Lessons from Vietnam: no quick fix to being 'gender friendly'
By Cheekay Cinco
HO CHI MINH CITY, VIETNAM, 13 December 2005
The Women and Health Taskforce of TUFH, together with Global Health through Education, Training and Services (GHETS) and the University of Science in Malaysia, was one of the GKP Seed Grantees in 2004. At a recent meet in Ho Chi Minh City, Vietnam, I worked with the head of the Women’s Taskforce, Rogayah Ja’afar from Malaysia, to evaluate their Women and Health Learning Package (WHLP) project.
The WHLP are online modules — with CD versions — that are aimed at making it easier for medical education institutions to incorporate women’s health issue in the mainstream health education curriculum.
Topics for the modules are: violence against women; female genital mutilation; gender and health; adolescent health; contraceptive practices; and unwanted pregnancy and unsafe abortion.
Basically, through the modules, health educators can sensitise students — who are the future health workers — to
understand and deal with women’s issues in providing healthcare services for women. Beyond this, there is also a
longer-term goal of incorporating these modules within the general medical and health curriculum.
SEVEN VARSITIES, INSTITUTIONS
This project worked with seven universities which customised and modified the modules to reflect their contexts and cultural realities, and then held workshops and courses for students using the modules.
Universities and institutions that participated in the project included the Ahfad University for Women School of
Medicine (Sudan); Mahatma Gandhi Institute of Medical Sciences, Department of Community Medicine (India); Makarere University Faculty of Medicine (Uganda); Maseno University School of Public Health and Community Development (Kenya); Suez Canal University, Faculty of Medicine (Egypt); Universidad Autonoma Metropolitana-Xochimilco (Mexico); and the Ziadduin Medical University (Pakistan).
After over a year of project implementation, the Women’s Taskforce and the participating institutions have already
gathered their initial lessons but are looking to deepen their understanding of how the WHLP has met its goals,
particularly in getting the health educators and providers take women’s health issues a lot more seriously.
This explains why I was invited to conduct a GEM workshop for them in Ho Chi Minh City, where the annual The Network: Towards Unity for Health Conference took place this year.
[GEM, or Gender Evaluation Methodology, is an on-line guide for conducting gender evaluations of initiatives that use Information and Communication Technologies (ICTs) for social change. See http://www.apcwomen.org/gem/ for more details of the free on-line and downloadable guide which provides users with an overview of the evaluation process, explores gender and ICT issues, and outlines suggested strategies and methodologies for incorporating a gender analysis throughout the evaluation process. There’s also a GEM Practitioner’s Network to exchange methodologies and ideas with other GEM for ICTs users.]
The GEM workshop on 12 November was attended by 20 participants from Kenya, Uganda, Egypt, USA, Malaysia, Sudan, Philippines, Mexico, Pakistan, Iran and South Africa. The workshop ran from 9 am to 5 pm, where we tried to cover all of the aspects of GEM as much as we could. As per standard GEM workshop "procedure", we began with an overview of the GEM tool and the main documents.
During the workshop, I proposed the following areas to evaluate — both as a platform (case study, if you will) for
the small group discussions and as a way of recommending evaluation areas to the network: 1. Development and
Modification of WHLP 2. Dissemination of WHLP (including the workshops, online modules and CD version 3. Effect of the WHLP on: medical students, the medical curriculum, the faculty, and the community. 4. GHETS Women’s Health Taskforce Communication Strategies.
The participants agreed to split themselves up into three groups for the workshop. Groups were focussed on development, modification and dissemination of the WHLP, effect of the WHLP on the community, and WH Taskforce Communication Strategies.
Given that it was only a one-day workshop, we didn’t have much time for more although we did manage to discuss gender and ICT indicators in general (in plenary), using the evaluation questions they came up with to develop some indicators.
We ended the workshop with an evaluation of the day. The main feedback was that they were happy with the tool and that they wanted to have copies of it so that they can study it further and use it in their work. I handed out soft copies of the GEM tool.
A mini-workshop on GEM was also held on November 13 during the The Network: TUFH Conference proper. The two-hour workshop was attended by TUFH members who were not members of the Women and Health Taskforce.
After giving an GEM overview, I focused on gender and information and communication technology issues, which was followed up with a brief discussion on how these issues intersect with gender and health issues.
One issue that we discussed was that of bio-informatics and gender issues within that. According to participants, the categorisation of health symptoms are still largely based on the male anatomy, which means that women sometimes do not get proper diagnosis and treatment because the medical conditions they have do not fall into standard symptoms of particular ailments.
An example they gave was that of women dying from heart attacks because the symptoms they exhibit do not match standard heart condition symptoms and are often simply categorised as a result of menopause. As a result, preventive measures are often not taken and doctors just realise that a female patient is a high risk heart patient only when the woman is actually having a heart attack.
Interesting stuff, I wish we had more time to discuss it.
During the workshop, we also had small group discussions on the question: "Does the gender of the provider (doctor, nurse, medical assistant) affect the kind of service they provide?" and the group agreed to use the rural health services in Vietnam as an example.
Unfortunately, there was not enough time to really go into this, but the groups did manage to come up with a few
indicators to answer this question.
On November 15, the WH Taskforce had another meeting to set their strategic priorities for the next two years. They had included evaluation and improving their communications (by exploring other ICT options) in their priorities. They seemed very keen to continue working with APC WNSP on these priorities, particularly in using GEM in carrying out their plans to evaluate their work.
The main challenges in conducting the workshops, aside from time constraints, were:
* Integrating GEM in the women’s health context, particularly looking at broad gender issues in the various
contexts. I have to admit that it was daunting to do this and I think there is a lot of room for improvement and
calibration of our understanding of gender and health, and gender and ICT issues.
For sure, my exposure to this community/network has helped towards understanding these issues, but I think more studying needs to be done if we’re going to pursue this path.
Fortunately, the WH Taskforce and its members are willing to continue collaborating with us, so hopefully, our grasp of these issues will have more opportunities for fine-tuning.
* The expectation that GEM would provide quick answers to gender issues in their contexts, that through GEM, an initiative would immediately know if their projects are "gender friendly"
I think this is a much bigger issue that GEM itself. It has to do with people’s perception of gender issues in general, and the need for "quick fixes" in order to meet the requirement of being "gender-friendly".
Had to bite my tongue a bit and not tell them that if that they really want to be "gender-friendly" they would need to sweat blood and tears (ha!). Instead, I told them that gender issues are complex and context-sensitive, and that gender analysis is not an easy task because of that. And where GEM helps is in providing spaces/venues and guides so that these issues may be threshed out, discussed and analysed.