Each month, across Sub-Saharan Africa, more than 95 million people access Facebook, with 97% on mobile. The future of the iKnow Concert Series is strongly recommended to look into expanding as a virtual model. There are many successful examples of virtual public health campaigns that we have drawn inspiration from including Tanzania’s soap opera to destigmatize HIV and Malawi’s radio broadcasts as a part of a broader HIV prevention and mental health awareness communication campaign.
Through various research, the avenue of live streaming a concert through the Facebook Live platform looks the most promising due to an abundance of features including user engagement analytics, the ease of shareable content, the ability to share on the timeline afterward, send notifications to followers when the live stream goes live, allow real-time engagement through comments during the stream, and a donation option during live streams. Facebook has a far-reaching audience with a large established user base. Furthermore, Facebook Live Stream works well on both mobile and desktop devices.
We recommend complementing Facebook Live Stream with other innovative technology avenues, such as a podcast to disseminate pertinent public health education and a Youtube channel to broadcast helpful and educational public health videos as well as feature the recorded concert series. Possible promising streams of revenue through a virtual model include linking and promoting a platform to sell music albums and other mediums of art to promote the cultural arts, a donation option to donate to performers, a specific public health cause, and/or organizations such as GLI, as well as include advertisements either directly on the virtual concert content or during the performance.
Some advice for a successful virtual concert includes: establishing a hashtag to promote the event, choosing the best time based on your targeted audience and creating a consistent schedule, enabling as much engagement as possible such as a responsive live chat, giving a reason for users to watch until the very end, and building anticipation such as trailers and countdowns. There are numerous advantages to a virtual model including, but not limited to, the ability to make public health information more available, shareable, and tailored; the opportunity for users to have privacy and anonymity, and establishing a virtual community to destigmatize HIV and discuss other public health and social issues. Live video streams could potentially ease the number one barrier to attending a music festival, transportation. Live videos are gaining popularity with consumers spending almost 83 minutes per day consuming digital video, growing to 92 minutes by 2020. Video posts attract the greatest amount of user engagement on Facebook with users watching live video 10 to 20 times longer than on-demand content.
The primary disadvantages of a virtual model are barriers to technology, internet, and electricity access as well as a lack of physical interaction. There is evidence that live video streams are greatly popular, especially among the youth, since it is interactive and convenient. A virtual model will allow the ease of gathering a multitude of significant data points, both qualitative and quantitative, to assess the impact of the virtual concert series. By utilizing technology, GLI can collect data through open-ended surveys, semi-structured interviews, and HIV stigma assessment tools. According to Facebook’s research, nearly two-thirds (63%) of people surveyed across Kenya, Nigeria and South Africa are connected (they have used the internet in the past two years), with smartphones as the primary way to connect. The internet is becoming more inclusive as shown in a research study where 1 in 4 people surveyed who are unconnected plan on getting online in the next year. The technology model is promising because funders are attracted to bringing the world into a technology platform. While the concert series will hopefully transition back to in-person, the virtual model provides the opportunity for GLI to collaborate with global organizations to promote health, wellness, and cultural sharing by featuring global artists, music, regions, countries, and platforms which will increase global engagement and reach.
Switching the concert series to a live format also raises the question of accessibility. Mobile commerce is already widespread in Uganda and Rwanda, but since the COVID-19 Pandemic began in East Africa, there has been an increase in the use of digital technologies. Governments have been encouraging the use of mobile money for transactions instead of cash, and mobile network operators have increased daily limits and waived fees on transfers. Companies have also been doubling internet speeds at no extra cost to users for at least a month and deploying a variety of ways to boost 4G network coverage in remote areas.
Some workarounds to technology challenges would be to encourage having multiple SIM cards in case of spotty network coverage, keeping phones off until needed, and keeping data off by default. In order to incentivize people to log on to the virtual platform, we recommend GLI approach MTN (Uganda’s internet service provider) with a strategic partnership in which they would give us ____ amount of free bandwidth over the specific day of the concert series in exchange for free advertising.
While GLI is not currently having a physical concert, we recommend GLI utilize a mobile health truck service which Rumbi Gumbie claims would be viable if we use a central place in the community where people are already gathering, such as churches, schools, and community centers, and ensure this service is COVID safe. This could include offering additional COVID testing, temperature screening, sanitizer/soap, and having contact sheets for follow up. In addition, we could give out free masks, which Andrew Ward pointed out could be made by local artisans as another form of revenue generation.
In regards to the addition of EFT (Emotional Freedom Technique) to the concert series, we recommend GLI ensure there is proper follow through so community members have permanent mental health resources available to them. GLI has already expanded its music series to Rwanda and this is exactly where GLI needs to be. We support Sheila Gabeya’s recommendation that GLI partner with the LCI Chairmen of each community as well as the pastors in these communities because the Catholic Church is so heavily influential, specifically when it comes to sexual health and reproductive health.
When researching the GLI concert series’ expansion into more countries, such as Nigeria, India, and Tanzania, we developed criteria for the country to be considered. The criteria included whether the country had a need for a version of the health services offered; whether arts/music was normative in the culture of the country and therefore appropriate for the concert model; and finally the access and limitations of the country in relation to our model to determine the viability of expanding into that country.
It is critical that we understand the fruitful opportunities associated with expanding this kind of project to other areas of sub-Saharan Africa that are disproportionately affected by HIV/AIDS and other health crises. Nigeria should be near the top of the list of countries to focus on expanding to, when considering our criteria and the penetrability of iKnow methodology into the cultural context. Nigeria has the second largest HIV epidemic in the world, and one of the world’s highest rates of new infection. It is the breeding ground of the majority of new HIV infections in West & Central Africa, and makes up an overwhelming proportion of all continental HIV infections each year. Nigeria has one of the largest populations in the world, with rates of urbanization increasing dramatically; this devalues the usefulness of prevalence metrics on the national level. The United Nations and the World Health Organization have recently echoed concerns over the stagnated pace of healthcare response in the country. While other affected countries of sub-Saharan Africa have reported a substantial reduction in HIV infection in the period from 2010 to 2017, Nigeria’s rate has not declined at all; other STIs and infectious diseases that increase the coinfection risk are also pervasive among the increasingly urbanized populace. This is further propagated by Nigeria’s booming population (dominated by youth), poor access to healthcare/public services, and the relatively low rates of HIV/STI screening. Women and young people are disproportionately affected by the epidemic, and notably, Nigeria is home to the most HIV-positive babies in the world. Women are unaware of their HIV status during pregnancy, and thus do not receive pivotal prevention treatment that could stop mother-to-child transmission. Notably, Nigeria is also home to the greatest number of people who inject drugs among the region. The need for intervention services to help coordinate an effective response is palpable.
The impact of implementing this kind of project in Nigeria would be profound. By reaching easily accessible target populations and encouraging a proactive approach to understanding one’s status, the iKnow series has potential to make a marked difference in the health outcomes of countless Nigerians. Lagos, Nigeria, the most populous city in all of sub-Saharan Africa, and one of the fastest growing cities in the world, would be an ideal entry point when considering markets to approach moving forward. There are immense opportunities to penetrate the population with lifesaving resources. Lagos is, by many, considered the cultural, technological, and financial capital of Africa. High prevalence of sex work and travel to and from this critical city are also factors to consider. Lagos is home to Africa’s most popular music, arts, and film industry, with artists from around the world contributing to this hotbed of cultural richness. This flourishing culture is a lifeblood for many Nigerian communities. Focusing on the social media sector, Nigeria is a clear leader in this regard as well. While many African countries have a complicated relationship with access to social media, Nigeria has more social media users, and more active Facebook users than any country in Africa. This makes it an ideal population to pursue if a virtual model relies on social media penetration. As alluded to, Nigerians care deeply about arts and culture, and would likely be interested in such a culturally-immersive model as the one we are considering here. Studies from the World Bank have also been undergone in Nigeria, showing that there is a link between people adopting positive behaviors as a result of information campaigns brought through “radio, digital, social media and mobile elements.” If we are interested in making a substantial contribution to health amelioration, sustainable development, and expanding our reach to populations in need, then Nigeria should certainly be considered one of the next (if not the next) avenue that GLI approaches for such endeavors. Opportunities to expand GLI’s programs in Nigeria are bound to be exceptionally fruitful.
India is another country to expand to, but perhaps in a different way. According to UNAIDs there were 2,100,000 living with HIV, but it is projected to reach a 90-90-90 target by 2020. This target means that 90% of people know their status, 90% have access to care, and another 90% have a suppressed viral load from treatment (UNAIDs, India). So, instead of the focus being on the iKnow my status, our research suggest GLI should consider conducting further research in regard to making the concert in India around gathering survivors of human trafficking, domestic violence, child abuse, and anyone else who needs healing. At this concert, we would provide local musicians to play music, artists share their artwork, tell their stories, provide education about these issues, and teach the emotional freedom technique. This suggestion has been brought up because of the data that shows twenty to sixty-five million people are estimated to being human trafficked (Human Trafficking India, dianova). It was stated that in India being born a girl is when discrimination starts (Human Trafficking India, dianova). This statement is very similar to what Agnes Igoye stated as her very first sentence in her TED TALK, Did you ever fall and never got up, “My birth was a scandal, reason, because I’m a girl” (Agnes Igoye). Additionally, India’s large and growing middle class provides the opportunity to implement a for-profit model and collaborate with organizations that do similar work to GLI in a new region.
Agnes Igoye, a Ugandan Deputy National Coordinator who works to prevent human trafficking, is willing to share her story, her work, inspiring others, and reducing stigma for those who have experienced trauma in these future podcasts, Facebook Live videos, and the in-person concerts. Agnes shared with us that different kinds of music can be healing, but if it has a message other than just a positive one, we need to provide a solution to the issues brought up. We asked if she found art to be healing. Agnes mentioned that it can be if there is a supportive audience and the art has a positive message. Some individuals, including herself, prefer to create art on their own. As she said, art can be healing but we need to find the root of the wound in order to heal as a whole.
In addition to creating a virtual model, expanding to new countries, and continuing health services with CDC guidelines, we also researched future projects for GLI to consider and recommend considering music and art therapy, other art mediums including visual art, and emotional freedom technique to reach an even broader group of people, such as trauma survivors.
Dr. Mukwege’s Panzi Foundation uses music therapy, in this case during the video they are singing, to help survivors. Tatiana Mukanire was the founder of the Movement of Survivors of Sexual Violence in the Democratic Republic of the Congo. Tatiana describes it as “actually a good therapy. To me, in a song, we can express what we feel and in a song we can express our pain and exteriorize it. The song helps us break the silence” (United Nations Video). Dr. Denis Mukwege, Nobel Peace Laureate, works with her to end sexual violence. Tatiana was a survivor herself,
You have to understand that after being raped, one feels like being dead inside one’s own flesh. It’s like a gathering and you are raped in front of everyone. It’s too hard. Then after they rape you, you are tied up to a tree and buried alive. It’s too hard, but to survive there is always a glimmer of hope (United Nations Video).
Noeline Kirabo, the founder of Kyusa in Uganda who works with young entrepreneurs in the region, says “I personally love instrumental music for days when I am not at my best, I find them soothing and they get me into a reflective mood so as to connect with my inner self.” Reagan Nowamani and Raymond Bokua also shared with us that Entusi Resort and Retreat Center provides live musicians when applicable. These musicians are already a part of the GLI Concert Series, but there are also musicians at the center who play soothing music such as the Inanga that possibly could be integrated into the concerts. The New Times articles say that it is considered an instrument that is very important to Rwanda (New Times, 2016).
Collin Sekajugo, a Rwandan visual artist, says “Rwanda’s best kept secret is the traditional sound from Inanga...Rwanda’s traditional guitar” (The Culture Trip, 2016). Adding the visual arts and artists is a component that could be added to the GLI Concert Series. Collin Sekajugo has been able to use art as a way to bring about change in his community such as encouraging safety by wearing a helmet on the Boba-Boba. Art has changed his life,
Losing my mother at age 13 and my father at age 16 put me in situation where I had to choose between being a beggar or starting to carve out my own life... Whether through painting, art installation, or performance art, my work subjects are always centered around people, community, and transformation (The Culture Trip, 2016).
It is stories like this that would be wonderful to add to the concerts whether they be in person, through podcasts, featured on the YouTube channel, or Facebook Live. Reagan Nowamani and Raymond Bokua who work at Entusi Resort and Retreat Center shared with me that the Entusi Women’s Association would love to share their artwork and deep conversations in these concerts. Their discussions speak about the different kinds of issues women face such as gender-based violence, sexual reproductive health, unemployment, and early marriage. From the questions asked, we learned that the most common art materials they use are wood, banana fiber, cotton thread, and local fabric. Some themes that are integrated into their artwork are wildlife, African animals, African homesteads, African women, and African traditional wear. The Entusi Women’s Association also creates three-dimensional art such as pottery, eating utensils, tablecloths, and mats using home materials as well as tools. Another question asked was if art is considered healing and in what way. We learned that “traditional art was used for healing especially by traditional medicine men [Shamans]... but the practices are slowly disappearing because of civilization though we still have a few people practicing these at the Lake Bunyonyi” (Reagan and Raymond).
The Inema Arts Center located in Kigali, Rwanda, teaches all people “through the common language of art” (Inema Art Center). They also have what is called Art with a Mission working with orphans to provide an opportunity for them to create art on a weekly basis (Inema Arts Center). Later on, GLI could explore partnering with this organization to create programming and workshops at the intersection of art and health education/healing.
The idea of healing as a whole would be to add Emotional Freedom Technique ( EFT) to the concert and as a resource for people. Agnes, Noeline, Reagan, and Raymond are not familiar with this technique. Agnes mentioned how she is unsure about this method of healing since trauma affects people differently. Also, that we should include how those traditionally deal with trauma in their own regions. Reagan and Raymond mentioned that EFT could be considered useful for the GLI concerts, but we need to find a way to not abruptly change gears and fit it into the current setting already laid out.
There have been multiple research studies and clinical trials. One journal article to mention is by the US National Library of Medicine. It states that PTSD treated by EFT shows,
(a) time frames for successful treatment generally range from four to 10 sessions; (b) group therapy sessions are effective; (c) comorbid conditions such as anxiety and depression improve simultaneously; (d) the risk of adverse events is low; (e) treatment produces physiological as well as psychological improvements; (f) patient gains persist over time; (g) the approach is cost-effective; (h) biomarkers such as stress hormones and genes are regulated; and (i) the method can be adapted to online and telemedicine applications (study by the US National Library of Medicine).
This study explained that exposure therapy is used for treating PTSD. To explain what happens when administering EFT, there is a “Setup Statement” where someone recalls the trauma and then accepts themselves such as, “Even though I have these painful memories of being hurt, I deeply and completely accept myself,” while tapping on the side of the hand. Then there is the “Reminder Phrase” to remind themselves of the setup statement such as, “these painful memories” while tapping the other acupoints on the body as described: “start of the eyebrow, side of the eye, under the eye, under the nose, under the lips (chin crease), an inch under the collarbone, under the arm, and top of the head” (study by the US National Library of Medicine).
Lori Leyden, PhD/MBA Psychotherapist, is an International Trauma Healing Expert who has used this technique with Rwandan genocide survivors where one million people were murdered in one hundred days (YouTube, Lori Leyden). In the Documentary, When I Was Young I Said I Would Be Happy, we learned about the organization she started called Project LIGHT as a “new form of humanitarian aid” (Documentary, When I Was Young I Said I Would Be Happy) . Dr. Leyden has made eight trips to Rwanda since 2007. In the documentary, there are twelve survivors who speak about their trauma. One of which saw her parents and siblings murdered. She has a scar across the back of her neck from where they attempted to do the same to her. She had to hide from the killers and found the safest place to sleep was to lay among those who were already dead. The rebel military rescued her to safety. Dr. Leyden said that the yearly memorial at the Kigali Memorial was the original method of healing in the community with clergy as well as missionaries present. Unfortunately, this process re-traumatized the community by being reminded of the horrific memories. EFT was something different to the region that had not been tried before as mentioned in the documentary. With Project LIGHT, Dr. Leyden mentions that the goal is not to erase the memories but to eliminate that traumatic response that is associated with the memory. She works on deep breathing to accompany EFT. Project LIGHT trained ambassadors who were also survivors of the genocide. They went into the community to share this technique, EFT, with other survivors. These ambassadors also were able to communicate online with those who were affected by the Sandy Hook shooting as well. Those they helped were able to provide funding for these ambassadors to go to a university in Rwanda. Dr. Leyden found that more than just healing needed to be a part of Project LIGHT. They started an entrepreneurial program for individuals to become self-sustainable much like Noeline’s organization, Kyusa, in Uganda. GLI may want to partner with Dr. Leyden’s work, Project LIGHT.
The Tapping Solution, from their website, describes EFT as the following,
Tapping, also known as EFT (Emotional Freedom Techniques), is a powerful holistic healing technique that has been proven to effectively resolve a range of issues, including stress, anxiety, phobias, emotional disorders, chronic pain, addiction, weight control, and limiting beliefs, just to name a few. Tapping therapy is based on the combined principles of ancient Chinese acupressure and modern psychology. Tapping with the fingertips on specific meridian endpoints of the body, while focusing on negative emotions or physical sensations, helps to calm the nervous system, rewire the brain to respond in healthier ways, and restore the body’s balance of energy.
Annually, The Tapping Solution hosts a free online event for ten days called Tapping World Summit with the intent on making it accessible to anyone. It provides daily presentations and meditations on different topics to help others. Dr. Lori Leyden has been a part of the Tapping World Summit as well. If individuals want to and are able to, they can purchase the videos from the summit as well as additional resources such as books about EFT. There is a free app called The Tapping Solution that people can continue to use after the summit, or if it is included, after the GLI Concerts Series.
The Tapping Solution for Pain Relief discusses how The Adverse Childhood Experiences (ACE Study) funded by the CDC discovered that trauma experienced during childhood that remains unresolved affects people when they are adults ( Ortner, Pg. 118-119). In addition to adding this technique to the GLI Concert Series, we could provide weekly gatherings for people to do EFT together either online, through the radio, or in-person with a psychologist present for individuals who would like to participate. In the documentary for Project LIGHT, they asked around the room to see if there was a common feeling that everyone had. The one they shared was hopelessness of the future. And so, together in the room everyone began tapping together and a translator would translate what Dr. Leyden said. Perhaps something like this could happen in these types of gatherings that GLI could provide. I mention having a psychologist present because re-living the trauma can be very traumatizing in itself and in order for it to be safe, there would need to be additional support (Ortner, Pg. 120).
Our research group regarding Public Health and Music related to the Global Livingston Institute iKnow concert series during a pandemic has led us to decipher how best to go forward. We have researched a way to keep these concerts going by administering on an online platform such as podcasts, the radio, and Facebook Live. They will provide education and reduce stigma on HIV/AIDs through music. Then on the ground, we will continue to provide health services following CDC guidelines. Some new components to incorporate into the concert are visual arts and artists, music therapy, and the Emotional Freedom Technique (EFT) to reach an even broader group of individuals such as those who have suffered trauma.
