Material &Learning Experiences

Material &Learning Experiences
A major goal of this consultancy was to help the project staff in their health education
efforts. This was done by helping them consider how to adapt their health messages to
the Melanesian context through the use of the local language and a better understanding
of cultural issues. This section now considers how to take these health messages and
present them in ways that will maximize the potential for learning.
The basic recommendation is to use a multi- faceted approach to health education that will
reinforce health messages in as many ways as possible and move health education into as
many spheres of live as possible. The staff should make the most of opportunities to
combine written material with oral presentations. If using carefully translated written
material, the staff can have increased confidence in what is being orally communicated
through translation. So, Group action is possible in the egalitarian setting of Melanesia, but it is somewhat problematic in that it is dependent on the capacity of individual members to create consensus in the group and to persuade the those in the group to comply with their plans. There is little hierarchy in society and leadership is achieved (based on ability), not based on heredity or social position. Leaders should be seen as people who have the verbal
skills to persuade people to their point of view, not people who can dema nd compliance
based on their position. But individuals have the right to agree or disagree, and so even
the most skilled orators are not always successful in their attempts to persuade. Even
though Lani society has come to include social positions based on outside structures
(government positions such as kepala desa, camat, or bupati, or religious positions such
as pastor or gembala), the success of people in these positions is still contingent on their
ability to persuade. To outsiders who do not understand the nature of Melanesian
leadership, “leaders” can appear ‘weak’ and ineffective, particularly when outsiders
assume they can mobilize communities through the ‘authority’ of local leaders.

Gender Interventions

Gender Interventions
The project has been involved in gender awareness training both at the district and
subdistrict level and this has brought about several positive aspects including a much
needed openness to discuss women and men’s roles in society. The project has also
sincerely endeavored to improve the well-being of women in Jayawijaya. However,
some of the conclusions reached about “gender imbalances” and the need for
interventions to “correct gender imbalances” or “gender inequalities” need to be reevaluated
and re-formulated from a better understanding of Melanesian ideas about
gender.
It is very widely assumed that women in Melanesia are socially inferior to men, and
reading the situation in places like Jayawijaya from contemporary foreign (particularly
Western) va lues and expectations, this appears hard to deny. However, there is also
contradictory data. Melanesian cultures are fiercely egalitarian: no one is considered
inherently ‘better’ or ‘superior’ to another person (the lack of structured hierarchy in Lani
society and their ‘everyone is equal’ attitude are cultural realities of which the project
staff have become very aware). Furthermore, in regards to children, there is generally no
preference for one sex or the other. Daughters are loved and valued equally to sons
(another cultural point of which the staff was aware). So how is it possible to make sense
of gender relations in Jayawijaya without imposing an ethnocentric framework that
automatically assumes gender differences are evidence of inequality?
In the past two decades there has been an unprecedented amount of work by
anthropologists on the cultural construction of gender in Melanesia. The following points
draw on this social research. (See Annex 3 for a listing of the more important w

Defining the Health Messages

Defining the Health Messages
Medical Interventions
Danger Signs Needing Immediate Treatment: As previously noted, the three major
medical problems addressed by the project include malaria, pneumonia, and diarrhea. In
discussions with WATCH and DepKes staff about what specifically needed to be
communicated regarded these diseases, they saw a major problem to be delay in seeking
treatment by patients and their families. From a Melanesian perspective, this is
somewhat understandable in that disease is often viewed as evidence of a social problem
that needs rectifying. Delays (from a medical point of view) often come about as families
put priority on determining and fixing the social problem, knowing that once it is dealt
with, the physical problem will also be resolved. Even though WATCH staff and other
health workers may not share these same views regarding the social cause of illness,
interventions can focus on minimising delay. Families need to know that when certain
physical signs occur (high fevers, continued vomiting or diarrhea, etc.) they need to seek
immediate medical help. Their seeking of medical treatment does not preclude dealing
with the spiritual and social causes of disease as well, but parents (particularly fathers)
need to understand the physical signs indicating that immediate medical intervention is
warranted.
3.1.2 Treating Diarrhea: WATCH staff have been able to successfully promote the use of
sweet potato flour in oral rehydration fluid as an intervention for diarrhea. Health
material should continue to focus on the treatment of diarrhea including the use of oral
rehydration fluid both from sweet potato flour or from pre-packaged rehydration mix
(since many people are familiar with the pre-packaged mix and prefer to use it when
available).
3.1.3 Making Sweet Potato Flour : Sweet potato flour has been produced for oral
rehydration therapy and as a supplement to breast milk for older infants. However the
methods used in producing the flour clash with local cultural taboos which prohibit the
cutting of sweet potato. The local logic being that if sweet potatoes are cut into smaller
pieces, the sweet potatoes in one’s garden will similarly be small and not grow. At this
point, the recommendation is made to continue to promote sweet potato flour for infant
feeding and rehydration, but to recognize that people will need time to socially consider
and process the value this new item has for them. If they see it as desirable, they will
find some way around the taboo (possibly disregard the taboo, possibly have non-locals
make the flour and cut the sweet potatoes, or another creative solution). If the flour is not
desired for other reasons, (too labor intensive to produce, not necessary when prepackaged
rehydration solution is available, etc), the cultural taboo against cutting sweet
potato will remain a good excuse to avoid making the flour.

Adapting Health Education Context

Adapting Health Education Context
Over the years WATCH has determined the following problems as causes of the poor
levels of maternal and child health in the Jayawijaya District:
the three major medical problems of malaria, pneumonia, and diarrhea
poor antenatal/maternal care
poor environmental sanitation
malnutrition
gender imbalances
While it is not very difficult to target these as causes of poor health in Jayawijaya, it is far
more difficult to determine what interventions are appropriate and effective in the
physical and socio-cultural environment of Melanesia.
Over the span of the project WATCH staff have collected various examples of
educational material addressing these topics (including some material produced by the
project itself). And yet the staff expressed considerable frustration and a sense of futility
in attempting to use such material, either because the material was inappropriate, the
people were unable to comprehend the material, or if they did understand it, they were
simply unwilling to change their behavior. The basic approach to health education
implied by much of this material could be described as the “injection method” in which it
is assumed that by merely “injecting” health messages into people, there will be an
automatic change in their behavior. Obviously, this method was not working and not
producing the desired outcomes. In sum, many of the attempts at health education and
promotion by the project and by DepKes had resulted in numerous frustrations for the
staff and not resulted in much behavioral change on the part of the target communities.
As the project staff were coming to realise, success in health education does not
necessarily result from the production of flashy materials. It depends rather on how health
messages are understood, accepted, and implemented by the learners. This means that
the health messages themselves must be carefully analysed and formulated from the
perspective of the learner, the target audience. By presenting health messages in
understandable and relevant ways, they will hopefully ‘resonate’ with the learners and
have maximum potential to impact their behavior.
But successful health education is particularly difficult and elusive in a place like
Jayawijaya because of the cross-cultural context in which health workers and target
communities interact. The ‘language and culture gap’ makes it difficult for health
workers to communicate understandable and relevant messages to the target audience.
While they may have considerable medical knowledge, health workers are rarely trained
in cross-cultural communication skills and principles. When their attempts at health
education fail, it is easy for victim blaming to occur. The people are accused of stupidity
and unwillingness to participate in ‘development,’ when in fact, those initiating the health
education have failed to communicate successfully.

Gender and Development

Gender and Development
Since 1991 the WATCH project has been involved in the development of a primary
health care model appropriate to the highland regions of Irian Jaya. The project operates
in the Jayawijaya District where health centres and clinics are poorly serviced, and where
maternal and infant mortality is high and life expectancy is low. The project has attempted
to determine and tackle some of the root causes of women and children’s ill- health
through a combination of community development, gender role change, improved
essential clinical services for women and children, and community based preventative
health programs.
During its first two phases the project targeted interventions throughout Jayawijaya District,
a large rugged mountainous area covering 52,916 km2 where many culturally and
linguistically diverse people live in isolated communities. In October 1998 a two year
project extension began. This Kanggime Extension has the goal of consolidating
interventions, and maximising sustainability and project impact. In this phase the project
narrowed its focus to the two Jayawijaya subdistricts of Kanggime and Mamit. In this
region target communities comprise one relatively homogenous ethnolinguistic group
called Lani Barat (also known as Dani Barat). One of the key health issues in eastern Indonesia is the communication of appropriate messages that will influence communities to consider alternative behaviors for promoting health and improving their chances of reducing mortality and morbidity. The objective of the current consultancy is to assist the WATCH staff to develop ways in which the project’s health messages could be communicated effectively. The health education is to include basic medical topics relevant to maternal and child health as well as environmental sanitation, nutrition, and gender issues, all of which are seen as key interventions in the project’s overall strategy for reducing the mortality and morbidity of women and children in Jayawijaya.