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Transcript

You come home and things here are pretty much the same, and I think sometimes it’s quite a dramatic shift for yourself, because you know that something has shifted internally and emotionally, intellectually.

Yvonne

Switching realities

Special guests:

Yvonne Ginifer, Nurse, emergency health delegate  

Host:

Alex Hahn, Australian Red Cross

 

Alex

One minute you’re in the remote villages of Myanmar disseminating education on HIV and malaria, the next you’re in Alice Springs providing health care to indigenous communities. How do you switch realities and cope with the culture shock. Nurse, Yvonne Ginifer shares her secrets.

Hi, Yvonne, thanks for joining me.

Yvonne

Hi, how’s it going?

Alex

So you’ve done many missions with Australia Red Cross, International Committee of the Red Cross, and the International Federation of the Red Cross. You’ve worked in places like South Sudan, Liberia, Myanmar, Pakistan, Sri Lanka, Zimbabwe, central and northern Australia, just to name a few. Do you feel like a woman of the world?

Yvonne

I feel like a gypsy. I feel like that, perhaps, um, yeah, the gypsy lifestyle is something that suits me quite well and I have, uh – it’s my preference to, uh, just keep stimulated and – and potentially to keep moving a little bit. But saying that, I have sat down in jobs for two years at a time on occasions.

 

Alex

And, uh, how does that go?

Yvonne

Um, good because that was in Myanmar so it was – it was brilliant actually, because working in Myanmar required a bit of a longer-term approach because it was more of a development programme, so it’s not something you can go in there and do in a hurry, and, um, the – the long – longer term, um, way of working there really helped because it was quite slow to actually get anything started given that it was a massive bureaucracy and it was also new territory for – for Red Cross to be working in terms of HIV and with those minority groups there.

Alex

Right. So – so what exactly was your role in Myanmar?

Yvonne

I had a bit of a dual role. We had a – an Australia Red Cross funded project which was initially around HIV, but it, um, worked itself to be more about doing some, um, basic health programming around water, uh, safe water and sanitation and – and hygiene, uh, programmes, because, uh, HIV was a problem but, um, the other, um, deficits in – in their health structure, I guess, um, were – were more of a priority to the people at that time.

Alex

So you were in Myanmar in 2003 as a health delegate, it was your first Australian Red Cross mission, is that right?

Yvonne

Yep, first Australian Red Cross mission. It was a brilliant first mission, actually, it was something that – it was described as a place where you – where, if you were going to go and work there, you would you take one step forward and two steps back. It was, uh – and, to me, that – that – just even saying that that particular challenge was there was something that tickled my fancy really because I’m a bit persistent and I – and I really like following through what – on what I do. So I put my hand up for the job, it took a year to come around, I mean that was even just an indication on how difficult it was to get things going over there. But, um, yeah it was – it was a – it was my first mission, it was a big eye opener, it – the – the – the culture, wouldn’t call it culture shock but the difference in culture was huge working within an Asian situation and a very traditional Asian situation, which of course if so different from Australians who – you know, we’re very bold, we’re very direct, we’re very pragmatic, and, uh – and I was a bit younger and not that savvy on a - in a political sense, and – and even in negotiating, you know, within different cultures, it was – it was – I wouldn’t have got out of that the same. I can remember having meetings with the exec team and going up to talk to them about things that we needed to do on the ground, you know, and not – not – not too big, you know, in terms of just having a conversation about stuff and getting things approved, and I would go up there and – and I would put a meeting aside and we’d have an hour and I’d go up there, and – and I tried to introduce what I needed, what I wanted, and they would never answer the questions. And what I learnt over time is that you go up there and you can spend 50 minutes having a conversation to be polite and to talk about other things, and then right at the end of the meeting is the time that you can introduce what it is that you want.

Alex

Right.

Yvonne

And then they would respond to that, usually very positively, um, but that was – that was an interesting learning for me because it was – yeah, come – as I said, being Australian is, uh – that’s not how we usually do things.

Alex

I want to read a quote that I read from you about your time in Myanmar, you say, “the people of one village didn’t have any understanding of the concept of health, they didn’t even know when they were sick, they didn’t know they could do anything about their health.” Is that something that you came across quite a lot in your work in Myanmar and in other areas or was this fairly unique to Myanmar?

Yvonne

Myanmar – this was something that was really obvious in Myanmar. The thing there was the people knew they didn’t know, but they had no resources to go to, to find out. So when we went in there with this health programme, they really did, uh, you know, welcome us with – with open arms, and so it was very easy to do good work there. Um, these people were quite hungry for information really and, um, and we were able to give that to them. So that was – and – and over time, I think it did make a big difference. And so there’s a lot of satisfaction in that, where you’ve local people really willing and working hard to – to – to get as much out of what you can offer as – as is possible.

When you work overseas, there’s always some barriers to how you can – how much you can deliver what people want and, um, you know, how receptive they are to – to – to the support that you’ve got to offer really, and for Myanmar, they were desperate for information, and very willing to learn and to take up what we had on offer. So it was – it was excellent.

We went in there. They said, “You can teach us whatever you like, but this is our first priority, we need to have enough safe water to drink.” Fair enough, you know, and so then I’d come back and – and negotiate back across with Australian Red Cross and say, you know, “This is – this is their priority, this is what we need to work on, and can we adapt the project to support that.” And they were good with that.

Alex

So, I wanted to ask the question, ABOUT whether or not there were any taboos that you came across when trying to disseminate education on HIV?

Yvonne

The taboo for HIV in Myanmar wasn’t – actually, it wasn’t spoken about at all, so when we went there – when we first started up, it was a topic that was, um, pretty much not talked about at all, and this came right from the top in terms of the – the military, the regime that was in place. So we had to frame how we talked about the programme quite carefully so that we didn’t, um, upset, I guess, the powers to be that had, uh, had the potential to – to make things difficult for us if they felt that we were doing something that wasn’t in their, uh, best interest I guess.

So HIV was a taboo subject on its own without how do we talk about it. Saying that, people were prepared to listen a little bit originally, and given that we came in and ended up doing a lot of the other, um, more basic health programme stuff around water and sanitation and health education, by the time we really did start pushing the HIV story, uh, they trusted us and they knew us, and so in fact it – at – at that point it became much easier to do. If we tried to do it right from the very beginning, I don’t think we would have managed, because it was such a – it was such a topic that nobody was able to talk about it, let alone wanting to talk about it, and, um – and – but given that we took our time and necessarily, from a number of levels, it – it – it did end up being, um, not so difficult, you know, 18 months down the track.

Alex

So why – why was there this taboo in Myanmar specially? Why couldn’t they talk about it?

Yvonne

I think it was probably related to the fact that it was related to the sex industry and it really – the people that were being affected in Myanmar were young women that were going across borders to work to earn money for their families, uh, and they were coming back sick and – and dying really. It – it was a bit of a hot spot up there in Shantung, which is why the project came about.

Alex

And so, can you talk through some of the specifics, what you actually did in your communications to try and work around all those barriers? Like, how did you actually disseminate that education to these women or to the husbands of these women in this – in this town in – in Myanmar if you had really top down pressure from the military regime from, you know, lack of funding, how do you go about that day to day, how do you get that information out to them?

Yvonne

One of our strategies was to work with the taxi drivers, they – they were the people that were transporting people to the – to the places where, um, their brothels were operating, and they were also, you know, some of their clients, I guess, that were hanging around – while – while they were waiting for clients, they became clients themselves, you know, clients of the brothels, and so we – one of the – that was one of our first targets in terms of just really doing, um, some health education. We did a screening programme at the same time and then we did a little bit of, uh, incentive working using road safety, so we – we – we offered helmets to taxi drivers if they were to come along spend some time with us where we did a lot of health education and condom demonstration and distribution and – and we also engaged with the local sexual health team from the – from the government who – who – who were heavily involved in this and – and were helping us to, you know, devise how it would work. And, uh, we thought we’d run the programme over about two weeks, and on the very first day all of the taxi drivers from Shantung turned up…

Alex

Every single one?

Yvonne

Almost every single one.

Alex

Was it the helmets that got them there?

Yvonne

I suspect it was the helmets, but obviously, you know, it was more than that, I mean some of them already had helmets, but I think, uh, yeah I – I think there was a – a curiosity, there was also a bit of comradeship in terms of, well some of them are going so the rest of them would go, so – and I think also at that point in time Red Cross had quite a good reputation, we’d been doing quite a lot of work at that time, and – and I think people wanted to be involved.

Alex

So how did you actually get into international aid work?

Yvonne

I turned 40 and I was at a crossroads really in terms of choosing where my career was going and what I was – what opportunities lay there and what was I capable of doing that was going to make sure that I, over time, had some, you know, fulfilment, I guess, in my life. I wasn’t married at the time and I didn’t have children, and so I was quite, uh, flexible. I had a good, strong background in nursing in a variety of ways. I’ve – I’ve been – I was quite well travelled at that point in time and – and I thought, I think – you know, I – I think Red Cross is the way to go, you know, I – I’m – I can do this because I don't have responsibilities. I do have a good skill set and, um, and I think I wanted to be able to contribute somehow to, you know, situations where they needed expertise around health and health programming.

Alex

And so you mentioned that you travelled a lot before you started working for Red Cross, was that part of the – the decision making, that you would be able to go all over the world and – and help people that you hadn’t met before or help people that were more vulnerable than – than you had experienced before?

Yvonne

No it wasn’t about the travel, really it was about, um, tapping into opportunities where I knew that I would, a) be able to contribute, and b) I knew that there was a need and that I could, I don’t know, work within – work within, sort of, an organisation that was doing good from – from a global level somehow. Um, I mean you can travel, people can travel and – and get the enjoyment out of that, so I think it was – it was more than that, it really was about working, definitely in different cultural situations, but more around responding to – to need really. Um, working in a day to day job, for me, was – was okay, but I didn’t – it – it wasn’t really that challenging and it wasn’t really that satisfying somehow.

Alex

You’ve done a lot of work overseas and you’ve also done a lot of work here in Australia. There’s another quote here that I want to read from you, and it says – “it’s very interesting, it says, ‘overseas they’re more vulnerable because we tend to be helping after a disaster has struck, but here the help that’s needed is longer term”. What did you mean by that?

Yvonne

Uh, primarily working in – in remote Aboriginal communities, that – I mean, the health situation up there is quite grim, there’s a lot of chronic disease, uh, there’s a lot of other factors that, uh, impact on health around, um, you know, mental health, isolation, housing issues, education issues, it’s – it’s quite a complex, uh, context to work in regards to as a health professional. And improving health in that sort of context takes more than health professionals, you need – you need efforts across the board. So it’s not something you can go in and, uh, contribute to and then come out and feel like you’ve actually achieved something in a – in a short timeframe. You need to be in for the long haul, you need long term programmes, you need long term staff, in fact, um, so that you can develop relationships and – and, uh, and strengthen mature programmes really to – in terms of working with – with these – with – with Aboriginal people.

It’s – they have been exposed to a lot of, uh, different programmes by different people over time, a lot of it’s influenced from – from a political level, and so things change with governments and, um, and of course it’s a difficult situation working in – in isolated areas, so staff change as well. So there’s been not – no real continuity over time, um, and I think this is where we’ve – we’ve made mistakes over the time, um, we need good – we need good policies, we need good programmes and we need good staff, but – and we need it in there for a long time to make such a difference. I mean the – the health situation has been a long time coming and it’s going to be a long time to – to, you know, improve it. There’s a lot of good things going on and there’s some improvements that you can see, but there’s still – we’ve still got a long way to go.

Alex

Talking about different cultures, obviously it’s different overseas, but was there an element of culture shock for you working in your first indigenous community?

Yvonne

Um, I’ve – I’ve thought about this culture situation. My – the culture shock that I experience is when I come out, it’s not when I go in. So, in fact, when I go in to a different cultural situation, whether it’s here, uh, in Australia going into a community, an Aboriginal community, or whether it’s being overseas going into a – to a, you know, another country, another culture, going in – I think you go in, you’re motivated, your eyes are open, you know it’s going to be different, you know you’ve got a job to do, so you go in there open to everything so that you can get in there and get started and get working quite well quite quickly. So you’re not going in there with preconceived ideas. Um, coming home is where I experience culture shock. It’s – it’s – that’s the hardest change.

Alex

And so in what way do you experience that shock when you – when you come back to Australia?

Yvonne

Yeah, I – when I come back – when I come back from overseas from a mission, I come back home, and that – that’s actually the most difficult time, going over is quite easy because you go over with an open mind into a situation that you know is different from a cultural point of view, from a work point of view, so you go over and you just go into it, uh, no expectations really because you’ve got to keep an open – open mind about what it is you’re going to be able to do when you get there. When you come home, uh, that’s where I find it’s the most difficult. Uh, you come back after quite a huge experience, uh, where, you know, you’ve seen things that you’ve never seen before and experienced things, you see a lot of suffering, I guess, and a lot of trauma, um, and you come home and things here haven’t changed, you know, it might have only been a matter of weeks or might be a few months, um, but you come home and things are pretty much the same, you know, things are still ticking along quite nicely. And what I find is that I am completely disconnected for quite a period of time, uh, and find it a little – quite difficult to settle back down into – to life somehow. You come back – come out of difficult situations, you know, the Ebola crisis for instance, and you come back, and here, life’s just plodding along and you come back and – and – and you question where you fit in all of this somehow.

Alex

So do you feel like you change with each mission?

Yvonne

For sure you change on a mission. You go over there and you – you have new experiences, you see different things, you know, some of them very positive and some of them quite traumatic, and so you change, you grow with that, um, you learn from that, and your – you know, your knowledge base has shifted and your – your attitude, I guess, to – to life has shifted once again, you know. I can remember the first time coming back from Sri Lanka, I hadn’t – working in Sri Lanka I was working in conflict, and to be in – living within a war zone where – is something that – that, for Australians, don’t experience, we – we haven’t had conflict, you know, in these last generations we haven’t had that conflict, and so to understand what that really means, um, it’s impossible, you know, and you don’t want – you don’t want anyone to experience, but the reality is we’ve got conflict all over the world now, and coming home from that, I think, changed me for sure, you know, now I can – now – you know that there’s conflict out there, but now I can live that – that emotional side of that in terms of understanding what that means for people who are from there, the – you know, to watch the TV footage, you can be disconnected from watching TV footage of war zones and things, and so it’s really terrible, but you don’t feel it, you don’t have – emotionally, you can’t connect with what those people are experiencing, whereas I’ve lived it a little bit, not a lot thank goodness, and I could see that – those war zone footage and, you know, it makes you want to cry, you know, the – it – it really is an awful situation for people, and when you come home it – you are a different person, you are a different person, you’ve learned, you’ve grown, and – and you’ve changed really. Um, but you come home – you come home and – and things here are pretty much the same, and – and I think sometimes it’s quite a dramatic shift for yourself, and you know that, you know that something has shifted internally and emotionally, intellectually, and – but here it doesn’t seem to make much difference because, um, every – every – everything is just carrying on as it was before. I don’t know, it’s a difficult concept, I guess, to – to – to explain because it’s – it’s, uh, it’s almost subconscious.

Alex

What is – what do you think that emotional – or what has that emotional shift been for you? Is it a – an awareness, is it a sadness, is it a frustration? What is that emotional shift for you after Sri Lanka?

Yvonne

It’s a sadness, it’s a sadness that – that, you know, for all of the humanitarian efforts in the world, we are still seeing conflict after conflict and it – it – it’s almost a despair sometimes that you think that the – we’re still trying to solve things through – through fighting and that we haven’t actually learnt over the centuries that this is not a good solution, you know. So, no, it’s a sadness really. It’s not a frustration it’s – yeah, it’s – yeah, you just wish that we could change things and that people could be taken out of having to survive in conflict areas while the world, you know, grapples with the whole political situation, and – and, uh, it seems to – I don’t know, it’s a bit of a negative statement, but I think we’re just making a mess after mess, and I’d rather see us coming up with more positive solutions instead of political solutions somehow.

Alex

So you mentioned Ebola earlier and you were sent over to Liberia as part of the Ebola response, and one of the biggest factors in the deadly spread was people’s customs around burying their dead. Uh, when international aid workers went over to places like Liberia and Sierra Leone, they had to essentially tell communities that they could no longer bury their loved ones the way they had for thousands of years, and I found this a very interesting case on how culture and humanitarian aid intersect. Can you talk to us about the difficulties that you faced while you were in Liberia, um, in terms of trying to cross a cultural divide in order to save lives?

Yvonne

The burial practices is – is a good example of one of the biggest challenges that they had in terms of the Ebola response. Where I was working was, uh, in the hot spot areas where new – new cases were coming up and the Red Cross, local Red Cross, would be out there trying to do health education, trying to get good hygiene practices, trying to make sure that if people were sick that they were – they – they presented themselves to Ebola treatment centres. But there was massive fear around the Ebola, and one of the fears was – was about the cultural practice, but it was also complicated by the fact that if people were getting sick and they were going away, they weren’t coming home. And so you combine being told you can't bury your people as you should – I mean, the bodies were being taken away and you couldn’t bury your own people, and so people were doing it, um, secretly, which of course exacerbated, uh – made it harder for – for the – for the Ebola response to – to be effective. Um, and because it was such a nasty disease that – that was killing people, people were really frightened, but they were also really frightened about not practicing their religious – it was cultural but it was also religious, you know, not following through on their normal practice to – to see their loved ones off who had died. So it was a very hard area to work within and there were no easy solutions, a) because of the number of people that were dying, b) the bodies were taken away and buried in places where they had – didn’t know and had no access, c) people were going away sick and they were dying and they weren’t coming home and they didn’t really understand that was going on, whether – whether they’d survived or not. So there was a lot of – a lot of – a lot of fear and a lot of, um, trauma around that.

The way that we had to – I mean it was – it wasn’t something that was overcome easily, but the – people dying, uh, literally in front of – in front of them, obviously it was obvious that it was a crippling – or it was dangerous, a dangerous situation, and yet – and yet people still were – weren’t able to give away their cultural practices, because that’s what they knew and that’s – that’s how they lived their lives. So the – the fear of – of catching something was less than their fear of not following through on what they felt was the right thing to do for – for their families. Um, and this is – this is – overcoming that, you know, was just through brute force really in terms of it had to happen like that, there was no other solution apart from burying those bodies safely, otherwise the disease would still be going on now. So it wasn’t about trying to provide culturally appropriate support, because it wasn’t going to work like that, and that’s – that’s – that was one of the major traumas of this whole – this whole outbreak.

Saying that, people did, um, adapt as much as they could over time, uh, and – which is why the – the Ebola crisis was – was overcome, but it took a lot of people on the ground and a lot of local people being involved, especially local people who had lost their own family members, they – they were the ones that could tell the story and, uh, convince people that they really did need to do what the authorities were asking them to do, that was really the only way that that could work.

Alex

I suppose Red Cross and Red Crescent is really fortunate in that we have so many national societies in so many countries. How important in the Ebola response, while you were there, was the National Society in helping you do your job in getting that information out there?

Yvonne

The National Society did the job. I – my role there really was to offer them some technical support, um, help them coordinate their efforts, try and advocate and, um – to the authorities or to Red Cross for more money, more resources, to shift resources, without the local Red Cross, we wouldn’t have been able to achieve what we did achieve.

Alex

So it was really the local National Society and the safe and dignified burial teams that, essentially, stopped the Ebola outbreak.

Yvonne

Along with thousands of others and many, many other organisations. This Ebola crisis was so complex that it took a worldwide effort to do it. So we had the best researchers in the world, we had different organisations communicating and coordinating better than you’ve ever seen before, it was really something to – to – to see and experience to understand, um, the – how big this problem was and how great the effort was to – to get on top of it. So, um, multiple organisations, multiple people, multiple skills, and it really – it was from the ground up. So, yes, Red Cross volunteers, absolutely necessary in playing their part in – in overcoming it. You know, they were ones that were putting the message out about if you’re sick you need to go and see someone, if – try not to travel, wash your hands. You know, they put out washing hand facilities and – and, uh, they were the ones that were supporting the – monitoring people that were in, um, quarantine. People – if – if they’d been – if someone had been exposed to someone who’d been sick, um, they were in quarantine for three weeks, they were housebound, they couldn’t go out to get water, they couldn’t go out to get firewood, they couldn’t get food, they were dependant on people to bring them stuff, they were literally in their house and they couldn’t leave it. And they had to sit there for 21 days and wait to see if someone else got sick, and then if someone else got sick, then another 21 days and another 21 days, and for every one person that was sick they had 10 people that – that were contacts of that one person, so this – supporting these people in quarantine and trying to encourage them not to go out into their fields and – and do their farming or whatever, um, was another one of the really important jobs of Red Cross in the communities.

Alex

I want to move on to some of your other missions now. So you were working in Pakistan in response to the Kashmir earthquake in 2005 with the ICRC, uh, you then got to go back 10 years later in 2015. What was it like for you going back there?

Yvonne

Going back was amazing, I went back to exactly the same place, I was kilometres from where I’d lived for – for 12 months, you know, six months after the earthquake where – when I was there the first time, people were still living in – in tents and shelters and hadn’t got re-established in their homes and their business, and so people were still in recovery, seriously in recovery, and still suffering a lot – a lot of the infrastructure was – was still not resolved, and this is 12 months after the earthquake, so we’re not – things don’t get better quickly.

Going back 10 years later, um, it was almost – it was – it wasn’t a miracle, obviously it wasn’t a miracle, but to see the difference in terms of you could see families had re-grouped and were – were now living normal lives again, and it was joy to see the – the – efforts of government, the efforts of humanitarian agencies, the efforts of the communities themselves, um, and their resilience to actually stand back up and – and re-build and then get going. So it was really – it was a wonderful thing to go back.

Alex

And did you feel quite proud at what you had achieved while you were in there, going back and seeing people having recovered?

Yvonne

I think proud’s probably not the right word, because the reality is we did our bit at the time, um, but the biggest effort comes from – from the people themselves really. To regroup after such devastation where you’ve lost your home, you’ve lost family members, you’ve lost your business, you’ve lost centuries of family build up, you know, like they – they work their land and build their home structures, and things hadn’t changed for a long, long time, and then suddenly it’s all gone, it –

it’s all gone and people have died, and – and you’re starting from nothing, and to see now where they’ve got to was – was – it is about them, you know, the – those – they stand up and they regroup and they – they embrace what’s offered, you know, the – the government and – and the bigger agencies support infrastructure rebuilds and things like that, and – and, yeah, we, as aid workers, we do our bit, as aid agencies we do our lot, um, but it really is about the communities themselves stepping up and – and getting back into it again.

Alex

And so you – you would have seen communities stepping up and – and trying their best to recover after many different situations, after, you know, disease or conflict or natural disasters, and you know, this podcast has been all about cultural differences, but the question that I’m interested in is what – what is similar? What cuts across the board with every community that you’ve worked in, every country that you’ve worked in, every vulnerable population? What is it that’s exactly the same there as it is here?

Yvonne

Um, I think it’s the generosity, somehow, and the – the willingness or the ability to – to just – to stand back up, um, and not give up their generosity has – always astounds me, you know, you go into people’s homes and they will give you what they have, even if they have nothing. That – that’s just common across the board really, and I when you have nothing, they still – they still find something to give, and that’s inspiring, that’s really inspiring, yeah, and the strength, they have a strength I think. When you don’t have much, they have to, uh, depend on their own internal strength rather than their – their wealth or their resources that they can use to fix things, they have to do it themselves.

Alex

Yvonne Ginifer, thank you very much for your time.

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