Surmang Rural Health Clinic• Community Health Worker Program
▫Trained local Tibetan women to be birth attendants (prenatal counseling, pregnancy warning signs, and safe delivery).
▫Interviewed CHWs.
• Home Visits to Grandmother's Village▫Visited elderly, observed living conditions,
screened elderly for high blood pressure, provided medications.
• Medical Emergencies
Lisa's Internship Experience• Abbreviated Internship Objectives:• To examine disparities of access to adequate
health care between urban and rural populations, stratified by gender and socioeconomic status
• To understand the role of a comprehensive social business like the Grameen Bank in improving access to health care
• To evaluate the health infrastructure in Bangladesh with consideration for the active NGO environment
Lisa’s Internship Experience
• Asia Pacific Center for Security Studies:▫ Discussions of microfinance as a mechanism for developing secure
social settings
• Grameen Bank Internship:▫ In-depth study of finance and banking related mechanisms of the
bank as well as the health related changes mediated by the presence of Grameen and their associated health programs in rural villages
▫ Projects Included: Comprehensive evaluation of one Grameen Kaylan health
branch office Participant observations at community loan meetings, district
loan offices and during loan disbursement procedures Meetings with a variety of Grameen sister organizations Analysis of collaborative work throughout Grameen
organizational structure Annual report writing for Grameen Trust on their China
Grameen model replication project
Lisa’s Internship Experience
•ICDDR,B: International Center for Diarrheal Disease Research, Bangladesh▫Studied research programs targeted at the
intersection of poverty and health▫Worked within the social and behavioral
research department▫Enabled me to see how microfinance
participates in the health system at an infrastructural level
▫Met with key policy makers to discuss health status in Bangladesh
Lisa:
▫Spent a year writing papers and doing projects on my topic Studied microfinance in-depth
▫Went on short-term study abroad experience in Bangladesh 3 months before leaving for my internship
▫Talked to a lot of people, asked a lot of questions▫Read local newspapers (The Daily Star)▫Read international news on the country (BBC
News)▫Applied for over 10 different funding sources
Tina:
▫Undergrad research project in Tianjin, China▫Took international and multicultural-related
courses. ▫Found faculty members with connections in
China. Searched for an internship. Applied for internship funding.
▫Plans changed to go to Qinghai Province Read a history book on Tibet and China
relations. Read a travel memoir of a Canadian who taught
English in Bhutan. Bought necessary equipment, packed light. Prepared mentally for a rural village experience.
▫Tina: American, Han Chinese, didn't speak Tibetan, Altitude.
▫Lisa: Skin color = wealth, education & happiness
Gender Norms▫Different standards/expectations for us
versus for the local women▫Varying degrees of oppression▫Entering into both male and female
spheres Child birth, family planning, home visits,
kitchen, religion, interpreters Dictated by male understanding and interest
Political Context▫General directorate of health meeting▫China:
Dalai Lama has called for autonomy in Tibetan regions of China and not outright independence.
March 2008 Lhasa riots: Han Chinese settlement, peaceful protests by monks, government backlash.
Lack of civil society: Few non-profits, state-controlled media, and state policy on religion.
Social Change▫People within the country need to
recognize and own a particular problem.
▫Purpose is to create something sustainable that is not driven solely by a foreign entity. Foreign aid, both through volunteers and
money, comes and goes according to political will and economics.
▫Community-level change that draws on local people's knowledge and values.
Critical Reflection to Promote Contextual Social Work Practice and Education
• The global community is a concept used to indicate how we live in a small world, primarily due to easy access to communication and travel▫ There is an urgent demand for relevant and
adequate, rather than universal, knowledge▫ Embrace ambiguity!
• What is critical reflection?▫ An educational and supervision method that
combines practice, research and education in a circular process Learning about and improving practice Learning to develop practice-based theory Learning to connect theory and practice Improving and changing practice
Critical Reflection
• Similar to reflective learning▫ Circular experiential learning cycle of…
Action Reflection Conceptualization Experimentation
• Critical elements emphasize how gaining personal insight and learning to know oneself is a never-ending task, important for professional development
• Reflexivity (a term often used in anthropology) refers to critical reflection which is concerned with the positioning of the self▫ How power is experienced and exercised
Backdrop to Global Social Work
▫History of colonialism▫Globalization▫Lack of critical self reflection and change among
international health and social service institutions
▫Usually focused on specific disease or humanitarian crisis rather than sustained change, short funding cycles
▫Tension between biomedical understanding and local understandings of health and wellness. Western models assumed to be universal.
▫Development, modernization, and the economic bottom line
Critical Incidents• “If it made a ‘significant’ contribution, either positively
or negatively, to the general aim of the activity observed” (pg. 39 of text)
• Procedure is as follows:▫ Describe the critical incident: analyzing and
understanding▫ Reveal deep-seated assumptions▫ Explore individuals’ experiences in light of historical,
social political, economic, cultural and religious contexts▫ Ask if the discussion would be different if it were
happening elsewhere in the world and why.▫ Create emancipatory knowledge resulting in professional
growth and development▫ Create a collective professional knowledge base to be
followed by transformative change
Critical Reflective PracticeCase Studies
▫Community health worker training program (Tina)
▫Cyclone relief effort and aid (Lisa)
•Exercise: In your groups, please develop a case example where you/your group/your organization, as an international social worker, face a difficult ethical decision.
▫Know your role. Don't come in saying, "I am going to fix things."
▫No Asshole Rule▫The awareness and sensitivity that you
bring to a situation may not be met with same response by people of that country Power of the third party perspective Foreigners are hyperaware of the lack of
awareness between populations within country
▫Dissociation with lower classes in society▫Tibetans and Chinese▫Urban (Dhaka) Bangladesh and village Bangladesh▫Same would be true of foreigner visiting the U.S.
▫Active listening Sponge: soaking up information and asking
questions Allowed for things to become more of an
exchange than strictly a benefit to me▫Language barriers
Using non-verbal body language and smiles ☺ Developing rapport with translators Try to learn the language, even if it is only 5
phrases ▫Suspend Judgment then Reflect▫Making yourself available for experiences not
traditionally associated with your internship Looking at all experiences as opportunities to
grow, share and learn Be flexible. Combine your skills with their needs:
grant writing, networking with Westerners Yak tent, cyclone relief, following traditional
religious practices in a respectful way
▫What country are you from? How long are you visiting my country? Where have you been? Time = respect
▫Developing personal connections Use your social identities Make friends Like having an extended family abroad Use your privilege to help local people
Impact Assessment of YOU!▫Despite these challenges, recognize the
importance of reflexivity and your development as an engaged and interacting being
▫Your job should be to fill in the footprint of your influence through your actions during and after an experience abroad You want to leave a situation at equilibrium
Not stagnant equilibrium You continue to give back what you have received
even after your experience is over Ongoing iterative process that involves further
critical reflective practice Always carry those memories in the back of your mind
Ongoing Reflexive Practice
▫ Well-rounded person: self-care, relate-ability ▫ Worrying▫ Time▫ Food▫ Water▫ Poverty▫ Expertise▫ Invest in people▫ Inform professional practice▫ Interconnectedness▫ Educate, share, advocate▫ Breaking stereotypes▫ Intricate situations – learn to love ambiguity ▫ Remain curious!▫ Don’t accept mediocre!!!
Internship Funding Sources
• International Center Websitehttp://www.internationalcenter.umich.edu/swt/work/internfunding.html#gradtips
• Area Studies• School of Social Work, Office of Global
Activities
• Other Funders William Davidson Institute, JW Saxe
Memorial Fund, Ginsberg Center, Wallenberg Fellowship, International Institute, and more...