Entering as a Foreigner, Leaving as an Ally

Tina Sang & Lisa Smith2 October 2009SW 701

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 

• Pictures!

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

PREPARING FOR AN EXPERIENCE ABROAD

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.

DEFINING FEATURES OF A FOREIGNER

▫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.  

EXERCISES IN CRITICAL REFLECTIVE PRACTICE

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.

BECOMING AN ALLY

▫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.

China’s Urban and

Rural Divide

Home in Qinghai

vs

Home in Beijing Expat

Suburb

▫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...