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InPsych 2010 | Vol 32

October | Issue 5

Public issues

Working as a psychologist in Afghanistan and Bangladesh

Jamie Terzi completed studies in psychology and cognitive science before working as a psychologist in several community health settings in Melbourne. She worked for seven years in Afghanistan, originally as a volunteer then as paid Director of Programs with an Afghan Women's Education Centre, before being appointed Assistant Country Director for CARE Afghanistan. She now has the same role in Bangladesh. She was interviewed by phone from Dhaka.

How did you come to be working overseas and what was/is your role in these NGOs?

It was a matter of where I was in life at the time. I always wanted to work overseas to travel and volunteer. I'd had significant work experience as a psychologist in community health and women's health in Melbourne. I was still single, so it was fortunate that I was at a stage of life to make decisions not everyone can make. I applied to work as a volunteer in Afghanistan in January 2002, just after the start of the war when the US and its allies invaded Afghanistan. I was interested in central Asia - partly out of a romantic idea of travelling the silk route - and was offered a placement with a non-government women's organisation that focused on improving the lives of women in Afghanistan, training social workers, psychologists and counsellors. I took the position but did not end up doing any training until three years later. There was so much else to be done.

My current role is similar to the first three years overseas - I oversee a program that works to address violence against women, food security, economic development, maternal health, HIV/AIDS, and services for vulnerable groups. I'm now playing a management role and so my work is less hands on. I work closely with the respective project managers.

What were/are the major challenges facing you in this work?

When you're trained as a psychologist you have certain ways of doing things. You work within a health system where people have disposable incomes and there's primary care looking after individuals and families. In countries where nothing like that exists because there are no viable public service systems, your work with individuals can touch so few, so it's difficult to justify working one-on-one. I found myself negotiating funding for education programs for women, organising peace education projects, and supporting a new manager in her role of leading an Afghan women's organisation and being a leader in her community. So my technical skills in counselling were less relevant than the ‘bigger picture' community development understandings. It's impossible to think it's all about the individual when people are immersed in poverty. Helping individuals just makes me feel bad about the other 35,000 in need.

It's not about instant gratification, but the immensity of the problems gets me down. The whole system is built on such exploitation here in Bangladesh. It breaks my heart to walk away from a brothel full of 12-year-old girls. You need to set boundaries to avoid being overwhelmed. I'm not going to be Angelina Jolie! It's not just wiping dirt from faces. You constantly have to ask: What is my role? If I don't speak the language, understand the culture or development work, what am I doing here? There are no firm answers to these questions - they are rhetorical, much like the ones you have to ask yourself as you enter psychology and counselling. People mostly do good work, but you need to arm yourself. I spent nine months in Pakistan before I felt comfortable, and after seven years in Afghanistan I still don't know what I did. I let go of that question. You never know the direct impact of your work as counsellor, and I certainly can't clearly define the impact of all the things I've done since I've been away.

In Melbourne I had worked in community development in a women's health service, and as a psychologist in community health. So I already understood complexity, and how tough it is to change behaviours in Australia. But it's so much tougher to make changes over here with no supporting structures (like the rule of law, public services, shared understandings of how to address family violence, or even what it is). I'd had to make tough personal decisions in my previous roles - those decisions around mandatory reporting and family violence set me up well for some of the challenges here.

How would you describe some of the differences between working in Afghanistan and in Bangladesh?

Both Bangladesh and Afghanistan are Islamic but very different countries. The defining issue in Afghanistan is conflict. In Bangladesh it is more about exploitation, but women are more able to fight for their rights and there's a more progressive middle/upper class, so you can have more in-depth and challenging conversations. The birth rate has dropped dramatically in Bangladesh. Society was more closed in Afghanistan, especially to foreigners, with less chance of real development because of the current political climate. Women's roles there often have so little power. In Kabul prison, women's living conditions are not so different from outside, but they are at very high risk of being exploited by power holders.

When you are new to a country, you can lack the context that helps you really understand what you are seeing. There is no functioning rule of law, so you need to be careful about the notion of charity. In Afghanistan, psychologists are not trained in the way we are in Australia and you can find bizarre combinations of medications being prescribed for unclear and unexplained illnesses. As for me, I had to pare down my expectations - you find yourself facing your own belief systems (e.g., about time and how long something might take, or beliefs about women's roles and how these can be changed in traditional societies).

What have you learned about yourself in these eight years?

I learned that I could see things through in difficult circumstances, I got stronger and could stand my ground more. I've been maturing in the job and not requiring others' affirmation. I'm facilitating people to do their job better, but I'm not indispensable. I'm far more mindful of cultural differences now and my changing expectations of what people can and can't achieve.

What kinds of professional skills have been most valuable to you?

I'm letting go of the title ‘psychologist'. Should I still be using it? Performance appraisal and coaching skills are relevant - as is knowing how to communicate things. The skills and experiences I have make me better at what I do now. The individual skills plus an awareness of the bigger picture mean I'm probably practising community psychology. Nothing you do is untouched by political machinations, so it's vital to understand this aspect.

As for psychology as a profession, we receive training and professional development about setting up service delivery models, but our training needs to be clearer about cultural issues and the interface between psychology and international development, broadening it out so that we are not so inwardly focused. I don't just mean our psychology associations - as individual psychologists we need to let go of dogma. I am proud of being a psychologist, but I've learned to let go of models. The needs in poorer countries are huge - counselling will be different, roles will be different, so we need to open up dialogue. Psychology doesn't have to be everything to everyone. Being a teacher in Australia doesn't qualify you to be an educator overseas. Psychology is just a bit player in international development.

What's it like being there as an Australian?

I'm very aware of how Australia comes across to the rest of the world, and I get embarrassed at the parochialism. I have more empathy with the real people involved in immigration debates. Canada takes many more refugees. What is our responsibility as a fortunate developed nation? We don't really understand poverty in Australia - for example, a sex worker in Australia has some protection by rule of law.

There's such a huge sense of entitlement in Australia - three cars, big houses. There's a question of what is necessary to exist versus luxury - confusing wants with needs. There's financial interest in making you believe you need a five bedroom house with a home theatre and library and makeovers every five years.

I'm also happy to be Australian - all countries are parochial. Racism exists everywhere - I don't believe Australians are necessarily more racist than others, however the response of ‘we're not racist' is a non-response to these accusations. The point is to understand that racism is felt by the person who experiences it and should not be defined by the people who are displaying racist behaviours. It is how you address the issues themselves, by looking at the facts and also people's subjective realities.

How would you advise APS members who might be considering working with an international NGO?

Learn about the organisation and country you're interested in. What role can you really play? Does the agency need you in the way you are making yourself available? You need to understand the context of international development, as well as the specific context of where you might be working. Otherwise there is still room for getting active internationally within Australia, by joining campaigns and raising awareness at home, which may be more useful.

Training needs to include self reflection and awareness. What do you think you're doing? What attitudes and mindsets are you bringing? It's not just about wanting to do good. My expectations dropped many times over before I got them right. For example, I'd have ideas about how something should be done, but then discover it would not be done in my timelines. I'd have to let it go and accept that it will be done in some way.

Thanks to Heather Gridley, Manager of Public Interest at the National Office, for conducting this interview.

References

Disclaimer: Published in InPsych on October 2010. The APS aims to ensure that information published in InPsych is current and accurate at the time of publication. Changes after publication may affect the accuracy of this information. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. The information provided in InPsych does not replace obtaining appropriate professional and/or legal advice.