Sunday, May 10, 2009

India's 'Untouchables' and the West's Addicts

The "untouchable caste" of India, the "Dalits," are culturally in much the same position as addicts in the West. They are commonly viewed with fear, disdain, hate, and revulsion. Their lives, human value, and sufferings are typically discounted. For example, when a Dalit dies, the event is often treated with little concern, a mere footnote on society's functioning.


Some in India have come forward to address the plight of the Dalits. Progress has been made, but at a slow pace. Mahatma Gandhi championed this cause decades ago. He successfully freed India from British colonial rule, but made only small progress in addressing the plight of the Dalits. Political and legal problems, even on a global scale, are easier to fix than cultural attitudes.

If one imagines a service program designed to help the plight of a population of Dalits in India (perhaps an educational, nutritional, or legal aid program), one can envision predictable issues which need to be considered.

The biggest issue would be staff attitude. Many or most might be expected to approach their duties from an enlightened stance, having examined and worked through their prejudices. But others would be expected to approach their employment with a residual attitude of superiority, condescension, and even hostility. The obligations of duty of care and other ethical standards can be forgotten in the face of such prejudice.

A rational service program would have to be carefully designed to detect poor staff attitude or poor program policies and procedures, with vigorous mechanisms for correction. The centerpiece of such quality control would need to be systems for concerns and grievances of clients to be solicited, listened to carefully, and addressed with respect and compassion.

It would be utterly inadequate to require client grievances to be submitted in writing; this is difficult for many on psychological grounds, and often impossible on literacy grounds. It would be utterly inadequate for grievances to be heard first only by the supervisor of an employee. In any organization, supervisors and subordinates ALWAYS develop interdependent relationships which hamper the freedom of a supervisor to address client grievances objectively. Superiors and subordinates generally anticipate a long relationship in which easy relations are essential to be able to work productively and effectively. In essence, there can be a real conflict of interest for any supervisor to be the primary mechanism of hearing of grievances by any client in ANY service organization.

It would be utterly inadequate for such quality control measures to depend upon client questionnaires being distributed and handed back to program personnel. Any client feeling fear (rationally or irrationally), would not want that questionnaire to be seen by program personnel, and would tend to self-censor or "whitewash" any concerns in any such document.

A rational system would have to be designed with an independent ombudsman or "office of the client advocate" who could hear grievances in any form and investigate, with resulting recommendations to be addressed at high levels.

Most organizations with active internal quality control mechanisms employ "exit interviews." Most commonly, exit interviews are given to employees leaving a business as a way to raise and address problems which current employees may not feel free to bring up, for fear of retribution. The same kind of process can, however, be employed with clients of service organizations. These need not necessarily be face-to-face interviews with every exiting client. The process could be carried out by phone or written questionnaire, and might be done with only a statistical sampling of clients. As with exit interviews for employees, an effective approach would not be to question only those leaving in good standing, but also those who are fired or quit.

Any kind of service organization without vigorous quality control procedures in place can be expected to suffer characteristic aggravations. Clients who do not feel able to have grievances and concerns listened to within organizational channels will tend to carry their concerns elsewhere. Such unanticipated and less-effective channels can include public word-of-mouth, stories in the press, reports to outside governmental authorities, malpractice suits, and even criminal complaints to law enforcement. When one sees a service organization having clients raise concerns in unusual venues, such as within advisory councils, the primary lesson to be gleaned, I think, is that effective internal quality control measures are deficient.

1 comment:

SteveMDFP said...
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