UNDERSTANDING THE CONTEXT OF POVERTY
AND INVESTIGATING CULTURALLY RELEVANT STRATEGIES AND
RESOURCES TO PROMOTE HEALTH AND MENTAL HEALTH FOR WOMEN
EXPERIENCING POVERTY IN KORAH, ETHIOPIA
By
Jacqueline Strating
Bachelor of Social Work, University of the Fraser Valley, 2014

MAJOR PAPER SUBMITTED IN PARTIAL
FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SOCIAL WORK
in the School of Social Work and Human Services

UNIVERSITY OF THE FRASER VALLEY
Spring 2018
All rights reserved. This work may not be
reproduced in whole or in part, by photocopy
or other means, without permission of the author.

ii
Approval

Name: Jacqueline Strating

Degree: Master of Social Work

Title of Thesis: Understanding the Context of Poverty and Investigating Culturally
Relevant Strategies and Resources to Promote Health and Mental Health for Women
Experiencing Poverty in Korah, Ethiopia

Examining Committee:

Anita Vaillancourt, BSW/H, MSW, PhD
Faculty, School of Social Work and Human Services
MSW Chair

Lisa Moy, BA, BSW, MSW, PhD, RSW
Senior Supervisor
Faculty, School of Social Work and Human Services

Robert Harding, BA, BSW, MSW, PhD, RSW
Supervisor
Faculty, School of Social Work and Human Services
Date Defended/Approved: April 19th, 2018

iii
Abstract
Women in Korah, Ethiopia experience numerous challenges in their health and mental health due
to the influence of poverty. Though research on the relationship between poverty and mental
health for individuals in low- and middle- income countries is growing, research is lacking on the
specific ways that poverty impacts women’s lives in Korah. More contextual knowledge is
needed to improve best practices for supportive professionals working in this community. Using
feminist theory, post-colonial theory, and anti-oppressive theory, this study explores the impacts
of poverty for women in Korah, including how poverty relates to mental health. Current coping
strategies utilized by Korah women are also explored, along with recommendations for social
workers in this community. Through semi-structured, qualitative interviews, seven supportive
professionals shared their knowledge and insights from their experiences working with women in
Korah. Themes that arose in the data included the impacts of poverty, gender roles and cultural
norms, spirituality, and tensions of development work. Implications for policy, social work
practice, and future research are also addressed.

iv
Acknowledgements
I would like to acknowledge and thank my major research supervisor, Dr. Lisa Moy, for your
genuineness, support, and attention to detail and organization throughout the research and
writing process. Your questions and careful insights were invaluable. To Dr. Katherine Watson,
thank you for your support during the early stages of the research process. To my second reader,
Dr. Robert Harding, thank you for your time, encouragement, and suggestions.

To each of my study participants, who play an instrumental role in supporting women in the
community of Korah – thank you for your genuine care, your hard work, and for investing in the
wellbeing of Korah women and their families. I am so grateful for your willingness to share your
knowledge and insights with me.

I am incredibly thankful to friends and family who have supported me throughout my education.
Most of all, I would like to thank my husband Jesse for being a constant source of love, support,
and encouragement throughout the process of writing this paper. Thank you for always helping
me find my sense of humour and for being the best friend and life partner for me.

Thank you also to the women of Korah, who continue to inspire me with their daily tenacity,
resourcefulness, and strength. I am honoured to know you and to be invited into your stories.

v
Table of Contents
Abstract .......................................................................................................................................... iii
Acknowledgements ........................................................................................................................ iv
Introduction ..................................................................................................................................... 1
Situating Myself .......................................................................................................................... 2
Literature Review............................................................................................................................ 5
Understanding Mental Health in Ethiopia ................................................................................... 5
Mental health paradigms in Ethiopia. ...................................................................................... 5
Service provision. .................................................................................................................... 8
Historical Context of the Social Safety Net and International Partnerships in Ethiopia........... 10
Construction of the Third World Woman ................................................................................. 12
Ownership of Knowledge and International Knowledge Sharing ............................................ 13
Theoretical Framework ................................................................................................................. 15
Anti-Oppressive Social Justice.................................................................................................. 15
Feminist Theories – Contributions and Cautions for International Social Work ...................... 19
Postcolonial Understandings of International Development ..................................................... 23
Design and Methodology .............................................................................................................. 26
Recruitment ............................................................................................................................... 26
Data Collection and Analysis .................................................................................................... 28
Ethical Considerations............................................................................................................... 29
Limitations of the Study ............................................................................................................ 31
Discussion of Findings .................................................................................................................. 33
Impacts of Poverty .................................................................................................................... 33
Lack of formal and informal education. ................................................................................ 33
The impossibility of prevention. ............................................................................................ 35
Drastic measures. ................................................................................................................... 37
Traditional Gender Roles and Cultural Norms ......................................................................... 38
Child marriage and household obligations. ........................................................................... 39
Male roles and responsibilities. ............................................................................................. 41
Spirituality ................................................................................................................................. 43
The importance of religion and spirituality to Korah women. .............................................. 43

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Spiritual conceptualization of mental health and emotional problems.................................. 45
Faith and spiritual community as both a protective and a risk factor. ................................... 49
Tensions of Development Work ............................................................................................... 52
Positive impacts of development work. ................................................................................. 52
“Dependency syndrome”. ...................................................................................................... 53
Unpacking “dependency syndrome”. .................................................................................... 56
Implications for Policy, Practice & Future Research.................................................................... 60
Conclusion .................................................................................................................................... 62
References ..................................................................................................................................... 63
Appendix A ................................................................................................................................... 70
Appendix B ................................................................................................................................... 71
Appendix C ................................................................................................................................... 73
Appendix D ................................................................................................................................... 76

1
Introduction
As one of the poorest nations in Africa, many Ethiopians struggle with poverty, disease,
and hunger (Swancott, Uppal, & Crossley, 2014). Because poverty limits access to resources
while increasing vulnerability to precarity, trauma, and depression, research is needed to
determine the unique health and mental health challenges faced by women living in abject
poverty in Ethiopia. This research is therefore seeking greater understanding of the health and
mental health impacts experienced by women living in poverty in Korah, Ethiopia, and is
seeking to discover ways to improve practices and resources for women in this community. Jalal,
Samir and Hinton (2016) note that traumatized cultural groups often have access to limited
education and experience extensive trauma and additional barriers due to stigma surrounding
mental health. The community of Korah is situated on and around the city garbage dump in
Addis Ababa, Ethiopia, where many people make their living through begging, prostitution,
labour jobs, and scavenging at the trash dump. To address the complex ways that women are
adversely impacted by poverty in Korah, it is important to first gain a holistic understanding of
the broader community and environmental factors, as well as the specific individual factors that
contribute to their unique challenges and strengths. While certain cultural norms are reflected
across the Ethiopian population, great variations still exist within the country’s 80 distinct
linguistic and ethnic groups (Palmer, 2010). Because Korah is home to many Ethiopians from
various regions of the country, it is very critical to gather information about the cultural nuances
that exist in this community.
The impacts and presentations of mental health issues vary in diverse populations
(Williams, Chapman, Wong, & Turkheimer, 2012). Therefore, to provide effective support to
women in impoverished settings, it is important to gather information about their cultural context

2
so that services can be catered to meet their specific needs. To help address the many health
challenges faced by women in Korah, Ethiopia, this research project will gather information in
three key areas. First, I will seek to understand how poverty influences health and mental health
in this population of women. Additionally, I will gather information on the strengths, beliefs, and
coping strategies used by women in this poor urban community to manage the impacts of
poverty. Finally, this project will gather information about the barriers and gaps that limit women
in Korah, Ethiopia from experiencing optimal social, emotional, economic, physical, spiritual,
and psychological/ mental health. The four research questions being investigated in this study
are: What are the impacts of poverty for Korah women? What is the relationship between mental
health and poverty for Korah women? What are the coping strategies used by Korah women to
address these health and/or mental health impacts? And, how can supportive professionals help
Korah women to address the health and/or mental impacts created by poverty?
This research is needed because little is known about what specific resources will best
meet the health and mental health needs of women living in poverty in Korah, Ethiopia. There is
a scarce amount of research on the use of traditional therapeutic approaches in low-income
countries, and more specifically, on their use in Ethiopia. Therefore, research is needed on the
specific manifestations of health and mental challenges in Korah as they relate to poverty, and
what services and practices are currently effective in improving the holistic health of women in
Korah.
Situating Myself
While this research project is not a case study, it is important that readers are introduced
to two organizations that have played a role in my research and are given some background
information about how I became connected to Ethiopia. As a researcher that is an ‘outsider’ to

3
the Korah community as a Canadian-born white woman, it is important to explain how I became
connected to the community of Korah, and why I chose to conduct my research there. My
relationship to Korah began on a 10-day trip to Ethiopia in April of 2013. During this trip I was
volunteering alongside Hope for Korah (HFK), a registered Canadian charity. HFK operates in a
close partnership with Kore Great Hope Charities (KGHC), an Ethiopian organization that works
with families facing urban poverty in Korah, the trash dump area of Addis Ababa, Ethiopia.
These organizations work together to provide holistic support and transformation for Ethiopian
families through a combination of family sponsorship, income generation and job-skills training,
savings, self-help groups, education, and basic health care. Though these are development
organizations, and are not technically faith-based, staff are primarily composed of individuals
from the Christian faith, which serves as an undercurrent in the development of programming
and perspectives on community development. For the purposes of this paper, faith and
spirituality will refer to “an internal domain of human experience that may include a personal
relationship with a higher power” (Tangenberg, 2005, p. 198).
On my first visit to Korah I had the opportunity to engage in home visits with existing
sponsored families, to help facilitate a women’s health education day to over 150 women in the
community alongside other nurses and social workers from Canada and Ethiopia, and to meet
with and assess new families’ eligibility to begin the Family Empowerment Program (FEP). The
FEP was developed by HFK with the goal of keeping families healthy and together; this is
achieved through matching Ethiopian families with sponsors in North America that provide
monthly financial support to cover basic needs such as rent, groceries, education, basic health
care and fire wood. The children of these families attend school, tutoring, and youth programs,
while their parents participate in literacy and numeracy training, savings and credit self-help

4
groups, and business training. After reaching a period of stabilization over approximately 2
years, families are gradually transitioned out of sponsorship into self-sufficiency as they launch
small businesses of their choosing, with the support of HFK social work staff. After my first trip,
I became an employee of HFK and have since been working as the Programs and Sponsorship
Manager. In this role I work alongside the HFK executive director and Ethiopian staff from Kore
Great Hope Charities to develop and improve our development model to help promote
sustainability, empowerment, and long-term change. I have been to Korah on three occasions in
this capacity, giving me the opportunity to continue developing relationships with our Ethiopian
staff and beneficiaries.
My intention for sharing this personal history is to ensure that readers understand how my
social location and personal connection to the work and the people of Korah have influenced my
perspectives and my motivation to conduct this research. I acknowledge that my positionality
with regard to Korah is complex; I do not share the culture or personal lived experience of those
who reside or work in Korah, however my role with HFK has exposed me to the personal stories
as well as the inner workings of development work in this community beyond that of a typical
‘outsider’. Witnessing firsthand the challenges that women face due to extreme poverty in Korah
has inspired this research; I hope it plays a role in highlighting the perspectives, programs, and
practices that are already working to meet the needs of women in this community, while
exposing gaps, barriers and tensions that need to be acknowledged to approach these complex
issues with sensitivity, creativity, and respectful collaboration.

5
Literature Review
Understanding Mental Health in Ethiopia
It is important to address the unique contexts in which mental health needs arise for
women in diverse cultural and economic environments. As one of the poorest countries in Africa,
many Ethiopians experience the adverse impacts of poverty, hunger, and disease (Swancott,
Uppal, & Crossley, 2014). However, the World Health Organization (2005) proposes that HighIncome Countries (HICs) contain about 90 per cent of the world’s resources for mental health,
leaving a very small percentage of these resources available for the rest of the globe where much
of the world’s population resides (as cited in Swancott, Uppal, & Crossley, 2014). While it is
important not to make uncritical assumptions about another population’s needs, it is still
important to consider how the uneven distribution of mental health resources across the world
may disadvantage certain Ethiopians, perpetuating inequality. It is understood that differences in
culture, socioeconomic status, and acculturation impact individuals’ worldview as well as their
definitions and presentations of mental health challenges (Swancott, Uppal, & Crossley, 2014;
Williams, Chapman, Buckner & Durrett, 2016). Therefore, HIC resources for mental health
challenges cannot be delivered as-is to a new context and be expected to deliver favorable or
contextually relevant outcomes.
Mental health paradigms in Ethiopia.
Ethiopia’s mental health system is currently influenced by multiple paradigms which
have the capacity to work in complimentary or conflicting ways with one another. The first
paradigm that shapes perceptions, attitudes, and access to mental health is religious and cultural.
Because mental health in Ethiopia is frequently understood at least in part as having spiritual or
supernatural causes, “traditional healers play a major role in the treatment of mental health; in

6
one study (Alem et al 1999) it was found that 85% of emotionally disturbed people sought help
from traditional healers” (as cited in WHO, 2005, p.190). A recent study by Monteiro and
Balogun (2015) surveyed 115 laypersons, traditional healers, and healthcare workers to ask their
perceptions on “the best place to get help with mental illness” (p.10). Results showed that 33%
of respondents believed that a combination of traditional and modern psychiatric treatment was
best, while 16% exclusively preferred traditional treatment, and 46% suggested that modern
treatment alone was best. This data revealed that approximately half of respondents believed that
traditional healing should at least have some part in mental health services. Monteiro and
Balogun (2015) report that “traditionally, it is believed that mental illness can be caused by the
malevolent wishes of evil-minded people, bad spirits, the evil eye (buda) and the hostile feelings,
ill will and envy of common people. Although these causes are external, the sufferer is believed
to bear some responsibility for the problem, for example by offending spirits or provoking envy
(Hodes, 1997)” (p. 2). The lens in such explanations is that external supernatural causes have an
impact on the mental and emotional state of individuals. In explaining the cultural and religious
conceptualizations and behaviours that exist within mental health frameworks in non-Western
societies—such as Possession Trance, which is “the displacement of a person’s soul or other key
element by another entity” (p.137) which leads to changes in one’s behaviours or state of
consciousness - Ember and Ember (2004) suggest that
To see Possession Trance only in medical terms would be a mistake. Behavior that might
be seen as pathological in the Western or bio-medical system, may be seen in terms of a
mythico-religious system in a traditional society. Hollan (2000, pp.546-547) notes that
“possession behavior that is culturally normative, no matter how bizarre or irrational it
appears from a Western point of view, should never be considered pathological or

7
psychotic…. [It] is culturally symbolic behavior….” (as cited in Ember & Ember, 2004,
p.142).
While traditional conceptualizations are certainly not the only paradigms used within
Ethiopia to make sense of mental health, their prevalence suggests that it is necessary to consider
how these understandings continue to influence mental health manifestations and treatment in
this context. As Monteiro and Balogun (2015) suggest, simplistic models of mental health which
only validate supernatural explanations of behaviour are likely to be insufficient. Instead, a more
complex conceptualization and approach to mental health is needed.
Mental health paradigms in Ethiopia also include socioeconomic explanations, as well as
modern medical explanatory models. Efforts have been made in recent years to ‘scale up’ the
mental health care and improve its available in primary care facilities in Ethiopia (Federal
Democratic Republic of Ethiopia Ministry of Health, 2012). While medical explanations for
mental health are certainly prevalent in Ethiopia, as evidenced by the prescription of
psychotropic medications, and the psychiatric units available to treat individuals in Addis Ababa
with severe mental disorders, the WHO (2006) acknowledges that Ethiopia lacks assessment and
treatment protocols for mental health professionals. So, while the DSM is used in health care
settings, standardization and monitoring of mental health interventions and follow up is
insufficient to meet current levels of need in the country.
What is promising about the blend of traditional and medical approaches to mental
health, is that the two can act to complement each other and help make sense of or provide
diverse explanations for complex human behaviour. As noted by Fekadu (2010), the DSM- IV
even acknowledges a culture-bound syndrome known in Ethiopia as Zar, which refers to “a spirit
that possesses someone, usually a woman. The behavioural manifestation of the spirit in the

8
possessed person is also termed Zar” (p.13). These types of episodes are culturally normative and
“are not considered pathological in Ethiopia and the East African countries where Zar is known
to occur” (Fekadu, 2010, p.11). Through a combination of traditional, socioeconomic, and
medical explanations, mental health can be better understood, and more effectively addressed in
Ethiopia.
Service provision.
The inadequacy of Ethiopia’s current health care system in addressing the health and
mental health related needs of its large population is widely documented. Ayano (2016) reports
that male and female Ethiopians have a combined life expectancy of 56.2 years, as compared to
71 years for the global population. While a complex combination of factors is likely to blame for
this startling statistic, the drastic disparity between the life expectancy and health outcomes of
Ethiopians and the general global population clearly reflect a healthcare system that has not been
able to match the unique demands of its population.
As recently as 2006, the World Health Organization reported that in Ethiopia, “only 64%
of the total population is served by the public health care system” (p.7), clearly showing the
degree of underdevelopment in their system of care. In one study in the Sodo district of Ethiopia,
researchers reported that to receive necessary health care, citizens of the region were forced to
make “out-of-pocket expenditures,” which is a similar dilemma faced by many other Ethiopians
throughout the country (Hailemariam, Fekadu, Prince, & Hanlon, 2017, p. 2). For those who are
already facing the challenges of extreme poverty, paying for unexpected healthcare bills is often
not a luxury they can afford. The same study also noted that fee waivers are available for
individuals who qualify as the ‘poorest of the poor’, however these funds are restricted, and the
need for such subsidies far outweighs the allowable quota that healthcare providers can access

9
(Hailemariam et al., 2017, p.3). As such, many Ethiopians are unable to access the services that
are necessary to meet their health needs.
In addition to gaps in the Ethiopian healthcare system, mental health care in Ethiopia also
contains several barriers which make it difficult to adequately meet the needs of its citizens.
Ayano (2016) noted that “psychiatrists are an extremely scarce resource in Ethiopia”, with only
63 psychiatrists providing services to 101 million Ethiopians (p.2). Another study cited a similar
figure, noting that for every 100,000 Ethiopians, there were just 0.07 psychiatrists available to
serve them (Mugisha et al., 2017, p.9). While efforts have been made to increase the number of
professionals available to serve those with mental health challenges, a 2012 report from the
Federal Democratic Republic of Ethiopia Ministry of Health stated that at the time there were
“40 practicing psychiatrists in the country, 461 psychiatric nurses (there is no accurate estimate
of those still working in mental health), 14 psychologists (none of whom have training in clinical
psychology), three clinical social workers, and no occupational therapists” (p.13). These
numbers are startlingly inadequate to serve the 101 million people living in Ethiopia.
This gap in service provision is especially concerning, given that estimates suggest that
mental disorders impact the lives of 25 million people in Ethiopia (Ayano, 2016). Lacking a
specific mental health policy, Ethiopia uses a National Mental Health Strategy (2012-2016) to
provide direction to mental health services in the country, an approach that is believed to “limit
opportunities for resource mobilization for the mental health sector and efforts to integrate
mental health into [primary health care]” (Mugisha et al., 2017, p.1). Ayano (2016) reports that
community models of mental health care are impeded by
the uneven distribution of mental health resources, problems of accessing services in
remote locations, affordability, and social acceptability in relation to ignorance and belief

10
systems. Families often have to make out-of-pocket payments for these services due to
nonavailability of social support systems (p.2).
Though there has been movement toward integrating mental health care, much remains to be
done to accomplish this task.
These gaps in services demonstrate that current approaches to mental health care in
Ethiopia must adapt to the financial barriers and social stigma associated with accessing such
services, otherwise approaches will continue to be inadequate in addressing needs in a relevant,
inclusive way. Consequently, Ethiopia’s Federal Ministry of Health has acted in recent years to
‘scale up’ mental health care and incorporate it into the primary care system to overcome some
of these barriers (Mugisha et al., 2017). Much work remains in making this a reality. Due to the
complexity and level of risk facing those with mental health disorders in Ethiopia, Ventevogel
(2014) suggests that “larger social schemes, such as poverty eradication plans and educational
strategies” also need to be considered in the creation of mental health strategies (p. 675). Without
putting mental health in context with the co-occurring influences of poverty and limited
educational access, interventions will surely come up short.
Historical Context of the Social Safety Net and International Partnerships in Ethiopia
Understanding the circumstances and historical tensions that Ethiopia has faced in its
international partnerships is important for addressing the challenges the country currently faces
in establishing effective and far reaching social protection programs and relationships with NonGovernmental Organizations (NGOs) operating throughout the country. Hailu and Northcut
(2012) argue that
a nuanced understanding of the landscape requires going beyond a functionalist analysis
of the surface structure of this landscape by explicating ideas and ideologies that have

11
shaped it, interests it is made to serve, traditional beliefs, values and norms in which it is
embedded as well as the limits that history sets to policy and strategic options (p.829).
Without paying attention to events and circumstances that have underpinned decision making,
social workers and policy makers risk making superficial attempts at change. Repeated exposure
to extreme droughts, namely in 1972-4, and 1984-5, forced the Derg government of Ethiopia to
begin creating social protection initiatives, and to invite the participation of international and
local organizations to address severe and widespread hunger in the country (Hailu & Northcut,
2012). Since this time, Ethiopia has continued to experience food crises that have left large
portions of its population vulnerable and dependent on emergency food assistance: the
Department for International Development (DFID) (2007) stated in a report that each year since
the mid -1980s, international partners have provided emergency food relief “for between one
million and 14 million Ethiopians” (p.5). According to the same report,
By the early 2000s, the Ethiopian government and most international actors were
increasingly convinced that they needed to move beyond the emergency appeal system.
Relief was saving lives, but not livelihoods. It was costly and inefficient. It was overly
focused on food. And it was unpredictable: beneficiaries tended to receive food aid
several months later than it was needed. This delay often contributed to the sale of assets
and greater destitution and vulnerability. (DFID, 2007, p.5)
It was significant that the Ethiopian government and its international partners began to recognize
how insufficient this system of relief was in providing long-term stability for Ethiopians. This
realization ultimately led to the creation of the Ethiopian Productive Safety Net Program (PNSP),
which combines the giving of cash and/or food transfers for over seven million food insecure

12
Ethiopians, with opportunities to improve community assets through “labour intensive public
works” such as building and maintaining roads and schools (DFID, 2007, p.4).
While the PNSP has improved the situations of the chronically food insecure, it has not
erased some of the challenges the Ethiopian government still faces in its interactions with
international NGOs. When international partners become involved, this can create tensions when
competing interests and people vying for power conflict with local government. Hailu and
Northcut (2012) acknowledge that policy making is influenced by the value systems and
worldviews of those in power, which can ultimately lead to policies which maintain “culturally
rationalized social and psychological risks and vulnerabilities” such as the maintenance of stigma
towards certain marginalized groups like those living with HIV/AIDS, gender-based violence,
early marriage, and female genital mutilation (p.833). Hailu and Northcut (2012) also note that
donors have political power to invest money in those governments which they believe will
champion human rights and democracy, an action which can be interpreted by government as
acts to undermine national sovereignty. Ultimately, it is these kinds of political tensions which
led to the creation of the Proclamation of Charities and Societies (2009) “which severely restricts
NGOs receiving more than 10 percent of their budget from external sources from engaging in
[political] activities” (Hailu & Northcut, 2012, p.836).
Construction of the Third World Woman
In efforts to improve women’s health in Ethiopia, it is important to be mindful of biases
which may impact how women in low- and middle- income countries (LMIC) are portrayed in
some streams of media. As Mohanty (1984) states, women in LMICs tend to be portrayed as a
homogenous group of powerless victims. Subsequently, the contextual and cultural forms of
resilience displayed by women in these regions may be discredited or overlooked because these

13
women are perceived as weak or helpless. However, context needs to be acknowledged, as White
(2011) cautions against the categorization of “traditional African culture,” arguing that this
ignores the changing and evolutionary nature of culture (p. 203). The idea of including
‘traditional culture’ in the creation of health resources also needs to be applied with discretion, as
some cultural practices may not be representative of an entire population.
On a similar note, Mohanty (1984) warns that assuming the homogeneity of oppressed
women creates the notion of an “average third world woman,” characterizing them as ignorant,
victimized, uneducated and tradition-bound (p. 337). This framing of the “third world woman”
reinforces Western dominance by presenting these women as though they do not possess what is
necessary to overcome oppression without some external power to assist them. These
assumptions oversimplify and marginalize women in these areas of the world by negating their
strengths, capacities, and diversity. Indeed, it would be ignorant to assume that there is one
single way to address Ethiopian women’s health issues, being that Ethiopia has vast cultural and
linguistic diversity (Palmer, 2010). Contributions from culture and tradition need to be respected
and upheld in mental health resources, while accepting the fluctuating expressions and
interpretations that exist within and between cultures.
Ownership of Knowledge and International Knowledge Sharing
There is debate about whose perspectives and knowledge is to be given priority in the
field of women’s health and development. These questions have the potential to either inhibit or
promote the pursuit of social justice depending on whose sources of knowledge and
understanding are deemed credible, and whose are deemed to be obsolete. Historically,
discourses of development have quite clearly privileged the voices and the knowledge of the
global North. Heron (2007) and Razack (2000, 2002) state that “most knowledge-sharing has

14
happened as ‘transfer of knowledge’ from North to South. Indeed, Gray (2005) cautions us not to
engage in perpetuating social work imperialism by imposing our practice models on those in the
South” when this knowledge may not be needed or valued there (as cited in Wehbi, 2011, p.134).
Viewing sources of knowledge from the global North and the global South as incompatible or in
rigid opposition to one another results in ‘othering’ the alternate source of knowledge. As Kumsa
(2011) identifies, rigid insider/outside or ‘us’ and ‘them’ binaries are often inadequate in
establishing a path towards liberating oppression. Due to the characteristically colonial and onesided process through which most knowledge has been exchanged globally, it is important for
postcolonial social workers to be mindful of these biases underlying knowledge that is shared.
However, it is also important to consider that excluding Ethiopians from learning about HICs’
approaches to mental health may hinder them from the benefits of participating in the global
mental health community (Swancott, Uppal, & Crossley, 2014).
Therefore, social justice requires that knowledge and power is exchanged and shared
between these diverse voices. Clough and Fine (2007) argue that “what must happen and happen
often is the overcoming of the oppositions on behalf of the process of scholarship, research, and
criticism of policy, program, and legislative reform” (p. 273). Contrary to popular discourse,
social progress is not achieved by expanding the reach of Western knowledge, but through the
critical, humble, contextual, and participatory process of mutual knowledge exchange. As
Swancott, Uppal and Crossley (2014) propose, global knowledge sharing between HICs and their
Ethiopian colleagues should be a reciprocal process, rather than one directional. This exchange
aids the process of justice not only through inclusion and collaboration, but also through
ideologically positioning Ethiopian forms of knowledge as being worthy and integral to global
conversations about mental health.

15
Theoretical Framework
Anti-Oppressive Social Justice
This research study has been influenced by an anti-oppressive social justice framework.
As Drolet and Heinonen (2012) describe, “an anti-oppressive approach to international social
development considers how to challenge and transcend the oppressions that disempower (such as
poverty, disability and so on)” (p. 5). An anti-oppressive, social justice-oriented approach to
international social work requires an analysis of the complex relations of power operating within
and between local and global contexts. As Baines (2011) describes, “macro- and micro-social
relations shape, perpetuate, and promote social ideas, values, and processes that are oppressively
organized around notions of superiority, inferiority, and various positions between these two
polar opposites” (p. 5).
It is therefore important to acknowledge how people in certain social positions reap the
privileges of these imbalances while perpetuating inequality and oppression for others. Gender
liberation is something that Kumsa (2011) refers to as a lifelong process that cannot simply be
given to the oppressed as a gift. Indeed, there may be temptation to see social justice as the
delivery of power and privileges from those who currently possess it, to those who do not. The
pursuit of social justice however, is much more complex, and requires critical engagement with
the language, structures, and forces that perpetuate inequality; as Baines (2011) suggests,
it is important to ask who benefits from the way things operate at any given point in time,
who can help make the changes we want, how we can help ourselves and others see the
many ways in which issues are political, and how multiple strands of power are operating
in any given scenario (p.6).
These ideological and theoretical questions proposed by Baines also affirm Young’s position that
although politics are what create social change, examining one’s own ideals is crucial for

16
“[dislodging] our assumption that what is given is necessary” (1990, p.256). Discerning who and
what is needed to confront these forces of oppression starts with unveiling how these oppressions
are enabled and sustained. Through this research, in depth interviews will allow local service
providers to share their perceptions on the systemic and other forms of oppression that prevent
Korah women from experiencing optimal health and mental health.
Within anti-oppressive practice (AOP), there is a need to critically reflect on the nuanced
ways that power operates, and some common assumptions in the field that are fueled by the
ideology of whiteness. Jeffery (2005) refers to the characterization of whiteness as altruistic,
‘normal’, and having an “unmarked, apparently content-free quality” (p. 412). The danger within
such a characterization is the presumed innocence and goodness of the white helper. Whiteness,
then, remains outside of the realm of critique; normalized, unquestioned, and silently
authoritative. AOP challenges uncritical adoption of the status quo, instead, urging that we
recognize the role we play in reproducing oppression because of our affiliation with the
dominant culture (Fay, 2011).
Importantly, Jeffery (2005) also highlights that dominance can be established without the
presence of malicious intent. This critique is essential for social workers to be mindful of, as it
urges us to question and to search out the less obvious forms of oppression working within us
and among us. Critiques of oppression must also acknowledge the complex interplay between
“race, class, gender, ability, sexual orientation, and ethnic origin,” as these factors represent
areas where both resistances and vulnerabilities to forces of oppression may simultaneously exist
(Fay, 2011, p.71). Oppression is therefore both nuanced and imprecise: as Barnoff and Moffatt
(2007) highlight, “oppressions need to be seen as intersecting; ranking them on a scale of which
is more or less harmful is both misleading and counterproductive” (as cited in Wehbi, 2011, p.

17
143). Asking how and when these powers operate within a given context provides more valuable
information. Embracing the complexity of how power operates is fundamental to understanding
how we relate to, perpetuate, and resist these forces in social work practice.
Effective AOP with marginalized populations requires the use of critical reflexivity to
engage with difficult, and often conflicting objectives that arise. As Congress (2005) states,
“cultural sensitivity often begins with self-assessment” (p.250). If we do not examine our own
biases, assumptions, and areas of privilege within our own lives, we risk becoming ignorant and
inadequate in our responses to the hurting populations we serve. Initially, feminist notions of
participatory research inspired me to find ways to actively include my participants in the research
process wherever possible. The Ethiopian women I proposed to study already possess and
exercise power, knowledge, and resistances in their daily lives which I believe to be integral to
informing future mental health strategies to improve their wellbeing. By helping to facilitate
opportunities for them to use their voices to shape the services that impact their lives, my hope
was to create space for political and emancipatory change through the women’s involvement.
Though I expected that extra caution would need to be taken to protect vulnerable
participants from the unintended risks and consequences of their involvement in the research
process, I was not entirely prepared for the steep and uncomfortable learning curve that Fay
(2011) describes as the product of confronting our own complicity in reproducing oppression. I
began to wrestle with the question of who would ultimately benefit most from my direct
interviews with the Korah women, many of whom do not speak English, have limited access to
education, and may not truly comprehend the personal risks of their participation in the research.
I started to see the innate power and privileges that I possess as a researcher, which I not only

18
must acknowledge, but also place at the forefront of my methodological considerations. As Fujii
(2012) wisely cautions us,
we must remind ourselves that to enter another’s world as a researcher is a privilege, not
a right. Wrestling with ethical dilemmas is the price we pay for the privileges we enjoy. It
is a responsibility, not a choice, and, when taken seriously, it may be one of the most
important benefits we have to offer those who make our work possible (p. 722).
Good intentions do not erase power imbalances; indeed, many harms have been caused by the
assumption that well-intentioned actions make up for practical and ethical negligence.
What I have learned is that the implications and consequences of the research process are
just as important as the outcome of the research; if I have oppressed my research participants in
my attempt to participate in a process of their liberation, I have failed as an anti-oppressive
researcher. Obtaining interesting or even helpful data does not mitigate harms committed in the
process of gathering this information. After consulting with my research advisor and several
Ethiopian contacts, I had to make the (admittedly) disappointing decision to switch from direct
interviews with Korah women, to gathering information from individuals who work closely with
them. The feelings of disappointment were likely a product of several factors: having to abandon
part of the participatory feminism that had initially inspired my research project, realizing the
flaws in my feminism, and recognizing that in my haste to play a role in placing Ethiopian
women’s perspectives in the forefront of service delivery I could have inflicted great harm.
Baines (2011) expresses that our disappointments, insights, and successes as researchers are
invaluable to the advancement of theory and practice, which has inspired me to share my
rationale for shifting my research methodology. By admitting to my own assumptions that may
have perpetuated oppression against the Ethiopian women I work with, my hope is to urge future

19
researchers and development workers to consider how their social location and actions may serve
implicit oppressive agendas, while operating under the guise of benevolence.
The need for critical reflexivity does not end after modifying my methodology, or at the
point of ethics approval, but continues throughout the process of data collection, analysis, and
dissemination. Wehbi (2011) affirms this point, expressing that we must “understand that our
positionality is shifting, not static” (p. 139). Therefore, our relations to the individuals we
research and hope to work alongside are constantly in flux, leaving the potential for unconscious
participation in oppression an ongoing concern. As incompatible power dynamics force
researchers to make choices which may involve making difficult sacrifices to the research
process or ethics, what must remain foremost is a commitment to upholding respect for the
human beings involved. Trying to merely be sensitive or to acknowledge someone’s point of
view is not enough. Anti-oppressive practice requires recognition of my own privilege, and
immersion into what Dumbrill (2011) calls emic understanding, which is a process of tentative
knowing in which a social worker looks “through that person’s eyes, feeling with [their] feelings,
and experiencing events in the light of [their] histories, [their] values, and [their] beliefs” (p. 5859). This is not a passive or natural process, rather it requires what is sometimes a painful
recognition of how one’s actions, assumptions, or negligence may suppress the freedom of
others.
Feminist Theories – Contributions and Cautions for International Social Work
Feminist theory is also woven into my research framework. Its focus on advancing
human rights and social justice across the globe makes it an essential framework for social work
practice with women (Turner & Maschi, 2015). Different waves of feminist thought are united
by

20
The belief that the inferior status delegated to women is due to societal inequality, that
the personal status of women is shaped by political, economic and social power relations
and that women should have equal access to all forms of power (Turner & Maschi, 2015,
p. 152).
In other words, women’s oppression is not due to some inherent gender flaw, but rather is a
result of overlapping forces of inequality that operate in all levels of society.
Overlapping with anti-oppressive theories, feminist theories pathologize “oppressive
relationships and systems” rather than viewing mental health issues as “symptoms of individual
pathology” (Dietz, 2000, p. 374). This is a systemic shift away from psychological theories that
blame individuals for their own suffering, and which further exacerbate the stigma that
individuals seeking help already face. Being more holistic and multi-faceted, feminist theory
recognizes that effective interventions cannot be limited to the micro environment that exists in
individual therapy. Allen and Jaramillo-Sierra (2015) assert that gender “happens, influences,
and interacts” in micro levels within one’s self and relationships, as well as in the macro contexts
“where institutions, politics, and economics set limits to relationships and individuals” (p. 94).
As such, conducting social work from a feminist lens requires that we embolden those we serve
to re-claim their power in micro and macro spheres of their personal, political, and social lives.
Feminist theory is also appropriate for transnational social work practice due to the way it
challenges both practitioner and client to examine how oppression impacts underprivileged
populations. Feminist practice seeks to “[dismantle] the social stratifications of gender, race,
class, sexual orientation, age, and the like, which are the primary ways in which disadvantage
and oppression are structured (Allen & Jaramillo-Sierra, 2015, p. 94). While gender is one layer
in the oppression of marginalized women, an analysis of the intersecting forces of oppression is

21
needed to holistically address the relationship of power to the maintenance of poverty and
inequality. Feminist theory acknowledges the influence of individual factors such as one’s
trauma history, thoughts, and past experiences, as well as the role of external political and
environmental factors that also shape individual experience (Turner & Maschi, 2015). Feminist
practice also considers both the micro and macro levels of social work practice (Allen &
Jaramillo-Sierra, 2015; Turner & Maschi, 2015).
On the micro level, the goal of feminist practice is to empower those who are oppressed,
and to analyze the systems which contribute to this oppression (Dietz, 2000). In this way,
feminist practice seeks to empower women by depathologizing their challenges, by revealing
how these conditions are expressions of oppressive social structures (Eyal-Lubling & KrumerNevo, 2016). In other words, women are not inherently flawed or incompetent, and do not create
their own suffering; gender disadvantages are the result of complexities beyond one’s individual
make up. As summarized by Dietz (2000), “the personal is political, and individual change and
social change are seen as interdependent” (p.372). One cannot exist without the other because the
two are mutually reinforcing. Political and structural injustices impact lives on an individual
level. Turner and Maschi (2015) assert that feminist perspectives acknowledge and work to
address the impact of resource deficiencies and structural injustices at work in individuals’ lives
and in broader society. This perspective influenced the selection and development of interview
questions that focused on potential structural barriers or limitations that exist in Korah women’s
lives, rather than assuming women’s poverty and oppression is a result of individual pathology.
The interviews also explored participants’ perspectives on the gaps or influences which have
prevented women from accessing certain services, or even impeded the creation of certain

22
services, opening the potential for participants to comment on broader forces that perpetuate
oppression such as gender, politics, stigma, power, and inequality.
While feminist theories provide a strong framework for confronting and overcoming
oppression, they also pose specific limitations and potential pitfalls unique to these perspectives.
For example, in creating a unified picture of women’s oppression, Brown (2011) states that
essentialist feminists may present only a partial view of what it means to be a woman who is
experiencing oppression, inadvertently ‘othering’ women whose experiences fall outside of that
stereotype, and thereby classifying them as deviant. Further, she argues that there is a “tendency
to emphasize the idea that everyone within oppressed groups shares the same ideas, reality, and
experience” (Brown, 2011, p. 101).
This assumption negates the fact that similarities and differences can and do coexist
within groups of women. Mohanty (1984) also affirms this potential trap in feminist
perspectives, stating that “sisterhood cannot be assumed on the basis of gender; it must be forged
in concrete, historical and political practice and analysis” (p. 339). While similarity needs to be
highlighted at times to create solidarity or to group shared experiences, feminist social workers
must be careful not to reinforce oppression by assuming they understand and share the same
experiences as women from another culture, socioeconomic status, religion, or ethnicity. This
insight has prompted me towards an exploratory, open-ended interview approach, as I am
cautious about my own biases as a clinical social worker towards wanting to help identify mental
health supports in light of the stories of death, economic instability, disease, poverty, and hunger
I have personally witnessed in my work with this community.
Instead of projecting my own interpretations of how poverty influences Ethiopian
women’s mental health, I have explored workers’ perceptions of how women are impacted by

23
poverty in the areas of social, cultural, emotional, psychological, and physical wellbeing, as well
as the ways that the Korah women cope with these impacts. My hope is that this process has
drawn me closer to a contextual interpretation of health in this community, and to the strengths
and capacities that women in this community already utilize. Bishop (2002) asserts that
oppression and privilege “only unravels when people who are oppressed are empowered to
speak, when people with privilege practice humility and listen, listen, listen times ten” (as cited
in Fay, 2011, p.77). However, the ways that the oppressed experience empowerment and voice
needs to be carefully considered in context, in collaboration with insider knowledge, and with
sensitivity, to avoid enhancing their vulnerability by trying to force this process into being when
it is not natural or appropriate.
Postcolonial Understandings of International Development
Postcolonial theories are integral for understanding how to approach the nuances and
contradictions inherent in international social work. As Lawrence and Dua (2005) state, it is
important as an anti-racist feminist to recognize the ways that one may participate in the ongoing
colonization agenda. By not examining one’s own connections to the colonization process, it is
very easy to unintentionally reproduce these harms. This project of colonization can be identified
in several ways. Iris Marion Young (2003) coined the term “the knights of civilization” to
characterize the justification of imperial objectives, as Western democracies “bring enlightened
understanding to the further regions of the world still living in cruel and irrational traditions”
(p.19). By representing other nations as being held back from progress by their ‘traditional’ ways
of thinking, this characterization suggests that Western bodies have nothing but benevolent
intentions in their interactions with these opposing nation states.

24
Expanding on Young’s analysis, Jiwani (2009) suggests that by representing Oriental
women as though they are imprisoned by their circumstances and in need of rescue, “the ‘knights
of civilization’ redeem their dominative masculinity by being ‘good men’ protecting their
women within the homeland and rescuing helpless maidens outside it” (p. 729). This benevolent
representation of Western intentions disguises postcolonial objectives by suggesting that
interventions are in the best interests of the development of the receiving culture or group.
Colonial domination of “other” cultures can then continue, disguised as altruism.
Ongoing colonization can also take place through the subtleties of globalization and
knowledge sharing. Alfred and Corntassel (2005) state that ‘globalization’ is merely an extension
of the imperial empire which continues to evolve and erase Indigenous histories. This can occur
through the replacement of Indigenous histories and ways of knowing with what Fanon refers to
as “doctrines of individualism and predatory capitalism” (as cited in Alfred & Corntassel, 2005,
p.603). Though it may appear to be a harmless, value-less process of sharing global sources of
knowledge, the hidden goal is extending a certain and specific set of values that benefit imperial
powers.
In contrast, some postcolonial approaches to international social work place a strong
emphasis on respecting and preserving Indigenous or local cultures, however, this too has flaws.
For example, if cultural revitalization is used as the primary strategy for confronting inequality
or oppression, this can distract attention away from the existence of economic imperialism and
racism that also perpetuate issues of inequality (St. Denis, 2004). While it is important to
examine the role of culture in strategies of resistance and emancipatory politics, it does not
address the complete intersectionality of power dynamics. Additionally, as St. Denis (2004)
describes, fundamentalist forms of cultural revitalization pose a risk of uncritically deeming

25
‘culture as good’. The danger in assuming that culture is innately good and necessary, is that
culture is not a concrete, homogenous entity, and is in fact subject to change and influence over
time. There may be aspects of one’s culture that serve oppressive objectives, while other cultural
beliefs and practices may promote solidarity, creativity, and freedom.
Mere acknowledgment of other cultures in international development discourses does not
dissolve colonial oppression. Indeed, Dussel (2015) proposes that postcolonial critiques ought to
unpack Northern/Southern classifications and identify the ways in which these different forms of
knowledge blend together in non-binary categories, rather than “celebrating Southern
contributions only because they are Southern” (p. 96). Postcolonial social work requires an
acceptance of the intersectionality of culture, gender, class, and ethnicity. In some ways, this
necessitates an embrace of the unknowable: “Levinas says that people who think that they fully
understand another person have essentially forced the other person’s existence into their own
conceptual frame, which renders their own view the only view that counts” (Dumbrill, 2011,
p.59). To be anti-oppressive then is to admit to only partial understanding of another’s
perspective. It is in the tension of not fully knowing, and not fully comprehending, that antioppressive knowledge sharing and social transformation must take place.
These postcolonial theories have shaped my research project by leading me to use an
exploratory research design (Dudley, 2010). This method allowed for the use of open-ended
questions, thereby creating space for participants to share a range of reflective responses with
minimal influence from the researcher (Dudley, 2010). The study specifically asked participants
to comment on their perceptions of any negative or positive impacts in the Korah community due
to foreign involvement, with the intention of exploring any observations of oppressive forms of
power, knowledge-sharing, or colonialism that may be present in this community. Furthermore,

26
five of the seven participants in the study are Ethiopian nationals. The purpose of having more
Ethiopian participants than North Americans in the study was to highlight ‘insider’ knowledge
(Epston, 2014) from those who live and/or work regularly within the Korah community and are
thereby able to offer cultural perspectives and insights that may not be experienced by those who
do not share an Ethiopian cultural identity.
Design and Methodology
This study used an exploratory, qualitative research design (Dudley, 2010), as currently
little is known about how women in Korah are impacted by poverty, how they cope with its
impacts, and how supportive professionals can best serve this population. Originally, the
intention of this study was to conduct interviews directly with Korah women using a translator,
under the assumption that this would provide the most direct and empowering process for the
women being studied. After consulting with those familiar with my research aims and those
familiar with the political and social context in Korah, I began to question how Korah women
would be impacted by direct interviews with a foreign, educated, White Canadian woman who
speaks English rather than Amharic, their native tongue. I was challenged by the realization that
it would be difficult to communicate the ethic of free and informed consent in the research due to
the imbalance of power existing in this relationship. Through this reflexive process, I determined
that it would be more ethical to interview service providers who work closely with Korah
women, rather than the women themselves.
Recruitment
Recruitment of participants for this study began after the University of the Fraser Valley
Human Research Ethics Board gave their approval for the study on May 17th, 2017 (see
Appendix A). The initial participants were recruited through the researcher’s personal

27
connections with Kore Great Hope Charities, a local Ethiopian NGO that works to empower
Korah families through income generation activities, education, health training, and other forms
of economic, emotional, and spiritual support. Other participants were identified from the
community using snowball sampling techniques (Dudley, 2010). Some participants were asked
to identify other key informants who would meet the criteria of the research study. A recruitment
email (see Appendix B) was sent to a several social workers, nurses, program directors, human
service workers, and a pastor who met the criteria for the study. Individuals who received the
recruitment email were encouraged to contact the researcher if they were interested in
participating in a research interview. After hearing back from prospective participants, a letter of
informed consent (see Appendix C) was emailed to them, outlining more details about the study,
and coordinating an interview time. Those participants residing in Ethiopia were notified at this
time that the researcher would be in Addis Ababa, Ethiopia from June 2-23rd 2017, during which
time the interview could take place in person.
The sample population included seven key informants that have had current or past
personal/professional experience working closely with marginalized women for a minimum of 1
year, and at least 6 months working directly with impoverished women in Korah. Among the
sample was one nurse, two social workers, two human service workers, a pastor, and one
executive director of a non-profit organization. The pastor was approached after the first several
participants noted the critical role that faith communities have in caring for Korah women’s
mental health. Participants were also required to have a proficient level of English to avoid
language barriers which may have impeded communication or interfered with accurate
translation of data. Research interviews took place between April 19th – July 21st, 2017. All
interviews were voice recorded with permission from participants. Four of the interviews took

28
place in person during the researcher’s trip to Ethiopia, while the remaining three interviews took
place over Skype. Participants were given a gift of chocolates as an honorarium for their time.
Data Collection and Analysis
Data was collected in this study using semi-structured interviews with participants.
Interviews varied in length from 55 to 100 minutes. A research assistant did not end up being
needed, as was originally proposed in the ethics submission for this study. The ethics board was
notified afterwards that a research assistant was not used. Prior to starting the interview, the
researcher briefly went over the contents of the informed consent agreement and ensured the
participants understood and signed the consent document. The researcher asked a series of openended questions of participants to encourage them to share in-depth, qualitative answers. In some
cases, further explanation was provided by the researcher when participants required clarification
on what the question was asking, due to having English as an additional language. Questions
explored participants’ observations and experiences regarding how poverty impacts health and
mental health in various areas, such as social, cultural, physical, emotional, and spiritual wellbeing. Participants were also asked to comment on the coping mechanisms and current services
that Korah women utilize and have access to in order to cope with the impacts of poverty (see
Appendix D).
Interviews were recorded using a recording application on the researcher’s phone which
was password protected until data could be transferred to a password protected computer.
Interviews were then deleted off the phone. Each participant was encouraged to choose their own
pseudonym to protect their identity in the publication of their responses within the research
study. All interviews were transcribed by the researcher using Nvivo10 software and each
transcript was documented under each participant’s chosen pseudonym. Word for word

29
transcription was used for research interviews, so the grammar in some direct quotations in the
study findings reflect the fact that English is not the first language of all participants. Each
participant was asked whether they would like a copy of the final report of research findings. All
participants expressed interest in receiving the study results and will be emailed a copy upon
completion of the project. Participants were notified that the published findings will be
accessible through the UFV library, and findings may be used in peer reviewed journal articles,
conference presentations, and other dissemination formats.
After completing the transcription process, open coding was used to identify key words,
sentences and phrases that could be interpreted in the analysis stage (Dudley, 2010). Notes and
transcripts were re-read several times to identify and capture themes and differences between the
participants’ narratives.
Ethical Considerations
There are several ethical considerations worth noting in this study. One area of ethical
concern in this research involved the power dynamics between the researcher and some of the
participants. Indeed, Fujii (2012) states that “the existence of a power imbalance, however, bears
on one of the central responsibilities that researchers have—to obtain voluntary, informed
consent” (p.718). Though HFK and Kore Great Hope Charities (KGHC) are separate
organizations, it is important to disclose that HFK is directly involved in the hiring, ongoing
leadership, and direction of their Ethiopian staff, in conjunction with KGHC. This power
dynamic had the potential of making KGHC staff feel obligated to participate in the study, even
if they would have preferred to say no. They may have assumed that saying no could have an
adverse impact on their reputation or on their employment. Because many KGHC staff also
know the researcher on a personal level, they may also have felt a sense of obligation to

30
participate. Therefore, the consent form clearly stated that participation is voluntary, and there
would be no penalty for anyone who did not wish to participate, or anyone who decided to
withdraw from the study at any point before, during or after the research process. By sending out
recruitment letters well in advance of June (when the face-to-face interviews took place)
individuals had the choice not to respond, or to thoroughly consider their participation in an
interview before being in the presence of the researcher.
Another risk in the study is that HFK and KGHC are small staff teams that work closely
with one another through daily communication and the sharing of offices. Because of their
integrated staff team and the use of snowball sampling, participants could not be guaranteed
anonymity. However, they were also asked to choose a pseudonym to protect their identity, and
all responses were coded and themed so that no identifying information could be linked to
individual participant responses or identities. There also may have been a perceived or actual risk
to participants’ employment relationships if they chose to comment negatively on their agency’s
practices. Participants were given the option to refuse to answer specific questions if they
perceive any personal risk in responding. If participants perceived any risk to their employment
or economic well-being from participating in the study or answering a specific question, they
were encouraged to refuse to answer that question, or to withdraw from the study. No
participants perceived any personal or professional risk as a result of their participation.
Another ethical consideration within the study is regarding funding for the researcher’s
trip to Korah. The researcher’s plane ticket to Ethiopia was paid for by HFK because the
researcher’s primary purpose for being in Ethiopia was work-related, and the funding was not
specifically related to the research that was conducted. All other travel, lodging, and
transportation expenses for this research project were paid for personally by the researcher.

31
Because the research occurred during the researcher’s work-related trip to Ethiopia, and because
HFK paid for the plane ticket and will likely benefit from the research that was conducted, this
funding was reported to the University of the Fraser Valley Human Research Ethics Board for
the purposes of transparency. The benefits that HFK is likely to gain from this research is greater
knowledge of the gaps in services and impacts of poverty in their beneficiaries’ lives, and an
improved ability to develop programming and practices that utilize and honour the cultural
needs, perspectives, and strengths that exist within the community. HFK and KGHC will receive
a copy of the final report, but will not have access to any participant responses, raw data, or
personal information.
Limitations of the Study
While steps were taken to carefully consider the most appropriate approach to conducting
this study, it is important to acknowledge the limitations within this research and its design. For
the sake of convenience, and to avoid the ethical implications of using a translator during
research interviews, only participants with a proficient level of English were recruited for
participation in an interview. This may have limited the scope of people interviewed to a certain
socioeconomic or education level, while excluding those participants who have not studied
English as a second language or have not had the opportunity to do so. In addition, the
participants in the study either identified with the Protestant Christian faith or the Ethiopian
Orthodox faith, which would have influenced their responses and perspectives according to their
belief systems. This unintentionally will have excluded the voices of individuals with no spiritual
affiliation, or those from a faith community not mentioned above. The study participants were
selected due to availability and the researcher’s connections, not with the intention to exclude
certain voices. Future research on this topic would benefit from including the perspectives of

32
individuals from various faiths, or those who do not self-identify as religious, in order to reveal
the ways in which one’s faith conceptualizations may influence the study findings. Though the
intention of this exploratory study was mainly to gather information about a topic that little is
known about (Dudley, 2011), one limitation of the findings in this research study is that it
includes a relatively small, nonprobability sample, meaning that results cannot be generalized to
a larger population. Additionally, as a result of my own positionality, my research has the
potential to perpetuate the image of the White, Western feminist freeing the Ethiopian women
from their oppression, as my work has failed to follow the suggestion of Collins (1990, p.221) to
put “Black women’s experience at the center of analysis” (as cited in Weinberg, 2006, p. 168). In
other words, by interviewing key informants rather than the Ethiopian women under analysis,
this study fails to incorporate the specific voices and insights of the women being studied. While
ideally the women’s own perspectives would be at the centre of the study to provide
opportunities for participative empowerment, it was carefully decided that in this case, the risk of
potential harm to the women would not outweigh the potential benefits of their direct
participation. It is also recommended by Arzubiaga, Artiles, King, and Harris-Murri (2008) to
have a key informant on the research team, especially when the data collection timeframe is
short, to help “share information that is partially understood or even misinterpreted by
researchers because of their lack of familiarity with the community's language and cultural
practices” (p.312). As an outsider to this Ethiopian community, having a key informant on the
research team would help alleviate the potential for misunderstanding across cultures, however
due to the short data collection phase in this study, having an Ethiopian research partner on the
research team was not logistically plausible. My hope is that future studies will be able to place
Ethiopian women’s experiences at the forefront of analysis to honour their knowledge in more

33
direct ways. Context and culture are inherently connected to the ways that mental health is
addressed and understood (Swancott, Uppal, & Crossley, 2014). Therefore, it is best whenever
possible to not only glean contextual knowledge through interviewing insiders, but also to have
insiders as part of the research/analysis team.
Discussion of Findings
Several important themes were identified as the data from this study was analyzed.
Research interviews explored participants’ observations and perceptions of how Korah women
are impacted by poverty, as well as the relationship between poverty and mental health for
women in this community. In addition, participants shared their insights on the coping strategies
used by Korah women to address the health and mental health impacts caused by poverty in their
lives. Finally, participants were given opportunities to comment on ways that supportive
professionals can come alongside Korah women to help them address the ways they are impacted
by poverty. Many of the themes that arose in the data are overlapping, and reflect the complex
way in which poverty creates, interrupts, and sustains health and mental health challenges.
Themes from the data include the impacts of poverty on Korah women, traditional gender roles
and cultural norms, spirituality, and tensions of development work.
Impacts of Poverty
Lack of formal and informal education.
The impacts of poverty in Korah are far-reaching and interconnected. While it is beyond
the scope of this paper to examine every way that women in Korah are impacted by poverty, this
paper will explore some of the key themes that arose from the data on how women’s lives are
impacted by poverty. Participants in the study identified poverty impacts such as a lack of formal

34
and informal education, the impossibility of prevention in women’s health, and the need for
women to take drastic measures in order to survive and provide.
As one participant, Asher, expressed, women’s formal education is disproportionately
affected by poverty due to cultural gender roles:
if a boy or a girl is in the family, the majority of the time that boy's going to get a proper
education, or some sort of education, and that girl is going to miss out because she has
obligations as a girl in that culture.
The same participant expressed how the majority of women in Korah came from the countryside
where cultural gender roles are even more pronounced, so the barriers waiting for them in Korah
are significant: “they came from a rural setting, and now they're coming into an urban setting, so
the environment changes which brings on many more problems, but their mindset and how they
were raised doesn't change.” It was noted that their rural upbringing limits their employability as
most women’s skillsets are based in farming, cooking or being a housewife - tasks which have
limited profitability in an urban slum setting. Another participant, Shalom, stated
anyone is in poverty, he lacks to be educated, yeah. Most of the women and young
children are not educated... their education status affects their spiritual life and also their
mental thinking. So, they live just with a culture that they were doing before. It is
difficult to change their mind because their knowledge is just a little bit limited.
This barrier of limited access to education at an early age can create a systemic trend in
which knowledge is not passed down from parents to their children, or from one generation to
the next, and women are not accustomed to having their ways of thinking challenged and
broadened formally, or informally. For instance, Yacob shared that

35
a lot of poor women, they don't have able to go to school, education, even they don't have
knowledge to teach her kids. So, um even they, a lot of young womans they surprised
when the have the first-time menstruation because she doesn't know. Even her mom she
doesn't help her, she doesn't know anything.
So, women in Korah do not only experience barriers in receiving education itself, which
translates into difficulty obtaining employment and job stability, but their opportunities for
empowerment are also compromised by this dynamic as they lack the support and knowledge to
even understand processes like puberty that affect their own bodies. This lack of informal
education and empowerment can have the effect of limiting women’s ability to believe that there
is any alternative life available to them: “just in their self they think they can't do it. You know
only the man can do it. You know that's wrong. There's a lot of smart woman, and they just not
able to, they don't have a chance to go to school... And they feel a lot of pressure” (Yacob).
The impossibility of prevention.
This lack of knowledge or self-advocacy ability is one among several factors that
contributes to the impossibility of prevention in regard to Korah women’s health. Steve also
touched on this fact, noting:
there's a cultural idea that...and this is true for pastors, its true for doctors, its true for
professors, you're taught that you don't question, um, anything they say. So, whatever
they say, is, that's, that's true. Um and even for nurses as well, um, depending on how
deep their qualifications are...people learn to not question them. So then if you're poor it
adds another level to that.
The result of such a dynamic is that those who are poor learn not to challenge the authority of
those who are in positions of power over them. Coupled with the fact that women are less likely

36
to receive an education, this elevated status given to educated individuals places poor women in
a state of greater vulnerability, and gives them less exposure to, or awareness of how to advocate
for their own needs or health related concerns. Preventative health care is also impeded by the
economic burden of poverty which leads many women to prioritize other basic needs over their
health:
You know, the first thing they worry about is what they are eating. They concerned for
their need. So, they focus on getting their daily bread. That hinders them to seek good
health. The second thing...they also worry about their...paying their house. Unless they
feel sickness or the illness very high, or they feel they are very sick, they don't go to the
hospital. (Tessema)
Several other participants noted this same barrier to seeking preventative health care,
whether it is due to a lack of affordability, waiting among thousands of others at a public clinic,
or just simply that other needs such as food, housing, or education for their children took
immediate precedence over their own health. Even when individuals are given access to
education on basic hygiene, water sanitation, and hand washing, financial poverty often prevents
women from being able to prioritize some of these basic preventative measures:
people say to boil your water. But the reality is in Korah charcoal costs money. So, you're
not going to waste charcoal to boil your water. And another problem is you can't really
use an electric pan because landlords typically will charge you much more money for rent
for using the electricity, so most people prefer in Korah to use charcoal because it's
cheaper and the electricity cost more money which would draw up their housing. So
boiling water is difficult to do within Korah. It is not feasible for many people (Asher).

37
Though boiling water may seem like a simple step that is possible for those in even the direst
circumstances, the strains of poverty prove that this is not always the case, therefore one
participant mentioned that Korah families are frequently sick with intestinal parasites, diarrhea,
typhoid, gastroenteritis, and other such water borne and sanitation related illnesses.
Drastic measures.
It was routinely noted in the data that women continue to take drastic measures to provide
for their families, often leading them to risk their life or take on very dangerous and precarious
forms of work. One participant shared about a woman he worked with that refused to take her
antiretroviral medication which is intended to prevent the progression of HIV. The woman was
told that in the short term the medication would make her feel sicker, and she worried that if she
couldn’t make it to work as a daily laborer, then her children would starve and die, so she
decided to “take her chances with HIV” and continue going to work without taking her
medication. When offered two months of rent and groceries to get through the initial sickness of
starting her medication until she felt ready to go back to work, the woman agreed. Because of the
dire and immediate impacts of poverty, woman are often faced with critical decisions like this, in
which they must take extreme health risks just to be able to feed their children for one more day.
Lack of choice also leads many women to engage in drastic and risky forms of work.
Asher affirmed that “women in Korah especially are forced to do just unimaginable things in
order to provide, due to the fact that they just don’t have what the majority of other people have.”
He expressed that a lack of education and skills due to growing up in the countryside severely
limit their employment opportunities. Kidist affirmed that many women display “a kind of
warrior mentality” or strong spirit that helps them not to give up. Five participants mentioned
that many women engage in prostitution as a means of providing for their families:

38
there are a lot of girls, or a lot of women participating and working in commercial sex
work. This is a secondary trauma because of poverty, because of discrimination, they
prefer to engage in prostitution…Womens are suffering in different social crisis,
economical crisis, health crisis, spiritual crisis… (KS).
This same participant spent time interviewing women involved in commercial sex work in Korah
and reported that the women cried and expressed that they were suffering not only physically,
but also emotionally due to the social stigma in their community associated with engaging in
prostitution. He stated that “especially the term in Amharic is not good word, it attacks, it cracks
your mental...yeah, the word prostitution” (KS). One participant referenced the “strong
entrepreneurial spirit” the women exhibit as they go to extreme measures to feed their children,
or to keep them in their care. Other forms of precarious work that were mentioned by
participants include begging at the roadside, selling vegetables on the side of the road, carrying
heavy bricks and stones for construction, and scavenging at the trash dump. One participant
stated that you will often see women who are up to 7 or 8 months pregnant carrying heavy
stones, doing concrete jobs or carrying large stacks of wood just to make a marginal wage. These
types of jobs leave women susceptible to illness, injury, and working conditions which do not
guarantee a dependable way for them to provide for their families.
Traditional Gender Roles and Cultural Norms
The impact of poverty for Korah women can be better understood by acknowledging how
gender roles and cultural norms may contribute to maintenance of poverty in this community.
Several participants referenced how the culture of Korah is a unique product of internal
migration; Ethiopians come from different parts of the country, particularly the countryside, and
are “transplanted to the area” (Steve). Asher stated that

39
many of [the women] come from the countryside, and so the culture that you view
within Addis Ababa is very much Ethiopian culture, but there's many things that are not
practiced in Addis Ababa… and it has a culture all of its own. But if you look, women
face many problems within the countryside, and I think many of those problems then
follow them into the urban setting.
In this way, Korah presents its own unique blend of cultural practices and roles which interact
with the environment to create specific challenges for women in the community.
Child marriage and household obligations.
The data also gave evidence of the prevalence of child marriage, and its influence on the
gender roles lived out by many families in Korah. Four participants referenced the practice of
girls getting married at a very young age in Korah. Yacob shared that “some womans... if you've
heard before there is some culture tradition like they married early, and they have like fistula
problems… there is a lot of issue in Korah too.” Another participant referenced that women get
“married very young and then they start having children very young which leads to other health
issues of having children so young.” Beyond pointing out the health concerns that arise for some
women when they become married and pregnant at a young age, another participant described
this practice of early marriage as a form of abuse that has been adopted as a cultural norm. Kidist
stated that “with the husband I would say they don't even sometimes understand what abuse
means because that's kind of...they feel like that's the way it is in the country.” This participant
further stated that girls will have their marriage arranged as early as the age of 7. Furthermore,
Kidist described that
when they get married like the girl would be in her you know...not even in her twenties,
no, yeah, just starting from 12 to something...er teenage and the husband can be 40 or 50,

40
so she is submissive, and she is like a child so she doesn't even know whether you know
what are her rights and responsibilities and duties.
While Kidist described this practice as abuse, they also acknowledged that for many
individuals, they may have a very different perception of the practice of early marriage: “even if
you try to interview those people ...they might not say that we're abused because they don't really
understand what that means...Because they think that's the norm, that's how it's supposed to be.
So that's why I’m just generalizing that mainly its abuse.” Child marriage can further cement
women’s poverty by fixing them to household and mothering duties from a very young age,
which interrupts their ability to receive an education and skills in self-advocacy.
Nearly all participants spoke about the disproportionate burden that Korah women carry
for household and childrearing responsibilities, often leaving them vulnerable if their husband
does not fulfill the cultural role of primary breadwinner for the family. Several participants
connected this in some way to the gender roles that are prevalent in the countryside. Asher stated
that
a woman has a lot of responsibility, and so, you know, we say women which we would
consider someone in their early twenties to be a woman but when I'm saying women I use
that term very loosely because these are actually children. And so, from a young age and you'll start to see this in Korah, and you'll see it especially in the countryside - girls
have a lot of responsibility from a very young age and there's a huge expectation for girls
with in Ethiopia. As soon as they're old enough, they begin to cook, and I'm not talking
traditional things like your mom teaches you to cook, it's a responsibility, that is what
they are expected to do.
Yacob further described that women’s roles in the culture are to

41
take care of the kids, she take care of the food, she take care of everything around the
house and the husband never help anything. He just, his job is just provide money, that's
true, that's a lot of um kind of like the culture.
He shared that this trend has shifted somewhat as more women have had the opportunity to
pursue education and get a job, however he maintains that “when you go like countryside or
Korah you know a lot of womans they don't have a job.” So, while the culture may be changing,
this is taking place very slowly, and leaves many women to carry the bulk of responsibility for
the care of their children and households.
Male roles and responsibilities.
Several participants referenced how the local culture allows men and fathers in Korah, in
many cases, to carry out a lack of familial responsibility, whether through a lack of financial
provision or through lack of involvement with the children or family unit: “so I think you know
the culture um more helps for the men… But nobody taught him, they just um you know there's
no like equality” (Yacob). Furthermore, this participant expressed that
the culture a little bit change now, but it's still uh the only the husband provide for the
house. And then so if they have argument or if they fight or if the husband sometimes
leaves. Or the husband maybe addicted like alcohol or something and then he maybe
spend a lot of money outside, maybe he doesn't have enough money for his children and
for her.
Additionally, coping strategies that are deemed to be appropriate seem to be categorized
by gender. Two participants referenced the fact that it is not culturally appropriate for women to
engage in alcohol use, or to chew khat (a plant which acts as a stimulant when chewed or
consumed as a tea), while these behaviours are much more permissible for men in this culture.

42
Asher disclosed that women do sometimes use alcohol as a coping as it is “very accessible and
very cheap” to obtain in Korah, however women who drink will typically do so in their home.
Contrarily, it is much more acceptable and prevalent to see men in Korah drinking during the day
in the local bars. One participant stated that “the few men that are in Korah, many of them abuse
alcohol.” In a study by Kebede et al (1999), it was found that “alcohol dependence was reported
almost exclusively in males” (as cited in WHO, 2005, p. 188). Steve explained that it is partially
cultural expectations, and partially lack of resources that discourage women from engaging in
substance use to the same degree as men:
for many of these mothers, they really are going to look to um to trying to provide for the
child first, and that means that they don't have...they're going to put food in their child's
mouth before they go out and drink, or before they chew khat. Guys on the other hand,
just with a lack of responsibility culturally, um they you know, they can do whatever they
want to with their day's wage...and often times gets them into those other cycles. (Steve)
When coupled with the fact that men are mostly relied on as the primary breadwinners in
Ethiopian society, men being able to freely spend their day’s wage leaves their wives and
families vulnerable to poverty and precarity: “you take out the male figure within the family, the
primary breadwinner, and then mothers are just forced to deal with extreme situations, which
then can indirectly affect their kids” (Asher).
Yet another trend in the data is the absence of fathers from the household, or transience in
their involvement:
in many of the households there are not a lot of men, there's not a lot of husbands. Or
those husbands are not emotionally there for their wives. So, you know, if there's no
husband in the house, then that mom really has to be the strong person within that

43
family, the glue that holds that family together. And so, you can imagine that just puts a
lot of pressure on the woman (Asher).
The same participant shared his personal observation that for many families involved with Hope
for Korah, “the fathers that are active within the household, they come, and they go” freely.
Another participant shared about his own personal experience growing up in Korah with a single
mother:
I think a lot of pressure for the womens. A lot of responsibility. And you know they don't
share everything, like even the children. Like I grew up, my mom is single mom. And I
never see my dad help me when I was a child. You know, always my mom to take care of
me. I know my dad he always outside, he gone always. And uh I think that's even a lot of
children they don't have memory from you know their father playing with them, or you
know just cook with them, you know, it's just so different.
Because of the unpredictability and inconsistency of many Korah fathers’ involvement in their
families, women’s roles and family duties are compounded. While there is a cultural expectation
for women to engage in household and childrearing roles, when women are single parents,
widowed, divorced, or otherwise abandoned by their spouses, they must not only care for their
families, but find ways to provide financially from a significantly disadvantaged position of
having little to no education or work experience. This cycle cements poverty by forcing women
to focus on survival, rather than giving them opportunities to develop their abilities and thrive.
Spirituality
The importance of religion and spirituality to Korah women.
The significance of religion and spirituality in Korah has also emerged as an important
theme in the data. Spirituality and religious culture in Ethiopia was repeatedly highlighted as a

44
significant component of Korah women’s identity, and consequently a way in which they cope
with the impacts of poverty. Participants expressed that most Korah women belong to the
Ethiopian Orthodox religion, while a smaller number are Muslim or ‘Pente’ Christians (a term
referring to Pentecostal or Evangelical Christians). This finding is consistent with literature
confirming the significant role of the Ethiopian Orthodox church in Ethiopian society (Blystad,
Haukanes, and Zenebe, 2014). Tessema affirmed that “most of the community are Orthodox.
They love their religion,” and though his opinion was that their faith itself may not always help
them cope with the impacts of poverty, he expressed that “they pride of their identity, religious
identity…that may feel good and maybe help them to feel hope, hope to work.” Women were
described by Yacob as finding hope in their strong faith and being able to joyfully sing and
worship at church even when basic needs such as food and clothing were not met.
Participants confirmed that women’s commitment to their faith is so strong that many
will maintain rituals such as fasting even while malnourished or living with HIV. When
describing how some women use their spirituality to cope with the impacts of poverty, one
participant expressed that women display a
kind of gutted-out... fatalism in Ethiopia, so along with that some of them just kind of see
that as their lot in life, and so they're just going to keep playing it to the best they can, uh
and that just keeps them driving forward (Steve).
Another participant described that going to church, praying, and “sticking to the words of God”
provide sources of encouragement for many women. Asher reflected on the ways in which
religious tradition is imbedded within Ethiopian culture and everyday greetings:
Even within their culture - like you ask someone ‘is there peace, how are you doing?’
The typical response within Ethiopia is ‘Xavier meskin’, which means thanks be to God.

45
That's so much different from many other cultures you see, like how many people do you
walk up to and you ask them how they are, and they say, ‘thanks to God I'm fine?’ So,
people are very, very in tune with the spiritual aspect of their life. And it's a part of the
culture and tradition, and so I think faith is the one thing that many people hold on to.
The same participant spoke about his experiences visiting with and mourning alongside
the community in the week following a landslide at the local trash dump in March of 2017. The
slide claimed the lives of approximately 200 women, children, and men, along with their
makeshift homes, late one evening when a mountain of trash gave way. As he reflected on this,
Asher highlighted the particularly spiritual lens through which many of the women and families
seemed to interpret this tragedy:
just seeing people who have lost everything, their family members, everything and they
say ‘this must be God's will... This must be the will of God, you know, he has a plan...’
And so, they are very much in tune to their spirituality.
As reported by this participant, leaning on their faith seems to have provided a great source of
strength for many hundreds of individuals mourning the loss of their loved ones in the wake of
the landslide.
Spiritual conceptualization of mental health and emotional problems.
The data also revealed that spirituality seems to have a significant influence on Korah
women’s conceptualization of mental health problems, and subsequently on their help-seeking
behaviours. When asked where or to whom women would initially go for help if they noticed
some distressing psychological symptoms, Asher responded that
they would go to the church and do holy water, or they would maybe talk to a priest or
maybe talk to a friend, they wouldn’t even know where to go for, for mental health…and

46
so they would just try to deal with it spiritually as a spiritual problem, versus a mental
illness. I've had many circumstances where women have said ‘I'm just acting very weird
and there's been like I blackout almost and then I'm very aggressive towards people and I
start... I don't act like myself, I yell profanity at people, and then all of a sudden, I snap
out of it and I don't really remember, people are just telling me this.’ And you're
wondering okay, if someone did that [in North America] you'd say, ‘oh man there's
definitely some sort of psychological problem with you’, you would never say ‘oh, you're
possessed by a demon, or there's some sort of spiritual warfare going on.’ There, that's
what people would say... ‘You're possessed or there's a spiritual warfare going on within
you.’ You know, they would never say, ‘oh you probably have this [diagnosis].’
This participant observed that “the whole spiritual and psychological they kind of mesh” in
Ethiopia. Therefore, determining a distinction between spiritual and psychological causes or
influences of behaviours is complex, and the ways that women in Ethiopia seek help for
challenges they face is determined by their understanding of the causes of these conditions.
Four participants noted that women seeking help in Korah would first go to spiritual
leaders such as pastors or priests for prayer or counselling, or they would seek solutions through
traditional religious practices such drinking or immersion in holy water (baptism), taking
traditional medicines, or going to the witch doctor who may “call the evil spirit…to judge” or
may suggest that a sacrifice be made to evil spirits “like coffee, smoking incense...like
slaughtering sheep or chicken.” Tessema described that
the community are predominantly Orthodox. The first thing they prefer is to go to the
witchcraft. Witchcraft, yes, or to the priest. Here in the Orthodox church, the priest they

47
have their own magic or kind of doctor, witchcraft. They go there...but if they are
evangelical, they directly go to the pastor to pray for them.
Kidist and Tessema further described that if the practicing of ‘Sabelle’ (the name for the
Orthodox baptism program) or the prayers of the pastor or priest do not adequately meet the
Korah woman’s need, the final step for most individuals would be to consult a hospital or
physician; however, this was noted as being a last resort for most women. Research done by the
Federal Democratic Republic of Ethiopia Ministry of Health (2012) affirms that in Ethiopia
“severe mental illness is more often attributed to supernatural causes, for example spirit
possession, bewitchment or evil eye, rather than as a result of biomedical or psychosocial causes.
As a consequence, affected individuals and/or their families often seek help from religious and
traditional healers rather than health facilities” (p.12). Indeed, a greater understanding of the
spiritual lens that informs Ethiopian understanding of mental health will be important for
establishing effective ways to address women’s health in this context.
Asher described Korah women as being “much more susceptible and open, and receptive
of kind of the spiritual realm” including the use of alternative medicines such as those provided
by witch doctors. “Bizarre spiritual things” such as demon possession were also described as a
common occurrence in Ethiopia by Asher and several other participants. Tessema offered his
perceptions of the contrast between Western and African spiritual worldviews, and the
importance of understanding how this world view may influence many Korah women’s
perspectives on the causes and solutions for distressing psychological symptoms and behaviours:
The Africans and the West have different world view. The West believe that God is the
creator, and he only bless as much…as much as we...as long as we work from service. Or
anyway, most Western do not believe in God, they believe only that if you work hard you

48
will get wealth. But when you come to Africa, Africans think that everything is guided by
God or angels and evil spirits...the universe is guided by that. So, they seek solution from
them. They seek solutions, they seek support to be rich or economically better, they seek
support from God or the angels or the evil spirits to get good health, even to have good
relationship with people (Tessema).
Repeatedly in the data, participants affirmed that Ethiopian women in this community
often have a spiritual conceptualization of the problems that they face, particularly those related
to mental health. “Africans believe that illness is not only a physical thing,” (Tessema) which
suggests that there are contributing factors beyond simple medical explanations for women’s
circumstances and challenges. Shalom expressed that
Most of the time, when someone is mentally ill, they directly link it with evil spirit. They
believe that it is due to evil spirit. So, any family or somebody don't want to be labeled
mentally ill because the neighbour or the community around them will talk about them as
that...that they are just worshipping evil spirit.
When asked whether women might vary in this conceptualization of their mental
wellbeing based on factors such as education level or variations in cultural groups, the same
participant responded that “it is more of cultural belief...culturally, yeah most people believe that.
But maybe educated people will be better at understanding and going to get help, but most of it is
culture…” Tessema offered a poignant comparison of Western and African worldviews, and how
this has a significant influence on the causes attributed to certain problems:
After the Enlightenment in the West, they value medical enlightenment and reason is
very important in thinking. In fact, they benefited from that. It is important. In another

49
way, it puts God within reason. In Africa, they believe that everything is a result of
unseen spiritual forces. First you need to understand their worldview.
In his observations, Africans tend to “think all good things and bad things, circumstances uh,
opportunities, evil situation, all these directed by unseen forces. God is within this as a supreme
God, and the angels is under him, and the evil spirits.” Through this lens, if God is good and is
not to be blamed for evil, then it is determined that the “evil spirit is the cause of mental health,
even their poverty, bad relationship with their friends...all bad things caused by evil spirit.”
Therefore, it is natural that many women in Korah tend to attribute their mental and
physical health challenges to spiritual oppression or evil forces. Another participant described
that this worldview can make it difficult at times to distinguish between problems that he sees as
truly being of a spiritual nature, or those which might be addressed more adequately when
approached as a more complex mental health concern:
it makes it very hard for someone in the profession of mental health to kind of say you
know ‘what am I dealing with here?’ You know, because people automatically just want
to treat something as if it's a spiritual problem (Asher).
This tension creates a delicate complexity in the quest to improve service delivery for this
population. The aim of services is ultimately to honour cultural and spiritual conceptualizations
of problems, while ensuring that the measures taken to address mental health issues avoid
exacerbating stigma and still address the full complexity of the psychosocial challenges faced by
women in Korah.
Faith and spiritual community as both a protective and a risk factor.
Faith communities were noted in the study as having the potential to enhance women’s
ability to cope with the impacts of poverty, while also having the potential to compromise

50
women’s resilience toward poverty and mental health challenges. Several participants noted the
positive impact that community and collective support can have in the lives of women
experiencing poverty. Steve noted that different religious communities seem to vary in their
capacity to assist women who are struggling economically:
the Muslim community has a better handle on kind of caring for their own. They are
more likely to make sure that the children are in school, or the mom has some kind of
outlets too. And that's why in our project only 10% of the population is Muslim, while
the area would have a much greater representation of them.
As noted earlier in the study, faith and spiritual community was referenced as a support system
for many women in Korah through providing a sense of hope and purpose beyond the burdens of
one’s present reality and challenges.
One participant spoke about potentially negative or stigmatizing experiences that some
Ethiopian women may face within their religious communities when they seek help for mental
health challenges. For those women who deeply link their identity and sense of self with their
faith, the possibility of harm or shame could be amplified when undergoing ‘spiritual
deliverance’ sessions:
within protestant churches, um there's a very strong belief that once someone becomes a
Christian then any kind of problems they've ever had go away. So… if they stick around,
then there's only two options, the one is that the person didn't actually come to Christ, or
the second option is that they…um that they're demonized. And so, they go through long
deliverance sessions which actually end up many times inflicting more psychological
wounds on people, depending on how those are handled. So that means that even the
church community's not able to... is not equipped to the place where they're able to step

51
in. And so, I think I would say that it's not just mental health, all services that would be
impacting the poor um within Ethiopia are severely underdeveloped compared to um
most other places. (Steve)
The same participant described that the approach to these spiritual deliverance sessions is what
can inflict shame:
sometimes the person would be called up to the stage in the middle of a worship sermon,
worship service, and the pastor would begin to pray and scream and shout over the
person, sometimes for long, long, long periods of time. Sometimes it’s done in more
private settings... lots of screaming, lots of shouting, um...lots of um...and I mean in those
settings, they can go on for 2, 3 hours.
The public nature of such practices begs the question of how women seeking help in this
way might be perceived by others in the congregation, or how the women might perceive
themselves if the problem they are seeking help for does not get addressed through the
‘deliverance sessions’. Could this be interpreted by her or her faith community as her lacking
enough faith, lacking God’s favor, or somehow ‘doing’ spirituality wrong? The shame of being
perceived as doing something wrong in one’s faith may have the effect of blaming the individual
for their circumstances, rather than offering the spiritual and psychological freedom that is
intended by spiritual practices like ‘deliverance sessions’. The tension in addressing this delicate
issue is in discerning the individual and the community’s perceptions of what problems are
instances of spiritual oppression, which problems may be attributed to psychosocial, or a
combination of cultural, spiritual, and environmental factors.

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Tensions of Development Work
Positive impacts of development work.
Tensions of development work became an integral theme that emerged in the data. This
theme can further be separated into three sub-categories: positive impacts of development work,
“dependency syndrome”, and unpacking “dependency syndrome”. Some positive consequences
of the presence of foreign organizations and people in Korah include an increase in financial and
material resources, relationship and partnership, and educational and income generation
opportunities. Interestingly, several participants mentioned child and family sponsorship as being
helpful programs, however each also highlighted that while needed, the financial and material
aid of these programs need to be offered alongside a “well-executed plan” (Asher) that also
considers the long-term impact of these programs on families.
Programs that offer material aid and resources such as food, rent, and education were
highlighted as being necessary due to a very depressed economy that leaves many in Korah
unable to meet their basic needs. Shalom confirmed the need for material support in the area,
stating: “I think there are many women, or many people who need help, immediate help. So after
just making them to survive by providing basic things. As I said, we have to think for sustainable
program.” Kidist described that some positive implications of sponsorship and foreign influence
include “giving them whatever's necessary like the grocery, and provisions of those things that
help them to provide for themselves and their family. And ... access to health services, education,
and all those basic needs and basic and essential stuff.” The World Health Organization (2008)
offers evidence that there is a substantial need for this kind of holistic intervention in Ethiopia, as
“poverty increases the likelihood of mental health difficulties and this affects a person’s ability to
contribute to the economy, highlighting the way in which poverty and mental health difficulties

53
are often intrinsically linked in a vicious cycle” (as cited in Swancott, Uppal, & Crossley, 2014,
p.581).
One participant’s description of the primary advantages of foreign involvement focused
on knowledge sharing, partnership, and funding. He noted that some primary positives include
raising awareness for long-term engagement of... long term funding of projects, long term
equipping... kind of imparting to projects what's needed for them to care for the moms
and the women. Um, we believe very strongly that its nationals, its locals that do the
actual face-to-face work, and so as far as the benefit to the women at the end of the day,
um the direct benefit I would say comes through the organization getting extra funding,
um and extra resources. (Steve)
He also described creative advantages that westerners could share with those in Korah including
taking that entrepreneurial spirit and trying to help them think within their culture what
they can do to really engage with that. And then experience sharing also with staff
members as far as imparting the ...you know spending time with medical people to help
them understand, maybe there's some improvements to the systems of how they provide
care, helping teachers hone their skills, those kinds of things…
Through this process of collaboration, partnership, and sharing of expertise, positive outcomes
have been seen in Korah such as creativity, and enhanced levels of efficiency and care.
“Dependency syndrome”.
While some positive impacts of development were noted by all participants, the
interviews also revealed that foreign involvement or development work in Korah has a range of
potentially negative impacts. All seven participants voiced that development organizations have
the potential to end up fostering dependency among the Korah community. Yacob described that

54
organizations which provide for material needs only are often not helpful in the long-term
because “not a lot of women independent from the organizations because of they always waiting
from money.” The implication is that even though the material needs are met, some women
become dependent upon organizations to provide for their needs, which does not offer a longterm or sustainable solution to poverty. While stated differently, Asher also expressed a similar
sentiment, that “prolonged sponsorship or aid can be more negative than positive” in terms of
providing effective long-term support. Steve suggested
at times [aid] can continue to create this dependence, this dependency syndrome where
the expectation is that here come the foreigners in from abroad, and they're here to give
free stuff away. Which often times only addresses kind of the very tip of material
poverty, but it never can get down into the root causes of poverty. And it almost makes it
a kind of a superficial kind of intervention then.
From an anti-oppressive social work lens, these findings are significant for social workers
and NGOs as they suggest that it is important to question how development is done, and how it is
impacting individuals’ lives. This is consistent with Baines’ (2011) emphasis on the importance
of asking “who benefits from the way things operate at any given point in time, who can help
make the changes we want… and how multiple strands of power are operating in any given
scenario” (p.6). These findings imply that there are significant flaws in some current models of
aid/ development, and it may be an opportune time to question who is truly benefiting from this
process. Are foreign donors benefiting more from their involvement because they feel like they
are making a difference, or is development structured in such a way as to ensure that sustainable
and empowering change is truly taking place? More research may be necessary to explore these
important questions.

55
Several participants used the term ‘dependency syndrome,’ describing how this
phenomenon can manifest and affect the community of Korah in a variety of harmful ways,
individually, economically, and culturally. Kidist expressed that
sometimes there are handovers. Handing over some things. So, the women they see a
westerner, they think of getting something, expectation. And this is affecting them in so
many ways. One – they lie about themselves and their family situations…and to the point
sometimes of showing a house that is in a very terrible situation when in fact that’s
another person’s house because you know they have pity and they will get many things.
These dynamics highlight not only the high level of need and lack of choice that many women
experience, but also shows how women are put in a greater state of vulnerability when aid is not
carried out cautiously and responsibly. That some women feel they must lie to get support to
meet their basic needs implies that there is a level of shame involved in the process of asking for
help. Or, they feel that they must demonstrate how dire their circumstances are to prove they are
worthy of receiving economic support. It would be important to explore the factors that drive
some women to give false information about their families in attempts to provide for them.
In terms of how dependency impacts Korah women economically, Tessema stated that
many individuals “live by getting some assistance from NGOs” and his negative observations
from that process are that it “doesn't make them economically independent. Instead it makes
them economically dependent.” Kidist described that the long-term impact she has observed in
Korah due to this is that “many people instead of engaging themselves in something serious, like
having a business of their own, or instead of being independent and doing something, they would
look for different organizations to be sponsored.” In certain instances, she described that those
who are currently employed will even leave their current jobs to become a beneficiary. This of

56
course, promotes the opposite of economic self-sufficiency and empowerment. Further, she
argued that the presence of many different NGOs and services can make it difficult for
beneficiaries to choose a specific program to commit to. This can complicate NGOs and the
Ethiopian government’s ability to track which families are receiving support from multiple
organizations, and those families that are receiving none.
These findings suggest that the presence of a variety of NGOs, charities, and programs in
the area - especially those that do not incorporate a gradual transition towards education and
financial independence - can have the effect of discouraging impoverished women from working
for themselves. One participant described how the culture in the Korah area has been negatively
impacted by the presence of certain foreign visitors who give money to people they meet on the
street, a practice which over time, has encouraged many adults and children in Korah to beg:
‘I am needy, I am needy people, I am needy people, please give me, forenge, forenge!’
…It is not good culture in our culture even it is condemned that…We don't like this, but
because of a lot of visitors, a lot of Westerns, community members are affected and lose
our culture, our just ...we don't care about what people say give me, give me, give me...
(KS)
This finding also demonstrates how irresponsible foreign actors may serve to discourage
independence and self-sufficiency, by encouraging a culture of begging which is not historically
acceptable in this community.
Unpacking “dependency syndrome”.
It is important to unpack the term “dependency syndrome” as well as the challenges that
participants named as they discussed their interpretations of how dependency is manifested in the
Korah community. As participants spoke about dependency in Korah women, they did so

57
alongside discussions of the need for international partners to be mindful of the critical need for
sustainability and long-term empowerment of women. It did not seem to be the intention of any
participants to blame women as being responsible for dependency. However, as Fraser and
Gordon (1994) poignantly state, “naming the problems of poor, solo-mother families as
dependency tends to make them appear to be individual problems, as much moral or
psychological as economic. The term carries strong emotive and visual associations and a
powerful pejorative charge” (p.331). Therefore, as supportive professionals and social workers it
is critical to be mindful of how language can serve oppressive or blaming agendas, even when
that is far from one’s intent.
In their discussions of women being in a position of economic dependence, participants
reflected the sentiment that sustainability and empowerment should be the goal of organizations:
If you have any just... concern to help me, you have to ask me first. What shall I do? I
need this. After this I will stop my help. Can you sustain by yourself? Even I will help
other boys, I will help other girls, sure. This is sustainability. And also, this is connection
to each other. I have to learn from you, just help each other…The programmer design the
program and other social workers, they have to, they have to know the strategy how they
are going to just bring out the community from their snare... just the community may
have vision after you train, a lot of training, and encourage them (KS).
In this regard, organizations and social workers are responsible for the ways that they
facilitate development work, and how these approaches impact the empowerment of women.
When development work fails to equip women over time with a means of providing for
themselves, it may enhance women’s vulnerability by encouraging a system in which they are
reliant on external organizations or people to meet their daily needs. While this position of

58
vulnerability is largely due to a lack of economic choice and freedom, participants repeatedly
commented that while reliance on sponsorship money or material goods is beneficial for women
(and often necessary) in the short-term but fails to offer long-term sustainability. In fact,
vulnerability may be enhanced in cases where funding is from foreign sources, as there is always
the potential that funding could dwindle or get interrupted due to shifts in political agendas in the
local or international community.
Managing ‘dependency’ then is largely the responsibility of NGOs, local government and
front-line workers. Participants gave several examples of ways in which their current
organizations have successfully transitioned individuals from a place of living off sponsorship
donations, to being able to economically provide for their families; this has been done through a
combination of small businesses, investing in personal and group savings accounts, participation
in savings and credit self-help groups, all methods that help contribute to the local economy, and
thereby enhance the potential of sustainability. Tessema shared that the “western look for ways
they can empower [women] economically by providing training to do something or by giving
seed money to start minimum business - they will be empowered economically and become
financially independent.”
It is important to critique the implications of the language of ‘dependency’ and how this
can influence perspectives on and approaches to development. For instance, participants
cautioned against several colonizing practices that they had identified more generally in the
community of Korah, namely, projecting Western ways of thinking onto the locals, and
undermining the authority and ideas of locals. Asher cautioned against circumstances
[W]here its more about kind of colonizing a ministry versus growing a ministry. You
know like you’re just kind of colonizing the people and getting them to think a certain

59
way like you do, versus kind of understanding how they think and how you think, and
then making an educated decision based on what’s best for them and not what’s best for
you.
This striking statement underlines the importance of the need for reflexivity in the
process of development, and to ensure that improving women’s health is truly the underlying
motive in development projects. As Lawrence and Dua (2005) state, it is important as an antiracist feminist to recognize the ways that we participate in the ongoing colonization agenda.
Even in the act of ‘helping,’ there is potential for unintentionally harming others. Several
participants spoke about the need to include the cultural perspectives and expertise from local
Ethiopian leaders, rather than using methods and words that could be ineffective, or even
offensive because they are not properly catered to the culture and the people. Yacob provided a
contrast of American or Canadian cultures to Ethiopian, suggesting that Ethiopian cultural
traditions differ quite significantly:
they are not like very open to talk about it sometimes and so it takes time. So, I think
that's why it's very important to know the culture, how you say it, how the words, you
know. That's why if you work with the local, the local knows the culture, there are a lot
of smart women in Ethiopia; they speak English, they went to college, um and they work
like this kind of organization, and they're very, um really smart women too. So, work
with those womens, the culture and they know how to talk about it. And then it takes
time, you can learn from them.
These findings affirm the need for anti-oppressive and context-specific approaches in Korah
which incorporate the local expertise of women receiving services, service providers, and those

60
who are involved in funding, providing training, and shaping the policies and practices of
development.
Implications for Policy, Practice & Future Research
The findings of this study suggest that one of the most debilitating impacts of poverty is
the way in which it severely limits or eradicates women’s choice. In matters of advocacy,
education, financial provision, and prevention of health and mental health crises, Korah women
rarely possess the economic or social freedom to seek the support and education required to
allow them to experience optimal health. This barrier speaks to the need for social workers in
Korah to serve as advocates for women who may not know their rights to treatment or support,
or even know the services available to them. In addition, supportive professionals must exercise
awareness and adaptability when creating preventative health strategies, recognizing that the
seemingly simplest of interventions such as boiling water to prevent waterborne illnesses may be
restricted by women’s severely limited socioeconomic situations. Working with women directly
to identify barriers to applications of health interventions could be an important step in making
change realistic and effective. In addition, further research is needed on the systemic and cultural
factors that contribute to limited or transient family involvement for a large proportion of Korah
men.
As Ember and Ember (2004) attest, “what people do for their health depends to a large
degree on how they understand the causes of an illness” (p.6). Interviews revealed that for many
Korah women, their initial interpretation of health and mental health concerns, is that they derive
from a spiritual cause or affliction. Therefore, churches, pastors, priests, and places of worship
are often the first places that women will go to for counselling or support with their mental
health. More research is needed to understand the frameworks and methods used by local Korah

61
churches and mosques to approach the poverty and mental health issues displayed by women in
their community. Collaboration, training, and communication is needed between spiritual
leaders, mental health, and health professionals to more holistically address the spiritual, mental,
and socioeconomic needs of Korah women. A study by Monteiro & Balogun (2013) discussed
that communication between those offering modern and traditional approaches to healing “would
help to identify the beliefs and practices effective and those that are harmful and under what
circumstances” (p. 11-12). The need for humility and an intersectional practice emphasis cannot
be ignored when working to create truly effective resources for diverse people across cultures,
continents, ethnicities, and gender. To embody this anti-oppressive framework in social work
practice, one must follow Wehbi’s suggestion that “instead of seeing ourselves as insiders or
outsiders, experts or novices…[we] need to see that we are always ‘in relation’” (2011, p. 138).
This perspective frees social workers from the constraints of binary thinking, allowing the
embrace of messy contradictions that are inherent in collaborative social work practice.
Tensions are inherent in international social work, due to the sometimes-conflicting
values, beliefs, practices, and politics that influence individual and agency priorities. It is
important for social workers to be cognizant of the implications of using the language of
‘dependency’ in their work with impoverished women, as it can contain subtle and overt
messages of blaming them for their circumstances, lack of choice, and lack of agency. It is
significant then for social workers and professionals in these contexts to consider not only the
language they use in development, but also the constant need for reflexivity, collaboration,
reflection, and ongoing research in their development projects. These measures are important for
ensuring that sustainable, empowering, and effective change is being pursued in Korah women’s
lives.

62
Conclusion
This research explored key informants’ insights into how women in Korah are impacted
by poverty, the factors that help them cope with these impacts, and important considerations for
improving the practices of supportive professionals working directly with these women. While
there are certainly benefits to international social work with women in this community,
approaches must be carefully developed in concert with local leaders, government, beneficiaries,
and cultural insiders to truly contextualize services and programming so that it fits within a
cultural framework that is relevant and meaningful. Because poverty is created and maintained
through a complex interplay of economic, political, environmental, social, and spiritual factors,
context needs to be explored thoroughly before best practices can be developed. This study has
therefore explored not only the coping strategies used by women to navigate the impacts of
poverty, but also broader questions about factors that inhibit their access to health resources;
such a perspective sheds light on oppressive structural and political forces in their lives.
Exploring the various dimensions of power in practice is important in international social work
with women, as these forces do not operate in isolation. They are fueled and shaped by political
constraints and objectives, the friction or merging of foreign and local ideologies and culture,
and the micro interactions that occur between researcher and researched, and the social worker
and the recipient of services.

63
References
Alfred, T., & Corntassel, J. (2005). Being Indigenous: Resurgences against contemporary
colonialism. Government and Opposition, 598-614.
Allen, K., & Jaramillo-Sierra, A. (2015). Feminist theory and research on family relationships:
Pluralism and complexity. Sex Roles, 73(3-4), 93-99. doi:10.1007/s11199-015-0527-4
Arzubiaga, A. E., Artiles, A. J., King, K. A., & Harris-Murri, N. (2008). Beyond research on
cultural minorities: Challenges and implications of research as situated cultural practice.
Exceptional Children, 74(3), 309-327. Retrieved from http://web.a.ebscohost.com.proxy.
ufv.ca :2048/ehost/pdfviewer/pdfviewer?sid=f69e971d-96e9-4f71-94d0-1dabb8035bb4
%40sessionmgr4006&vid=7&hid=4104
Ayano, G. (2016). Primary mental health care services in Ethiopia: Experiences, opportunities,
and challenges from East African country. Journal of Neuropsychopharmacology &
Mental Health, 1(4), 1-3. DOI: 10.4172/2472-095X.1000113.
Baines, D. (2011). An overview of anti-oppressive practice. In D. Baines (Ed.) Doing antioppressive practice (pp. 1-24). Halifax, NS: Fernwood Publishing.
Brown, C. (2011). Reconceptualizing feminist therapy: Violence, problem drinking, and restorying women’s lives. In D. Baines (Ed.), Doing Anti-Oppressive Practice: Social
Justice Social Work (2nd ed.), (95-115). Halifax, NS: Fernwood Publishing.
Clough, P. T., & Fine, M. (2007). Activism and pedagogies: Feminist reflections. Women’s
Studies Quarterly, 35(3/4), 255-275.
Congress, E.P. (2005) Cultural and ethical issues in working with culturally diverse patients and
their families, Social Work in Health Care, 39(3-4), 249-262.
doi: 10.1300/J010v39n03_03

64
Department for International Development. (2007). Building consensus for social protection:
Insights from Ethiopia's productive safety net programme (PSNP). Retrieved from:
https://europa.eu/capacity4dev/project_psnp_ethiopia/document/building-consensussocial-protection-insights-ethiopias-productive-safety-net-programme-p-0
Dietz, C. A. (2000). Responding to oppression and abuse: A feminist challenge to clinical social
work. Affilia: Journal of Women & Social Work, 15(3), 369-389.
doi: 10.1177/08861090022094001
Drolet, J., & Heinonen, T. (2012). An introduction to international social development. In T.
Heinonen & J. Drolet (Ed.), International social development: Social work experiences
and perspectives, (1-12). Blackpoint, NS: Fernwood Publishing.
Dudley, J.R. (2011). Research Methods for Social Work (2nd edition). Boston, MA: Allyn &
Bacon.
Dumbrill, G. (2011). Doing anti-oppressive child protection casework. In D. Baines (Ed.), Doing
Anti-Oppressive Practice: Social Justice Social Work (2nd ed.), (51-63). Halifax, NS:
Fernwood Publishing.
Dussel, I. (2015). Feminists in search of a postcolonial turn: Locating ourselves in the geopolitics
of knowledge. Gender and Education 27(2), 95-96. http://dx.doi.org/10.1080/
09540253.2015.1016328
Ember, C. R., & Ember, M. (2004). In Encyclopedia of Medical Anthropology: Health and
Illness in the World’s Cultures. Retrieved from https://books.google.ca/books?
id=nrMRezmNrPcC&pg=PA143&lpg=PA143&dq=mental+health+paradigms+in+Ethio
pia&source=bl&ots=WWQxmlbgtw&sig=X7j7Ml7dRdAjmK0Ow9pSn1w7BbY&hl=en

65
&sa=X&ved=0ahUKEwjShpzyhvfZAhVX9GMKHV5NBwYQ6AEIZDAG#v=onepage
&q=mental%20health%20paradigms%20in%20Ethiopia&f=false
Epston, D. (2014). Ethnography, co-research and insider knowledges. Australian & New
Zealand Journal Of Family Therapy, 35(1), 105-109. doi:10.1002/anzf.1048
Eyal-Lubling, R., & Krumer-Nevo, M. (2016). Feminist social work: Practice and theory of
practice. Social Work, 61(3), 245-254. doi: 10.1093/sw/sww026
Fay, J. (2011). Let us work together: Welfare rights and anti-oppressive practice. In D. Baines
(Ed.), Doing Anti-Oppressive Practice: Social Justice Social Work (2nd ed.), (64-78).
Halifax, NS: Fernwood Publishing.
Federal Democratic Republic of Ethiopia Ministry of Health. (2012). National mental health
strategy 2012/2013 – 2015/2016. 1-53. Retrieved from
http://www.globalmentalhealth.org/resources/introducing-ethiopia%E2%80%99snational-mental-health-strategy-201213-201516-federal-ministry-health-ethiopi
Fekadu, A. (2010). Studies on affective disorders in rural Ethiopia. Department of Clinical
Sciences Division of Psychiatry. Retrieved from https://www.researchgate.net/
publication/267681200_Studies_on_Affective_Disorders_in_Rural_Ethiopia
Fraser, N. & Gordon, L. (1994). A genealogy of dependency: Tracing a keyword of the U.S.
welfare state. Signs, 19(2), 309-336. Retrieved from https://povertyandsociety.files.
wordpress.com/2015/08/3174801.pdf
Fujii, L. A. (2012). Research ethics 101: Dilemmas and responsibilities. PS: Political Science
and Politics, (4), 717-723. Doi:10.1017.S1049096512000819
Hailemariam, M., Fekadu, A., Prince, M., & Hanlon, C. (2017). Engaging and staying engaged: a
phenomenological study of barriers to equitable access to mental healthcare for people

66
with severe mental disorders in a rural African setting. International Journal for Equity
in Health, 16(1), 1-12. DOI 10.1186/s12939-017-0657-0
Hailu, D., & Northcut, T. (2012). Ethiopia’s social protection landscape: Its surface and
underlying structures. International Social Work, 56(6), 828-846.
doi:10.1177/0020872812441646
Jalal, B., Samir, S. W., & Hinton, D. E. (2016). Adaptation of CBT for traumatized Egyptians:
Examples from culturally adapted CBT (CA-CBT). Cognitive And Behavioral Practice,
(13),1-14. doi:10.1016/j.cbpra.2016.03.001
Jeffery, D. (2005) ‘What good is anti‐racist social work if you can’t master it’?: Exploring a
paradox in anti‐racist social work education. Race Ethnicity and Education, 8(4), 409425. Retrieved from http://dx.doi.org/10.1080/13613320500324011
Jiwani, Y. (2009). Helpless maidens and chivalrous knights: Afghan women in the Canadian
press. University of Toronto Quarterly, 78(2), 728-744. Doi:10.3138/ UTW.78.2.728
Kumsa, M. K. (2011). A resettlement story of unsettlement: Transformative practices of taking it
personally. In D. Baines (Ed.), Doing Anti-Oppressive Practice: Social Justice Social
Work (2nd ed.), (229-248). Halifax, NS: Fernwood Publishing.
Lawrence, B., & Dua, E. (2005). Decolonizing anti-racism. Social Justice, 32(4), 120-143.
Loewy, M. I., Williams, D. T., & Keleta, A. (2002). Group counseling with traumatized East
African refugee women in the united states: Using the kaffa ceremony
intervention. Journal For Specialists In Group Work, 27(2), 173-191. Retrieved from
http://www.unevoc.unesco.org/e-forum/EbscohostTVET.pdf
Mohanty, C. (1984). Under western eyes: Feminist scholarship and colonial discourses.
Boundary 2, 12/13(3/1), 333-358.

67
Monteiro, N. M. & Balogun, S. K. (2013). Perceptions of mental illness in Ethiopia: A profile of
attitudes, beliefs and practices among community members, healthcare workers and
traditional healers. International Journal of Culture and Mental Health, 7 (3), 1-16.
DOI:10.1080/17542863.2013.784344
Mugisha, J., Abdulmalik, J., Hanlon, C., Petersen, I., Lund, C., Upadhaya, N., & ... Kigozi, F.
(2017). Health systems context(s) for integrating mental health into primary health care
in six Emerald countries: a situation analysis. International Journal Of Mental Health
Systems, 111-13. doi:10.1186/s13033-016-0114-2
Palmer, D. (2010). Beyond buna and popcorn: Using personal narratives to explore the
relationship between the Ethiopian coffee (buna) ceremony and mental and social wellbeing among Ethiopian forced migrants in London, UK. Advances In Mental Health,
9(3), 263-276. Retrieved from http://dx.doi.org/10.5172/jamh.9.3.263
St. Denis, V. (2004). Real Indians: Cultural revitalization and fundamentalism in Aboriginal
education. In C. Schick, J. Jaffe & A. M, Watkinson (Eds.), Contesting fundamentalisms
(pp. 35-47). Halifax: Fernwood.
Swancott, R., Uppal, G., & Crossley, J. (2014). Globalization of psychology: Implications for the
development of psychology in Ethiopia. International Review of Psychiatry, 26(5),
579-584. Doi:10.3109/09540261.2014.917610
Tangenberg, K. M. (2005). Faith-Based Human Services Initiatives: Considerations for Social
Work Practice and Theory. Social Work, 50(3), 197-206. Retrieved from https://eds-bebscohost-com.proxy.ufv.ca:2443/eds/pdfviewer/pdfviewer?vid=8&sid=8cc861d7-3e3b4b97-ae3d-22c55fac93a1%40sessionmgr4006

68
Turner, S. G., & Maschi, T.M. (2015). Feminist and empowerment theory and social work
practice. Journal of Social Work Practice, 29(2), 151-162.
Doi:10.1080/02650533.2014.941282
Ventevogel, P. (2014). Integration of mental health into primary healthcare in low-income
countries: avoiding medicalization. International Review Of Psychiatry (Abingdon,
England), 26(6), 669-679. doi:10.3109/09540261.2014.966067
Wehbi, S. (2011). Anti-oppressive community organizing. Lessons from disability rights
activism. In D. Baines (Ed.). Doing anti-oppressive practice (pp.132-145). Halifax, NS:
Fernwood Publishing.
Weinberg, M. (2006). Pregnant with possibility: The paradoxes of “help” as anti-oppression and
discipline as a young single mother. Families In Society: The Journal Of Contemporary
Social Services, 87(2), 161-169.
White, A. M. (2011). Unpacking black feminist pedagogy in Ethiopia. Feminist Teacher, 21(3),
195. Retrieved from http://www.jstor.org/stable/10.5406/femteacher.21.3.0195
Williams, M. T., Chapman, L. K., Buckner, E. V., & Durrett, E. L. (2016). Cognitive behavioral
therapies. In A. Breland-Noble, C. S. Al-Mateen, N. N. Singh, A. (Eds.), Handbook of
mental health in African American youth (4), 63-77. Doi:10.1007/978-3-319-25501-94
Williams, M. T., Chapman, L. K., Wong, J., & Turkheimer, E. (2012). The role of ethnic identity
in symptoms of anxiety and depression in African Americans. Psychiatry
Research, 199(1), 31-36. doi: 10.1016/j.psychres.2012.03.049
World Health Organization. (2005). WHO mental health atlas 2005: Profiles countries E-I.
Retrieved from http://www.who.int/mental_health/evidence/atlas/profiles_countries
_e_i.pdf?ua=1

69
World Health Organization. (2006). WHO-AIMS report on mental health system in Ethiopia.
Retrieved from http://www.who.int/mental_health/evidence/
ethiopia_who_aims_report.pdf
Young, I. M. (2003). The logic of masculinist protection: Reflections on the current security
state. Signs: Journal of Women in Culture and Society, 29(1), p. 1-25. Retrieved from
http://www.signs.rutgers.edu/content/Young,%20Logic%20of%20Masculinist%20Protec
tion.pdf

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Appendix B
Recruitment Email
Introduction
My name is Jacqueline Strating and I am a Master of Social Work Student at the University of
the Fraser Valley. I will be the principal investigator for this study. I currently work in the field
of social work and international development, and have an interest in working with women who
experience multiple barriers including poverty, trauma, and mental health challenges.
I believe that it is important to gather information about the strengths and limitations of current
programs, strategies, and cultural practices to provide support and services that are effective and
culturally relevant for women experiencing the adverse effects of poverty in Korah, Ethiopia. It
is recognized that the health issues faced by women living in poverty are complex, varied, and
unique to each community. My goal is to strengthen the knowledge of best practices when
working with these women to meet their social, emotional, economic, physical, spiritual, and
psychological needs through gathering information from individuals with first-hand experience
working alongside women living in poverty in Korah.
Purpose/Objectives of the Study
This project is seeking information on the strengths and coping strategies used by women in
Korah, Ethiopia to cope with the impacts of poverty on their health. Another goal is to gain
information about the barriers and gaps that limit women in Korah, Ethiopia from experiencing
optimal levels of social, emotional, economic, physical, spiritual, and mental/psychological
health. This information will be gathered through conducting in-person interviews with
individuals who have worked closely with women living in poverty for at least 1 year, and who
have worked specifically with women in Korah for at least 6 months. This may include human
service workers, social workers, nurses, social services workers, or program directors who work
directly with women facing poverty and marginalization. This may also include individuals who
directly provide resources to marginalized women through counselling, medical care, social
support, spiritual support, sponsorship, or income generation services.
Procedures involved in the Research
For this phase of the study we are conducting four to six interviews with individuals who have
current or past experience working with women experiencing poverty in Korah. The purpose of
these interviews is to gather information about strengths, barriers and weaknesses used to address
the health impacts of poverty on the lives of women in Korah. The interviews will take place at
the Hope for Korah compound in Addis Ababa, or in a convenient location selected by the
participant. The interview will take approximately one hour of time. The responses from the
participant will be recorded by a Research Assistant, and audio recorded. Your participation is
voluntary, and all responses will be kept confidential.

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The project seeks to assess whether current strategies being used by women and for women in
poverty are achieving the best health outcomes. The benefit of this may result in better services,
training, and relationships between service users and service providers by identifying gaps in
current programs. In addition, it may benefit participants by helping them to examine their
personal experiences and assess their current social work/social service practices with respect to
women living in poverty in Korah. This will ultimately benefit women facing poverty in Korah
and the community overall as better quality programs and services may result.
If you would like to participate in a one hour interview about your experiences and suggestions
to improve services for women in the community of Korah, please respond to this email
indicating your name, contact information, and the name of the agency you work for.

Sincerely,
Jacqueline Strating, BSW, RSW
MSW Student in the Department of Social Work and Human Services
University of the Fraser Valley

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Appendix C
Letter of Informed Consent
School of Social Work & Human Services
University of the Fraser Valley
33844 King Road
Abbotsford, BC V2S 7M8
604-504-7441
January 27th, 2017
Investigating Culturally Relevant Coping Strategies and Resources
to Promote Health for Women Experiencing Poverty in Ethiopia
Letter of Informed Consent for Interviews
Introduction
My name is Jacqueline Strating and I am a Master of Social Work Student at the University of
the Fraser Valley in British Columbia, Canada. I currently work in the field of social work and
international development, and have an interest in studying and working with women who
experience multiple barriers including poverty, trauma, and mental health challenges. I will have
a research assistant helping me to collect and analyze data in this study.
Purpose/Objectives of the Study
This project is seeking information on the strengths and coping strategies used by women in
Korah, Ethiopia to cope with the impacts of poverty on their health. This project is also gathering
information about the barriers and gaps that limit women in Korah from experiencing optimal
levels of social, emotional, economic, physical, spiritual, and psychological/mental health. We
want to learn how to improve the quality and cultural sensitivity of health services for women in
Korah. The Principal Investigator for this study is Jacqueline Strating.
Procedures involved in the Research
Participation in this study will include one in-person interview, lasting approximately one hour in
length. The interview will be conducted by Jacqueline Strating. Either we will have a research
assistant present to take notes, or you will be audio recorded for the purposes of data analysis.
We would like to learn how the health of women in Korah is impacted by poverty, and the
barriers that may prevent them from achieving wellness. We will be asking questions about your
personal and professional experiences and observations of the different ways that women cope
with the impacts of poverty. The interview will take place in Addis Ababa in June, 2017, at a
previously agreed upon location that is convenient for you. Information gained from the
interview will be published in a paper that reviews major findings and themes from the data. It
will be available in the UFV library. Data from the interview may be published in academic
journals, or shared in conferences and informal settings. Data will be used in the future to inform
and improve practices at Hope for Korah and Kore Great Hope Charities, and to increase
knowledge in the field.

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Potential Benefits
The potential benefits of this research include increased knowledge about culturally sensitive and
culturally relevant practices for addressing the mental, emotional, social, spiritual, and physical
challenges faced by impoverished women in Korah, Ethiopia. The research may help expose
gaps that currently prevent women in Korah from achieving optimal health. The community of
Korah will ultimately benefit from this improved cultural sensitivity, awareness, and information
about how to best meet their health needs. This research may also improve professional
knowledge about best practices when conducting cross-cultural research. You may benefit as a
direct result of engaging in the interview process as you will be asked to critically reflect on your
personal experiences and assess the strengths and weaknesses in current agency or personal
social work/social service practices with respect to women living in poverty in Korah. You will
be offered a meal or snack as an honorarium for your time.
Potential Harms, Risks, or Discomforts to Participants
Due to the nature of the small community being studied, and the potential interconnectivity of
organizations and their staff, it is possible that other participants in the study may be aware of
your identity. However, no one outside of the study will know who has followed up and
participated in an interview. No data, transcripts, or identifying information will be shared with
anyone outside of the study. If you choose to disclose your job title and the number of years of
experience you have, this will be grouped together in the published findings with other
participants, so that there is no link between your responses and your identity. You may feel
uncomfortable providing information that comments on any negative practices that your
employer or other local agencies use to address women’s health. You do not need to answer any
questions that make you feel uncomfortable. If you work for an agency that is connected to the
researcher in this study, your decision to participate or not to participate in this study will not
affect your employment, and your responses will be kept confidential.
Confidentiality
All your responses will be kept confidential by the researcher. Your data, name, responses, and
any identifying information will not be shared with anyone other than Jacqueline Strating, her
research assistant, and Lisa Moy - UFV Associate Professor and project supervisor. You will be
given a coded identity, and published responses will also be coded and themed so that there will
be no connection between responses and your identity. Anything that you say or do in the study
will not be published without your permission. Your privacy will be respected. We will secure
all electronic data in password protected computers and any paper files in a locked cabinet. Data
will be safely destroyed after the study is complete by April 30, 2019.
Participation
Participation in the study is voluntary and you may withdraw at any time before, during, or after
the study without consequences. If you choose not to participate there is no penalty. You can also
refuse to answer any questions but stay in the study. If you do decide to withdraw, your
responses will not be used in the analysis and your data will be safely destroyed. You can
withdraw from the study by contacting Jacqueline Strating.

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Study Results
Study findings will be published in a report that will be available at the University of the Fraser
Valley. The final report will also be shared with Hope for Korah and Kore Great Hope Charities
staff as requested. You may contact Jacqueline Strating if you would like a copy of the results of
this study emailed to you.
Questions
Contact for Information about the Study:
If you have any questions about the study you may contact Jacqueline Strating at any time at
You may also contact Lisa Moy at lisa.moy@ufv.ca or at 1-604-504-7441 ext. 4239.
Contact for Concerns:
If you have any concerns regarding your rights or welfare as a participant in this research study,
please contact the Ethics Officer at 604-557-4011 or Research.Ethics@ufv.ca.
The ethics of this research project have been reviewed and approved by the UFV Human
Research Ethics Board.
Consent Form
By signing below, I agree to participate in this study: ‘Investigating Culturally Relevant Coping
Strategies and Resources to Promote Health for Women Experiencing Poverty in Ethiopia.’
I have read the information presented in the letter of informed consent being conducted by
Jacqueline Strating at the University of the Fraser Valley. I have had the opportunity to ask
questions about my involvement in this study and to receive any additional details.
I understand that I have the right to withdraw from the study at any time and that confidentiality
of all results will be preserved. If I have any questions about the study, I should contact
Jacqueline Strating at
If I have any concerns regarding my rights or welfare as a participant in this research study, I can
contact the UFV Ethics Officer at 604-557-4011 or Research.Ethics@ufv.ca.
I consent to having my interview audio recorded for later transcription and data analysis: (please
print yes or no) ________________.
Name (please print) ____________________________________________________________
Signature ____________________________________________________________________
Date ________________________________________________________________________
Once signed, you will receive a copy of this consent form.

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Appendix D
Semi-structured Interview Questions
1) What role do you have in working with marginalized women, and for how long have you
been in this role? In what communities or contexts have you worked with marginalized
women?
2) What are some of the primary health impacts of poverty that you notice in women that
you work with in Korah? Do you notice any social, emotional, mental, spiritual, cultural,
or other impacts?
3) What kinds of social, emotional, mental, spiritual, cultural, or other coping mechanisms
do you observe women using to cope with the impacts of poverty?
4) What kinds of services are available to women to cope with any social, emotional,
spiritual, or cultural impacts of poverty? Do you see any gaps or barriers that prevent
women in Korah from experiencing optimal social, emotional, psychological, spiritual,
and cultural wellbeing?
5) What positive or negative impacts do you see in Korah due to Western or North
American individuals providing services for local Ethiopian women living in poverty?
6) What are your suggestions for improving services and access to services for marginalized
women in Korah?
7) Where is the first place or who is the first person that women would go to for help with
mental health or psychological symptoms?
8) For those women who struggle with mental health challenges, what do they view as the
cause of their mental health problem?
9) Do you see the impacts of trauma while working with women in this community? If so,
what kinds of trauma do women face because of living in poverty? How does trauma
impact their lives or behaviour?