating market-based privatized social change commodities. To disseminate social change is to create new markets for innovations as products, integrating the audience of social change communication as markets of private transnational capital. In this backdrop, the CCA foregrounds the agentic capacity of communities at the global margins in driving social change communication that fundamentally interrogates the structures that constitute the hegemony of social change.

Power and Communication Power is closely intertwined with the processes and flows of communication, constituting the terrains of planned social change. That those in power define the structures, processes, forms, rules, and roles of communication and the ambits of social change serves as the basis for interrogating the ways in which these power structures reproduce forms of marginalization that displace the poor from their sources and sites of livelihood. The understanding of communication as being intertwined with the inequalities in distribution of power guides the development of communicative infrastructures for the participation of the voices of the margins. 318 M. J. DUTTA

Academic-Activist-Community Partnerships Culture-centered processes attend to the material and symbolic needs expressed at the margins of organizing systems. With the emphasis on disrupting unequal flows of power, culture-centered processes are anchored in partnerships with communities at the margins, working in tandem with activist groups and networks that are committed to the issue. In the backdrop of the global co-optation of civil society spaces under neoliberal modes of governmentality, culture-centered processes work toward identifying activist partners grounded in community-lived experiences and struggles, and engaged in the struggle to transform unequal structures. The recognition that structures are fundamentally unequal serves as the basis for partnerships that are attentive to the sites of inequalities, and seek partnerships with the very margins. Activist collaborations that are articulated as resistance anchor social change communication in practices of radical democracy rooted in the grassroots level.

The Culture-Centered Method The community, as a site of power negotiations, dialectical aspirations, and heterogeneous ideas of change, is embodied in an advisory group of community members that plays a key role in culture-centered processes. The advisory group members in the CCA are selected through an ethnographic process of community immersion, where academics working in community first build relationships with community members through participation in community life, in community-driven events, and more closely, in community-driven advocacy processes. Embedding in community organizations and collaborating with them emerges as an anchor to knowing the community and building community ties. Based on relationships built in the community, the culture-centered process focuses on identifying community members that are most likely to be marginalized within community spaces, working through axes of social class, caste, gender, ethnicity, etc. that offer insights into the sites and spaces of erasure in community life. Based on ethnographic community negotiations, the CCA offers a framework for the formation of community-based advisory boards that play instrumental roots in identifying problems and developing solutions. Figure 15.1 illustrates the community-driven framework of the CCA (Dutta-Bergman, 2004a, b; Dutta, 2008, 2016, 2017). The CCA utilizes community-based participatory strategies for building community-based CULTURE-CENTERED SOCIAL CHANGE: FROM PROCESS TO EVALUATION 319

Problem Identification

Advisory Group Members Process feedback Research Design

Peer Leaders Key stakeholders

Community-driven Evaluation Community Strategic framework

Implementation Processes Tactical Plan

Fig. 15.1 CCA-based approach to designing community-placed solutions communication infrastructures by emphasizing the central role of the community in defining the problem and corresponding solutions (Dutta, 2008, 2016, 2017). The methodological tools of the CCA, (a) listening, (b) dialogue, and (c) participation, generate key concepts and infrastructure design solutions through the conversations between communities and other key stakeholders. Placing communities at the margins at the center of theorizing social change communication foregrounds the knowledge- producing roles and capacities of communities. The dislocation of sites of knowledge creation to the margins of local-national-global power is tied to the disruption of the dominant knowledge claims generated at centers of expertise. To listen to the voices of the subaltern margins of global discursive spaces and processes is to fundamentally interrogate the very conceptual categories that make up the foundations of the mainstream. Culture-centered interventions, for instance, challenge concepts such as reasoned action and dual processing that shape the ways in which social change communication interventions are traditionally designed. The framework of listening attends to the work of building communicative infrastructures at the subaltern margins through which subaltern voices emerge into the neoliberal knowledge formations. In co-constructing infrastructures of listening at the margins, culture- centered projects often take the form of advocacy and social movements, interrogating the organizing logics of dominant structures, and seeking to invert these dominant logics. To build infrastructures of listening at the 320 M. J. DUTTA margins is also to invite possibilities that seek to transform the existing power formations, thus emerging into transformative moments that challenge the existing configurations. Culture-centered interventions therefore often negotiate the workings of state-market power, deploying a wide array of strategies that range from dialogue to contestation. At transformative sites of contestations emerging from the margins, the sustainability of the communicative infrastructures is threatened, and the academic- community-activist partnership has to work through the development of creative plans and community-driven solutions that negotiate surveillance and control from the top-down. The CCA employs the methods of (a) participation and (b) dialogue that facilitate the participation of the local community in the definition of problems and solutions. The core elements of the CCA involve the creation of spaces for knowledge sharing, collaboration, and decision-making at the community level, building on the various resources (knowledge, communication spaces, technology etc.) brought to the table by the academic-community partnership. With an emphasis on local participation, the culture-centered method involves cyclical, iterative and dynamic communication processes that include: (1) identifying and selecting community partners; (2) developing communication processes for participation, collaboration, and decision- making that emphasize local decision-making; (3) identification of community-specific needs and corresponding research problems guided by community participation; (4) developing the communication processes, resources, and strategies for creating community-specific solutions through the involvement of community members and through their leadership in the decision-making processes; (5) developing research methodology built upon community and academic partnership; (6) implementing the community-based, community-driven solutions; (7) analyzing and interpreting data through collaboration between academic and community partners; (8) developing the design and community resource mapping; and (9) establishing community structures and processes for sustaining the CCA-based solutions. The iterations in the communicative processes are guided by community members through their participation in discursive processes and sites. The iterative cycle of the culture-centered method is built on the notion of reflexivity, continually interrogating the role of the researcher, questioning critically the relationship of the researcher with the community, and continually working toward cultivating an ethic of solidarity that connects the academic with the community. CULTURE-CENTERED SOCIAL CHANGE: FROM PROCESS TO EVALUATION 321

Local community participation fosters a dynamic and interactive relationship among structure, culture, and agency (Dutta, 2008). Structure refers to the overarching framework of organizing that limits and enables access to resources. Culture is conceptualized as the contextually situated framework of meaning-making that offers the template for everyday action. Agency reflects the participation of individuals, households, and communities in making sense of the structures and in simultaneously negotiating them. Community participation strengthens individual and community efficacy in problem solving (Dutta,2008 ). Moreover, the CCA suggests that the creation of participatory spaces catalyzes the participation of community members in a range of community activities, in solving problems, and in community efforts seeking to develop health solutions.

Communication Processes in the CCA The communication processes in the CCA include community participation and community dialogues that create resource-based capacities in local communities (Dutta-Bergman, 2004a, b; Dutta, 2008; Wang, 1999; Wang & Burris, 1994). From policy, planning, and implementation standpoints, participatory spaces are created and sustained that allow experts the opportunity to engage with the cultural participants, listen to their voices, and create transformative opportunities through dialogues (Basu & Dutta, 2008; Wang, 1999; Wang & Burris, 1994). In addition, it also seeks to build community capacity by investing in the communication infrastructures that are meaningful to the community (Dutta, 2007). Through an immersive ethnography of the participatory processes, the research team will examine the relationships, roles, and functions that are negotiated in these participatory processes.

Access to Resources and Problem Solving The CCA suggests that community participation emerges as an avenue for understanding problems, for prioritizing solutions, for developing solutions, and for implementing them (Basu & Dutta, 2009; Dutta, 2008, 2013, 2014, 2017). Essential to this process of identifying problems and developing potential solutions is the identification of resources that are needed for addressing the material marginalization experienced by community members. Communities that have participated in online and 322 M. J. DUTTA offline processes at the grassroots level are also more likely to secure access to resources than communities that have not participated in these processes and/or do not have access to them. By extension, communities where the CCA interventions are implemented are expected to participate more in problem solving, building networks with various stakeholders, and securing resources as compared to communities that have not gone through the CCA interventions. Given the role of academic communities and health service providers as partners in the CCA, communities and academics negotiate a variety of roles, relationship expectations, and leadership opportunities. The nuances of communication in these relationships are rooted in cultural textures, expectations, and patterns.

Interrogating and Resisting Power The theorization of structure as a site that constitutes the margins points to the work of the CCA in interrogating the structural configurations that constitute community life. The communicative spaces built in communities offer infrastructures for communicative justice, continually reflecting on the ways in which power relationships marginalize community members. Culture-centered processes interrogate the normative ideas of community to open up the sites of community participation to the margins within community spaces, creating communicative infrastructures for the margins to voice their ideas and aspirations (see for instance Dutta, 2004a, b).

Culture-Centered Method The culture-centered method foregrounds the contingent, heterogeneous, fragmented, and contested nature of community spaces, attending to the plethora of voices that flow through community sites, disrupting the hierar- chies of power written into these sites, and simultaneously co-creating communicative infrastructures that are grounded in the rhythms of community life. That communities are sites where power is worked out frames the culture- centered method as one of deep reflexivity, interrogating the sites of power inhabited by the academic, and working out dialogic processes for interrogating and inverting power. The continuous attention to the question of erasure within community spaces serves as the foundation for building communication infrastructures that are continuously open toward the margins within community spaces, focusing on the ways in which the voices of the margins within community sites can be foregrounded (Dutta, 2014, 2015). CULTURE-CENTERED SOCIAL CHANGE: FROM PROCESS TO EVALUATION 323

Ethnographic Immersion in Activist Contexts The context of the culture-centered process emerges from the interactions, communicative patterns, and collaborations between academics and community members toward addressing the social change issues identified by community members. Immersion within existing processes of activism within communities offers insights into the potential sites for intervention, the interplays of power, as well as the openings for disruption of power. The research team observes as participants in the social change communication processes. Observations of communicative processes, strategies for resources mobilized, communicative infrastructures available to the community are carried out through participant observations. In this phase of culture-centered projects, researchers collaborate with community members, community leaders, and advocates in seeking out resources, in advocating for resources, as well as in mobilizing communities in creating transformative spaces for democratic participation at the grassroots level.

Participation in Advisory Groups Advisory groups from the community usually serve as the decision-making nodes for guiding the design process for the social change communication intervention. How the advisory group members are recruited, the nature of the decision-making in the advisory groups, and the fabric of advisory group participation are rooted in a commitment to listening to the margins. Interrogating the fundamental notion of community as a homogeneous category, the CCA attends to the margins within/of community spaces, seeking to form advisory groups from the margins. The notion of reflexivity forms the basis of an iterative cycle of member selection, continually attending to the representation of the margins in the advisory groups.

Advisory Group Formation Advisory group members are often recruited through theoretical sampling, attending to the opportunities for the subaltern margins to represent subaltern issues and agendas within community contexts, and anchored in reflexive analyses of power formations within community spaces. Whereas in some instances, the process of forming advisory groups begins with one advisory group, in other instances, depending upon community-wide inputs secured in the ethnographic research, multiple advisory groups are formed, attending to the inequalities within the community. The advisory groups, comprising community 324 M. J. DUTTA members from households, represent a range of at-risk groups that initially come together to discuss and share everyday struggles. These include representatives of local community associations, representatives of local NGOs, social workers, and state representatives, with the majority of the advisory board comprising community members (70%). The advisory group collaboration is a one-day training session on the core methods of (a) dialogue, (b) listening, and (c) participation. At the end of the training session, the advisory board members are offered practice exercises to pre- pare for the planning meetings. Each advisory board member is usually paid an honorarium for their participation in the one-day workshop and will receive a peer leader certificate.

Advisory Group Discussions Drawing upon the inputs of key community collaborators, ten face-to-face advisory group discussions (n = 10–15) are typically held in this phase of the research, with the purposes of: (1) identifying problems and prioritizing them (two meetings); (2) developing a template of solutions (two meetings); (3) developing the question protocol for the interviews and focus groups (one meeting), and identifying the community participants for the interviews and focus groups; (4) selecting and co-coordinating the resources needed for the community level solutions (one meeting); (5) developing the objectives, design, and implementation plan for the project (two meetings); and (6) evaluating implementation processes (two meetings). The summary findings of the interviews and focus groups are usually presented at the advisory group.

In-depth Interviews In-depth interviews with various stakeholders will offer interpretive and explanatory insights into the lived experiences with and uses of resources, the opportunities and barriers to the delivery of resources, and the framework of design solutions.

Community Level In-depth Interviews The goals of the interviews at the community level are to understand the material and communicative needs of individuals and families residing in the communities, the everyday contexts of health and living, and the community imaginations for the design and delivery of solutions (see for instance, Dutta-Bergman, 2004a, b; Yehya CULTURE-CENTERED SOCIAL CHANGE: FROM PROCESS TO EVALUATION 325

& Dutta, 2010). Community members are selected on the basis of the theoretical tenets of the CCA, attending to the representation of the margins. Data from the analysis of the interviews are fed into the advisory group discussions for the further development of the design solutions. Community level in-depth interviews interrogate and disrupt the organizing logics of the dominant structures, instead offering alternative knowledge claims that serve as sites of resistance (see for instance, Dutta, Anaele, & Jones, 2013; Dutta, Dillard, Kumar, Sastry, Jones, Anaele, Dutta, Collins, Okoror, & Roberson, 2013).

Furthermore, based on the responses in the interviews, the focus group questions are further streamlined. A minimum of 30 in-depth interviews are usually conducted, each ranging from 60 minutes to 90 minutes, although in some instances, depending upon the nature of the problem being studied and the diversity of responses, the number of community members interviews might go up to 100 or so. The interviews are usually conducted at accessible locations that also offer privacy to the participants. Based upon the incentive structures offered in past research, community members are offered a token of appreciation that is grounded in the cultural logics. The interviews are audiotaped and notes are taken by a research assistant as the interviews proceed. In addition, immediately after the interview, the team debriefs and discusses the interviews, reflecting upon the key points made at the interviews and the ways in which the responses were communicated by the participants. In order to maintain the confidentiality of the participants, codes are assigned to each of the respondents. Subsequent interviews are conducted with community workers and policymakers to develop an overarching framework for designing the community-grounded solutions.

Interviews with Community Workers Community workers include a variety of participants that work on the everyday delivery of the resources, services, and solutions. Depending upon the nature of the problem that emerges from the in-depth interviews and advisory group discussions, the selection of community workers is strategized. These interviews offer insights into the structures that organize resources, as well as potential strategic roadmaps for developing solutions that negotiate, redeploy, and transform structures. A total of 30 in-depth interviews are usually conducted in this phase of the project. The emerging insights from the interviews with community workers are consistently fed to the advisory group. 326 M. J. DUTTA

Interviews with Key Informants Key informants usually include stakeholders from government, health systems, funders, NGOs, academia, media, with a detailed knowledge of how the structure works. Interviews with policy makers will use topic guides focused on their diverse perspectives and area of practice (e.g. some work on food security-related issues, some focus on irrigation, etc.). Only a few informants with an overall perspective will be interviewed at length as they will have an overview of multiple aspects of the system. A total of 30 interviews are usually conducted to generate opportunities for identifying resources and strategic maps.

Community Level Focus Groups The goals of the ten or so community-wide focus groups are to follow up on the findings of the interviews to discuss the resource and service needs of the community at a group level, thus creating a collaborative space for open dialogue and discussion on the problems and potential solutions, and therefore, bringing forth an open climate for sharing knowledge, developing collective understandings of problems facing community members, and developing solutions for these problems. Based on the estimation of a 70% consent rate, culture-centered projects typically enroll 15 or so individuals to participate in each of the focus groups and also send out reminders to participants the night before. A light meal is usually provided at the meeting (the nature of the meal, how it is prepared, and shared depend on the cultural cost), and the meetings are usually held in an accessible and culturally meaningful location. In addition, focus group participants typically receive an honorarium that is culturally meaningful. The focus groups are usually audiotaped and the tapes are destroyed after transcription, being kept in a locked cabinet in the meanwhile. The confidentiality of the participants is maintained by assigning a code number to each of the participants. An assistant keeps notes on a large “flip chart” paper and common themes are developed by the group in the latter half of the meeting, reaching consensus on critical issues and questions before the end of the focus group. Field notes are taken during the focus group sessions, and these notes are shared as entry points for interpreting the data. After the focus group, research team members discuss their field notes, their own observations, and their personal reflections of the experience. CULTURE-CENTERED SOCIAL CHANGE: FROM PROCESS TO EVALUATION 327

Analyses of Qualitative Data The data from the interviews and focus groups, combined with the journal entries and field notes, are analyzed using open coding, axial coding, and selective coding (Strauss & Corbin, 1990). The data gathering, transcription, and data analysis continue side-by-side with data analysis. The results of the data analysis are summarized in a brief report and a PowerPoint presentation to be shared with the workshop participants and advisory board. The interviews are recorded and transcribed in full in their respective language. Data are analyzed thematically in two steps. The first step consists of a deductive analysis, coding units of data according to key inputs, and other elements of the selected theoretical framework, which inform the study design. This is followed by an inductive analysis, seeking to elicit new themes or unexpected findings through coding and catego- rizing, following some of the techniques of grounded theory which include looking for deviant cases and using the constant comparison method by comparing codes and categories (Strauss and Corbin, 1997).

Community Level Design Workshops The potential solutions to work on, the strategies for the solutions, and the specific tactics for communicating social change are created in the community level design workshops. These design workshops draw members from the wider community who come together to brainstorm on the solution configurations, developing strategic maps to be implemented. First and foremost, the design workshops work toward co-creating spaces for subaltern voices to be heard. To address the structures of power that constitute patterns of inaccess to resources, the workshops pay attention to inviting community members to participate who are more likely to be silent/erased. The community level design workshops are held in collaboration with the members of the advisory board, key members of the communication design team, development and health workers, activists, community advocates, key decision-makers in the community, and policymakers. These workshops employ an empathic and co-design methodology to uncover and understand the specific information and communication needs of the various stakeholders, then working to develop specific symbolic and material solutions that address the problems identified. This process seeks to include often marginalized users in the design process and have them be invested in the solutions being created. The community participants will work on devel- 328 M. J. DUTTA oping design strategies based on inputs from the in-depth interviews and focus groups, followed by identifying the elements of key solutions, the resources to be mapped and mobilized, the various stakeholders to network with, the frameworks for the sharing of community voices on key issues, and the modes of materiality for sharing these voices, working toward building communicative infrastructures for networking with various stakeholders (DeSouza & Dutta, 2008). Finally as a group, the participants will come up with a shortlist of implementation and evaluation strategies, specific tactics, and the implementation and evaluation plans. The research team will also take notes on flip charts throughout the process, to be utilized during the different phases of collaboration, as well as in the evaluation of the project.

Community-Wide Surveys as Evaluative Tools In carrying out the evaluation of the culture-centered process, community- wide surveys are usually conducted to compare attitudes, beliefs, behaviors, resources, solutions before and after the implementation of the solution. The randomized pre-post, experimental-control design enables culture-centered projects to make evidence-based arguments that sustain the interventions. The baseline community-wide survey builds on the in- depth interviews and the focus groups to draw out the key determinants, attitudes, beliefs, needs, and uses of resources in the community, thus also offering an anchor for the community design workshops. In such instances, the survey, combined with the data from the in-depth interviews and focus groups, guides the development of key design solutions for the design and development of the solutions. Although the field-based experimental design is written into multiple culture-centered interventions, community and activist partnerships grounded in community voices often challenge the quantifying instruments and organizing logics. Instead, they suggest alternative tools for evaluation, such as measuring media content, evaluating policy discourses, and evaluating material solutions (such as building of a community care center or a cultural resource center).

Community-Wide Meetings In communities that are geographically proximate, community-wide meetings emerge as sites for the formation of coalitions, movements, and ground-up advocacy directed at transforming structures. Across a wide CULTURE-CENTERED SOCIAL CHANGE: FROM PROCESS TO EVALUATION 329 range of culture-centered projects, community-wide meetings form the basis of the culture-centered intervention that is developed. The entire community is mobilized toward building a material infrastructure or toward generating symbolic articulations as discursive registers to social change.

Discussion The culture-centered method described in this chapter serves as the basis for academic-community-activist partnerships that are directed toward building communicative infrastructures at the margins. The building of communicative infrastructures at the margins serves as the basis for the generation of knowledge from the margins, constituted in the discursive spaces, tensions, and negotiations of community life (Basnyat, 2014; Basu, 2016; Dutta, 2015, 2017; Dutta, Comer, Teo, Luk, Lee, Zapata, Krishnaswamy, & Kaur, 2017; Tan, Kaur-Gill, Dutta, & Venkataraman, 2017). The chapters that follow in this section depict the culture-centered processes of social change communication, working through a wide range of contexts. In each of these projects is the explicit articulation of power, the margins that are produced through the workings of power, and the transformative possibilities that are opened up when power is interrogated. The knowledge generated through the projects resist the knowledge claims circulated in dominant structures, thus challenging the marginalizing practices written into the dominant forms of knowledge production.

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Embodied Memories and Spaces of Healing: Culturally-Centering Voices of the Survivors of 1965 Indonesian Mass Killings

Dyah Pitaloka and Mohan Jyoti Dutta

Narratives, as symbolic expressions of pain experienced in the body, offer communicative frameworks for accounting for the violence experienced in the body. Narratives mediate the relationship between the material embodiment of pain resulting from torture and the material structures that constitute the deployment of violence through the structures of the state-military nexus. Moreover, in structural contexts where voicing of violence perpetrated by the state-military-police structure is erased from the discursive space through various overt and covert strategies of communicative inversion and communicative erasure, narrative accounts voiced by subaltern communities experiencing the violence carried out by the state-military nexus offer entry points for structural transformation through the sharing of accounts of truth located in the materiality of the

D. Pitaloka (*) School of Languages and Cultures, University of Sydney, Sydney, NSW, Australia e-mail: [email protected] M. J. Dutta Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University, Palmerston North, New Zealand

© The Author(s) 2019 333 M. J. Dutta, D. B. Zapata (eds.), Communicating for Social Change, https://doi.org/10.1007/978-981-13-2005-7_16 334 D. PITALOKA AND M. J. DUTTA body. In this essay, drawing upon the narrative accounts of the 1965–66 Indonesian military killings voiced by the children of the survivors of the violence, we offer the culture-centered approach (CCA) as a theoretical framework for listening to stories, remembering the pain inflicted by torture and registering embodied accounts that resist the communicative inversions in state propaganda. Through these narrative accounts of remembering the bodily experiences of torture, entry points are co-cr eated for collective transformations and structural interventions in a politics of material and symbolic inequalities. For 50 years since the mass killings, arrests, and torture led by the Suharto-governed military in Indonesia, the victims of the 1965 mass killings (survivors, their family, and their descendants) have been framed in Suharto’s New Order discourse and in later versions of state narratives as deserving of the violence because of their Communist linkages (connections to the Partai Komunis Indonesia, referred henceforth as the PKI), as threats to the legitimacy of the nation-state. Stigma, discrimination, violence, public hatred, and economic and socio-political exclusion have systematically distanced those associated with the PKI and communism from the normative social structure of Indonesian society. Memories of trauma and violence attached to the mass killing are erased from the military-state narrative of a necessary violence to fight the evils of communism, instead erecting a narrative of heroism celebrating Suharto and his military in curbing the spread of communism. Contemporary state discourses in Indonesia narrate the PKI-based September 30, 1965 revolt as the day when Indonesia managed to survive the communist treachery through the heroic action of the military. In this dominant discourse circulated by the state-military apparatus, the focus of the discussion about the September 1965 events has been on the murder of the seven generals attributed to the PKI instead of the organized military operation that killed between 200,000 and 2 million Indonesians without trial, tortured and raped many more, and put a large number of Indonesians in jail (Wardaya, 2010). The mass killings conducted across the country targeted those who were accused as active members of the PKI and its supporters, especially in Central Java, East Java, Bali, and North Sumatra (Cribb, 1991; Crouch, 1978). Ironically, to determine whether one was a PKI activist or its supporter, the government-military structure relied solely on casual reports made by neighbors or the head of the neighborhood, pointing toward the large scale deployment of the violence within intimate spaces of local communities. Survivors suffered various forms of exclusion, having been exiled EMBODIED MEMORIES AND SPACES OF HEALING… 335 from the country and/or having undergone forced labor in prisons and detention camps. Cribb (1991, p. 22) describes two notable features of the Indonesian mass murders. First, the murders were ‘incomprehensibly excessive,’ considering that many of the killers and those killed were close neighbors, colleagues, or kin. Second was the degree to which the murders were communal, rooted in the everyday networks of rural Indonesia. Three striking characteristics of these killings were: the vulnerability of the victims to the violence in their immediate contexts of everyday life, the general lack of shame or guilt on the part of the killers, and the swiftness with which the violence was carried out (pp. 17–18). Observing the suddenness and intensity of the murders, Cribb noted, “the killings burst suddenly upon the scene and then are over, having arrived and departed with the rapidity and evanescence of a tropical thunderstorm” (pp. 1–2). The bloodshed, torture, death, and terror generated deep trauma of a magnitude whose boundaries remain obscure, unaccounted for in national-global discourses. The legacy of this period has permeated and redefined social relations and subject identities in the most quotidian spheres of Indonesian life, leaving indelible marks on human health, human relationships, and the networks of community life, and yet is mostly erased from sites of knowledge production. Moreover, the massacre and its aftermath have remained largely unaccounted for in public discourse, although increasingly, activist groups and collectives of victims’ groups have started organizing spaces for voicing the stories of suffering, often under ongoing threat from vigilante groups and state repression. This essay seeks to contribute to the body of work on the aftermath of the killings and the political and economic contexts of the events by working with the CCA to focus on the meanings victims make of the violence they experienced and the ways in which they remember these experiences within a broader political-economic context. Based on the voicing of these experiences and the felt pain in the body offer spaces for conversations, co-constructing accounts of truth that resist the dominant narrative of the military nation-state based on communicative inversions and erasures.

Culture-Centered Approach, Voice, and Pain The culture-centered approach (CCA) to communication builds on theoretical articulations of the Subaltern Studies collective (Guha & Spivak, 1988) to understand the erasures that are produced through the struc- 336 D. PITALOKA AND M. J. DUTTA tures of the state, military, and transnational capital, and to simultaneously explore theoretical-methodological-activist entry points for listening to the voices of subaltern communities (Dutta, 2008; Dutta-Bergman, 2004a, b). Subalternity refers to the condition of being erased from mainstream discursive spaces and is constituted in raced, classed, gendered, colonial, and other forms of oppression, carried out through the logics of the mainstream. In the context of state-sponsored violence and torture, particularly in contexts where the state continues to actively erase spaces of articulation, attention is drawn to the communicative strategies of erasure that work toward silencing the experiences of subaltern groups. In this sense then, the culture-centered approach understands subalternity as communicative erasure, produced through the procedures, rules, and logics in mainstream discursive processes and spaces that limit the opportunities for participation, representation, and recognition of the margins. In culture-centered studies of violence reproduced within dominant structures of rule, deconstruction attends to the taken-for-granted assumptions in the mainstream, the cultural values underlying mainstream logics, the communicative processes through which these culturally rooted logics are turned into universal claims about societies, and the agendas of power that are served through dominant logics of communication situated within the agendas of the state. Attending to the erasures that are produced through strategies of communication, the CCA attends to the interplays of culture, structure, and agency that constitute these erasures. Structure refers to the systems of organizing that constrain and enable access to resources, offering as normative certain material configurations of resource distribution. Noting the role of structures in communication attends to the organizational relationships which define the interpretations and the actions taken by individuals, families, groups, organizations, networks, states, and communities situated within specific formations of power. Structures are representations of material distribution of resources and simultaneously constitute these patterns of distribution within social systems, thus simultaneously constituting spheres of communication. Culture refers to the local contexts and the dynamic web of meanings through which individuals, families, and their communities negotiate the structures that they find themselves amid. Culture is both continuous and emergent, drawing upon existing cultural logics that are passed on through generations, and simultaneously shifting these logics through the participation of community members in cultural processes. Culture offers the template through which meaning is constructed and action is understood. EMBODIED MEMORIES AND SPACES OF HEALING… 337

Communication draws upon this template and, at the same time, imagines new meanings and values that shift these existing templates. A culturally-centered reading of mainstream discourse attends to the meanings through which normative constructions are constituted culturally and juxtaposes it amid diverse forms, discourses, and meanings that draw upon cultural logics and express the agency of the subaltern. Similarly, culturally-centering communication theories foregrounds the cultural logics embodied in dominant conceptualizations of communication and places these understandings alongside the localized understandings of communication in communities at the margins. The culture-centered approach decenters communication theorizing by opening up the conversational space to subaltern publics through collaborative acts of solidarity. Voices from the margins emerge in the discursive spaces of knowledge through conversations among researchers, community members, activists, and various stakeholders participating in the discursive space. In remembering the violence carried out by the military-state apparatus, victims of torture and violence participating in collaboration with civil society groups, academics, and community members co-create spaces for articulating stories that have been strategically erased by the propaganda machinery of the state. Agency refers to the intrinsic ability of cultural members and their families and communities to make sense of structures and contexts and to chart out courses of action that are meaningful to them. Agency is expressed in the everyday negotiations of cultural members, as well as in the transformative opportunities that are created in their interactions and collective organizing. In negotiating and resisting the structures of a violent state and memories of a violent attack on the body, cultural members share and circulate stories, which in turn emerge as opportunities for imagining alternative forms of organizing, for constituting relationships, for resisting and for re-organizing spaces. Agency is expressed in the everyday participation of cultural members in meaning-making, in negotiating their bodily experiences of pain, in negotiating structures of silencing, and in actively working collectively to transform the unequal structures of voicing and participation. The culture-centered approach notes that agency of the subaltern sectors is undermined through racist discourses of the state-military apparatus that depict the subaltern sectors as deviant, as the “other” that belongs outside of the normative spheres of society and therefore in need of monitoring, control, and violent intervention. Therefore, the role of the researcher is one of respecting the agency of local communities through humility and simultaneously foregrounding the complexities in 338 D. PITALOKA AND M. J. DUTTA co-creative projects of articulation that seek to recognize and represent subaltern agency amid the tremendous violence carried out by the state and the military. For instance, localized understandings of trauma experienced in the body offer entry points for witnessing the violence embodied in the structures of the state-military apparatus and, simultaneously, offer a collective opportunity for introducing a subaltern narrative of pain that disrupts and transforms the meaning structure imposed by the state- military apparatus. Based on the framework of the culture-centered approach (CCA), we seek to co-create entry points for listening to stories that have been historically erased by dominant structures (Airhihenbuwa, 1995; Dutta & Basu, 2007, p. 38). In the backdrop of the mass killings and the erasure of voices of the victims of the 1965–66 purges, the CCA suggests coconstructive strategies for listening that invert the dominant narrative circulated by those in positions of power (Dutta, 2008, p. 45). In negotiating structures, the CCA attempts to deconstruct the taken-for-granted values in dominant articulations of knowledge, thus co-constructing meanings, discursive forms, discursive processes, and discursive spaces grounded in the voices of the victims of the mass killings. By remembering the past and the violence experienced in their bodies, the victims of the 1965–66 mass killings search for entry points for collective re-interpretation of the narrative constructed by the state. The narrative of the state constructing a communist threat that poisoned Indonesian society and sought to desta- bilize it is resisted by the narratives of the victims of torture and violence, attending to the communicative inversions carried out by the state-military apparatus.

Situating the Violence of 1965: The Torture, Contamination, and the Body The discourse of the nation-state in Indonesia has historically erased the narratives of the 1965–67 massacre carried out by the State, instead offering a state-scripted propaganda-based account of the September 30th movement, framing a PKI-attributed coup that sought a Communist take- over of Indonesia as the event, and simultaneously erasing accounts of the state-orchestrated politicide. The departure between the interpretations of what materially transpired during this period, as constructed through various historical accounts and the official narrative constructed by the state EMBODIED MEMORIES AND SPACES OF HEALING… 339 through its myriad propaganda instruments bear the marks of the symbolic violence embodied in the New Deal structure of Suharto. During the 1965–67 period, thousands of Indonesians were abducted, tortured, or exiled on the island of Buru for ten years or more without trial. For the victims and their families, the 1965–67 mass killings left them with not only the imprints of the physical torture, but also horror scenes and terror, reminiscing “the streets littered with body parts, innards, and blood and the rivers that were overrun with the stench of death” (Dwyer & Santikarma, 2003, p. 295). Among the tortured and murdered were individuals, including pre-school children, who were taken by mistake as convenient substitutes for the suspects who escaped the purges. Many of these prisoners died in the camps. When large numbers of detainees were released in the late 1970s and up to 1980, they were condemned as social outcasts, subject to periodic “re-victimization,” having to be identified and being subject to state surveillance (Southwood & Flanagan, 1983). They had to carry an identity card at all times bearing the special mark “ET” (Eks Tahanan Politik, “ex-political prisoner,” henceforth ex-tapol) and had to report periodically to the local police and to military apparatuses. Depending on the category of charges against them, the lifelong stigma denied the former political detainees basic civil rights. These included freedom of movement (such as going out of town or moving to a new house within the same district; overseas travel was strictly forbidden); freedom of association (meetings in groups of more than five); freedom of expression (including writing ‘letters-to-the-editor’); and access to employment (especially in the Armed Forces, government service, “strategic” national and private commercial enterprises, and in areas related to public opinion, such as teaching, priesthood, journalism, or as traditional puppeteer-storytellers). In everyday life, these individuals regularly became convenient targets for further scapegoating and blackmailing within their familial networks and local communities. Those stigmatized invariably bear the state-imposed designation of being “involved in G30S/PKI,” signaling a state of being “unclean,” marked as being outside the normative sphere of society. Individuals marked with this label were required to regularly endure a series of security screening procedures to obtain clearances and to renew them periodically. The problem of making a fairly accurate estimate of the victims has been compounded by three additional factors after 1980. First, the number of victims multiplied as a result of a 1982 official measure that dis- 340 D. PITALOKA AND M. J. DUTTA criminated against those who had any relationship either by marriage or blood with any G30S/PKI ex-tapols (Administrative Guidance of KOPKAMTIB, No. 15/Kopkam/V/1982, dated 27 June 1982). In marking out a body politic contaminated with communism, it declared pro-communist ideology to be socially contagious and hereditary. As a result, the 1980s, especially the 1985–88 period, saw the massive break-up of engagements and marriages as well as the dismissal of thousands of employees because of the fear of contagion. Second, although there was no indication of a communist revival in any foreseeable future, the government’s incessant calls for vigilance met with a positive response from various segments of the population for different reasons and in different ways. The government-manufactured propaganda discourse of ‘“the latent danger of communism” proliferated into the broader society and introduced a new mode of interrogation, questioning the values, attitudes, opinions, and thoughts of individuals who were thought to be connected to the movement directly or indirectly (Van de Kok, Cribb, & Heins, 1991). Making virtually every citizen liable to renewed scrutiny, the policy introduced a renewed climate of fear and silence. The discourse of “latent danger of communist revival” is reproduced by the nation-state through periodic modification and reinforcement, simultaneously consolidating its power, and the power of the pro-capitalism, pro-free market ideology it upholds. The latest incident of stigmatization was the disbanding of the victims of 1965 meeting in South Sumatra on February 22, 2015. In addition, more than 200 victims of the 1965–66 oppression suffered further intimi- dation and violence in the form of threats, abuse, and insults, as well as being physically forced out of the venue by the residents of the community (Protection Online, 2015). Finally, there was no stable status of liability or clearance, with anyone being subject to re-designation as a communist sympathizer. Many who had been cleared after a series of official screenings later became the subjects of renewed screening and victimization. Some who had been officially detained were later rehabilitated to only be victimized again in another round of witch-hunts. Shifting categories of charges and guilt applied to the same individuals at different times. This phenomenon of re-victimization on the basis of the articulation of a communist threat loomed large in the 1980s. Material and historical accounts of the violence point toward the truth that the military regime and its later incarnation as the military-state had inflicted harm and pain in communities suspected to be pro-communist EMBODIED MEMORIES AND SPACES OF HEALING… 341 across Indonesia (Das, 1990, 1993; Scarry, 1985). While men were exposed to the risks of incarceration, torture, and mass killing, women were more likely to be victims of sexual violence and other types of violence that did not cease when the New Order regime fell. (Dwyer, 2004) The excessive use of sexual violence toward the victims of 1965 is similar to what happened in the Democratic Republic of Congo, where social bonds were disrupted and social connectedness was destroyed (Duroch, McRae, & Grais, 2011; Maedl, 2011; Derluyn et al., 2013). Being accused of being involved in the murder of the generals, conducting sadistic murder (castrating the generals and gauging out their eyes) while at the same time dancing an erotic dance (Anderson, 1987; Wieringa, 2009), members of the Gerwani, a progressive women’s group in Indonesia, and many other women who had alleged communist ties were labeled as threats to Indonesian society (wild, demon, worthless, of less value, illicit), subject to various forms of sexual violence as strategies of disciplining, and were later discriminated against within their own families, kinship ties, and communities.

Embodied Memory and the Space of Resilience Macarena Gómez-Barris in “Where Memory Dwells” suggests that those most affected by the legacies of violence continue to live with the presence of violence in their bodies, in their daily lives, and in the identities they pass along to younger generations (Gómez-Barris, 2009). Gómez provides an important departure to understand how memory can be transmitted to other bodies, transmitted inter-generationally in the intimate family domain. The witnessing of violence can be understood as the concept of embodiment, as a pre-reflexive and pre-rational process. It marks the lived experience of the body as one’s primary ontological experience of “being in the world” (Csordas, 1994, p. 10). In Merleau-Ponty’s (1962) word, the (practicing) body and consciousness are inseparable. Memory and the process of remembering are reflexive, as individuals recall events that have occurred in the past. Together, embodied memory refers to a pre-reflexive or a reflexive experience of memory, the imprints of the past on the sensuous body, the imprints of pleasure, the smell, the touch, the taste–of the past (Young, 2002). Building on the work of Gómez and referring to the work of Rachmi Diyah Larasati (2013), we will argue that such embodied memory, as an expression of subaltern 342 D. PITALOKA AND M. J. DUTTA agency, that which has been erased and simultaneously cannot be recov- ered, offers the seed for symbolic and material resistance, constituting a framework of counter-memorialization through the presence of the body, through silence, and through voice. The presence of the bodies of the tortured survivors disrupt the communicative apparatus of state-cleansing that is meant to create political terror and to preserve public memory of the PKI-induced murders of the generals through the circulation of the inverted narrative of PKI violence through stories, film, memorializing sites, memorializing status, museums etc. The dichotomy of good and evil, dirty and clean, straight and deviant, or religious and atheist locate the victims within frames of othering sponsored by the state that produce simulacra of truth through communicative inversions. Whereas the accounts of the September 30 revolution attributed to the PKI dominate the discourse circulated by the nation-state, the accounts of the mass killings and the large-scale violence carried out by the state-military nexus remain erased. The discourse of “threat of Communist violence” controls and occupies the discursive spaces in Indonesia, leaving the victims of the mass violence with no entry points into public meaning- making and collective witnessing of the history of torture they experienced in their bodies. Various propaganda devices, including poetry, films, and novels deployed by the state, work actively toward constructing the communist threat. The novel ‘“G30S/PKI” (The revolt of G30S/PKI, 1982) for instance, positioned the generals as the “good guys” while framing PKI members and supporters as the “bad guys,” attributed with the qualities of “ferocious, savage, brutal. No more human qualities. Turning into savage wolves” (Atmowiloto, 1994, p. 134). The state propaganda thus continued to circulate frames that carried out violence on the bodies, memories, and everyday lives of the survivors. The fabrication of PKI-related identity and affiliations as being demonic and threatening to the nation-state served as the backdrop for the act of what Indonesians believed as “cleansing” the nation-state from the PKI and its followers. The word PKI had been transformed into a sign where society could easily identify and judge survivors, family members, and those with direct or indirect ties with PKI as guilty, dirty. For instance, the media framing of the Gerwani participants (Gerakan Wanita Indonesia or Indonesia Women’s Movement) as “bitch,” “brutal,” “bloodthirsty,” and “wild,” depicting them as dancing naked and performing indecent sexual acts while celebrating the murder of the six generals in Lubang Buaya, Jakarta, dominated the public discourse. Simultaneously erased from and EMBODIED MEMORIES AND SPACES OF HEALING… 343 implicitly justified in the discursive space was the violence carried out on women suspected to be attached to Garwani. Note for instance, the following depiction in a newspaper account:

Saina told the investigating team that she participated in a “dirty, indecent dance, the dance of the ‘Fragrant Flowers’ which was performed nakedly everyday, both during the day and at night. The 400 men present would watch 200 women, after which free sex would occur, in which every woman sometimes had to serve three or four men sexually” (the “confession” of Saina, a seventeen-year-old identified by Angkatan Bersenjata, a military newspaper as a member of Gerwani, December 13, 1965 – quoted in Wieringa, 2002, p. 314).

Saina’s story shows how the state narrative surrounding the 1965 mass killings were reproduced in society through the fabrication of memory carried out through various propaganda devices of the state. Her story is preserved within public memories through films, educational curricula, museum exhibits, sculptures, historical textbooks, and performing arts, continuously producing the state’s narration of the past depicted in the symbolic representation of a violent communist threat that sought to disrupt Indonesian society and all its semblance of humanity, dignity, and nor- malcy. These memorials exist to continue documenting the threat of communism that stands in as a perennial threat to national and local imaginations, provoking mistrust for anyone suspected to be associated with the ideology and upholding the dominant narrative of cleansing the nation-state (Dwyer & Santikarma, 2003). Memory here is actively constructed by the state in the realms of the structure, to circulate a narrative that upholds the version of history told by the state, erasing the violence carried out by the state and simultaneously upholding the logic of capitalism propagated by elite state- military actors and their ties to US-led capitalist interests in the region. The New Order government created sites of memory containing meanings constructed with the intention of repressing the memories of traumatic experiences produced by the violence carried out by the military, framing the military as heroes that were responding to the threat of communism that loomed large in the history of Indonesia in 1964. Pierre Nora (1989) in his concept of “sites of memory” argues that:

Lieux de memoire are complex things. At once natural and artificial, simple and ambiguous, concrete and abstract, they are lieus – places, sites, causes – in three senses: material, symbolic, and functional (p. 14) 344 D. PITALOKA AND M. J. DUTTA

The most prominent and reified symbols of the mass killings of 1965 can be found at Lubang Buaya (Crocodile Hole), located in East Jakarta and tied directly to the New Order regime. Lubang Buaya refers to both the material site itself as well as the state-sponsored version of the traumatic event of the killing of the generals that spurred its creation (Schreiner, 2005). Lubang Buaya is discursively and materially extraordinary in a way that the whole site marks the five principles of the New Order ideology— Pancasila—that was, according to the state discourse, denied and betrayed by the treacherous acts of PKI. Dedicated to the memories of the generals who are depicted as heroes in the narrative, the mural at Lubang Buaya narrates the story of the PKI threat and the way in which General Suharto controlled the threat, thus emerging victorious. As a site of remembering, Lubang Buaya remembers a history of the nation-state told by its dominant actors, magnifying the pretext that justified the mass murder carried out by the military state, simultaneously both erasing the story of the murder and re-narrating the anti-communist plot that silences the stories of trauma and violence experienced by the survivors. The state narrative, memorialized through the stories of the fallen generals and the violent PKI, foregrounded the rhetoric of “never again,” “prevention,” and “learning.” Studies argue that memorials can aid postconflict reconciliation, repair the relationships, and rebuild the trust (Clark, 2013; Govier, 2009; Staub, 2000). Other studies, however, argue that memorials tend to minimize and silence some stories and memories while promoting others (Chiwengo, 2008; Ricoeur, 2004; Sorabji, 2006). In the case of the 1965–67 mass killings, memorials served as sculpted remembrances of a national past, as well as violent communicative strategies for forgetting the actual historical experiences of the victims of trauma through manufactured simulacra working as communicative inversions. The truth about the violence carried out by the state was inverted through the powerful role of the state in foregrounding the PKI pretext as the eternal thread to the security of the nation-state, thus consolidating power in its hands. Memorials symbolize the legitimacy of the state with mas- sively enforced forgetting of actual historical experiences grounded in the bodily, mental, and emotional pain experienced by the victims of the violence. Taking our departure from Mary Douglas’ concept of pollution and taboo (1966) and Benedict Anderson’s (1983) analysis of nationalism against Western imperialism, we suggest that these September 30, 1965 EMBODIED MEMORIES AND SPACES OF HEALING… 345 memorials do not provide a space for true reconciliation and healing for the victims, instead circulating a simulacra based on communicative inversions that silence and erase the voices of the victims of the mass killings carried out by the Indonesian state, with support from the USA under its democracy promotion efforts. As sites of remembering created and reproduced by the dominant structures, these memorials create a “destiny” for the victims, muting their voices and excluding them from the state narrative. These victims are being left out in the patterning of society and in the formation of the national imagination, continuing to reify the power of the status quo through the articulation of the communist threat. The victims of the 1965–67 tortures thus are placeless, without a site to anchor their memories on, being put permanently outside the ordinary social system. Thus, being labeled as “disorder,” the victims cannot find spaces for voicing narratives of their abnormal life contexts. Through state-driven memorials, the power structures in Indonesia edited which part of the history must be remembered and which part that must be forgotten. The past, the sequence of events and the important events are all edited, recon- structed, exploited, and forgotten in attempts to shape public consciousness and memory within the agendas of the status quo.

Voice, Embodied Memory, and Resistance Based on the interrogation of the communicative inversions situated within the frameworks of the dominant structures, the CCA seeks out entry points for listening to the voices of subaltern communities that have hitherto been erased, exploring possibilities for co-constructing spaces for voicing subaltern rationalities and imaginations. The erased accounts of violence and repression, carried out through the strategic deployment of “communicative inversions” are disrupted through the embodied voices of the participants, decolonizing the stigmatizing messages of dominant social change communication processes.

Co-constructing the Replaced Voices In Imagined Communities, Benedict Anderson (1991) elucidates the “strange habit” of the European colonizers’ way of “constructing of a “new version” of their existing capitals on occupied territories—as in New York, New England, or Nouvelle Orleans. In the later instances, he 346 D. PITALOKA AND M. J. DUTTA argues that the “claiming of a ‘new’ functioned to signify a succession, inheritance, or geographical shift in the locus of regional power,” as if the “old” had vanished and been replaced; “new,” and “old” are aligned dia- chronically, and the former appears always to invoke an ambiguous blessing from the dead. There, the “‘new’ and ‘old’ were understood synchronically, co-existing within homogeneous, empty time.” (p. 187). The birth of the Indonesian ruling elite, the “New Order” under Suharto, ousted the previous regime lead by Sukarno as the “Old Order.” The new regime engendered specific patterns of memory and forgetting, established a state-driven scripting of national identity that excluded the victims of the mass killings carried out by Suharto’s military, crafting a narrative of violence that marked the PKI as the pretext and the event. In this backdrop of the state-sponsored memory of the genocide that simultaneously erased the possibilities of articulations by the victims of torture or by family members of the dead, the victims of 1965–66 and their descendants live with no space for voicing their stories, negotiating the silences that are marked by state policies and state propaganda. Maurice Halbwachs (1985) argues that human beings can remember their history, but cannot freely choose the circumstances and conditions of their remembering. Therefore, social environments influence and shape an individual’s capacity to remember and to recall. In this particular case of the 1965 mass killing, the contexts for remembering were shaped and fabricated by the state, further constraining the spaces within which these memories could then be shared. At the collective level, memories are constructed within present frames of reference such that sites of memory, which Halbwachs defines as places and items that possess the capability to store memory and to trigger acts of remembering, connect references to the past with the morals and sensi- bilities of the present. The past comes alive in the embodied narrative of the experience of pain in the present. What then are the possibilities for the victims to find their spaces of reconciliation and healing amid such state-sponsored efforts of silencing? How can the structure be disrupted to create openings for such voices? How the victims found their narratives to connect histories of traumatic events to present-day experiences and contexts, including the contemporary health of the victims and their families, point toward the role of agency in scripting out a space for alternative narratives. EMBODIED MEMORIES AND SPACES OF HEALING… 347

Enacting Embodied Memory in Everyday Life Benedict Anderson (1991) noted, from “remorselessly accumulating cem- eteries…the nation’s biography snatches…exemplary suicides, poignant martyrdoms, assassinations, executions, wars, and holocausts. But, to serve the narrative purpose, these violent deaths must be remembered/ forgotten as ‘our own’” (p. 206). The selected part of histories had been chosen for the victims of the 1965 mass killings to remember and to be remembered as members of a collective that threatened Indonesia’s national security. Through collective conversations held with each other, with others in their communities, and with various civil society actors, victims voice their identities of resilience and healing. Conversations among and with victims who have experienced torture involves the continual process of deconstructing and contesting the preserved dominant narratives. In the backdrop of the state-sponsored rules and implicit communicative expectations that mark out what can be remembered and spoken of, the victims offer other rationalities for remembering, speaking, and voicing. For the victims, the inability to erase the markers of pain on the body offer entry points for speaking through the body in silence in a scenario where remembering has been silenced (Banjeglav, 2012; Hinton et al., 2016; Larasati, 2013; Muhoma, 2012). In the case of Indonesia and the 1965 mass killings, the government punishment associated with the “misuse” of the dancing body left the victims with embedded fear and trauma. The government holds this tacit acknowledgement that dancing body becomes a symbolic power, as a weapon and thus needs to be controlled. While dance resembles the memory of the past, at the same time, it provides a space to claim power and identity in post-mass killings Indonesia. It provides a space of disruption where the victims are able to continuously question the version of truth and the official political discourse that label them as “the dirty ones.” In The Dance That Makes You Vanish, Larasati mentioned how the strategic transmission of dance technique provides her with a space of “healing” and a space to construct her bodily-situated narratives as forms of resistive practices.

In my own experience, and that of other dancers in East Java, this was enacted not by filmmaking or overtly political art work, but rather through strong family leadership – women’s covert transmission of artistic practice to 348 D. PITALOKA AND M. J. DUTTA

their children – that implanted fragments of unrestrained “memory” in the minds and movements of many young dancers. (Larasati, 2013, p. 61)

The bodily response to memory requires performers to actually remember and honor the moment of suffering and torture, and strategically transform these memories into sites of resilience in negotiating and resisting the military-state structures of violence. These performers perform as victims and as subjects working out of the position of victimhood, articulating resistance in how they narrate stories of violence through their bodies and through their embodied subjectivities. Similar to Larasati, Margo shared her search for such alternate narra- tions of resistive knowledge within his own body. He developed a sophisticated sponge-painting technique while being imprisoned for seven years, having been accused as a supporter of the communist party. The transfer of knowledge happened in prison, during discussion with other artists, painters, and an art professor. The encounters with fellow artists in prison provided Margo with a unique skill that no Indonesian painter mastered. Paintings became Margo’s indirect actualization of his embodied memory and he transformed his paintings into performative and communicative sites of dialogue with his buyers, exhibition attenders, and collectors. Taking children as the model in all of his paintings, Margo found his place of resilience in creating alternative narratives. The children in his paintings symbolized “lost,” “pain,” “waiting in silence” for parents, father, mother, who suddenly vanished. As he shared:

I want people to see that I have outstanding skills and talents like others. I want them to see that I am a human. I feel sad with what happened, and how today people still stigmatized us. Often, I ask myself, “Whom do you call a human?” You guys, who think that you are clean? Or us? In my everyday life, I always try to do good things and strive to become a better person.

Central in this discussion is that the memory of violence and oppression are lived in within these victims’ bodies, and to survive, they must turn toward sustainable, celebratory, and resistant embodiments (Clare, 2001). Body, for these victims, is seen as a site of knowledge, pleasure, and active resistance. What Larasati and Margo did with their bodies was to insert the body itself as a site of knowledge above the system that marginalized them, and to locate the body as a site of opposition and resistance to the normal- izing power of the state-military structure and its propaganda machinery. EMBODIED MEMORIES AND SPACES OF HEALING… 349

The embodied performances of remembering co-created by the victims of 1965 mass killings confirmed the need to re-conceptualize the Western concept of the effects of trauma and violence, and to begin to recognize the social and political factors involved in the subjective-collective response(s) to violence (Goldfeld, Mollica, Pesavento, & Faraone, 1988; Turner & Gorst-Unsworth, 1990). Memory for the victims of 1965 mass killings has been, and remains, a political act. At the same time, for Larasati and Margo, memories work in creating and maintaining individual and collective identity. Individual identity is constructed at the intersection of the familial, social, cultural, ethnic, religious, and professional contexts, linked to the transmission and biological constitution of the person (Edelman & Kordon, 2002). Acts of remembering and memory are an essential part in ones’ personal lives. These individual memories are constantly re-enacted and collectivized through sharing the memories. Through the dance, the paintings, or novels, the victims of 1965 constructed the collective images through which individuals perceive themselves as a collective (Connerton 1989). The process of sharing memories helps these victims confirm their experiences and perceptions of the past, and establish and maintain a sense of continuity and social identity (Halbwachs, 1992; Kalayjian et al., 2008; Lowenthal, 1985). It is through this interplay that we construct a sense of continuity with the past and with others, amid a strong sense of discontinuity rooted in memories of mass trauma. Memories have the power to trigger mechanisms and processes of recognition that allow the individual and the collective to give meaning and purpose to their lives, to affirm their identities, and to challenge the oppressions written into structures of violence (Lira, 1997; Lowenthal, 1985; Rousseau et al., 2003; Rüsen, 1989).

When Memory Becomes Speech: Historical Trauma as Public Narrative According to Haryo Sasongko, a writer who was persecuted as a student activist in 1965 but never imprisoned, memoirs provide “counter-histories based on people’s experiences as historical witnesses” (quoted in Hearman, 2009, p. 24). Writing, for political prisoners and survivors like Sumiyarsi and Pramoedya Ananta Toer, is a way to rediscover themselves as human beings, of resisting the state propaganda that has historically demonized them, and at the same, working creatively as a form of resistance to disrupt the status quo. In her autobiography, Plantungan, Pembuangan Tapol Perempuan 350 D. PITALOKA AND M. J. DUTTA

(Plantungan, The Exile of Women Political Prisoners), Sumiyarsi Siwirini (2010) a former member of the Indonesian Graduates Association (representing the small number of Indonesian university graduates in the 1960s, a group that later was banned because of suspected links with the PKI) captured the motivations of many ex-political prisoners while recording their life stories. She wrote:

The strongest urge for me is to resist, in the ways that I can, the attacks by the New Order, which have been levelled against political prisoners and their families, [portraying them] as bad people, criminals, even as national traitors. By writing this, I want to resist [to show] how false and misleading those accusations are. (p. 26, translation by author)

Pramoedya Ananta Toer, a worldwide renowned Indonesian writer, was kidnapped from his home in the night of October 13, 1965 and thrown into the military prison and his life as a writer came to a sudden end. For more than 14 years, his voice was silenced. Through his notes, letters, and essays that survived his years of incarceration—which were smuggled out of the penal colony—Pramoedya provides a picture and memoir of his life. In The Mute’s Soliloquoy (1999), he wrote:

Hoping to still my disquiet and as medicine for treatment of my mental and physical decline, I began to write, a quarter of an hour each day. Initially this form of treatment proved unsatisfactory; its effectiveness was gradual and it was some time before I was able to make my brain work again. But eventually, through this exercise, I rediscovered myself as an Indonesian, a person of respect, living and operating with a sense of values; I rediscovered myself as a man in all his nakedness, free from pretentions and ambitions, a creature not powerless but, in fact equipped with the will to define his own course in history. I found, in the end, that the man is far more than his pretensions and ambitions. The man himself determines who he becomes. (p. 36)

For Pramoedya and Sumiyarsi, and many other writers, these memoirs serve as ways to restore their voices and identities. Based on the victims’ personal and sensory perceptions of torture, pain, and violence, these writ- ings create spaces of healing, forming alternative narratives of one’s nation’s history, and of humankind. At the same time, these memoirs also serve as ways of restoring the voices and identities of the victims of mass violence in Indonesia, creating collective entry points for subaltern accounts of remembering. EMBODIED MEMORIES AND SPACES OF HEALING… 351

By conceptualizing historical trauma as a public narrative, these victims built the link that connects their past experiences or traumatization by a group or community to healing over time (Cox & Perry, 2011; Evans- Campbell, 2008; Rieder & Elbert, 2013). Through honoring the memory and the past, the victims of the 1965 mass killings do not deny the veracity of past traumatic events, but rather redirect focus on how the victims deal with this trauma inside themselves, how those events are represented in their everyday lives, and linked to their wellbeing today. The narratives written by Larasati through her dance, Margo through his paintings, Pramoedya and Sumiyarsi through their novels show how trauma narratives represent an interplay between personal stories, experiences, and culture and, therefore, are culturally constructed (Foucault, 2003; Herman, 1997; Kienzler, 2008). The victims of the 1965 mass killings transformed their personal experiences into public narratives, shaping collective memory through reliance on narrative elements such as characters, actions, places, and time (Wertsch, 2008). Through their narratives, these victims honor their past and transform their past as strategies of resilience for themselves and the collective of victims, encouraging a sense of participation in a political struggle to claim their rights and restore their identity, evidencing collective strength (Wexler et al., 2009). As forms of resistance, these alternative narratives mediate different conversations and facilitate negotiations with the dominant public narratives of remembering carried out by the state-military structure.

Discussion History provides a narrative context within which contemporary social issues—the 1965 mass killing and the September 1965 PKI putsch—are interpreted, situated within the agendas of the dominant structure and co-constructed subaltern narratives that deconstruct the simulacra situated within these structures. The communicative inversions carried out by the nation-state are interrogated through the presence of voices of authenticity, narrating lived experiences of the pain. The embodied narratives of pain work through the un-translatability of pain as a construct and the simultaneous erasure of narrative accounts by tortured subjects. The Western-national propaganda structures constituted around portraying the evils of communism mark the victims of torture as threat, thus erasing discursive spaces of articulation grounded in the lived experiences of the tortured. 352 D. PITALOKA AND M. J. DUTTA

The narrative of memory, recalling a set of events organized within the dominant structures of power, therefore, is also a narrative of selection, where selection works precisely to uphold the story of the nation-state and its military, deploying the combined tools of public relations and propaganda to portray a communist threat, which then works to establish the hegemony of the dominant actors. The propaganda, as a symbolic resource in the hands of the structure, memorializes the events of 1965–67 in the inverted language of communist threat to the nation-state, obfuscating the truth in accounts of large-scale violence carried out by the state. The narrative structure of remembering thus works within the agendas of the state to consolidate state-military power and simultaneously to expand the logics of capitalism. Remembering the 1965–67 period as a period of Communist threat and the heroic national response to the threat serves the agenda of the powerful state-military apparatus, simultaneously erasing the possibilities for listening to the voices of the victims of torture and violence. The un-shareability of the pain of violence, abuse, and torture is constituted within a socio-political-economic sphere that leaves no room for articulations of the murders carried out by the military-state structure. Absent from the discursive sites of memorializing are narratives that examine the interplay of the state-US/Western nexus in establishing and recirculating the hegemony of capitalism, producing markets and resources for raw materials for a transnational capitalist hegemony. The symbolic resources at play that draw on cultural resources and narratives to portray the threat of communism foreclose entry points for articulations grounded in the lived experiences of the survivors and victims. The narratives “written” by the victims of 1965 could never be detached from the trauma experienced in the body, thus situating the sites of storytelling in the tortured body and its losses, and at the same time, connecting the experiences of the body to the socio-cultural contexts of political-economic violence. The stories narrated at bodily sites are also stories that account for and interrogate the social structures that constitute the violence carried out by the military. The movements in the body, remembering the inscriptions of pain marked by the instruments of torture, offer testimony to the violence carried out by the state. Public narratives of historical trauma interact with contemporary communicative inversions of truth carried out by the state through its public relations EMBODIED MEMORIES AND SPACES OF HEALING… 353 tools (i.e. films, books, monuments, events, exhibits, museums, press coverage etc.), and provide spaces to sustain resilience in response to the ongoing oppressions, violence, and weapons of inflicting symbolic, bodily, and material pain. The symbolic storying of the pain experienced by the victims of the mass murders carried out by the Indonesian state offers entry points for witnessing and for transforming the structures of violence built upon elite networks of local-transnational cooperation (Farid, 2005). Culturally- centered and co-constructed narratives of pain and suffering depict the ways in which victims of torture enact their agency in drawing upon cultural symbols to resist structures and to introduce stories of transformation amid communicative structures that seek to erase these stories.

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Inequalities and Workplace Injuries: How Chinese Workers Cope with Serious Diseases Caused by Benzene Poisoning

Ee Lyn Tan and Mohan Jyoti Dutta

Workplace injuries and occupational diseases are health concerns as they unleash suffering on victims and their families, and exert pressure on healthcare systems (Danna & Griffin,1999 ). Rehabilitation can take years, even the remaining lifetimes of victims, often crippling permanently a person’s economic productivity at the prime of life (Boden & Galizzi, 1999). The International Labour Organization (ILO) estimates that each year, 2.3 million workers die as a result of occupational accidents and work- related diseases globally (ILO, 2015). Hamalainen, Saarela, and Takala (2009) found that every day, over 960,000 workers get injured because of accidents and 5330 people die from work-related diseases.

E. L. Tan (*) Department of Communications and New Media, National University of Singapore, Singapore, Singapore e-mail: [email protected] M. J. Dutta Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University, Palmerston North, New Zealand

One cause of work-related diseases is exposure to harmful chemicals (WHO, 2013). The International Agency for Research on Cancer classi- fies 150 chemicals, biological agents, or exposure situations as known or probable human carcinogens and many of them, such as benzene, are pervasive in workplaces (Driscoll et al., 2005). Rapid industrialisation in China brought forth by internal political changes and globalisation since the 1980s has resulted not only in an explosion of manufacturing spaces but also its attendant ills, such as benzene poisoning, which threatens workers’ health (Liang et al., 2005; Wong, 2001). A by-product of crude oil, benzene is ubiquitous in the manufacturing process as it is found in paints, inks, industrial glue, cleaning fluids, and thinners (Petrochemistry, 2015). Its absorption into the body—through the skin or by inhaling—is linked to diseases like leukaemia, leukopenia, severe anaemia, and asthma (Oldfelt & Knutson, 1948; Liang et al., 2005). Studies show higher risk of leukaemia, lymphoma, and lung cancer in those exposed to benzene (Yin et al., 1996; Hayes et al., 1997); blood- related abnormalities in healthy subjects exposed to benzene (Aksoy, Dincol, Akgun, Erdem, & Dincol, 1971); changes and damage to DNA in benzene-exposed patients (Frantz, Chen, & Eastmond, 1996); sperm deformities in exposed male workers (Xing et al., 2010; Marchetti et al., 2011) and low birth weight in babies born to benzene-exposed mothers (Chen, 2000). China first introduced limits on benzene use in factories in 1956 (Liang et al., 2005, 2006), the same year that the first compendium of industrial hygiene standards, Tentative Hygiene Standards for Industrial Enterprises, was published, based on guidelines developed in the former USSR (Pringle and Frost, 2003; Camp et al., 2003). The limit was 50 milligrammes of benzene per cubic metre of air [mg/m3] from 1956 to 1979, and that was tightened to 6 mg/m3 by 2002. However, this limit is still nearly 19 times that recommended by the US National Institute for Occupational Safety and Health (Capleton & Levy, 2005). In 2002, China implemented the Work Safety Law and the Law on the Prevention and Cure of Occupational Diseases (Pringle & Frost, 2003). Notable provisions of these laws include enterprises having to implement a system of education, training, and assessment of safety knowledge of workers. Employers must adopt effective measures to prevent and guard against occupational diseases and provide equipment to individual workers that guard against such diseases (NPC, 2002a, b; Zou, 2016; Pringle & INEQUALITIES AND WORKPLACE INJURIES: HOW CHINESE WORKERS… 361

Frost, 2003). The State Administration of Work Safety (SAWS), a primary ministerial-level department of the State Council, oversees work safety in the country and controls lower-level agencies (Zou, 2016). Local work safety administrative units are responsible for conducting inspections of factories. A 2014 amendment granted them greater enforcement powers during work safety inspections, including entry into production facilities, access to all relevant materials, and interviewing personnel, demand on- the-spot rectification of violations, impose administrative penalties on employers, as well as powers to eliminate hidden dangers, order evacua- tion of staff and temporary halt of production, and seize equipment (Zou, 2016). But restrictions on benzene use and provisions of the two laws have had mixed effect on the ground and studies show they are not evenly enforced throughout the country, if at all (Liang et al., 2006). Wong (2001) described Chinese occupational medical journals as replete with reports of benzene poisoning and leukaemia in workers exposed to benzene. Workers in painting, paint producing, shoe making, and rubber industries were particularly at risk. Given all these laws and regulations, why is this problem still around and thriving after nearly 60 years of official limits and curbs on benzene use? Have the risks of benzene exposure been communicated to factories and workers on the ground? If yes, how are these instructions lacking? Are these regulations accepted by local governments, factories, and workers? What is frustrating the process of implementing these disease-prevention changes? Pringle and Frost (2003) and Zou (2016) allude to the failure of implementation and enforcement as reasons, but details in the literature are scarce. While there is a preponderance of published data on benzene poisoning in China, they are mostly medical and epidemiological in nature (Liu et al., 2017; Glass et al., 2014; Hu et al., 2016; Xiao et al., 2013). There is much less qualitative sociological research documenting workers’ voices, such as how they came to be exposed, their struggles to be clinically diagnosed, and later, confirmed with an occupational disease in order to obtain treatment, and the socio-psychological impact their illnesses have on them and their families. Other scholars have noted this gap (Lora- Wainwright, 2014; Liu, 2011; Sun & Liu, 2016), with Ho and Fung (2015) pointing to inadequate attention being paid to how victims face and resist the social structure (e.g. oppressive institutions like employers, 362 E. L. TAN AND M. J. DUTTA government agencies) in their post-diagnosis experience. Hu, Cook, and Salazar (2008) too pointed to this gap in the literature, saying there is little systematic research on how Chinese rural migrants perceive health, disease, and the healthcare system, and they stressed that understanding them will be crucial to prevention, intervention, and other health-related measures for the migrant population. In this study, we used the conceptual framework of the culture-centred approach (CCA) (Dutta, 2008) to converse with 34 participants, of which 33 are workers who were poisoned by benzene at work. The remaining one is a father who helped speak for his son when the latter suddenly fell ill during the interview with breathlessness—an outcome of the young man’s leukaemia. All 33 patient-participants are migrant workers, who left their homes in rural China in search for work in the cities so that they can earn a better income and livelihood for themselves and their families. Through the lens of the culture-centred approach (CCA), this chapter interprets how these marginalised workers struggled to cope with severe illnesses caused by benzene poisoning in an ecosystem that is heavily weighted against them. The CCA offers an entry point for understanding and interpreting the agency of workers as they fight for access to diagnosis, and later go through an onerous process of getting their illness confirmed or determined as occupation-related. Of note here is the difference between getting clinically diagnosed, for example, with a disease like leukaemia, and getting one’s disease confirmed or determined as occupationally-caused, for example, by benzene exposure in the workplace (Sun & Liu, 2016). It is paramount for an affected worker to get his or her illness determined as occupationally-caused because failure to do so means the illness has nothing to do with the employer and treatment costs will not be borne by the employer or the country’s work injury insurance fund. The worker will then have to pay out of pocket, which he/she cannot possibly afford as these illnesses require costly, long-term treatment. Failure to establish the causative link to the workplace means the worker cannot get access to treatment and the likelihood of a quicker death from the illness. Through documenting the experiences of these 34 participants, this qualitative research project hopes to fill these gaps in the literature. It hopes to make policymakers aware of the hardships faced by victims of benzene poisoning so that change may be made. INEQUALITIES AND WORKPLACE INJURIES: HOW CHINESE WORKERS… 363

Culture-Centered Approach The culture-centred approach was chosen as the theoretical lens of this study because it attends to the erasure of voices from mainstream discursive spaces, and through co-constructive conversations with subaltern communities, seeks to co-create communication infrastructures of recognition and representation (Dutta, 2015). Subalternity is the condition of being erased from mainstream discursive spaces (Guha & Spivak, 1988), and workers in this study are subalterns because of their erasure from the processes of diagnoses and treatments. From this data set, workers typically complain of employers raising obstacles and foiling their attempts to seek diagnosis and treatment because companies do not want to bear any responsibility. Workers found ill are often fired or offered a token compensation and told to leave, communicatively erased from sites of articulation. They are literally silenced or erased by the powerful organising framework of structures: an outcome desired by employers as they do not want to bear the costs of taking care of sick workers (Nang & Ngai, 2009). There are three strands in the CCA—structure, culture, and agency. Dutta (2008) defined structure as “the arrangement of organizational and administrative networks that regulate and influence resource availability in marginalized contexts”. Giddens (1984, 1990) explained structure as rules and resources which make up patterns in the social world that impact the everyday lives of individuals. These structures are not necessarily fixed or constricting, rather they can be enabling, and individuals, when given the right triggers like knowledge, can exert their agency and challenge these structures. Dutta (2008) and Guha and Spivak (1988) describe agency as the basic human capacity of subaltern communities to engage in actions. As for culture, it is conceptualised as both dynamic and generative; cultural knowledge, rules, and roles that are transmitted through generations and are constituted through everyday practices of communication (Dutta 2008). Looking at this data set through the lens of the CCA, agency and culture are displayed when Chinese villagers leave their homes in search of jobs, paying heed to Confucian cultural values that one is responsible for the greater good, in this case improving the fortunes of one’s family (Chang, 2010). When they fall ill, they find themselves having to navigate an oppressive structure comprising lumbering government bureaucracy and powerful self-serving corporates. Reduced to a state of precarity with no earnings, little savings, ballooning medical bills, and debts, they are left 364 E. L. TAN AND M. J. DUTTA with little choice but to enact their agency to fight and access essential services like healthcare and treatment. The CCA has been used in a growing number of studies to examine meanings of health in the realm of work (Dutta & Basu, 2007; Dutta & Kaur, 2016; Dutta et al., 2017; Gao, Dutta, & Okoror, 2016; Dutta, 2017), and this study hopes to add to the literature of the CCA in the area of toxicity at work. More specifically, the chapter hopes to contribute to the literature on CCA and occupational health and safety by showing how structural elements in Chinese factories either aid or hamper diagnosis of work-related diseases and access to treatment. In this context of exposure to benzene poisoning and the subsequent negotiations in seeking treatment, we ask the following research question:

RQ: How do Chinese workers go about obtaining confirmation or determination that their illnesses are occupationally related to benzene poisoning in the workplace, and thereby gain access to state insurance paid treatment?

Method Through our collaborator, Labour Action China (LAC), a Hong Kong based non-government organisation and labour activist group, 34 participants were recruited using snowballing. Of the 34 participants, 19 were men and 15 were women. Their mean age at the time of the interviews in June 2013 was 38.4 years. Participants were briefed by LAC staff ahead of the interviews on the purpose of this study and had a few days to consider whether or not to participate. The interviews were conducted over two weeks in the Chinese cities of Huizhou, Shenzhen, and Guangzhou. Below is a table on their job nature and length of exposure (Table 17.1): Due to the sensitive nature of this topic, interviews in Huizhou and Shenzhen took place in hotel rooms for the privacy they afforded. In Guangzhou, most of the interviews took place in the Guangzhou prevention of occupational disease hospital where the participants were admitted. All participants were shown a consent form laying out the objectives of this study at the start of their interviews, but all declined to sign due to concerns for their own safety. Despite their concerns, participants agreed to be interviewed as they saw this study as necessary to highlight the problems they were facing and the suffering they have had to endure. All of them requested anonymity for themselves and asked that their employers INEQUALITIES AND WORKPLACE INJURIES: HOW CHINESE WORKERS… 365

Table 17.1 Job nature and length of exposure of Chinese workers

Name Age Work nature Exposure duration

Michael 33 Cut steel plates to make shipping containers 2 years Abraham 35 Foreman in paint factory 10 years Martha 29 Store keeper at paint factory 5 years Rick 35 Skilled paint technician at paint supplier—job requires 10 years him to develop new paints Tommy 40 Skilled paint technician at paint supplier 8 years Richard 36 Manager, set up new rubber factory—exposure to 12 years thinners, paints, rustproofing, pipe-laying Robert 50 Spray painted and washed ornaments, e.g. Christmas trees 7 years Leonard 33 Paint technician in furniture factory 10 years Thomas 34 Paint mixer in furniture factory 9 years Lily 45 Odd jobs at furniture factory 5 years Nancy 38 Odd jobs at antique furniture factory 6 years Luke 48 Spray painter at woodcraft factory 2 years Francis 38 Spray painter at furniture factory 3 years Irene 34 Printing bicycle labels 11 years Faye 43 Cleaned zippers on bags with thinners 13 years Jolene 40 Polished spectacle frames with solvents 1 year Beryl 49 Mixed paints, did painting work at furniture factory 3 years Caitlyn 46 Odd jobs at container factory, including spray painting 10 years Bruce 38 Inject glue onto base of containers 20 months Rebecca 30 Print logo on golf balls, used inks, thinners 1 year Kate 43 Cleaned hair curling equipment with thinner, mixed 7 years paints, contact with glue Susan 40 Skilled worker—hand-painted glass products, mixed paints 6 years Desmond 38 Carried freshly painted wooden floorboards in and out of 6 years furnace Tony 52 Farmer (father of Benjamin) None Benjamin 27 Cleaned electronic parts using solvents 5 years Rita 48 Cut and sewed sofa covers, benzene was used as solvent 5 years for leather Ramona 37 Cleaned and repaired tyres, filled holes with glue 3 years Theodore 28 Spray painted window frames, construction material 3 years Fred 35 Printed paper, film, used paints, ink, thinners, solvents 15 years Martin 34 Paint technician, mixed paints, sprayed paint 9 years Martina 47 Shoe factory worker, used glues, thinners, solvents 1 year Vera 37 Sprayed glue into earphones 4 years Lionel 44 Print company trademark on products, used inks and 6 years thinners Bernard 37 Sprayed paint and glue into gaps of undercarriages used 2 years in container ships to prevent rusting 366 E. L. TAN AND M. J. DUTTA not be identified—underlining the caution that the participants took with privacy and confidentiality. At the time of the interviews, all of them were either negotiating with their employers or had already taken up lawsuits against them and did not want further publicity. The investigator agreed and assured them that neither their names nor names of their companies would be disclosed. Instead of their names, pseudonyms will be used. Data was collected over two weeks across the three cities, and 35 hours of conversation were recorded. One female participant refused to be digitally recorded and the 55-minute conversation with her was recorded by hand. Due to the sensitivity of the topic, the first author took the added precaution of returning to Hong Kong once every few days to offload recordings onto a laptop that was kept in Hong Kong. This was to ensure safety of the materials, and each time the investigator returned to mainland China, there would be no recordings on her as she crossed the land border. This was a procedure she undertook while operating in Huizhou and Guangzhou, which are relatively far from Hong Kong (at least five to six hours by rail and road, one way) which meant that making such trips on a daily basis would be too time consuming. In Shenzhen, she would return to Hong Kong daily as the one-way commute was shorter (two hours). Participants spoke in Mandarin, except for one in Cantonese. These were translated into English during the transcription process by the first author, who has facility in all three languages, with Cantonese being her mother tongue and Mandarin her second language. Given the dynamic nature of this problem and emphasis on context, the grounded theory method of analysis was used to analyse the data (Strauss & Corbin, 1990; Charmaz, 2000). As our objective was in meaning- making through thematic analysis, the grounded theory was particularly suitable because it posits that theory is grounded in themes (Strauss & Corbin, 1990). Thematic analysis is a qualitative research method involving the coding of concepts. The idea is that by analysing discrete concepts, the researcher can better understand emergent theoretical relationships between concepts (Charmaz, 2011). The investigator used open coding, axial coding, and selective coding systematically to organise the data which spanned across the spectrum of the workers’ experience of working in cities, of discovering they were ill, and their struggles in coping with their illnesses. INEQUALITIES AND WORKPLACE INJURIES: HOW CHINESE WORKERS… 367

Results In this study, 31 of the 34 participants successfully obtained confirmation or determination that their illnesses were caused by benzene exposure using several creative means: (a) proactively seeking help from pro-bono lawyers, labour rights groups; (b) getting government agencies to intervene; (c) taking radical steps such as threatening to protest; and (d) by giving bribes.

Seeking Help from Concern Groups Frustrated with the lack of cooperation from employers, a number of participants sought help from pro-bono lawyers and labour rights groups to help them explain to government agencies that their illnesses were caused by benzene exposure at work. In the case of Kate, even though she was clinically diagnosed with reduced white blood cell count, she failed to establish it was caused by benzene poisoning as her company refused to furnish air quality reports to the government as required. Without such corroborating evidence, there was no way she could make the causal link which would render her company culpable.

Kate then sought help from labour rights experts and lawyers to help her articulate that while the company gave the excuse that it had no reports to give to the government as her particular work unit had never undergone any air quality checks during the time that she was employed, there was other evidence that the government could use, such as air quality reports of other departments in the factory that were actively using benzene:

Then I wrote a declaration [to the government] to say that the chemicals used in my unit were used throughout the factory, and just because there were no [air quality] checks on my department did not mean it did not use benzene … Other departments were using benzene. The spray painting department underwent air checks and these continued to use benzene…As for writing the declaration, personally, I don’t know how to write, even though I know how to say it, but I didn’t know how to say it in sentences. I went to find lawyers and many of them were not aware of this occupational disease, I was running everywhere and faced a lot of hardship. Eventually in Dongguan, I found a lawyer and he wrote it for me. At the end, because of all this evidence, the factory admitted [to using benzene in the factory], then I secured what I wanted. 368 E. L. TAN AND M. J. DUTTA

Here, Kate fights against all odds and displays agency in finding a lawyer to help her frame her argument in the legal language so that it may be perceived as more credible and persuasive to government structures presiding over her appeal. In the letter crafted by her lawyer using her argument, Kate makes the case that chemicals used in her unit were the very same ones used throughout the factory. So by extension, air quality reports of other units should be admissible as substitutes for the air quality reports that the company could not produce for the unit where she worked. Apart from securing a diagnosis that is linked to benzene exposure, workers need to obtain a disability rating when their illnesses stabilise. This rating purports to establish the severity of the person’s disability with 1 being the most severe (such as losing completely and permanently the ability to work) and 10 the mildest. A rating of 1–4 means the person’s medical needs would be taken care of by the state insurance fund, which is the best assurance the worker would have of lifetime medical care. Anything higher than 4 is shouldered by the employer, which means that one’s medical care is assured only if the company continues to be solvent and continues to pay the worker’s insurance premiums. But this puts the worker at risk especially if the company shuts down, which is not uncom- mon. A rating of 7–10 means the company has the right to terminate the worker’s contract when it is up for renewal. If that happens, it means the worker will have to pay his or her own medical bills thereafter, which would be impossible as they can rack up to 30,000 yuan a month, which is the average monthly treatment bill for participants suffering from benzene-related leukaemia. For an occupationally-disabled migrant worker, the disability rating is therefore critical because a rating of 4 and lower will mean he or she is taken care of by the state. Anything higher will put the worker at the mercy of the employer and the worker faces potential financial ruin. In the case of Vera, who ended up with benzene-caused leukaemia and who only found out about her illness after a miscarriage, she was initially given a grade of 8—too mild by any standard. While in hospital for treatment for her leukaemia, she describes how she ran into a pro-bono lawyer who helped her:

That time, when I got grade 8, I could not even sleep. Because it would mean that the company can terminate my contract, and I wouldn’t even get treatment, I will have no medicines, and that means I will die. If I get fired, I die…I wanted to apply for help from the courts. I was lucky to run into a INEQUALITIES AND WORKPLACE INJURIES: HOW CHINESE WORKERS… 369

pro-bono lawyer who visited us here [in Guangzhou hospital]. Then I told him of my case and I asked him how I could write it and I asked him to help. Then I submitted it to the Guangzhou city office. I gave him all my supporting evidence, even bone marrow details. Then the grading was changed. It [Guangzhou city office] saw me when I got the result. My company representative also went. The office explained to my company representative, saying the [switch in] grading given to me was simply too huge. How can I jump from grade 8 to 3? The office said benzene-caused illness [leukaemia] cannot possibly be graded 8. They gave the company the grading book. Then I felt a little happy. Now I am also happy to be given 3, that grading given to me in May 24 this year.

Here, Vera relates how her disability rating was changed from a less serious grade of 8 to a much more serious grade of 3, which will give her access to state insurance-paid treatment for life. This means she will be taken care of by the state instead of being left to the mercy of her employer, which is a significant success for her. In the meeting she described, the government official reprimanded the company representative, saying the change in disability rating was simply too huge. The government office said no leukaemia patient could possibly be graded an 8 simply because it is a serious illness—implying that the earlier rating of 8 could have been rigged, even though the government official did not explicitly state it in the meeting. Looking through the lens of the CCA, Vera’s agency in obtaining the help of the pro-bono lawyer enabled her to put her arguments in the legal language, which is a recognised communication tool in the formal world of business. Without this communicative tool, Vera would otherwise be unable to articulate her arguments to the necessary government bodies presiding over her disability grade and she would probably not have secured the positive outcome for herself.

Persistence in Getting Government Agencies to Intervene While pursuing a determination that a disease is caused by benzene exposure at work, most participants faced employers who were hostile and reluctant to cooperate. The reasons were obvious. A determination would invariably point to flaws in safety standards at the factory and in the way it was managed, which may result in punishment for the employer. A confirmation linking the worker’s illness to toxic agents in the factory meant the employer was culpable, resulting in financial costs as the employer will have to shoulder medical insurance premiums of the sick worker and dole out a lump sum compensation to settle the case eventually. 370 E. L. TAN AND M. J. DUTTA

Furthermore, most of the workers reported not only themselves falling ill, but co-workers too. So for a factory to have several such confirmed cases could potentially mean bankruptcy for the employer. As such it is easy to understand why an employer would resist attempts by the worker to obtain such a confirmation. But workers who were determined to fight for access to treatment pressed on to secure this confirmation. A few workers appealed to government officials and authoritative figures, such as medical experts, to intervene. Susan was fired by her company when it learnt she obtained determination that her aplastic anaemia was occupationally linked. She quickly complained to the government:

It gave me a termination notice, but I didn’t sign it. Even though the doctor wouldn’t discharge me from hospital, I insisted and I went to the factory. It said I had been gone so long and was ill, and now I couldn’t go to work, what was there for me to do? So I went to a government department and showed them the termination notice and the doctor’s diagnosis showing I had an occupational disease. Then they rang the factory and told them that they cannot fire me while I was ill and that since I was already diagnosed with occupational disease, the factory had to act accordingly. Then the factory accepted it, and I continued to borrow money from them (for treatment) and they wrote out IOUs.

Here Susan describes how she managed to get the government to intervene through making a complaint. Looking through the lens of the CCA, one can see how powerful structures surrounding the worker, such as the employer, erects barriers to frustrate the worker’s attempt to seek long- term treatment through using illegal tactics, in this case terminating the worker’s contract even after the worker’s illness had been determined as occupationally related. It was only when Susan exercised her agency and made a formal complaint to the government that the latter intervened to force her employer to reverse its decision. It is worthy to note here how powerful government orders and officials can be in China: that when an official order is given, factories can be intimidated into obeying. In the case of Desmond, he related how a government hospital had given him a preliminary diagnosis of occupation-related asthma, but his company refused to accept responsibility and furnish evidence to help confirm that his asthma was caused by benzene exposure in the workplace. His employer’s refusal to cooperate left him with no choice but to complain to the government, but unlike Susan, he had to negotiate his way INEQUALITIES AND WORKPLACE INJURIES: HOW CHINESE WORKERS… 371 around numerous government departments before eventually getting a senior official to intervene:

It was a lot of hardship. I needed to look for departments, and it was very hard for us to talk. A lot of departments treat you like a football, they kick you around. They don’t want to undertake any responsibility. I went to many places in Guangdong province and the higher up I went, the easier it got. More senior officials dared to take decisions unlike lower ones. They would give you a glass of water and they would ask you to state your complaints. But the ones lower down, maybe it’s their quality or something, I don’t know what’s wrong with them. The official in Guangdong province health department, once I got there, he saw me, and he said he would consider my case because I had come all the way from Shenzhen, that was no easy task, especially when I was that ill, and the transportation costs was another issue. He even gave me his telephone number and told me to find so and so, and if he doesn’t help you, you give me a call, and I will send people to the factory directly. Do you see how considerate that is? Lower [ranked] officials can’t match such standards. When I got to the health regulatory board, they will merely try to entertain me and then they get rid of me. But I will just go look for someone one level higher, and if that won’t do the job, I will go to a city level official, I will soon find someone who will talk to me. I will find someone senior to put pressure on the lower one to help me. And then it is finally the lower ranking one who will directly help me solve the problem.

According to Desmond, the senior provincial official eventually ordered lower ranking health officials to organise a spot check on the factory. Accompanied by government health officials, a doctor, and nurses, Desmond went back to the factory where they found the factory had shut operations for the day. The officials then ordered the company to simulate a normal workday environment. Desmond describes:

It was obvious the company had been tipped off and had let its workers off for the day. Then the inspectors requested to see the place where they spray painted the floorboards, then they placed the floorboards on the ground in the room and they sprayed the paint. In under 10 minutes, I had an asthma attack. The moment I inhaled the paint, I had an asthma attack. So the doctor said ok, that’s enough, we have seen enough. I immediately wore the oxygen mask because once I get an attack, I can hardly walk. I got an injec- tion immediately and was given my medicine, and the asthma settled. So that was how I was diagnosed. 372 E. L. TAN AND M. J. DUTTA

Looking through the lens of the CCA, the employer’s refusal to cooperate became a significant structural barrier to Desmond’s fight for access to treatment. But Desmond chose to exercise his agency. Through going to numerous government bodies, he finally managed to find a senior official who was sympathetic to his plight, who then ordered lower ranking officials to conduct a spot check on the factory. Here it is important to note that during the spot check, government officials ordered his employer to simulate and recreate the conditions of a regular workday. The environment quickly became polluted, triggering Desmond’s asthma attack on the spot—which gave government officials and the accompanying medical team the very evidence they needed to link Desmond’s disease to his work environment.

Resorting to Threats In navigating access to diagnosis, a worker faces the uphill task of getting help and cooperation from both the employer and the government. In some cases, these powerful structural forces—which get to decide if a worker gets access to treatment—are so reluctant to offer assistance that workers are forced to resort to radical measures. Lionel shared how his factory refused to support his request to get his clinically-diagnosed leukaemia confirmed for its causal link to benzene exposure at work:

My company boss said this: the company has operated over 30 years and there has never been a case of occupational disease. But I said: it’s because people don’t know about this, they may die not even knowing what the cause was.

Lionel then took the unusual step of approaching government departments and threatening to protest at what was then the Paralympic games in November 2010 in Guangzhou city if they did not step in to intervene in his case. Lionel described:

I went to the government office every day. I made a lot noise, they even put me under soft detention (house arrest) for a few days at the time when the games were coming to a close because they were afraid I would make trouble. They put me under house arrest for a few days in a hotel, they gave me food and drink for 4 days. That was during the close of the Paralympic games in 2010. They were afraid I would go to the athletic stadium to create trouble. They told me to stay there quietly for a few days and that once the games was over, they would handle my case. They arranged for me to live and eat there, but really, it is a soft detention. In reality, government officials INEQUALITIES AND WORKPLACE INJURIES: HOW CHINESE WORKERS… 373

accompany us to eat and drink and they talk to us every day. That was between November and December 2010. After the games, the government went to the factory to seek a resolution, to tell them to support my request (to establish if my illness is caused by workplace benzene exposure). This is because the company needs to furnish information, otherwise you can’t process the request. The company needs to give a lot of information. If it won’t cooperate, then you look for the government and get them to confront the company. You can’t go through the process just by yourself. After I went through the government department, the company gave its cooperation and it supplied all the information that was needed.

Looking through the CCA lens here, Lionel displays extraordinary agency. Faced with a terminal illness, he had little option. If he was unable to link his illness to benzene exposure at work, he would have had to shoulder his illness by himself, bringing financial ruin to his family. So he took the unusual step of threatening to protest and disrupt an international sport- ing event under the full glare of the media which would have brought great embarrassment for the country—and punishment for provincial officials for being unable to keep such “troublemakers” under control. In China, protesters are viewed by authorities as troublemakers and local officials are expected to preserve the peace especially during huge events when the country is under international media scrutiny (Li, 2016). Lionel understood this interplay of modern Chinese culture and structure—and exercised his agency at just the right time, i.e. at the close of the Paralympic Games in 2010. By threatening to protest, he was placed under house arrest for a few days. Here, it is important to note that while he was locked away in a hotel room and prevented from making his protest, he was not tortured but was instead given food, drink, and shelter. He also had the constant company of government officials, who he managed to win over with his arguments. After the games ended, they accompanied him to the factory and there, officials ordered the company to cooperate and facilitate the confirmation of his diagnosis. Again, as in the previous cases with Desmond, Susan, and Vera, Lionel’s company obeyed. Lionel was eventually diagnosed with benzene-related leukaemia three weeks later.

Navigating Access to Diagnosis Through Bribes While it took as long as two years for certain participants in this study to obtain a diagnosis, and then another few more years to secure a disability rating, there was a rare case where it took a worker a year from getting the first symptoms of his illness to obtaining a disability rating. Luke, who obtained determination 374 E. L. TAN AND M. J. DUTTA that his asthma was work related and a disability rating of 4, had no qualms at all about paying bribes to get what he needed. Such a rating meant the state would take care of his medical expenses for life. Luke shared:

It took me 4 months to get from diagnosis to disability rating. That’s very fast. I paid to get it, I paid the doctor, I paid the hospital, government offices (rating agency), that’s why it was so fast. If I had gone through the normal procedure it would have taken 1 to 2 years … I gave them about 20,000 yuan in total. It’s not much because my medical bill from August 2009 till now is over 7 million yuan (way over 20,000 yuan). This is just the expenses, examination fees, injections, treatment costs etc. The factory bears 15 percent of my costs, state insurance 85 percent. The 20,000 yuan I paid out of my own pocket. With the report, the factory can’t not accept the verdict, it has to accept. If you don’t pay the money, your case will be dragged out for 1–2 years. My lungs have blisters. You see my health seems fine, I look hearty, no one thinks I am ill. This is what happens in our country. I was never given health checks and I never signed any work contract. I don’t bother with any lawsuits, I just see what they have to say. I just give money and I get what I want.

Here, Luke was alluding to corruption within the Chinese bureaucracy (Qian and Wen, 2015). Seen through the lens of the CCA, this corrupt- ibility is a well-known but little spoken system within the Chinese bureaucracy, a culture where bribes can be used to oil and manipulate the country’s bureaucratic processes and red tape for the payer’s own ends. Like Lionel who understands the unique cultural nuances influencing how protests are interpreted and managed within the structural corridors of power in China, Luke understands this interplay of culture and structure within China’s administrative structure. Instead of complaining to government bodies, seeking help from labour concern groups, and threatening to go public with protests, Luke instead makes use of this culture of graft and subverts it, using it for his own ends. Through playing along with these unspoken but well-known rules, Luke gets the diagnosis and disability grade he needs to secure access to long-term treatment and survive.

Discussion The findings of this study attend to the interplays of culture, structure, and agency in the constructions of benzene poisoning offered by the migrant workers who participated in our on-going culture-centred project INEQUALITIES AND WORKPLACE INJURIES: HOW CHINESE WORKERS… 375

(Dutta, 2008). The access to healthcare, treatment, and compensation are shaped structurally. The ability to seek healthcare and compensation are tied to the confirmation or determination of occupational disease. The experience of seeking a determination of occupational disease is filled with structural barriers that the workers experience. These barriers are significant, making the process a long and onerous one, depicting the material influences of structures, especially in constituting the access to healthcare and health justice for affected workers. The tests and re-tests that need to be done in order to secure a diagnosis constitute the entry point to securing a diagnosis. Because the tests themselves are constituted within company infrastructures, the workers depend upon the company in order to secure the tests. In getting government authorities to confirm that the clinical diagnosis is causally linked to the work environment, workers depend on the employer to (a) pay for a confirmatory occupational disease test which can cost up to 10,000 yuan; (b) supply past official documents such as workplace environment test results which are potentially incriminating for the employers themselves; and (c) open up the factory for visits by environmental health officials. Given the power held by the employer in this decision-making structure, the struggles of workers are often constituted in the ambits of a plethora of tactics used by employers to deny access. In the absence of adequate government monitoring and with the power to cooperate being placed in the hands of the employer, the workers experience complex layers of structural impediments in securing determination of occupational disease. The narratives also point towards the complicity of government officials with company owners, further disenfranchising the workers from securing confirmation that their illnesses are causally linked to workplace benzene exposure and thereafter, treatment. Amid these structural limitations to accessing determination, the workers enact their agency, depicting their creative practices that negotiate structures and simultaneously challenge them. The structures of the local, state, and national governments, legal structures, and structures of private capital are negotiated through practices that adapt to the structures as well as through practices that disrupt them. Strategies such as proactively seeking help from concern groups of pro-bono lawyers and labour rights groups, persisting on getting government agencies to intervene, taking radical steps such as threatening to protest, and giving bribes are constituted within the local structures of everyday politics, and simultaneously extend the realm of possibilities of everyday politics. The inaccess to infor- 376 E. L. TAN AND M. J. DUTTA mation and communication that constitute the power of state-capitalist nexus is disrupted through everyday acts of witnessing, developing strategies of observing, and taking into account the effects of unhealthy workplaces. Establishing causality in the realm of chemical exposure is mired with difficulties, and the workers depict the ways in which they draw on cultural scripts to interrogate the organising logics of structures. Collaborations with concern groups such as labour groups and legal assistance groups are shaped by needs for crafting the evidence they gather in the legal language. While securing a diagnosis, workers seek the assistance of lawyers in helping them put together letters to respective government agencies on the basis of the evidence they have gathered. Similarly, in securing the appropriate disability rating, collaborations with lawyers offers the necessary linguistic capacity to engage the state structure. Persistence is another strategy that depicts the resilience of the workers amid the precarity that is produced by the structures that organise work. Workers resist the practices of deception and foot dragging put up by employers by continuing to push for classification, seeking out various state agencies in the process, and continuing to pressure state agencies. Moreover, the practices of putting up protest and bribing depict the ways in which the workers draw upon the cultural context to disrupt the structures of communicative inequality. In the absence of communication structures that enable workers to secure detection and treatment through transparent mechanisms, these creative practices of securing classification and treatment build on existing cultural scripts (such as bribing), as well as disrupt them (worker bribing a government official as opposed to the typical story of the employer bribing the government official). In sum, this chapter points towards the interplays of culture, structure, and agency in the constructions of health risks at workplaces, the sites of precarity in global manufacturing and production networks. The state- driven rules of workplace safety remain erased from the everyday lives of workers in factories in China, mostly migrating from rural spaces in search of livelihood. The communicative inequalities experienced by the workers in the form of lack of access to information on chemicals and precaution- ary steps constitute the lived experiences of the workers. The workers participating in this project negotiate these communicative inequalities through strategies of persistence and resistance, negotiating structures of inaccess, and seeking to transform them. It is important to note that the small number of interviewees does not allow us to generalise how migrant workers will respond when faced with INEQUALITIES AND WORKPLACE INJURIES: HOW CHINESE WORKERS… 377 an occupational disease. However, data saturation was attained and it is hoped that these in-depth interviews offer a detailed and nuanced understanding of migrant workers’ corresponding social behaviours in practice. We also acknowledge a selection bias in our data collection process as our participants were identified by our collaborator. Furthermore, they all belong to the class of workers who, upon falling ill, chose to exercise their agency and pursue clinical diagnosis, and subsequently determination of occupational disease. It is important to remember that many more never choose such a path because of the difficulties described in this study and the length of time it would take to secure an outcome that is best described as uncertain (Sun & Liu, 2016; Chen, Ding, Cook, & Pong, 2014).

Conclusion This chapter has provided a rich body of information on how workers, in the face of their debilitating diseases, negotiate access to diagnosis, determination that their illnesses are causally linked to workplace exposure, and treatment. It is hoped that this information would provide deeper insight to policymakers so that change may be pursued, whether in the tackling of this hazardous workplace pollutant or in opening up access and treatment for those suffering from benzene poisoning.

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Media Portrayal Stigma Among Gender and Sexual Minorities

Jagadish Thaker, Mohan Jyoti Dutta, Vijay Nair, and Vishnu Prasad Rao

Stigma is a discrediting social marker (Goffman, 1963). According to Link and Phelan (2001), stigma “exists when elements of labeling, stereotyping, separation, status loss, and discrimination occur together in a power situation that allows them” (p. 377). A socio-functional perspective states that stigmas originate and persist to protect and promote groups’ values through social cohesion and control (see Smith, 2007 for a review of different approaches; Goffman, 1963). Public health scholars substantiate that stigma results in psychological distress and negatively

J. Thaker (*) School of Communication, Journalism & Marketing, Massey University, Wellington, New Zealand e-mail: [email protected] M. J. Dutta Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University, Palmerston North, New Zealand e-mail: [email protected] V. Nair • V. P. Rao India HIV/AIDS Alliance, Hyderabad, India

© The Author(s) 2019 383 M. J. Dutta, D. B. Zapata (eds.), Communicating for Social Change, https://doi.org/10.1007/978-981-13-2005-7_18 384 J. THAKER ET AL. affects several key health outcomes (Hatzenbuehler et al., 2013; Schrimshaw, Siegel, Downing Jr., & Parsons, 2013). For example, stigma is considered as a fundamental cause of population health inequalities (e.g., Hatzenbuehler, Phelan, & Link, 2013; Monteiro, Villela, & Soares, 2013). Communication is likely to play a key role in how stigmas are perceived, experienced, and managed (Meisenbach, 2010; Smith, 2007). We focus on homosexuality-related stigma in India, specifically individuals and groups assigned within the category of “men who have sex with men” (MSM), transgender and hijra (together, MTH) communities in India. Several studies in India show that sexual minorities face stigma and discrimination at home, in the neighborhood, in terms of healthcare, and in workplace settings (Chakrapani, 2010; Chakrapani, Newman, Shunmugam, McLuckie, & Melwin, 2011; Khan, 2004; Logie, Newman, Chakrapani, & Shunmugam, 2012; Thomas et al., 2011; van Griensven & de Lind van Wijngaarden, 2010). The behaviorally-based category of “MSM” was coined in 1994 by epidemiolo- gists to focus on sexual behaviors as key to understanding and reducing modes of HIV transmission (see Young & Meyer, 2005). The National AIDS Control Organization (NACO), the prime government agency that overlooks HIV/AIDS prevention and treatment programs in India, also uses the term “MSM” to refer to homosexuals. Referred to as “high-risk” groups, the HIV prevalence among “MSM” is estimated to be 4.43% in 2010–2011, compared to 0.35% in the general population. Transgenders and Hijras were previously categorized under “MSM” by NACO, and only recently, in 2013, HIV prevalence was separately estimated for Transgenders and Hijras, which was 8.82%, the highest among all the identified “high-risk” groups in India. Prevailing negative attitudes against homosexuals, and the Section 377 law that bans homosexuality in India, has resulted in less funding for research and outreach efforts directed at homosexuals (Bharat, 2011). In this chapter, we focus on stigma communication and management among gender and sexual minorities in India, drawing upon the culture- centered approach to resist the mainstream narrative/interventions on gender and sexual minorities (Dutta, 2008, 2012). As part of our larger culture-centered project with a subaltern community of sexual minorities in Andhra Pradesh and Telangana, India, stigma emerged as the key MEDIA PORTRAYAL STIGMA AMONG GENDER AND SEXUAL MINORITIES 385 site for addressing the health challenges experienced by community members. Interrogating the erasure of subaltern voices from dominant sites of theory generation, the culture-centered approach foregrounds and actively co-constructs communicative processes through which subaltern knowledge claims can emerge into dominance (Basu & Dutta, 2007). The everyday experiences of health voiced by community members are situated amid their experiences of stigmas. Based on the principles of the culture-center ed approach (CCA), our advisory group of subaltern community members identified the structures that constitute stigma, the cultural contexts of stigma, and the everyday agentic expressions of negotiations of stigma, grounded in the voices of community members. The work of the academic team as interlocu- tors moved back and forth between conversing with the literature and attending to the voices of subaltern community members, expressed in the advisory group of gender and sexual minorities. What we present as the literature on stigma communication and our methodological negotiation of this literature is grounded in the constructions of community members of the public, media, and institutional stigmas as the sites of risks to health. Although the manuscript is written in the language of academic constructs, theorizing these constructs, and drawing out relationships, the conceptual framework for these constructs and their relationships was developed by the advisory group of community members. The chapter is organized as follows. First, we focus on negative media portrayal of gender and sexual minorities in India and elsewhere and evaluate previous studies on media exposure and perceptions of stigma. Although there are several studies on stigmatizing attitudes among the general public, little research currently exists examining stigma perceptions among stigmatized individuals and groups and its impacts on their health (Anderson & Bresnahan, 2012; Meisenbach, 2010). We seek to add to the research evaluating media’s role in stigma communication and management using data from three south Indian cities. Finally, we evaluate the impact of perceived stigmas on gender and sexual minority identity disclosure strategies, an important health indicator for seeking and receiving health-related information (Rains, 2013; Schrimshaw, Siegel, Downing Jr., & Parsons, 2013). 386 J. THAKER ET AL.

Culturally-Centering Knowledge Production The CCA foregrounds the agentic capacity of subaltern communities to examine their lived experiences, make sense of the structures that constrain their lives and erase their voices, and negotiate and resist such structures through a wide range of practices (Dutta, 2008, 2015). Interrogating the erasures that are constituted in the mainstream production of health communication/intervention knowledge that mark subaltern communities as sites of interventions, the CCA offers entry points for theory-building from the margins, with the role of the academic being one of a facilitator that enables subaltern knowledge to emerge into hegemony. The role of the researcher becomes one of facilitating the community’s production of theoretical knowledge, developing methods/ instruments for legitimizing this knowledge as anchors to conceptualize health and well-being. The literature presented in this section, the methods, and the results are written in a traditional academic language, acceptable in the normative structures of knowledge production. However, the concepts explored emerge from sites of subaltern articulation. The advisory group of gender and sexual minorities in our project conceptualized media stigmas as being related to exposure to the media, which then worked hand-in-hand with other forms of stigmas to impact health behaviors. In the rest of this section, we present a literature review that draws on the literature to substantiate/support the theoretical concepts offered by our advisory group.

Media Portrayal of Gender and Sexual Minorities Our advisory group members pointed to negative media portrayals of gender and sexual minorities as key elements in the perpetuation of perceived stigmas. Critical analysis of media coverage in the USA suggests that gender and sexual minorities are marked by their absence in mainstream media, also referred as “symbolic annihilation”. The rare feature on minorities is framed within the disease context, primarily as sources of HIV/AIDS and its transmission route (e.g., Gross, 1991). For example, primetime network TV coverage of sexual minorities in the US media indicates a shift from the non-recognition stage to the stage of ridicule— the first two stages of four-stage media representation of minorities, with regulation and respect as the last two stages. MEDIA PORTRAYAL STIGMA AMONG GENDER AND SEXUAL MINORITIES 387

Studies in India similarly show that mass media frame gender and sexual minorities primarily within the HIV/AIDS context, as transmission routes and deviants, outside the heterosexual norms of Indian society (Karnik, 2001; Khan, 2014; Nambiar, 2012; Sabharwal & Sen, 2012). Even in well-intentioned media campaigns, sexual minorities are framed as “high-risk” groups, and these campaigns provide content cues that identify sexual minorities as guilty and deviants that threaten the social and moral values of society (Dillon & Basu, 2014; Dutta & Basu, 2008; Karnik, 2001). Documenting the history of popular media representations, Shahani (2008) shows that homosexuals are portrayed as stereotypical comic characters in Bollywood (Hindi film industry) movies. Homosexuals are largely absent in the Indian news media coverage, and the rare feature on homosexuals is often sensationalized, primarily featur- ing homosexuals as involved in crime or in relation to HIV/AIDS (Shahani, 2008). Similarly, Sabharwal and Sen (2012) conducted a content analysis of popular Bollywood movies showing that sexual minorities are portrayed as comic or criminal stereotypical characters. Recently, prominent English newspapers in India, including the largest circulating English daily in the world, The Times of India, refused to publish a matri- monial advertisement—a popular match-making method for arranged heterosexual marriages in India—from the mother of a homosexual individual looking for a partner (S. Dutta, 2015). Fear of legal action due to homosexual ban law in India appears to have affected editors’ decision.

Media Portrayal Stigma Among Gender and Sexual Minorities Several studies show that media frequently portray minorities in an exagger- ated manner that perpetuates false beliefs, assigns differentiation, and implies moral and social judgments (e.g., Pirkis et al., 2006; Klin & Lemish, 2008). These negative media portrayals result in negative public attitudes toward stigmatized individuals and groups (Athanasopoulou et al., 2015; Clement et al., 2013; Domino, 1983; Pirkis et al., 2006; Stack, Kral, & Borowski, 2014). A meta-analysis of 77 studies showed a moderate negative association between media depictions and body-image concerns among women. While some studies show that exposure to homosexual characters in media, such as in TV programs and movies, is associated with positive attitudes toward homosexuals (Detenber, Ho, Neo, Malik, & Cenite, 2013; Schiappa, Gregg, & Hewes, 2006), other studies show that general media use is asso- 388 J. THAKER ET AL. ciated with more negative attitudes. These results provide mixed evidence for media exposure and public attitudes toward homosexuals. Compared to general public, studies of media use and stigma perceptions among stigmatized groups are few. Steward et al. (2008), based on in-depth interviews with people living with HIV in south India, argued for another stigma dimension they called, “vicarious stigma,” referring to hearing about stories of enacted stigma by people living with HIV/ AIDS. Based on social learning theory, they argued that hearing “stories communicated information about the likely consequences of being publicly identified as having HIV and thereby contributed to respondents’ perceived need to manage access to information about their health status” (p. 1228). They tested the HIV/AIDS stigma scale with four dimensions (experienced, normative, self-stigma, and vicarious stigma) using a sample of 229 respondents who were HIV positive in a southern Indian city. They found that although participants reported few enactments of stigma, vicarious stigma was found to be a critical channel for documenting HIV/ AIDS related stigma. They concluded, “Participants did not need to encounter actual enactments of stigma to fear its social consequences. Stories communicated norms about HIV and shaped behavior” (p. 1233). The findings of Steward et al.2008 ( ) about vicarious stigma holds promise for communication research, and this chapter attempts to align communication research and public health scholarship to contribute to a stigma management communication framework. To our knowledge, this is the first study that applies the stigma communication management theoretical framework to investigate perceived media portrayal stigma among gender and sexual minorities in India, and its associated impacts on stigma- coping strategies such as self-disclosure. Following studies that media is more likely to negatively depict sexual and gender minorities in India (Sabharwal and Sen, 2012; Shahani, 2008), we hypothesize:

Hypothesis 1: Media use will be positively associated with perceived media portrayal of stigma among stigmatized individuals.

Stigma Communication Management Our advisory group members conceptualized the perceptions of media stigmas as challenges to identity disclosure among gender and sexual minorities in India. They drew upon their lived experiences to explain that MEDIA PORTRAYAL STIGMA AMONG GENDER AND SEXUAL MINORITIES 389 greater perceptions of media stigmas would prevent gender and sexual minorities from disclosing their identities in their networks. This notion of the relationship between stigma perceptions and identity disclosure is supported by the literature. Goffmann (1963) argued that individuals tend to use two distinct ways to negotiate their spoiled identity based on the visibility of the stigma condition. For discredited identities, where a person’s stigma condition is easily detectable and socially well known, such as a physical disability, the primary stigma management strategy focuses on coping with stigma and discrimination, or tension management. For discreditable identities, where the visibility of stigma condition is not overtly apparent, such as HIV or gender and sexual orientations, individuals are primarily concerned with management of stigma information: “to display or not to display; to tell or not to tell; to let on or not to let on; to lie or not to lie; and in each case, to whom, how, when, and where” (Goffman, 1963, p. 42). Privacy Management Theory suggests that identity disclosure is a critical stigma-coping strategy, as although disclosure risks facing moral and social censure, it also facilitates better health information seeking and sharing (for HIV status privacy management). Several studies by Greene and colleagues show that perceptions of stigma decreases intentions to disclose physical or mental health-related information. More recent studies have extended the findings to disclosure in new media. Rains (2013) found that among individuals who blog about their experiences coping with a health condition, illness-related stigma was associated with using an anonymous online identity. Similarly, Meisenbach (2010) argued that when faced with moral and social censure, people use several stigma-coping strategies such as denial, evasion of responsibility, and social withdrawal, among others. To specifically test the effects of media portrayal stigma in the Indian context, we hypothesize:

Hypothesis 2: Perceived media portrayal stigma will be negatively associated with identity disclosure.

Methods Data for this study was collected as part of a community-driven project to understand the health communication needs among gender and sexual minorities in south India. As noted earlier, the culture-centered 390 J. THAKER ET AL. process of the study placed the framework of theory-building in the hands of a community of advisory group members (Dutta, 2008, 2011, 2012, 2015). Advisory group members developed a theoretical framework that conceptualized media stigmas and everyday experiences of stigmas as key elements that impacted the health of gender and sexual minorities. The subalternity of gender and sexual identities was constituted amid the various forms of stigmas that played out in different structures of community life. Community members in the advisory group felt that perceptions of stigmas impacted a variety of health behaviors including disclosure of their gender and sexual identity to those in their interpersonal networks. While there are several differences on what a community-based project entails (see Peterson & Gubrium, 2011), here, we refer to community members deciding the project aims and objectives, rather than academic experts from outside the community, as the basis of a community-based participatory project. Briefly, this project initially began with focus group discussions (FGDs) and in-depth interviews with researchers and community-based organization (CBO) workers in south India. These initial discussions were focused on exploring important barriers to health and well-being among sexual minorities. Following the initial set of data collection, a few CBO members who showed an interest in an academic collaboration were invited to be part of an advisory board to help understand prominent issues facing the community, and ways to address them. Stigma and ways to reduce stigma was identified as the central theme of the study by this advisory board. The advisory board comprised 16 community members apart from researchers from two universities. Together, the advisory board discussed and developed the questionnaire to assess stigma over multiple rounds of fieldwork. The survey was translated and administered in a local language, Telugu, and field-tested with 40 participants before final implementation in November–December 2014. Formation of the advisory board to lead the project, regular field visits by academic partners, comprehensive and iterative feedback process through focus group discussions, and field-testing, helped develop a sensitive, and culturally grounded survey. We used a convenience sample technique to recruit participants for the survey because of the hard-to-reach nature of respondents due to the prevailing stigmas in India. Advisory board members were trained to conduct the surveys, and they recruited participants at different “hot-spots,” or cruising sites of sex workers in the city such as railway stations, bus stops, MEDIA PORTRAYAL STIGMA AMONG GENDER AND SEXUAL MINORITIES 391 and public parks. Most interviews were conducted at cruising sites, but few participants also choose the option of visiting the local CBO center to participate in the survey. Other participants were recruited when they visited the CBO center to access community services. Before the start of the survey, a consent form was read and verbally explained to each participant, and the participant was asked to verbally agree to participate in the survey. Participants were informed that as a token of appreciation, Rupees 200 (4 USD) would be paid for participating in the survey. Interviewers were trained to direct any participants who showed signs of depression or needed help to the local CBO center. In the event, no participant reported any signs of depression during this survey. The survey was administered face-to-face, and the questionnaire was translated into the local language Telugu, and back translated to English to verify for consistency. The survey took about 30 minutes to complete. Based on prior surveys with sexual minorities in India (Logie et al., 2012; Steward et al., 2008), we set a target of completing 75 surveys each in three cities across two states in south India, resulting in an overall sample size of 225 men who self- identifiedas gender and sexual minorities. See Table 18.1 for demographic profile of the sample.

Measures The measures for the survey to be conducted were developed by advisory group members in conversation with our academic team. We conversed with the literature alongside conversations in our advisory group, comple- mented by dialogues with themes raised in in-depth interviews and focus groups. The multi-layered conversations in the culture-centered process on one hand translated the findings from the literature for the advisory group, and on the other hand served as facilitators for the advisory group to offer their concepts as well as the measures for these concepts.

Stigma Stigma was measured using 20 items on a four-point scale ranging from 1 (Very often) to 4 (Not at all); higher scores indicate less stigma. The questions were developed based on prominent themes from in-depth interviews, FGDs, and advisory board feedback as well as based on previous stigma studies in India and elsewhere (Steward et al., 2008; Liu, Feng, Rhodes, & Liu, 2009; Logie et al., 2012). All the items were direct quotes from participants’ transcribed interviews, modified to build consistent responses on stigma. Stigma items focused on stigma experienced or per- 392 J. THAKER ET AL.

Table 18.1 Demographic characteristics of sexual and gender minorities in three south Indian cities

n %

Primary self-identity Gay 4 1.8 Kothi/B-MSM/Mangalmurti 24 10.7 Panthi/A-MSM 2 0.9 Double-decker/A-B MSM 38 16.9 Bisexual 11 4.9 MSM 1 0.4 Hijra 16 7.1 TG 123 54.7 Jogappa/Jogati/Shivashakti 6 2.7 Education Never attended any school 8 3.6 Less than primary school 13 5.8 Primary school completed (1–5) 34 15.1 Upper primary school completed (6–8) 50 22.2 Secondary school completed (9–10) 57 25.3 Higher secondary completed (11–12) 30 13.3 Diploma 4 1.8 Graduate degree completed 27 12 Post graduate degree completed 2 0.9 Average monthly income Up to 3000 rupees per month 53 23.6 3001–6000 109 48.4 6001–10,000 54 24 10,001–15,000 5 2.2 No response 4 1.8 Current marital status Never married 126 56 Currently married 79 35.1 Divorced 8 3.6 Separated 5 2.2 Deserted 6 2.7 Other 1 0.4 Caste Upper caste 40 17.8 OBC 123 54.7 SC 45 20 ST 14 6.2 Did not respond 3 1.3 Entitlements

(continued) MEDIA PORTRAYAL STIGMA AMONG GENDER AND SEXUAL MINORITIES 393

Table 18.1 (continued)

n %

BPL card 143 63.6 Bank account 134 59.6 Voter ID 191 84.9 PAN card 25 11.1 Passport 23 10.2 Insurance policy 24 10.7 Adhar card 214 95.1

Note: N = 225 ceived in different contexts: home, workplace, health settings, and in general public contexts. Items also referred to perceptions of confusion, guilt, shame, as well as perceptions about social support from family and friends. Moreover, items also referred to perceptions that the public associates “MTH” with HIV/AIDS, because several participants mentioned that for the general public, “MTH” is synonymous with HIV/AIDS. Perceptions of HIV-related stigma within the community, such that community members tend to hide either their HIV status, or medication for HIV, also emerged in the interviews, and were recorded in the questionnaire. Finally, the stigma scale also contained items reflecting stigma related to negative portrayals of gender and sexual minorities in newspapers, TV programs, and movies, or media stigma. See Table 18.2.

Identity Disclosure Respondents were asked if they have disclosed their gender and sexual minority identity to community members, friends, siblings, parents, spouse, and children. Responses available were, No and Yes, and Don’t Apply. A majority of respondents said they had disclosed their identity to community members (92%), with fewer respondents saying they did so with friends (35%), siblings (14%), parents (9%), spouse (3%), and children (1%). Identity disclosure was computed as a dichotomous measure (1, “Yes”; 0, “No/Don’t apply”) indicating if a respondent had disclosed one’s identity to any of the personal networks. Identity disclosure with community members was an item in the scale that was not used because of its high positive response, indicating that a majority of participants felt low perceptions of stigma about their identities with other community members. 394 J. THAKER ET AL. ) Felt stigma continued normative ( Media stigma portrayal stigma Self- related related 0.77 0.62 0.5 stigma vicarious HIV- 0.82 0.79 0.78 0.72 0.69 0.48 stigma or enacted Experienced SD 1.05 1.12 1 0.96 1.05 1.06 0.91 1.02 0.95 M 2.52 2.56 2.31 2.8 2.7 2.53 2.53 2.6 1.99 Factor analysis of gender and sexual minority identity stigma scale

How often have you been abused by doctors and nurses? How often did you decide not to go a doctor because you felt that the would not give you good care and attention? How often have you experienced police harassment? How often have you received proper care and attention at the government hospitals (recoded)? How often have you lost a place to live? How often have you lost a job or career opportunity? How often have you heard that people with _____ identity who are HIV+ bring bad name to other community members? How often do you think people with _____ identity are blamed for HIV/AIDS in society? How often have you heard that people with _____ identity find it difficult to tell others about their HIV status to other community members? You said that you primarily identify You yourself as (insert self-identity category). In the past 3 months, because of your identity as a (insert self-identity)… Table 18.2 Table MEDIA PORTRAYAL STIGMA AMONG GENDER AND SEXUAL MINORITIES 395 ) 0.75 0.2 Felt − − stigma continued normative ( 0.85 0.66 0.65 Media stigma portrayal stigma 0.86 0.85 0.34 Self- related related 0.38 stigma vicarious HIV- stigma or enacted Experienced SD 0.95 0.98 1.01 0.96 0.89 0.9 0.85 M 1.95 2.31 2.32 2.14 1.82 2.02 1.84 (continued)

How often have you heard that people with _____ identity do not want their community members to know about their treatment? ART How often have you felt confused about your gender roles? You said that you primarily identify You yourself as (insert self-identity category). In the past 3 months, because of your identity as a (insert self-identity)… How often have you felt guilty? How often have you felt that brought shame to your family and friends? How often did you hear that people with _____ identity complain general public doesn’t want to sit next them in bus or train? How often have you felt that the newspapers negatively portrays behaviors of members your community? How often have you felt that movies make fun of behaviors members your community? Table 18.2 Table 396 J. THAKER ET AL. 0.34 0.47 0.46 6.21 1.24 Felt − − stigma normative 0.57 0.56 6.58 1.31 Media stigma portrayal stigma = 0.82 7.99 4.59 α Self- < 0.001. p related related 2.51 stigma 12.58 vicarious HIV- (190) = 1903.76, 2 χ 6.12 stigma 30.62 or enacted Experienced SD 0.86 1.02 1.05 0.96 M 1.88 2.06 2.02 2.05 < 0.001; Bartlett’s test of sphericity p (continued)

: N = 225, Kaiser-Meyer-Olkin = 0.84, : N = 225, Kaiser-Meyer-Olkin How often have you felt that TV programs make fun of behaviors members of your community? How often have you been made fun of or been called names by general public on streets and buses? How often do you think people with _____ identity feel pressured by their family members to get married to a woman, although they would prefer to be in a relationship with other genders? How often have you felt that your friends and family members are very supportive in spite of knowing your identity (recoded)? % of variance You said that you primarily identify You yourself as (insert self-identity category). In the past 3 months, because of your identity as a (insert self-identity)… Eigenvalues Note Table 18.2 Table MEDIA PORTRAYAL STIGMA AMONG GENDER AND SEXUAL MINORITIES 397

Media Use Respondents indicated the frequency with which they used different media, on a four-point scale ranging from 1 (Almost every day) to 4 (Not at all). Responses were reverse coded such that higher scores reflect more media use. The most frequently used media was TV (M = 3.64, SD = 0.66), followed by newspapers (M = 3.21, SD = 0.94), Internet (M = 2.14, SD = 1.08), and radio (M = 2.09, SD = 1.07), on average over a week.

Control Variables Demographic variables were developed based on previous surveys and advisory board feedback. Age (in years), education level (illiterate to graduate and above), average monthly income, current marital status, and access to government services were used as statistical control variables in the model. Primary self-identify was asked and one of the following categories was noted by the trained interviewer. The popular self-identify of Kothis refers to those whose gender expression is considered feminine and are attracted to masculine partners, called as panthis. Double-deckers refers to men who report practicing both functions of male and female partner. As mentioned earlier, members in the community report practicing one or more sexual behaviors.

Entitlements (M = 3.35, SD = 1.29) or access to government services is a sum of seven items measured dichotomously if the respondents had access to several government schemes and identity cards in India: (1) Below-poverty line card, (2) bank account, (3) voter identity card, (4) Personal Account Number (PAN) card (for financial transactions), (5) Passport, (6) insurance policy, and (7) Aadhaar card (a biometric identity card). Ownership of these government-certified identity cards affords respondents to access government services for free or at reduced costs.

Analysis Exploratory factor analysis was conducted to examine the different dimensions of stigma. The criteria, used to determine the number of “meaningful” factors to retain, were the eigenvalue criterion, the scree test, and the proportion of variance extracted. For the scree test, the eigenvalues associated with each factor were plotted and a “break” was determined between the factors with relatively large eigenvalues and those with small eigenvalues. The factors that appeared before the break were assumed to be meaningful and were retained for rotation; those factors appearing after the 398 J. THAKER ET AL. break were assumed to be unimportant and were dropped. The third criterion was the cumulative proportion of variance extracted by successive factors (Hayes, 2005). The factors were named based on previous studies and new concepts—such as vicarious HIV stigma within community, negative media portrayal stigma—developed in this study. Bivariate associations were checked for the independent and dependent variables and regression models were used to test the hypotheses, as mentioned below. Finally, following Steward et al. (2008), we conducted post-tests to verify if experienced or enacted stigma—as a powerful source of stigma—mediated the associations between perceived media stigma and identity disclosure.

Results Based on the above criteria, five factors were exacted, representing different dimensions of enacted or experienced stigma, self or internalized stigma, felt normative stigma, HIV-related vicarious stigma, and negative media portrayal stigma. The first dimension was titled as experienced or enacted stigma as items referred to real experiences about stigma and discrimination by doctors and nurses, deciding not to go to a doctor due to fear of discrimination, police harassment, losing a job, and losing a place to live. The second dimension, HIV-related vicarious stigma, referred to perceptions that the general public blames gender and sexual minorities for HIV/AIDS in society. Three items that referred to hearing stories about negative reactions within community due to HIV disclosure were also treated as HIV- related vicarious stigma. The third dimension was identified as self-stigma, with items representing feeling of guilt, shame, and confusion about one’s identity. Three items related to media portrayal stigma loaded on one factor. These referred to perceptions about the frequency of negative portrayal of behaviors of community members in newspapers, movies, and TV programs. Two other items that partially loaded on this factor were also considered to represent the same construct: vicarious experience of stigma and discrimination through hearing stories about general public avoiding sitting next to a minority individual on a bus, and experienced stigma of being made fun of or being called names by general public on streets and buses. Because mainstream Indian movies often show homosexual characters being avoided or called names in buses and in public places (Shahani, MEDIA PORTRAYAL STIGMA AMONG GENDER AND SEXUAL MINORITIES 399

2008), we treated them to be part of media portrayal stigma. Advisory board feedback also indicated that such stereotypical portrayal of sexual minorities in public places was frequently used in popular media for comic relief. Finally, two items that referred to perceived pressure from family to marry a woman and perceived family support in spite of identity disclosure loaded on one factor, which we called felt normative stigma. Together, the 20-item scale reflected five stigma dimensions. Generally, different dimensions indicated high internal reliability. See Table 18.2. Participants reported high media portrayal stigma (M = 1.93, SD = 0.67), followed by vicarious HIV-related stigma (M = 2.26, SD = 0.64), felt normative stigma (M = 2.07, SD = 0.58), self-stigma (M = 2.26, SD = 0.76), and experienced stigma (M = 2.56, SD = 0.79) (lower scores indicate higher stigma, see Methods section). Among the variables used in the regression model, frequency of TV use was negatively associated with stigma. A one point-increase in frequency of TV use was significantly associated with an increase of 0.26 points in perceived negative media portrayal stigma (β = −.26, p < 0.001). Radio use (β = 0.27, p < 0.001) and Internet use (β = 0.08, p = 0.07), however, were positively associated with less perceived media portrayal stigma. Newspaper use was associated with higher perceived media stigma, but the association was insignificant (β = −.06, p = 0.20). Moreover, respondents with more entitlements (β = 0.07, p < 0.05), older respondents (β = 0.02, p = 0.05), and those who self-identified themselves as “A-B MSM or double-deckers” (β = 0.41, p < 0.01) were more likely to report less media portrayal stigma. H1 is partly supported. See Table 18.3 Logistic regression with identity disclosure was associated with only experienced stigma and those who self-identified as kothis compared to others. Kothis were, on average, three times more likely to disclose their identity compared to other minorities. Respondents who reported less experienced stigma were three times more likely to report disclosure. Media stigma was not significantly associated with disclosure. See Table 18.4. As part of post-hoc analysis, we tested for indirect association between media portrayal stigma and identity disclosure, mediated by experienced stigma. Previous research indicates that experienced stigma is a more proximate and powerful source of stigma and that it mediates the effects of other stigma dimensions (Steward et al., 2008). We used Andrew Hayes’s PROCESS (see Hayes, 2013) procedure to test if experienced stigma 400 J. THAKER ET AL.

Table 18.3 Regression with media stigma as outcome variable

B Std. error β

Constant 2.11*** 0.37 Age 0.02 0.01 0.13 Education −0.03 0.03 −0.09 Income 0.00 0.00 −0.02 Transgender −0.18 0.12 −0.13 Kothi −0.07 0.16 −0.03 A-B/MSM 0.41 0.14 0.23** Entitlements 0.08 0.03 0.15* Ever married −0.10 0.09 −0.08 Newspapers −0.07 0.05 −0.09 TV −0.27 0.07 −0.26*** Radio 0.17 0.04 0.27*** Internet 0.08 0.04 0.13

Note: n = 223, Adj. R2 = 0.25, * p < 0.05, ** p < 0.01, *** p < 0.001

Table 18.4 Logistic regression model predicting identity disclosure

B S.E B Odds ratio

Constant −1.30 1.22 0.27 Age −0.04 0.03 0.96 Education −0.01 0.09 0.99 Income 0.02 0.01 1.02 Self-identifiedkothis vs others 1.11*** 0.51 3.04 Ever married −0.05 0.33 0.95 Entitlements 0.16 0.13 1.17 Normative stigma −0.24 0.32 0.78 Media stigma −0.38 0.30 0.68 Self stigma −0.29 0.23 0.75 HIV stigma 0.05 0.28 1.05 Experienced stigma 1.21*** 0.28 3.36

Note: n = 223, Nagelkerke R2 = 0.22, Cox & Snell square = 0.16, p < 0.05, *** p < 0.001 mediates the association between media portrayal stigma and disclosure. All other demographic variables used in the above logistic regression model were entered simultaneously in the model as covariates. We found evidence of indirect effect of media stigma with identity disclosure through experienced stigma (Z = 3.56; p < 0.001; κ = 0.65, 95% CI for 10,000 bootstrap samples: 0.26, 1.07). See Fig. 18.1. MEDIA PORTRAYAL STIGMA AMONG GENDER AND SEXUAL MINORITIES 401

Fig. 18.1 Experienced stigma mediates media stigma association with identity disclosure. Unstandardized coefficients, Sobel test:Z = 3.73, p<0.001, κ = 0.65, 95% CI for 10,000 bootstrap samples: 0.26, 1.07

Discussion According to Gross (2002), “all minorities share a common media fate of relative invisibility and demeaning stereotypes” (p. 90), and several critical studies identify media depictions of stigmatized individuals as largely negative and counterproductive to reducing stigma and discrimination in society. Gender and sexual minorities are often targets of negative stereotypes in society. Media amplifies such negative societal stereotypes against minorities and this can result in further marginalization of minority groups (Gross, 1991, 2002; Klin & Lemish, 2008; Miller, 1998). India remains one of the several countries where homosexuality remains outlawed, which contributes to stigma and discrimination against minorities. Using data from a cross-sectional survey of self-identified sexual and gender minorities in south India, we identified five dimensions of stigma: experienced stigma, HIV-related vicarious stigma, self-stigma, media stigma, and felt normative stigma. Respondents reported highest amount of media stigma, followed by vicarious HIV-related stigma, felt normative stigma, self-stigma, and experienced stigma. The findings are similar to other studies in India such as Steward et al. (2008) who also reported higher rates of vicarious stigma than experienced stigma. Results suggest that media are not just potential, but also prominent sources of stigma for gender and sexual minorities in south India. Five different dimensions of stigma were found in this study, following previous research and community members’ feedback. Following previous research, we identified experienced or enacted stigma that refers to real experiences of stigma and discrimination; internalized or self-stigma refers to negative self-image; felt normative stigma refers to pressure to adhere to social norms. In addition, we found two unique dimensions of stigma 402 J. THAKER ET AL. in this study. HIV-related vicarious stigma refers to hearing stories of stigma and discrimination among HIV-positive individuals, within the community members, as well as with general public. Finally, negative media portrayals stigma refers to perceptions of being stereotyped in popular Indian media. As hypothesized, more media use was generally associated with higher perceptions of media stigma. Among general public, previous studies found mixed results between media consumption and attitudes toward homosexuals (Detenber et al., 2013; Ho, Detenber, Malik, & Neo, 2012). We found that more TV use was associated with more perceived media stigma. But more radio use was associated with less perceived media stigma. Remaining agnostic about the differences in media content and framing of gender and sexual minorities in TV and radio, this finding suggests that potentially TV, compared to radio, plays a more negative role in influencing stigmatized perceptions. It is possible that participants are exposed more often to stereotypical homosexual characters on TV than compared to other media. Alternately, TV may have stronger impact on perceptions of stigma compared to radio because of the nature of visual impacts on people’s perceptions. Previous studies show that stigma content cues in media are likely to negatively impact public acceptance and support toward stigma. Future research could test these possibilities to understand how different media use patterns and media frames result in media stigma. The second hypothesis that media stigma will have a direct association with stigma-coping strategies, identity disclosure in this case, was not supported. However, we found that participants who reported less experienced stigma were more likely to disclose their identity to family and friends. Following prior research (Steward et al., 2008), we tested and found that experienced stigma is a more proximate source of influence on disclosure, such that media stigma is associated with disclosure through experienced stigma. In other words, for respondents who experience stigma and discrimination, perceived media portrayal stigma will be associated with less disclosure. For example, it is possible that experience of stigma and discrimination increases the respondent’s salience and sensitivity toward stigma and discrimination in media and affects disclosure. Cross-sectional analysis—as indicated in the limitations section—however precludes claims of causality. Theorizing a minority stress management model, Meyer (1995) suggested that, “A high level of perceived stigma would lead minority group MEDIA PORTRAYAL STIGMA AMONG GENDER AND SEXUAL MINORITIES 403 members to maintain a high degree of vigilance—expectations of rejection, discrimination, and violence—with regard to the minority components of their identity in interactions with dominant group members” (p. 41). Moreover, how public and stigmatized individuals construct stigma may differ from popular stereotypes and future research could explore how stigma is perceived and constructed from the stigmatized individuals’ perspective. Together, these studies show that stigmatized groups may perceive stigmatizing cues and contexts differently from the general public. Future research exploring minorities’ perceptions of stigma would better inform stigma management strategies framework. If media are sources of stigmatizing messages for stigmatized individuals, it may result in several coping strategies such as avoiding the media altogether, challenging media frames, or decreasing disclosure of the stigmatized condition to family and friends due to fear of negative reactions. For example, Boudewyns, Himelboim, Hansen, and Southwell (2015) found that individuals who perceive high stigma toward HIV/STD testing reported less interpersonal interaction with their sexual partners, as well as less social interactions about the taboo health topic. Moreover, they found that health contexts associated with higher stigma—such as relatively low stigma associated with hypertension or breast cancer compared to high stigma associated with HIV in society—results in lesser number of online postings on twitter. They concluded that higher stigma results in low information sharing interpersonally as well as on social media. Fox and Warber (2015) found different patterns of usage of social networking sites by individuals based on their identity disclosure, such that sexual minorities who did not disclose their identity were found to be silenced by perceived heteronormative majority. On the contrary, sexual minorities who had disclosed their identity were found to silence the dominant group. They concluded that withdrawal from public forums, such as social media, due to fear and stigma may be counterproductive to efforts to challenge and end stigma. There are several limitations to this study that include the cross-sectional design, convenience, and small sample size, with potential sample and response biases, and limited amount of variance explained in the regression models. Moreover, the insignificant direct association between media stigma and identity disclosure points to other potential factors that may intervene in the relationship. We specifically tested and found that experienced stigma mediates the relationship between media stigma and identity disclosure. Future research could test for other potential important medi- 404 J. THAKER ET AL. ating factors, including media trust, specific news program viewership, and uses and gratifications of various media. Future research can test media stigma management longitudinally to better explain these processes. We tested a stigma communication framework developed by subaltern advisory group members to explain a unique social and cultural context of stigma experienced by gender and sexual minorities in India, who form a diverse range of non-heterosexual identities and groups. Our participatory culture-centered approach to the project, such as advisory board decisions on aims and objectives of the project, has framed the research questions and shaped the development of a culturally appropriate questionnaire (Dutta, 2008, 2011, 2015). The academia-community partnership emerges as a site for a sexually subaltern community to theorize how stigmas emerge and circulate in society, and more importantly, how to change the stigmatizing attitudes and norms. The lessons gleaned from this initial survey research offered the bases for the advisory group members to develop communication strategies for communication advocacy.

Acknowledgments The Office of the Provost of the National University of Singapore provided funding for this project to the Center for Culture-Centered Approach to Research and Evaluation (CARE). We thank advisory board members and other community members for participating in this study.

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Epilogue

Mohan Jyoti Dutta

The chapters weaved together in this book offer theoretical frameworks for communicating social change, drawing from their locations at the margins of the neoliberal order. The majority of the chapters draw from their locations outside of the Euro-US-centric mainstream of communication for social change, interrupting therefore many of the taken-for-granted assumptions that make up the fabric of the literature. Academia, as the site of the production of knowledge of social change communication, is explicitly theorized, attending to the power embodied in the role of the researcher in his/her relationship with communities at the margins of the global order. The unequal terrains of production of knowledge of communication for social change are disrupted through the presence of authors from the global margins who draw upon everyday practices of social change to theorize the role of communication. Reflexivity as a critical anchor inverts the power embedded in knowledge production, inviting academics communicating for social change to actively examine their roles in social change communication processes. The chapters collectively point towards the need for future scholarship that actively take power into consideration and seek to understand communicative processes as bases for inverting dominant relations of power,

M. J. Dutta (*) Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University, Palmerston North, New Zealand

© The Author(s) 2019 409 M. J. Dutta, D. B. Zapata (eds.), Communicating for Social Change, https://doi.org/10.1007/978-981-13-2005-7_19 410 M. J. DUTTA including the power that constitutes sites of academic legitimacy. The subject position of the academic, instead of being obfuscated from the discursive space, is foregrounded in the conversations, depicting the negotiations of power in working through academic-community partnerships. The chapters also draw out the concept of voice as an anchor for communicating for social change. The question, “How do voices at the margins emerge into the mainstream?” plays out through a number of the chapters. The insights gathered in these chapters point towards concepts of solidarity, connection, and creativity that lie at the heart of centring voice as the foundation for social change communication efforts. This emphasis on voice sets in motion new imaginaries for social change communication that attend to the ways in which communicative infrastructures at the margins may be co-constructed so voices of the margins be heard. Also, the chapters in this book draw out the concept of commitment as integral to communicating for social change. Interrogating academic investments in social change communication processes, they collectively encourage academics to critically interrogate their relationships with communities, the sustainability of these relationships and the nature of the academic involvement in relationships. The voices emerging from the margins hold to account the academic voice, raising uncomfortable questions about the location of the academic and the tendency of academics to profit from circulating stories of the margins without committing to processes that communicate social change. The next generation of social change communication work ought to grapple with this critical question, being held to account by communities. Finally, communicating social change is first and foremost about the doing of the social change communication work. That the labour of “communicating social change” is to be borne by academics writing about social change communication inverts the established academic logics that are fundamentally colonial in nature, extracting knowledge about the margins to make academic careers. The act of doing social change communication work brings home the contingencies, precarities and labour that are disproportionately borne by communities and activists. This book offers hope for social change communication work that attends seriously to the act of communicating social change, constructed in active voice, as a form of labour that ought to be borne by academics amid the global erasure of communicative spaces and sites. Index

A Climate change, 263 Active, 216 Climate change adaptation, 236 Activist collaborations, 318 Collective, 350 Activists, 7, 235 Collective strength, 351 Adaptation, 279 Communication intervention, 217 Advocacy messages, 181 Communication platforms, 236 Agency, 118 Community, 74 Agriculture, 263 Community members, 323 Anti-trafficking movement, 256 Context, 2, 18 Asian American, 286 Co-opting, 316 Attentiveness, 90 Corporate responsibility, 246 Audiences, 182 Critical consciousness, 77 Authentically, 80 Culturally consistent, 183 Authoritarian, 1 Cultural sensitivity, 227 Cultural spaces, 71 Culture, 42, 183 B Culture-Centered Approach, 70, 286 Barriers, 182–183 Behavioral changes, 265 Bicultural, 296 D Bilingual, 296 Democracy, 316 Democratic participation, 323 Descriptive research, 267 C Development, 169 Campaigns, 244 Diabetes, 287 Chinese American, 289 Dialogic spaces, 82, 289

Dialogue, 70 I Digital activism, 258 Ill, 363 Digital technologies, 242 Implementation, 214 Displace, 317 Indigenous, 197 Disruption of power, 323 Inequalities, 21, 317 Doctor-patient, 89 Information sharing, 216 Dominant discourse, 334 Infrastructures for communicative Dominant framework, 315 justice, 322 Intergenerational transmission, 302 International Labour Organization E (ILO), 359 Economy, 169 Interviews, 101 Embodiment, 198 Invisible, 25 Emotional, 90 Involvement, 100 Empowering, 100 Engaged, 19 English proficiency, 287 J Environment, 73 Justice, 74 Evaluate, 88 Exclusion, 334 K Knowledge, 302 F Facilitation, 227 Farming customs, 224 L Flows, 317 Legislators, 188 Focus groups, 181, 304 Listening, 70, 99 Food, 287 Lobby, 188 Food qualities, 303 Local wisdom, 228 Freedom, 71 Freire, P., 75 Fundraising, 255 M Marginalized, 219 Marginalized voices, 70 G Marketing mix, 184 Global power, 315 Media portrayal stigma, 389 Goal displacement, 242 Methodology, 74–76 Goal expansion, 242 Mobile, 16 Goal succession, 242 Mobilizing voters and protestors, 240 Modern, 38 H Modernity, 38 Hashtags, 252 Modernization, 173 Health insurance, 296 Motivational, 182 Health literacy, 287 Movement goals, 245 INDEX 413

N Social justice, 237 Narratives, 152 Social networks, 252 Networks, 240 Socio-political-economic sphere, News media, 245 352 Non-profit organizations, 245 State propaganda, 334 Stereotyping, 383 Stories, 143, 296 O Stress management, 402 Online, 255 Structures, 49 Online activism, 244 Subaltern margins, 6, 315 Oppressive, 71 Suffering, 90 Survivors, 245 Sustaining, 265 P Pain, 334 Passive, 216 T Personal responsibility, 295 Tortured subjects, 351 Political struggle, 351 Traditional CM (TCM), 288 Poor, 317 Transformative possibilities, 329 Positive health practices, 289 Transformative spaces, 323 Poverty, 6 Transgender, 384 Power, 7, 71, 329 Transnational capital, 316 Privileged, 289 Trauma, 351 Processing information, 216 Treatment, 364 Public sphere, 202

U Q Uncertainty, 279 Quantitative approach, 267 Unidirectional, 251 Universal, 140 Urban, 38 R Reflexivity, 7, 199 Resilience, 351 V Resistance, 71 Venue, 82 Restoring the voices, 350 Violence, 88 Virality, 244 Visuals, 188 S Voices, 18 Self-help, 279 Volunteering, 246 Services, 88, 245 Sexual minorities, 384 Sign petitions, 188 W Social injustice, 79 Western medicine, 297