Tuesday, April 19, 2011

Is it sinking in?

I’ve taken a break from blogging about READY while starting a new position at the International Rescue Committee. The intervention pilot trial is continuing, though, and I recently returned from a visit to Muhuru.

Because READY is delivered in Dholuo, the local language, it’s rare for me to have a direct conversation with participants about what they are learning and practicing in the program. So I was thankful for this young man’s confidence in front of a camera and his excellent English that gave me a glimpse into his experience. 

In this first clip, I ask about if there have been any changes in his family since participating in READY. He focuses on the ways that quarrels have changed and (with the help of a friend) remembers the communication and relationship skills he's learned. 

Here, I was curious to ask more about whether he thought the Economic Empowerment module of READY might have led to any changes...

This interview doesn’t document behavior change with confidence. But his comments do speak to whether the content is being delivered with fidelity and in a way that is understandable and accessible. 

(Note: This young man and his caregivers gave permission for this to be online.)

Monday, December 13, 2010

A Small Step with Skuma

Two girls in the READY program asked Vivan, a READY leader, to visit their “Step of Hope.” In Module 1, families, including youths, were given basic budgeting skills. Facilitators challenged families to find creative ways to invest small amounts of capital into income generating activities.

So yesterday, the two girls led Vivian and me us to a small plot of land near the lake, about a 20-minute walk from their homes. There, they pointed to a few rows of tiny sprouts – the beginnings of skuma wiki, a green leafy vegetable eaten daily in Muhuru households.

One of the girls, Dot (age 11, 4th grade), lives with her grandparents and asked her grandmother to give her a small piece of land. Because her grandparents are already busy in their own garden, she recruited her friend from church, Eva (age 12, 3rd grade), to help start a garden. Dot asked Eva because she said many of the other girls were skeptical about the success of the garden. Eva, though, was glad to help. As she lives with her cousin since her parents died, it worked out well for her to take a “Step of Hope” with a friend instead of her family. She said she is looking forward to making her own money.

Dot and Eva planted the skuma together and now tend the garden twice daily – once in the morning and once at night. They expect the first plants to be ready next week hope to sell them for a total of 50 Kenyan Shillings. They plan to give Dot’s grandmother the money for safekeeping until they need it. When they have enough, they plan to buy clothes and shoes for themselves. Dot acknowledges that some insects might cause some problems along the way, but assured us that they will take good care of the garden so that it can be even bigger in the future.

While READY provides only basic information about budgeting and investing in addition to activities focused on mental health and HIV prevention, other organizations, such as the Population Council
(http://www.popcouncil.org/topics/fl.asp) are increasing their focus on programs that build adolescents’ financial literacy, especially for girls.

*We obtained permission before posting this story and photo.

Saturday, December 11, 2010

Why Children are Afraid to Ask

The final module in READY is “Learning and Talking about HIV Together.” The goal is to gradually expose families to the experience of talking about sex and HIV so that parents can learn to support youths to make safer decisions. We hope to decrease the anxiety associated with these discussions by equipping families with communication and coping skills to make the conversations more pleasant and productive.

Last week, we asked youths to discuss their emotions related to discussing sex and HIV with their parents. We asked them to role play how they expect caregivers to react when they ask questions about these topics.

Here are 3 of the scenarios they wrote and acted out in their youth support groups (with youth acting out the parts of both the youths and caregivers).

#1 – “What is sex?”

Youth: What is sex?

Father: You cannot talk about that. I refuse to listen to this.

Child: I was playing at the lake and I heard people discussing this thing, and I didn’t understand.

Mother: You must be going with men. Maybe you are already even infected with a disease and that is why your hair is falling out.

#2 – “What is a condom?”

Girl: What is a condom?

Father [yelling]: Where did you hear that word?

Girl: From other kids at school

Mother: You are asking that because you are already knowing men. That is why you know words like that. You have already started sex – I can see it in your eyes.

#3 – “I shared a razor…”

Girl: I used a razor and then gave it to my boyfriend for him to use. If I have HIV, will he now get it also?

Mother: Where did you get money to buy a razor?!

Father: To get that razor, you must have gone out doing some bad things [transactional sex] to get money from some man.

Role Play in Girls' Support Group(Girl on Right is playing the father, girl in Middle is playing the mother, girl on Left is playing the child); Photo posted with permission from youths and their caregivers

Throughout the role-plays, the main theme was fear that parents will suspect them of having sex if they initiate discussions related to sex or HIV. This coming week, we will ask families to discuss the youths’ fears together, along with the fears and hesitations of the caregivers (e.g., feeling embarrassed or afraid when talking with youths about these things).

Tuesday, December 7, 2010

Reaching the “Head of the Household” (Posted by Eve with input from John)

“The man is the head of the household.” A readily accepted norm by both men and women in Muhuru. In focus groups, participants easily cited cultural and Biblical reasons that men – and their decisions – should be accepted, usually without question.

Given this, I have been concerned about many women who are often attending READY without their husbands, though they enrolled in the program as a couple. John provided some cultural reasons this might be happening:

1.     The culture in Muhuru does not promote sitting next to your wife for long because it is a sign of weakness on the side of the man. A man should be out with other men doing “mens’ jobs.” Even in the normal church service, there are fewer men.
2.     Men in Muhuru like doing things that produce immediate results –monetary results. They often do not participate in any non-paying activities.
3.     Men are supposed to provide for their families, so they are expected to spend most of their time looking for ways to make money while the women spend time tending to children and attending church.

It seems logical to hypothesize that the families who attend without the husband/father may not benefit from READY as much as those who attend with all members. However, it is possible that these families may still benefit, though perhaps in different ways.

One woman who often comes without her husband agreed to discuss this issue. Here is part of our conversation (responses translated by John; she gave consent to post this). My questions to her are in bold, her responses in italics.

Who usually comes to the READY sessions?
Myself and one child. My husband only came once.

So in READY, we ask you to have a “Budho Makende.” Can you explain what that is?
That is a time when we are to discuss things together as a family – like how can budget together and work together. (Budho Makende literally means “special talk time.”)

Yes. So in your home, who attends your Budho Makende?
Myself, my husband, and one of our children.

Oh, so your husband participates in the Budho Makende but does not come to the sessions…can you explain more about this?
My husband drinks a lot. Most of the time when we have these READY sessions, he is out drinking ­­– or he may be at home but too drunk to come.

I see. But it seems that his drinking could also prevent him from being available for Budho Makende. How is he is able to participate in those discussions with your family?
Yes, for our Budho Makende, I choose to time it when he’s sober. Even this morning, we talked after breakfast, and yesterday also. When he is too drunk, I avoid bringing up these discussions. The timing varies. Sometimes it is after supper or lunch - it depends on his condition. Then I bring out the notes I take during READY and explain the things to him.

How does he react when you do this?
He’s normally cooperative when I tell him about having our discussions. What he enjoys most is the teaching about respect within the family. He also likes when I suggest to him that when we get some money, we should budget to buy some things for our children and then other things we need for ourselves . He has been very cooperative and takes those suggestions - and then he does exactly what we have talked about.

How do you feel during these Budho Makende discussions?
I feel happy and good when we have these discussions because in the trainings, I learn very helpful things, and I like to extend these discussions to my home…The discussions are very different from the normal discussions we had before. The topics are new. Now we can talk about HIV in the open. We also talk about respecting each other. We never used to discuss these issues in the family.

Even though your husband has not been able to come here to the sessions, have you noticed any differences in your family?
Yes, there is a difference. When we are talking together, my husband says, “This is a new thing. You must be learning this in that program, but I like it. You should keep learning them. They are good.”

So do you think he is open to hearing these ideas from you?
Yes, yes. Depending on how we have been relating of late, when I give a suggestion, we usually discuss it and he usually accepts.

Perhaps the women in Muhuru take on more leadership in their families than the outward customs suggest. And perhaps the men accept the women’s leadership and suggestions, at least on certain topics and when suggestions are presented at certain times, in certain ways. If this is true, women may be finding ways to bring new knowledge, ideas, communication patterns, and parenting practices into their homes in ways lead to family-level benefits ­– even if their husbands do not have direct exposure to the intervention. This is one question we will ask the data.

A picture of one READY session...look closely and you will note that most in attendance are women and children

Wednesday, December 1, 2010

About Me…and Why I Thought READY Might Not Work (Blogger: John)

I (John Ombajo) was born of a family with a humble background in 1976 in Muhuru Bay where I’ve lived for the better part of my life. My mother’s first husband died, and she was then inherited by her deceased husband’s cousin (as the customs dictate). My mother had 12 children in total, 3 with her first husband and 9 of us with the new husband. This new husband did not take a single care for us, and we had to struggle with our mother to survive. We went to school in tattered clothes and sometimes without school materials. Nevertheless, my mother was - and is still - a hardworking woman. She brewed local liquor (but did not taste it) to buy cows that she sold to fund our education. Today I have a Bachelors degree in Math and a Post Graduate Diploma in Project Planning and Management from the University of Nairobi. I’m planning to start my Masters and PhD program next year.

I have been working with READY as a member of Community Advisory Committee since its inception and helped in the formulation of the intervention. Currently I’m a Research Assistant on the project, supervising our survey team, translating materials, entering data, and assisting the intervention team with ideas and feedback during their preparations.

At first I thought the people of Muhuru were not going to embrace the READY program. Why?

1. The people here like doing things individually, and READY asks people to work together with their families and communities. In Muhuru, the times you see an emphasis on the importance of family and community is when one member of the community is seen to be rich. Those are the only times you will see people coming together – usually with people coming to ask assistance from the person who has money. Even within families, they typically only come together when there is a very big problem to solve; however, during normal times, family members tend to ignore things and to keep issues and problems to themselves until they get out of hand.

2. Teaching families how to communicate and to talk about emotions in Muhuru is something new. It has never been tried here. Also, culture poses a challenge since a man is not supposed to “waste time” talking to his wife for long. This is viewed as a weakness on the side of the man and they expect to always have their way in all discussions. So I thought bringing them together to participate in a group and with their families was not going to be easy.

So, is it working?

We will need some more time to know. However, despite the challenges I expected, participants in the churches have shown some positive signs. First, they attend – many of them week after week. Second, they participate in discussions and debates. Third, when the families sit together, they share much more intimately than I expected. For example, we asked them to tell each other when they felt loved by one another. One woman said, “I felt loved when my husband appreciated my cooking.” And her husband said, “I felt loved when she [my wife] bought a shirt for me.” As they shared this with the larger group, they were both smiling and seemed genuinely happy to have heard this from one another.

I am still concerned that people have the tendency of going back to their original ways when not watched. Therefore, we will continue to watch what happens.

Wednesday, November 17, 2010

Talking about Economics

Across cultures, talk of money often creates unease and conflict. But how do you talk about money when there is little or no money to discuss? We just finished our Economic Empowerment module, where we encouraged our study participants to budget, prioritize, and if possible, save for the future. Consisting of three sessions, we started off our first session with an introduction to the program and an overview of ways to maximize local resources in order to become economically empowered. Our second session focused on prioritizing, spending money wisely, and taught basic skills of budgeting. The last session of the Economics module taught participants how to save and included a local loan representative to answer any questions from the audience as well as assist anyone who wished to open an account or apply for a loan.

And the overall reaction to our program has been a success! Despite the limited resources, individuals have been receptive to the skills we are teaching. The concepts of prioritizing and spending on needs versus wants are skills that incorporate all members, regardless of how limited their income might be. However, the idea of saving for the future creates more of a problem when asking those who are struggling to pay for basic of needs to cut back even more. Despite this, those with very limited income are still interested in learning about savings, applying for loans, or opening a bank account. I believe this interest is rooted in the hope that at some point in their lives, they will have the resources and then be able to use the skills they are learning.

While attendance during our second session was limited due to a village funeral and a “harambee” (local fundraiser), our attendance for the third session on economic empowerment was very promising. Several participants who missed the second session expressed regret and requested copies of our budgeting sheet handouts so they could practice budgeting at home on their own. This example of interest and initiative really give us hope for the upcoming two modules on Emotional Support and Learning about HIV/AIDS as a family.

We believe one of the most engaging and valuable aspects of each session are the family skits, which model negative and positive family interactions, as well as family communication activities. The skits give families the opportunity to see that while negative interactions may be taking place in their homes now, we are teaching skills that if practiced, could make their families happier. We are lucky that our logistics coordinators also happen to be very skilled actors! The family communication activities then give our participants to opportunity to practice using these kills to improve their household interactions. Education through modeling is an important teaching method throughout READY and we’ve had feedback from participants that they can’t believe how closely our skits reflect their family interactions. Most likely because they are developed and acted by community members themselves.

This is an English translation of one of the skits we use to begin a discussion on the ways in which gender roles and culture influence finances and family relationships.

These next two weeks will focus on giving and receiving emotional support -- how to share feelings and to be supportive within your family, and skills to cope with stress. We’re halfway there in climbing our ladder of family communication.

Jessica & John

Monday, October 18, 2010

The Ladder to Family Communication

If there's one thing that is straightforward in psychology, it's treatment for phobias. If a child (or adult) is scared of a dog, we help them create a hierarchy of anxiety-provoking stimuli related to dogs: 1) picture of a dog, 2) looking at a dog in a cage, 3) petting a dog....etc. They can then climb the "bravery ladder" to conquering their fear of dogs. This process of exposure usually works because the individual gradually habituates to the feared stimuli such that they no longer need to worry about or to avoid the feared experience (or animal).

It's the subtle frightening tasks in life that are a bit more difficult to conquer - a shy adolescent boy asking someone out on a date, a people pleaser saying no when she's feeling overwhelmed. It's often the difficult aspects of communication that are most frightening in our relationships.

Exposure is one central intervention strategy in READY. We are attempting to guide participants to climb a "bravery ladder" towards more open, effective family communication about topics that are often avoided - finances, emotions, and sexuality (including issues related to HIV/AIDS). We begin with very brief family communication exercises that emphasize expressing positive thoughts and feelings about family relationships. We then progress to more difficult conversations throughout the intervention.

Jessica Pian, our research coordinator, taught our intervention team about exposure therapy and its relationship to the READY intervention.

 This week we had our first READY session that emphasizes the importance of family communication and begins discussion of financial issues in families. Here are some families beginning to climb the ladder.