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Get the Facts: Collection of Project Case Studies
Hepatitis C Prevention, Support and Research Program

Case Study: Kamamakus Theatre Troupe
Prince Albert, Saskatchewan

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The Development of Kamamakus

A young woman called Stephanie demonstrates a dynamic hip-hop dance routine at the front of a schoolroom in Montreal Lake, Saskatchewan. To the pulse of music emerging from the speakers, a positive message is delivered, "Live a healthy lifestyle." Many of the 60 junior high school students in the audience try out the dance routine with much laughter and joking. Some mimic the stars they have seen on TV. Stephanie is joined by seven other troupe members who perform various skits and songs. They tell personal stories about the dangers of drug use, needle sharing, peer pressure and hepatitis C. The presentation lasts for about an hour and everyone - troupe members, teachers and kids - seems to enjoy it a great deal. 

These young people have travelled for an hour and a half from Prince Albert to put on this presentation. They are not being paid. The funding from Health Canada for this two-year project has run out. The troupe has been driven there by a volunteer mother who put some of them up for the night, paid for the gas, and fed them pizza and breakfast. The Health Centre across the road from the school also feeds them, contributing a lunch of sandwiches and cake before the troupe performs a second time, now for the senior high students. By the time they get back to Prince Albert, they have had a pretty full day but some of them still have to go on to their part-time jobs; others have homework ahead of them to prepare for their own school the next day. Their commitment to their troupe is remarkable.

The theatre troupe is known as Kamamakus, the Cree word for butterfly. This name was chosen to capture the nature of a butterfly - a creature of change, metamorphosing from a sluggish, unappealing insect to a beautiful, airborne creature. However, this change does not happen overnight. The butterfly must struggle to achieve greatness and so too the members of Kamamakus have struggled. Some were submerged in the ugliness and pain that exists in the cycle of drugs, alcohol, violence and abuse but with courage, they fought to reach their goals. The act of "breaking through" has become the motto and philosophy of the troupe.¹

Sample Kamamakus Program
Poet's Prayer	Opening prayer, sweetgrass burning and song written/performed by Cory
Fresh Fried Bread	Song written/performed by Cory
The Vampire Skit	Skit explores dirty needles and the effects of hepatitis C
The Running Skit	Skit explores peer pressure, drugs and exercise
Hip Hop Dance	Dance by Stephanie/Jolene with audience participation
Breakdance Demonstration	Dance by Chad & Steven
Bullying Sketch	Discussion of peer pressure, gangs and suicide
Jigging Demonstration	Traditional dance by Chad & troupe member
Seven Days from Midnight	Sketch about IV drug use
Personal Stories	Stories by troupe members about personal experiences with drugs and alcohol
Fruit Basket	Game with audience participation
Circle Dance	Dance with all asked to participate

Members of Kamamakus live either in Prince Albert, Saskatchewan, which, in 2001, had a population of 34,291 or on neighbouring reserves. The Prince Albert Health District (PAHD) encompasses several reserves and rural municipalities and serves nearly 76,000 people.² There is a great deal of mobility in and out of town as residents deal with issues of employment, incarceration, addiction, and poverty. Prince Albert is a hub for many services, particularly corrections. There are three federal institutions - the Saskatchewan Penitentiary, the Prison for Women, and Riverbend Institution; two provincial correctional centres - Pinegrove Correctional Centre (for women) and Prince Albert Correctional Centre (for men); and four youth facilities. Prince Albert is also a gateway to the North. As a community stakeholder explained to the evaluators: 

Kids come here from northern rural communities and reserves and they are looking for a better life. They can fall prey to people who take advantage of them. 

It has been estimated that up to 200 children live on the streets of Prince Albert at certain times of the year. Overall, in the PAHD, population characteristics include: 

• 15% of the population have less than a grade nine education; 26% do not have a grade 12 diploma; 

• Average family income of Prince Albert residents is $46,309.00 per year; 

• 32.7% of families in Prince Albert are single-parent families; 

• Over half of the population in Prince Albert has an income under the national average; 

• 25% of the population's income is less than $20,000 a year; 

• 35% of families are considered low income compared to the national average of 22%; 

• 34% of families are of Aboriginal ancestry.³ 

Other social issues identified by the PAHD include the negative impact of shift work on family time and youth supervision, and high rates of teen pregnancy, youth crime and child prostitution.⁴ Some schools in the area experience a 100% turnover in the student population during the year.⁵ According to a staff member we interviewed from the Methadone Assisted Recovery Program, Ritalin® use is a serious problem in Saskatchewan where more prescriptions for this drug are issued than in any other province. The prescriptions are sold for cash and the Ritalin (or another drug, Dilaudid®) is melted down and injected. (Ritalin, or methylphenidate HCl, is a central nervous system stimulant commonly prescribed for attention-deficit hyperactivity disorder. Dilaudid is a prescription analgesic.)

In Prince Albert there are several organizations that offer services to individuals infected with or affected by hepatitis C. In particular, the Sexual Health Clinic tests for HCV and STD's, provides transportation for patients to access treatment in Saskatoon, offers support to families, and provides sexual health education in schools and correctional facilities. Prince Albert also has a methadone clinic and a needle exchange that, at the time of our visit, was providing 6,000 needles per month. However, the incidence of intravenous drug use appeared to be even greater; the PAHD Population Health Director commented, "We get back more[needles] than we give out". 

In response to the high number of HIV cases diagnosed in the Health District between September 1996 and February 1997, the Prince Albert Seroprevalence Study was conducted. The study's objectives were to estimate the prevalence of HIV, HBV, and HCV among injection drug users and their sexual partners in Prince Albert, to describe high-risk behaviours and the risk factors associated with them, and to determine service needs and barriers. The study accessed 247 injection drug users and/or their sexual partners. Key results included: 

• 40% of all participants had hepatitis C 
• 66% had a history of abuse (abuse before age 16: sexual 38%, physical 41%) 
• 65% experienced alcohol abuse in the home 
• 58% left home before age 16 
• 34% experienced mental health problems in the home 
• 20% experience drug abuse in the home 
• Injection drug users engaged in risky behaviours 
• Their sexual partners also engaged in risky behaviours 
• Alcohol dependence was high⁶ 

The high prevalence of hepatitis C and needle use in Prince Albert was a concern for the Meyoyawin Circle Corporation, an Aboriginal health organization committed to holistic health and striving to represent the health concerns of the Aboriginal community to the PAHD. On February 2, 2000, with the support of Health Canada's Hepatitis C Prevention, Support and Research Program, Prevention and Community-based Support Regional Project Funding, Meyoyawin and the PAHD held a one-day conference on hepatitis C. Approximately 70 people attended and their discussion resulted in the creation of a working group to address the critical needs of at-risk youth and issues related to injection drug use. Some of the group's members had dramatic experience and they thought that drama and dance would provide a better means of communicating health promotion messages to youth than would traditional techniques. 

The group worked with the Health Promotion Facilitator at the PAHD to prepare a formal proposal for the Prevention and Community-based Support Regional Project Funding. Members included: 

• Health Promotion Facilitator, PAHD; 
• Sexual Health Clinic Nurse/Manager, PAHD; 
• The Youth Activity Centre; 
• West Flat Citizens Group, Inc.; 
• Prince Albert Indian and Metis Friendship Centre. 

A member invited his drama coach to attend one meeting. She became involved in the development of the project proposal and subsequently became the troupe's acting instructor. The proposal was submitted at the end of March but there was a delay in the approval process. On August 8, 2000 the PAHD received $61,990 for Kamamakus for a 22-month period ending June 30, 2002. Along with many in-kind contributions, the PAHD also contributed approximately 15% of the project's budget. 

The project's purpose was described as follows:

It was the intent of the project to: 

• Raise awareness about the risk factors associated with hepatitis C; 

• Raise awareness about the implication of personal health and lifestyle choices in contracting the virus; 

• Involve at-risk youth in raising peer group consciousness to affect a broader population of young people; 

• Involve the participants in decision-making and problem-solving skills; 

• Serve as a catalyst to accessing different and positive social environments for youth; 

• Build self-esteem, self-concept, interpersonal social skills and whole life discipline; 

• Incorporate a multicultural aspect of learning focusing on mental, physical, emotional and spiritual health; and 

• Involve the audiences in the measurement of success. 

Kamamakus Implementation 

Activities

In the fall of 2000, a core group of youth solidified to form a troupe. They were mainly Aboriginal and included one individual with hepatitis C. Twice a week, they attended four-hour workshops on stage performance and technology, stagecraft and general technical skills. Specific skill areas included the following: 

• Self-esteem/self-concept 
  • Introduction to acting
  • Improvisation and its uses
  • Vocal development
  • Body language skills 

• Communication skills
  • Oral interpretation
  • Reading skills
  • Vocal projection
  • Oral tradition

• Self discipline
  • Cultural studies
  • Directing

• Interpersonal/social skills
  • Performance techniques
  • Peer coaching 

The troupe members began to acquire information about hepatitis C, risk behaviours and prevention strategies. They attended workshops provided by staff from the STD clinic, observed public health nurses in school classrooms and interviewed people living with hepatitis C. They read about hepatitis C and discussed their own experiences and those of their friends and families. They attended a series of writing workshops conducted by Maria Campbell, a well-known Métis playwright. They began to incorporate all this knowledge into skits, songs and a question and answer session. 

In November 2000, Kamamakus presented their debut performance in Prince Albert as part of Drug Awareness Week. By the end of March 2001, they had completed 15 performances in schools and community halls in the Prince Albert area and had reached approximately 1000 students and adults with their hepatitis C message.⁷ 

One of their early performances was attended by a member of Operation TARGET - Together Accepting Responsibility Giving Enhanced education Towards youth - a partnership involving the Prince Albert City Police, the RCMP, Addictions Services, the Sexual Health Clinic, Prince Albert Correctional Centre, Prince Albert Youth Activity Centre and various community role models. This program was designed to deliver a consistent message to northern Saskatchewan on battling the effects of drugs, gangs and child exploitation.⁸ The TARGET member was moved by the power of the Kamamakus message and immediately saw that the young actors connected with youth in a way that the officers could not. TARGET quickly incorporated Kamamakus into their own presentations. Troupe members accompanied them in their police airplane to over 20 northern communities. After seeing them perform in the TARGET program, several northern bands paid for Kamamakus to return and perform at various health conferences and other special events. 

By the end of their second year, the troupe had developed approximately 30 songs, dances, skits and informative pieces. Their understanding of youth and their needs led to some important program changes. As the project evaluator explained: 

Very quickly the Kamamakus troupe realized that the youth audiences had a short attention span and so they modified the pacing, timing and type of presentations, alternating from song, dance and short skits with the information they wanted to deliver. They also recognized the need for the youth to not sit passively and so there are several songs and dances where the audience becomes actively involved in the performance.⁹ 

The information they provided was direct and non-judgmental. As one of the youth leaders, Jolene, explained: 

You can't preach to kids because they don't like that. Their parents preach and the kids see them as hypocrites because they engage in the same behaviour. We just let them know how they can be safer about some of the things they might do. We have information and give it to them. The kids are sick of hearing "Don't do that!" and will do it anyway. Especially here because there is little else to do in terms of sports and recreation.

They also tried to personalize the information they provided. According to Jolene: 

We try to make the performance a personal experience, share our personal stories. People identify with that.

They made the information as simple as possible. For example, when talking about tattoos:

We tell kids to make sure the places are safe, clean and have autoclaves. If they can't remember "autoclave", we tell them to ask if the place has a machine that cooks everything at a high temperature. Put it in simple language. 

Finally, they made the experience fun. 

Between April 2001 and March 2002, Kamamakus performed in approximately 75 venues.¹⁰ These included health and health educator conferences, correctional institutions, community schools and high schools in the Prince Albert area, schools located in northern communities, the Aboriginal Winter and Summer Games, and many other health and educational events. As the project evaluator commented: 

The overwhelming number of requests by schools, institutions and groups for Kamamakus to perform, coming from all areas of the Province, is a clear sign that the format and style of the message is connecting with youth and adults as well.¹¹

Administration

This tremendous success, however, was not reflected behind the scenes, in particular because the management structure for Kamamakus had been poorly defined. The original agencies had come together for the sole purpose of preparing the proposal. When the project was funded, the PAHD held the contract and thus was responsible for the financial administration but the structure of the board, hiring policies and project management were not clearly defined. As one board member explained: 

This is not an organic board. The board never had control of the budget. There was/is some confusion about who is in charge and who pays the bills. From the beginning the structure wasn't there to move the project along. There was never a set number on the board - one week someone might bring an interested friend along who then became a board member. There were a few key players who were around from the beginning. 

Another board member commented: 

We weren't really a board with a mandate, or a president or anything like that. We were more of a committee. This committee got less and less involved over time.

And a third added: 

Kamamakus youth were not always represented at board meetings. Initially the [Acting Instructor] represented them, but this was not a good system. It was not a good advisory group - [it] needs to have people involved who care about hepatitis C. 

Issues related to control, discipline, reporting and expenditures surfaced; personality clashes emerged; the relationships that the acting instructor had with both troupe members and the external evaluator deteriorated; troupe members were confused by the lack of structure, leadership and trust. As the Project Progress Report indicated: 

It was very surprising to see how quickly a highly successful project could fall to pieces due to poor initial structuring....The youth had never been part of the board meetings to any meaningful degree. The project had been designed and funded on the [presumption] that adults could find, train and use youth to educate youth and did not recognize the inequity of the power relationships.¹²

Eventually, in the fall of 2001, the Acting Instructor resigned. Around the same time, the Health Promotion Facilitator position also became vacant. Then, as one of the board members explained: 

They really lost momentum. There was no one to call, no one to organize meetings and keep people informed.

The board was basically rudderless and funding was running out, yet Kamamakus continued to perform. 

The Troupe

The key to sustainability lay with the troupe members themselves. In the early days of the project, the core group of youth wrote their own goals and objectives. They all signed the following Vision Statement:

They forged a pact with each other to remain drug- and alcohol-free, to attend rehearsals and hepatitis C workshops, and to be on time for all planned meetings.¹³ When a member's dedication or interest flagged, the group voted to decide whether or not to give him or her a second chance. When life issues intervened, they tried to counsel and support their peers as best they could.

The heart of the project lay in the twice-weekly sessions at which the group met to: 

Develop, rehearse and share ideas to create strong presentations for delivery to their peers. Here they support and encourage each other and maintain the discipline to keep their troupe together and their goals moving forward.¹⁴

Another management tool was the use of a talking circle. As troupe members described: 

At practices we have a talking circle and we make decisions about what to do, who is going to do what, and how we will get the message out there. Everyone has a chance to get their input in.

Group support was a significant factor in the development of troupe members as individuals. As the project's most recent Progress Report stated: 

All members are now back in the school system or work place. Risk behaviours have been reduced as members have taken and stuck to a pledge not to drink alcohol or take drugs. They are very serious about their chosen path of being role models to their peers. They all celebrated a year of being alcohol- and drug-free.

When asked how Kamamakus had changed their life, troupe responses included: 

• I was getting peer pressure to try drugs. I did this instead. 
• Bad lifestyles lead to disease. It wasn't fun any more. 
• This is about positive lifestyles. It helps you. 
• People with bad lifestyles are unemployed. They have no food, no house. It has let us see what is not a good lifestyle. 

The Prince Albert Chief of Police could see their personal growth. He commented: 

Since September 2000, I have seen a great change in the young people's self esteem and development. They continue to grow and it is obvious that they are confident in their performances. The young people's message to their peers is a great part of what they do. I have no doubt the youth will continue to do great things.

At the peak of the project's management problems, a number of troupe members dropped out. Two of the remaining four members got together and held auditions. By October 2001, they had 10 members again and at the time of our visit in April 2002, they had 13 members. 

A new, youth-centred structure emerged. The position formerly held by the acting instructor was changed to that of Theatre Manager and one of the young troupe members was hired to fill it. Kamamakus members began to attend all board meetings and were able to make suggestions about future directions for the troupe. 

With the change to self-management, school became a clear priority for troupe members. As Cory, the lead singer, commented: 

If Kamamakus affects their schooling, they are put on probation. School comes first.... Their grades have gone up. We ask to see their report cards.

And troupe members added: 

If someone gets behind in school, they get pulled out until their grades improve.

They were also getting involved in other activities as well such as circle dances, sports and air cadets. Cory was planning his own talk show. 

Kamamakus Theatre Troupe Project Accomplishments 

1. Impact on level of public awareness

It is evident from the information we were able to collect on our case study visit that Kamamakus has had an impact on public sensitivity to and awareness of hepatitis C in Prince Albert and northern Saskatchewan. To begin with, being involved with the project was an educational experience for board members. As one explained: 

Each one of us on the project knew hepatitis C as just a word - we all learned. The information is just not out there, especially for youth with the dangers of tattooing and piercing. This is a city with a lot of needle use and poverty. There is a great need for information that is accessible - they need Kamamakus. There is a lot of success with this, they have reached a lot of kids - to change kids' lifestyles and behaviours they need the information and it needs to come from youth.

In terms of accessing the public, between March 14, 2001 and April 12, 2002, approximately 9,410 people saw Kamamakus perform in approximately 36 different venues - some venues had multiple performances.¹⁵ The largest audience was the Aboriginal Winter Games, which was attended by approximately 5,000 people; the smallest was at the Cosmetology Department at the Saskatchewan Institute of Applied Science and Technology (SIAST) where there were only 20 in the audience. However, even this performance had a lasting impact because the information they provided precipitated the addition of "precautions" to the cosmetology curriculum. A frequent venue for the troupe was the Youth Activity Centre, where they played every two months. As Cory described it: 

It is electric when Kamamakus gets there. People come in, they fill the place and they stick around.

The ability of the troupe to interact with young audiences was its greatest strength. The use of music, dance and personal anecdote combined into a powerful prevention message that was well received by a high-risk target population. Troupe members also felt that they have made a positive difference for many individuals, particularly for the kids who see them as role models. Troupe members commented in their interview: 

We sometimes hear the kids singing the songs we do while they are walking down the street. The songs and skits we do are pretty well known in the community. Sometimes Cory gets recognized walking down the street, some of the other youth have been recognized as well.

When asked if the project had made a difference in the community, Cory and Jolene described a number of interactions where they had been able to raise awareness about hepatitis C. They described visiting correctional centres, making a presentation at the annual school principals' meeting, and working with troubled youth. In each case, they had been able to promote prevention messages and model a positive life style. One striking example occurred at the Aboriginal Youth Summer Camp in LaRonge, where the troupe had performed all week to Saskatchewan youth. As Jolene recalled: 

At the end of one of the performances kids kept coming into the tent. Cory told stories about his life, gangs and other things associated with hep C [hepatitis C]. One kid was wearing a bandana to represent [his gang], and he took it off and put it in his pocket as Cory was talking.

Everyone concerned is certain that, as a result of the Kamamakus presentations, over 9,000 Saskatchewan children, teens and adults now know about hepatitis C, the disease, the pathways of infection, risk behaviours and prevention strategies.¹⁶ At the time of our case study visit, the troupe was looking forward to performing at the First Annual Aboriginal Hepatitis C Conference that was held in April 2002, in Edmonton. They were also going to do a presentation at the conference on peers as educators. They had also done some videotaping to show groups how to develop a popular theatre troupe in their community.

2. Development of Capacity of Board Members 

Another Kamamakus accomplishment related to increasing understanding in the community about hepatitis C. The board had experienced a positive change and was clearer on how to interact with these independent young people. It had become: 

A circle of adults who are active in public health administration and programming and who hold great respect for the youth involved.

When this description was compared to early interactions when the young players were completely shut out of the decision-making process, this was progress indeed. The board had developed work plans for the coming year and planned for Kamamakus to become administratively and financially independent. However, there was still board development work to be done; a stronger management structure and clearer role definitions were still required. 

3. Development of Effective Partnerships 

Some strong partnerships had developed in the community and continued to make significant contributions to the project, as follows: 

Prince Albert Health District

• Project coordination by the Health Promotion Facilitator; education by Sexual Health Clinic Nurse/Manager; support and commitment by the Medical Health Officer and the Executive Director of Population Health

• Office space provided for the Theatre Manager and boardroom space for meetings

• Technical support, supplies and training workshops provided for troupe members on public health issues and presentation skills

Prince Albert Grand Council

• The Sexual Wellness/Prenatal Nutrition Coordinator was very active on the board
• Provided access to key venues for presentations

The Youth Activity Centre

• Director was a key player on the board
• Rehearsal space provided twice a week
• The first point of contact for many youth

TARGET (Prince Albert Police Department/Royal Canadian Mounted Police)

• Provided access and transportation to northern venues
• Provided on-going support and publicity

The most important lesson learned through the project was how an atmosphere could be created in which the young players could find a successful, culturally appropriate outlet for their creativity. The sense of cohesion and teamwork experienced by troupe members caused their communication, decision-making and theatre skills to improve significantly. Their success had a positive impact on their self-esteem and such lifestyle choices as staying in school and being drug- and alcohol-free. The theatre proved to be a catalyst for them. They could then communicate these positive experiences to their young audiences in engaging and acceptable ways to spread the hepatitis C prevention message. 

The Challenge Faced by Kamamakus

One over-riding challenge faced the troupe and that was the issue of sustainability. They had hoped that Health Canada funding would be extended, but the proposal process was very lengthy and feedback was slow to come. At the time of our visit in April 2002, the project was without funding. They had received $15,000 from the Saskatchewan Entities Program to support members' extended time and travel commitments over the winter. The troupe was preparing a documentary film for which they were seeking a funder and the board was exploring charitable status to make fund-raising easier. However, as the project's final Progress Report stated: 

It is critical that the PAHD and the board find funding for one more year to train the Kamamakus Theatre Manager in the necessary skills in order for the group to self-manage. It is unrealistic to believe that such a youth theatre group can ever be self-supporting in a city the size of Prince Albert but they can certainly continue to carry on with their mandate by forming new partnerships with other groups and institutions who want and need to work with youth directly on like issues.

The future of the troupe seemed problematic but as far as the troupe members were concerned, they would continue. As an early troupe member had written: 

The butterfly will continue to carry its message upon wings of concern and hope, and [will] fly with the grace and skill of a thespian plying his trade in the spotlight on centre stage.¹⁷

The following types of documents were reviewed in the preparation of this case study: 

• Project documents from Health Canada 
• Various scenes the troupe performs 
• Original project proposal 
• Kamamakus brochures 
• Listing of past gigs, including approximate number of people who saw the performance 
• Kamamakus vision statement, goals and objectives 
• Letters of support 
• Newspaper clippings

References

1. Breaking Through - A look at the Kamamakus Hepatitis C Drama Troupe - by John McDonald
   
   
2. Statistics Canada, 1997.
   
   
3. Information gathered from Understanding the Early Years, Early Childhood Development in Prince Albert, Saskatchewan. KSI International Inc. Applied Research Branch, Strategic Policy, Human Resources Development Canada. April 2002.
   
   
4. Proposal for Hepatitis C Funding. Prince Albert Health District. March 27, 2000. Facts provided by the Prince Albert Race Relations and Social Issues Committee.
   
   
5. Secondary client interview, Barrington Research Group, Inc. April 15-17, 2002.
   
   
6. Proposal for Hepatitis C Funding. Prince Albert Health District. March 27, 2000.
   
   
7. Project Progress Report. March 31, 2002.
   
   
8. "Agencies target drugs, gangs, exploitation." Daily Herald. March 3, 2001.
   
   
9. Project Progress Report. March 31, 2002.
   
   
10. Project Progress Report. March 31, 2002.
    
    
11. Project Progress Report. March 31, 2002.
    
    
12. Project Progress Report. March 31, 2002.
    
    
13. Hepatitis C Prevention, Support and Research Program: Project Performance Reporting. September 2000-March 2001.
    
    
14. Project Progress Report, March 31, 2002.
    
    
15. Kamamakus records of past gigs.
    
    
16. Kamamakus Past Gigs. Project document, April 12, 2002.
    
    
17. John McDonald, "Words of the Past, Vision of the Future." Prince Albert Shopper, Volume XXX, No. 21, January 8, 2001.

 

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