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Sustainable Cultural Change in action – One woman’s approach to women’s wellness in Lao PDR

For the majority of my corporate life I have been working in one way or another within the field of change. Change Management, Organisational Transformation, HR & People Leadership, Organisational Development etc. all for the purpose of improving an organisation through the value of its people. We talk about sustained cultural change starting at a baseline of behavioural change across an organisation and their team members. We measure their levels of engagement, place metrics on “Happiness” and use that as an indicator that we are achieving the shift. However, if you applied these theories to changing long held cultural beliefs in a nation such as Lao PDR how long does true cultural change take, how do you embed it and how do you enable people to take accountability to continue to sustain the culture change? Is it years, decades or generations? I don’t yet have the answer to that question, but I have met a woman who is doing her utmost to change behaviour, long held beliefs and ultimately a nation’s culture. A challenge that may take her and many of our lifetimes to achieve.

Luang PrabangFor many of us Lao PDR may not even be on our radar. It sits landlocked between Cambodia, Vietnam, Myanmar, China and Thailand. It too has the mighty Mekong running through it and has some of the most beautiful scenery and people making it a place where I want to do what I can and use the capabilities I have developed to working with Lao people to improve women’s wellness, now and into the future.

The current population of the Lao People’s Democratic Republic is a little under 7 million based on the latest United Nations estimates. The population density is 30 people per kilometre in a country smaller than the state of Victoria, Australia. Of that approximately 7 million people 49.9% are female and only 44.3% of the population live in an urban area with access to basic services such as hospitals, doctors, or hygiene facilities that we all take for granted. The demographic makeup of the population is unclear as the government divides people into three groups according to the altitude at which they live, rather than according to ethnic origin. The lowland Lao (Lao Loum) account for 68%, upland Lao (Lao Theung) for 22%, and the highland Lao (Lao Soung, including the Hmong and the Yao) for 9%. With each group speaking its own dialect and having its own customs, traditions, religion, belief systems, ‘old wives’ tales’ and oral histories passed down through families and villagers. Faced with those challenges. How do you sustain cultural change for the improvement and life expectancy of people’s lives?

During my career sabbatical I have developed an affinity for the Lao people and through acquaintances made, I was introduced to a remarkable woman, Sally Piper Pillitteri. I am full of gratitude for having met her, in awe and inspired by the woman she is and the work that she does. Since 2010, the NGO she founded, Eau Laos Solidarité (ELS) has been helping children in Laos improve their health through basic hygiene. To further improve women’s wellness and to collaborate with the local Lao PDR communities, in 2015 she began her work “Laos Girl Teen Project.” At that time, they published the “I am a teenager book”, which is thoroughly researched and culturally sensitive. The reason for publication was due to a baseline study of 150 girls aged 11 – 17, which found that 97% of girls had not known they were going to menstruate before they did.

Can you imagine your daughter, your wife, your sister or any woman you know not having knowledge of their bodies and the fear they must have felt when it first happened to them? As a woman it would be terrifying and confusing. What I admire most about Sally’s NGO and why I have found myself involved, is the power it provides to the people of Lao to create sustainable change, she’s guiding them through the process and providing the skills they need to alter their culture and take accountability now and into the future.

So why is this change so critical? 

  • A UNICEF study showed that 1 out of 3 girls in South Asia knew nothing about menstruation before it happened (WaterAid, 2013)
  • Through conversations with the Lao girls, it was discovered that prior to the work Sally and her team began, young women thought they had a disease or were dying (anecdotal evidence, Sally Piper Pillitteri)
  • Young girls with no knowledge use whatever is at hand to stop the flow of blood including such things as leaves, mud and old scraps of material
  • Lack of knowledge about looking after her body during menstruation, can mean a girl practices poor hygiene, poor diet and may miss school on “difficult” days

ELS published the book, “I am a teenager” in 2015. As with all NGO operations in developing nations there are a number of approvals that must be obtained. The Ministry of Education and the Ministry of Information had to approve it and from that process it is now also recommended by the Head of Obstetrics & Gynecology at Luang Prabang Hospital. All the educational and teaching materials are in the Lao language and have been approved by their committee of Lao advisors. However, to affect real and sustained change Lao teen girls require more than a book. They require support from their teachers, their mothers, extended families and they need to support each other. To enable this Sally and her team are up skilling and developing teacher training across northern Lao PDR

Since 2015, they have provided 2-day training in Menstrual Hygiene Management (MHM) to 103 secondary school teachers, educators, nurses, doctors, and education officers. In addition, they have trained the Lao Red Cross who will reach 5000 girls in 3 years. They have also distributed more than 10,000 books and hygiene bags to rural school girls who participated in puberty workshops given by their trained teachers.

All girls attending secondary school in 5 districts in Luang Prabang Province now know that they will menstruate and that it is normal, not shameful and not a secret. They share this knowledge with sisters, mothers and friends. All girls now practice daily hygiene, are able to attend school without the fear and shame that they previously experienced and know how to manage period pain and maintain their (energy) vitamin levels through a healthy diet. Girls are supported in school by sympathetic teachers and classmates with the older girls now sharing their knowledge with their younger classmates. Through this sharing of knowledge with friends and family they are creating a new cultural narrative and dispelling long held cultural behaviours. The taboo in these schools and the local community has been lifted.

Across the 2017- 2018 Dry Season (starts in October and ends in April) when many of these Northern Laos rural villages are only accessible, the project team have spent October to February evaluating 48 teachers in 24 secondary schools, travelling hundreds of kilometres on dirt tracks in tractors, trucks, and at time crossing rivers in leaky boats. Sally and her team commit to evaluating their trained teachers every year. Sadly, leaky boats and travelling on uncomfortable tractors are not the only challenges the team face. In evaluating the teachers training, they have also found that many teachers themselves had an inaccurate comprehension of menstruation. Through workshops with the teachers they too learn from each other, improve their knowledge and create a fantastic opportunity to empower women to better manage their wellness.

The scarcity of skilled doctors in rural areas (2.89 health workers per 1000 people – World Health Organisation 2015) makes this even more important, and the team provide them with the information and tools to improve their and their students’ wellness around menstrual hygiene. In addition, they lack the funding they require to provide resources (teachers training kits, transport, financial requirements for the teachers to attend training) and it takes a long time to dry reusable cotton pads in the wet season that may lead to some women wearing them damp – or revert to other means. There is no conclusive evidence that wearing wet pads leads to infection, but it certainly causes rashes, discomfort and may be a contributory factor to candida.

In secondary schools this year, teachers have educated 1160 more girls about menstruation and puberty. Each girl has received the book “I am a Teenager”, and a welcome teenager hygiene bag containing underwear, soap and sanitary pads to enable her to manage her first period.

A “Rural Women’s Knowledge Outreach” team is currently facilitating evening workshops in 10 mountain villages of ethnic minorities. This is the first time these women have received any knowledge about menstrual health. Until this, access to any information was impossible, due to distance, finances, illiteracy and unawareness. This rural team has so far reached approximately 600 women in mountain villages.

The numbers thus far are a drop in the ocean when you consider the population of Lao PDR and the median age being only 23. In my mind however through Sally’s passion and drive, this creates an incredible opportunity to build sustainable change through conversation and change long held beliefs and taboos in a way that allows the Lao people to own the outcome, increase teacher capability uplift, utilising local Lao villagers to lead the discussion which includes the extended family support and the opportunity it provides for girls to continue their education.

Sally’s plans don’t end here and nor does my involvement. Often NGO’s come into a town, fix what they see as wrong, give themselves a pat on the back for their altruism but do not involve the locals or to begin them on a path of sustained cultural and behavioural change – this is not the case with Eau Laos Solidarité (ELS) and “Laos Girl Teen Project”. Sally is attempting true Culture Change across a nation of approximately 7 million people, with many who do not have access to information, education, doctors and rely only on long held cultural beliefs passed down through generations. This is not a deterrent to her though, this challenge is the fire that keeps her fighting for women’s wellness across Lao PDR. It’s a fire and a passion that is contagious.

Moving forward in 2018-19 “Laos Teen Girl Project” plans to:

  • Train, evaluate and support 16 more secondary-school teachers from a district in Northern Lao
  • Visit each teacher in their respective schools to evaluate lessons
  • Distribute books and hygiene supplies to 1000 girls aged 10 – 16
  • Hold revision workshops in 3 districts and provide books and hygiene bags to all first-year girls in the respective secondary schools
  • Further develop the Rural Women’s Knowledge Outreach, with evaluations and extension of village workshops
  • Trial a boy’s puberty training guide for teachers
  • Provide innovative, fast drying washable sanitary pads made from a micro fibre which are guaranteed to last for 2 years, and often 3-4 years for as many rural girls and women as possible.

I’m hoping that it’s about now that you’re asking yourself what can I do to help?

  • You can visit the “Laos Girl Teen Project” on Facebook to learn more
  • Visit or email
  • You can follow this link to donate via PAYPAL 
  • Any donation will assist in ensuring this powerful and empowering work continues to allow Lao women the dignity and wellness they so richly deserve. As a guide for what is needed to ensure financially we can keep this important cultural shift to occur across the country;
  • US$ 1500 pays the salary of a rural puberty educator for 1 year.
  • US$ 100 pays for a day of transport in a 4×4 over rugged dirt roads to rural schools.
  • US$ 500 will enable us to supply 68 teenage girls with a pack each of washable and reusable pads made from an innovative, quick-drying material.

Any amount you can spare will change the lives of rural teenage girls and improve women’s wellness across this beautiful country and keep true sustained cultural change occurring.

For further information drop me a line via the contact link, follow me on twitter or Instagram @Ms_Scrummy or contact me via LinkedIn



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