An Interprofessional Educational An Interprofessional Educational

Intervention:Intervention: the Bedouin Health Module in Jordanthe Bedouin Health Module in Jordan

Fadia Hasna, PhDFadia Hasna, PhDMohammed Smairan, PhDMohammed Smairan, PhDSahar Makhamreh, PhDSahar Makhamreh, PhD

Gillian Hundt, PhDGillian Hundt, PhDSalah el Zaroo, PhDSalah el Zaroo, PhD

Bedouin Health ProjectBedouin Health Project

• EC funded through FP6 INCO DEV programmeEC funded through FP6 INCO DEV programme

• Co-ordinated by the University of Warwick, Co-ordinated by the University of Warwick, UKUK

• Partners – Partners –

• Philadelphia University - Philadelphia University - JordanJordan

• American University of Beirut - American University of Beirut - LebanonLebanon

• University of Stockholm - University of Stockholm - SwedenSweden

• University of Oxford - University of Oxford - UKUK

• CERMES, Inserm - CERMES, Inserm - FranceFrance

Jordan MapJordan Map

Bedouin Rural Health Project Bedouin Rural Health Project (BHP) Aims (BHP) Aims

• Assess current health status, health seekingAssess current health status, health seeking behaviour and current health service provisionbehaviour and current health service provision

• Elicit the views of stakeholders-policy makers, Elicit the views of stakeholders-policy makers, health personnel and Bedouinhealth personnel and Bedouin

• Develop model interventions in partnership with Develop model interventions in partnership with stakeholdersstakeholders

• Evaluate and disseminate the interventionsEvaluate and disseminate the interventions locally, nationally, regionally and internationally locally, nationally, regionally and internationally

BackgroundBackground

• BedouinBedouin

• NE desert area of JordanNE desert area of Jordan

• Living in villages and encampmentsLiving in villages and encampments

• Rural area, large distances, uneven health Rural area, large distances, uneven health care provisioncare provision

Educational Intervention in Educational Intervention in Jordan relating to Bedouin Jordan relating to Bedouin HealthHealth

• Interviews with policymakers, health Interviews with policymakers, health professionals and Bedouin in 2007-8 professionals and Bedouin in 2007-8 showed the need for an educational showed the need for an educational interventionintervention

• Educational intervention piloted in Educational intervention piloted in the autumn 2008the autumn 2008

Bedouin in JordanBedouin in Jordan

• 5%of total population5%of total population • Today, 5-10% of Bedouin remains nomadic, traveling the area in their black Today, 5-10% of Bedouin remains nomadic, traveling the area in their black

goat hair tents called Beit Shaar or "hair tent".goat hair tents called Beit Shaar or "hair tent".

• Self-employment in herding or farming, Government is the largest single Self-employment in herding or farming, Government is the largest single employer (Jordan Army and Ministry of Education)employer (Jordan Army and Ministry of Education)

• Low standard of sanitation and hygiene, malnutrition and a harsh Low standard of sanitation and hygiene, malnutrition and a harsh environment go together to make the Bedouin prone to various classes and environment go together to make the Bedouin prone to various classes and types of diseases types of diseases

• Girls in the Badia married earlier than their counterparts elsewhere on the Girls in the Badia married earlier than their counterparts elsewhere on the other parts of Jordan, higher fertility rates other parts of Jordan, higher fertility rates

• Health issues: high fertility, respiratory diseases, Brucella (livestock raising Health issues: high fertility, respiratory diseases, Brucella (livestock raising and dairy products), gastro-intestinal, chest and skin conditionsand dairy products), gastro-intestinal, chest and skin conditions

• Transport and distances to health services Transport and distances to health services

Gradual Settlement of the BedouinGradual Settlement of the Bedouin

• Water is one of the most important factors for Water is one of the most important factors for Bedouin settlementBedouin settlement

• Loss of much of the herds as a consequence of Loss of much of the herds as a consequence of prolonged droughtprolonged drought

• Availability of services such as roads, Availability of services such as roads, telecommunications, electricity, schools are other telecommunications, electricity, schools are other factors responsible for Bedouin settlementfactors responsible for Bedouin settlement

• Despite government efforts aimed at providing the Despite government efforts aimed at providing the Badia with basic services, the quantity and quality Badia with basic services, the quantity and quality of these services remain inadequateof these services remain inadequate

Data Collection MethodsData Collection MethodsMethodMethod Location Location TotalTotal

A. In-depth semi-A. In-depth semi-structured structured interviewsinterviews

1.1. Policy makers:Policy makers:

2.2. ProvidersProviders

3.3. Women in the Women in the community community

B. Semi-Structured B. Semi-Structured interviewsinterviews

with women in the clinicswith women in the clinics

Policy makers Public Policy makers Public sector, Royal Court, sector, Royal Court, BDRC, (MOH and Army), BDRC, (MOH and Army), NGOsNGOs

•RHCL village centre, RHCL village centre, Azraq Azraq

(Public sector, MOH and (Public sector, MOH and private sector)private sector)

Alternative healers Alternative healers (private)(private)

SSCL, NBCL, MACL, AZCL, SSCL, NBCL, MACL, AZCL, RWCL, SACL, RHCLRWCL, SACL, RHCL

SSCL, NBCL, MACL, AZCL, SSCL, NBCL, MACL, AZCL, RWCL, SACL, RHCL RWCL, SACL, RHCL

Public sector (MOH and Public sector (MOH and Army), Army),

1010

RHCL: 3 with physician, nurse and RHCL: 3 with physician, nurse and driverdriver

1 with private physician in Azraq1 with private physician in Azraq

5 in Ruwaished, Northern Badia 5 in Ruwaished, Northern Badia and Safawi regionsand Safawi regions

7 interviews with women users of 7 interviews with women users of servicesservices

7 interviews with women non-7 interviews with women non-users of servicesusers of services

Total in-depth interviews: 33 Total in-depth interviews: 33 interviewsinterviews

6 per clinic6 per clinic

Total semi-structured interviews: Total semi-structured interviews: 42 interviews42 interviews

Data Collection MethodsData Collection MethodsC. Audit clinic statistics C. Audit clinic statistics and outreach and outreach immunization activitiesimmunization activities

SSCL, NBCL, MACL, SSCL, NBCL, MACL, AZCL, RWCL, SACL, AZCL, RWCL, SACL, RHCLRHCL

Public sector (MOH and Public sector (MOH and Army)Army)

7 clinics and 4 health 7 clinics and 4 health directoratesdirectorates

D. Non-participant D. Non-participant observation observation

MAQ check list as an MAQ check list as an instrumentinstrument

SSCL, NBCL, MACL, SSCL, NBCL, MACL, AZCL, RWCL, SACL, AZCL, RWCL, SACL, RHCLRHCL

Public sector (MOH and Public sector (MOH and Army)Army)

7 clinics which include 7 clinics which include comprehensive health comprehensive health centers CHCs, primary centers CHCs, primary health centers and health centers and village centersvillage centers

E. Focus Group E. Focus Group Discussions Discussions

1.1. ProvidersProviders

2. Women in the 2. Women in the catchments catchments communities of the communities of the clinicclinic

3. Men in the 3. Men in the catchments catchments communities of the communities of the clinicsclinics

SSCL, NBCL, MACL, SSCL, NBCL, MACL, AZCL, RWCL, SACL, AZCL, RWCL, SACL, Mafraq hospital and Mafraq hospital and private practitionersprivate practitioners

Public sector (MOH and Public sector (MOH and Army) and private sectorArmy) and private sector

SSCL, NBCL, MACL, SSCL, NBCL, MACL, AZCL, RWCL, SACL, AZCL, RWCL, SACL, RHCL RHCL

Same households but Same households but men separately men separately

8 that include 8 that include comprehensive health comprehensive health centers CHCs, primary centers CHCs, primary health centers as well as health centers as well as Mafraq hospital and Mafraq hospital and private practitionersprivate practitioners

7 for women 7 for women

7 for men same 7 for men same households separately households separately (culturally-sensitive)(culturally-sensitive)

Total FG Discussions: 22 Total FG Discussions: 22

Data Collection Methods Data Collection Methods (Continued)(Continued)

F. MappingF. Mapping1.1. Location of clinicsLocation of clinics

2.2. Women interviewed Women interviewed in clinics residencein clinics residence

3.3. Households where Households where FG Discussions done FG Discussions done men and womenmen and women

4.4. Households of Households of women users and women users and non-users (in-depth non-users (in-depth interviews)interviews)

5.5. Outreach locations Outreach locations of clinic services and of clinic services and health directorates health directorates for immunizationsfor immunizations

6.6. Disease blocks for Disease blocks for the CHCsthe CHCs

7.7. Distance to nearest Distance to nearest CHCs for women CHCs for women delivering and delivering and emergenciesemergencies

SSCL, NBCL, MACL, SSCL, NBCL, MACL, AZCL, RWCL, SACL, AZCL, RWCL, SACL, RHCLRHCL

Zarqa, Mafraq, Zarqa, Mafraq, Ruwaished and Ruwaished and Northern Badia Northern Badia DirectorateDirectorate

77

4242

77

1414

Many Many

55

Educational Intervention in Educational Intervention in Jordan relating to Bedouin Jordan relating to Bedouin HealthHealth

• Interviews with policymakers, health Interviews with policymakers, health professionals and Bedouin in 2007-8 professionals and Bedouin in 2007-8 showed the need for an educational showed the need for an educational interventionintervention

Views of policymakersViews of policymakers

Data on cultural competence:Data on cultural competence:

““I say that if there is something missing in our I say that if there is something missing in our staff it is the skill of communication. I always staff it is the skill of communication. I always stress the importance of communication skills. It stress the importance of communication skills. It is important that when you work in an area you is important that when you work in an area you understand the culture. It is important that he understand the culture. It is important that he speaks the same dialect of the people of the area. speaks the same dialect of the people of the area. It is important to deal with them in the way they It is important to deal with them in the way they like. This is one of things that we miss if I want to like. This is one of things that we miss if I want to send someone from Amman to Ruwaished area. It send someone from Amman to Ruwaished area. It is possible that he doesn't know the habits and is possible that he doesn't know the habits and the customs of the people there”. (PM3).the customs of the people there”. (PM3).

Views of policymakersViews of policymakers ““Nurses and midwives are the first priority. We have Nurses and midwives are the first priority. We have

problems in dealing with clients. We have some nurses who problems in dealing with clients. We have some nurses who are rude to clients but if you meet them in another place are rude to clients but if you meet them in another place they are different. Midwives know their jobs; they have they are different. Midwives know their jobs; they have experience in dealing with emergency situations and coil experience in dealing with emergency situations and coil installation. We also have continual training courses…. installation. We also have continual training courses…. Psychologically speaking, professional – patient interaction Psychologically speaking, professional – patient interaction is very important not only in Zarqa but all over Jordan. I is very important not only in Zarqa but all over Jordan. I expect that there will be in- service training on this because expect that there will be in- service training on this because it was neglected in the past. It is very important because it was neglected in the past. It is very important because when the patient comes to the health centre and is treated when the patient comes to the health centre and is treated badly, he will leave unsatisfied even if he received all the badly, he will leave unsatisfied even if he received all the health care that he wanted. The patient's satisfaction is an health care that he wanted. The patient's satisfaction is an important dimension of the health system because all important dimension of the health system because all services are available to serve the patient. We try to talk services are available to serve the patient. We try to talk about this issue in all the courses we do. There is no about this issue in all the courses we do. There is no independent programme that focuses on this but it is a part independent programme that focuses on this but it is a part of training that is delivered generally in workshops (PM8).of training that is delivered generally in workshops (PM8).

Views of health Views of health professionalsprofessionals

““Many times, problems happen between doctors and the people of Many times, problems happen between doctors and the people of this area. They don't understand people or accept them. People this area. They don't understand people or accept them. People here are simple and doctors know that they don’t know anything here are simple and doctors know that they don’t know anything and their thoughts are narrow. I see them in the emergency room a and their thoughts are narrow. I see them in the emergency room a lot. …. They complain against the general doctor and whether he is lot. …. They complain against the general doctor and whether he is good or not. When a doctor comes from Amman, he feels proud good or not. When a doctor comes from Amman, he feels proud and he doesn’t bother to answer greetings. He has his status. Then and he doesn’t bother to answer greetings. He has his status. Then he adapts to the situation here”. NBCLP11he adapts to the situation here”. NBCLP11

“ “When a Bedouin visits a clinic, everybody feels disgusted from When a Bedouin visits a clinic, everybody feels disgusted from

him, so it's very important to educate the staff and give them him, so it's very important to educate the staff and give them training courses about how to receive a Bedouin although he is training courses about how to receive a Bedouin although he is smelly. The relationship between the patient and his doctor or smelly. The relationship between the patient and his doctor or nurse is very important. Staff need to be qualified in order for them nurse is very important. Staff need to be qualified in order for them to really help Bedouins ….. If a patient distrusts the doctor who to really help Bedouins ….. If a patient distrusts the doctor who describes the medicine, the medicine will lose its value”describes the medicine, the medicine will lose its value” (MFPD3)(MFPD3). .

Views of Bedouin men and Views of Bedouin men and womenwomen

“ “The nurse started mocking me there. Every body did that The nurse started mocking me there. Every body did that even the people sweeping the floor, started mocking me. even the people sweeping the floor, started mocking me. They asked me how many kids I had. If you tell them 4,5,6 They asked me how many kids I had. If you tell them 4,5,6 they start mocking you again. When you call one of them and they start mocking you again. When you call one of them and you ask them to check on you because you're about to give you ask them to check on you because you're about to give birth, they say no, go give birth on your own”birth, they say no, go give birth on your own” ( (Bedouin Bedouin woman).woman).

“ “The midwife in the health centre who is from Tafilah do not The midwife in the health centre who is from Tafilah do not communicate with me as well, some times she see me in the communicate with me as well, some times she see me in the centre and doesn't say hello, although she knew very well centre and doesn't say hello, although she knew very well that I am the Mukhtar (chief of the tribe), I do not care about that I am the Mukhtar (chief of the tribe), I do not care about her behaviour because I have insurance for me and my her behaviour because I have insurance for me and my family but I care about those who have no health insurance” family but I care about those who have no health insurance” (Bedouin Man).(Bedouin Man).

Views of Bedouin men and Views of Bedouin men and womenwomen ““Frankly, they are not good and they don’t benefit us. We Frankly, they are not good and they don’t benefit us. We

want good doctors. The doctors here aren’t good. They want good doctors. The doctors here aren’t good. They don’t understand anything at all we want other doctors. don’t understand anything at all we want other doctors. ….We want doctors that understand, not any kind of ….We want doctors that understand, not any kind of doctor, the doctors who are here don't understand" doctor, the doctors who are here don't understand" (Bedouin Woman).(Bedouin Woman).

“ “When we go to the doctor in the health centre in order to When we go to the doctor in the health centre in order to get treated. You sometimes want to talk to him privately get treated. You sometimes want to talk to him privately and not in front of people but this doesn't happen because and not in front of people but this doesn't happen because the female nurse, the two janitors, the male nurse and the the female nurse, the two janitors, the male nurse and the pharmacist are all sitting there. If we say something, they pharmacist are all sitting there. If we say something, they become upset and don’t even leave. Imagine that the two become upset and don’t even leave. Imagine that the two janitors have chairs in the doctor's room and they remain janitors have chairs in the doctor's room and they remain sitting there when clients see the doctor” (Bedouin sitting there when clients see the doctor” (Bedouin Woman).Woman).

Design and Preparation of Educational Design and Preparation of Educational Intervention (June-Sept 2008)Intervention (June-Sept 2008)

• When? June – Sept 08When? June – Sept 08• For who? Nursing and Social work fourth year students For who? Nursing and Social work fourth year students

at Philadelphia (private) and Al Balqa Applied (public) at Philadelphia (private) and Al Balqa Applied (public) universities. universities.

• How? Series of meetings then individual preparation How? Series of meetings then individual preparation and email, consultations with Vice Dean of Social Work and email, consultations with Vice Dean of Social Work

• Behavioral objectives as well as module contents in Behavioral objectives as well as module contents in units were prepared.units were prepared.

• Contents writing including photos and references Contents writing including photos and references (Literature review) as well as based on findings (Literature review) as well as based on findings collected (interview data, maps, observations, clinic collected (interview data, maps, observations, clinic records and statistics were used)records and statistics were used)

Implementation of Educational Implementation of Educational Intervention: the Bedouin Health Intervention: the Bedouin Health Module Module (October-December 08)(October-December 08)• Aim: Aim:

To sensitize nursing, social work and To sensitize nursing, social work and medical students to the Bedouin culture medical students to the Bedouin culture and health needs in Northern Badia of and health needs in Northern Badia of Jordan making them more aware and Jordan making them more aware and culturally sensitive to this local culturally sensitive to this local population’s health, economic and psycho-population’s health, economic and psycho-social needs.social needs.

Structure of the Module Structure of the Module

Theoretical part:Theoretical part: Integrated into community health nursing course Integrated into community health nursing course

(3 credit hours) and community health course for (3 credit hours) and community health course for social work students.social work students.

Duration:Duration: - Total of - Total of sixsix lectures in Philadelphia for 145 lectures in Philadelphia for 145

nursing students - nursing students - TwoTwo lectures at Al Balqa lectures at Al Balqa Applied University for social work students from Applied University for social work students from October –December 08October –December 08

Structure of the Module Structure of the Module (Continued)(Continued)Practical part:Practical part: - Integrated into community health nursing practice (3 - Integrated into community health nursing practice (3

credit hours) course as well as community health course credit hours) course as well as community health course for social work students.for social work students.

DurationDuration:: - Seven weeks (Two times a week)- Seven weeks (Two times a week)

- When? - When? October-December 08October-December 08 - Where? - Where? Sama el Serhan and Northern Badia CHCs, Sama el Serhan and Northern Badia CHCs,

Elementary and Secondary schools in Sama el Serhan Elementary and Secondary schools in Sama el Serhan & Northern Badia as well as home visiting in both & Northern Badia as well as home visiting in both communities communities

- Who? - Who? About 45 nursing students (2 sections and About 45 nursing students (2 sections and their faculty) and eight social work students and their their faculty) and eight social work students and their facultyfaculty in collaborationin collaboration with the clinic staff.with the clinic staff.

Contents of the ModuleContents of the Module

• Unit 1: The Badia of JordanUnit 1: The Badia of Jordan• Unit 2: Population Characteristics and Socio-Unit 2: Population Characteristics and Socio-

economic Conditions in Northern Badiaeconomic Conditions in Northern Badia• Unit 3: Determinants of Health: Community Unit 3: Determinants of Health: Community

Services and Facilities and their Impact on Badia Services and Facilities and their Impact on Badia HealthHealth

• Unit 4: Health Services Unit 4: Health Services • Unit 5: Role of Women in Health Promotion Unit 5: Role of Women in Health Promotion

among Bedouin in Northern Badia among Bedouin in Northern Badia • Unit 6: A Strategy for the Development of the Unit 6: A Strategy for the Development of the

Badia based on FindingsBadia based on Findings

Module Evaluation (December 08)Module Evaluation (December 08)MethodsMethods For Who For Who ResultsResults

Pre and post test Pre and post test

20 MCQ (first and 20 MCQ (first and last lecture)last lecture)

145 nursing students at 145 nursing students at

Philadelphia and 4 social workPhiladelphia and 4 social work

students at Al Balqa Applied students at Al Balqa Applied

University University

Results were significantly better in 10 Results were significantly better in 10 out of the 19 questions for the right out of the 19 questions for the right answer for the nursing students answer for the nursing students

FG Discussion (1)FG Discussion (1) Faculty of Faculty of

Philadelphia + BalqaPhiladelphia + Balqa

Universities Universities

SF5 the objectives of the project was SF5 the objectives of the project was good, Participation and commitment good, Participation and commitment from both staff and students was high. A from both staff and students was high. A relation of trust was established with the relation of trust was established with the people; beside the program identified people; beside the program identified some of hidden social and health some of hidden social and health problems. It was an opportunity to problems. It was an opportunity to understand how to deal with the Bedouin understand how to deal with the Bedouin communitycommunity

FG Discussion (3)FG Discussion (3) Nursing Students of Philadelphia and Nursing Students of Philadelphia and Social work students of Balqa Applied Social work students of Balqa Applied universityuniversity

Questionnaire Questionnaire Sama el Serhan and Northern Badia Sama el Serhan and Northern Badia Comprehensive ClinicsComprehensive Clinics

More time needed for practiceMore time needed for practice

Students were very enthusiastic to learnStudents were very enthusiastic to learn

FG Discussion with FacultyFG Discussion with Faculty

Strengths - FacultyStrengths - Faculty

“ “They were very enthusiastic and committed to what they They were very enthusiastic and committed to what they were doing but sometimes there were not enough patients were doing but sometimes there were not enough patients to work with. The experience definitely changed their to work with. The experience definitely changed their attitudes toward the Bedouin community and they learned attitudes toward the Bedouin community and they learned how to communicate. Feedback from the students was very how to communicate. Feedback from the students was very positive “SF2. positive “SF2.

“ “It was a very good practical experience for the students, It was a very good practical experience for the students, the involvement of the students familiarised them with the involvement of the students familiarised them with health services available to the community and developed health services available to the community and developed networking between nurses, social workers and providers of networking between nurses, social workers and providers of health services” SF1. health services” SF1.

“ “Home visits were very useful with some students .The Home visits were very useful with some students .The

experience developed the abilities of students to solve experience developed the abilities of students to solve complex situations” SF3. complex situations” SF3.

Weaknesses- Faculty Weaknesses- Faculty

“ “ Inability to follow-up some cases and Limited Inability to follow-up some cases and Limited time to provide better services” SF4.time to provide better services” SF4.

“ “Health education needs to be emphasized and Health education needs to be emphasized and needs better organization. More of social work needs better organization. More of social work involvement, many social problems need to be involvement, many social problems need to be addressed” SF1.addressed” SF1.

“ “there were difficulties to approach people there were difficulties to approach people beside the need to know more about tradition and beside the need to know more about tradition and culture before embarked on the project” SF3.culture before embarked on the project” SF3.

Strengths- StudentsStrengths- Students

“ “I feel that the project served the local people and I feel that the project served the local people and identify the problems, there was a positive identify the problems, there was a positive reaction from the local community” St3. reaction from the local community” St3.

“ “Sharing and cooperation with nursing student Sharing and cooperation with nursing student was great, the project joined both social and was great, the project joined both social and health worker to help the Bedouin” St2. health worker to help the Bedouin” St2.

“ “It gave us the opportunity to explore the social It gave us the opportunity to explore the social problem of the Bedouin which some time they do problem of the Bedouin which some time they do not talk about it such as domestic violence” St5. not talk about it such as domestic violence” St5.

“ “The chance to give the right advice to the The chance to give the right advice to the people” St1.people” St1.

Weaknesses -StudentsWeaknesses -Students• Objectives were not very clearObjectives were not very clear

• Transport and distancesTransport and distances “ “Traveling and limited time to do the job Traveling and limited time to do the job

properly” St 3.properly” St 3.• Not enough time Not enough time • Not enough supervisorsNot enough supervisors• Access to unsettled BedouinsAccess to unsettled Bedouins ““some people show no trust in our work” St 1. some people show no trust in our work” St 1. “ “Families some time hesitates to invite us inside their Families some time hesitates to invite us inside their

home home specially when there is female” St 6. specially when there is female” St 6. “ “we participate in the immunization, but it was difficult towe participate in the immunization, but it was difficult to get permission to do our work and planning was notget permission to do our work and planning was not enough” St 2. enough” St 2.

Lessons Learnt -StudentsLessons Learnt -Students ““We had a good understanding of the health & social We had a good understanding of the health & social

problems of problems of Bedouin” St 13.Bedouin” St 13.

“ “We found out that there is a shortage of health services in We found out that there is a shortage of health services in the area” St10. the area” St10.

“ “There is not enough equipment available to them such as There is not enough equipment available to them such as

ECGs , ECGs , emergency equipment” St8.emergency equipment” St8.

“ “We understood what Badia meant and we had an idea how We understood what Badia meant and we had an idea how to approach people” St 6.to approach people” St 6.

“ “The experience changed our attitude toward the Badia; The experience changed our attitude toward the Badia;

Bedouin can be sometimes very secretive about their health. Bedouin can be sometimes very secretive about their health. In some cases,it was difficult to get information from them. In some cases,it was difficult to get information from them. One of the household refused to talk about his diabetes and One of the household refused to talk about his diabetes and he said he got a herb from the Sahara to take” . St 7he said he got a herb from the Sahara to take” . St 7 . .

Challenges Challenges

• Resistance of facultyResistance of faculty: they wanted incentives : they wanted incentives

• ExpenseExpense: In Al Balqa university we had to rent a bus : In Al Balqa university we had to rent a bus

• DistancesDistances: 200 km per trip : 200 km per trip

• Lack of motivation of providersLack of motivation of providers to participate to participate

• Lack of commitment of the medical schoolLack of commitment of the medical school

• SustainabilitySustainability - We are trying to replicate this - We are trying to replicate this intervention at Al Bayt and Al Hashemieh Universities intervention at Al Bayt and Al Hashemieh Universities (adjacent to Badia) (adjacent to Badia)

Lessons LearntLessons Learnt

• More time is needed in preparation of staff More time is needed in preparation of staff and for the implementation of the moduleand for the implementation of the module

• Participatory approach in design and content Participatory approach in design and content preparation and not only findingspreparation and not only findings

• Incentives for faculty, and clinic staff would be Incentives for faculty, and clinic staff would be helpful helpful

• BH module and pre and post test should be BH module and pre and post test should be assessed within the curriculumassessed within the curriculum

• Resources are required (buses, money to pay Resources are required (buses, money to pay clowns)clowns)

• Evaluation and monitoring necessary when Evaluation and monitoring necessary when replicated in other universitiesreplicated in other universities

Thank you Thank you