When we are designing for other cultures, we are at risk of imposing our own cultural perspective. The most relevant approach is therefore to take a step back and guide them to go through the process themselves.
Naomi Saville works for a Nepalese research organisation helping mothers and infants in Dhanusha district in the plains of Nepal. There are ways in which they work that we can draw upon for designing with other cultures.
Women come together in groups with a trained Female Community Health Volunteer (FCHV) who is part of the government health service. The FCHV is the local person and point of contact between the group and organisation, thereby allowing the groups to evolve without outsiders. This gives the women ownership and makes the groups more replicable. They start with a problem and then through games and discussions find ways of raising awareness and tackling the issue. Over the next six months to one year they implement their plan. With groups that have limited or no literacy, it is important to make the process inclusive and empowering. These groups have taken role plays and card games into their communities. The cards illustrating the problems and solutions have been drawn by a local artist, and with cultural sensitivity. Other activities for low literacy groups could involve theatre, puppets, models, animation and films.
The groups generate a new ‘group think’ which starts to shift some of the cultural taboos. At one time this led to a march of 800 women against the cultural practice of women being isolated in the cowsheds or outhouse during their first six days after delivering a baby.
The groups follow a participatory action research model of:
Researching or identifying problems > Prioritising problems to be overcome > Designing strategies to overcome prioritised problems > Doing the strategies > Evaluating how well it went and what to do next to improve them > Then moving on to a new problem or issue.
This design is for a Women’s Health Programme (WHP) run by the Himalayan Permaculture Centre (HPC),2 in Humla a region in North Western Nepal. The design was made in 2011 at the beginning of the programme. Similar programmes have been run previously in the same area. I conducted interviews with Hom Maya Gurung, district co-ordinator and women’s health specialist, with Chris Evans translating.
This area of Nepal is one of the poorest regions in the country. There is little or no health care, basic hygiene is poor and there is no knowledge of women’s health and self-awareness. Women in the area suffer from more types of diseases and more seriously than in other areas.
With HPC’s input women can bring improvement to their own health, teach others and become more self-reliant. To have easier, happier lives, be more aware, have less children, better communication with their husbands in running the house/land, more help from their husbands and better techniques for farming. Now in Humla, women say they have no value in living; my vision is that people will think, ‘What can I do in my life?’
There is big gender differentiation in this area in Nepal and a very patriarchal system. Things are not as open to women as for men – they can’t travel so easily. There is pressure to have boys; if they have girls then it is seen as the women’s fault and there is pressure to have more children. There are cultural taboos around childbirth and menstruation, relating to diet and hygiene. Men generally own land and control money and women have little access to credit. Women do most of the work around the house, family and farm.
By and large men do not understand about women’s health. When men get sick they rest or go and get treatment straight away. When women get sick they get treatment less frequently because they worry about who will do the work.
Once at a women’s health camp there was a drunk man accusing the programme of disturbing gender roles. Men are part of the system and part of the cultural patterns in the house and wider community. There have been many cases of reactions from men.
There is only me to do the work, no one else is trained. We have not found anyone as yet that I could train to support my role.
Not understanding, lack of education, fear from patriarchs, men not wanting to share power, unwillingness of women to rock the boat. There are strong beliefs keeping taboos in place. Even if the taboos are broken, they find negative things that happen to confirm that the taboos need to be kept.
There is slowly more awareness. Women are now allowed to own land in Nepal. Women also see other people who have made changes and realise that there can be change and the benefits it can bring.
Marriage at a young age, too many children, eating last when all the best food has gone, not getting diagnosed or treatment soon enough, big work loads, carrying heavy loads, smoke in kitchens, poor hygiene, lack of washing facilities and also time to stay clean and taboos particularly around menstruation.
HPC’s other work has changed some cultural patterns for the better; now smokeless stoves are commonplace, and people have fresh vegetables to eat in the winter.
At the moment women only rest when they are eating and they have one day off a month at the end of menstruation to wash.
In the future perhaps we can have a special training programme where they come and chill out, watch training films, and sing and dance. We need men’s participation and agreement for this though, because the women’s work has to be done by someone.
During the health training we get them to reflect on their wealth of skills. They find they have many and this builds confidence.
Women have appreciated the general counselling and the rapport that builds up, and the sense of them being supported. Through being listened to they start to build confidence in themselves.
Once women have learnt new habits they don’t go back to old habits. But the problems they face haven’t gone away. They are helped by continued training, follow up activities and the creation of supportive network.
From this interview the following needs for the design were identified:
We then went on to think of many ways of meeting these needs.
| Needs/purpose | Ideas |
|---|---|
| 1. More female staff | More budget; apprenticing/students; teenagers; slowly giving more responsibility to suitable people; opening up to outside people – advertising; volunteers from Humla; exchange with other NGOs. |
| 2. Awareness raising for women | Training and workshops; exchange programmes and exposure trips; film nights; after treatment given responsibility to share and inform other women; health camps. |
| 3. Awareness raising for men | Initial workshop to include men; poster; training HPC staff and board so they can spread the message with HPC’s other work; transparency of process; show men the direct and indirect benefits for themselves and household. |
| 4. Farming techniques – food security | All techniques that increase nutrition and/or reduce work: fodder growing; vegetable growing; agroforestry; fruit; stoves; urine collection. |
| 5. WHP link with HPC’s other work | HPC staff to share benefits and raise awareness with men and women; specific training on growing and using medicinal herbs. |
| 6. Networking -creating connections | Creating and using the network; connections from the trainings and from the groups; creating microcredit funds. |
| 7. Preventative measures | Teaching them the whys and hows; hygiene; self diagnosing; toilets; improving quality of drinking water and reducing the work to get it; health camps. |
| 8. Treatment | Herbs; prolapse treatment; counselling; health camps. |
| 9. Self-esteem and confidence building | Education and awareness of what is possible; demonstration from others; collecting stories from people/communities that have changed; clinics, counselling and treatment – realising they can get better if treated in right way, place, time; practical literacy; realising their own ‘wealth of skills’ as part of training; looking at gender roles and who does what, realising women are very skilled; developing income generation – handling money. |
| 10. Education and training | Short and long training; two five day trainings; training materials; short workshops within health camps. |
| 11. Research and understand patterns | Discussion groups; social anthropologist; asking older generations what’s changed already; explore feelings around what has changed; change patterns around domestic violence. |
| 12. Create momentum for women’s health | Raising awareness; festivals; fun events; keeping it active; demonstration; building on success; how it’s taught from one to another within the family and network. |
From these ideas the following action points fit with the resources of time, budget and labour for the first year. Hom Maya would design each activity in more detail and look to meet as many of the needs as possible with each activity.
The first action is to train HPC male and female staff and board members about the what and why of women’s health, the benefits for the whole household and how it relates to the rest of HPC’s work. There will then be more people to spread the message and men can talk to the other men in the village groups. This was seen to be the action for minimum effort and maximum effect.