Localising Social Work:Lessons Learntfrom aCommunity Based Intervention amongst the Bedouin in Jordan

Introduction:

Localising the education and practice of social work has received considerable attention fromJordanian social workers both academics and practitioners (Al-Makhamreh,2005; Al-Makhamreh and Sullivan2011; Ibrahim, 2010). This debate on indigenisation has been a theme withinthe international social work literature (Gray,2010) as sensitivity towards culture and local context liesat the heart of social work practice.Rankopo and Osei-Hwedie,(2011) believed that this issue in social work practice remains critical. While Cocks et al (2009) feel that there needs to be afocus on the commonalities between local and international cultures.

In this article we are not questioning the values and the principles of Western social work nor to what extent it is appropriate or relevant to practice within non-western contexts but we arguefor implementing culturally competent practice within education in social work.

Developing a culturally effective and relevant model of intervention for particular populations can produce tensions, which might emerge between models that are mainly focused and dedicated each to a specific culture.Gray and Coates, (2010) advocatesensitivity towards the members of an ethnic minority group that may not necessarily be included within the cultural diversity approach (Chau,et al,2011).

Social workers should be aware of their own culture. This will help their reflective practice(Munford and Sanders, 2010, Gray,2010 Rankopo and Osei-Hwedie, 2011). Reflective practicecan enhance students’ abilities in integrating knowledge with action. In addition it is a critical method of tacit learning within education and training for the profession (Could and Tylor,1996). Localising social work practice does not only influence the construction of the social work practice but also may have an impact on shaping larger policy frameworks (Munford and Sanders, 2010). This paper argues for the need for culturally- competent practice and suggests that it can be accomplished by promoting cultural competence through community based training.

Background - Bedouinsand Social Work in Jordan

Jordan has a population of 5230000 and has a total area of 88778km (DOS,2011) consisting of arid to semi- arid regions. In Jordan, the Badia extends from north to south along the eastern portion covering about 80% of the country's total area. It has an arid climate, harsh weather conditions and little natural vegetation. ‘Badia’ is the term for the place where the Bedouin (bedu )(بدو) live, and is the same name commonly given to the semi-arid and arid lands of the Middle East. The Badia population is only about 3% of the county’s population .Their number has sharply declined since the introduction of the Ottoman land laws in the mid-eighteenth century, which abolished the communal ownership of the land that was a basic component of the nomadic lifestyle. The Bedouin traditionally were nomadic or semi-nomadic living fromherding and agriculture moving from one area to another according to the availability of water and pasture(Chatty, 2006). Today the majority of Bedouin live a settled lifestyle in villages in the North Eastern Badia (Hasna et al, 2010;Chatty, 2006). The society is based on tribal organization that is characterized by collectivism and fierce loyalty to family, clan and tribe. There is a segmentary patrilineal tribal structure based on tribes (ashirah), which is subdivided into sub-tribes or clans(hamoulah) , which in turn are divided into families (fakhdh. ahle) (Dutton and Shahbaz, 2008).

Theremoteness of the areais a disincentive for health and social work professionals who are reluctant to work there.The government has provided roads, water supplies, schools health clinics and other services yet the North-eastern Badia remains a less developed rural area. The majority of itspopulation work in wage labour as soldiers in thearmy, or teachers in the schools. However agricultureis still considered a supplementary source of income (Hasna,et al,2010);The Bedouin differ in lifestyle and history from urban city dwellers or agricultural villagers and their difference is not always viewed sympathetically or understood.

This is a case study of the localisation of social work practicethrough learning in combined classroom sessions and community based .practice about Bedouin life. Preparing students through field training is a requirement for developing social work education and practice. Empowering students and developing their abilities and skills of communications through education have been identifiedas a key issue in developing the profession through national and international literature (Sullivan et al, 2010,Cocks et al,2009).

PrincessRahmaUniversityCollege offers a four years Bachelors degree in Social Work. There are two levels of field training: Level one focuses on case studies intervention while the second level offerstraining about groups and social development of local communities or organisations. Most placements are usually in cities or towns that are close to the university (Princess Rahma University College,2011).

The students who choose this training module are fourth year social work students who registered for the field training level (2) . This training focused on how to practice professional kills and utilise social work methods of intervention for working with groups and local communities.Iit is also aimed atdevelopingstudents’skills to adapt, adjust and modify values and knowledge that they had learnt in class. All students were asked to keep notes reflecting on their practicein their portfolio.

The higher education programme emphasises the need for Social Work education and accreditation that is appropriate for Arab Jordanian culture and market job needs (Al-Makhamreh and Sullivan, 2011). This paper will discuss the experiences of students and the field training team at AL-Balqa Applied University/ and Princess Rahma University College –social work department with the cooperation of Philadelphia UniversityFaculty of Nursing. This model of training offered the opportunity to focus on assessing and improving access to health care for Bedouin in the North Eastern Desert of Jordan.

Preparation for Model of Training

The aim of the training model was to sensitize, social work and nursing students to the Bedouin culture and health needs. This explains the main aim of the partnership with a range of providers for improving access and quality of health care. The Bedouin Health module wasdeveloped from the findings of the Bedouin Health project conducted in the Northern Badia during the years 2006-2010. The mixed method study included interviews with.policy makers, health providers in Northern Badia, alternative healers, Bedouin men and women and observation of service provision in the clinics.The community based training intervention was piloted with nursing and social work students in 2008. This paper focuses on evaluating the experiences of the social work students who were involved.

Structure of the Bedouin Health Module

The module had both theoretical and practical components.The former comprised atotal of six lectures that were delivered to145 nursing students at the University of Philadelphia and the content was modified and delivered as two lectures at Al Balqa Applied University for 5 social work students.

The topics included were information about the Badia of Jordan, Population Characteristics and Socio-economic Conditions in the Northern Badia,the Social Determinants of Health, Community services and health provision,household and gender issues and strategies for development.

Pre and post testswere administered to the social work students based on the learning objectives for each unitThe testconsisted of 20questions specificto the Northern Badia and Bedouin lifestyle habits. Students were asked about what increased communicable health disease, the most important determinants of health, factors affecting reproductive behaviour,health needs, and health provision. In addition, how to reduce service barriers, and challenges in implementation of a development strategy in Northern Badia

The practical part focused on community social work and nursing practice. The duration of the training was for twodays a week overseven weeks. The placements were at two comprehensive health care clinics in the Northern Badia as well as in elementary and secondary schools. Students were also asked to do home visits in both communities. Each social work student was a team member with nursing students.

Two focus groups discussions were conducted at the end of the training. One was with five members of the practice assessors from both universities and the other was with five social work students. The purpose of the focus groups discussions was to evaluate theintervention,to discuss their experience in field training and their recommendations for future planning.

Findings

The findings of pre and post test questions for 5 social work students were significantly better in 14 of the 19 questions for the right answers.Thepre and post test was analysed for the t- test for statistical significance. The analysis showed that the mean value for the responses of the samples according to the performed T-test (pre-test) phase was about (8.6) and comparing to the T-test result for the (post-test) phase which increased to (13.4); in addition, the correlation coefficient for the two performed tests was (0.92) and statistically indicates at the level of (α=0.05) and T has reached a value of (T=3.073) with a statistical significance level (α=0.05); it follows that this difference implicates the improvement of the individual responses according to the T-test.

This evaluation indicated that the class room and community based training had increasedthe students knowledge

Thefocus group discussions and student filed noteprompted reflection on localized practice. Students acknowledged that thiswas their first exposure to the Bedouin community and gave them an opportunity to familiarize themselves with this group.

‘ It is a good idea to have these lectures and test before starting the training, although classroom experience is completely different from field practice, but at least I know what I might face’ ( SW, male student, field note)

‘Yes I completely changed my attitude toward this community’ ( St 1,FG)

‘I now have some information and expectations I was embarrassed when the lecture asked us about Bedouins lives. I was lacking of a basic knowledge about our communities’ (SW, Female student, field note)

Inter-Professional Learning

Sharing the experience of learning from the filed is potential solution to overcome tension and conflicts between different professionals. It preparing the students to work together as practitioners which impact on developing the notion of partnership, team and role clarity between professionals in social and health care organizations (Carpenter and Dickinson, 2008).

‘WhenI first saw the nurses I thought what they are doing and how we are going to work together? Today our attitudes changed towards each other. I was very pleased when I asked the nursing student while conducting a home visitabout the medical condition of a child, he described his case as ‘Downs Syndrome’ and explained what it is. Then I in my turn told him why and how child abuse or domestic violencehappened and its impact on children’s lives’(SW, female filed note).

‘Today we discussed what is socialwork and how we can work on cases as a team. The students started to refer and ask for our advice in some cases that they thought needed our intervention’(SW,male student,filed notes)

‘Sharing and cooperating with nursing students was great, the project joined both social and health workers to help the Bedouins’ (St 2,FG )

‘Home visitswere very useful with some students. Information given to the families enlightened them about what was available for them in the case of any health and social problem. The experience created the opportunity for students to solve complex situations’ (FG ,Practice assessors )

‘It was very good practical experience for the students. The involvement of the student lead to the familiarisation of what health services were available to the community (FG,Practice assessors)

Localisingsocial work is about generating empirically-based knowledge for front line workers, which fits culturally and engenders appropriate solutions for particular contexts (Gray and Coates,2010).

‘The experience definitely changed their attitude toward the Bedouin community and they learnt how to communicate with them. Feedback from the students was very positive on the whole experience.’(FG,Practice assessors)

The data revealed that students started to think about the way they constructed their practice within the local context (Munford and Sanders (2010) . The provision of outreach services was suggested by students as a way to deliver equal services to Bedouins. It was clear that the principles of social wok and the value of human rights and local justice, were both local and universal global needs. (Hong and Song,2010).

‘We should design methods where we can reach people who are living far away from the services. Those who need counseling and immunization.May be we can use mobile units like the military; they need outreach services’(SW female student field note)

‘It was a real opportunity to help other people. It made students realise the need for their work and contribution to improve community health’ (FG,Practice assessors).

‘In our meeting with the headmistress I asked her to have some space for slow learners, so they can have the chance to express themselves to learn more and to merge them more with their classes to develop their skills. It is all about integration now, I felt that teachers and students did not feel comfortable to discuss this problem, they might think they are useless. They need more of awareness. I am thinking of organising a lecture about those children’s needs’ (SW Female student, field note).

LocalisingPractice

It can be argued that localising practice was a lesson learnt from this field training as the students were exposed to the needs of a socially disadvantaged group living in a remote area(Chau et al. 2011). In addition, the students experienced what it meant to be rooted in their culture.

‘I realised how much I have been ignorant about this society. I have to be sensitive in how I communicate. ,Even if we live in same country, there are some patternsof communication I am not familiar with! I was thinking what if I worked and have a Bedouin client would I be successful in my intervention?’ ( SW,Female Student field note).

‘ I felt as a social worker that I have to do something when the old man told me he felt that Bedouins were neglected and forgotten’ (Male SW student field note).

‘The experience gave us the chance to understand the tradition, culture and how to approach the Bedouins’ (St 2,FG)

‘It was an opportunity to know how to work in real life, and how to work with people with different educational levels’ (St3,FG)

‘ Even though I came originally from a Bedouin background, I never lived and talked like them.My grandfather moved a long time ago. However I understand now why my father’s attitudes towards helping others and using medicines like the Bedouins. I even discovered that sometimes I think differently from city girls’ (SW, female student field note)

‘The experience changed my view completely on Bedouin; they definitely need help and resources’. (St 3,FG).

‘It developed my personality, and gave me real practical experience as a social worker’ ( St 4,FG).

Localised cultural competence was felt only by the students but also by the social work practice assessors

‘The programme identified some of the hidden social and health problems. It was an opportunity to understand how to deal with the Bedouin community’ (FG, Practice assessors).

‘There were difficulties in approaching people beside the need to know more about tradition and culture before embarking on the project’(FG, Practice Assessors).

Informality and Wasta

Understanding the social context is vital for a successful intervention. Informality and Wasta.Some of the participants mentioned . Students did not suffer confusion or conflicts when responding to Bedouins’ needs by utilising their influence as this is a specifically accepted cultural practice (Al-Makhamreh, 2005).

‘ When I told her to go to the police station to write a statement about the birth identity of her granddaughter she looked strangely at me and said ‘I am not going make a scandal’., I told her that you are the only relative for this 11 yeas old girl.What will happen to her if you die?She said that Allah will be taking care of her, I decided to ask one of my relatives in a senior position to help this woman’ (SW, female,filed note)

‘She told me that she felt dizzy most of the time. I asked her to go to the health centre. She said that she would ask her relative who is a nurse to find her some medicine first before she went to the medical center as it is faraway from her house’ (SW student filed note)