All posts by Weh Yeoh

Weh is a disability development worker currently based in Cambodia. He is a professionally trained physiotherapist who has completed a MA in Development Studies at the University of NSW. He has a diverse background, having spent years travelling through remote parts of Asia, volunteering in an orphanage and adult shelter for people with disabilities in Vietnam, interning in India, and studying Mandarin in Beijing. He has experience in the NGO sector both in Australia and internationally in China, through Handicap International. He is an obsessed barefoot runner, wearer of Lycra, and eats far too much for his body size. You can view his LinkedIn (www.linkedin.com/in/wmyeoh) and follow him on Twitter @wmyeoh.
Weh-and-his-grandfather

Hey aid worker, what’s your legacy?

As a child, I grew up with the notion that I wanted to do great things. That my mark on the world would be significant. By that goal alone, the past 12 months have been the most fulfilling period of my life. A few months ago, I woke up one Saturday morning and stepped into the shower. I spent the next 20 minutes crying uncontrollably. No matter how hard I tried, it would not stop. Everything seemed to be going so well, but all I could feel was loss. Why? Though I was making my mark on the world, I’d forgotten about the mark I was making on those around me.

This week, my grandfather would have celebrated his 90th birthday. From my own interactions with him and the countless stories I have been told, he embodied everything in the word “great.” As a young man in his home country of Malaysia, he excelled in his studies, but he left school before his final year to work and support his family, handing over his salary to his mother every month. At the age of 22, he won the local lottery, worth $5,555. He took the entire winnings and gave it to his family. This was the equivalent of 31 years of his salary at the time. My grandfather was not the perfect human being, but overwhelming messages of support and love can only mean one thing. When he passed away late last year, this was a man who had left his mark on the world.

Weh and his grandfather
Weh and his grandfather, the man who taught him about leaving a legacy

When people talk about my grandfather, they rarely mention his many achievements. They don’t talk about his successful businesses, the school for underprivileged children that he established, or the fact that he founded the Red Cross society in his hometown. Though his achievements read like a never-ending reel of credits at the end of a film, they don’t define his legacy.

My grandfather will be most remembered for the way he made others feel. He gave time and attention to every person who crossed his path, regardless of their age, wealth or race. It’s hard to imagine that his attention to other people was ever determined by the question, “What can this person do for me?”

The late Maya Angelou once said:

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

Her words are relevant for every single one of us, but her message might well have been tailored to humanitarian workers. The dilemma that each of us must face is this: is your legacy what you achieve in your work life, or how you impact those around you? The former is not the same as the latter.

Once you invest your energy into a cause, it’s impossible for it not to occupy your entire being. The cause becomes you. For me, my own work has become exactly that. It’s more than a job to me – it’s everything about who I am. It’s fulfilling that somewhat vague childhood notion of leaving a mark behind. Yet, with every gain in my work life, parts of me slipped away. I felt less joy over social events than I’d ever felt before. I forgot important details about friends’ lives. I lost track of birthdays and important events. I even forgot to ask the simple question: “Is everything okay with you?”

I cried in the shower because I had experienced loss. I had forgotten that no matter what it is I want to achieve, being human means being the best I can be to those around me. Nothing else matters more.

People are often surprised just how unfriendly and unhelpful humanitarian workers can be. I used to feel anger at people who, despite being incredibly good at their work, were unable to be cordial or friendly. Now I try to feel empathy. I try to imagine what they might be going through.

How do you break the cycle? There’s no simple formula, but there are some common sense ideas. I noticed the signs of burnout early. I started to work out what it was that I needed to perform well, and I prioritized them. I started to perform random acts of kindness, particularly if there was no way the person was able to repay me. I started to listen, truly listen, to what people were saying.

I started to introduce deliberate moments of emptiness into my life. Rather than waking up in the morning and immediately checking my work emails, I made myself a cup of tea and stared out the window for a few minutes. Instead of obsessing over what I had to do tomorrow just before going to bed, I wrote them down on a list, and then spent at least two minutes thinking about everything I was grateful for that day.

I often wonder what went through my grandfather’s mind when he was alive. Did he ever feel overwhelmed by his work? Did he ever battle with the concept of work-life balance? Or did it just come naturally? Either way, as humanitarian workers striving to leave the world in a better place, one lesson he taught me should always stick. It doesn’t matter what you say or what you do, what matters is how you make people feel.

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Why did this woman refuse a job offer that would double her salary?

This is Phearom and she is my hero. She is one of the reasons why I still believe that we can do great things in global development.

As Phearom’s organisation is facing a funding crisis, they are only able to pay her $200 a month. Recently, she was offered another job that would see her salary double. Amazingly, she turned it down. Why would she do this?

This is what Phearom’s day looks like. She travels by motorbike to the small office, just outside Siem Reap, Cambodia, where her team members congregate. It’s over 35°C already, but the office doesn’t have air conditioning – only a few fans to keep the staff cool. She brings her own water from home, because they can’t afford a water cooler.

After some planning, she gets back on the motorbike and travels for an hour to meet 11-year-old Ouk Ling.

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Photo credit: Weh Yeoh

Ling has cerebral palsy – brain damage that occurs in a young brain around the time of birth. As a result, his movement is affected and his speech is slurred. He’s intelligent and affectionate. In fact, when I accompany Phearom to see him, he bursts into a huge smile and runs towards her to give her a big hug.

Since Phearom has been visiting him, transformational change has occurred in his life. Where he was previously incomprehensible, he can now communicate basic sentences with those around him. His movement has improved as well. He goes to school daily, by riding his bicycle. As his family now understands that he only has problems communicating, they no longer label him as “stupid.”

Phearom has 36 children like Ling to keep up with. Not all of them have had such huge progress as him, of course, but that isn’t through lack of trying. Phearom herself didn’t finish high school. She never went to university and what she has learnt about how to help children with disabilities has been on the job, through 15 years of experience.

She is of the age where most Cambodian women are married and having children. Recently, her mother tried to arrange for her to be married to a local businessman, which would mean quitting her job and helping him with his business. Phearom refused.

“If this man really loved me, why would he stop me from doing the thing that I love the most?” she asks. “Often in Cambodia, people don’t think that women can work in different fields. So, I am even prouder to be a woman working in this job.”

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Photo credit: Weh Yeoh

What made Phearom turn down a job with another organisation that would see her salary double?

Recently, she has been part of a pilot program improving her knowledge of speech therapy, with the aim to help children with communication and swallowing problems. She estimates that up to 70% of the children she sees have problems with communication, while up to 60% cannot swallow food and liquid safely. The latter can cause pneumonias and often death.

In fact, at least two children that Phearom visited have died in this manner. She describes how one of them literally choked to death on his own phlegm because his swallow was not strong enough to allow a safe passage into his stomach.

This weighs heavily on Phearom.

“Before, I was not clear on how to work with children with communication and swallowing problems, but when I had skills on speech therapy, it made it easier for me to make decisions on my therapy,” she tells me.

“I refused the job that paid more because I have had the opportunity to learn about speech therapy. That convinced me to stay.”

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Photo credit: Anna Clare Spelman. www.annaclarespelman.com

World statistics state that only 13% of people are actively engaged in their jobs. When I worked as a physiotherapist in a public hospital in Australia a decade ago, one colleague was incredibly inventive in the ways that he would avoid doing work. He would either disappear to the local shopping centre, or hang out in the emergency fire stairwell, playing Snake on his Nokia for hours, rather than see the patients he had been assigned to. I often thought it would be less effort for him to just do his job, rather than coming up with inventive ways not to.

Despite her lack of education, Phearom’s perspective on disability and patient care trumps most people that I’ve worked with in the past. She just gets it. Without a high salary, and without high status, Phearom is doing this job because she really does care. Any investment that we put into her, in terms of training, time and energy, we’re going to get back a hundred fold.

The current situation is by no means perfect. Even with my now fading memory of good physiotherapy practices, I can tell that Phearom lacks a lot of skills in therapy that prevent her from doing a great job. She isn’t reaching her potential. But that isn’t anything to do with her – it’s to do with lack of resources.

I started this piece saying Phearom is one of the main reasons why I still believe in global development.

What we see with Phearom is the ultimate development dream. Cambodian people helping Cambodian people. Surely, this is what global development should be all about.

Our role, as foreigners working in this field, should be to help local people do their jobs better. To give people the resources to be effective. And yet somehow, amongst the billions of dollars spent on aid and well-meaning yet ineffective small projects that we start, this often gets forgotten. Nonsensically, we restrict funds so that local organisations cannot spend them on staff salaries. Invest in people like Phearom and great things can happen.

 

You can support staff like Phearom to do their job more effectively by contributing to this campaign. $200 keeps her doing her best for one month.

Decisions, decisions...

Why we ignore global issues, according to science

You’ve had a long day at work. Your boss kept demanding more information on a project that you’d already had two meetings about last week. He probably wasn’t listening at the time, he was too busy bragging about his new catamaran. It took every ounce of energy you had not to strike him over the head with the weighty three-ring binder you’d been carrying around all day.

Now, as you settle down on your couch with your significant other and turn on your TV, you have two choices. The first is a documentary exploring the unfortunate treatment of Indigenous Australians since the arrival of the British. It’s likely to garner some interesting discussion but you’re both not sure if it’s worth the effort. The second is a gameshow where celebrities perform comedy segments on a set that, wait for it, tilts on a 22.5 degree angle. Which do you pick?

If this sounds vaguely familiar, you are not alone. At least one million Australians regularly pick the gameshow-with-an-angle rather than the documentary. How many times have you watched a documentary and said out loud “it should be compulsory viewing for EVERYONE”? Then what makes us more than often than not choose the gameshow?

Decisions, decisions...
Decisions, decisions…

In 1998, Roy F. Baumeister and colleagues conducted an experiment which sounds tantamount to torture. They asked participants in the experiment to skip a meal before coming in (already, I’m surprised no human rights groups were involved). They then led two groups into a room with both a bowl of freshly-baked chocolate chip cookies and a bowl of radishes on the table. One group was allowed to eat the cookies, while the second were only allowed to eat radishes. A third control group didn’t enter the room at all.

Even though the radish-eaters didn’t touch the cookies, it was not without anguish. Some even went as far as to pick up a cookie and smell it, but not one participant bit into one.

All three groups were then told to go into another room where they were to solve a geometric puzzle within 30 minutes. The catch - this puzzle was impossible to solve. The cookie-eaters and those who did not enter the first room gave up after about 20 minutes. The cookie-resisters, however, only lasted eight minutes. The researchers hypothesised that exercising restraint previously had a pronounced effect on that group, and hence coined the phrase “ego depletion”.

Restraint and exercising willpower is not something that is isolated to resisting cookies. Unless you are Chris Brown, you make choices every day that fit into society’s expectations and norms. In the above example, you resist the urge to strike your boss down when he bores you. This effort may deplete you enough that you’re tempted to skip the documentary I mentioned earlier.

We know after we watch such documentaries, we often feel mentally nourished, and want to discuss what we’ve learnt with others. The initial investment is often worth the return we receive. Just like overly simplistic marketing for aid and development, there might be short-term gains, but in the long run it can be detrimental.

How do we get people to care about and invest time in issues like poverty, inequality, and human rights, if we are constantly depleted throughout the day? The evidence on this isn’t clear, though some of it is common sense. We need to ensure that we’re all getting enough rest and staying fresh. Don’t use your smartphone before bed, or even better, keep it in a completely different room. Human beings, it seems, have limited capacity to make informed decisions. Looking after your ego shouldn’t be a guilty pleasure, just common sense.

As David McRaney writes in his incredibly informative, yet accessible book You Are Not So Smart:

It is as if the mind were a terribly designed experimental spaceship. As long as the ship travels in a straight line it burns very little fuel, but as soon as the pilot takes over in any way, to dive or bank or climb, this imaginary ship burns fuel at an alarming rate, leaving behind less fuel with which to steer in the future. At some point you must return the craft to autopilot until it can be refueled, or else it crashes.

Pilger's Utopia: "should be compulsory viewing for EVERYONE"
Pilger’s Utopia: “should be compulsory viewing for EVERYONE”

On May 31, 2014, John Pilger’s Utopia will be screened on national television in Australia. You can also watch it online. The feature highlights the reality of life for many Indigenous Australians. By going back to communities he filmed 25 years ago, Pilger shows that despite rhetoric, the situation has remained unchanged for many in spite of progress elsewhere.

The most disturbing part of the documentary occurred during Australia Day celebrations, when Pilger asked revelers, usually draped in the Australian flag or with their face painted as such, how the first Australians might feel about celebrating the day their country was invaded. A few of those interviewed didn’t twig to his nuance, so Pilger had to explain that Australia’s national day was also the same day Indigenous people considered their land invaded by the British.

It was startling to see the cognitive dissonance of these white Australians. One man, clutching his wife and son, shouted over his shoulder “you’re full of shit, mate”. His depletion of his sense of self, built entirely around history as written by the British, was evident.

As Australian of the Year Adam Goodes put it, there has been a disturbing “silence” over Pilger’s Utopia, which should enrage us all. It could be that ego depletion is the culprit for much of this silence. I reckon we should all put our spaceships into autopilot as much as possible, keep fuel reserves high, and take the time to watch this amazing documentary.

Trust me. It should be compulsory viewing for EVERYONE.

Save the Children Australia's poverty porn, captured by WhyDev's Brendan Rigby who posted it to our Twitter account first. Video has since been taken down.

5 reasons why effective marketing and good development work are incompatible

I finally watched Kony 2012. From a pure marketing perspective, the video itself is absolutely flawless. They manage to take a very complex situation, and not only make the audience understand it, but also care. But herein lies the problem. Critics of Invisible Children say that Kony 2012’s simple message of “catch the bad guy” is a distraction from the real issues that exist in Central African Republic. The message doesn’t reflect the complexity of the work needed.

Effective marketing brings attention and donations. Good development work should improve the lives of poor people. Does the latter limit the ability of good marketing folk to tell that simple story which the public seeks? Here are the 5 reasons why effective marketing cannot co-exist with effective development work.

1.     We have short attention spans

Research shows that when we read web pages, we actually don’t. In fact, we typically read 28% of the text that is on a web page. Similarly, only 12% of readers read all the way to the bottom of a page. (I’ll be accessing NSA records to check if you make it all the way down in a few minutes).

Knowing this, people who work in communications for non-profits boil down the complexities of the program so that it hardly represents the actual work done. Then they stick it in the slow cooker for another 12 hours until it is reduced even further.

In the push and pull of what needs to be done versus what people consume, clever communications folk know that they have to cater to the amount of effort that people are willing to give.

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2.     There is no incentive to translate complexity.

Even if an organisation truly values the work they do, and talks endlessly about how good this work is to other people in the sector, or even institutional donors such as government agencies, this matters little to the public.

Think about selling a product like Coca-Cola. In this transaction, the person buying the product is also the same person as the one receiving the benefit. In global development, the people paying and the person receiving the benefit are completely different. In the case of public donations, the payer is the general public and the people receiving services or programs are those in poor countries.

This creates a power imbalance because the person paying becomes the boss, not the person receiving benefits. Communication and marketing that oversimplify the message is another way of pandering to the needs of potential donors.

3.     Even if it offends some, on balance, dumb simple is better

When an organisation produces some marketing material that is offensive, such as Save the Children Australia did recently, they are likely to face some kind of backlash. In this case, the use of starving African children, often referred to as poverty porn, will offend some. Those in the know will be up in arms over what clearly negative tactics, and will write in to complain, post about it on social media and so forth.

Save the Children Australia's poverty porn, captured by WhyDev's Brendan Rigby who posted it to our Twitter account first. Video has since been taken down.
Save the Children Australia’s poverty porn, captured by WhyDev’s Brendan Rigby who posted it to our Twitter account first. Video has since been taken down.

But at the end of the day, poverty porn and other negative marketing tactics work, at least in the short term. They raise funds from the public because they tell a simple message about the “other.”

The conversation that occurs within organisations is then around the costs versus benefits of running a campaign that uses poverty porn. And on balance, despite criticisms which I personally think are valid, those tactics remain. The prevailing attitude is still that the end justify the means. The proof in the pudding is that weeks after this backlash, Save the Children Australia were at it again. Same poverty porn angle, different ad.

4. Money drives the work, not the need.

I touched on this earlier, but the vast majority of aid and development still revolves around what the donor wants to do, not what the people need. The debate around overheads, which reflects the administrative costs of an organisation’s work, is an old one within the development sector, but knowledge of how irrelevant this metric is for the general public is still low.

Why? Because organisations don’t want to talk about it. In fact, if you go to pretty much any large non­profit’s website, somewhere, they’ll be boasting about how low their overheads are.

A large and internationally recognised non-profit bragging about low overheads. Based on this, who in the public would think this was irrelevant?

 

As long as we have donor-driven marketing, we cannot have needs-driven development.

5. Effective marketing draws on herd mentality

Interlinked with the need of non­profits to focus on fundraising is the realisation that good marketing is very much infectious. Everybody in non­profit communications wants to create that viral piece of campaigning.

charity: water are great exponents of this. More than 20,000 people have held birthday campaigns to raise funds for them, simply by sharing their desire to help out through social media and email. It’s been incredibly effective. charity: water have raised over $27 million in 2012. Not a bad effort for an organisation with less than 50 staff.

Forgetting for one moment criticisms about the actual impact that they make, charity: water are able to leverage off herd mentality and the bandwagon effect. These social pressures exist often because we want to be seen as being on the “winner’s side”. If the goal is getting a campaign to go viral, it’s not the effectiveness of what the organisation does that matters, it’s how much other people are sharing the same material.

 

We all know the power of communications to drive awareness and as importantly, donations. But the reality is, unless we change the way we consume communications as human beings, overly simplistic marketing tactics will always butt heads with good development work. Don’t agree? Please restore my faith in humanity and prove me wrong in the comments.

We’ll be posting a rebuttal to this post by Rachel Kurzyp, freelance writer and communications professional, in a few days.

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The way we deliver aid and development is flawed. Here’s why. [INFOGRAPHIC]

In global development, it seems that some issues get more traction than others. Huge inequities exist because too often, issues are determined by what rich countries perceive as important, rather than what people actually need. As a result, though great gains are made in certain areas, there are plenty that fall to the wayside.

For the past year, I have worked, mostly on a voluntary basis, with CABDICO, a local Cambodian non-profit organization working with people with disabilities. They had identified that there was a huge need for Speech Therapy in Cambodia. The population that this profession aims to treat are people with communication and swallowing disorders.

I’ve been incredibly fortunate to see up close what CABDICO can achieve, with minimal resources. They have affected the lives of thousands of people with disabilities, all with an annual budget that is smaller than many UN salaries. Due to the lack of available funding in disability, they have had to let some staff go, some of whom only earn US$150 a month.

Organisations like this cannot reach their potential because donor priorities do not target the areas where funds are really needed. They are left to try and contort the real needs of a population to fit the donor’s call for proposals, or, more often than not, simply shut down. Once I dug deeper into the situation in Cambodia, it became clear how the way we deliver aid and development is incredibly unequal. No one is discounting the validity of causes that receive good funding. They have made great gains because they are internationally recognised.

However, for those other causes left behind to make similar progress, they too need some of the same attention.

If you wish to read more about CABDICO’s project to work within this area, and their need for support, you can do so via this Huffington Post article. Click the image below if you would like a larger version.

Ignore coffee

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Your organisation isn’t going to help you, help yourself.

This post originally appeared at How Matters

Generally speaking, it doesn’t matter how large or how small the organisation you work for is. If you work in aid and development, it’s up to you to look after yourself. Sure, there are exceptions out there. Anecdotally, Save the Children and MSF are both large organisations that are investing time and money into the mental health of their staff. But the reality is, for the bulk of them, the onus is still on the individual to take care of their emotional and mental wellbeing.

A volunteer in a large government volunteer program was working in an area of considerable stress, dealing with victims of sexual violence on a daily basis. She had put in an application to continue her association with this small local organisation, through another volunteer scheme managed by the same company. After she experienced mental health issues, she informed her employer that she was struggling and needed help.

The response that she was given was that she was jeopardising future placements through this company by requesting help. Quite simply, she was showing that she was not of the right fortitude to deal with the requirements of the job. They did however tell her that she was entitled to three hours of free counselling services. Over the 12-month period of her contract.

We put people in places where we demand a great deal from them, and expect our pound of flesh. But rather than give them the tools to do the job that is needed, we treat them with suspicion that they are incapable or weak when they need help.

How did it get like this?

Two years ago, WhyDev ran its first pilot program into peer support, aiming to match isolated aid workers around the world together, to support each others mental, emotional and professional well-being. Back then, the idea that aid workers were able to reach out for this kind of support was something of a novelty in itself, even more so than it is now.

An older man who had worked in the aid and development sector for a couple of decades felt the urge to write to me out of the blue. His email started politely, though (unsurprisingly perhaps) condescendingly.

“I am sure that you are a nice and well intentioned chap”, he wrote, much like the old uncle with a pipe in one hand and a cricket bat in the other, poised to strike you on the bottom just as you think you’re getting off with only a verbal warning. He continued to tell me how in his considerable experience working in conflict and post-conflict areas, he was yet to meet anybody who could benefit from this kind of support. What we were doing at WhyDev was, in his own words, “creating yet another coffee-club for people who ought to pull themselves together and stop whinging.” He urged that I “should put my considerable energy and brainpower into something worthwhile.”

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It speaks volumes about the capacity of someone to provide empathy when their solution to a problem is to grin and bear it. It also says more about the aid and development sector when people who we can assume are in higher management positions have this attitude. When they were our age, they toughed it out, and learnt how to “stop whinging”, the younger generation simply needs to do the same.

It is for this very reason that progress from organisations towards true comprehensive mental and emotional support for aid workers is slow. Look at an example of who is green-lighting them (or not, in this case).

I have two simple suggestions on how we can start to improve the situation from an organisational point of view. The first is employ more women in management positions. The science has shown again and again, that on balance, women have more characteristics than men that are suitable for management. Humility, sensitivity and emotional intelligence, just to name a few. Surely these sorts of characteristics, not the overconfidence that male managers tend to display in their own opinions, are more likely to result in organisations that know how to care for their employees’ mental and emotional health. Not only care, mind you, but give them the right tools to do the job.

The second comes back to title of this piece. Realise that, for now, organisations are generally not going to provide staff with the sort of support that they need. This doesn’t exonerate them of their responsibility to do so. It means individuals who work in aid and development need to let them know that it is something valuable to them. And support each other. Changing the perception of mental and emotional needs of aid workers will take a long time. But collectively, it is possible.

John Steinbeck’s quintessential bromance novel, Of Mice and Men, contains one of my favourite passages that encapsulates what working in isolation feels like.

A guy sets alone out here at night, maybe readin’ books or thinkin’ or stuff like that. Sometimes he gets thinkin’, an’ he got nothing to tell him what’s so an’ what ain’t so. Maybe if he sees somethin’, he don’t know whether it’s right or not. He can’t turn to some other guy and ast him if he sees it too. He can’t tell. He got nothing to measure by. I seen things out here. I wasn’t drunk. I don’t know if I was asleep. If some guy was with me, he could tell me I was asleep, an’ then it would be all right. But I jus’ don’t know.

Crooks, a black, stable hand with a physical disability, is always someone who is on the periphery of everything. He has no measuring stick to which he can exist in his life. It’s just him. But we can help each other, by first helping ourselves.

DevPeers: Improving aid through peer support from Weh Yeoh on Vimeo.

Early results of the largest survey of humanitarian workers ever show that burnout is a key issue already. At WhyDev, we are raising funds for the next iteration of their peer support program: DevPeers.

We are currently halfway to what we need to get the program launched. Without it, we cannot support the hundreds and thousands of aid workers out there. All help is appreciated.

You can also register your interest in DevPeers as a participant.

Who is the focus of the voluntourists mission? Photos like this speak volumes.

Hey voluntourist, take a back seat!

This originally appeared on New Matilda

Last year, I spoke with an American lady who brought troupes of foreign volunteers to do a few weeks of “giving back” in Cambodia. The main objectives of her non-profit organisation are to provide tourists with the experience of helping those who are less fortunate, in international locations, for an intercultural learning experience. If the people in poor countries benefit, it seems like a fortunate by-product.

I stumbled across this organisation in my work with a small organization called CABDICO, who work with people with disabilities in poor communities in Cambodia. The American organisation was giving adult-sized wheelchairs to children with disabilities. Why? Because despite their suppliers making adult wheelchairs, they preferred their volunteers to interact with children rather than adults.

The wheelchairs are designed in the USA by a partner organisation, made in China, flat packed in containers, and shipped from Shanghai to the destination of need. Once they arrive in the country, such as Cambodia, they are assembled by local workers or volunteers.

People don’t need any particular skills to assemble them, and in fact the design is intentionally dumbed down so that, for example, unskilled tourists could assemble them together at “wheelchair parties”. On top of this, as they are made with parts that cannot be found locally, if they break down, the communities can’t repair them.

Wheelchairs such as this are manufactured offshore, then delivered and assembled by volunteers at "wheelchair parties".
Wheelchairs such as this are manufactured offshore, then delivered and assembled by volunteers, who brand the wheelchairs with their own names, at “wheelchair parties”

In the process of being given to recipients, the distributor works with local partner NGOs to “verify need”. Yet, as this occurs right at the end, this step seems somewhat tokenistic. The need is verified, but there are no other possible solutions because only one type of wheelchair exists.

So even if the product doesn’t fit the need (adult wheelchairs for children), there is no alternative available. In the absence of any real alternatives, it’s hard to imagine that any poor family would refuse something if it is given for free.

A representative from another local organisation in Cambodia recently told me that he estimated that 75% of these wheelchairs are not used as wheelchairs. Instead, they are commonly used as pieces of furniture for other family members. We can speculate this is because they were inappropriately prescribed, or they broke down and were unable to be fixed, or the need changed and there was no follow up or reassessment.

On the website of the manufacturer and distributor, Free Wheelchair Mission, they claim to have delivered 8,250 wheelchairs to Cambodia. The cost of one wheelchair, according to their site, is $71.88. Incredibly cheap for a wheelchair, yet incredibly expensive for a piece of furniture.

This means that they have been responsible for delivering the sum total of $445,000 worth of IKEA-like furniture, direct from factories in China, to Cambodia. There’s your aid money at work right there.

When I raised my concerns about the effectiveness and dangers of this program, the American lady’s response was to say that what she was doing was inspiring people from developed nations to care. She was “lighting a fire” underneath them, so that they would do more good in their lives in the future. My response to this was “what is the point of this, if you don’t make a difference to people’s lives in Cambodia?”

Who is the focus of the voluntourists mission? Photos like this speak volumes.
Who is the focus of the voluntourists’ mission? Photos like this, taken from the ethical voluntourism organisation’s website, speak volumes.

As nonsensical as this approach is, this kind of “voluntourism” is rife in places like Cambodia, and not just in the disability sector. “Orphanage tourism”, where tourists are able to visit orphanages, play with children for a while, and generally feel good about themselves, is a booming industry in Cambodia. Yet the dangers around this are well-documented. Supporting a system of institutional care for vulnerable children, when there are better alternatives, is only one reason why this is problematic.

Elsewhere, unskilled Western tourists have been transported at great expense to build schools, churches and other buildings in poor places, often supplanting local labour and hence depressing the local economy.

It’s perhaps too easy to sneer at well-intentioned, yet clueless, foreigners who come to poor countries with the aiming of helping. Perhaps they do not know better. However, there are a range of better initiatives that do make a difference in places like Cambodia.

As I witnessed recently, there are already some incredibly ingenious solutions to problems, owned and initiated by Cambodian people. In regards to wheelchair provision, some Cambodians, aided by foreigners who play a supporting role, are tackling some incredibly difficult problems step-by-step.

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Thankfully, small scale and locally grown solutions do exist. They just need our support.

This wheelchair is a good example. It has large bicycle wheels so the person can travel longer distances and a smaller castor that drops down for manoeuvring indoors. It allows the person using it to tackle both the difficult roads that exist outside the house, while also being able to use the wheelchair inside their own house.

I spoke to the Cambodia man who leads the team that makes them, and was fascinated by his thoughts, one of which was quoted as the title of this piece. He has worked with foreigners, like myself, previously with some good success. For example, he worked with a British engineer who listened to what the Cambodian people needed, provided his own technical expertise, and then worked with him to come up with the design. Once he left (which mind you, unlike the voluntourists, was not a matter of weeks, but months) the work could be continued independently by the Cambodian people.

The story of this Cambodian man is in itself quite inspiring. He graduated from high school during the civil war, travelled overseas to educate himself and source ideas, and now works virtually unnoticed making and modifying equipment like this for people with disabilities. He is so humble and away from the spotlight that he wouldn’t even let me take his photo. Oh, by the way, the team of 18 mechanics he has trained all have disabilities.

Often, the answers to the problems are right in front of us. Foreigners should take a supportive role in helping people access resources, be they financial, technical or otherwise — not pretend to help while really putting ourselves in the way.

Numbers can be confusing.

Why personal stories trump numbers in global development

In global development, we are always looking for the most scientific way to show what works. For example, academics heavily criticised the Millennium Villages Project because of the lack of control group. Simply put, we demand more rigorous proof of what does and doesn’t work in development. We want the hard numbers backing up studies. Anecdotal evidence is not enough.

While not refuting the validity of these criticisms, there are some major reasons why anecdotal evidence of what does and doesn’t work in development still gets traction.

The first reason is simple. Human beings are not good with evaluating statistics, percentages and probability. Dan Gardner’s Risk: the Science and Politics of Fear begins with the telling figure that after September 11, an estimated 1,595 Americans were killed when they switched from flying to driving, perceiving the latter to be safer. Our comprehension of numbers, it seems, is poor.

Numbers can be confusing.
Numbers can be confusing.

A second and more complex reason can be seen through our desire to make sense of the world through stories, rather than numbers. This desire is outlined in the brilliant book Thinking Fast and Slow, by Nobel Prize-winning author Daniel Kahneman.

In 1975, the social psychologist Richard Nisbett and his student Eugene Borgida, at the University of Michigan, conducted the helping experiment on a cohort of psychology students. The experiment was set up like so: six participants were placed in individual isolation booths, where they were allowed to talk for two minutes at one time about their personal lives and problems. Only one microphone was active at one time. Importantly, one of the participants was a stooge, covertly instructed by the researchers prior to the experiment.

The stooge spoke first, speaking about adjusting to life in New York, and admitting that he was prone to seizures which would could be set off by high-stress situations. Each of the other five participants had their own turn, then it came back to the stooge again. This time, he became agitated and incoherent, told the five others that he felt a seizure coming on, and asked for someone to help him, gasping “C-could somebody-er-er-help-er-uh-uh-uh [choking sounds]. I… Im gonna die-er-er-er Im… gonna die-er-er-I seizure I-er [chokes, then quiet]” as he fell to the ground. Not a further sound was heard from him.

How many of the other people would you expect to rush to the aid of the possibly dying man?

The answer is disturbingly low. Only four of 15 (27%) participants responded immediately. Six never got out of their booth, and five others came only after the “victim” choked to death. This effect is known in psychology as the bystander effect, where the diffusion of responsibility occurs when there are other people around to take action. Decent people, like you and I, are less likely to help someone in need when there are others around that might avoid you dealing with an unpleasant situation.

After describing this experiment, Nisbett and Borgida showed the psychology students video interviews of two people who had supposedly participated in the New York study. The interviews were deliberately bland, where the interviewees talked about their hobbies, plans for the future, and so on. They were designed not to elicit any further information about their propensity to help or not.

Students were then asked to guess whether or not the two interviewees had helped the person in distress. This would help to answer the pressing question: given that students knew the statistical unlikelihood of participants in the helping experiment coming to the aid of the person in distress, would this knowledge affect their guesses about whether the two interviewees had helped?

The answer is both worrying and surprising. They learnt nothing at all. 100% of the class still predicted both interviewees had helped immediately, despite knowing that the probability of anyone helping is only 27%.

This shows that statistical knowledge of human behaviour has very little bearing on our ability to apply that knowledge in predicting human behaviour.

However, all is not lost. The researchers took another class of students, showed them the two video interviews of participants in the helping experiment, and simply told them that these two had not immediately helped the person in distress. They then asked them to predict the global results for the rest of the participants in the helping experiment. The predictions were surprisingly accurate.

This tells us that teaching people a surprising statistic, and then asking them to predict behaviour, is futile. Yet when people were surprised by individual cases, and then asked to generalise from these cases, they do so with relative ease.

Nisbett and Borgida brilliantly summarised the results of this experiment by stating:

“Subjects’ unwillingness to deduce the particular from the general was matched only by their willingness to infer the general from the particular.”

This telling illustration of human behaviour, one of just many within Kahneman’s book, speaks volumes about our desire to prove what works and what doesn’t work in development. We need stories (the particular) to infer information about the world (the general).

Sachs' Millenium Villages Project, heavily criticised for being unscientific, still centres the narrative around people.
Sachs’ Millenium Villages Project, heavily criticised for being unscientific, still centres the narrative around people. Photo credit: Nina Munk

This is why ideas like Sachs’ Millennium Villages, although easy to criticize, received so much support from the United Nations and other funders. Not because they are rigorous and scientific, but because they are case studies involving people. Until we recognise that human beings have a bias towards seeking particular stories that we can identify with, we will not be able to convince people of where resources should be allocated.

In a famous study, Paul Slovic, Deborah Small, and George Loewenstein asked people to donate to African relief. One of the appeals showed statistical evidence of the extent of the problem, another profiled a 7-year-old girl, and a third combined statistics and the profile. Unsurprisingly, the profile generated more donations than the statistics, but most surprisingly, it even generated more giving than the combination of profile and statistics. It was like the numbers alone had turned people off the idea of giving.

We still need statistical information, rigorous trials, and solid data in development. The more we can show that development is a science, as opposed to guesswork, the better.

But there is something be learnt from all of this. Even though we push for statistical information to demonstrate to the public the net effect of what works, and what doesn’t, or talk about the need in terms of numbers of people, we still need to keep the message centered around human beings. Without a human story, our ability to empathise and understand is severely hampered.

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How only small NGOs can address unmet needs

Whether it is Daniel-san in Karate Kid, the Jamaican Bobsled team or Mel Gibson in a kilt, people love to support the underdog. Here’s a feel good story with a simple lesson – in international development, we should often do much of the same.

In Cambodia, it is estimated over 600,000 people with disabilities lack access to basic Speech Therapy services. These are people who have disabilities related to communication and swallowing. They may have had a stroke and cannot swallow food independently. They may have been born with cleft palate, and require surgery and therapy to eat and communicate. They may have Autism Spectrum Disorder, and require communication strategies to interact with their family, friends and community.

Despite this great need, there is a huge lack of services that exist for this population. There is a multitude of reasons for this, but this lack of services can be explained through this (grossly oversimplified) diagram.

policy

At the top of the diagram, there is no explicit mention of disability in the Millennium Development Goals, nor does the UN Convention on the Rights of People with Disabilities mention Speech Therapy services, or the needs of people with communication and swallowing disabilities.

When conventions, laws and policies are not inclusive, this creates the same problems in funding. This affects programs, which in turn affects services. As a result, although no disability organisations in Cambodia could claim to be flush with funding, some of the best funded focus on hearing and visual impairments.

One organization, however, was unable to ignore the needs of 600,000 people needing Speech Therapy services in Cambodia.

CABDICO, a small organisation with 11 Cambodian staff and an annual budget smaller than many UN salaries, went searching for funds to support a program that helped initiate sustainable in-country Speech Therapy services and education.*

Despite the huge need, almost a year of searching provided fruitless. The most common response was “I can see that you’ve raised something very important (for over 600,000 people), yet this area of disability is not our focus and we cannot help.”

When needs are unrecognised at the international level, but felt at the local level, what could CABDICO do?

Larger NGOs often pursue funds that are in the order of millions of dollars. These funds exist because they are in internationally recognised areas of need – education, HIV/AIDs, maternal health, for example. Yet, smaller NGOs like CABDICO, pursuing funds that were closer to $30,000, face tremendous challenges in finding resources.

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The little guy often displays more flexibility, which can be beneficial as demonstrated in this photo.

How do most NGOs respond when then cannot find funding? A good example can be seen through a large and relatively well-funded disability organisation in Cambodia, who, like CADBICO, also recognised the need for Speech Therapy a few years ago. However, due primarily to lack of motivation from funding bodies, they were unable to take steps towards addressing it. Concurrently, they started to develop programs in mother and child health. Why? Due to the availability of funds this area, as a focus of the Millenium Development Goals.

I am by no means suggesting that a focus in mother and child health is unwarranted, nor that this NGO’s work in this area is ineffective. However, the choice this organisation made to pursue available funding affected its ability to be flexible and responsive to the population it serves.

CABDICO, on the other hand, decided to start a funding campaign through the online platform StartSomeGood to offer community-based Speech Therapy services. With these funds, and later, having successfully secured funds through the Australian Embassy, CABDICO began to take steps to address this huge problem.

The first task was to gather everyone who had been doing bits and pieces of Speech Therapy, and those who should know about it, together in the one room. As simple as this sounds, CABDICO had never organised a workshop on a large scale before. It was a daunting task, yet with their can-do attitude, something that they embraced. They partnered with a government coordination body, the Disability Action Council, to help  get access to people from Ministries of Health, Education, Social Affairs and Labor, whom they would otherwise have difficulty reaching.

As a result, for the first time ever in Cambodia, people, international and national, governmental and non-governmental, came together to discuss the future of Speech Therapy in Cambodia.

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Secretary General of the Disability Action Council, HE Em Chan Makara, speaking about Speech Therapy on national news. Unprecedented.

Working groups were set up to address the problem. Buy in from government, so crucial towards success, has begun. Speech Therapy was explicitly mentioned in the strategic plan of the Disability Action Council, but as importantly, in the National Strategic Disability Plan. A Cambodian university that teaches Medicine, Nursing and other Allied Health disciplines has agreed to initiate a Speech Therapy course.

Although there is so much more to be done, the change that has already occurred has happened at breakneck speed, and CADBICO has shown that things can happen like this:

policy2

Identifying an unmet need requires going to one place, listening and observing. Anybody can do that. But, often, only small organisations have the agility and capability to do something about what they hear.

In this underdog story, ordinary people generously helped to create change, because those in positions of power wouldn’t. CADBICO’s efforts, and those of countless other effective, small NGOs demonstrates that it doesn’t take millions of dollars to create change, just the belief of the little guy to dare think that things can change for the better.

 

Addendum: There is still a long, long way to go in this journey. If you would be interested in supporting, in any way, please contact CABDICO.

*I have worked as an external advisor to CABDICO since July 2012.

Cambodian Geo Savy, who had his leg amputated because of diabetes. Photo courtesy of IRIN news.

How to value over one billion people

Over 15% of the world’s population lives with some form of a disability. Yet, in the year 2000, when the Millennium Development Goals (MDGs) were formulated, there was not one explicit mention of disability within it. Since then, progress towards recognition for the over one billion people across the world living with a disability is slow.

In the United Nations 2013 MDG report, disability is mentioned but once within the 59-page document. At this rate of progress, by 2026, we may be lucky enough to see the word “disability” mentioned twice.

On September 23 this year, a UN high-level meeting was held in New York, to discuss the under-representation of people with disabilities within the development agenda, through the MDGs and other internationally agreed conventions. Preceding this, a high-level breakfast, presumably involving pancakes and croissants placed on unreachably high buffet tiers, was held with UNICEF and the Permanent Missions of Mexico and Australia to the United Nations.

The outcome document from the UN meeting makes for good reading, urgently asking development actors to promote the inclusion of people with disabilities, as well as advocating for disability-specific services. There is nothing surprising in there, particularly for people familiar with disability trends worldwide, but that isn’t to say that it isn’t chock-full of common sense.

Speaking of which, a recent Inter Press Service article, which I would highly recommend reading, highlights some of the reasons why those with disabilities have been continuously ignored at an international level. For example, in health-related interventions, we tend to focus on lack of productivity as a reason to intervene. But that doesn’t help everyone of course – especially those with moderate to severe disabilities.

Another interesting point raised by this article is that of perception. In my mind, this is the fundamental reason why disability is not high on the international agenda. If we want to know why those with disabilities are being ignored, we simply have to look at our own perception of the situation.

After the Boston Marathon of April 15, 2013, runners who lost limbs from bombs exploding during the event were flooded with millions of dollars in donations for medical care for the public. As of September this year, $69.8 million had been received by the One Fund Boston, a foundation established to administer funds to the 294 victims of the bombings and their families. Of these, 14 people required amputations.

Yet, in the US alone, approximately 65,000 diabetic patients require lower limb amputations yearly. Resources for the latter group are scarce, and even more scarce in poorer countries like Cambodia.

Cambodian Geo Savy, who had his leg amputated because of diabetes. Photo courtesy of IRIN news.
Cambodian Geo Savy, who had his leg amputated because of diabetes. Photo courtesy of IRIN news.

Similarly, organisations in Cambodia that care for victims of land mines are relatively well resourced in comparison to those that deal with more complex disabilities, such as Autism or Cerebral Palsy. In 2012, there were 185 land mine casualties, down 12% from the year before.

The reality is that these two examples illustrate a fundamental difference in the way different groups with disabilities are perceived. We support one over the other because of our own perception of people with disabilities.

The identifiable victim bias states that we are much more likely to help a victim that we know and understand. It explains why so many people opened their wallets to assist those who were victims of Boston Marathon bombings. The more we understand and can identify with a victim, the more likely we are to want to support them.

Similarly, land mine victims in Cambodia and runners injured during the Boston Marathon share a few key common attributes. They are all victims. They are blameless. It could happen to any of us. The cause of the problem (and perhaps the solution too) is simple and obvious.

Our desire to keep things simple, and not overwork our brains means that we naturally have a bias to support these sorts of projects. Compare that with the mental energy (and education) needed to understand how diabetes can lead to lower limb amputations, or how unsafe birth practices or poor maternal health can lead to a child being born with Cerebral Palsy. These concepts are more difficult to grasp and therefore less likely to receive support. This explains why projects that could potentially assist over 600,000 people in Cambodia struggle to get support from traditional sources.

Yet, research suggests that people who use a more analytical style of processing information are less likely to default to the identifiable victim bias. They are more likely to support the greatest need, rather than the victim that is easier to identify with. What this suggests in practice is that potential donors need to take the time to analyse the situation more, and not donate purely on the basis of impulse or emotion. This might not seem like anything remarkably ground-breaking, but it is something to keep in mind.

Unfortunately, as long as NGO marketing continues to follow the lowest common denominator approach, it is unlikely that we’re going to see a major shift in the way appeals are made sector-wide.

How then do we ensure that people with disabilities are no longer forgotten worldwide? We encourage people to look at the facts and figures on the need that exists, and discourage them to support based upon their ability to identify with the victim alone. Pushing back on these instincts might just mean a brighter future for over one billion people in the world.