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"Pigs for Peace" : A Microfinance approach to helping sexual violence survivors

February 28th, 2013

The National Institute of Minority Health and Health Disparities, based at the John Hopkins’ School of Nursing, is currently conducting a study evaluating a microfinance intervention, called “Pigs for Peace” (PFP). Microfinance is the provision of small loans to individuals with limited economic means. PFP is designed to improve the health of rape survivors in the Democratic Republic of Congo.

The study is a collaboration between the Johns Hopkins University School of Nursing, US-based NGO Great Lakes Restoration and DRC-based NGOs Programme d’Appui aux Initiatives Economiques du Kivu (PAIDEK), which provides financial support for “micro-economic initiatives in the region” and the Rama Levina Foundation, which offers free health care services to survivors of sexual violence. The various organizations hope to use their research to improve the lives of survivors of sexual violence. Research began in April 2010 and is scheduled to end this March. While researchers are continuing to gather data, the use of microfinance as a means of intervention for victims of sexual violence thus far appears successful.

The research from the organizations identified two primary themes: the health consequences of sexual violence, such as STIs, and the need for survivors to regain their sense of worth. Based on the findings, the community-academic partners found that prioritizing economic empowerment for women would be the best approach to helping survivors reintegrate into society. The partnership concluded that “credit efforts, such as microfinance, have demonstrated success in many communities.” Those living in war-torn regions of eastern Congo face a constant gap between flows of income and expenditure. Due to an absence of banks, poorer families cannot access credit “to mitigate economic and social shocks.”

Microfinance, until recently has not been present in rural regions, due to the substantial cost combined with the high demand for microfinance institutions. In addition, individuals living in remote regions fear the inability to pay back a loan, and thus are reluctant to take a loan out. In order to address these needs, PAIDEK initiated PFP, an animal husbandry microfinance program based in the Ngweshe Chiefdom in the Walungu Territory in South Kivu. PFP lends out pigs to women, in order to help them with household income. PAIDEK decided to lend pigs, instead of cash, since many women did not have the financial means to repay the organization with cash. Since pigs are a smaller animal, women are more likely to have a say in decisions related to the animal. This would not be the case with a larger animal, like a cow. PAIDEK assists villages with creating a PFP association, which is designed to support women in managing the pigs. Support services include providing education on the needs of the pigs. The PFP project provides male and female pigs for breeding. The pigs are a sustainable source of income, since they give birth often. Piglets can be sold to pay for the needs of women. As of 2010, 166 families have benefited from PFP and the program is currently in 14 villages in South Kivu.

Thus far, the program has been found to improve overall health, to reduce chronic stress, and to increase economic sustainability.

http://www.tandfonline.com/doi/pdf/10.1080/17441692.2011.594449

http://nursing.jhu.edu/faculty_research/research/projects/pigs/index

No Controversy: Maternal Health Interventions

February 28th, 2013

Improving maternal health is one of the eight Millennium Development Goals adopted at the 2000 Millennium Summit. The target for this goal is to reduce the maternal mortality ratio (MMR) by 75% and achieve universal access to reproductive health by 2015. With only 2 years to go, there are some countries that have made considerable progress, some countries that are slowly but surely trying to meet these standards, as well as other countries that have actually increased the MMR over the years.

As I have mentioned in previous births, most of these births could be avoided because of the highly efficacious interventions that are already in existence. The issue is agency; the solutions are right in front of us, but there needs to be a concerted effort to implement them. Narratives are a way to appeal directly to individual human emotion as a way to spur change. The power of the narrative has been a strong theme in my blog, and the Bill and Melinda Gates Foundation Family Planning Sector is using it to spearhead their “No Controversy” initiative.

When you first visit  ‘http://no-controversy.com/,’ you are asked to sign a pledge that states:

 

 

Upon entering the site, you can read stories about contraception experience from real women around the globe. Some are stories of heartbreak and sadness while others are ones of triumph and success. I was personally moved by the countless women that used birth control to expand their educational opportunities. Their ability to pursue personal ambitions and control when to have kids and how many reflected the autonomy that birth control can provide. After reading stories, guests are encouraged to share their stories or make a pledge to the foundation.

The foundation’s goal is to meet the contraceptive needs of 120 million additional women and girls in 69 of the world’s poorest by 2020. This number was based on current birth control trends and incremental improvements that were deemed attainable. The goal was presented at the 2008 London Summit on Family Planning and is a MDG in essence but one with a more structured plan for implementation. The ambition behind this initiative makes it an intervention worth contributing to and following. In a quite unique way, this initiative relies on social media and narrative sharing to get the word across as well as creating viable markets for contraceptive manufactures that ensure innovation. Think about it. Why is it that women have had the same 5-10 birth control options for the past 30 years? The time for innovation is now, and Bill and Melinda Gates are making noticeable steps to improve the lot of women and girls everywhere.

 

Sources:

http://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdf#page=32

Faith on the move!

February 28th, 2013

God doesn’t count calories [6] : Faith-based health interventions

Religion plays a powerful role in the everyday lives of women around the world – a fact that has not gone unnoticed by scientists seeking to improve women’s health outcomes. This week, we will turn to successful examples of healthcare interventions that take advantage of religion’s influence on specific populations.

1. Faith on the Move

In the land of freedom and fast food, obesity ranks among the greatest challenges to Americans’ health. Excessive weight gain puts individuals at risk for a variety of chronic diseases, and may even increase women’s likelihood of developing breast cancer [1]. For this reason, developing initiatives that target obesity has the potential to address multiple facets of women’s health, from heart disease to cancer.

But weight-related interventions often struggle to gain traction and fail to generate lasting results. In the same way that organizations like FACE AIDS tailor their curricula and materials to different cultures, the most successful health interventions must appeal to community attitudes. Religion emerges as the ideal conduit for communicating health information and staging lasting interventions.

“Faith on the Move” represents one such attempt at introducing a healthcare program to a community through religion. The program recruited 59 female African American subjects regardless of their church affiliation and developed a series of aerobic fitness workshops coupled with related scripture readings from the Bible. Many faith-based programs target African American populations because of the especially strong role of religion in such communities [2]. Women who participated in the exercise and faith-based program demonstrated slightly increased weight loss as compared to counterparts in previous exercise-only study [1], suggesting that incorporating a faith component to health interventions might yield additional benefits.

2. Limitations

That said, the study’s design was wrought with flaws; for example, there was no control group and physical activity as well as fat intake information were collected based on self-reports [1]. Moreover, the Bible passages chosen were often only peripherally related to health and wellbeing – or sent mixed messages:

Take no thought for your life, what ye shall eat, or what ye shall drink; nor yet for your body, what shall you put on. Is life more than meat, and the body than raiment?…But seek ye first the kingdom of God and His righteousness (Matthew 6:25 and vs 33).

Despite the existence of such dubious materials, a comprehensive review of faith-based physical activity interventions revealed the positive impact of religion on health programs intended to increase physical activity [2]. Efforts that target mind, body and spirituality, rather than focusing only on physical wellbeing, often see lasting impacts on participants [3]. An entire field of church-based health promotion programs (CBHPP) is emerging, with initiatives like The Heart and Soul Program to target women’s cardiovascular health [4].

Before applauding religious interventions as a successful solution for obesity in America, further and better-designed studies are needed to elucidate the connection between faith and physical health. Would similar programs that incorporate inspirational but non-faith-based material have similar degrees of success, or is there something special about religion?

To test the power of religion to boost physical wellbeing for yourself, try out Revelation Wellness’s At Home Workout. To quote the instructor, “Suffering is a gift that God gives us.” [5]. Ruminate on that during your lunges.

Sources:

[1] Fitzgibbon, ML, Stolley, MR, Ganschow, P, Schiffer, L, Wells, A, Simon, N, and A Dyer. “Results of a Faith-Based Weight Loss Intervention for Black Women.” Journal of the National Medical Association, 97(10): 2005. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594697/pdf/jnma00299-0083.pdf.

[2] Bopp, M, Peterson, JA, and BL Webb. “A Comprehensive Review of Faith-Based Physical Activity Interventions.” American Journal of Lifestyle Medecine. 2012.

[3] McKeever, C, Faddis, C, Koroloff, N, and J Henn. “Wellness Within REACH: mind, body, and soul: a no-cost physical activity program for African Americans in Portland, Oregon, to combat cardiovascular disease.” Ethnicity and Disease, 14(3): 2004. http://www.ncbi.nlm.nih.gov/pubmed/15682777.

[4] Peterson, J, Atwood, JR, and B Yates. “Key elements for church-based health promotion programs: outcome-based literature review.” Public Health Nursing, 19(6): 2002. http://www.ncbi.nlm.nih.gov/pubmed/12406175.

[5] Keeton, Alisa. “Hold it! – At Home Workout – Revelation Wellenss [sic] – Faith Based Fitness.” 9 January 2013. http://www.youtube.com/watch?v=eJxBMISl_Lo.

[6] Keeton, Alisa. “God Doesn’t Count Calories! Chair Workout – Faith Based Fitness.” 6 February 2013. http://www.youtube.com/watch?v=OjeskpFgUSM.

An Exploration of International Lesbian Rights: "It's easier to be a lesbian in Saudi Arabia"

February 28th, 2013

Last week’s blog discussed the “Asian Model” of maintaining familial harmony and appearance that many Asian cultures expect while having the freedom to express sexual orientation. I described it more or less as a culture similar to the “Don’t ask, don’t tell” policy where lesbianism is frowned upon that the United States previously upheld. This blog will continue the discussion of the realities of being a lesbian where the ideal situation is to remain invisible.

In the Kingdom of Saudi Arabia, it is punishable by death to engage in any sexual activity before marriage. Tradition, and even law, posits that the distinction between men and women in their appearance and roles in society must be extremely clear. As even heterosexual relationships are so strictly forbidden, one might assume that being lesbian in this society would be impossible. It is argued, however, that being lesbian in Saudi Arabia is actually more manageable than being straight, especially for younger women. How is this even possible? To begin with, lesbian women find it much easier to spend time with lovers since they are of the same sex and lesbian activity is never assumed. For example, almost all schooling is segregated by sex. This makes it extremely difficult for straight women to interact with men and much easier to lesbian women to interact with other lesbian women. According to Yasmin, a 21 year old lesbian student, one building at her school was considered to be the lesbian enclave. Here, the bathrooms were very private and the walls were often covered in graffiti offering romantic and religious advice such as “she doesn’t really love you no matter what she tells you” [1].  More generally, since two women walking together is much less suspicious than a man and a woman, it is much easier to have lesbian relationships than straight relationships.

In such a repressive society, one might also think that living in the closet would generate psychological stress and frustration. As another described it, however, living a double life is already essential in Saudi Arabia since any activity that deviates from tradition must be kept secret, including consuming alcohol, smoking, and going to discos [1]; Having sex with another women is just one more thing that has to happen behind closed doors. For this reason, the number of people that is the closet is huge and almost like its own community. Additionally, while most people know that lesbians exist, it just is not an issue if it is not public and the police just aren’t concerned with arresting lesbians. As a result, the lesbians in Saudi Arabia live in this unconventional situation where they enjoy a broad amount of tolerance for their sexuality without any acceptance at all.

Yet many feel like legally achieving rights is not necessary to them. They would rather continue living as they have been and not attract too much attention. Still, invisibility makes it difficult to identity a public community and keeps lesbians from truly expressing their identity. Regardless, some people feel like change in this culture is slowly arriving. With increased visibility of more Western ideals of lesbianism, more and more women are coming out of the closet and it remains to be seen how the Saudi Arabian government and people will react [2].

[1] Labi, Nadya. “The Kingdom in the Closet.” The Atlantic. The Atlantic, May 2007. Web. 28 Feb. 2013. <http://www.theatlantic.com/magazine/archive/2007/05/the-kingdom-in-the-closet/305774/2/?single_page=true>.

[2] Kharbash, Hayat. “Saudi Lesbians Coming out of the Closet | Crossroads Arabia.”Crossroads Arabia. Crossroads Arabia, n.d. Web. 28 Feb. 2013. <http://xrdarabia.org/2007/02/20/saudi-lesbians-coming-out-of-the-closet/>.

International Medical Corps

February 28th, 2013

Today I will be blogging about a fantastic organization called the International Medical Corps. International Medical Corps responds to mental health and psychological needs during or following humanitarian crises to strengthen mental health systems and inform national policies on mental health. As we know, following crisis and conflict in a country women are usually the most negatively impacted. Women and children account for four of every five refugees in the world. The International Medical Corps recognizes women’s well-being as “the key ingredient to promoting health, building stable, confident, self-reliant communities, and eradicating global poverty.” They work in 30 countries,in 13 of which they have mental health and psychosocial programs. When the Internationa Medical Corp steps in there is usually little to no existing infrastructure for mental health care. The Corps establishes community based mental health services and works to decrease stigma of mental illness. They train locals to recognize and treat the symptoms of mental illness and mental disorders and work to change attitudes towards mental illness. 14% of the global disease burden is attributed to mental illness. In emergencies, the percentage of the population suffering mental disorders doubles and at the same time whatever attention there was to mental health is diminished. However, there is only one psychiatrist per every two million people in developing countries so it is essential that community members be trained as best they can to assist each other. They conduct assessments of psychological needs in various countries such as Libya, Jordan, and Ethiopia to provide valuable information to local and international governments as well as other aid organizations. The Corps works to integrate mental health attendance in to primary health care.

The International Medical Corps also has a division for sexual and gender-based violence. We know that violence against women is rampant around the world and these transgressions lead to physical harm and deterioration of mental health. According to the United Nations Population Fund Worldwide, one in three women have been beaten, coerced into sex, or abused in some way, leaving billions of women in need of medical attention, including psychological care. The International Medical Corps functions with a “holistic approach,” attending to the physical and psychological trauma resulting from abuse and also working to prevent future incidences through community education. Their goal is to ensure that women who have been victims of violence have access to the medical, psychological, legal, economic and social resources they need to heal and function successfully in society as healthy, happy and safe individuals. This often means partnering with other organizations. In the Democratic Republic of Congo, they have partnered with the American Bar Association Rule of Law Initiative in the Care, Access, Safety and Empowerment Program to make legal assistance available to women. This is something that these women would not ordinarily have access to and their perpetrators would go unprosecuted.

The Corps is doing amazing work to alleviate the mental suffering of women internationally.
 

Sources

https://internationalmedicalcorps.org/GBV

 

http://internationalmedicalcorps.org/document.doc?id=18

 

WINGS – Family Planning NGO in Guatemala

February 28th, 2013

This week’s blogpost discusses an intervention addressing last week’s topic on Guatemala’s rural and indigenous community. WINGS is a United States based NGO focused on providing Guatemalan families with opportunities to improve their lives through family planning and reproductive health services. It aims to target men, women and children, the organization strives to improve women’s reproductive health through five separate programs:

 

Family Planning
In 1999, WINGS founded the Family Planning Program to provide educational tools and health access to low-income, rural and indigenous communities in Guatemala as a way to overcome many of the common barriers to healthcare such as linguistic and cultural issues, geographic isolation and inability to pay for services. These services include health talks in group settings, home visits, and counseling sessions. Uniquely, the program has both mobile and stationary clinics. The program strives to train Guatemalan-based organizations in family planning and reproductive health practices to distribute knowledge, experience and skills to people living in isolated geographic areas far away from clinics. These “Family Planning Promoters” travel to numerous communities and distribute birth control pills, condoms, and 1- or 3-month injectables.  Costs are subsidized to address financial barriers to healthcare. Here is a brief list of how the NGO has made healthcare economically available:

  • Each tubal ligation or vasectomy costs $40
  • Depo-Provera injections cost $3.13 each or $12.50 for an entire year/woman.
  • Sino Implant, a reversible contraceptive implant, costs approximately $25 and offers protection for 4 years.


Cervical Cancer Prevention Program
The Cervical Cancer Prevention Program was founded in 2001 in response to the disproportionately impacted poor, rural and indigenous Guatemalan communities. The program focuses to conduct pre-clinic education seminaries (charlas) in which women are provided with basic education regarding cervical cancer such as disease progression, risk factors, treatments and screening. A cryotherapy technique involving acetic acid allows low cost visual inspection of the cervix. The procedure detects precancerous lesions and treats with cryotherapy treatment during the same day. This intervention is able to reduce expense and time on the part of the patient. One of the barriers to obtaining screening and treatment for cervical cancer is the requirement that women must make several appointments. The same day treatment has been potential to save many women’s lives from cervical cancer. For women who need more advanced care, WINGS subsidizes all care at private clinics or at Guatemala’s National Cancer Institute.

  • Cervical cancer screening services are $12/woman. If a test is positive, the total cost for detection and treatment is $25 per woman.

An additional method to provide women with preventative care is to offer the HPV vaccine at low-cost to the women. There may be economic and geographical obstacles to address the high cost of the vaccine and make sure that the three series vaccine is delivered in concordance with protocol.
Youth WINGS Program
This program works with adolescents, school administrators, teachers, healthcare personnel, and parents to provide youth with vital sexual and reproductive education and services. In 2011, the program created a Street Theater Initiative that trains adolescents to perform art techniques in public spaces such as soccer fields and public parks. This initiative targets youth who are not enrolled in school. It delivers to the community messages about a wide range of reproductive and sexual health topics.

 

WINGS for Men Program
In Guatemala, men usually hold the decision-making power over their partners’ use of sexual protection and contraception, thus compromising women’s ability to have a say in their reproductive health. The program uses campaigns, peer education and community workshops to encourage greater sensitivity to gender issues and wellbeing of both women and men. This addresses one of the points I made earlier in my blogs that it is important to include men in the discussion of women’s reproductive rights.

 

Advocacy Program
The program strives to train women leaders in community leadership and basic advocacy skills. Through educational outreach to women and youth, it aims to empower women to advocate for their reproductive health rights. Women are trained to be community leaders to raise awareness for women’s sexual rights and encourage women to demand the reproductive and sexual health services that are guaranteed to them by Guatemalan law.

Resource:http://www.wingsguate.org

Pre-natal care for you!

February 28th, 2013

In the previous weeks of my blog I have talked about issues regarding prenatal care and maternal health as it pertains to a population as a whole; whether it was about how prenatal care and maternal health should be improved in a certain population or why one population was better than another. In my first blog I mentioned that I not only wanted to talk about these kinds of issues, but that I also wanted to learn something about prenatal care that I didn’t already know, not facts and figures but real medical information I could use when I eventually may need to know them.
So, this week I found a sheet that described some pre-natal problems and how to go about dealing with them. While I have heard of the first problem mentioned in the article, I didn’t really know about the rest. While many of you might already know about all of these, I’m betting that there is at least one other person in the class who doesn’t know them all. So, my random classmate, this is for you!

Morning sickness
Cause Hormones–and during pregnancy, levels skyrocket. As many as 85 percent of women suffer some nausea and/or vomiting, mostly in the first trimester.
Danger “Though morning sickness is uncomfortable and can be emotionally trying, there is no physical harm to mother or baby as long as the mother doesn’t become dehydrated,” says Joel M. Evans, M.D., director of The Center for Women’s Health in Darien, Conn., and author of The Whole Pregnancy Handbook (Gotham, 2005). However, severe morning sickness, or hyperemesis gravidarum, can rob you and your baby of essential hydration and nutrients.
Treatment Stay hydrated with water, sports drinks or whatever fluids you can keep down. Eat frequent, small meals and snacks high in complex carbohydrates, such as whole grains or vegetables. Sour and salty foods sometimes help, as may ginger. Ask your doctor about taking vitamin B6, alone or with an antihistamine. If you vomit more than a few times a day, lose weight or can’t keep down water, call your doctor. You may need intravenous nutrition.

Gestational diabetes
Cause Blood-sugar (glucose) levels soar because the body develops an insensitivity to insulin, a hormone that ushers blood sugar into cells. Some 3 to 5 percent of pregnant women develop gestational diabetes, usually in the late second or the third trimester.
Danger Elevated blood sugar can disrupt fetal metabolic function, so you grow a large baby, but not necessarily a healthy one, says Elizabeth Stein, R.N., M.P.H., a certified nurse-midwife in New York. A big baby is more likely to have birth complications and need to be delivered by forceps, vacuum or Cesarean section. Very large newborns may have low blood sugar, develop jaundice or breathing problems and need to be observed in the high-risk nursery.
Treatment Reduce blood sugar by exercising regularly and eating a diet low in sweets and other simple carbs. If blood-sugar levels remain high, you may need to consult a nutritionist and take prescription medications or insulin injections. Gestational diabetes disappears after delivery, though it predicts a 50 percent greater chance of developing type II diabetes later in life.

Preeclampsia (”toxemia”)
Cause Unknown, although a recent study found a higher risk when either the mom or dad has a family history of preeclampsia, suggesting a genetic link. Preeclampsia affects about 5 to 8 percent of pregnant women–often in the third trimester, though sometimes earlier–and is more common in first pregnancies and in women who have gestational diabetes, are over 40 or under 18, overweight, sedentary or carrying multiples.
Danger The mother may develop any of the following: high blood pressure; protein in the urine; swelling of the hands and feet; sudden weight gain of as much as a pound or more a day; blurred vision; severe headaches; dizziness and intense stomach pain. Preeclampsia can slow fetal growth and boost the risk of the placenta separating from the uterine wall. In very rare cases, it develops into eclampsia, which can cause stroke, liver damage, coma and death of mother and baby.
Treatment “The only true treatment is to deliver the baby,” Evans says. Bed rest and, in some cases, blood pressure medi-cation can prevent mild preeclampsia from getting worse. Mind-body exercises, such as relaxation breathing, meditation and imagery, have been shown to lower blood pressure, which can be helpful in the management of preeclampsia.

Thyroid disease
Cause Too much (hyper) or too little (hypo) thyroid hormone, resulting in an over- or underactive metabolism. Thyroid disease occurs in about 3 percent of pregnancies, and hypothyroidism is five times more common than hyperthyroidism. “Most of the time, thyroid disease precedes the pregnancy,” says Ashi Daftary, M.D., a maternal-fetal medicine specialist at Magee-Women’s Hospital of the University of Pittsburgh Medical Center. Many women aren’t aware they have it, however. The increased medical scrutiny received during pregnancy often reveals the condition, and many experts maintain that all expectant women should be tested for it.
Danger If not controlled, thyroid disease can increase the risk for miscarriage, fetal growth delays, preterm birth, preeclampsia, impaired neurological development and, in rare cases, death of the fetus.
Treatment For hyperthyroidism, a doctor may prescribe oral medications that suppress thyroid hormone production. For hypothyroidism, thyroid-replacement pills are generally taken.

Gum disease
Cause “Hormonal changes affect blood supply to the gums,” says Sally J. Cram, D.D.S., a periodontist (gum specialist) in Washington, D.C., and consumer advisor for the American Dental Association. “Pregnant women may experience red, puffy or irritated and tender gums that bleed easily, particu-larly during the second and early third trimester.” An estimated 60 to 75 percent of women get this “pregnancy gingivitis,” an aggravated response to the bacterial film, or plaque, that builds up on teeth. If neglected, it can lead to periodontal disease, an infection of the gums and bone under the teeth.
Danger Women with untreated perio-dontal disease are seven times more likely to deliver a preterm or low-birth-weight baby. The disease also can cause large, noncancerous “pregnancy tumors” on the gums that may require surgical removal after delivery.
Treatment Brush twice and floss once daily. If you need help controlling plaque, your dentist may recommend an antibacterial mouth rinse and professional teeth cleaning every two to three months during pregnancy.

Sex and the Ciudad 7: Designing Refugee Camps part 2- Haiti

February 28th, 2013

“The situation of women and girls has deteriorated since the earthquake. This is a country where the power imbalance between men and women takes many forms, from the most subtle to the most violent. And in Haiti, as anywhere, sexual violence increases dramatically during times of crisis.” Miriam Castaneda, head of the International Rescue Committee (IRC) in Haiti

When the earthquake hit Haiti in January of 2010, the world watched in horror as the death toll climbed: over 316,000 dead. As the international aid poured in, images of flattened buildings and crushed bodies transformed into images of neat rows of white and blue emergency tents and aid workers passing out bags of rice. But besides the appalling death and injury data, there were other important numbers: 250,000 homes destroyed, 30,000 commercial buildings destroyed, and 1.5 million newly homeless Haitians. Today, three years after the earthquake, despite all the efforts of the Haitian government and international aid organizations, the aftershocks of the disaster still persist. An estimated 520,000 people are still living in emergency camps where conditions continue to deteriorate as foreign aid dwindles.

As I began researching for this post I became increasingly overwhelmed by the amount of work it takes to build and administrate these emergency camps, and by the myriad barriers to the eventual reconstruction of destroyed areas. I cannot hope to convey all of the challenges and components to camp construction and improvement in one post. This post will be less about the specific design layout of emergency camps in Haiti, (I failed to find any in depth information on this subject- perhaps there is none, as most of the camps emerged organically as displaced people occupied any vacant spaces) but rather a look at the innovative interventions that have taken place in and around emergency camps to improve women’s health and safety. While hundreds of thousands of Haitians continue to live in the precarious conditions of emergency camps, there are some interesting and inspiring projects taking place to change this situation.

Safe spaces
In emergency camps the IRC has built eleven “safe spaces” for girls to meet and discuss the issues they are facing in the camps.
The testimonies of the girls who have participated in the programs at the safe spaces are compelling. One girl, Kristen at “Espas Pa Mwen,” meaning “My Space,” says her experience at the center has taught her that women and girls deserve to feel safe and secure. Before, she says, she thought that if a woman was raped it was her fault, that women incite men by the way they dress. “Now I know that my friends and I can dress as we like and that violence against women is never okay.”
Another girl, Roxanne says that, “Now I have the courage to talk to my parents about my rights, about the limits to how much work I should do at home. And about hitting — that it’s not the right consequence to not doing my chores.“
By establishing a specific location within the camps where girls can feel completely at ease, IRC’s safe spaces program has empowered girls to know their rights. Hopefully this program can expand beyond its eleven current locations.

Communications
One of the most interesting approaches to creating safer and healthier environments in Haiti’s emergency camps and transitioning neighborhoods is a focus on small communications interventions. The International Organization for Migration (IOM) has tried to use and build on existing systems in order to increase awareness about health and safety concerns. For example, IOM has developed programming for Radyo Tap-Tap, the radio station that plays on Haiti’s informal bus system, that aims to convey direct messages such as how to prevent cholera or now to deal with domestic violence. In addition, small kiosks were set up at strategic points around the camps where residents could leave anonymous notes reporting rape, violence and other concerns. Select letters were read aloud on Raydo Tap-Tap in order to raise awareness and, in some cases, try to locate the perpetrators of violence. Residents were also encouraged to call in to Radyo Tap-Tap to make similar reports and calls were geolocated so that IOM organizers could track which geographic areas were hearing and responding to the messages, and be able to find other ways to reach out to the areas that we not being serviced. By using the existing transportation network and making small strategically placed internventions, IOM was able to make sure the majority of the displaced population was aware of the health risks they faced as well as the available resources.

Mapping and land tenure
Another interesting aspect of IOM’s camp improvement and city reconstruction efforts has been innovations in open-source mapping projects to help identify needs and solve land tenure issues. Without knowing exactly where people are living, and how many people are living there, and furthermore, where all these people came from, it is impossible to design appropriate reconstruction projects. The ultimate goal is to help all camp residents transition back into a permanent housing situation, so it is essential that the urban planners have an accurate understanding of present and previous population distribution. The IOM has developed a comprehensive yet straightforward survey system that not only documents where people live and who owns what, but also specific risks to women’s wellbeing such as the number of suicides in the area, any perceptions of problems with alcohol or drugs, the number of widows and orphans, the existence of separate toilets for men and women, etc. Both aid workers and camp residents can document their spaces and upload them to a comprehensive map that helps aid workers design future interventions.

I had the opportunity to work in an architecture firm in New Orleans in the years following Hurricane Katrina and quickly learned how all the complications surrounding land ownership formed a major barrier for reconstruction projects. Many of the residents of the Ninth Ward had disappeared, evacuating to neighboring states or cities and leaving no information of their whereabouts. While there was a “if you build it they will come” mentality, the simple fact was that not everyone was coming back and this left the city and its urban planners in a quagmire. Additionally, what was healthiest in terms of city planning (creating a smaller footprint rather than restoring the entire ward) was culturally and psychologically problematic. I can only imagine what the situation in Haiti, a nation with much more complicated land ownership issues than the United States, would be like.

Other interventions include designing better transitional shelters, using construction and rubble clearing projects as a source for job creation and creating women-lead canteens for distributing provisions.

For more information, read a comprehensive report here.

On the Hotline

February 28th, 2013

In this post I will talk about a potential intervention to provide increased support for people suffering from mental illness in communities where finding that support is otherwise difficult.

 

Two things that stood out to me from our discussions/the movie this week were
1) the fact that there is a huge scarcity of doctors prepared to deal with the health issues of women in “developing countries” &
2) the importance of establishing a network of support for women– an organized structures so that they know their needs are important and can be addressed. An example that comes to mind is one group’s proposed intervention of developing a framework to make lawyers more accessible to women in need of legislative action.

 

Both of these themes play into mental health. Something that comes up again and again in researching mental health is that, in “developing” countries, there is a great shortage of health professionals specifically trained in mental health issues. This is partially due to stigma in the society; these professionals do not have the community support, nor perhaps the business, to firmly establish a foothold in a community.

 

I am intrigued by hotlines of health professionals in developing countries. As defined by the Development Fund, “health hotlines are medical call centers that provide health-related information, advice, and sometimes prescriptions to individual callers over a phone line” (1). To date, health hotlines have fielded 4 million calls, the majority of which are in “developing” countries. Women make more use of this service than men. In Bangladesh, for instance, women comprise 77% of callers. In rural areas, that number increases to 81% of total callers. These hotlines operate globally, everywhere from Mexico to Pakistan.

 

There are several reasons why health hotlines are especially helpful in developing countries. Perhaps the most important is the physical shortage of both primary care physicians and specialists in many communities; as we saw in the video, one obstetrician might serve thousands and thousands of people. Another issue is cost; even if a health professional is local and available, many people cannot afford to pursue treatment in this way.

 

How can the health hotline model be applied to mental health? Currently, these hotlines serve to address non-mental health issues. However, the service could easily be transferred to mental health. Health professionals trained specifically in mental health could join the hotline networks to offer their advice.

 

The majority of callers to hotlines in developing countries are women already. If women are suffering from mental health problems, they can consult with a doctor via a health network. This might alleviate shame they might feel because of social stigma; nobody needs to see them visiting a clinic, for instance. The idea of hotlines for mental health issues is certainly widespread in the United States. It is recognized that even knowing that somebody is there to help can be curative. The way that people in developing countries currently use the hotlines lends itself to an expansion into mental health, as well. Most of the calls handled by hotlines result in the caller self-caring (43%) instead of actually visiting a physician (35%). (1). In the case of mental health, a doctor can give callers advice on how to self-care. Perhaps the most important service that a health professional can give to some of these women is the acknowledgment that their problems are real and that they deserve attention.

 

There are several drawbacks to a hotline approach to mental health care. First, the service is only available to those who have phones. Luckily, hotlines often partner with the major mobile phone companies in a particular area. Second, there is something to be said for actual contact with somebody who will listen and help with a mental health concern. Given the current climate regarding mental health in these areas and a shortage of doctors in the foreseeable future, however, this service might be a way for people to receive the recognition and help that they need.

 

 

References
1. Ivatury, G., Moore, J. & Bloch, A. “A Doctor in Your Pocket: Health Hotlines in Developing Countries.” Development Fund. 2009. Web access.

Cell Technology 7: Mobile Phones as a Tool, Not a Solution

February 28th, 2013

 

As a component of the larger technological revolution sweeping across global markets, the spread of mobile phone use has profound implications for communication, the spread of information, and commercial transactions. As I’ve discussed over the last several weeks through this blog series, the oft-entitled “mobile revolution”  possesses unique characteristics in sub-Saharan Africa, particularly within the context of poverty alleviation. Mobile phone use in itself, as well as particular interventions we have examined, seems to have the potential to serve as a powerful tool for female empowerment. Although empirical research linking mobile phone use and mobile-based interventions to measures of female empowerment is quite limited, anecdotal evidence and program implementation results indicate that increasing mobile phone use amongst women in sub-Saharan Africa is a positive and encouraging trend. Yet, as I will explore further in my final blog post next week, I believe it is critical to maintain cautious perspective regarding any new concept or tool utilized in international development and international health. The tendency to characterize new tools and trends like mobile-based interventions as “silver bullet” solutions is a recurring theme through ought the history of international development efforts.

So, as we seek to accurately situate mobile phone use and mobile-based interventions within the broader struggle towards gender equality, I think it is important to take a step back and consider the range of ways in which a mobile phone can serve as an empowerment tool. I’ve touched on some of these channels over the last several weeks. In covering the various ways in which mobile phones can serve as tools, we simultaneously recognize the limitations of such tools; mobile-based literacy programming is not a replacement for quality education systems; Similarly, mobile-based maternal health information is not a replacement for access to high quality healthcare during pregnancy. Mobile phones serve as tools, not overarching solutions. Yet, as a tool, a mobile phone can function in many different capacities to increase a woman’s access to health services, financial services, and information.

A 2008 posting on a forum entitled “MobileActive.org: a global network of people using mobile technology for social impact” listed the following examples ways in which mobile phones can serve as an empowering tool for women:

“Mobile phones are slowly changing the lives of women who use them and the communities in which they live. They’ve created a path out of poverty for many women in the developing world, as microfinance and “phone ladies” running businesses increase in numbers. Mobiles are enabling translation for victims of domestic violence in the United States, providing Ukrainian sex workers with a way to safety, and protecting Philippine domestic workers in the Middle East. Mobile phones are giving voice to female reporters in Africa and encouraging free speech in Egypt. And as mobile phones become increasingly ubiquitous — they’re already at 3.3 billion and counting — they are likely to continue to influence the lives and societies of the women who use them in the future.”[1]

While the posting from which I pulled this excerpt does not cite specifics regarding these examples, the broader point made in the overview above regarding the impact of mobile phone use for women is, I think, quite important. In a global world, mobile phones serve as a tool in cross-cultural contexts and a means for communication in dangerous situations. In a world where migrant work is an increasing trend, particularly for women, mobile phones can serve as a connection to families and communities left behind, as well as a tool with which one can better navigate new communities and economies. First and foremost, mobile phones enable individual communication abilities, and communication, in turn allows for access to information. So many of the “critical issues” in international women’s health we have discussed in this class relate at some level to information access, and the ability to connect, or communicate, with resources. Herein lies the value in mobile phone use at its most basic level: mobile phone ownership can give women a voice, and with a voice comes the ability to ask for information, for services, for help.

Beyond its fundamental offering as a product, mobile phones serve as a platform for additional services. We’ve touched on three main areas in which mobile phones are being utilized as tools to assist women in sub-Saharan Africa; literacy, financial services, and health information, particularly regarding maternal health. Yet the range of mobile-based interventions currently in place around the globe stretches beyond these particular examples. Types of interventions currently targeting or including women include language translation services for migrants, emergency alert systems for specific communities of women, toll-free trafficking hotlines for sex-trafficking victims, text-message based HIV support groups, expression of political voice and opinion through mobile-based journalism, and mobile-based emergency medical alert systems. This list is not comprehensive; however, the key takeaway here is breadth; mobile-based interventions address mental health, physical health, emergency services, and a range of other needs. The potential impact of such services is, I believe, exponentially higher in sub-Saharan Africa where mobile communication leap-frogged past landlines, yet computer access is still quite limited.

Lastly, mobile phones serve as a critical tool for small-business owners, many of whom, in sub-Saharan Africa, are women. In Mobile Telephony: Leveraging Strengths and Opportunities for Socio-Economic Transformation in NigeriaJummai Umar writes that mobile phones have altered traditional social orders, both in terms of class and gender. In observing the impact of mobile phone use in isolated villages, Umar writes that:

“Some of the poorest women in the villages held in their hands instruments of global communication, thereby causing ripples in the highly stratified villages. Even a relatively rich person in the village had to walk up to a poor woman’s home for a service needed. Phone services were being retailed in these villages almost exclusively by women, since it was the men who went to the cities for work or trade or even to foreign countries as migrant workers, while it was the women left behind in the villages who needed to contact their men traveling or residing outside. Female phone operators don’t only benefit economically themselves, but contribute to the economic development of communities — and especially other women — at large. Mobile phones connect female traders to the outside world, allowing them to save valuable time and money that it would have cost for them to walk to visit suppliers or customers. Phones connect them to outside information, such as intermediaries and price information, allowing them to run better and more efficient businesses. In a survey of female market traders in the Obiaruku market region of Nigeria, for example, 95% of survey respondents said that mobile phones had a significant impact on their business.”[2]

In many sub-Saharan African economies, where formal sector job opportunities are scarce, informal training, shop-keeping, and small business ownership  serve as common means for income generation for both rural and urban women. As the bolded points in the quote above illustrate, mobile phones can play a powerful role in increasing the efficiency and profitability of small businesses. As we have discussed in class, financial independence is a critical component of the broader effort to achieve gender equality; thus, mobile phones can serve to expand economic opportunities for women as well.

In conclusion, much of the evidence discussed above is anecdotal, as mentioned. However, the goal of this post was to illustrate the range of forms mobile phones can take as a tool. They are a communication tool in themselves, a business tool, and a platform through which women can access services. As a tool, mobile phones appear extremely promising in the context of female empowerment. Yet it is critically important to keep in mind that mobile technology serves as a tool that can mitigate against various manifestations of gender inequality, not a solution that addresses the root causes of gender inequality itself.

 

 


[1] http://mobileactive.org/woman-and-mobiles-possibilties-and-challenges-developing-world

[2] http://mobileactive.org/book-review-nigeria-goes-mobile