Here are a few scenarios that were presented in class. In each one, the individual has both strategic and practical needs to be addressed. Our aim is to identify what they are.
"Tui completed two years of school, married at 15 with her first child soon after. She is a
rice farmer and typically gets up first light and when she has finished her housework she
goes with her husband and baby to the rice fields. In the evening she collects water from
the river, takes a bath in the river, collects firewood and cooks dinner (rice and a little
chilli sauce). Sometimes she walks the 5km to the market to sell some vegetables which
she grows on the bank of the river. She often feels tired. She had her first sexual
intercourse when she was 15 and soon after became pregnant and got married. She
wasn’t sure if she wanted to have sex with her (now) husband but she was afraid she
would loose him. She had heard of condoms for preventing pregnancy from the local
health worker but she was too embarrassed to go and get some from the health worker
and she was not sure her partner would like them. She went to ANC a couple of times.
She wanted to go again as she had run out of the medication they gave her (not sure
what it was) but her husband was busy and could not take her. She gave birth at home.
She has not been to post natal care as she did not feel ill but her baby was vaccinated."
So what are Tui's practical needs?
- Tui could probably benefit from having access to a range of contraceptives other than condoms (seeing as she is uncomfortable asking her husband to wear one) such as intrauterine devices (IUDs), birth control pills, injectable birth control, diaphragm, etc, which may be more convenient and easier to negotiate but also so that she can have more control over her own fertility.
- Because she only eats rice with chilli sauce and often feels tired, it's fairly evident that she needs more nutritious food including protein and vegetables and would likely benefit from vitamin supplements as well (iron, etc).
- If accessing health services was difficult for her and that's why she gave birth at home, she may need better and easier transport to health services, more family support to help when her husband is busy and possibly a clinic with skilled health workers nearby.
- Tui could certainly use a water pump in her village or near her house so that she doesn't have to go down to the river to get water and bathe, which could be dangerous if she cannot swim or the water is carrying pathogens (such as schistosomiasis, etc) that could make her ill. Carrying water all that way could also be very labor intensive, especially if she's also carrying her child.
- Tui could benefit from some education (formal or informal) about nutritious food, family planning, contraceptives (the different kinds that are available and how to use them) and reproductive health (such as ideal spacing of pregnancies), particularly regarding the importance of having a skilled birth attendant and preferably going to the hospital to have a baby.
- Tui needs more self-confidence and social and cultural empowerment so that she feels more comfortable voicing her wants and needs to other people and acting on them. For example, she should be more at ease going to get contraceptives from the health worker and discussing it with her husband as well as other people in the community. This may also help her to insist to her husband and family (his or hers) that she deliver in a clinic the next time she has a baby since she may have felt that she did not really have a say in the matter the first time.
- Perhaps there needs to be more social acceptance of contraceptive use in the community, particularly for unmarried couples and women specifically so that they don't feel ashamed asking for condoms and birth control from health workers.
- Tui may also need for her community to have more trust in health facilities and to change their views on giving birth at home in the traditional way to a preference for clinic deliveries.
"Lui is a rice farmer and she also grows some corn. The area where she lives is peri-
urban/rural and experiences some flooding during the monsoon season, she did not go to
school and in her village there is access to secondary education opportunities and health
care. She considers herself ‘average’ socio-economic status for her village. Mainly her family
eat rice with chilli sauce and maybe a little vegetable. The vegetables she eats are the ones
that are “easy to find at little to no cost. This is mainly morning glory, ivy gourd and ginger
leaf. In the wet season she raises fish in a small pond and eats the fish, fish are also fairly
cheap to buy. Sometimes she buys pork meat which is not too expensive but foods such as
pork intestine, beef, and soybeans are too expensive. Other foods which she thinks are too
expensive are carrots and sweet potato. If she has a little money from selling vegetables she
likes to but some MSG and chilli. She gets her water from the river and is very careful to boil
it on her wood fire."
- Lui does pretty well for herself but she could probably benefit from better access to healthier food items (i.e. the more expensive but more nutritious).
- She could probably use a house that's a little further from the flood waters, or one that is on stilts so that her children aren't at risk of drowning and their belongings are not at risk of being damaged or lost.
- She may also benefit from a water pump closer to her house so she has a close water supply nearby and doesn't have to carry water very far.
- Hopefully she has an outdoor area to boil water and cook food so that she isn't inhaling a great deal of smoke which could affect her respiratory system.
- Lui could probably use some more education (even if it is informal) about the nutritional content of different foods and the health benefits of paying a little extra to buy carrots or sweet potato at least every once in a while.
- She may benefit from having a system in place to provide her with more knowledge about how to optimize and expand her crop and fish farm yields.
"Madeline moved from her village to the city. She works in a large factory making clothes. She
gets paid quite well as she makes boutique clothes and she is able to send some money home
to her family. She gets paid per piece so she works very hard to earn more money to send
home. In the factory they are not allowed to talk to the other girls and not allowed to go to the
toilet before mid-day. The supervisor comes round with water but she found after a while she
could not sleep and she started to loose weight, someone told her it is because there are
drugs in the water the supervisor brings round has drugs in it. Usually 10 people sleep in a row
in a small room at the factory where the scraps of material are stored. Sometimes people have
accidents, their hands get caught in machines of they fall asleep. The company will usually pay
for a doctor and medicines."
- Madeline really needs a new job. One where she has improved health and safety (no hands getting caught in the machines) and a better boss that allows her to go to the washroom when she needs to during the day, that doesn't drug their staff by putting amphetamines in the water, or refuse to let the workers talk a little bit throughout the day.
- She also needs a better place to sleep where she can actually get some rest outside of the factory.
- Madeline needs empowerment and self-confidence to stand up to her boss and ask for better working conditions.
- She would benefit from a government that is interested in establishing and enforcing policies to protect the rights of all workers.
- She would also particularly benefit from having a union to speak on her behalf and fight to protect her rights. Therefore she needs political and social systems to be put in place that will allow for the creation and functioning of labor unions. In fact, she and some of the other female workers could start a union of their own if they felt confident enough to do so.
"Mary is 78. Her husband died several years ago and she lives alone in a small apartment.
Mostly she stays at home watching television. She is quite poor and worries about the rising
cost of living. She has ringing in her ears and cannot hear very well. She also has high blood
pressure and type 2 diabetes has to take medication every. Mary has decided to save some
money she will try and reduce by a small amount some of the amount of medication she takes.
She has not mentioned this to her doctor, to her doctor, nor has she mentioned the ringing in
her ears to her doctor."
- Mary needs to visit an audiologist, preferably one that will not cost her much or anything at all.
- She may need a hearing aid to help with her hearing.
- She needs access to less expensive medication, such as generic versions of the drugs she is on now.
- Mary needs to feel like she can talk to her doctor or pharmacist about the ringing in her ears and not being able to afford medication so that she can receive proper treatment and so that her health and well-being can be taken care of. Mary needs to feel confident and empowered to discuss her situation with them.
- Mary would benefit from a government and society that are more concerned with looking after the elderly through social assistance programs so that she didn't have to worry about money all the time.
- She might also do better if she knew about social groups and gatherings, especially for people around her age and the courage and willingness to go out and make new friends so that she doesn't feel so lonely.
One thing that we discussed in class, particularly in relation to Lui, was how resourceful people can be, even without a formal education. It's important that individuals are treated like the capable people that they are when developing and implementing projects so that their skills are utilized and they don't feel put down.