Preventing workplace injuries and illnesses through ergonomics

or many people, work means pain: eyestrain's, back pains, traumas, strains, and repetitive motion injuries. Ergonomics focuses on the prevention of such injuries through the proper design of equipment, workstations, products, and work methods according to people's capabilities and limitations. This article explains what ergonomics is, how it works, and what the ILO is doing about it.

In the United States, back disorders caused more than 27 percent of all non-fatal occupational injuries and illnesses involving days away from work in 1993. Government studies have estimated total costs of low back pain to society to be between US$50 billion and US$100 billion yearly. Moreover, up to 30 percent of US workers routinely perform activities that may increase their risk of developing low back disorders, and it is estimated that half of the workers in the US hold jobs which could cause Cumulative Trauma Disorders (CTDs),

At the Colmotores automobile factory in Colombia (1,600 employees produce 100,000 cars yearly), where most sick leaves and occupational injuries are due to musculoskeletal disorders, company medical experts realised that the work environment had to be improved and that ergonomic principles had to be applied. The experts understood that better working conditions would be the most effective way of reducing the risk of musculoskeletal injuries.

Ergonomic-related injuries and illnesses affect workers worldwide, from eyestrain's and headaches to musculoskeletal ailments such as chronic back, neck and shoulder pain. Repetitive Strain Injuries (RSls), Repetitive Motion Injuries (RMIs), and CTDs are terms used interchangeably.

While there are no global figures, data concerning such injuries are largely gleaned from national sources, mostly from industrialized countries. Millions of workers around the globe probably suffer from one or more of the above ailments yearly. Result: downtime, reduced productivity, and high costs for both employees and employers.

To date, reliable figures are generally not available to describe the extent of ergonomic-related injuries and illnesses in non-industrialized countries. It is encouraging, however, that in a number of developing and newly-industrialized countries such as Hungary, Tunisia, Singapore, and Myanmar, musculoskeletal diseases, RSls and vibration-related diseases are recognized as occupational diseases. This means that a physician or employer who detects a work-related case is required by law to report it to the competent authority. The reporting system breaks down, however, even in many industrialized countries, when there is a lack of motivation on the part of employers, employees, and physicians. Without accurate reporting, reliable figures cannot be obtained to describe a country's situation.

Ergonomics, the integration of anatomy, physiology and psychology, which is used to match jobs, systems, products, and environments to the physical and mental abilities and the limitations of workers, has a proven track record in reducing work-related ailments.

The experience of the Norwegian State Institute is a case in point. Ergonomic improvements made on workstation layouts and seating halved absenteeism due to back pain in one year. In the Colmotores automobile factory, its medical director used a Finnish model of work organization and design involving choice of tools and equipment and adjustable chairs. The result was a productivity increase of 15 percent during the first five months following the application of such measures. Experience has shown repeatedly that the application of ergonomic principles in the workplace can result in marked, even dramatic, improvements.

THE SCOPE OF THE PROBLEM

Repetitive Strain Injuries are a category of injuries which occur from repeatedly performing a task putting stress or strain on a certain part of the body causing damage to nerves, muscles, tendons, and other soft body tissues. They comprise more than 100 different types of job-related injuries and illnesses, some so crippling that they may require surgery or cause permanent disability. Repetitive Strain Injuries can cause severe pain and often make daily tasks such as getting dressed, shopping, turning taps, cooking, child care, etc. difficult, or even impossible, to perform.

Increased tension at home and at work is frequently associated with RSIs due to several factors. For one, since RSls are not usually visible to the naked eye, colleagues and family members may not believe what they cannot see. For another, the resulting disabilities usually affect the type of tasks which can be performed at home and at work which may temporarily increase the burden of work for others. For still another, those not suffering from the condition often don't understand the nature of the injury or illness. Finally, depending on the extent of the condition, treatment and healing time can range from a number of weeks to more than a year. Some cases never heal and may leave the injured person permanently disabled.

Not localized to any type of job, RSIs tend to affect workers in a wide variety of occupations ranging from assembly line and food processing jobs to secretarial work, data processing, and work at visual display units or VDUs (also called visual-display terminals, or VDTs), to name a few.

Repetitive Strain Injuries, though they can take years to develop, usually strike when the workers are still in their prime around the age of 40. Fortunately, treatment is available and, in many cases, yield good results, especially if the symptoms are diagnosed early. Once "cured," however, if a worker returns to the same working conditions which caused or aggravated the condition in the first place, recurrence is likely, which in turn usually necessitates more days off work.

More on RSIs:

• In an 11 December 1996 article in the Washington Post, US Labor Secretary Robert Reich acknowledged that RSIs were the fastest growing jobrelated impairments in the United States. In March 1997, the United States Department of Labor reported that 6.6 million work-related injuries and illnesses were reported in the USA in 1995. Sixty-two percent (or three out of five) of the workplace illnesses were disorders associated with repeated trauma, such as carpal tunnel syndrome
• Outlined in the 1994 issue of Euro Review on Research in Health and Safety At Work, research has shown that, in Sweden, one out of every four workplace accidents and more than 50 percent of the reported cases of occupational disease involve the musculoskeletal system. Two-thirds, or around 20,000 of the cases, involve symptoms of the neck, arm/shoulder, or hand. On average, musculoskeletal injuries led to more than 100 sick-leave days per case. Sweden's women in manufacturing industries have the highest risk of developing RSIs. The risk of musculoskeletal diseases among women who perform assembly work in the Swedish electronics industry has been reported to be 20 limes higher than in the country's working population as a whole. Germany has also reported higher prevalence of RSIs among women. Another startling statistic from Sweden reveals that, across the board, injuries of the lower back are estimated to make almost 40 percent of all musculoskeletal injuries on the job, in any country, with some cases resulting in permanent disability.
• A 1992 report on workplace injuries published by the United Stales Bureau of Labor Statistics showed that the majority of the workplace disorders that year were associated with repeated trauma, affecting some 282,000 workers or 62 percent of total private industry illness cases in the United States.
• A 1994 report of the Health and Safety Commission of the United Kingdom showed that, during the financial year 1993-1994, there were at least 107,000 people in the UK alone suffering from musculoskeletal symptoms brought on as a direct result of poor workplace design. Half of these symptoms caused an absence of three or more days off work. The cost of these to British industry, including lost output, medical treatment, and individual suffering, exceeded UKL90 million (US$144 million). The total cost of musculoskeletal symptoms to British industry is conservatively estimated at UKL25 billion (US$40 billion) a year. These disorders, however, should not be considered as a hazard only of modern-day life. According to the 1994 issue of Euro Review on Research in Health and Safety at Work, RSIs were reported in the former East Germany as early as 1952, with between one and two thousand cases documented a year after.

CARPAL TUNNEL SYNDROME DOCUMENTED MOST FREQUENTLY

The most frequently documented RSI is Carpal Tunnel Syndrome (CTS), today a compensable occupational disease in many countries. Carpal Tunnel Syndrome occurs when the median nerve (a major nerve in the wrist) cannot function adequately because of pressure caused by repeated finger motions and/or a bent wrist. Symptoms can include numbness, pain and/or tingling in the thumb and fingers, a burning feeling in the hands or forearms, a dry, non-sweaty palm, reduced strength of the hand noticeable by the inability to open jars or to lift or hold objects, and discomfort in the arms, shoulder, or neck.

Some of the symptoms may occur during the night rather than during the day. Extreme cases can result in permanent disability due to a complete inability to use the wrists in performing or holding an object in the hand. The disease is often suffered by workers who spend long hours using computers, particularly where the computer workstation is not adequately adjusted to the side of the user, workers who process meat or poultry, supermarket check-out workers who use electronic scanners, other workers who perform repetitive tasks. Working with vibrating hand tools also increases the risk of CTS. Wrist-intensive activities at home, such as gardening or painting, can greatly exacerbate CTS or other RSIs.

According to the US Bureau of Labor Statistics, every worker suffering from CTS loses more than 30 days of work. This is longer than absences from amputation and fractures. The United States Occupational Health Safety Administration (OSHA) estimates the annual cost of these injuries to be about US$100 million.

"ERGONOMIC PHILOSOPHY" PAYS OFF

Eyestrain's, headaches, and musculoskeletal disorders can be prevented and optimal performance can be obtained if equipment, workstation, products, and work methods are designed according to human capabilities and limitations, by applying the principles of ergonomics. The costs of ignoring these principles include:

• injuries and occupational diseases (including RSIs, CTDs, and RMls
• increased absenteeism
• higher medical and insurance costs
• increased probability of accidents and errors
• higher turnover of workers
• less production
• lawsuits
• low-quality work
• less spare capacity to deal with emergencies

The adoption of an ergonomic philosophy in the workplace has a proven track record. For example, an ergonomic evaluation and redesign were carried out in a park and school involving the janitorial staff in Mostreras, Sweden. The project, which was implemented from 1991 to the end of 1992, proved the benefits of ergonomics. Sick leaves went down from 44.1 days to 10.1 days per employee per year. In 1992, savings to the employer and the social insurance system amounted to SEK 417,000 (US$57,000). Productivity rose by 150 personnel days and satisfaction among workers increased

In the case of the Norwegian State Institute which studied the incidence of back discomfort among office workers, the ergonomic improvements made to workstation layouts and seating for the workers reduced back-related absenteeism by half and turnover from 40 percent to five percent and 40 percent of the workers on disability leave returned to work. The importance of these results cannot be overstated as muscular soreness is the second greatest cause of absenteeism next to common cold.

ERGONOMIC CHECKPOINTS: ILO RESPONSE

It is essential to identify ergonomic risk factors (defined as any imbalance between the worker and the work environment which results to extra demands on the worker) to prevent ergonomic-related illnesses. The first step is to perform a superficial audit of the workplace using an ergonomics checklist. It may contain the following questions

1. Are carts, hand-trucks, and other wheeled devices or rollers used when moving materials?
2. Are workers trained before allowing them to use power tools?
3. Are workers consulted when there are changes in production and when improvements are needed for safer, easier, and more efficient work?

Once an ergonomics checklist is employed and risk factors identified, a set of corrective actions should be outlined. Such actions might include ergonomic design changes in the tools, products, process, and work environment. Corrective actions can also address training needs, including identification of prevention responsibilities and development of necessary skills and knowledge to implement corrections.

Many ergonomics checklists are available but, for most of them to be effective, they have to be used by someone with a firm knowledge of ergonomics. This is where the recent (1996) publication by the International Labor Office (ILO) makes a difference.

Due to its simple and easy to understand format, the manual, Ergonomic checkpoints, developed jointly with the International Ergonomics Association, can be used by managers, supervisors, workers, trainers, and ergonomics specialists who wish to learn low-cost practical solutions to ergonomic problems which can be applied locally.

The manual's 128 checkpoints provide sound guidance for filtering and disseminating ergonomically sound workplace improvements. An ergonomics checklist is included. The solutions provided are fully illustrated and demonstrate good work practice. The manual will be an invaluable asset in any workplace and will surely contribute to improving both working conditions and productivity.

The high cost linked to workplace illnesses and injuries is causing policy-makers, employers, and workers to broaden their perspectives. There is incontestable evidence that fitting jobs to workers and designing and redesigning jobs taking into consideration human factors, including both capabilities and limitations, yield positive results. Eliminating the suffering of workers and their families and minimising the financial burden borne by employers and insurance companies are attainable goals. Waiting for symptoms to appear instead of preventing them will only continue to injure and cripple millions of workers in the world

Source: World of Work, No. 21, September/October 1997

CAMBODIA

WATERED BY WOMEN'S SWEAT AND TEARS

By Nancy Pearson Arcellana

PART ONE: Brief Overview of the Country*:

For more than three decades, Cambodia, because of its unique situation, has had no official census since 1962. The first phase of a government census (1997-99) was interrupted by another violent change of power in July 1997. To what extent the turmoil and uncertainty damaged the reliability of information gathering will be difficult to ascertain but they undoubtedly affected the initial phase of the census.

Nevertheless, Cambodia currently estimates the population at 10.7 million with approximately 53 percent being female. The female population is higher at 58 percent for the over-40 age group. The population is believed to be increasing at a rate of 2.8 percent per year. Cambodia continues to be primarily an agrarian society with an overwhelming 86 percent of the people residing in rural areas.

The burdens of trauma, war, and on-going civil disturbances rest heavily on the shoulders of Cambodian women with nearly every fourth household headed by a female. Interestingly, a World Bank survey which assessed poverty— based on food consumption—found that female-headed households fare much better than their male-headed counterparts. According to the survey, the female-headed households "account for 23 percent of population but they account for only about 15 percent of poor." The World Bank report naively concludes: "Overall, it does not appear to be the case that female-headed households are generally more vulnerable to poverty than those headed by males; in fact the opposite seems to be the case. In this respect gender and poverty patterns by household headship are similar to those observed in other East Asian countries such as Vietnam and Indonesia." The report should have acknowledged that despite women's severe disadvantages and poverty— often to their own physical detriment—they prioritize the food security of their children and families over expenditures common to men (i.e., alcohol, gambling, entertainment, etc.).

Literacy Rates: Aged 15 and above

These burdens are aggravated by a very low literacy rate among Cambodian women. (See box on Literacy Rates.) Among those who are literate, aged seven and above, 96 percent have NOT completed even secondary level education. To make matters worse, almost 62 percent of females have not even completed the primary level. The legacy of the Khmer Rouge regime has resulted in only 1.5 percent of the population achieving levels beyond secondary education. The girl-child is significantly disadvantaged and represents more than half of the child labor force, estimated to be about 10 percent of all children aged 7-14.

To bring the reality of the situation closer to home, basic services such as potable water, toilet facilities, and electricity are unavailable to more than 90 percent of the population. This inevitably results in additional time-consuming labor for women and young girls. The pervasive lack of access to basic education, primary health care, immunization and social welfare services has resulted in a high child (under five) mortality rate of 181 per 100,000 live births-estimated at over 80,000 deaths per year. Malnutrition is cited as a major underlying cause of such deaths. In addition, Cambodia has the highest maternal death rate in Asia-600-900 per 100,000 live births. The high rate of anemia among pregnant women (50 percent) certainly contributes to the incidence of birth complications resulting in death.

The First Socio-economic Development Plan 1996-2000 of the Ministry of Planning of the Royal Government of Cambodia (February 1996) states: "For some, the rapid liberalization of the economy has resulted in exploitation. The psycho-social conditions of a nation recovering from massive destruction adds to the vulnerability of people, many of whom are isolated from the traditional networks of social protection. The breakdown of many nuclear and extended family units has had a significant impact on the protection of individuals, most notably for children." This is clearly an understatement considering the alarming rise of street children, forced prostitution, trafficking in women and children, and domestic violence. These will be further discussed in the second section of this article.

Economic liberalization in Cambodia began in 1985. Prior to that the economy was organized primarily along centrally-planned lines. Private property rights were restored and government control of prices was abolished in 1989. After the signing of the Paris Peace Accord in 1991, economic liberalization went in full swing.

Perhaps due to the massive influx of investments and consumer needs of the international donor and service agencies, the fastest growing sectors in the country were industry — especially construction —and services, with the hotel and restaurant component expanding by the widest margin (21 percent a year).

Unfortunately but not surprisingly, agriculture —by far the largest sector —was considered the main drag on economic growth. It grew at a mere 2.6 percent during the period (1990-95), slightly below the rate of population growth. Rice production in particular did not increase at all over the same period. The government acknowledges that food shortages were common in man\ areas and aggravated by the difficulties surplus producers faced in transporting their produce. The government admits that, "This points to food insecurity in the rural areas as a major problem and demonstrates that economic welfare is not directly proportional to the level of GDP per capita." In fact, "considerable inequality exists, both across and within regions."

Cambodia seems to be following the footsteps of many other Asian governments. Rather than focus on sustainable agriculture, food self-sufficiency, and security, the government is advocating and focusing on the expansion of more commercial or cash crop diversification, especially rubber plantations. In addition, the scale of deforestation in Cambodia is massive and alarming. A principal government objective is the "controlled, managed exploitation of the forests" and more accurate GDP calculations in the future taking into account "resource depletion...[and] the destruction of non-renewable resources."

PART TWO: The following section highlights government statements* and reality as perceived by a number of Cambodians working in various areas of development and social services regarding issues of domestic violence; forced prostitution; the girl-child; and mental health.

"The manifestations of violence within many households and within society are evidence of the isolation and insecurity felt by many ....Domestic violence and rape are also critical problems. Preliminary findings of a recent survey indicate that domestic violence is much more pervasive than originally thought; and that the levels of violence are extremely high and occur across socioeconomic classes and geographical regions."

In the words of a young male Cambodian development worker regarding the incidence of domestic violence: "Violence has been used to change each regime and government in Cambodia. This has been seen as the way to resolve problems. It is not, surprising that it has been carried down to the family level." Surprising or not, understandable or not given Cambodia's history, the situation is appalling.

The Cambodian Women's Crisis Center (CWCC) was set up less than a year ago to change that pattern and work toward the elimination of all forms of violence against women (domestic violence, forced marriage, prostitution, rape, etc. —See side story). In such a short time, it has already served almost 150 women and won a landmark civil law case.

The CWCC assisted in a civil suit against an abusive husband —who happens to be an employee of the UNDP in Cambodia —for both wife battery and child abuse. The court awarded the wife a divorce, custody of the children, the family home, and entitlement to child support and alimony. Unfortunately, the husband did not agree to appear or abide by the court's decision. He refuses to vacate the family home, continues to hold one child, and has hired armed men to secure the compound. This forced the judge to issue arrest warrants for all parties standing in the way of the implementation of the judgement.

The UNDP was requested to garnish the employee's wages and remit it directly to the wife. The UNDP, however, claims it cannot do this without the consent of the employee or permission from the head office in New York. This is indeed unfortunate given the fact that the husband has been convicted of severe abuse of his wife and children. Certainly, it is not in the interest of the woman for the UNDP to fire the employee but the UNDP could set a strong example and certainly bring pressure to bear upon the employee to comply with the court's judgement. This could be a strong example of the UN's commitment and would be a tremendous support and service to the advancement of women's human rights.

"An alarming aspect of the lives of too many young girls and women is their 'commoditisation.' Anxious to do what they can to provide financial support for their families, some of them are tricked into lives of debt and virtual slavery. Many have few alternatives but prostitution, with the high risks of contracting HIV/ AIDS which such a life entails.

In November 1997 alone, CWCC helped rescue 200 women from a brothel where they had been forced into prostitution. Brothels have become rampant and the supply of young women from the poor rural provinces is unending. As a way to raise community awareness and stop the recruitment cycle, the CWCC asks women if they are willing to return to their communities to share their stories. Many of the women have risked social isolation and prejudice in doing so. They often find that they are not the only victims from their community. In one village, as many as 27 young women "disappeared" and families have not heard from their daughters or seen the "job recruiters" again.

The prostitution of women and teenagers has been growing at alarming rates. In 1990, there were an estimated 1,500 prostitutes; by late 1994, the figure rose to an estimated 17,00020,000. The Cambodian Women's Development Association conducted a survey in an attempt to gauge the extent of the problem. They found that sophisticated networks for abduction, sale, and trafficking of women have been established both domestically and across international borders. The survey also showed that 50 percent of commercial sex workers had been deceived or sold, 86 percent of them by their parents, relatives, neighbors or friends whom the girls/women had initially trusted. Most often, the reasons were to pay debts or help the family survive. Among the young prostitutes under 18 years, half were sold with the understanding that they would be placed into domestic service.

in addition to the blatant abuse of women and girls as a result of forced prostitution, the high incidence of HIV/AIDS positive cases is horrible. The CWCC provides education to women regarding HIV/AIDS and offers women the choice to be tested. They provide counseling services before, during, and after the testing process. HALF of each batch of women tested so far have come up HIV positive. This includes a group of women rescued from a "high-class" brothel.

Commonly held views among Cambodians are that only Vietnamese women are prostitutes, not Khmer women, and they voluntarily chose the profession. From a group of 103 women rescued from a brothel, only one said she had voluntarily entered prostitution because her family desperately needed the money. About 35 percent of these women were under 18 years. There were 10 Vietnamese women in this group, all of whom had been tricked by recruiters and brought across the border illegally. Clearly the public perception is having a hard time catching up with reality.

"The main problem faced by rural female-headed households is lack of labour...These women face problems of child care, having nobody to look after their young children while they work. The elder daughters in such families usually have to take much of the responsibility for caring for their younger siblings, so that they often drop out of school."

Hope Amidst Despair: the Cambodian Women's Crisis Center

By Nancy Pearson Arcellana

Survival often requires being inconspicuous. The Cambodian Women's Crisis Center (CWCC) has had to balance this need for privacy with an equal need for public visibility. Yet their PUBLIC office is a lesson in quiet but intense existence.

I'm sitting in a small room of their center with Executive Director Chanthol Oung while she tells me about the inner workings of their fledgling organization. The going hasn't always been smooth and they've sometimes had to learn lessons the hard way. At the same time they have had exceptional success by anyone's standards. The CWCC has already served almost 150 women since opening their doors in March 1997.

Chanthol has license of law and public administration — AND she finds good lawyers. Recently, one of the CWCC clients won a landmark domestic violence case in civil court with the help of the Cambodian Defender Project.(See main story.) I was so absorbed in the stories of the women and how the center is able to provide services that I completely forgot to ask her what brought her into this line of work. Whatever her motivation, she exudes passionate interest and perhaps that passion sparks hope in the women who enter the CWCC's doors.

I say doors — plural — because the CWCC has two places: the public office and the women's shelter. The shelter, as women know, must be absolutely confidential in order to protect women from abusive husbands, pimps, brothel owners, and even law enforcement personnel and high level government officials who are involved in the prostitution and trafficking of women and children. In order to maintain this confidentiality, the public office serves as the intake center and has a capacity to house 10 women. During the first week, CWCC does intake assessment, counseling, and screening of the women before moving them to the shelter.

The shelter has been "home" to an average of 50 women a month since it opened even though the ideal capacity is about thirty. The women always make room for more. The women can stay in the shelter for up to six months. The CWCC provides food, medical assistance, clothing, literacy training, counseling — both psychological as well as legal—and make referrals for various kinds of vocational training with other NGOs. In the first nine months alone, 10 women have availed of vocational training and five were already placed in factory jobs which CWCC located. Some women do want to reintegrate into their communities and CWCC helps them return. Thirty-one women so far have taken that difficult step.

Community education is a critical concern and aspect of CWCC's efforts. Four months ago, the CWCC launched a TV video and radio spots on sex trafficking which are still being aired. One of the immediate results was the awakening of the vice-mayor of Phnom Penh. Last 5 November, he brought district police chiefs from all city districts for an orientation where the CWCC showed their video, presented the issues, and asked for support in stopping the trafficking of women. The results in the last weeks have been dramatic with a significant rise in rescues of women from brothels and arrests of people involved in trafficking. How are they able to trust the police? Chanthol calmly replied, "We only trust those who have been referred by our husbands, friends and former classmates." So far, that policy seems to have been a good one.

In addition to the terrible emotional and physical scars inflicted upon women and girls — many forced into prostitution are between the ages of 12 and 17 — the incidence of those testing positive for HIV/AIDS is astounding. It confirms the UNDP assessment that Cambodia has the highest HIV transmission rate in the world. It is highly unlikely that the new and expensive treatments now available in the West for prolonging life will be available to these poor women and girls. This fact, among others, makes places like the CWCC even more remarkable in their ability to spread hope in the midst of despair.

The legacy of the Khmer Rouge regime continues to wreak havoc on the social fabric. The unusually high number of orphaned and abandoned children in Cambodia is but another of these tragic testaments. It is difficult to assess their numbers although a "study in 1991 in the 11 most populous provinces, [found that] one out of every 13 children was reported to have lost one or both parents. Forty-five percent of these had lost both." These are the children most at risk of many forms of abuse —child labor, physical and sexual abuse, and exploitation. Girl-children suffer with long hours of work and lose opportunity to attend school. They are also at high risk of being sold to supplement family income.

MENTAL HEALTH: An entire nation affected by a legacy of armed conflict.

"Cambodians are not only living with the dangers of continued localized armed conflict but also with the consequences of two decades of civil war. The direct consequences of this include the dangers of land mines, of being displaced, of losing family members, and of living with violence as a way of life."

The decades of war have scarred the land and countless numbers of people —both visibly and invisibly. It is estimated that one in 236 persons is an amputee and that there are an average of 300-500 victims of land mines per month. The vast majority of victims are men (18 to 35 years old). Five to eight percent of those maimed are women, seven percent children. These are the visible scars. The mental health of an entire nation is difficult to gauge but the high rate of domestic and civil violence is clearly an indication of the invisible scars left on the psyches of millions.

Isis had the opportunity' to interview seven of the first 10 Cambodian psychiatrists who will graduate in February 1998 after three and a half years of training through the International Organization on Migration (lOM) and the tutelage of Dr. Ang Sarun. Dr. Lavrantz Kyrdalen, head of the Department of Psychiatry of Gjovik Fylkessykehus of Norway, was just completing one year with the candidates and stressed the huge demand in Cambodia for mental health services.

Dr. Ka Sunbaunat, one of the Cambodian psychiatrists and chairman of the Mental Health Sub-Committee, Ministry of Health, will be taking over the leadership of the group after February. He said that though they are young, they are very committed to strengthening their competency to transfer knowledge to the next generations. Their challenge is tremendous.

In spite of the fact that the social stigma against people with mental health problems is very high in Cambodia, they are not abandoned by their family members. Ironically, this could be one of the "benefits" of not having any in-patient mental health facilities in the entire country. Families literally have nowhere to put their ailing family members. The outpatient clinic can provide a room and sedate a severely psychotic patient until he or she is able to go home.

As in most other parts of the world, two-thirds of the patients are women and one-third are men. However, there is a dearth of research relatecf to the mentally ill, let alone the Impact on women, as mentally ill or care-givers. With such significant numbers of women patients, it is encouraging that one of the psychiatrists, Dr. Ang Sody (the only woman in the batch of ten), is doing her research on the high incidence of postpartum depression disorders in Cambodian women and possible treatments.

The most common reported problems are depression, anxiety disorders, and severe psychosis. Men are more likely to exhibit acute psychosis. The main problems for women are generally duo to their husbands, namely, domestic violence and economic difficulties. The doctors believe that they will undoubtedly begin to see more mental health problems in women associated with the rise in forced prostitution and the resulting incidence of HIV/AIDS.

It is deeply encouraging to witness the dedication and commitment shown daily by these people who are stemming the tide of violence to build a healthier society.

Pradham, Menno and Prescott, Nicholas. World Bank Discussion Paper No. 373, October 1997, A Poverty Profile of Cambodia. [1997]

Nancy Pearson Arcellana, M.S.W., is an American who has lived and worked in the Philippines for the past seven years— five years with the Mennonite Committee working with street children and peace and conflict issues with the National Council of Churches in the Philippines. She has served two years as Research Manager for Isis International-Manila.

By Gina Mission

MANILA (Women's Feature Service)—"No voice, no choice, no power," was how Anna Leah Sarabia, executive director of Women's Media Circle, summarised the situation of most Filipino women today during a recent symposium on Women and Technology.

In her talk on "the new technologies from a feminist viewpoint," jointly sponsored by

Easymailer (EMC), a national E-mail service, Isis International-Manila, and Woman Health, Sarabia started with, the roles that women play vis-a-vis technology as audience, as consumers, and as inter-actors.

We are audience, according to her, when we listen to priests deliver the homilies in the pulpits; when we listen to politicians announce their platform of government; when we sit in boardrooms dominated by men. It is a situation where the main players are men.

"As audience, we are expected to listen to those in power," she says with bitter sarcasm. "After all, silence is supposed to be a virtue for women," she added.

But we are now in the 90's where women, apart from opting to be full-time housewives, now pursue professional careers—for economic independence or when to or not to sell," she explained.

With some money, Sarabia contended, women as consumers can be equal with men in some aspects. "As buyers, for example, they can dictate the market what to or not to sell," she explained.

Women who work outside the home believe equality begins with economic independence. "However, there is still that 'broadcast' clock which shows how women in the Philippines, even with money, are stereotyped," Sarabia conceded, herself a mother and a producer of radio and TV programs.

The advertising rates for primetime shows (between 6 to 10 p.m.—the time when husbands and kids are supposed to be home) cost twice the rates of the morning noontime shows (consisting mainly of fashion, cooking, showbiz news, etc. and considered watched only by housewives). In fact, some Philippine TV stations don't start until 12 noon.

"The irony is that while advertisers pay much to be seen by primetime audience, it is the women who do the 'grocery,'" she added matter-of-factly, prompting a suppressed laughter in the audience.

The advent of telecommunication technology brings yet another role for the women to play—that of inter-actors.

Unlike the first two roles where they are quite passive, women as inter-actors now approach things rather aggressively, whether through the 15x9 inch beeper or the 2x5 inch cellular.

It is common nowadays to hear stories of people sending uncensored messages (expressed at most in 400 characters) to each other or for some to talk unrestrictedly on the phone.

The same is true with telephone hotlines where callers can share their wildest or cruelest experiences simply because nobody sees them.

And where anonymity is the name of the game, the emergence of E-mail and the Internet is considered to be God's gift to the women's movement. Computer intersection through network gives the women a 'feel' of the ultimate communicator.

Easymailer, where 150 subscribers are connected through the E-mail, serves as an avenue for women who want to address issues of all concerns on a national level. The issues 'talk' politics, ecology, culture, gender, etc. with the hope of influencing policy on these issues.

Pi Villanueva, section editor of Women in Action, a publication by Isis International-Manila, confesses to have been attracted to the computer because "you don't have to dress up to face an audience to convey your message."

"It offers them privacy which makes it possible for women to create a new self, a virtual self they themselves designed (in as many words as they want), which is devoid of prejudgment because of physical absence of the other party," asserted Sarabia.

"This development brings in what they call 'cyberfeminity' which creates virtual freedom for women. Unlike being audience or consumers where they are voiceless and therefore powerless, they can now explore or break boundaries to constantly create or define who they are, to show that there are voices other than those in power," she maintained.

In the same manner that we abhor any violation of the freedom of expression, Sarabia believes that "invasion of this privacy would trigger them to create communities of their own. Diversity would then exist, which in turn makes democracy possible."

Ande Andolin of the Women's Education, Development Productivity and Research Organization (WEDPRO) conceded that it is to the great advantage of those who have access (like when you type a password and on the screen will appear, for example, a woman's face in the mail-order bride directory of the Internet). However, it is surely a major form of exploitation on the part of those who are in the directory, knowingly or unknowingly. "I may wake up one day to see my face in one of those in the directory," she exclaimed.

Villanueva, on the other hand, claims that goodness or badness of this information technology (IT) is relative. "After all, it's the user that gives it value," she countered.

Access to this interaction means you have a personal computer and a modem connected to the Internet or the local E-mail through a telephone line. Dr. Sylvia "Guy" Claudio, chairperson of Linangan ng Kababaihan (literally means developing the women or LIKHAAN), an NGO that trains and educates grassroots women, said that this development creates two classes; "the haves and the have-nots or the knows and the know-nots."

Robert Verzola, operator of EMC, activist, and a convenor of Philippine Greens, said that the Philippines, "basically an agricultural country trying hard to be industrialized, has a dilemma like other developing countries to tn,' or not to try."

"Being in the transition period, we tend to change the order, by replacing manual works with computerized ones, in the honest belief that it is the only way to get there, wherever and whatever that is."

A person, for instance, may be contented with using the non-complicated DOS at first. But with the various Windows-based softwares now proliferating in the market, everyone wants to have his/her PC upgraded to accommodate the latest version. One may be spending the last centavo in the ardent desire to join the bandwagon.

"The key is to be careful not to fall into this trap," advised Verzola. That is, enjoying the wonders which this new technology offers without forgetting the value of one's needs for it.

However one views this development, one thing is sure though: information technology gives a level playing field for men and women. Women can now be heard or represented equally. IT is it!

By Catherine Russo

Telemanita is a center dedicated to training women in the use of electronic technologies.

Since 1992, more than 40 women have been trained in video production. The courses offered are: basic video production, editing, sound, and lighting.

Our courses include media literacy education with a gender perspective. Our goal is to encourage women to develop new ways of seeing the images they consume and then to think about new ways of producing images that empower women.

We analyse the communications industries and examine their biases. In 1995, we designed a ten-day workshop for 18 women. The first days were spent in deconstructing media images and analysing their patriarchal content. For the remainder of the workshop, women wrote scripts, including documentary, drama, and experimental pieces and produced a video.

Groups that have produced videos at Telemanita include: Madre Tierra—Guatemalan women refugees from Las Chavas; a young girls' gang from Mexico City, Sipam; a women's health centre in Morelos that runs a recycling centre; students from the University of San Luis Potosi and Las Reinas; and a group of older women who run workshops on women and aging.

We also produce videos for other groups. We produced a video for the sixth and seventh Latin American Feminist Conferences and another for the fourth Lesbian Feminist conference in Mexico.

CATALOGUE ON WOMEN'S WORK

Over the past two years, we have trained ourselves to use the Internet. This year, we began training other women, too. We produce an electronic bulletin called Video Red Mujeres,' which is sent over the Internet to 35 groups involved in women and communications projects. This bulletin is produced in Spanish and English and open to others wishing to receive information about new video productions, new technology, and other news affecting women producers.

The goal is to share information, which is hard to come by, especially in Latin America. One of our goals is to develop this bulletin into a conference. We are dedicating our services to organise, translate, and distribute the bulletin. It includes the responses we have received from members, as well as information we have come across that seems useful.

We feel that a conference of this sort may just flounder without a group assuming responsibility for some time. Many fine videos are produced and sparsely distributed. In addition to disseminating this information via the bulletin, we are presently producing our first catalogue of video productions by women in Latin America. We highly recommend the productions included in this catalogue to groups who need educational videos. The themes include domestic violence, pre-natal care, women and AIDS, environmental issues, women and religion, sexual preference, sexuality, and others. We have produced three women's video festivals in Mexico City and sent video festival packages to groups in other parts of Mexico and Latin America.

BETTER TRAINING WITHOUT MEN

It is our experience that women learn better in groups without men. They are not as afraid to appear stupid and ask more questions. They more eagerly pick up the equipment without deferring to the men in the group. Women have been taught to be intimidated by technology. We have created our own production manual where we break down the terminologies and concepts of production.

In the very first class, we pass around the camera and let women shoot whatever they like. As the classes progress, they can view their progress from that very first shoot. The classes include anywhere from five to ten women and run over three weekends for a total of six days.

It is our experience that women in Mexico and Central America most often need additional one-on-one training sessions after the workshops. We encourage these women to continue working with us and to produce their own piece as soon as possible. Otherwise,: time passes and the task seems overwhelming.

We are here to help develop a script, make a production plan, look for funding, and help with the actual shooting and: editing. Most women who come to our courses need all these types of assistance. They also need access to equipment.

Our Internet training began last year. For a while, it was difficult to work with "La Neta" and we still have problems because of the poor telephone service available. We have to pay for long distance calls to Mexico because that is the closest node and this has made it difficult to really investigate with Netscape.

Many women's groups in Latin America do not use Internet services or, if they do, only one woman in the group knows how to use it. Phone lines are still very expensive and so it is hard to dedicate the office line to women learning and using the Internet.

A very important part of the Internet training is to have a very knowledgeable and patient teacher. We ourselves have had the experience of learning from people who were also learning from people who were also learning and it was frustrating to feel we were wasting time through lack of basic knowledge. Someone who knows how to teach is also important. It is one thing to know the information and another to be able to pass it on. Internet training for women must be consistent. The women must be able to practice regularly so as not to forget the skill.

Finally, we have designed and are presently giving a media literacy course for fifth and sixth graders. The concept of media literacy does not exist here and we have not been able to define it in a few words in Spanish. We are looking for media literacy material that is easy to use or to translate. We would also like to hear of experiences in training young students as well as adults. We would also love to share our experiences.

Source: Zebra News, Issue 32, 1997