Confidentiality in another context

I go to school in Norway, and I am studying to become a social worker. At school we learn about social work in different settings, and how to interact with our welfare system to help people. We discuss the systems' advantages and disadvantages, their different structures and how they function. Although in Norway we have a well-developed system, we also find challenges and limits within it. But mostly we look at it as a resource and a helping tool to meet people’s needs. The government invests a lot of resources in the social welfare system.

Coming from Norway with a support system like this, it takes a lot of effort to perceive the Tanzanian welfare system without judgement. It is necessary for me to set aside my own understanding about how social work practice should be, and adopt a position of openness to understand this context. I often find that I am asking myself, "Which western knowledge about social work is transferable to this reality, and which is not?"

A description of a client meeting at the Social Welfare Office, from my point of view.

“Come here!” The Social Welfare Officer (SWO) says to us and places two chairs in the back of the room, waving eagerly for us to take our seats. Another SWO is sitting behind the desk at the office and two clients are sitting at the other end, talking loudly and in chorus in Kiswahili. The room is framed with thin walls, and there is a gap between the wall and the ceiling. In the background you can hear humming from other clients chatting in the waiting room, right outside. It is difficult to say whether it is the thin walls that is the reason we can hear the many conversations, or the fact that the door is wide open. I wonder if I am the only one who finds this disturbing. There are some shelves next to the desk, with client files that are visible to everyone. The conversation in the room continues. Although, I don’t understand the language, I notice that it seems like a delicate matter. Suddenly the SWO turns to me to explain in English what the matter is about. I get a mixed feeling. On the one hand I am grateful that she is explaining to me what is happening, given the language barrier, on the other hand I feel out of place and that I am violating the privacy of the client.

During this client session I experienced several breaches of the practice of confidentiality. This story is clearly told from a western point of view, where the concept of confidentiality permeates social work practice, and is kept sacred. In school I have learnt that the purpose of confidentiality is to protect the individual right to privacy, which is a necessary step to build trust and respect. Confidential information can only be disclosed with the client`s consent. If there is no consent, the client shall be notified before confidential information is provided to others. In our practice, there are very clear circumstances for when the client's rights to confidentiality are waived.

I ask myself, "Isn’t confidentiality a transferable knowledge and a key principle in social work all over the world?"

I felt like an intruder bursting in to a room during a time when a client was sharing intimate details. An alarm went on in my head, telling me that this felt wrong in several ways.

On reflection, I can see how I continuously notice how confidentiality here is handled differently from Norway. I find that it is easy to get caught in a cycle of only noticing differences and catch myself as I shake my head in despair, and a judgemental attitude is starting to creep in. It’s hard not to think about how lucky I am to come from Norway, where everything is handled in a “better” way. That’s when I endeavour to be aware of this narrow-minded thinking and not compare and focus on what is different, but to view the practice of social work here, from the lens of the local context.

I ask myself, "Who am I to judge right or wrong?"

 I try to make sense of these observations and put them in a cultural context. I remind myself that the boundaries of privacy differ from culture to culture. In Norway the individual surrounds themselves with a wide, physical and personal space, that is an unwritten rule. For example, we don’t bump into or seek contact with strangers on the street, and we try to avoid sitting next to people on the bus if there is an empty seat elsewhere.  For a month now I have experienced the Tanzanian way of privacy. Several times I have been left with a child, or even a grown man in my lap while riding a dala dala. And it is not infrequent that a person grabs me by my arm to chat or entice me into buying one of his products. So according to these reflections, I ask myself if the Tanzanian people actually don’t mind the lack of privacy as clients? Do they as I would, feel uncomfortable and humiliated when the SWOs talk about their personal business with strangers? Or do they leave the office unaffected by the approach? Am I just a prim Norwegian, being too sensitive about private life in this context?

I also ask myself if it is mainly a result of missing resources. Would the practice have been different if the SWOs were provided with recourses that made it easier to act with the confidentiality concept? We asked one of the SWOs about this, and she said that the ultimate practice would be to exercise the concept of confidentiality the way she learnt in school. She added that it was not fully practiced at the office, and justified it in the lack of resources and poor facilities. I wonder if this justification leads to some kind of laziness. That the “resource explanation” makes it easy to scamp with the concept in other areas as well. Maybe it provokes some kind of apathy towards the theory of confidential practice. Like, if we can't talk to clients in confidential terms at the office, we don’t bother to keep their files discrete and safe, either?

It is necessary to contextualize your knowledge when visiting another culture. Maybe I have to contextualize the concept of confidentiality.

I have noticed that it exists a conviction that the solution often lies in the collective community. I think this is essential to take this into consideration, when discussing this matter. Maybe a strict use of confidentiality wouldn’t make it possible to keep this basic and cultural way of interacting with each other? I start to challenge myself. What do I notice about this approach that is good? It may be that the clients benefit from the collective knowledge shared in these “group” sessions. That their individual concerns when validated with several people will give them a wider point of view.

This leads to a further dilemma. I find that in a lot of cultures, the advice given is peppered with examples of someone else who was in a similar situation. In regards to the helping relationship, does the SWO help the client come to their best possible individual decision or cause of action, or are they more directive in terms of what people in those situation should do?