Content originally written by Andrea Kissick for KQED – November 18, 2015.


I am addicted to TED talks. They breath new life into what was once the boring lecture.

Some of the smartest people have now become some of the most inspirational, thanks to the TED format and delivery.  TED is now its own global industry which includes smaller, more affordable, TED X talks,  a TED video channel and NPR’s TED Radio Hour.

TEDMED, which is kind of the sci-fi edge of medicine, is one of the biggest gatherings in the TED culture.

The TEDMED stage.

This year’s conference, which begins today in Palm Springs, is a who’s who in medical innovation. The list includes several people we  interviewed for KQED stories, including consumer genetics guru, Anne Wojcicki, scientists from UCSF’s genome editing project Crispr, and physicians specializing in mobile health.

There are also a number of speakers that are new to me.  Here are five topics that caught my eye.

MakerNurse co-founder Anna Young

Inventive nurses have been doing workarounds for decades, cobbling together broken medical devices or adapting a dressing for a tiny patient’s wound.   Think about it, who really knows more about how to improve patient care then the person who is at their bedside every day?  I initially heard about Maker Nurse at a conference last year, so I am looking forward to meeting Anna Young and her team from MIT’s Little Device’s Lab.  They are using the ideas behind the Maker Movement to help bring rapid prototyping of tools to patient care.

UCSD sensor innovator Todd Coleman

Todd Coleman is a UC San Diego Bioengineering Professor who develops tattoos for health monitoring in order to make medicine less invasive.  He is also a staunch public health advocate who is looking for ways to deliver sustainable innovations to under-served groups.  Click here for our recent story on KQED’s Future of You about the use of ‘smart tattoos’ to revolutionize diabetes treatment.

Bioengineer Sangeeta Bhatia

Sangeeta is both a trained engineer and physician — a rare combination. In her lab at MIT she works with technologies from the computer industry, like semiconductors, to figure out how to make livers for off-the-shelf transplants that don’t depend on a dying patient’s donation. Her team has developed breakthroughs in cancer treatment and Fast Company named her one of the most creative people of 2014.

Electrified Biogeochemist Kenneth Nealson

What is an electrified biogeochemist? Just the title is enough to peak my interest for this session.

Microbiome researcher Chris Mason

Chris Mason is best known for his recent project to map the New York subway’s DNA, which too more than a year to complete.  But Mason’s interests go beyond swabbing subway trains and urban mircrobiology. His research extends to cruise ships,  Chernobyl-struck villages and outer space.  The Cornell professor is currently working with NASA on a long-term survival plan for interplanetary survival.

You can follow the conference at #TedMed and @andreakissack.  All talks will be available on the TEDMED site after the conference.


Another Option is proud to be a part of TEDMED 2015.

Article originally written by Barrett Newkirk for The Desert Sun – November 18, 2015.

Health and wellness reporter Barrett Newkirk can be reached at (760) 778-4767, barrett.newkirk@desertsun.com or on Twitter @barrettnewkirk.


The annual meeting of minds known as TEDMED got underway in La Quinta on Wednesday with hundreds of attendees hearing from a diverse lineup of experts discussing work that often overlaps medicine and technology.

The annual conference, which is the independent and medically focused offshoot of the TEDTALK series, continues through Friday at the La Quinta Resort & Club. As many as 800 were expected to attend, many of them students, medical professional or entrepreneurs.

Chris Bi, a cancer drug researcher with Pfizer in San Diego, took a moment to snap photos of palm trees lit up at night just before the first round of speakers began. Bi said he came to hear from innovators who may help his own research, but also to get exposure to people working in areas far different from his research lab.

“I want to see how things can intersect to help with work in a lot of fields,” he said.

For those who can’t attend in person, live-streaming events are happening around the world. Talks will also be posted on the TEDMED website after they’re completed.

Speakers Wednesday ran between humorous and deadpan serious. They included people working with the latest in human gene technology and a part-time cardiologist/part-time folk singer who is about to have her second child.

Physician Pamela Wible speaks at TEDMED 2015. Photo credit: Jerod Harris/provided photo

Physician Pamela Wible speaks at TEDMED 2015.
Photo credit: Jerod Harris/provided photo

Family physician Pamela Wible began her 15-minute talk in a light mood before calling an alarm on the medical profession.

“I love the three things that people fear the most,” Wible said, “death, disease and public speaking.”

She then discussed the problem of physician suicide, reading suicide notes and showing photos from three cases. She said it’s “medicine’s dark secret, and it’s covered up by our hospitals, clinics and medical schools.”

Conference speakers Karen Stobbe and Mondy Carter stood in the conference’s social lounge after traveling from North Carolina. Their work also crosses unusual boundaries. They use techniques from improvisational theater to help caregivers relate with Alzheimer’s patients.

Stobbe explained that like with improv, caregivers often need to follow someone else’s lead.

“If you’re on stage and someone says ‘I have a duck in my room,’ and you say ‘No you don’t,’ you get into a horrible argument on stage,” she said. “With Alzheimer’s, if someone says ‘I have a duck in my room,’ you go see the duck in their room.”

Stobbe and Carter’s talk is set for Thursday morning as part of a session all about the human mind.


Another Option is proud to be a part of TEDMED 2015.

Article originally written by Barrett Newkirk for The Desert Sun – November 17, 2015.

Health and wellness reporter Barrett Newkirk can be reached at (760) 778-4767, barrett.newkirk@desertsun.com or on Twitter @barrettnewkirk.


Dozens of people touted as innovators in health and medicine will be in the Coachella Valley for TEDMED, the health-conscious offshoot of the TED Talks speaker series.

As many as 800 people are expected to fill the La Quinta Resort & Club for the annual conference, which will be held Nov 18 to 20.

The 50 speakers slated for the conference range from big names in public health like U.S. Surgeon General Vivek Murthy and renowned HIV researcher Tony Fauci to business people like “insect protein marketer” Shobhita Soor and researchers like Laura Schmidt, a sugar policy expert from the University of California San Francisco.

TEDMED 2015 speakers include (clockwise from top left) Roberta Ness, Kevin Tracey, Daria Mochly-Rosen, Laurie Rubin, Elizabeth Iorns, and Tony Fauci. Photo credit: provided photos.

TEDMED 2015 speakers include (clockwise from top left) Roberta Ness, Kevin Tracey, Daria Mochly-Rosen, Laurie Rubin, Elizabeth Iorns, and Tony Fauci.
Photo credit: provided photos.

Chris Elliott of Palm Springs made plans to attend TEDMED 2015, but as of this week it looked increasingly as if his job might keep him in Washington during the conference.

“TEDMED tends to be on the leading edge of things,” Elliott said by phone Wednesday. “It’s really looking into what health care is going to be 10 years or even 20 years from now.”

Elliott was a neuroscience researcher at the University of California San Diego before he founded MyBrainTest, a market research firm for products that evaluate brain health.

He’s attended TEDMED once before and remembered a speaker discussing the future use of smartphones to negate the need for patients to see doctors in person for routine diagnoses such as the flu.

This year, if he is able to attend, Elliott was looking forward to a session on the mysteries of the brain, which relates directly to his work. The session includes Roland Griffiths from John Hopkins University, who’ll speak on the use of psychedelic drugs to create life-changing experiences for patients.

Elliott said he was particularly interested to learn how those drugs might improve end-of-life care or even assisted suicide.

“That’s what TEDMED does, bring up topics that aren’t usually discussed openly,” he said.

With an attendance price of nearly $5,000, TEDMED in unlikely to attract people just curious to hear a few smart people talk science on stage. Livestreaming events are taking place across the country and internationally, but none have been announced in the Coachella Valley.

Talks will also be posted on the TEDMED website after they’re completed.

TEDMED 2015’s valley location is a departure from past years. TEDMED was held in Washington for four years until 2014 when the nation’s capital and San Francisco split hosting duties.

The change to the desert was an intentional effort to get away from big cities, and give attendees a calmer setting where they would have fewer outside distractions and not be scattered between several hotels, said TEDMED COO Shirley Bergin.

“We hadn’t really been under one roof in four years,” she said. “We wanted to feel like a community. We wanted it to feel like a place where people could relax, let their guard down and really start to dig into the issues at hand.”

The La Quinta Resort & Club is also known as the place Frank Capra wrote the Christmas classic “It’s a Wonderful Life.” That history of storytelling appealed to TEDMED organizers, and Bergin said they are already in talks with the resort about returning next year.

Unlike many medical conferences that focus on a particular specialization, TEDMED takes on broad subject matters that Bergin said draws professionals from a variety of disciplines. Doctors and medical researchers can end up sitting down next to designers and tech entrepreneurs.

“Every year is a slightly different year,” Bergin said. “Different delegations repeat year after year. We infuse it with new and old, those that understand TEDMED and know TEDMED and those who have never come before.”


Another Option is proud to be a part of TEDMED 2015.

Insights from personal observations and interactions with two ethnic communities in Sekong province.

September 30, 2015. By Cecile Lantican.

Sekong Province, Lao People’s Democratic Republic – Early in the morning, our team traveled to Sekong province. With less than 100,000 residents, Sekong is the second smallest province in Lao. It is also one of the poorest. Sekong province is located in one of the most remote areas in Lao: most of the province’s 42 villages are inaccessible by road because the infrastructure has been poorly developed.

2015-10-01 12.56.47

Sekong province, Lao PDR

Our mission was to pre-test communication campaign concepts, materials, and messages for the Lao government’s sanitation program among representative audiences in two rural communities. The district coordinator of the Center of Information and Education for Health (CIEH) arranged for our group to meet villagers of Toungkeo in the Lamam district. Lamam, which means “lowland plain,” is one of the four districts in the province.

The ferry we took en route to Ban Tok Ong Keo.

The ferry we took en route to Ban Tok Ong Keo.

From the ferry station, we drove through rugged terrain and winding mountain slopes. We passed by three small streams that indicated the richness of the water reservoir further up in the hills. It was almost midday when we finally reached Ban Tok Ong Keo. Four staff of the village health center greeted us and joined us for a quick packed lunch.

One of the streams we passed.

One of the streams we passed.

Nestled in between the undulating mountain slopes, the village was covered by lush vegetation following the recent rains. The air was hot and humid. We noted electrical posts in the village, but none of the houses were connected to the main lines. There was no mobile signal and our phones did not work. Considering the distance we traveled, I could imagine how tedious and expensive it would be for latrine sales agents or businessmen to travel here with their latrine products and supplies.  Sales agent never reached this village.

Sekong province is very remote.

Sekong province is very remote.

Almost all of the houses followed a similar construction design: they were made of wood and standing on stilts. Under the houses, we noticed piles of firewood and free-range animals like pigs, goats and cows. Villagers also use the space under these houses as work and rest areas.

A typical house in Ban Tok Ong Keo.

A typical house in Ban Tok Ong Keo.

We proceeded to the house where we would meet our pre-test participants, who had been waiting for us since that morning.

Ethnicity and Language

Sekong province is ethnically diverse. There are 14 ethnic minority groups, and only three percent of the population is Lao Loum. While the government verbally recognizes the use of ethnic languages, it officially encourages people to read and write only in ethnic Lao Loum.

Village women and children.

Village women and children.

 These villagers belong to the Alak ethnic minority, which reportedly constitutes 21 percent of the province’s population. The government categorically includes them among the “Lao Theung” ethnic group, the “mid-slope Lao.” The Alak women are known for weaving unique and high quality Lao “sin” (skirts).

A group of 12 women was assembled to meet us in one of the houses.  The field coordinators explained that people are shy about talking to foreigners, so we did not ask for their names out of respect for cultural sensitivity. Instead, we noted their ages and education levels. We asked the most senior woman her age.  She said,  “I [am] maybe between 50 to 60 years old.” She could not remember her birthday. This is common among Laotians; people do not always know their birthdays and in practice, a majority do not celebrate birthdays. When asked about the names of her 19 children, she could not remember them all.  But she claimed that all 19 children and her grandchildren from her three married daughters are living with her in one house.

Women participants in Ban Tok Ong Keo.

Women participants in Ban Tok Ong Keo.

Most of the women pre-test participants spoke limited Lao language. Only three women could read Lao characters. These women reported that they had reached fourth grade in the primary school before leaving school. The rest of the women had reached only the second grade.

The government built their houses. This could explain why the majority of the houses had similar architecture. One elderly male neighbor said,  “A few years ago, the government resettled us to our present location. We used to stay in a much lower ground along the river. But every time it rained, the river overflowed. We experienced flooding.” As a result, the government built their houses in higher plains and provided gravity-fed water to a cluster of households.

The government also built a latrine for every family. But as the number of families grew over the years, others did not build more toilets. Older villagers in particular reverted to open defecation.

A government-built latrine.

A government-built latrine.

In the neighboring village of Ban Nava Kang, we met eight Alak women. None of them had attended school. They could speak very limited Lao, but could not read Lao characters. Two of the older women were asked of their age. Like the older woman in Ban Tok Ong Keo, they could not also tell us their real ages and birthdays.

Households in this village do not have latrines. We were informed that everyone goes to the open field to defecate. This observation was validated by our pre-test materials.

 Rethinking our BCC Materials and Messages for Sanitation

Among the four communities where we tested the proposed campaign concepts, messages and materials, the responses of villagers from Ban Tok Ong Keo and Ban Nava Kang led us to believe that open defecation is strongly related to factors specific to the culture of groups that practice it. The Alak villagers we met have particular ways of thinking about latrines, and they reacted to situations or events as they understood them.

Men participating in our pre-test.

Men studying our initial communication materials.

The Alak villagers of Ban Tok Ong Keo did not maximally use the pour-flush latrines built by the government. The men respondents suggested the following reasons for this disuse:

  • It is a hassle to collect water before defecating.
  • The water source is too far from their houses.
  • They would need to carry a lot of water because they have to clean the latrine after using it. If they do not clean it, it will smell bad because it is near their house.
  • They prefer to defecate in the open because they can do so easily. Feces will dry up quickly outside in the heat, rather than in a confined and unpleasant-smelling toilet.
  • They worry that neighbors will notice them walking to use the toilet.
  • They prefer the privacy offered by defecating in the bush instead of at home.

The Alak men agreed that latrines would help ensure their daughters’ safety, but the current structure of their toilets does not offer privacy. The Alak women of Ban Nava Kang told us that our visual showing the girl who feels the need to relieve herself was a woman who feels the pain of giving birth. After further probing, one of the women associated the girl’s stomach ache with “diarrhea” from eating unclean food.

Pre-testing our communications materials.

Pre-testing our communications materials.

These two Alak communities showed us that having a latrine was not among competing priorities of their daily needs. The open field where they defecated was seen as more convenient than a latrine. The open field was big, unlike the very small, closed, and hot latrines.

Open defecation has been part of their culture. It is a behavior that they have acquired over time. Hence, these communities could be resistant to changing their sanitation practices. They may choose to stop open defection, but it may take time.

The environmental conditions surrounding these villages further shaped their attitudes in favor of open defecation. In Ban Tok Ong Keo, the geophysical conditions of the village make latrine construction difficult. The soil can be too hard, and the ground water is sometimes too low. Thus, villagers were not motivated to construct new latrines.

This pre-test experience taught us valuable lessons about our communication approach to change sanitation practices among ethno-linguistic populations. It led us to strengthen the effectiveness of our approach by making it adaptive to specific local contexts.

Initially, our team agreed that a communication campaign to improve the sanitation practices of Lao communities like the Alak would require:

  • Determining the socio-cultural beliefs and ecological/environmental context of target communities,
  • Identifying the relevant communication networks, decision-making processes, and social leadership that could be utilized by the community to facilitate change, and
  • Identifying and building the capacity for trusted sources of information in the community.
CAPTION

We left Sekong province with valuable insights.


The National Centre for Environmental Health and Water Supply together with the World Bank’s Water and Sanitation Program and other development organizations have partnered with Another Option, LLC to create a series of communication products that will help to inspire the use of improved sanitation facilities in rural areas.

By Shane Powell.

Champassak province, Lao People’s Democratic Republic – Traveling the last stretch of road to Pha Kha village feels like looking out the window of an airplane that’s just broken through storm clouds and been greeted by a rich, blue sky.

Wet-season rice paddies – the road leading into Pha Kha village. Photograph by Judy Souvannavong.

Miles of dusty, potholed roads suddenly give way to vast fields of fluorescent-green rice paddies. The scene sweeps calmly to the horizon in every direction, broken only by streams and scattered, flattened rocks positioned like small islands.

Noy, 19, has spent most of her life in Pha Kha village, together with her mother and older sister. She says she likes the clean air and relaxed pace and she wants to raise her 9-month-old son here with her husband.

But having recently spent two years, caring for her younger cousins in the country’s capital city, Vientiane, Noy explains a few things she had to change once she returned home.

Noy, whose name means ‘small’ in Lao language, has helped to trigger big changes in her community in southern Lao PDR. Photograph by Cecile Lantican, Ph.D.

Noy, whose name means ‘small’ in Lao language, has helped to trigger big changes in her community in southern Lao PDR. Photograph by Cecile Lantican, Ph.D.

“I never realized how convenient having a bathroom would be,” she explains. “When I came back (from Vientiane), there was no way I was going to continue going into the fields. It was so uncomfortable.”

Noy uses the words ‘uht aht’ to describe how she felt at losing the convenience and dignity she previously had in Vientiane, forced to find a tree or bush to crouch behind. Roughly translated, the words connote the feeling of having an awkward itch that you can’t scratch.

“I told my mother ‘we’re building a bathroom’,” she says, recounting how her decision “was final”. A few weeks later, her husband and brother-in-law had finished building a brick bathroom just next to her home.

“Noy told us we had to have one,” her mother recalls. “At first, I didn’t really think it was necessary… I thought we should spend the money on something else. But now I can’t imagine not having it… And I wouldn’t want my daughters having to go without one.”

Noy’s family latrine was built in early 2014. Neighbors followed suit in their own construction of latrines, significantly raising sanitation standards in the surrounding community. Photograph by Judy Souvannavong.

Noy’s family latrine was built in early 2014. Neighbors followed suit in their own construction of latrines, significantly raising sanitation standards in the surrounding community. Photograph by Judy Souvannavong.

It wasn’t long before Noy’s neighbors also started building bathrooms. A construction salesman who lives just up the hill from her started designing a series of connected latrines and washrooms for his family that now rivals the size of smaller homes in the village.

While sending all the young women in such a village off to spend time in bigger, developed cities is not likely the answer to inspiring better sanitation in rural areas, Noy – whose name literally translates as ‘small’ – is a good example of how one person can start to catalyze a community.

“It’s happening now… it’s slow, but it’s happening,” explains Mr Bounpone, the head of the cluster of communities of which Pha Kha village is a part.

But arguably the movement to build latrines in Pha Kha is not so slow. It was just two years ago that the community had less than five latrines for more than 150 households. Today, the community has 78. Village authorities estimate that if solutions can be found to some of the village’s water problems, nearly every home will likely have a latrine in two more years.

“We want the status of having a clean and healthy village,” Mr Bounpone says. “The people here see others building latrines and they want them too. For some, it’s still a matter of money. For others, we first need to work on the locations for them to build.”

This is precisely the type of progress and development that the Lao Government’s Ministry of Health (MoH) wants to see in rural areas.

“We know that with the right inspiration, people will take ownership for their family and their community’s health,” says Dr Bouakeo Souvanthong, Chief of the Environmental Health Division in the National Centre for Environmental Health and Water Supply under MoH. “But it will take people seeing and realizing the benefits of a few, before it spreads to many.”

As for Noy, she says there are other conveniences she misses from living in a larger city. “Ease of shopping… some of the food… and nobody wanting to use my bathroom,” she laughs. “If (my neighbors) keep using this one, it’s going to overflow!”


 

The National Centre for Environmental Health and Water Supply together with the World Bank’s Water and Sanitation Program and other development organizations have partnered with Another Option, LLC to create a series of communication products that will help to inspire the use of improved sanitation facilities in rural areas.

Shane Powell is a communication specialist who has worked on behavior development issues for more than 10 years in Southeast Asia. His areas of work focus on health, nutrition, education and natural resource protection. Shane currently resides with his wife and two cats in Vientiane, Lao PDR where they maintain vast collections of tea and soap from around the world.

SOCIAL AND BEHAVIOR CHANGE COMMUNICATION:

Factors Influencing Rural Women’s Decisions about Sanitation in Lao PDR

Another Option’s social and behavior change communication (SBCC) is designed to reflect target audiences’ personal motivations and beliefs and the cultural and environmental factors that influence them. SBCC strategies range from mass media and digital communication to social impact gaming. It also includes interpersonal communication (IPC) and peer education, and advocacy and public relations to affect policy change and cultural and social norms.

Creating an enabling environment that supports individual and societal change requires a strategic approach. Societal and cultural norms as well as policy and regulations are the barriers that prevent change. Advocacy activities range from strategic public relations, thought-leader meetings, and engagement or participation in problem solving.

Program design begins with data and Another Option has extensive experience in designing qualitative and quantitative research to offer insights and information about key populations and segment audiences and to design effective programs.

Under a World Bank-funded program, Another Option developed a social and behavior change communication program on rural sanitation in Lao PDR. Other donors include UNICEF, Plan International, and SNV Netherlands Development Organisation. Dr. Cecile Lantican led the Lao activity and following a field visit meeting with women in the communities and rural areas she captured her observations in the following blog.


What motivates women?

By Cecile Lantican, Ph.D.

From June 7-13, 2015 I joined the team of Another Option LLC, commissioned by World Bank under the Water and Sanitation Program in Lao PDR to observe people’s motivation to change and improve their sanitation practices. This is a new assignment for me after six years working in this country on changing people’s mindset and behaviors that put them to risk when they interact with their domestic animals and wildlife that carry zoonotic diseases.

I attended a ceremony hosted by the Pinh District government in Savannakhet to recognize villages that have made progress in addressing poverty and achieved improved sanitation status (declared Open Defecation free). I talked with Lao women and listened to their stories about their aspirations, needs and motivations that may have influenced their decision to seek for better status in life. I was amazed and fascinated interacting with Lao women from the south who I saw to be very hardworking, loyal to their families, hospitable and warm to visitors.

Young Lao Loum girls in their traditional Lao dresses.

Outlining the situation of rural women in Lao

I have worked with rural and urban women in this country, but I noticed that there is limited scientific information about how Lao women make decisions that affect their lives. Ethnic, geographic, and ecological differences create variations in the Lao women’s way of life. Ethnicity persists through language and dress patterns.

Illiteracy among rural women is high, especially in certain ethnic groups where cultural attitudes hinder girls from going to school. Parents force them to drop out to assist with the farm or domestic chores. Their capacity to obtain employment and participate in decision-making is severely hampered by their low level of education.

Early marriage is common among rural women. Most of them marry at the age of 16 or 17 years. A UN report in 2012 revealed that almost twice as many women marry and bear children before the age of 18 in rural areas (43%) than urban areas (23%). The total number of children of women with no education is nearly three times greater than that of women with higher education1.

The majority of women, especially those in ethnic communities, suffer from poverty, food insecurity, and unavailability of health services. The Lao women carry a great responsibility in the family. Apart from housework, and child rearing, they are also engaged in generating income for the family through labor-intensive work like collecting non-timber forest products including wild animals, weeding in the rice paddy, harvesting, planting cash crops and selling these products in the local markets, tending their animals, weaving, and managing family food stores.

More women are engaged in earning income for the family.

Rural women face complex decision-making when it comes to meeting their basic needs. Most often, they follow their elders’ advice. They feel restrained from expressing what they actually have wanted to happen in their lives.

The critical role of education for women

In Ban Sa-phang village, Mounlapamok district in Champasack province, a young mother of a three-year old boy married when she was nineteen. She did not finish primary school because she had to stop and help her parents on the farm. She married the first man who came into her life who promised her a better future since he was working in Thailand.

She was emotional when she sad, “I dreamt of living in a big house and wanted to earn money to buy food for my family, but that did not realize. My husband’s income from being a construction worker at the border, and most of the times seasonal, is not even enough for us.”

“If I was given the chance to have full control of my life, I would finish schooling. I think my life today would be different,” – Mother in Ban Sa-phang

She recognized that lack of education hampered her from finding work outside the farm. Unlike other women in her village who had entered their first year of secondary school and worked as migrant workers, she could not find work off the farm.

Women supporting their families

Anecdotal evidence showed that an increasing number of undocumented Lao women migrate to Thailand as workers in service and domestic sectors, vulnerable to abuse, exploitation and human trafficking.

Madame Bunkhong, 55 years old, was one among the attendees of the ceremony in Pinh district. She married at twenty-two and had four children.

After college, she worked in a private bank. But after two years, she had to stop working to take care of her sick father and to help her mother manage a small food stall at home. “I gave up my desire of being an employed and earn money for myself because I needed to follow my family’s decision.”

“ I wish good life for my family – to have a home and always have food on the table.” – Mdm. Bunkhong

“If I had complete control of my life before, I wouldn’t give up my dreams.” She affirmed that she is happy with her own family now, but it could have been more self-fulfilling if she had decided for herself.

Making decisions to improve sanitation

Looking closely at rural women who chose to access improved sanitation, I approached a woman who attended the PSI and district Nam Saat-led sales event for latrines. Her name is Madame Tongkham, 30 years old.  She has three children.  She married at eighteen.  Six months ago, her husband left them. She was aware that he may never comeback having heard that he has another woman.

“I should decide now for me and my children’s life.” – Mdm. Tongkham, Ban Pinh, Muang Pinh, Champasack.

It was her third time attending the latrine sales event in the village. The village council members encouraged her to attend. Earlier, she could not decide for herself because she needed to consult her husband. During this event, she ordered from the sales agent the delivery of one latrine package worth LAK 500,000. She made a deposit of LAK 50,000. “I felt devastated when my husband left. I worry about my three boys, and my old and sickly mother living with us. I have no regular income. My family now only relies on my niece who works in Thailand,” she said. “I did not finish school. I can only do farming and sometimes go with neighbors to the nearby village to harvest coffee beans. From these activities, I earn some amount to buy food for the boys,” she added.

I asked if someone had discussed the health risk of defecating in the open with her.  She replied, “ No one gave us briefing on the health risk. But I do remember that sales agent told us that having a toilet would give us convenience, safety and privacy.”

What made you decide to have the toilet this time?, I asked. “I have waited for my husband to decide.” She continued in her low voice. “ I need this toilet. I have fears when my boys defecate in the river along with other young boys. Many young boys have died of drowning in the river. My old mother needs it too,” she said.

Laotian women as community leaders

Laotian women’s confidence and self-esteem increase when they have greater knowledge, economic assets and income-earning capacity. Their low participation in decision-making is often due to stereotypes in their culture, which assign men the role of decision maker in the family and domestic affairs.

I met two Lao Women Union (LWU) community leaders at the ceremony. The district government recognized their unwavering support to uplift the living conditions and promote the role of rural women through training and participation in community affairs where their knowledge, skills and decision-making are essential.

Mdm. Phavoun (left) and Mdm. Khamphet (right) display their certificates of recognition.

The two women received training on various women-related issues from the national chapter of LWU that would empower rural women. Under the rural poverty reduction program of their district, they include provision of information on importance of education, sanitation and hygiene.

This travel provided me anecdotal evidences that rural women in Lao PDR can decide for themselves and their families. Under difficult circumstances, they can cope with their situation and can find solutions to their problems. They can improve their social status if given the opportunity of social support, correct information and networking.


1 Country Analysis Report: Lao PDR. Analysis to inform the selection of priorities for the next UN Development Assistance Framework (UNDAF) 2012-2015, UN in Lao PDR , Vientiane.

It starts with hand washing. The basic preventative measure to staying well from a wide array of infectious diseases is to correctly wash your hands with soap and water.

In grade schools all over the world, students learn songs that teach them how to wash their hands. In the United States, signs are posted in public bathrooms reminding us to wash our hands.

But, really, how many of us wash our hands thoroughly and correctly every time? And, if asked, how many of us could demonstrate the correct way to wash our hands?

It sometimes is very hard to understand that a behavior as simple as washing your hands with soap and water can combat an illness as deadly as the Ebola virus. But it can.

That’s why WCI’s social mobilizers are participating in refresher training on hand washing and taking that behavior to their communities.

Continuing the Hand Washing Behavior

During the height of the Ebola virus outbreak in Liberia, chloride-water solution stations were installed at public buildings and a number of households, and they were regularly used. People of all ages in both urban and rural communities were instructed on how to use the chloride solutions.  Among the first messages disseminated in response to the Ebola outbreak was to wash your hands with chloride-water This message was strongly supported by the government of Liberia’s Ministry of Health and disseminated through social mobilization activities like WCI under the Ebola-Community Activity Platform (E-CAP).

In Liberia, reported cases of the Ebola virus are diminishing, and the shift from chloride-water to soap and water is underway. Hand washing remains a critical long-term public health strategy for Ebola prevention, and it is important that people continue the behavior as the country moves forward.

Social Mobilization Training

Though we all think we know how to correctly wash our hands, it is important to have refresher training. WCI organized a refresher training session for its social mobilizers in Tubmanburg in Bomi County. The training was led by field officer Morris Taweh. In addition to the refresher on how to correctly hand wash, there was a discussion with the mobilizers on how to ensure the practice of hand washing continues in homes, schools, and public places, and throughout rural communities.

With the expense of chloride and reduced availability of subsidized sachets, the focus is on using soap and water. Iron Soap, a locally-made soap, is affordable and widely available.  Iron Soap can be shaved and used as a powder for cleaning or used in its original solid block form for hand-washing.

Mobilizers at the training session explained that it is just as important to promote hand washing with Iron Soap as it was to use chloride solution to keep Liberia Ebola-free in the future. They focused on how to reinforce effective hand-washing techniques and make sure people take their time and don’t rush through the steps. . “We need to figure out simple ways to remind people to do it and do it right,” one mobilizer said.

Training poster illustrating the steps for effective hand washing

Training poster illustrating the steps for effective hand washing.

At the training session, Morris shared the graphic instructions on how to correctly wash hands. Then, the mobilizers each demonstrated the correct hand-washing procedure and talked through each step so that they could help reinforce the behavior in their communities.

A mobilizer demonstrates hand-washing following instructions from the training chart.

A mobilizer demonstrates hand-washing following instructions from the training chart.

After finishing the demonstration, a number of the mobilizers suggested that the chart should be posted at hand-washing stations in schools and other public places as a good reminder of the steps.

WCI will continue to demonstrate hand washing  as a preventive action against Ebola infection as part of its community mobilization efforts. WCI plans to produce the graphic as a flyer to be distributed and posted in homes and schools and throughout the communities.

“Washing hands is a critical behavior for preventing the spread of the Ebola virus,” Morris reminded the group.  “Everyone knows it. Let’s make sure they remember to do it.”

Women’s Campaign International currently is an implementing partner with UNICEF and USAID’s Ebola-Community Action Platform (E-CAP) in Liberia.

In collaboration with UNICEF, Women’s Campaign International (WCI) is using its grassroots approach to tell rural communities about Ebola prevention in the remote southeast region of Liberia. Travel to southeast Liberia is a major challenge: it is difficult and expensive to reach this part of the country because it is very remote and the infrastructure is less developed.

WCI Program Manager Rebecca Martinez visited River Gee and Maryland Counties to conduct a one-day training with 28 communicators in Fish Town and Plebo. She joined the WCI regional field officer Dominic Dennis and gave this report back about her visit and her observations.

Rebecca flew in and then travelled four hours by motorbike to reach southeast Liberia.

Rebecca flew in and then travelled four hours by motorbike to reach southeast Liberia.

Challenges in the Southeast

River Gee and Maryland’s location has affected these communities’ assessments of the Ebola virus. The region has been fortunate in that there have been only a few cases of Ebola. However, this has contributed to a lack of belief that the disease is real. The mobilizers have said that one of their biggest challenges is convincing people to use preventative measures – such as hand washing with soap and water, not touching people, or following certain protocols at funerals – against something that they have heard of but not personally seen or experienced.

Regional community leaders explained that if people do not see Ebola, then it is not real. One mobilizer said that if Ebola came to River Gee, “plenty of people would die because belief is not there”.

These counties’ citizens follow very traditional burial practices. There also is a high level of fear and distrust of the Ebola Treatment Units (ETUs) and burial teams. There is a fear among the citizens of being stigmatized if they go to the ETU, so they have stayed away.

That is very different from others parts of Liberia. There have been positive reports of Liberians leaving the ETUs healthy, and people are beginning to believe that it is possible to survive the ETUs. This message still needs to be strengthened within the communities, and this has been a central part of WCI’s work in the region.

WCI’s Approach to Fight Ebola

Mobilizers reviewing training materials on Ebola prevention.

Mobilizers reviewing training materials on Ebola prevention.

The trainings in Fish Town and Plebo emphasized Ebola prevention practices and basic information about what the ETUs are and how they should be utilized. In addition to the classroom training, there were demonstrations and practice by the communicators on effective hand washing with soap and water and correct preparation of cleaning solution.

 

Though there have been few reported cases of Ebola in the southeast, there are rumors and misinformation about the virus, its treatment, and the ETUs. A portion of the training was spent clarifying incorrect information about Ebola, the ETUs, how people become sick, and how to respond if someone seems sick. Dennis and Rebecca spent considerable time explaining when someone should go to the ETU and what to expect when a patient goes there.

 

There is a lot of stigma surrounding the ETUs. People are afraid to go to them because they believe they will die there. One of the roles of the social mobilizers is to make the ETUs less threatening by explaining what type of health care the patients receive there and that they are there to help, not harm.

Successes 

The mobilizers told Rebecca about changes they see among their communities in Maryland and River Gee. The people are increasingly receptive to the government of Liberia’s message that “Ebola is Real”, and they understand that people that visit ETUs can and do survive.

For hand washing, Samaritan’s Purse previously distributed hand-washing supplies and installed hand-washing stations in front of almost every household and place of business in Maryland. Though behavior change requires more than knowing what to do, having the necessary supplies available makes it easier for people to adopt preventative practices.

WCI’s mobilizers are pleased with the progress they have seen and will continue their strong efforts to keep Ebola out of these communities where its prevalence has been low so far.

“Sailing forward to a brighter future for Liberia”.

“Sailing forward to a brighter future for Liberia”.

Additional comments from field officer Dominic Dennis

 “Since the Ebola outbreak in Liberia, many other NGOs have been trying to fight this deadly virus that causedmany people to lose their lives. Among those groups helping to stop the spread ofEbola, WCI has partnered with the Liberian Ministry ofGender and Development and, through funding from the USAID and privatedonors, they are implementing multiple programs to empower the National RuralWomen Program of Liberia. The National Rural Women Program has worked with more than 20,000 rural women and men for many years and since three months ago they have established a strongnetwork which stresses community engagement to fight against Ebola across Liberia, including in the southeast region. WCI empowers the national Rural Women by building their social mobilization through training them in the area of preventing the spread of Ebola in more than 85% of the communities in the southeast including Sinoe County.

WCI has trained eight mobilizers, forty-one communicators, eightcounty leads and forty community leads  in Sinoe, Grand Kru, Maryland,and River Gee Counties. Two assistants have been employed in the southeast.

In partnership with UNICEF, our organization is still carrying on thepreventive measures of the awareness of Ebola activities in thecommunities in the Southeast.Through E-CAP, the Rural Women have also been trained to use the iPhone to take pictures and to send reports using the U-Report.”

When a public health emergency like the Ebola outbreak occurs, sharing correct information and managing uncertainty at the local level are critical steps towards preventing the spread of the virus and reducing deaths.  Working closely with the government of Liberia, Women’s Campaign International (WCI) has used their established reach – 20,000 volunteers that are part of the National Rural Women’s Program in all 15 counties, including remote rural populations – and presence in the communities to conduct Ebola prevention and response.

             WCI’s Approach to Communication on the Ground

In a conversation with Wilfred Kokeh, WCI field officer for Lofa, Nimba, and Grand Gedeh Counties, in February in Kakata, he talked about how WCI has applied its social mobilization skills to support USAID, UNICEF, and the government of Liberia’s response to the Ebola virus.

WCI field officer Wilfred Kokeh (left) syncing phones with Rebecca Martinez, WCI Program Manager

WCI field officer Wilfred Kokeh (left) syncing phones with Rebecca Martinez, WCI Program Manager

Mr. Kokeh explained that WCI’s approach differs from most other NGOs in that it is “bottom-to-top” to effect change. The overriding goal of WCI is to help people help themselves by working within their own communities to help their neighbors learn how to work independently, and create sustainable livelihoods. WCI does this by being community-oriented and what activities it starts it eventually transfers to local authorities to continue.

For the Ebola outbreak, Mr. Kokeh said that WCI “knew how to respond [to the outbreak]” from their democracy work “going door-to-door in the community.” He went on to say that “they have been successful doing exactly that” and it has made a difference in Ebola.

WCI field officers from l to r Wyaette Willet Moore, Binda Freeman, Morris Taweh, and Wilfred Kokeh (not pictured: Dominic Dennis).

WCI field officers, from left to right: Wyaette Willet Moore, Binda Freeman, Morris Taweh, and Wilfred Kokeh (not pictured: Dominic Dennis).

When the first Ebola cases were reported in Lofa County in early 2014, it spread quickly throughout the communities. WCI was working in the community on civic participation in run up to the elections and in August 2014 was asked by the Ministry of Health and Social Welfare to apply its social mobilization skills to the Ebola hotspots to deliver public health messaging and logistics for the delivery of food and water.

Mr. Kokeh succinctly summed up why WCI was asked to perform this activity, [WCI] was’ “not recognized as experts in Ebola, but […] as experts in Liberia.”

WCI is a unique NGO because of its close ties and relationships to the communities where it works. Community members interviewed talked of how they “felt relief” when they saw that NGOs including WCI were part of the Ebola response, and they became worried when stories circulated that the NGOs were leaving.

Wyeatta Willet Moore, WCI field manager for Montserado and Grand Bassa Counties, reiterated this response from the communities: “like after the [civil] war – NGOs coming in gave us hope and a return to normalcy.”

WCI social mobilizer (right), Makoya  Komara, and communicator (left) Mamie Sendolo, Nimba County

WCI social mobilizer (right), Makoya Komara, and communicator (left) Mamie Sendolo, Nimba County.

             The Critical Role of Women in the Ebola Response

WCI is women-centric and its core principles are to elevate the role of women in society with an emphasis on the rural, low-literate, and poor. In its Ebola social mobilization gender plays a role. It is estimated 90 percent of their mobilizers and communicators are women; the mobilizers live in the communities where they are conducting the work; and they are trusted and respected members of their community – teachers, midwives, pastors, and business women.

WCI is a partner in the USAID Ebola-Community Action Platform (E-CAP) working in Liberia.

WCI has five field managers assigned to five regions in Liberia. Each field officer is responsible for approximately 40 mobilizers and 50 communicators. Wilfred Kokeh is the field manager for Lofa, Nimba and Grand Gedeh Counties that cover a geographic area of 1000 miles. Wyeatta Willet Moore is field manager of Montserado County that includes Monrovia and Grand Bassa County. Morris Taweh works in Bomi, Grand Cape Mount and Gborpolu; Binda Freeman oversees Bong, Magribi and River Cess Counties; and Dominic Dennis is field manager for Southeast Liberia – River Gee, Maryland, Sineo and Grand Kru Counties.