Bachelor thesis
Myanmar
A research of the usability of different tools at work for people with a
disability.
Commissioned by: Enablement & The Leprosy Mission Myanmar Authors: M. van Eijk Student number: 500734831 R. Smallenbroek Student number: 500727459 In collaboration with: H. Cornielje A. Kester Aung Myo Thu Education: Occupational therapy – University of Applied Science, Amsterdam Coach: Ineke Smit Submission date: 31th May 2019 Word count: 9000 wordsPreface
This thesis is written as a part of the graduation program, facilitated by the Amsterdam University of Applied Science (AUAS). Two students from the occupational therapy course, Richelle Smallenbroek and Maaike van Eijk have designed this thesis during the period of February to June 2019. Research has been conducted in Taungoo, the Bago region of Myanmar. This thesis was commissioned by The Leprosy Mission Myanmar (TLMM) and Enablement with the aim of developing a barrier‐free labour market for people with a physical disability. This project was carried out to identify factors that influence the work situation of people who have a physical disability, or they are cognitively affected which resulted in physical disabilities. We will focus on the effects of physical disabilities. We would like to thank everybody involved in this project. Especially TLMM for this opportunity, cooperation, help and their hospitality. We would also like to thank Enablement for their guidance and coaching. And finally, we would like to thank Ineke Smit, our coach from the AUAS, for her feedback and coaching. We wish you a lot of reading pleasure, Richelle Smallenbroek & Maaike van Eijk Taungoo, 31th May 2019Table of content
Summary ... 5 Introduction ... 6 Orientation ... 6 1.1 Macro level ... 6 1.2 Meso level ... 6 1.3 Micro level ... 7 Chapter 1: Lead of the project ... 8 Partners ... 8 1.4 Problem description ... 9 1.5 Goal of the project ... 9 1.6 Relevance and delimitation ... 10 1.7 Main question ... 10 1.7.1 Pre‐research sub‐questions ... 10 1.7.2 Sub‐questions fieldwork ... 10 Chapter 2: Vision ... 11 2.1 Participatory Action Research (PAR) ... 11 2.2 International Classification of Functioning, Disability and Health (ICF) ... 11 2.3 Ethical considerations ... 12 2.4 Occupational therapy perspective ... 12 2.5 Financial accountability ... 12 Chapter 3: Methods ... 13 3.1 Method sub‐question A: literature search ... 13 3.2 Method sub‐question B: What does the target group look like and what are their needs? ... 13 3.2.1 Flowchart ... 14 3.3 Method sub‐question C: What tools would meet the needs of the target group and how can these tools be developed? ... 15 3.4 Method sub‐question D: How can these tools best be introduced to the staff of TLMM? ... 16 Chapter 4: Results ... 17 4.1 Results sub‐question A: literature search ... 17 4.2 Results sub‐question B: What does the target group look like and what are their needs? ... 18 4.3 Results sub‐question C: What tools would meet the needs of the target group and how can these tools be developed? ... 20 4.4 Result sub‐question D: How can these tools best be introduced to the staff of TLMM? ... 21 Chapter 5: Discussion ... 23 Chapter 6: Conclusion ... 25 Answers to the questions ... 25 Sub‐question A: literature search ... 25 Sub‐question B: What does the target group look like and what are their needs? ... 25 Sub‐question C: What tools would meet the needs of the target group and how can these tools be developed? ... 25 Sub‐question D: How can these tools best be introduced to the staff of TLMM? ... 26 Main question: Which work related tools are being used or can be used in an effective way by people with disabilities and how can these tools be made, and best be introduced? ... 26 Recommendations ... 26 Literature ... 27 Appendix ... 30 1. Keywords ... 30 2. Project plan ... 31 3. Questions for the interviews ... 42 4. Observations and additional interviews ... 435. ICF for all interviews ... 50 6. Activity analysis ... 53 7. Materials and costs of the tools ... 59 8. Consent forms ... 62 9. Feedback forms participants ... 65 10. Manual ... 71 11. Flashcards ... 83
Summary
In various developing countries it is difficult for people with a physical disability to find a job. The Leprosy Mission have set up an international project together with the organization DaNa Facility. The aim of this project is to create a barrier‐free labour market in the agricultural sector for people with a disability. The goal was to help 1500 women and 500 men to work. TLM approached the organization Enablement. Enablement approached the University of Applied Science (AUAS) to offer a project for students that could help achieve part of this goal. This project in Taungoo, Myanmar, had the aim to develop tools for people with physical disabilities so that the labour market becomes more accessible. The problem description that was used is as follows: People with a physical disability have difficulty finding work in developing countries. Having their own income is important for people with disabilities because they are in a difficult position in society. This includes exclusion from activities and being seen as less important than someone without a limitation. The objective of this project is to create tools and a manual describing how to make these tools that make work with a disability possible. These tools were implemented and tested for usability. To identify where the problems lie, interviews and observations were done. The target group consisted of people looking for work or working and who have a physical disability. People with a hearing impairment are not included in this project because they are dealing with a stigma. It is not always possible to develop a tool for a stigma because there must be behavioural change within the population groups. Various companies provide training, lectures and workshops to combat stigma. This project focuses on the development of tools for work. In addition, literature research has been conducted into the influence of having a physical disability on finding work. This showed that people with a disability have fewer opportunities on the labour market and that women earn less than men. Research has also been done into the effect of gender on finding work with a disability. These studies have shown that it is more difficult for women with disabilities to find a job than men with disabilities. During the data collection, it turned out that people's requests for help were focused on various domains, including living/caring and learning/working. In addition, the requests for help were not only within the agricultural sector. To delineate the project, after consultation with the organization Enablement and TLMM it was decided to focus the project on work in general. Literature research and practical research have shown that various problems in the field of work can be solved with a tool like straps and handles for more grip or a pillow to reduce pain. Eleven tools have been developed and implemented for this project. According to the participants the tools have made certain actions easier, reduced pain and reduced exhaustion. A manual has been made which contains the tools. The manual describes how the tools can be made, what the costs are and for which problems the tool can be used. More research should be done to measure the effectiveness of the tools and to add more tools to the manual. When looking at the link with occupational therapy it can be stated that occupational therapy plays a major role in this project. With the help of a number of adjustments and tools, certain actions for people are made possible (again).Introduction
In the introduction the baseline of the project will be explained. In appendix number one keywords can be found which clarify certain words. The direction of the project was based on the project plan, which can be found in appendix number two.Orientation
The relevance for this research is described on three different levels. These levels give insight from different perspectives. 1.1 Macro level Myanmar is one of the least developed countries in Asia. The population is divided into more than a hundred different ethnic groups. Each group has their own cultural norms and values. Most of the people are Buddhist. In the past Myanmar was part of the British colonies. Myanmar became independent on the fourth of January 1948 (Wikipedia, 2019). These Western influences can be seen in education. Most people can read and write a little, but the general level of education is low (Reizen naar Myanmar, 2019). Multi‐dimensional poverty is a big problem in Myanmar. 38,3 Percent of the population living in rural areas is deprived in at least one‐third or more of their non‐monetary indicators which reflect health, education and standard of living in 2018 (Open Development Initiative, 2018). People with disabilities are among the poorest people in the population. Because of their disability, they are excluded from community’s. A community is a group of people who are living in the same place (Oxford University Press, 2019). Most of the communities who participated in this research were living in rural areas. In smaller community’s disabilities are often seen as a punishment. Out of the 53.37 million people living in Myanmar, 1.3 million people have a physically disability. The expectation is that there are more people with disabilities than those that are registered because there is a tendency in the culture to be ashamed for having a disability. As a result, not everyone with a disability is registered (Leprazending, 2019). Most people with disabilities live in rural areas. Agriculture is the main source of income in rural areas. However, people with disabilities experience many obstacles to work as farmers or workers in the agricultural sector. Compared with other South‐East Asian countries, health standards are low in large parts of Myanmar. Hospitals are not very hygienic, have few resources and the staff is often poorly trained. In addition, occupational therapy is not known in Myanmar (Reizen naar Myanmar, 2019). With this project occupational therapy was introduced. The knowledge of the researchers was used to develop the tools and the manual. This project was executed in eleven villages surrounding Taungoo. This is in the Bago region of Myanmar. In Myanmar 15.8 million people are living below the poverty line. 13.8 Million live in rural areas like the eleven villages (Moe Moe, 2017). 1.2 Meso level The reason for this project based on meso level relates to the parties involved and their objectives. The purpose of the DaNa Facility is to help 1500 women and 500 men with disabilities find work. With this current project, a small percentage of their objectives are achieved. In addition, with the end product of this current project TLMM can help more people to get access to the work field. The end product is a manual describing effective tools for people with disabilities who are working and experience problems or want to work but experience a barrier. By offering occupational therapyknowledge to TLMM, this organization can help more people in the domain of work. This supports TLMM in reaching the goal of the DaNa Facility. 1.3 Micro level Personal requests for help from the included participants with a physical disability are taken into account. It is important for this project to sketch a clear picture of the problems in the field of work for people with disabilities. When a clear problem description has been created based on the included people, it is possible to look at change or improvement (Parker, 2012). This will allow the people participating in this project to give their opinion on the improvements or changes.
Chapter 1: Lead of the project
In this chapter you will find the lead of this project with an explanation of the involved partners. The problem description, goal, relevance and ends with the main‐and sub questions are described.Partners
Various organizations are involved in the project in Myanmar. First of all, the organizations will be described and their connection to the project will be explained. Following it is described how this project started. The Leprosy Mission (TLM) The Leprosy Mission is an international Christian organization that works in more than 50 countries. The Leprosy Mission Myanmar (TLMM) is facilitating the design of barrier‐free markets, the development of disability‐friendly agriculture, and job placement for about three hundred people with disabilities, preferably in the formal labour sector in three major cities of Myanmar (Leprazending, 2019). TLMM is working together with The Leprosy Mission Netherlands (TLMN). They want to protect people and reduce barriers for people who are affected by disabilities so that they can carry out meaningful and decent work. The aim of this collaboration is to help people with a disability to overcome barriers such as delayed access to health services, lack of access to private and public spaces, and the ignorance and discrimination that prevent their full participation and acceptance in society (Enablement, n.d.). TLMN approached the organization Enablement to assist TLMM in the development of a livelihood project in Myanmar. Enablement The organization Enablement is a non‐profit organisation in the Netherlands who work with professionals. They are specialised in Community Based Rehabilitation (CBR) and Disability Inclusive Development (DID). Training, research and consultancy are at the heart of their work. They try to bridge the gap between academic and government bodies and grassroots practitioners. This organization is working together with TLMM to achieve their goals together. BRAC The organization BRAC works together with TLMM in this project. BRAC was established to provide microcredit services to those who have been left out of the formal financial system and cannot avail credit (BRAC, n.d.). BRAC is responsible with TLMM for managing the microcredit components. DaNa Facility The DaNa Facility is an innovative private sector development program based in Myanmar. The UK Government’s Department for International Development (DFID) funded this facility with 25 million dollars. The Facility is designed to support the transformation of the economy of Myanmar. The focus is on serving the needs of the poor and groups historically marginalised from the economy, such as women and people with disabilities. The DaNa Facility grants subsidies to four different non‐profit organizations, including TLMM and BRAC. The purpose of this is to offer new and sustainable economic opportunities for people with disabilities. Innovative microfinance and the deployment of paramedics in Mandalay, Bago and Yangon are expected to reach more than a thousand people with disabilities. In Myanmar, two‐thirds of all people with disabilities who are of working age are unemployed. The figure is even higher for women with disabilities (DaNa Facility, 2017). This project fits the goal to support people with disabilities in finding a job and improving the work situation.Project The project of TLMM and Enablement concerns an in‐depth investigation into ability to develop adapted tools for work: possible utilisation as well as effectiveness of the different tools. To reach this goal Huib Cornielje and Angelique Kester, who work for Enablement, started with a manual of 42 various tools for people with disabilities who work in the agriculture sector in Myanmar. These 42 tools were found on the basis of a literature research. Some of the tools were made in the Netherlands and they were added to the manual. Because the end product has to be usable in Myanmar it is important to see if it is possible to create in Myanmar. This is why Enablement reached out to the Amsterdam University of Applied Science. They wanted occupational therapy students to create a part of the tools in Taungoo. The project was carried out in Taungoo because most problems occur in rural areas. In addition, TLMM is located in Taungoo. Occupational therapy is a paramedical profession that focuses on solving practical problems caused by a disorder. Actions can be made (again) possible by means of advice, guidance or the use of tools and adjustments. For this reason, the occupational therapy profession fits in well with the project in Myanmar. Physiotherapy is already known in Myanmar, so these paramedics are already present. Aung Myo Thu, who works for TLMM, and other colleagues from TLMM selected fourteen tools which were thought to be most effective with the target group in Myanmar. After doing research on what the target group looked like and what their needs where it was found that the fourteen tools, which were selected by TLMM, didn’t meet the needs. Because of this the researchers selected tools themselves based on the collected information. At the start of the project the focus was on the agriculture sector. During the research the focus shifted to work in general because many people with a physical disability were not working in the agriculture sector. The number of people with disabilities from the TLMM database consists of 300 people. At the start of the project 35 people who work or have family who work in the agricultural sector were selected for this project. The 35 people with disabilities were interviewed and observed. This showed that eleven people with a disability have work or are looking for work and have a request for help in the field of work.
1.4 Problem description
People with disabilities, especially women, face many problems in Myanmar. Their human rights are often violated, and companies do not take the problems into account that people with disabilities face (UN Women, n.d.). People with a physical disability have difficulty finding work in developing countries. Having their own income is important for people with disabilities because they are in a difficult position in society. This includes exclusion from activities and being seen as less important than someone without a limitation (UNPFA, 2017). Myanmar did not reach any of the Millennium Development Goals. To reach the new Sustainable Development Goals Myanmar is working together with other countries. Steps are taken to promote gender equality in school enrolment and to create access to clean water (Open Development Initiative, 2018). To reach the goals of reduced inequalities and stimulated decent work and economic growth various projects were created such as this project.1.5 Goal of the project
The aim of the project is to develop a list of essential adapted agricultural tools/instruments for people with disabilities in order to offer a guide that will help them to better participate in work and employment.1.6 Relevance and delimitation
According to the employees of TLMM there are several aspects that can be improved for people with disabilities for instance: 1) The labour situation in the agricultural sector. 2) Access to the job market and access to finances. 3) Barriers faced by families with disabilities and leprosy to gain access to work. 4) Negative attitudinal barriers faced by people with disabilities from society at large as well as their families. The focus was on the first and second aspect. TLMM made this decision because the rural agriculture is the most important source of income for most people in Myanmar. When this form of income is lost, more poverty is to be expected among this target group. In addition, people with disabilities or leprosy are often excluded from employment and may‐ due to their disability or stigma attached to their disability‐ be excluded from the job market as well. This also means that it is a very relevant and important topic to study and develop tools to further improve the situation of people with disabilities. For this reason, improving the functioning of a person with a disability through adjustments of tools was made.1.7 Main question
The main question in this study is as follows: Which work related tools are being used or can be used in an effective way by people with disabilities and how can these tools be made, and best be introduced? 1.7.1 Pre‐research sub‐questions Pre‐research was done by a literature research. Two literature study questions were made and investigated which are described in the method. The question in this study is as follows: Sub‐question A1: What is the influence of having a physical disability on finding a job in Asia? Sub‐question A2: What is the influence of gender on employment among people with a physical disability in Asia? 1.7.2 Sub‐questions fieldwork Practical research answers the following sub‐questions: Sub‐question B: What does the target group look like and what are their needs? Sub‐question C: What tools would meet the needs of the target group and how can these tools be developed? Sub‐question D: How can these tools best be introduced to the staff of TLMM?Chapter 2: Vision
A project vision gives direction to the goal, as described in the lead of the project. The visions of the project provide guidance and defines the whole.2.1 Participatory Action Research (PAR)
This study is a Participatory Action Research (PAR). This involves the researchers and participants working together to understand a problematic situation better and improve it (Institute of Development Studies, n.d.). Because PAR focuses on research with the purpose to enable action this model is very suitable for this project. Power relationships between the researchers and the researched become blurred because of the influence of the opinions and visions of the researched. This means that the researchers and the researched become partners in the process (Baum, MacDougall and Smith, 2006). Because of the eastern we‐culture in Myanmar it was important to work together with the participants on an equal level. Participation for people with a disability in society is the main goal of TLMM, the DaNa Facility and Enablement. Being able to participate actively in research can be one of the first steps to this goal.2.2 International Classification of Functioning, Disability and Health (ICF)
Because the influence of the opinions and visions of the researched is very important in a PAR research the ICF was chosen. The human functioning is divided into three perspectives in the ICF: ‐ The perspective of the organism (functions and anatomical properties) ‐ The perspective of the individual (activities) ‐ The perspective of society (participation, participation in society) The opinions and experiences of the researched play a big role in the ICF model. The ICF is a suitable tool for properly mapping more complex cases. This enabled a holistic view of the participants, assess the complexities of functioning and it gives an insight in the functioning of the participants (WHO, 2019). Due to cultural differences between the Netherlands and Myanmar such as language and customs, certain cases can be complex. This classification system provides a conceptual framework. The (dis)functioning of a person can be systematically described in relation to all medical and non‐medical factors that influence the person. Because the target group consists of people with disabilities, it is important to map medical factors. In addition, non‐medical factors can also play a major role in the field of work. For non‐medical factors, think of the workplace, travel time, the social environment and personality traits. The questions for the interviews and the results of the interviews are based on the ICF. Activities and participation have been combined because there was much overlap (arbeidsdeskundigen.nl, 2019).2.3 Ethical considerations
This research was done according to the rules of the General Data Protection Regulation (GDPR). This meant that participants were asked for permission to process their data. Before recordings were made permission was asked. The people could choose to not participate in the study. The collected data will not be used for other purposes. Only the necessary data was collected for this research. The data will not be kept longer than necessary. The data is protected against unauthorized access by passwords (Intersoft Consulting, n.d.). For the adapted tool catalogue pictures will be used. People were asked for permission before using the pictures. Permission forms can be found in appendix number eight. People will not be photographed without approval of the individual.2.4 Occupational therapy perspective
Occupational therapy plays a major role in this study. Occupational therapy is a paramedical profession in which the occupational therapist guides people with physical and mental problems in promoting, recovering or maintaining functioning as independently as possible in their personal living and working environment. The occupational therapist can teach someone an activity again or teach how to perform it in another way, possibly with the help of tools and adjustments (WFOT, 2019). One of the three domains of occupational therapy is learning and working. This domain fits well with this project because this research looks at the problems in the field of work. It was needed to look at which tools or adjustments could be effective to solve or reduce these problems. With the help of occupational therapeutic knowledge, various tools can be made from materials available in Myanmar. Occupational therapy is also promoted in a country where occupational therapy is unknown.2.5 Financial accountability
To develop the tools different costs have been made. For this project five dollar per tool was budgeted. For comparison, the minimum wage in 2018 was 4.800 kyats which is about 3.13 dollars per day (Trading Economics, 2019). Other costs came from transportation and any other needs. The total amount of costs is shown in table 1. For a more extensive explanation you can find the whole document in appendix number seven.Product/services Costs in Kyats Costs in Euro’s Cost in Dollars
Transportation 541.000 315,79 352,24 Standard supplies 184.400 107,77 120,96 Materials for tools 60.320 35,25 39,56 Services carpenter 12.000 7,01 7,87 Total amount spends 797.720 465,65 519,38 Table 1. Costs of products and services
Chapter 3: Methods
In this chapter you will find a description of the used methods per sub‐question. The methods of data‐collection and sampling are described.3.1 Method sub‐question A: literature search
A literature research was conducted to collect additional information on employment in Asia. Because little research has been conducted in Myanmar the focus was on Asia instead. The following questions were formed: 1. What is the influence of having a physical disability on finding a job in Asia? 2. What is the influence of gender on employment among people with a physical disability in Asia? The first question was created to sketch a picture of what problems people with a physical disability face when they are looking for a job. The second question focusses on the influence of gender because TLMM is mainly focussing on women. During the interviews in this project both, male and female face stigmatisation. This raised the question if women face more stigmatisation when they apply for a job than men.3.2 Method sub‐question B: What does the target group look like and what are their
needs?
The target group consists of people with a disability. They can be cognitively affected which can result in physical disabilities or they can only be physically affected. We will focus on the effects of physical disabilities. Interviews To give the target group the opportunity to tell their own story semi‐structured interviews were done with 35 participants. The participants were approached by TLMM. All participants had a job or were looking for a job. Eighteen people were female, and seventeen people were male. The aim of the interviews was to collect data about what the target group looked like, what their needs are and what their barriers are. The interviews gave the researchers the opportunity to gather information while building a relationship with the target group. The aim of this research and the context were explained at the beginning of each interview. This helps the interviewees to understand the questions better. To give the interviews structure the ICF was used. This model was described in paragraph 2.2. The three domains of occupational therapy gave direction in the interviews. The questions can be found in appendix number three. To transcribe interviews recordings were made. Recordings will be stored on phones with a password. The interviewees were asked for permission before recording the interview. The transcribed interviews are stored on a USB‐stick at the AUAS.3.2.1 Flowchart Out of the 300 people with a disability TLMM selected 35 people for the interviews. After the interviews, additional interviews and observations people were included and excluded for the project. This resulted in the following flowchart: Additional interviews Additional interviews have been done with three people because it wasn’t clear if they wanted to get back to work. The additional interviews gave clarification on this matter and helped with including or excluding people from the project. The additional interviews and observations can be found in appendix number four. The ICF with the information of the interviews, observations and additional interviews of the included eleven people can be found in the results. The complete ICF with the information of all the participants can be found in appendix number five. 35 People with a disability were interviewed 12 People were excluded after the interviews because they had no question related to work 5 People were excluded after the interviews because they could not be helped with a tool 2 People were excluded after the interviews because they had no job or plan on how to get a job 1 Person was excluded after the interviews because he didn’t want to work 2 People were excluded after the interviews because TLMM already helped him 2 People were excluded after additional interviews because they didn’t have a question or didn’t want to work 23 People with a disability 18 People with a disability 16 People with a disability 15 People with a disability 13 People with a disability 11 People with a physical disability were included because they had a question related to work and can be helped with a tool
Observations Out of the 35 interviewed people eleven people have been observed. These observations were done to see where the problems lie in a specific activity. These specific activities were noted as difficult activities by the interviewees. The following general things were observed: 1. Social surrounding To see what the support network looks like while doing this activity. This also gives an insight on who could help while doing this task or who could do this task instead. 2. Physical surrounding To see what possibilities and limitations are caused by the physical surrounding. This could show what things could be adjusted to make the activity possible or easier. 3. What tasks they do and how they do it To observe what actions the activity consists of and what the person has to be able to do. Activity analysis were done to measure the effectivity of the tools. The activity that was most difficult for the participant was observed and an activity analysis was done. An activity analysis was done again after one week of using the tool. The complete forms can also be found in appendix number six.
3.3 Method sub‐question C: What tools would meet the needs of the target group and
how can these tools be developed?
The interviews, additional interviews, observations and the activity analysis were analysed. This resulted in clear problem descriptions per person. For each problem description a tool that met the needs of the person and which would be possible to create in Taungoo was chosen. This resulted in eleven tools. With the help of the employees of TLMM eleven tools were made. Working together with them to make these tools was important since they are the ones who have to be able to make the tools. The products used to develop the tools are locally available or can be ordered from the TLMM head office in Yangon. They are low‐cost items to keep the costs of developing the tools at a minimum. For some tools the help of carpenters was necessary because they were too complicated to be created by the employees of TLMM. Participants were visited twice, the first time the tools were introduce and the second time feedback from the participants was collected. There was one week between implementing the tools and evaluating the tools Activity analysis have been done again to measure if there are differences between the doing the activity without an adjusted tool versus with an adjusted tool.The participants were asked to rate the tools on two point on a scale from one to four. The following form was used:
Feedback form
We would love to hear your thoughts, concerns or problems with anything so we can improve. Gender: Age: What tool: Please rate the tool based on the following scale: 1 = The tool doesn’t help 2 = The tool helps a little bit 3 = The tool helps 4 = The tool helps very well Criteria Scale The tool makes the activity easier 1 ‐ 2 ‐ 3 ‐ 4 The tool helps to prevent and/or relieve pain 1 ‐ 2 ‐ 3 ‐ 4 The tool helps to prevent exhaustion 1 ‐ 2 ‐ 3 ‐ 4 Describe feedback ……… ………... The outcomes can be found in the results. The full forms can be found in appendix number nine.3.4 Method sub‐question D: How can these tools best be introduced to the staff of
TLMM?
A concept of the manual was developed by Huib Cornielje and Angelique Kester. The staff of TLMM thought this concept was clear and easy to understand. This is an effective way to introduce the tools to the staff of TLMM. Because of this the lay‐out was kept the same, the developed tools were added to the manual. The manual can be found in appendix number ten. To see if there are other ways that are effective for introducing the tools to the staff a meeting was observed. Discussions were held with the staff to get their opinions, ideas and suggestions.Chapter 4: Results
In this chapter you will find the collected results of the four sub‐questions. The results are described per sub‐question.4.1 Results sub‐question A: literature search
1. What is the influence of having a physical disability on finding a job in Asia? With the results from the eight articles it can be concluded that people with a disability experience different problems. These consist of: reduced chances on the labour market, lower educational level, difference in wages compared to people without a disability, lack of financial support to work on an independent basis and that men have more chances than women on the labour market (Singh, 2014). A higher education level had a positive effect on employment. Discrimination at work was still an issue for some people (Achterberg, Wind, de Boer & Frings‐Dresen, 2009). In addition, it has been shown that inclusiveness training and vocational training can contribute to improving opportunities in the labour market. It also shows that there is a need for more knowledge and understanding of the barriers of people with a physical disability (Naraharisetti & Castro, 2016). The results of this research can be used for the graduation project by taking into account the problems for people with a disability on the labour market. In this way tools can be made, and advice can be given to increase opportunities in the labour market. 2. What is the influence of gender on employment among people with a physical disability in Asia? From the information of eight articles it can be concluded that the female gender among people with a physical disability has a negative influence in most countries in Asia. Although this is not the case in all countries and regions of countries. Because of discrimination from teachers it is more difficult for girls to finish their education (Quinn, Hunter, Ray, Quadir, Sen, & Cumming, 2016). Because of this they have a lower chance on employment. In many Asian cultures it is expected from women to stay at home and care for the children, elderly and household. Because of this woman in general are not stimulated by family to look for a job (Wang, & Li, 2018). Because every country has its own culture the influences of this depend on the country and even the region. In the countryside people do more physical labour which is more often done by men since they are seen as more productive because of their physical build. Overall people with a physical disability are, by society, often seen as less efficient and less productive (Duvdevany, 2009). Since a lot of data is old, the rise of feminism and many countries are actively trying to improve the status of disabled people more research has to be done to see what the influence of gender and disability is on employment. It is important to keep the influence of gender on employment in mind since this could be the reason why some people are not working. This could mean that a different approach, with a focus on conversations and motivation, might be necessary when working with this target group.4.2 Results sub‐question B: What does the target group look like and what are their
needs?
After excluding the people with a disability who were not suited for the project the ICF was used again to analyse the group of included people. After transcribing the interviews an analysis was done manually. The classifications of the ICF were used to structure the information. Activities and participation have been merged because there was a lot of overlap. The numbers in the ICF show how many people have these characteristics. Health condition (disorder or disease) Communicable diseases Polio: two Non‐communicable diseases Brain damage Stroke: one Accident: two Cerebral palsy: one Other Dislocation: two Muscle weakness: one Spinal cord accident: one Amputation: one Blind + finger deformity: one Missing fingers + stroke: one Body functions and structures (impairments) Pain: five Muscle weakness: six Activities and participation Eleven People with a disability said that work was the most important activity for them. The reason for this was the income. Many people had questions on multiple domains of daily living such as living and working. Six people had difficulty walking. One person was experiencing difficulty with standing and sitting. Two people had difficulty grabbing things. Living/caring Problems with getting water: two Problems with washing and dressing: four Pain (all the time or during tasks): three Problems walking around the house: one Problems with eating: two Learning/working Using work tools: two Doesn’t take enough breaks: three Pain caused by work: six Problems with carrying things: two Problems with riding motorbike: one Slower than others: five Free time There were no questions related to free time. Environmental factors Social factorsFamily, neighbours and community were mentioned as support network. Physical factors Transportation was an issue for five people with a disability. They were dependent on other people when they wanted to go somewhere else. The reasons for this were uneven roads and height differences in buildings. Many people with a disability face difficulty’s when visiting other villages since they were far away. This affects if they can go to work and how often they can see their family members who were living in another village. The work environment was not noted as something that prevented people with a disability from being able to do their job. For two people with a disability it is difficult to get around the house Personal factors The youngest person was 25 years old and the oldest person was 76 years old. Three people were female, and eight people were male. The average age for the females was 48 years old. The average age for the males was 49 years old. Five people with a disability can read and write, two can read and write a little, three cannot read and write because they had no education and one can only read a little. Positive traits that were often noted were easy learning, independent, tries to be positive, professional, never give up, energetic, patient, friendly and hard working. Negative traits that were often noted were no job, sad, angry, impatient, not being able to do like others or like before, needs a lot of rest and emotional. Nine people chewed beetle. One person smoked and one person drinks. Table 2. ICF of included people From these results it can be concluded that the target group for this project consists of people with a (cognitive) disability which affects the body and results in physical disability. Most of the people were male. This was surprising because the number of male and female participants at the beginning was almost the same. Women had less questions related to work, this is why they were not included in the rest of the project. All of the included people have a job, but not all jobs are related to the agriculture sector. The results of the interviews show that people have questions related to different domains of daily activities. To demarcate the project the focus was on the work‐related questions. Additional interviews were conducted with three people to see where the problem lies and whether motivation was present. Ten people were observed to see what the nature of the problem is and what could be possible solutions. No observation or extra interview was done for one person because the problem in the work situation was clear. Out of these thirteen people one person needed adjustments on his motorbike. Two people needed an adjusted tool because the tools slip out of their hands. Two people needed a tool to carry things at their workplace. Three people needed an adapted chair. One person needed support while going down a slope. One person didn’t take enough breaks while working and has pain in his joints. One person had a problem with ploughing.
4.3 Results sub‐question C: What tools would meet the needs of the target group and
how can these tools be developed?
Based on the information from the interviews, additional interviews, observations and the activity analysis certain tools were selected. The tools were then implemented, and an activity analysis was carried out again. An activity analysis using the implemented tools was performed to compare the initial situation with the situation in when the tools are used. This allowed the activities of the participants to be examined, so that suggestions could be made for adjusting activities. After the activity analysis the tools were evaluated with the participants to hear the thoughts, concerns or problems about the tools, so the tools can be improved. The participants rated the criteria for the tool based on the following scale: 1 = The tool doesn’t help 2 = The tool helps a little bit 3 = The tool helps 4 = The tool helps very well Criteria Scale A: The tool makes the activity easier 1 ‐ 2 ‐ 3 ‐ 4 B: The tool helps to prevent and/or relieve pain 1 ‐ 2 ‐ 3 ‐ 4 C: The tool helps to prevent exhaustion 1 ‐ 2 ‐ 3 ‐ 4Tool Why this tool Effectivity
1. Backpack Price: 1650 kyat/0,96 euro’s/1,09 dollars To make heavy things easier to carry and to divide weight over the whole back instead of just the shoulder. A: 3 B: 3 C: 3 2. Cart Price: 13100 kyat/7,67 euro’s/8,59 dollars To make heavy things easier to carry. A: 2 B: 3 C: 2 3. Stabilizer (two people) Price (per person): 14400 kyat/8,42 euro’s/9,44 dollar To divide weight and to give stability. A: 4 A: 1 B: 3 B: 1 C: 3 C: 1 4. Joint protection principles Price: 310 kyat/0,18 euro’s/0,20 dollar To prevent pain. A: 2 B: 3 C: 3 5. Breaks poster Price: 310 kyat/0,18 euro’s/0,20 dollar To prevent exhaustion and pain. A: 2 B: 3 C: 3 6. Handle for rope Price: 850 kyat/ 0,50 euro’s/0,56 dollars To give more grip and prevent pain. A: 2 B: 3 C: 2
7. Foam pillow Price: 3350 kyat/1,97 euro’s/2,21 dollars To prevent pain. A: 2 B: 3 C: 3 8. Straps Price: 500 kyat/0,29 euro’s/0,33 dollars To give more grip. A: 3 B: 3 C: 3 9. Foldable chair Price: 20000 kyat/11,70 euro’s/13,12 dollars To prevent exhaustion. A: 4 B: 3 C: 3 10. Handle for hoe Price: 1100 kyat/0,64 euro’s/0,72 dollars To give more grip. A: 1 B: 1 C: 1 11. Foam pillow motorbike Price: 4750 kyat/2,78 euro’s/3,12 dollars To give more stability and prevent pain. A: 1 B: 1 C: 1 Table 3. Effectivity tools The tools were created with the help of the staff from TLMM. This was done to see if it is possible for them to make it. Local available materials were used. Some materials were ordered from the head office in Yangon, TLMM orders these materials often since they also use them with different projects. Steps on how to create these tools can be found in the manual which is in appendix number ten. The tools were developed at the prosthetic workplace from TLMM. They have many materials and machines which can be used to create the tools. The flyer with the joint protection principles and the breaks flyer were translated by the staff of TLMM to Burmese. The principles and the importance of breaks were explained to the staff. The staff explained this to the participant. From the development of the tools it can be concluded that it is possible for the staff of TLMM to create the tools. The prices of the tools varied a lot. Not all tools were equally effective. To measure the effectivity more accurately an evaluation should be done at a later time. People have to get used to a different way of working and to new tools. Because the foam pillow for the motorbike was completely ineffective this tool was not included in the manual. Some other tools need adjustments, suggestions were given in the manual on how to adjust the tools.
4.4 Result sub‐question D: How can these tools best be introduced to the staff of
TLMM?
The manual (appendix ten) was created in English for the staff of TLMM. Because not all off the staff can speak English the manual will be translated to Burmese by the staff of TLMM who can speak English.A meeting was observed. Many visuals like pictures, colours and symbols were used. From this observation it can be concluded that pictures and visuals help people to understand the information better. Because the staff of TLMM cannot always create the tools for the people with a disability, flashcards were created. The staff can hand these out to the people with a disability. The flashcards consist of pictures from the manual which show how the tool can be made. 40 Percent of all the interviewed people could not read or could only read a little. Because of this there was no text used on the flashcards. The flashcards can be found in appendix number eleven. The staff has experience with flashcards since they are also used in other projects.
Chapter 5: Discussion
This discussion contains a review on the project that has been carried out. This explanation concerns the strengths and limitations of the project. First of all, there was no pre‐research done by TLMM or DaNa Facility. It was unknown what the target group looked like, what their possibilities and limitations were and what the needs were. This caused confusion at the start of the research. Because of this the goal of the research changed multiple times. At first the goal was to develop fourteen tools from a manual of 42 tools, made by Enablement. The fourteen tools were selected by the staff of TLMM, they didn’t consult the target group when choosing the tools. When doing the interviews, it turned out that the tools chosen by TLMM didn’t meet the needs of the target group. There was no clear goal at this point. The needs of the target group were on the domains living/caring and working/learning. When noticing this the focus was on both domains. The researchers had three months to carry out the project. Because of this it was decided to focus on the domain work since this was most important for many of the participants and for TLMM. The interviews and observations delivered important information about what the target group looks like and what their limitations and needs are, which is a strength. The interviews gave direction to the rest of the project and could help TLMM when doing different projects. Another limitation was the language barrier. English was the main language of this research. Dutch was the native language of the researchers and Burmese was the main language of the staff of TLMM and of course of the participants too. Because of the limited English skills there was confusion at some occasions. Help of outsiders who have a higher level of English was sometimes used to translate questions for the staff of TLMM. Google translate was often used in conversations, but this was not always accurate. A critical eye and assertiveness of the researchers guarded the quality of the end product. The third limitation was the budget provided by DaNa Facility. There was a lot of money provided and used for traveling. 85 Percent of the money that was used in this research went to traveling. The other 15 percent went to the making of the tools. There was a maximum budget of five dollars per tool. Some tools were very cheap, but others exceeded the limit by four times. The overall costs of the tools were under the maximum budget but if you would look per tool the budget would be exceeded. It would be beneficial if the maximum budget was more fluid. This would give more flexibility when making the tools. It could also be beneficial to get a bigger budget for the tools since the quality of some materials was low. The researchers expect that the tools will not be very long lasting. The family culture in Myanmar is protecting towards family members. All the participants noted that they had their family and community as support network. This gives people security, but overprotection sometimes held people with a disability back from developing themselves as a person and prevented them from working. Sometimes family members didn’t want person with a disability to work because they thought it would be dangerous or that they wouldn’t be able to do it. To tackle this the interviews were done with the people with a disability themselves. Family was present if they wanted them to be present. Even though a top‐down approach is common in this country a bottom‐up approach was used. This enabled possibilities among the staff of TLMM to give their opinion on things. It also enabled the participants to give their opinion and thoughts on topics. They also actively helped with developing the tools by giving suggestions and feedback.The findings of the literature search corresponded with the findings from the interviews. The participants were facing many problems like stigma, (gender)discrimination, physical barriers and exclusion. The literature research also helped the researchers to get a better understanding of the cultural differences. The roles of people with a disability are different in Myanmar from the Netherlands. In the Netherlands people with a disability have more possibilities. People with a disability have limited chances to enter the labour market. Stigmatization towards people with a disability made it difficult to implement the tools. Not all employers want their employees to use tools since this confirms the difference between the person without a disability and the person with a disability. There are also big differences in gender roles between both countries. Women are often expected to take care of children, elderly and the household. This is why many families don’t stimulate women to work. In the Netherlands 46.2 percent of the working people is female while in Myanmar this percentage was 39.8 in 2018 (World Bank Group, 2019). Many of the interviewed women worked as a tailor. The researchers noticed a traditional distribution in work between men and women. The researchers are both women. Even though Myanmar has a somewhat traditional view on what job women can do, the researchers didn’t experience any negative outlook on their own position. Participants didn’t show a negative attitude towards the researchers. Because the researchers didn’t speak the native language it could also be that negative remarks made by the participants were not translated by the translators.
Chapter 6: Conclusion
Firstly, the sub‐questions will be answered. After this the main question will be answered. Finally, recommendations will be given for future projects.Answers to the questions
Sub‐question A: literature search With the results of the literature search, where sixteen articles were critically assessed, it can be concluded that people with a disability experience different problems. These consist of: reduced chances on the labour market, difference in wages and lack of financial support to work on an independent basis. In addition, it has been shown that inclusiveness training and vocational training can contribute to improving opportunities in the labour market. Female gender among people with a physical disability has a negative influence in most countries in Asia. Culture plays a big role in the perspective of what people with a physical disability are capable of. Women are in many countries expected to take care of children, elderly and the household. This is why many families don’t stimulate women to work. Sub‐question B: What does the target group look like and what are their needs? Interviews, additional interviews and observations were done to answer this question. 35 People with a disability were interviewed. Eleven people with a disability were included after critically assessing their answers. The final group of participants consisted of eight men and three women. The youngest person was 25 years old and the oldest person was 76 years old. The average age for the females was 48 years old. The average age for the males was 49 years old. The participants had varies types of disabilities. All the disabilities had an effect on the physical aspects of the body. The disabilities often caused pain and muscle weakness. Five people with a disability can read and write, two can read and write a little, three cannot read and write because they had no education and one can only read a little. Positive traits that were often noted were easy learning, independent, tries to be positive, professional, never give up, energetic, patient, friendly and hard working. Family, neighbours and community were mentioned as support network. Most people had problems on the domains living/caring and working. Because the goal of TLMM is to create a barrier free market for people with a disability the focus was on the domain working. All the people with a disability said that work was the most important activity for them. The reason for this was the income. Because the of the pain and muscle weakness the tools are developed to prevent pain and give more grip and/or stability. They are made to be used at work so they can continue doing their job or have an easier time finding a job. Sub‐question C: What tools would meet the needs of the target group and how can these tools be developed? The following tools were created: a backpack, a cart, a stabilizer, a poster with joint protection principles, a poster to bring awareness to taking breaks, a handle, two foam pillows, straps and a foldable chair. The tools were created with the help of the staff from TLMM.Some materials were ordered from the head office in Yangon, TLMM orders these materials often since they also use them with different projects. The tools were developed at the prosthetic workplace from TLMM. For the foldable chair and the stabilizer, the help of a carpenter was necessary. Sub‐question D: How can these tools best be introduced to the staff of TLMM? The manual was created in English for the staff of TLMM. Because not all the staff can speak English the manual will be translated to Burmese by the staff who can speak English. From the observation it can be concluded that pictures and visuals help people to understand the information better. Because the staff of TLMM cannot always create the tools for the people with a disability, flashcards were created. The flashcards consist of pictures from the manual which show how the tool can be made. Main question: Which work related tools are being used or can be used in an effective way by people with disabilities and how can these tools be made, and best be introduced? A manual and flashcards are effective ways to introduce the tools to the staff of TLMM but also to the people with a disability. A backpack, a cart, a stabilizer, a poster with joint protection principles, a poster to bring awareness to taking breaks, a handle, two foam pillows, straps and a foldable chair were created. The tools were evaluated once which showed that not all were effective. Some of them need adjustments, suggestions for adjustments are given in the manual. The tools can be created with local products. Most of them can be created without help of a carpenter. To measure the effectivity more accurately there should be a follow up.
