Theatre of Alliances? Role-play, Representation, and Ecosystem Health in Ecuador

The ecosystem approach to human health attempts to develop community capacity to address environmental health concerns by crossing disciplinary boundaries and promoting equity and widespread participation. Role-play, a technique increasingly used in other training programs, is now being used in programs to promote ecosystem health.  Here we analyze a socio-dramatization recently used in Ecuador in an ecosystem health-training course. We explore the complexities that must be addressed in order to foster the use of this technique to achieve its intended progressive objectives. Drawing on Spivak's distinction between political representation and artistic representation, we analyze some of the issues encountered in using role-play to facilitate understanding of politically charged environmental health issues with an intercultural and interdisciplinary group. We highlight the successes achieved, but conclude that without adequate guidance in understanding and deconstructing the archetypes and actions presented by the group, the full scope of the lessons that role-play has to offer remain untapped. We therefore finish by noting that expertise in performance techniques for community empowerment and cultural emancipation would be a useful addition to interdisciplinary teams endeavoring to promote ecosystem and human health using theatrical techniques.

Introduction

Over the last decade a new approach, called an "ecosystem approach to human health," has emerged among environmental health researchers and practitioners. This approach understands health as the culmination of various social, cultural, economic, and biophysical factors. The philosophy governing the ecosystem approach to human health is that the skills, concerns, and understandings of those who comprise, influence, and live within a given ecosystem form the basis of initiatives to address health issues. As such, this approach seeks to facilitate productive encounters among members of a community, building on what has been dubbed the "three pillars" of this approach: transdisciplinarity, equity, and participation.¹

In 1995, the World Health Organization (WHO) engaged a team of environmental health experts to develop new training materials to better prepare the workforce needed to apply this emerging holistic approach to promoting environmental health. In keeping with the need to build skills in fostering understanding between diverse groups and to promote participation, the teaching materials developed utilize an interactive approach to learning (Yassi et al.).² One of the key techniques promoted in the new curriculum was role-play to assist students from a wide variety of disciplinary, social, and cultural backgrounds to understand the perspective of the various stakeholders in addressing environmental health concerns.

Recently, a Canadian-led international team of environmental health promoters, medical epidemiologists, and policy experts working with local counterparts launched an innovative program in Ecuador to train people to address environmental health problems in communities. The "International Masters in Health Utilizing an Ecosystem Health Approach," which was the core of the program as discussed later in this essay, began with a two-week workshop. A central exercise in this workshop was the performance of a dramatization of the situation regarding Texaco's oil extraction in the Ecuadorian Amazon. While this exercise appeared to the instructors to be an effective means of engaging participants in active collaboration, the extent to which it served as a useful vehicle to facilitate the exchange of knowledge among members of the group and promote alliances for problem-solving was less clear. The lead instructor (co-author AY) therefore engaged a critical theorist with expertise in performance techniques (co-author JBS) to review the materials, examine the photos and video of the role-play, and help make sense of what transpired. The analysis that emerged prompted reflections upon the various aims of the ecosystem approach to health, and both the possibilities of role-play and the challenges with its use that must be addressed if this technique is to be employed to help meet the objectives of an ecosystem health approach.

The central objective of this essay, therefore, is to explore the challenges in using role-play to facilitate understanding of the complexities in addressing a given environmental health issue, and to reflect on how to use this technique more effectively to promote ecosystem health. We begin with a brief...