Rebuilding Communities

bharris — Fri, 25 May 2007 20:08:11 -0500

Rebuilding Communities

by Binta Barry and Nancy L. Pearson

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In this notebook, we learn about building local and long-term capacity building within communities to address massive human rights atrocities. The Center for Victims of Torture has instituted an intensive training and supervision model for refugees to develop local capacity for providing understanding and skills for mental health support to rebuild communities after massive human rights atrocities. CVT has instituted the training model in refugee camps in Guinea and Sierra Leone for refugees from Sierra Leone and Liberia. The model combines intensive, hands-on training of refugees with ongoing supervision. These refugee "mental health specialists" build their capabilities, provide individual and group therapy for traumatized individuals and use their skills toward rebuilding their own communities and support systems.

There are currently 122 "mental health specialists" involved in this ongoing training and supervision model with thousands of refugees of all ages having received a wide variety of services. Devastating wars in every region of world have created massive number of refugees and internally displaced people who have witnessed or been victims of horrible human rights atrocities. This notebook may provide tactical ideas to those assisting these communities trying to rebuild their lives.

Even as the world has witnessed substantial gains in the development of international mechanisms to monitor human rights violations and prosecute offenders, mass atrocities continue to plague many countries, including Sierra Leone. The nation’s people endured more than a decade of civil war, suffering brutality and massive rights violations aimed at ripping apart the social fabric, undermining cultural and family values and destroying community leadership and structures. Sierra Leone, a country of approximately six million people, is composed of 20 tribes following a variety of faiths–Muslim, indigenous and Christian. The country gained independence from Great Britain in 1961. Despite rich mineral and human resources, by 1990 Sierra Leone had one of the most skewed income distributions, with 82 percent of the population living below the poverty line. An eleven-year civil war provoked in 1991 by the Revolutionary United Front resulted in tens of thousands of deaths and the displacement of over one-third of the population.

The conflict caused more than 450,000 people to flee to neighboring countries–mainly Guinea and Liberia–and left an estimated one million people internally displaced within the country. With the RUF conducting systematic and brutal assaults on the civilian population, survivors had witnessed or survived brutal atrocities including mutilations, amputations, forced recruitment of children and adults as soldiers, forced labor and horrendous sexual crimes. International observers described the situation: "The rebels sought to dominate women and their communities by deliberately undermining cultural values and community relationships, destroying the ties that hold society together. Child combatants raped women who were old enough to be their grandmothers, rebels raped pregnant and breastfeeding mothers and fathers were forced to watch their daughters being raped." Girls as young as seven or eight were used as sex slaves.

At the time the Center for Victims of Torture was launching its program in Guinea, there were more than 300,000 Sierra Leonean refugees and more than 120,000 Liberian refugees in the country. Conservatively estimating that 5 to 10 percent of the refugee population could benefit from mental health interventions and needed more than social opportunities or skills training to regain their life functioning, 20,000 to 40,000 people were in need of such assistance. Sierra Leonean communities were broken apart by the atrocities of the war. And many of the individuals who endured and survived such atrocities remembered their experiences in silence.

*Note: You need Adobe Acrobat Reader to open the files marked with an asterisk (*). You can download a free version of this program from www.adobe.com.

Engaging Key Stakeholders

bharris — Fri, 25 May 2007 20:08:01 -0500

by Syed Asif Atlaf Chowdhury and Roy Romesh Chandra

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In this notebook, we learn about how the development agency CARE-Bangladesh involved key stakeholders, particularly a transport workers’ union, in the task of HIV/AIDS prevention in Bangladesh. Although Bangladesh has one of the lowest HIV/AIDS infection rates in the world, it is surrounded by countries in which the disease is widespread, and many worry that it is only a matter of time before it spreads to Bangladesh. Transportation workers, such as truck drivers, are particularly at risk of contracting and spreading the disease. CARE-Bangladesh worked to gain the trust and respect of the Bangladesh Truck Driver’s Federation and then together implemented a program of advocacy including health education and services through integrated partnership. Particularly important was the cultivation of a sense of ownership of the project on the part of the union, including the employment of paid peer educators and the use of union premises for outreach work and health services. The story of CARE-Bangladesh’s work provides important insights into engaging key stakeholders in advocacy work that is socially acceptable and relevant to the lives and experience of target communities.

Since the first identification of HIV and AIDS, their prevalence has been particularly high in communities situated on transport routes, such as border posts and port towns and cities. The HIV virus spreads as people travel, so transport workers are particularly vulnerable. Although Bangladesh is currently rated 161st of 166 countries and territories in rates of HIV/AIDS, it is in close proximity to Asian countries with relatively high rates. Rather than wait for the epidemic to arrive, CARE-Bangladesh sought a strategy that would prevent the spread of HIV/AIDS.

CARE-Bangladesh recognized that it was crucial to engage transport workers, unions, and companies as key stakeholders in combating the spread of HIV/AIDS. As a result, in partnership with the workers’ union and associations, and with owners of the transport companies, we initiated a behavioural change program to prevent an HIV/AIDS epidemic and to provide quality health care services to transport workers, especially truckers. Because we planned to give the project over to its participants–namely the transport union–after the initial design phase, the primary stakeholders, especially the union, have been actively involved in program development and activities. By holding the union accountable and responsible, CARE-Bangladesh has facilitated a process whereby the workers’ union has become an implementer of health care services, including prevention services, related to sexually transmitted infections (STIs) and HIV.

The active involvement of the union has brought many positive results. Its participation and sense of ownership have been essential in sustaining the program and making it socially acceptable. Union involvement was also instrumental in the scaling up of project activities and the ability to quickly create a nationwide service network.

To address the mobility and needs of some 300,000 transport workers, the program now has 45 Drop-In Centres (DICs) nationwide, each called "Traveller," about 300 paid peer outreach workers, and 25,000 volunteer peer educators (recruited from the transport workers themselves). Approximately 4,000 transport workers receive health services from the DICs each month. The project has also established a system for the social marketing of condoms through Peer Outreach Workers and more than 200 local depot holders. On average, 200,000 condoms are sold through this system every month. The establishment of these DICs not only addresses the mobility of transport workers, but greatly improves their access to effective health care services.

In this notebook we share our experience of engaging critical key stakeholders–CARE-Bangladesh, the transport trade union, and the transport workers–to create a holistic approach to HIV/AIDS education, prevention, and treatment. We hope our experiences will be helpful for others who want to work with community-based organizations, unions, and other civil society actors in the context of their own countries and issues. And we hope this effort will provide a model for establishing effective cross-border interventions as well.

*Note: You need Adobe Acrobat Reader to open the files marked with an asterisk (*). You can download a free version of this program from http://www.adobe.com