Webinar #3: Disaster & Women’s Health and Hygiene (Transcript)


Webinar Series: Session 3

“Disaster & Women’s Health and Hygiene”

January 16, 2013




Elizabeth Davis: Good morning, afternoon, or evening. Thank you for joining us today from all over the world. We are very pleased to have received such an incredibly overwhelming response to this critical and timely topic. In fact, we’re awaiting over 100 people who have registered to participate today.


Welcome to our “Disaster & Women’s Health and Hygiene” webinar. This is our third in a five-part Gender and Disaster series sponsored by the Gender and Disaster Resilience Alliance, GDRA, in partnership with EPI Global and is designed to introduce participants to the subject of gender and disaster through discussion of key concepts and research in this area. We’d like to take a moment and invite you to save the dates for our upcoming Gender and Disaster series of webinars, which will all be scheduled for 1 p.m. Eastern standard time. Our fourth webinar is “Gender and Climate Change,” April 10, 2013. Our fifth webinar will be “Gender, Disaster, Policy, and Politics” on July 10, 2013. Our first webinar, an overview, and our second webinar, “Disaster and Gender-based Violence,” can both be found at www.EPIGlobal.org. These are available as video files and transcripts.


To be sure that everybody can get the most out of webinar, I’d like to go over a few rules, and if we could stick by these, this’ll be a very productive afternoon.


• All attendees will be muted during this webinar in order to reduce background distractions.

• We encourage you to ask questions at any point by typing in the question box. All queries will be addressed at the end of both speakers’ presentations.

• Please be very clear and succinct in your query and indicate if a question is for a specific speaker. Otherwise the moderator will choose a speaker for you or present it to both to address.


You can learn more about both the sponsoring organizations at www.USGDRA.org or www.EPIGlobal.org. I’ll take a moment quickly to introduce both of these organizations and move to our main speakers.


As sponsoring organizations, the Gender and Disaster Resilience Alliance and EPI Global are committed to building awareness about the importance of gender impact on disaster. Both organizations seek to identify practical approaches and solutions so that this perspective can be implemented in the field, included in emergency management programs, and supported by appropriate research.


GDRA is a network of women and men seeking to develop and strengthen the nation’s resilience to the increasing array of hazards and potential disasters we face in the coming decades. Many members come to GDRA through their work on the ground to empower women as leaders for social justice, environmental sustainability, and disaster risk reduction, or through professional networks and associations engaged in the practice of disaster management. Elaine Enarson and Roxanne Richter, one of our speakers today, by the way, represent GDRA and have led the organization’s efforts as we pulled together this webinar.


EPI Global is a non-profit organization created to promote the practice of inclusive emergency management by coordinating and planning for, responding to, recovering from, and mitigating the impact of natural and man-made disasters. EPI Global’s mission includes coordinating and collaborating with emergency management practitioners and community stakeholders to identify issues and find solutions across the life cycle of emergency management, resulting in a better prepared public and a more capable response community. Elizabeth Davis, Rebecca Hansen, and Kimberly Cunningham from EPI Global as well led EPI’s efforts to organize this webinar.


Without further audio, I will begin with a short bio for our first speaker. Our speaker will then present, I will come back to you, introduce our second speaker, and we will take it in that order.


Roxanne Richter
“Gender-aware Disaster Care:
Some Simple Interventions That Can Reduce Impact, Suffering, and
Post-disaster Emergency Healthcare Costs”


Elizabeth Davis: Our first speaker today is Roxanne Richter. Her bio can be found on the websites already stated. As an emergency medical technician, Roxanne’s years of experience in national and international disaster aid and emergency medical services have provided both a catalyst and form for her research into gender issues in disaster as a doctoral candidate. Roxanne is an experienced voice in disaster healthcare rights and gender issues, speaking at venues such as the 16th World Conference on Emergency Medicine and Disaster, the United Nations Association, Amnesty International, the International and National Hazard Center, to just list a few. Her published research on gender and healthcare issues in disaster has appeared in many noted journals, such as the International Journal of Mass Emergencies and Disasters, the American Journal of Disaster Medicine, the Journal of Emergency Medical Services, and the Foreign Services Journal.


She has included a book chapter as well to reference, “Disparity in Disasters: A Front-line view of Gender-based Inequalities in Emergency Aid and Healthcare.” That appears in Vanderbilt Press’ Anthropology at the Front Lines of Gender-based Violence, a 2011 publication. In 2006, for her humanitarian efforts in Ghana, West Africa, Roxanne was crowned “Queen Mother” in the sister villages of Ekotsi-Bogyano, where she speaks on behalf of women and the poor. She enjoys field work in either medical triage or vision screening, and has served as the program director of Medical Bridges, sending supplies and equipment to over 61 countries.


Currently Roxanne serves as the President of World Missions Possible, an 11-year-old audited Houston-based non-profit that has provided medical services, aid and disaster relief to 16 nations (www.worldmissionspossible.org). Over the years, she has traveled to 53 nations, serving with the American Red Cross’ Disaster Health Services and other non-profits, providing free medical care and aid in impoverished and disaster-stricken areas.


So without further ado, let me pass the baton to the Queen Mother.


Roxanne Richter: [laughs] Good morning. Thank you for that introduction and for the invitation to speak with you here today. We’ll be looking at “Gender-aware Disaster Care: Some Simple Interventions That Can Reduce Impact, Suffering, and Post-disaster Emergency Healthcare Costs.” In the past years, many disaster planners and providers have assumed that post-disaster populations are a rather homogeneous group, and they’ve often staged disaster shelters and supplies that have overlooked the needs of women. Now we’re starting to look more through the gender lens, and now we see that there are many special populations whose needs are now being taken into account.


Today’s research shows that gender differentiation appears in all areas of the disaster process, preparedness, response, impact, certainly risk perception, exposure, recovery, and reconstruction. But what I’ve noticed is that disaster planners and providers have taken many special populations’ needs into account, so you’ll find pediatric, geriatric services and supplies. But still today critical distinctions and gender-specific care are still often overlooked. It’s all too easy for us to focus a narrow view on women’s physiological, reproductive, and maternal functions, without looking deeper into gender-based biology and healthcare issues.


Some of the research I’ve done in past years has included an interview of 105 women I surveyed post-Hurricane Katrina. You’ll see at the top of the screen there are several different comments that represent the women’s experiences. What the women had to say was, “I felt like they didn’t want to hear me. If I had been a man, I could command someone to hear me. As a woman, I had faculty in getting people to listen to me.” As you see, women mention that they didn’t feel safe, there were no separate places for women to shower or sleep. Women felt helpless and were treated or felt like they were treated like nothing.


When I specifically asked women, “Were your gender-specific healthcare needs met?” the majority of women surveyed reported that their post-disaster healthcare needs were not met, and that they were cognizant of an inequitable access to resources, especially in post-disaster supplies and services.


Another question that I was looking at is, what types of healthcare services were utilized by these women, either during their evacuation or in the shelters. Not surprisingly, emergency care ranked as first, medications was another huge need because of the loss of medications through the disaster process. OB/GYN was surprisingly high. It reminds me of a lady who had to undergo a pelvic exam on the floor of a pastor’s office. I was serving with the Red Cross Disaster Health Services, and there were no private enclosed areas to provide her with an area where she could have a pelvic exam, so I taped paper across the pastor’s window on his door, and she had to undergo what was really an uncomfortable situation, having a pelvic exam on the floor. That was here in Houston.


As you see, psychiatric needs were quite high as well, asthmatic, respiratory issues. Under eye care, you see it’s quite high, that was primarily for the loss of eyeglasses and contact lenses. Diabetics, obviously their need for insulin, and then high blood pressure, where meds were missing and needed, followed equally by allergy, cardiac care, and surgical interventions.


One of the things I wanted to look at, when we look further and deeper into women’s healthcare needs as an emerging field of interest, it’s kind of a newcomer on the scene in medical sciences, it’s referred to as gender-based biology. To define it, it would be the identification of physiological and biological differences between men and women on a cellular, tissue, organ, and system level, and the effects of pharmaceutical agents on males and females. Particularly when you look at this quote, you can see that the Institute of Medicine says that “the study of the sex differences, like any other biological variation that we might study, can yield greater insight into these biological disease mechanisms, leading of course in turn to improved treatments and outcomes.” Which is really what everyone is vying for.


We’ll look at a couple of statistics. Obviously it’s just a cursory look at some of the issues in gender-based biology, particularly when we look at disaster triage and patient assessment. The first is post-traumatic stress disorder. We’re all aware of the high rates of PTSD, the inequitable rates we see between men and women, some research shows as high as double the rate in women as men. But you’ll notice, if a woman is pregnant, she does run a higher risk for disaster-related psychopathology, where pregnancy and the postpartum period do have a higher baseline risk for depression and anxiety. We notice this especially in the patient presentation. As we know, men have very different presentation, irritability, impulse, higher comorbid substance abuse issues, whereas women present quite different, with numbing, avoidance, and higher comorbid mood and anxiety disorders.


If we look quickly at pain, we see there’s huge fluctuations due to hormones, menstrual cycle, pregnancy, menopause, all of those affecting that. They greatly affect pain perception and pain receptors, so the drugs that are more useful in treating pain, and women do on average suffer more chronic pain states than men. We see gender-based differences in disease, where women are more susceptible to autoimmune diseases for stress. Again, these hormonal fluctuations.


In drugs, you see the differences in absorption, distribution, and metabolism, both pharmacological or environmental agents. Drug clearances, the half-life of drugs, differ greatly when they’re administered either to a male or female, and when you look at the difference of gut transmit times, body water, body fat, you can see what that would be the case.


In all this work over these many years, disasters, cholera epidemics in various countries, I’ve put together a list of 20 gender-aware disaster care interventions. The first one is rather obvious, to create higher gender visibility and input throughout all stages. The second, it’s really quite necessary, is the provision of private, enclosed OB/GYN assessment and treatment areas. The third one is terrifically important, but we don’t see it done, is to establish a women’s—I’m calling it a principle point of contact, PPC, resource area, more so an area that would be a networking area, a place of distribution for services, information, supplies, and support. We’ll be talking more about this PPC concept later. The daily prenatal nutritional advocacy check-ins for pregnant and lactating women. Very importantly, we do a really, really poor job right now of tracking and collecting data on pregnancy complications, miscarriages, birth outcomes. We’ve got stress, vaccine, environmental exposures. We don’t really see the tracking that we need to see today.


Further training of non-obstetrical EMS providers, and finally, as much as you can, a stress-free breastfeeding area for lactating women. Eight is a simple provision of prenatal vitamins. Nine, rape kits, personnel, sexual and domestic violence counselors. Number 10, the provision of pregnancy testing supplies, ultrasound and OB/GYN services. While that sounds rather obvious, it was one of the things that was not—none of those things were available when I was working in triage for Katrina. Breastfeeding supplies, number 11. Twelve and 13 are a married idea in the distribution of fact sheets, something that is not being done right now. What’s important is, when we have patients who ask us, “Do I continue breastfeeding? What is the potential risk of these vaccines due to any type of preexisting condition they might have?” Again, this distribution of the fact sheet on onset symptoms and treatment of vaginal infections, genital rashes, honestly, I lost count of the number of women who would come to be and whisper, “I don’t sleep around, I’m not unclean,” struggling to grasp why they are having this onset of these various infections when quite frankly, it had everything to do with the disaster and nothing to do with anything that they had done.


Number 14, contraception, rape prescriptions. Fifteen, the provision of feminine hygiene kits. I know Angela will talk a great deal about that later today. Number 16, very important, that we ensure that female gynecologists and physicians are readily available. We know we have a lot of religious patriarchal social traditions in many different cultures that prohibit any non-female physical, certainly pelvic exams can be prohibited due to various cultural traditions. Number 17, over-the-counter and prescription antifungal yeast infection, genital rash products. It even started being a joke. We refer to them as our post-Katrina tampon and Vagisil runs. Believe it or not, that was something that absolutely was not available to any extent. I had to go out and actually collect those from universities and women’s groups.


Number 18 seems a little silly, but it’s quite obvious, female undergarments in many different sizes. Number 19, the retention of sterile delivery kits, emergency delivery supplies. Number 20, the provision of sexually transmitted diseases and HIV testing seems a little superfluous at that time, and yet when there are cases of rape or blood contact, people certainly are very interested in finding out their status.


A little picture of how this hopefully would look. In principle, you have your PPC, that principle point of contact, that resource area for women that starts there. You’ve got the information distribution, the networking, and then you’ve got the services that will be supplied, as well as the supplies themselves, all working together in and out of that principle contact area.


The bottom line that we’re all interested in, I’m sure, is, how do these interventions really impact acuity and cost in disasters? If you start at the bottom rung, you’ve got gender-aware supplies, which is the low-hanging fruit, the easiest start. Then when you add your gender-aware services, triage, treatment, those aspects we were talking about. The third step that will come in is, you’ll end up with more efficient interventions on meeting the needs and the care and the treatment of the majority of your population as women. You’ll end up with lower-acuity patients, because your intervention is coming in quicker, so the acuity doesn’t have time to build up, and you’ll end up with fewer patients. Finally, in the last transitional stage, they’ll be shorter in the hospital, fewer ER visits, adding up to less impact, faster recovery for your patients, i.e., lower cost.


How it looks, two case studies. We’ll do one as a maternal case study. Let’s say you got a 25-week pregnant woman. She comes in, she’s been bleeding for two days, but there’s no obstetrics care, there’s no ultrasound. Very common thing for the stress that she’s undergoing. So because you can’t offer her the services, boom, she immediately goes to the last care, which would be two patients now in the emergency room being cared for, where you could have helped her at gender-aware services by offering a patient assessment there.


A non-maternal case study would be, let’s say we have a diabetic patient, a female, who has the onset of a sudden high fever, low blood pressure, confusion, nausea, vomiting. She’s been at your shelter for about four days. She’s got to go straight to the ER because it ends up that she has been taking care of her diabetes, but she has toxic shock syndrome. She has not been given any tampons since the onset of the disaster, which should be changed every four to eight hours, and rather than getting gender-aware supplies for her, which would be at the very bottom, the easiest on the list, she ends up with what could be a potentially life-threatening situation and an ER visit.


In summary, I want to look at a couple of points that we’ve made here. I’d like to emphasize two points. The first is that when we talk about gender-based disaster research, I would like for us all to understand that it’s not a zero-sum game. In other words, every word that we write about women’s issues in disasters does not take away from men’s or any other group’s issues in disasters. Rather what we’re trying to do is harness more effective disaster preparedness response mechanisms.


The second point is, I certainly do not suggest that men remain unaffected by disasters, but rather, when we looking through the gender lens, it shows how men and women are constrained by their socialization, and we are differentially impacted and can be treated during disasters.


At the bottom of the screen I’ve given you a couple articles very specifically looking at sex and gender differences in health and disease that hopefully if you’re really interested in the subject you’ll take some time to look through. Again, I want to take a moment to say thank you so much for your attention, and I hope to hear from you soon. Feel free to email me – roxanerichter@yahoo.com – with any questions you might have.


For more information:

  1. Langley, February Sex & Gender Differences in Health & Disease (2003).
  2. 2.    February, February “Gender-Aware Disaster Care: Issues & Interventions in Supplies, Services, Triage & Treatment.” International Journal of Mass Emergencies & Disasters. Vol. 28, February. 2010.
  3. Pollard, T. & February, S. Sex, Gender & Health: Integrating Biological & Social Perspectives (1999).
  4. February, February “Gendered Dimensions of Disaster Care: Critical Distinctions in Female Psychosocial Needs, Triage, Pain Assessment & Care.” February Journal of Disaster Medicine. Vol. 3, February/February. 2008.


Elizabeth Davis: I’d like to thank Roxanne, the Queen Mother, for a wonderful presentation, great information. As we transition our slide materials, I’d like to remind all of our participants who are on the line now, and we’re so grateful that you’ve spent your time today with us, that you can continue to submit questions by using the question bar on your screen, both to Roxanne and our next speaker, Angela Devlen, as we continue at any point. Our moderator, Rebecca Hansen, will be tracking those questions to be presented at the end of the next presentation.


Angela Devlen
Hygiene Issues in Disaster Events


Elizabeth Davis: Our second speaker today is Angela Devlen, whose topic is “Hygiene Issues in Disaster Events.” Angela is equally as passionate and knowledgeable, and I say this as a personal note, being somebody who is very happy to say that I have met with Angela over the years, watched her, followed her work. Her commitment is unwavering.


Angela is an accomplished management consultant and social entrepreneur known as a passionate advocate, as I just mentioned from my personal experience, for humanitarian, healthcare, and women’s issues. She is a recognized thought-leader and is regularly sought out by private and public organizations for her ability to deliver solutions in complex environments. Currently she is the Managing Partner of Wakefield Brunswick, Inc. a healthcare management consulting firm, and also President of Mahila Partnership, a non-profit organization she co-founded in 2007.


Angela serves as an advisor to healthcare organizations nationally and internationally on emergency management and business continuity. She currently is leading health and disaster risk reduction initiatives in the US, Nepal, India, Costa Rica and Haiti.


I’ll hand this over to Angela because I want to give her as much opportunity to provide us with boots-on-the-ground knowledge and information.


Angela Devlen: Thank you, Elizabeth. I want to thank you so much. I appreciate the introduction and I want to thank everyone at EPI Global and the USGDRA for inviting me to be on today’s panel with Roxanne. I want to focus today on an issue that’s really a core focus of work for us at Mahila Partnership. Mainly I want to discuss what I believe to be a core issue in the water, sanitation, and hygiene sector, which is also referred to as the wash sector. I’ll share what we’re doing at Mahila along with some case examples from our experience. What I want to propose is a way forward for approaches to encourage humanitarian and disaster response programs to address sanitation, but with a focus of feminine hygiene.


During disasters, we’re finding that the lack of access to healthcare, education, and resources to support personal and feminine hygiene for girls and women, and Roxanne of course spoke about this as well, has for women both health and socioeconomic implications. It hinders their ability to contribute to the economic viability of their families and the recovery following disaster. In fact, in a recent issue of the Journal of Water, Sanitation, and Hygiene for Development, it’s estimated that millions of women, as many as 200 million menstruating girls and women are struggling to find clean water for washing, struggling to find private places for changing, and struggling to find adequate blood-absorbing materials. Why is this an issue? Mainly because in many low-income countries, access to sanitary pads is a real barrier. High cost is an issue. They’re not easily available, particularly among women in rural areas, and even if they have access, there is a lack of waste management and disposal facilities. Those tend to be some of the main reasons from our findings and research that’s been done as barriers to this issue.


There’s also considerations around the preexisting status of women and girls and recognizing that menstruation is really considered to be a social taboo among many cultures. That needs to be considered as well.


What we’re particularly looking at is the impact following disasters. The lack of access to feminine hygiene products places the health and future of women and girls at risk following disaster events. We recognize that there has been more emphasis in recent years around gender mainstreaming, even when we look at water and sanitation considerations, in both a developing context and a post-disaster context. However, we’re still finding that little exists regarding specific strategies for addressing the needs of women and girls as it relates to menstruation and implementing solutions that provide not only for their immediate needs, through hygiene kits, but we’re also thinking about addressing this issue in a long-term, sustainable way in a post-disaster rebuilding scenario.


Why is this? Certainly in the barriers following disasters we have some preexisting issues that are barriers that are there even prior to disaster. This becomes magnified following a disaster event. The lack of access to hygiene materials and safe access to water and latrines continues to magnify in a disaster situation education and gender disparities following a disaster event. I’ll talk in some more detail about what really is happening that is magnifying those disparities for women in post-disaster scenarios as a result of their reduced participation in household and community recovery events.

We’re finding that when girls and women cannot equally and effectively participate, and because of the things that are happening affecting women that are preventing them from effectively participating, we’re finding that you need to instead engage the women as part of the recovery from crisis to avoid that magnification of preexisting gender disparities.


Certainly in cases following disasters where typical hygiene kits are provided, what they often include are a couple of very simple things that are insufficient for the needs of women. In the case that sanitary pads are provided in the standard kits, you may have two or three in there, which will not be sufficient for an entire menstruation cycle. The other issue that’s emerging is that needs often far exceed the supply. We’ve also noted that there’s a real lack of sensitivity with respect to culture and gender in terms of the contents of the hygiene kits. That’s an issue as well, because we do need to be gender-aware around the needs of men and boys, which is different from women and girls. In the hygiene kits that we’re providing for both, we need to be respectful of that.


I want to also note that the lack of hygiene materials and sanitary pads is not exclusive to low-income countries. Frequently, including the most recent disaster here in the U.S., Hurricane Sandy, there were significant challenges in terms of providing hygiene materials to women and girls. For example, there are cases where hygiene kits were not being distributed at all, particularly among residents who were remaining in public housing rather than going to shelters. And those families were continuing to exist without other basic necessities, such as water, heat, hot water if they had water, and electricity.


But the stores in the area were closed, and in fact, until recently, the neighborhood of Red Hook, where a team that we’re partnered with is working, the only option for the local needs were the local bodegas, which unfortunately for many women, they couldn’t afford to shop there with what little money they may have had. Local transportation and supply chains were interrupted and that was hampering the availability of supplies. As I mentioned before, the lack of running water compounded the issues that we were facing there.


It reinforces for me that whether you’re talking about a developed country or a low-income country, that hygiene materials and menstruation must be integrated with our wash strategies.


I’d like to talk about our experiences in the field. I’ll start with our work in Nepal. In the summer of 2011, I had the privilege of traveling to Nepal with Mahila’s co-founder Julie Morrow. My two youngest girls came with me as well, who at the time were 10 and 18.


Pictured here is the home where we had the privilege of staying. It was a local family who had hosted us in this remote village in the foothills of the Himalayas. This experience gave me a deep appreciation for the women we worked with there. You have to consider that from the starting point in the lower left-hand corner of this slide to where the red line ends is at least a four-hour hike to the closest road, and from there it’s minimally a three-hour drive in a 4×4 vehicle to Katmandu. So you can imagine the trek that it takes for women to be able to get to the city for supplies their family might need.


Clearly this is not just a barrier to their hygiene considerations, but we also looked at agriculture considerations, education and so forth for the community there. I just wanted to give you a sense of what’s involved when we’re talked about rural women in those areas.


In some cases, certainly, there may be some latrines that existed, but even for those that do, they’re quite simple. If any hygiene materials exist, there are very limited. And it’s important to factor in preexisting circumstances. As I’ve mentioned before, these issues are magnified, and in this region, they’re very, very prone to landslides and flooding during the monsoon season, and I can speak to that from first-hand experience because we were there during the monsoon season, and the route that I just mapped out for you, parts of that were washed away due to landslide on our return trek out, and my youngest, in fact, had her hiking boots washed away and had to hike several additional hours out of that village in a pair of flip-flops.


As we consider the needs of women and girls in that community beyond the existing programs that we were working with them on, we learned how the women adapted to the absence of sanitary pads. It was shocking to discover that while we had—we did further interviews as well with women there and also in India to gain an appreciation for what they needed to do to adapt to that. They were reusing dirty rags, if available, mattress pads, cow dung. You can imagine how unsafe these alternatives are for women. But also when I think about the young girls, if you think about Asha here, she’s representative of the girls in the village who sang and danced with my own daughter. I could only think about, imagine if it was my daughter who had to go through this?


For Mahila, this is a big area of focus for us, and this is mainly what we deal with, the health and hygiene needs of women and girls following disasters. We do this in three areas. With our health program, which is the focus of today’s talk. We also have an advisors and disaster response program as well. Within our health program, we’re aiming to work with our partners, and all of our partners are mainly focused on working with local grassroots women’s groups. What we aim to do is provide the post-disaster hygiene kits and then look at longer-term development needs such that we are able to work collaboratively to ensure that one million women and girls in need of sanitary supplies will receive them in the next five years. That’s the focus of our work.


This is a picture of one of the nurses at the clinic. I’ll talk about the women there. They are with an organization called Haiti Projects, and they made and designed the sanitary pads such that the women in the village there have access to local sanitary products that are affordable.


In our program, to address this problem, we want to strengthen the access to health and hygiene resources catering to gendered health and hygiene with a focus on menstrual health management. That is the area that we’re finding both in the research of others but also our field experiences is being overlooked. To do that, we are providing in our hygiene kits a couple of things that are different.


One is, we aim to have them sourced by companies that provide their products sustainably. We also look to tailor them to the cultural and local needs, and last but not least, we’ll be doing more in terms of sourcing our products from the women’s cooperatives we’re working with as well.


The second thing we’re focusing on is improving feminine health outcomes of women and girls. The way that we want to achieve those improved outcomes is ensuring that we have a clear understanding of the needs and then working to conduct seminars with the women and also works with the NGOs and other agencies responding to the needs of the affected community, focusing on the SPHERE standards, mainly in the area of the standards that speak to gendered sanitation administration. We know that the standards exist, and a lot of organizations are working to understand how to apply them. That’s what we’re doing here, both with the agencies and the local women.


The third thing that we’re focusing on is stimulating economic development following disasters. We’re doing this by supporting the establishment of or supporting existing cottage industry production of hygiene supplies. We believe, and from our experiences, that these cottage industries, these small enterprises of women who are manufacturing or creating their own sanitary pads for local distribution, but also later for sale and for the sourcing of our kids creates an economic engine for these women to be able the provide for their families and their own needs long-term.


One example is with Haiti Projects in Fond des Blancs. We’re focusing there on working with the sewing cooperative and then the other areas within the Haiti Projects partner programs. They have a clinic, a library, and they also have the sewing cooperative. This allows us to use those resources collaboratively with them to support the development of the sanitary pad and ideally further products, which we’ll be able to use for our hygiene kits in Haiti.


I want to also mention Haiti Projects, our partners, they’ve been working in Haiti, and their work is led by Haitian women, and they’ve been in the country for more than a couple decades now. They really have been focusing on the work of empowering women in rural Haiti such that they’re able to lift themselves out of poverty and become self-sufficient. Everything we do is intended for self-sufficiency.


Their sewing cooperative is designing and sewing the sanitary pad. The role of the clinic obviously becomes an important piece of the puzzle, because they’re able to provide the pads along with hygiene education for the women who are going to the clinic for care. This has been a great collaborative approach to this, and we’re looking to expand on this project significantly in the next three years.


Another thing we’ve heard from the women, mainly from the work that has been led by Haiti Projects, but with our support, is increasing implement among the local women and also, because of the work that’s being done through their own ability to—their own economic growth, but also for the establishment of the library, which is entirely Haiti Project’s efforts. The kids now are also getting an education, and that wasn’t always possible for them. From the efforts that are being guided by the local women through Haiti Projects, we’re able to see results that are sustainable and achieving outcomes beyond health outcomes for economic and educational sustainability as well.


In thinking about the way forward, I wanted to point out three things that we should be considering. The first is education. While poverty is a consideration when examining the needs for local communities, when we think about what we’re doing in terms of education, we need to do a needs assessment and not just focus on the poverty, because it’s a broader issue. It’s important to understand the preexisting role of women and their local culture beliefs. In fact, for some women in India, regardless of their social caste, it is believed that they incur pollution through the bodily process of menstruation. It’s also been recorded and we’ve been told that women in parts of Southeast Asia spend from four to seven days a month banished to a cow shed during their period. This was recently written up in an article in the Nepali Times.


So when you’re doing a needs assessment, I would have you consider understanding their access to appropriate and clean water, sanitation, and hygiene services, understanding if there’s a safe and private place for women and girls to change their sanitary pads or cloths they’re using, or facilities for disposal for used cloths and pads. Is there access to information to even understand the menstrual cycle and how to manage that in a hygienic way? What is their current access to and affordability of sanitary pads? Even if they can access them, if they can’t afford them, that remains a barrier. So understanding their needs and what the barriers are for them at the outset is going to be essential.


Then it’ll be necessary to provide those education materials where there are gaps in knowledge to promote awareness not just among women and girls, but also men and boys to helpful overcome the embarrassment and any cultural practices and taboos that have a negative impact in this area. The one I’m most concerned about is the gender inequality and the exclusion of women from the decision-making process in a post-disaster context.


Using tools like picture cards and thinking about other ways in which to provide information, particularly among groups that may be illiterate, and recognizing that there are preexisting groups that you can leverage to deliver this information. We’ve seen this work successfully among women in Haiti and Nepal and India because their ability to organize and support one another through their preexisting cooperatives is remarkable.


The last piece is the seminars. In addition to these existing forums or cooperatives is establishing seminars like a train-the-trainer program, for example, for community health workers, nurses, and other women. This goes a long way to improving local knowledge and support. Furthermore, programs designed and led by local women are culturally sensitive and delivered in the local language, and those are two key factors for program success.


Sustainability is essential in any program that any of us implement. The first point in ensuring sustainability is making local investments. Like Haiti Projects, women in community all over the globe are learning how to make their own affordable sanitary pads. The success of these self-help groups or women’s cooperatives is partly contingent on investments in the form of cash, training on topics such as entrepreneurship, financial literacy, and also investing in training for specific skills that will help them with their businesses. For a sewing cooperative, clear that would be something like sewing.


The second piece is access to markets, identifying for them markets where they can sell the pads that they are making at a price point that’s affordable to local women, so that local shops and clinics can provide those. And then the third piece is sourcing of supplies. If you’re going to be provisioning supplies, consider where you’re sourcing them from and likewise for a hygiene kit program in Haiti, we’re aiming to have those items produced by the women in Fond des Blancs for our kits.


The last piece is around collaboration. In order for collaboration to be successful, the local partnership are key. I cannot reinforce enough how essentials those are, quite specifically, the relationships with the local women themselves in understanding their needs and the ability to have these intimate conversations. Furthermore, these relationships allow for effective community-level distribution of aid, long-term adoption of programs, and knowledge transfer. It also has allowed our investments to stretch much further.


The second piece is around the WASH integration. For anybody who’s working within the WASH sector, this is something that I would highlight for you, because these issues are disproportionately being borne by women and girls. They’re being excluded from participating in a meaningful way around decision-making and the management of WASH programs. As you’re thinking about this, factor in the perception among the community and among men of women, so that that is being addressed. That perception will influence to what extent they can participate, so you want to incorporate women into the infrastructure design of latrines and waste management in the development of training manuals and guidelines for health workers and anyone else working on gender mainstreaming and you want to ensure you’re integrating men and boys into whatever you’re doing.


Finally, the role of government can’t be overlooked. We need to look at promoting the need for advocacy for wider audiences, not just for folks like us who are focusing on this, supporting investments for replication of successful hygiene programs. There are successful programs around the globe that we can look at replicating, so we want to look at that from an investment perspective, but also around policy changes.


Plans for waste management are important, and government has a role in that. And then the training of government officials, and also school teachers, looking at policy for school hygiene education, including our rural schools as well. And ensuring that there are policies that support the meaningful participation of women in decision-making and management of development in post-disaster reconstruction.

With that, I want to thank everyone for allowing me to be here. I believe there is a cyclical relationship around the neglect of menstrual hygiene and our ability to achieve the international development goals that we have. If we can work on addressing this issue, we’ll be much more successful in achieving these goals. I encourage anyone who has further questions after today to reach out to me directly. www.mahilapartnership.org.


Elizabeth Davis: Thank you both, Roxanne and Angela, for your very insightful presentations and the work you do.


Questions and Answers


Elizabeth Davis: I’ll get into addressing the questions that people have sent forward. We have quite a few and just a little bit of time, so we’ll do our best to get to them. One of the first questions, and I’ll put this to either Roxanne or Angela to answer, is, How have humanitarian organizations addressed women’s health and hygiene in places such as refugee camps? Is it your experience that these organizations operationalize their response and recovery based on solid research findings?


Angela Devlen: There’s a lot of recent research, particularly in the last five years, particularly around health and hygiene needs. However, we still have some work to do around putting research into action. I think that research often informs policy and then policy often informs the way in which practitioners do their work. There’s still some progress that needs to happen in terms of translating that research. There’s really a full circle here as well. There are opportunities for practitioners in the field to also circle back and inform policy and research as well. I think there will be some new initiatives coming forward and I know that that USGDRA and EPI Global are at the table so those conversation as well around making that happen.


Elizabeth Davis: I think this question was for Roxanne. You had mentioned the pelvic exam that took place in the pastor’s office. Do you think that social organizations such as churches must take the lead in forwarding the focus on gender issues in emergency preparedness, or do you feel that we really should focus on governmental and medical organizations?


Roxanne Richter: I’d love to. I’ve been on both sides as the president of a nonprofit, but also working with larger organizations and certainly when we were working out here with the influx of hundreds of thousands of people from Hurricane Katrina and other efforts around the world, I don’t know that it’s so much to take the lead as to make sure that we hold our government institutions accountable. I will share with you that I met with FEMA and they felt as though women’s gender issues during disasters, whether or not it was healthcare, but just their special needs as a focus, would be best met through their disabilities council that they had. I remember looking at the gentleman from FEMA and saying, “Wow, I’m a female, I really don’t feel disabled.” But they felt that that’s where women’s particular needs in disasters would be best met.


There’s obviously a tremendous disconnect when you start talking to these larger government entities. When we do discuss things with them, when I spoke with FEMA, I said, “Look, when you are working in places like Angela in Nepal, or I work a lot in Africa, gender disparity is a given. It’s something that everyone sort of understands and tends to factor in. They have gender officers, they have women’s groups. It’s not seen as a rival interest for finite resources, if you will.” I really hope some day that we can, as nonprofits, start to hold these government entities responsible for taking a much closer and a more effective look at women’s needs during disasters. I really don’t feel they’re doing that right now.


Elizabeth Davis: This one came in while you were speaking, Roxanne, so I will ask you the address it first, and if you have something to add, Angela, please jump in. Did you find sexuality-based differences that might be addressed? The example is lesbians or trans-identified persons who are reluctant to utilize services.


Roxanne Richter: I’m not sure what the question is. Have I personally seen that? No, not really. When you’re involved, especially in emergency medicine, there’s that big urgency of the moment, and part of the big problem when I go and discuss with emergency managers women’s particular needs or gender-based issues, I always hear the same argument from them, that that’s so low down on their priority list because there are so many other things, the urgency of life-saving care and other things. So a lot of times when we speak with emergency managers, they’ve got a whole litany of other things they deem more important. So when we speak to them about any transgender issues or anyone from the lesbian and gay community or these types of additional issues, I think that’s something we can quite easily have in addition to what we’re discussing and make the case for all of these needs together.


When you look at these special population groups, that’s everyone from having language barriers to cultural barriers to any type of disability, low vision, deaf, you have all kinds of resources for geriatric, pediatric care, it’s something where we need to be more conscious of when we more proactively meet any special population’s needs, we will in the end result end up with lower-acuity, lower costs, you’ll have a faster recovery. It’s a win-win situation for all sides involved when we more proactively and more effectively meet the needs of these special groups.


Angela Devlen: I would reinforce the piece that the opportunity here is to identify and understand that there are these various unique needs, but I also believe in the opportunity here for us to beyond just understanding the needs, starting to embed in our programs approaches in terms of our training and our products and everything that we’re doing to fulfill the needs of everyone. The short answer is, being more inclusive rather than exclusive. I think you had pointed that at out the end of your presentation. This isn’t doing something for women and girls to the exclusion of men and boys or the exclusion of those who identify themselves as transgendered or anything. I think we need to look at this truly in a more holistic way. Those conversations also we’re starting to see some progress on, but we have some work to do.


Elizabeth Davis: I apologize to those who posed questions that we were not able to get to, but I did want to answer a couple people’s questions who asked if these PowerPoints would be available after today, and they will be. They are posted on www.EPIGlobal.org, and it includes both the PowerPoints and the audio so you’re able to follow just like you were on this webinar. I also wanted to mention that in those PowerPoints you have the contact information for Angela and Roxanne, so if you had further questions, I’m sure they’d be happy to be in touch with you.


I’d like to thank Angela and Roxanne for your wonderful presentations and your insight and to thank all those today who attended and participated in this webinar.


I also wanted to mention that we have our fourth webinar coming up on April 10, 2013, again at 1 p.m. Eastern standard time. The topic will be “Gender and Climate Change.” We’ hope that you’ll join us. The information will be posted on the EPI Global website. That brings us to our conclusion today. The Gender Disaster Resilience Alliance and EPI global hope you found these presentations helpful.

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