A play the audience could rewrite taught a peri-urban Yangon community that antibiotics kill bacteria — but most of those who stepped on stage still could not say why buying them over the counter is a problem

In Myanmar antibiotics are sold without prescription, and shops sell “mixed medicine” bags combining painkillers, antibiotics and sometimes steroids. Health education there is mostly one-way talks. This project tried forum theatre — a play performed twice, where audience members replace the characters in the second run and steer the story to a different ending — and asked whether it improved the community's understanding of antibiotics and what the audience made of it.

The research team worked with a local theatre group in a peri-urban township of Yangon, choosing five overcrowded locations with poor water and sanitation, where most residents are factory and manual workers. Five story-gathering workshops of 25–35 people each collected residents' experiences of febrile illness, and two themes were chosen for scripts and songs: “Fever and antibiotics” and “Mixed medicines”. Ten plays ran between September and October 2018, each 45–60 minutes with seven youth actors, ending with the central character hospitalised after self-medicating; the replay invited audience members to take a role and change the ending, followed by four key messages from the World Health Organization's advocacy materials. Evaluation used pre- and post-performance focus groups on the same day for four of the ten plays, 40 participants in all, transcribed in Burmese, translated and content-analysed, plus observation notes on what audience members did on stage.

• The plays reached 1,175 people, and 36 of them stepped on stage to change the story (two to four per play), in a setting where public engagement with science had barely been practised before.
• Before the play, most had heard the word “antibiotics” but could not say what they were, and misunderstandings ran in every direction: for very high fever, for dog or snake bites, to prevent seasonal flu, or only for tuberculosis. Afterwards most focus-group participants could say that antibiotics are medicines that kill bacteria, should not be taken for every sneeze or headache, that mixed-medicine bags should not be bought on one's own, and that a clinic beats a drug shop.
• People enjoyed it and wanted more, proposing the next topics themselves — tuberculosis, hepatitis C, contraception and drug use among children — and said they preferred it to formal health talks because it was more fun and more informative.
• What happened on stage said more than the focus groups did. Most audience members who intervened simply advised the sick character to see a doctor, and did not appear to know why buying antibiotics without prescription was inappropriate. Whoever took the role of a junior family member was almost unable to persuade the elders, because family hierarchy carried real weight. Those playing neighbours typically offered money so the sick person could afford a doctor.
• Practical suggestions came from the community — build a more realistic pharmacy set, and perform on Sundays because people work on Saturdays. On the organisers' side, monsoon rain and poor drainage forced several postponements, and most venues offered by the authorities were Buddhist religious buildings, which may have kept residents of other faiths away.

For anyone doing health communication in communities where literacy is limited or lectures do not land, a play the audience can rewrite does two things at once: it sends knowledge out, and it brings the community's own reasoning back to the organisers — how people actually decide about medicines, who holds authority in the household, and what stands in the way — none of which a one-way talk ever reveals. The lesson about family hierarchy suggests that messages aimed only at younger people may never reach the person who actually buys the medicine.