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EWB Presentation

Thanks so much for being here! I am very excited about this opportunity to talk to you about this passion of mine- that is to work together in collaboration with others to help create sustainable solutions in resource poor countries- in particular- Haiti. But before I jump right in, I want to tell you a bit of where I’m coming from- at what angle I approach this topic and our work in Haiti. As an occupational therapist, we have been trained to think about peoples abilities with their physical function, psycho-social function, and roles they have in their families and communities- in spite of their disabilities. Etienne and cart example. 1st of all what, can they do? 2nd, what task or role can’t they do that they want or need to do? Why? then what is the specific next step they need to take (the just right challenge) toward functioning well with those tasks or roles? Along with person-centered assessment, we determine how the environment can be modified to further enable success. With increased activity/participation, one of the important things to keep in mind and continually assess when making environmental modifications is how the person’s function changes (hopefully improves) over time. So we have to keep modifications simple, often making them adjustable, yet easy to use. I love what Julie Geagen said in one of her emails to all the presenters at the conference. She said “what sets EWB apart from other development organizations is that we support community-driven programs, with limited on the ground volunteer involvement, and thus our scale (in most cases) and scope is pared down to reflect the technical and logistical capacity of the communities we partner with to ensure long-term sustainability. In other words, sometimes our best solution is the simplest one, and that is intentional.” Love that! We’re all on the same page. I’m the founding president of The Haiti Education Alliance (THEA). The focus of THEA is also very much in line with the focus and values of EWB. We, too are focused on facilitating long-term, sustainable solutions in one community at a time. Our mission statement is THEA provides education opportunities to children and adults in Haiti empowering them to emerge to lives of healing and hope. How we do that is by establishing community education programs. Currently, THEA’s on-going community programs are gardening training in order to improve nutrition and health within the community- so we have a community training garden and a sewing training program to especially empower women to gain this marketable skill and be able to provide for their children and others in the community. *** girl empowerment pic Our Medical Education Program encompasses three levels of training young men and women in the community. 1. in community health and rehabilitation; 2. At the vocational level and 3. At the university trained level- for the purpose of increasing # of qualified medical personnel in the community for greater access to healthcare. (We’ll talk more specifically about Haiti in just a minute, but wanted to tell you that 40% of Haiti’s population does not have access to any medical personnel.) We’re working on filling in the gaps by investing in the lives of young women and men within each community we work in who will in-turn be able to meet the needs of those in their community. I also want to quickly tell you about the World Report on Disability, because I will be referring to it several times. Learning about the information in this body of work was life changing for me. What it is is a report produced by the World Health Organization and the World Bank which describes a vast amount of research conducted on the state of affairs for people with disabilities worldwide- from richest to poorest countries- in the areas of general healthcare, rehabilitation, assistance and support, enabling environments, education, and work/employment. Each section also includes information on what has been shown to work, what doesn’t work, what are the unmet needs, and further recommendations. I was encouraged to understand that THEA’s programs- particularly the medical education and primary secondary programs- have been designed to be effective and create sustainability as evidenced by more seasoned international program developers and researchers. Next, I want to tell you about Haiti. Giving a few statistics helps us see the overall needs in Haiti but then I’ll relay more specific cultural practices and examples from our work in Haiti. Want to preface by saying- It’s not always necessary to know everything about the culture we are working in but it’s important to look

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at these things in order to maximize the positive impact of our projects and make them sustainable. So who are the people we are working with? What are they good at doing; and What are their needs. We will most often need to establish limited, yet on-going relationships with the people who will be responsible for using and most often maintaining the work we start. Stats slide A huge percentage of the population has a disability or multiple disabilities. There were about 800,000 before the earthquake and an additional 450,000 after the earthquake. Most likely there are more than this. People with PTSD, Depression (women who lost all her family members), low vision especially without access to glasses; arthritis; musculoskeletal disorders from everyday work; old women who fell off trucks going to and from the market; cognitive disabilities such as learning disabilities, memory deficits, etc. even those associated with malnutrition at whatever stage of development; and more. As stated earlier, 40% of the population in Haiti do not have access to a medical professional. Cultural practices… 1. Women carry the work load- carry water, laundry, etc. Some of the effects of this include higher levels of disability, problems with childbirth which also leads to higher incidence of birth defects/children with disabilities; -occupational hazards- cooking with open fires which often results in pulmonary illnesses and burns; sexual assaults- go for long distances in rural areas to get sticks for the cook fire. -One of the things we were so excited about teaching them was about solar cook stoves… It would change the health and lives of especially the women and children there in a dramatic way. I couldn’t wait to tell them all about the benefits of the solar cook stove! We had someone go down with us and do the training on making simple solar cook stoves from readily available materials. Women and men were gathered to learn. Women were not excited to make them and the men weren’t interested in getting involved with cooking. Came back and reported that to the Board; and Lynette- from a tiny island in the Caribbean called Nevis, shared that her mother used her new gas stove once a week for months before incorporating it into her routine. New concepts take time to teach and get used to. UN initiative: Solar Cook Stove Alliance 2. People with disabiltes are marginalized and hidden from mainstream society. That’s one of the

effects of a survivalist culture- *** boy with leg-length discrepancy and Etienne examples. The effects of a survivalist culture can also be confusing to us. Being tough on their children and each other is part of how they show love to each other- because they want their loved ones to be strong and survive.

Another thing to think about is that women are often hired as caretakers of people with disabilities which helps provide an income for their families needs, but depletes income needed for other things such as sufficient food and education for children in the family of the person with the disability. The cost of caretaking is something we’ll come across later in the talk, too. Stick a pin in that. 3. Interpersonal/communication- Not looking the person in the eye is respectful. How many times did your parents say to you “Look at me when I am talking to you!” In Haitian culture, it doesn’t mean they are not listening to you or don’t care about what you are saying. It’s their way of respecting you and humbling themselves to accept what you are saying. It’s good to discuss with the Haitians we are working with about this simple communication difference; -Eat everything placed in front of you- In American culture, we don’t want to be the one to eat the last one; guests are fed and housed 1st; - The young men call each other “neg”; - Generally, Haitians do not speak in details. So when we need information, we need to ask many specific questions. If you will have regular contact with people “on the ground” I recommend establishing an agreed upon specific communication system (a simple form) from the beginning to provide needed infrastructure for getting all the info you need and preventing unnecessary hard feelings (i.e. distrust, inferiority, etc.); Haitian pride- What’s wrong with the way we already do it? If learn new concepts, they become experts. ***drip irrigation

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4. Voodou- without proper access to adequate medical care, most people in Haiti turn to Voodou for healing; daily rituals/most often food sacrifices to appease evil spirits; ***girl with burn who fell into a cook fire story- Her family took her to a voodou witch doctor for healing and to appease the evil spirits not to inflict permanent disability on their child- most often seen as a curse. Put saav/herbs on her burn and it got infected. In desperation they brought the girl to us. III. Meeting un-met needs A. Universal Design- shape our thinking as we get started 1. Definition- Universal design is a concept used to create environments, products, services, or information that respond to the widest range of the population possible. *** Example in American culture of automatic doors, ramps, low counters at ice cream shops, etc. The universal design movement is committed to ensuring that all spaces, products, and communications meet the needs of people of all ages and various levels of ability and that design in general contributes to quality of life...It strives to achieve safety, comfort, and convenience for all citizens in the community. There are 7 principles of universal design. (We don’t need to talk about each of those, just get this idea in our minds as we continue to talk about creating sustainable projects.) 2. Projects utilizing Universal design enable individual and social participation 3. How we usually think about universal design is in it’s application to physical environments- wells/pumps; doorways; ramps to schools, clinics, churches; walkways over drainage ditches, etc.

4. Also want to talk about universal design applications to educational/intellectual environments. We need to consider 3 things:

1. Who will benefit from the projects? and how? 2. Who will care for and maintain the projects/structures long after we’re gone? 3. How will we teach them to care and maintain the projects for greater sustainability? ***Ken and well story-

-How to teach in Haiti (and elsewhere- as communities characterized by poverty tend to have similar needs as they lack adequate teaching resources and resort to teaching using rote memorization. This was an intellectual understanding on my part initially- that they learn by rote memorization. I didn’t start really understanding the ramifications of being raised in this kind of education system on intellectual functioning- concept development and problem solving skills, until we had a rain containment brainstorm session… More like an example of what not to do…

OK let’s look at some evidence-based practice guidelines of universally designed education: -maximize all student’s potential in an environment that meets their needs (need supplies/desks/chairs that fit all of them; food- we make sure everyone eats well when we are there teaching)

-type of classroom is less important than quality of teaching -there is no negative impact on children without disabilities by including children with disabilities in mainstream classes. -need multiple means of expression, representation, and engagement- in US you have to read and write to learn and assess math skills. In Haiti, I’ve observed they’re math skills and concepts are amazing even at an early age because that’s something they can learn without a lot of resources. Teach auditorily, visually with demonstration, and experientially with hands-on practice, include music, movement/dancing, skits. *** nursing with community health teaching -develop guidelines and tools for monitoring progress- assess whether they learned what you taught in these different expressions. -focus on education results, not access- How they learn is not important. What is important is if they able to demonstrate what is taught. -have high standards and more means- we don’t need to reduce the quality of our programs, just teach how to use them in many different ways. -variability is good for everyone! 5. Universal design on a national level in Haiti- current initiatives for reconstruction: FYI

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a. In partnership with the State Secretariat for the Inclusion of Persons with Disabilities (SEIPH), CBM launched an Advocacy program in March 2010 to strengthen the capacities of local Disabled Peoples Organizations (DPOs), enabling them to advocate for the consideration of disability in the development and implementation of public policies and projects. The program also seeks to ensure the inclusion of people living with disabilities in all aspects of the reconstruction process and to make certain that accessibility standards are taken into account in the reconstruction efforts. b. Toolkit for Long-term Recovery- titled, “Haiti:Reconstruction for all” written by Global Partnership for Disability and Development in 2010. 48 page on reconstruction of physical environments B. World Vision’s 5-Fingers of Development When thinking about what projects to do in a community, 1st do a needs assessment (incorporate the things we are talking about today). Then work toward projects which would help meeting the most foundational needs 1st. World Vision’s 5 fingers of community development are (in priority order): 1. Clean water 2. Food supply 3. Education 4. Medicine 5. Economic development *Need food and water for survival, then to benefit from education. Also, with proper nutrition and water comes improved health and less need for medication/medical services. C. Increase access to Clean Water and Nutrition (food security): Nutrition is foundational for education and healthcare. 1. Access to clean water (wells, water purification- using solar, bleach, etc.- hot topic after cholera epidemic) -picture of 2 different wells -Q-drum 2. Access to nutrition- Backyard gardens- THEA’s training garden and encouragement of students to plant own gardens on property of friends and family; need good seeds, most nutritious vegatables, high variety; think marketable. Gardens begin around wells ; drip irrigation for year-round food production. 3. Pay with food (increases nutrition and effects of that immediately as well as frees up money for education, care giving, and health care costs). D. Increase access to education 1. Make school buildings accessible 2. I love the Rotary Club because they build a lot of especially secondary schools in Haiti. The new Haitian President is also building a lot of schools, especially since over 2000 were destroyed in the earthquake. Partner with them for increasing accessibility and other ideas. Need dormatories for secondary students- otherwise can become mistreated, indentured servants, etc. 4. oral tradition, lack of qualified teachers and teaching resources (idea: when go in to a town, arrange with schools to come in and give a demonstration, have hands on projects for the students if possible. They will never forget that and will teach concept forming and problem solving- giving them the cognitive tools and confidence to work in the future.) 3. funding needs for the 94% of private schools in Haiti- donations, create jobs, increase family food production, pay with food, increase function of people with disabilities to decrease dependency on caretakers (which takes money from other needs within the family) E. Increase access to health care 1. Make hospitals/clinics accessible 2. Personnel- Are there qualified health care professionals?

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- train Community health and rehabilitation workers - vocational training - university educated doctors, nurses, therapists, dentists, etc. 4. Community health worker’s mobile technology for data collection- hand-held device 5. There’s another way to drastically increase access and improve healthcare- although it’s more indirect. Stick with me as I unpack this process… With the data collected from the community health worker, it’s possible to generate statistics on the medical needs of people in the community- even rural communities. The WHO even developed a set of 6 assessment questions, called the International Classification of Function (ICF) which already has normative data. With this research, funding increases for health care programs. This also then influences national policy and improves standards for improved health care in the country. You can be involved with ADVOCACY at the grass roots level and all these levels in-between on up to the national level. IV. Conclusion A. Wrap- up of ideas- What happens when we pull out of the community? In promoting self-sustainable communities, we may need to provide resources they don’t have (i.e. wells, training, assessment tools, etc.). However, in order to prevent dependency and welfare communities and increase the sustainability of our projects, we need to take into consideration the personnel/social/relational components of the project. B. We can’t do it all by ourselves! Collaboration!! As engineers, you bring skills to the field that THEA needs (case in point- the rain containment story). Working in collaboration with other organization increases the impact of our work in resource poor communities. Collaborate Educate Celebrate C. References and handouts available V. Questions and Ideas