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“The powerful play goes on and you may contribute a verse”

About a year ago, CNN and Time declared the identification of male circumcision as a preventive measure against HIV infection as the biggest medical breakthrough of 2007. Having worked on one of the studies that led to this “discovery” several years before, I quickly penned something which was published on Africa News on the 20th December 2007 (http://www.africanews.com/site/list_messages/14084).

What followed was an onslaught of comments prompting the publishers to keep the article open as a discussion. In this little microcosm of cyberspace, individuals debated the “truth” behind male circumcision as a potential preventative measure against HIV/AIDS. Right from the start it was clear that the readers of this forum were equally as concerned with the value of the science behind this declaration as they were with the power of agency and socio-political dimension that could have influenced and skewed the science in favour of male circumcision. To many this was a “western conspiracy”:

• “You need to be careful of these Americans who come to African forums to sell their ideas and to teach to the "stupid Africans."
• “Appeal to authority is nothing but intellectual laziness or incompetence. One should actually do a critical analysis of the evidence itself, and not rely on 'big brother" to do the thinking for them.”
• “.... For all the good work Stephen Lewis does he is a hypocrite in this case. He speaks against programs designed to promote behaviour change as being 'neocolonialist' yet sees absolutely no problem with telling African Men what they should be doing with their own bodies.”

Such reactions towards research in general are fairly common and well documented within medical anthropology journals and mainstream media. Four years before the article above was published, I had conducted an ethnographic study on people’s knowledge, attitudes and beliefs towards medical research using a trial on male circumcision as a case study in a town in western Kenya. For several months, I held hundreds of interviews and group discussions with the young, the old; the poor and the not-so poor; both men and women. More often than not, young urban youth in particular would make similar comments as the ones above. As an ethnographer, my job was to document and report my findings. The questions then and now is, are the presence of such perceptions important enough to address? Do such perceptions have any impact on the social acceptance of western models of research? Do populist opinions matter enough to scientists to actually address them?

I believe it is safe to say that beyond documentation, medical research has done little to address engaging with public opinion and understanding why communities hold such opinions probably because it rarely has a direct impact on the actual studies especially in poverty stricken environments. There is certainly never any shortage of participants willing to sign up to a study out of desperation for the paltry “benefits” offered (free medical care, transport fare, compensation for time). My experience conducting the ethnography showed that the very same young men who expressed their anger against western research stating that “we are just guinea pigs for the scientists” were the very same people lining up to participate in the study. This particular study has always been very pro-participant in terms of addressing their immediate needs such as setting up income generating activities; increasing compensation for time and providing medical care but the issue at hand in this particular paper is the impact web 2.0 is having on widening the paradigm of inclusion. Whereas once upon time, the academic ivory tower would have easily been able to ignore the populist paradigm, the increasing presence and public and accessible documentation of such discourse is pushing academics to engage and respond within a public domain. No longer can scientists hide within the exclusive world of journals and peer review or discuss amongst themselves such perceptions but now must engage the public domain whether it is conspiracy or not. I believe one of the main reasons for this is web 2.0 has allowed public opinion to infiltrate a paradigm that was once only reserved for scientists. What was once only orally expressed and taken and documented in the third person by researchers is expressed in writing first hand by the very people who voice these opinions. Simply put, the internet has allowed oral opinion to invade the stronghold of the written word and more importantly that oral opinion can be shared with millions around the world who would never have known what people at the grassroots actually believed or felt.

As stated in a conference paper by Luc Van Braekel, “The new age is the age of opinion not facts.”

Researchers are increasingly using web 2.0 tools. The Economist recently ran an article examining how web 2.0 is changing the shape of scientific debate: “With the technology in place, scientists face a chicken-and-egg conundrum. In order that blogging can become a respected academic medium it needs to be recognised by the upper echelons of the scientific establishment. But leading scientists are unlikely to take it up until it achieves respectability…Nevertheless, serious science-blogging is on the rise. The Seed state of science report, to be published later this autumn, found that 35% of researchers surveyed say they use blogs. This figure may seem underwhelming, but it was almost nought just a few years ago” (The Economist, September 2008). However, the issue at stake here is not about incorporating the tools within the exclusive domain of research but about using these tools to engage with the public sphere. Web 2.0 is a direct channel for anyone with access to the internet to interact and engage with one another on an equal ground no matter in what social category one is placed.

Blogging itself is an increasingly important paradigm for communications and it needs to be acknowledged and used. Today, there are over 72 million blog sites, making the practice of sharing your daily life and thoughts with the rest of the world one of the fasted growing areas on the internet.

Moreover, the impact of blogs on our world stretches beyond our immediate needs to be heard and is being used more and more to effect change. For example, the first blog-driven political controversy led to the eventual downfall of a U.S. Senate Leader exposed for his white supremacist sympathies. Just as one uses the mainstream media or traditional forms of communicating such as public gatherings, it is critical to use the World Wide Web. Just about everything that appears in the papers ends up being discussed on the internet whether on blogs, social networks, chat forums, comments, etc. Fine, this is the middle class who have a platform to voice their opinions and they are a minority of a minority in Africa but they are the ones that sit smack between the poor and the rich and connect those two worlds whether they are sitting in a bar and talking it through with a civil servant or when they return to the rural homes and sit with grandpa over a glass of a local brew.

As a blogger, I have been fascinated by the onslaught of blog posts, comments and campaigns (both for and against male circumcision) that have since emerged and for a brief time dominated the [public] sphere of public health. One particular post and the comments that followed caught my attention:
“Luo youths to disrupt a planned force[d] foreskin chopping exercise launching by VP ‘Judas Iscariot’ and Beth Mugo. Unsterile medical surgeon instruments and contaminated multi-dose vial are already in Luo land, reveals Luo Council of Elders” (MajimboKenya.com, 9th September 2008).

The title of this post says it all about the content of the article, but what is of more interest are the public comments framed in a political context. A few excerpts are reproduced below:

* “This is ridiculous for someone like Kalonzo and Mugo (Kenyatta family) to lead the onslaught on Luo chopping project, something is fishy. Luos should support the Mzee Riaga and stop this foolishness and useless political gimmicks.”
* “Akinyi, thanks for highlighting this subject. Luo must stand behind the Ker (Luo elder) and stop this act of dictatorship from Raila. Mugo is a circumcised women [sic] and she is being accused of secret women circumcision in Central Province, now the Luo are their project with Kalonzo. Luo women let us stand behind our Ker support our youths to stop this uncultural move the grand coalition.”
* “Anyang’ did not win any election in Kisumu Rural he was imposed on us by Raila. Now we can understand why Raila wanted him to be a minister of medical services, to help him circumcise Luo so that coming next election 2012 Raila wants to show Kikuyu how Luo men no more have a foreskin.(Foreskin vs. votes project). Raila should know that we are comfortable with being Kayi as the Kikuyus always call us. Raila will soon send Mungiki to force our women to circumcised just Mugo is doing in central province.”
* “I am again highly critical of the fact that our identity as a people and party is presently under discussion and considerable debate especially when it comes to this so called ‘circumcision’. I am looking at this as an attempt by some of us and our leaders to use our cultural and identity pillar as a tool that could be negotiated even in the elusive search for Kenya’s Presidency. This is unacceptable for it smacks of a deliberate and selfish move to bring the Luo under the hegemonic tutelage of other communities. I completely agree with the group that seeks to stop the dilution of Luo culture through the promotion of circumcision.

Since circumcision as a defining feature of one’s identity is so vital for those that maintain the practice as part of their ethnic identity, the discourse has become so embedded in the Kenyan social landscape partially due to the politicisation of ethnicity. The mutilation of non-circumcised Kenyans during the post-election violence attests to this and it is indeed a shame to see public reinforcement of the politicisation of what is essentially a public health issue coming from what one hopes would be a more informed community – i.e. the virtual community.

On the ground however, the reality has been very different. Hordes of young Luo men are prepared to wait hours and even days and, more surprisingly, are willing to take the chance of knowing their HIV status before getting circumcised regardless of the fact that, ‘knowing kills’ (a statement I heard so often regarding getting tested). I recently examined the reinvention of the cultural significance of male circumcision in an article published in Wajibu.

It is worth reiterating here that I never came across this sort of speak while interviewing people on a one to one basis or within Focus Group Discussions and neither did my fellow ethnographer while interviewing in Dholuo. Instead, what we found is that the majority of Luo say that culture/customs/tradition is not an important factor in deciding whether or not to circumcise. On a number of occasions when I explored this issue with informants these issues were raised only in terms of interactions with other ethnic groups, very broadly speaking in a sense of acceptance by “the other”. Unlike the comments above, the percentage of respondents that stated that they would not circumcise because it is not part of their culture was insignificant. On the contrary, I came across two Luo councillors who were very proud to state that they had been circumcised purely for hygienic and health reasons. One of the conclusions that we drew in our study was that simply adopting male circumcision does not diminish your cultural identity. Circumcision does not detract from the essence of what constitutes you as a person. The question is why, six years after the ethnography was conducted and male circumcision was publicly embraced was there a plethora of statements within the blogosphere against male circumcision based on culture and politics?

Given my involvement with the on male circumcision in Kisumu (western Kenya), I have maintained contact with the Principle Investigator and over the past year, we have had several discussions on the importance of scientists engaging within the blogosphere. From Prof. Bailey’s perspective, it is a question of whether the time taken to engage in the blogosphere is really worth it as he questions whether the blogosphere is reaching the necessary target audience (i.e. policy makers and implementers and local communities):

“First, how many people in Kenya really blog, and if they do blog, how many go to the site where you go? Precious few in the overall scheme of things…is it an effective way for me to spend my time if I want to influence people and policy? Do the MPs and Raila blog? I don’t think so. Does Mister Onyango tilling his shamba in Siaya blog? I don’t think so. Some poor STI-infested drunk poverty-stricken youth in Obunga blog? I don’t think so. For that matter, does the Ker blog? I don’t think so. One has to make choices about how one spends his time to be effective, and I am not convinced that blogging is IT. Similarly, if I had the money to hire someone to attend to the blogs – read them and write to them and post comments – would that be an effective way to spend our hard-earned funds rather than have that person out on the streets promoting circumcision or on radio or writing articles for the Nation. In Kenya, I don’t think so…”

My response to my good friend, Prof. Bailey:

“The medium is increasingly filtering through to the target audiences. Civil servants and civil society ranging from social activists to community health workers and public health researchers; employees and thousands of others sitting in offices are using the internet, and their perceptions are being influenced by what they read. University students would much rather spend 100ksh in a cyber cafe and download everything they need to cut and paste rather than spend hours in a library scanning through books looking for something to put in their papers. The PR machinery around politicians and all the other spin doctors and fixers are increasingly made up of young internet savvy people behind the scenes. I am not saying you replace one medium with another; I am saying we need to embrace this medium. How different would this be to what you asked me to do years ago: “Go and hang on the streets and listen to what people are saying and learn from them.”

* Dipesh Pabari is a Kenyan writer and freelance education and communications consultant.
* Please send comments to [email protected] or comment online at http://www.pambazuka.org/