A Discussion with Ulrike Gilbert-Nandra MSc, Technical Specialist, UNICEF Cambodia
November 24, 2009
Background: This discussion took place as part of preparations for a consultation on faith and development in Southeast Asia, held in Phnom Penh, Cambodia December 14-15, 2009. The consultation, an endeavor of the World Faiths Development Dialogue (WFDD) and the Berkley Center for Religion, Peace, and World Affairs at Georgetown University, with support from the Luce Foundation and the University of Cambodia, took stock of the wide range of ongoing work by different organizations that are, in varying ways, inspired by religious faith. It also explored policy implications that emerged from their interactions with development organizations. The interview was by telephone, between Ulrike Gilbert-Nandra and Michael Bodakowski. In this discussion, Ms. Gilbert-Nandra focuses on UNICEF's HIV/AIDS work and specifically engagement with Cambodia's monks to advance programs. She speaks about the unique challenges faced in Cambodia concerning HIV, especially those particularly acute facing today's youth. Coordination with the government and monks is a challenge as well, Ms. Gilbert-Nandra noted, but an important role that UN agencies should play. The opinions expressed are hers and do not reflect necessarily the policies or views of UNICEF.
What draws you to the topic of the upcoming consultation in Phnom Penh?
This conference comes at an interesting time. We are at a juncture where there is a need to revitalize the response to HIV in Cambodia by the religious sector. People generally speaking have fairly high awareness levels, however, stigma and discrimination are still high. Over the years, support by the monks, the pagodas has become more focused, and have moved away from general prevention to providing more strategic support to affected families, through meditation and spiritual support as well as in kind support to impoverished AIDS affected families. Monks are also being recognized by the government and civil society, for their important contribution to the AIDS response.
Cambodia is a deeply religious country. Monks are respected, including amongst young people. The religious knowledge and philosophy, however, since so many monks were killed during Cambodia’s difficult history, have to a large extent been lost, and is only now in the process of being rebuilt. Youth are growing up in a time where they see respect for traditional culture and religion, but also during a time in which the country is rapidly developing and experiencing growing inequality.
Can you tell me about your journey to your present position, and how you were inspired to do the work you are doing?
I have worked on HIV and AIDS for more than 10 years. The appreciation of the work by faith-inspired actors in HIV prevention and care was first triggered when I joined the UNICEF regional office for South Asia in 2003. My work included organizing the first regional interfaith conference on AIDS in South Asia. During those years, the involvement of faith-inspired actors in HIV prevention and care in South Asia was fairly limited. Our office tried to catalyze and mobilize greater action. Listening to the various faith motivated experiences from eight different countries in South Asia was a very powerful experience for me personally. The conference looked at the role religion and faith plays globally, as well as the challenges that different faith-inspired actors are dealing with in terms of interpreting scripture and applying them to AIDS responses.
I worked in South Asia for more than three years, and then I moved to the UNICEF Somalia office. In a country that is war torn and doesn’t have many functioning systems in place, the Muslim clergy was an important avenue to reaching the people and promoting compassion to families affected by AIDS and community acceptance to decrease stigma and discrimination.
I was also inspired by my Somali colleagues and the many colleagues from partner organizations, who agreed to jointly tap into the persuasion power of Islam to mobilize Muslim leaders to share information and provide compassion to affected families. It was a deeply inspiring and motivating experience for me to experience that a lot can be done even in a war-torn country.
In 2008, I joined the office in Cambodia, and there was already a long standing partnership (since 2000) in place with monks to provide support to families affected by AIDS. My responsibility includes assisting in revitalizing the work by Pagodas and the Ministry, given that Cambodia now has an epidemic which is concentrated and related to high risk behaviors. My work also includes assisting the government to plan and support the important work being done by religious clergy, and to facilitate sharing of experiences informing policies and strategies.
What do you see in your present position? What work are you doing, and how does it intersect with religion?
I am working in the UNICEF office as a technical specialist for HIV prevention and support for families and children affected by HIV. One of my roles is to provide technical guidance for the religious response to HIV in the country, primarily through the Buddhist Leadership Initiative.
What is the situation for youth in Cambodia, and what are the most pressing challenges they face?
Cambodia has a very young population. Roughly 44 percent of the population is under the age of 18. It is the second largest youth population in the entire region.
Of concern is the growing inequity and unemployment in Cambodia. This has an impact on young women and men and their development. While many make it to primary school, many are not able to complete secondary school. Cambodia is a country with a large number of youth that do not have jobs or opportunities, and a government which is rebuilding itself; its institutions, mechanisms, and policies. The actual service availability and delivery on the ground is still limited, especially social services.
Regarding the HIV situation, HIV prevalence has decreased and the epidemic is changing. HIV prevalence used to be about 2 percent some years ago, but now it is under 1 percent among the general population. However, Cambodia has high HIV prevalence among sex workers, those having male to male sex, and related to drug use. Many of these key populations are young people.
It is important that targeted HIV prevention interventions reach populations who have high risk behaviors, and that they are age and gender appropriate. It is equally important that faith-inspired actors provide care and support to families who are already affected by AIDS and continue to destigmatize living with HIV.
The country has been fortunate in some ways because it has been able to mobilize external resources to help accelerate the response to HIV over a number of years. The government has scaled up anti-retroviral therapy, and all of the provinces do have some sort of health system in place providing HIV testing and antiretroviral therapy. Access to facilities, however, can be a challenge. If you are young and under the age of 18 years, there are many challenges in receiving treatment, and teenagers, especially, struggle with fairly judgmental attitudes among health providers.
What challenges do faith-inspired organizations face in working on HIV/AIDS?
There are many different challenges. For example, some years ago, monks were mobilized to approach youth to talk about HIV prevention efforts. I think this was ill-advised, and was not appreciated in the communities. It was a good intention, but not very well thought through. Monks are powerful in terms of promoting care, tolerance, and compassion and providing spiritual support to those affected. You learn as you go along…
I think, secondly a challenge is that whether you are speaking about monk, priests, or imams, everyone has a personal belief system, and personal values tend to be often mixed with religious teachings, resulting sometimes in unintentional stigmatization or discriminatory attitudes. This is counterproductive. Good training and helping monks to understand and put aside one’s own values has been extremely important to our work in Cambodia.
Another challenge has been the issues of recognition and motivation. Cambodia faces very high turnover in the monkhood. Men can join the monkhood for three months, and then leave. I am not sure if this is stabilizing right now, but we are looking for mechanisms to make training an integrated part of Buddhist education.
A further challenge is the issues of confidentiality. An evaluation of the BLI in 2007 found that the people living with HIV have truly appreciated home visits conducted by monks. However, this has been more helpful when the neighbors knew already that the person had HIV. If the person had not disclosed their status and the community sees a monk visiting a home, and asks why the person is getting a home visit, it can breach confidentiality. Monks are now working to get consent from families before visits, and are working with local organizations of people living with HIV. We have been facilitating these support groups, and see that activities are starting to be better planned on the ground, improving issues of confidentiality.
On a separate note, I would like to say that we have moved away from general awareness campaigns, as awareness of HIV is already quite high. What is not high is accurate knowledge. We have tried to create networks of different partners to work on the ground together. The monks work on care, compassion, and spiritual support, where their strengths lie, rather than general awareness creation. Our focus is now on more targeted geographical activities where HIV prevalence is higher.
What are the primary gender issues that you face in your work, and does faith play a role?
A real challenge we have is that, for example, while overall the home visits are appreciated, if a women in the house is HIV positive, it is not permitted for the monk to provide one-on-one counseling. It is not seen as appropriate. In this case the person has to rely on professional secular counselors.
Can you speak to the role and influence of international organizations doing development work in the region, and what is their interaction with faith-inspired organizations?
An important contribution the UN agencies can make is to help the government coordinate and plan. It is incredibly difficult if you have a lot of different faith-inspired organizations and NGOs working in this area if they do not work under one plan and in one direction. UNICEF tries to help with information sharing, planning, strategy development, collecting evidence on what works, and geographical mapping so interventions are not duplicated. This is not easy because in Cambodia are many faith-inspired NGOs and some of them are not concerned about the national AIDS strategy or the overall national development plans. This has created duplication, sometimes competition, and collaboration remains limited. The UN has made headway, adding value and support to the government on issues of coordination, and creating a platform for faith-inspired actors to come together in their work on HIV.
Faith is often a topic that is not on the official agenda of development organizations, yet it is a crucial factor that should be given ample consideration, especially in Asia. What, from your view, is missing on the development agenda with regards to faith, and what should be added?
My first suggestion would be that for those Asian countries which have limited social services on the ground, mobilizing faith-inspired actors to provide coherent and quality services which follow international best practices should be seen and taken into account as vital.
Further, I think that much can be learned from faith-inspired actors; their strategies and outcomes, what works and what does not work, why, and in which given context. For the policy agenda, what comes to my mind is that the work around HIV tends to be influenced by people’s personal values and their own personal belief systems. If that personal belief system is shaped by religion or faith, it needs to be well understood. We can promote social and behavior change more effectively if local belief systems and religious interpretations are better understood.
It is further important that the motivation of faith-inspired NGOs be transparent, and that if a faith-inspired organization is engaged in development work follows international best practice.
Is capacity an issue for some organizations to always follow international norms and best practice?
I am not so sure if it is capacity, but really it is the motivation of why a group is acting. In Cambodia many faith-inspired actors are operating orphanages, and parents send their children with the hope that they will receive a good education, health care etc. But there is ample evidence that long term institutional care can have negative effects on the cognitive and emotional development of a child. This is not well discussed and taken into account.
You have worked in different capacities in different regions throughout Asia and Africa from what I have seen. Taking a comparative perspective, what do you see as the role of faith-inspired organizations in Cambodia, and how does it compare to other experiences you have had?
That is a question for a Master’s thesis! A challenge we have in Cambodia is while on the one hand we have a deep respect of Buddhism, we do not have the fundamental knowledge around Buddhism; it was by in large wiped out by the Pol Pot regime. In other countries that have also gone through conflict, for example in Africa, perhaps the interpretation of religious concepts is easier. The understanding of religious scripts and applying them to health promotion and social welfare appears a little easier. Investing in and supporting the religious knowledge base in Cambodia is important.
For example, in Cambodia you hardly see old monks. Most of the monks in pagodas are fairly young, while in Somalia I did meet very old Imams. Somalia has also known years of war and civil unrest, but religious leaders were not targeted as such, as they were in Cambodia. That is a fundamental difference, and it is challenging for a country that is influenced by so many external factors; the development agenda, Asian regional integration, and the high mobility of people, mean that a lot has to be done to relearn Cambodia’s own religious beliefs and use them for the benefit of its people, especially its women and children.