Institute of Community and Public HealthBirzeit University 1 October 2002
Students, Teachers, the Educational Process and the Crossings
Since the students came from different parts of the West Bank and had to go through several crossings, problems in relation to attendance and timing arose quickly, but were dealt with promptly in agreement with the University administration. Some of the problems encountered by students crossing from districts other than Ramallah included:
Late arrival of students, particularly the ones coming from the north and the south of the West Bank, due to closure of the main roads. The students would spend hours traveling on small agricultural paths, dirt tracks, and make-shift, newly erected passageways that people devised to reach their destinations during closures and siege, only to be denied entry at the checkpoint, and then going back and looking for another path that would get them across. Some students in the process gained a first hand experience in mountaineering, unprepared and untrained. On those mountain footpaths, a carriage, a donkey, a horse, each had a price. On the way, several students reported coming face-to-face with dangerous vigilante armed settlers or soldiers, and being held at gun point for several hours at a time. In winter the situation brought the students into class completely wet and muddy, swearing that they would quit the course (which they never did) or, alternatively, saying: ‘I am here despite it all’. At some points, we would stop the class for a finally arriving, exhausted and muddy student and simply clap!
Some students missed much of the contact time with faculty as a result of severe closures that went beyond what was acceptable by the University Administration standards or what was realizable for making up possibilities. Consequently, they were advised to withdraw from the programme without failure, and allowed the chance of joining the programme in the coming year once the severe conditions in their area eased up a bit.
Sometimes while in class, the Israeli army would invade Ramallah city, a bomb would explode inside Israel or around a settlement, or an assassination of a Palestinian figure would take place, whether in Ramallah or other cities. Everyone knew, as soon as such events took place, that severe closure, siege, curfew and/or retaliation would follow. At first, we would immediately stop teaching and send students home. With time, and with the build up of resilience, a strong sense of resistance to preserve sanity, and partially an increasing familiarity with the events and the repeated ‘déjà vu’ effect that normalizes the abnormal, students and faculty alike began to opt for continuing classes at the risk of being stuck in Ramallah. We devised quite a few innovative methods of dealing with students returning home after major incidents. These included shortening contact time and breaks, thus completing the working day early; housing students temporarily in Ramallah hotels and student hostels and even homes; using ambulance services for the doctors and nurses who could work inside the ambulance while at the same time transporting people to their homes; some students even braved the road back under seemingly un-believable conditions, having calculated from experience that retaliation would take a few hours to take shape.
Exams posed a serious problem, given that invariably, some students – never the same ones - were missing from class. Almost all exams were administered at least twice, and on some occasions, three times, in order to accommodate those students who could not make it. Although classes were mostly held in Birzeit during the academic year 2000-2001, Ramallah being used as a back-up teaching station, during much of the academic year 2001-2002, most classes were held in Ramallah as the situation worsened, especially after the closure of the Birzeit road. This entailed a serious compromise in the quality of education, as the Institute Resource Center and computer laboratory were not at hand. While we managed to use computer laboratories kindly donated for our use by local NGOs, some problems were encountered, including those related to system compatibility problems, package version and viruses. Still, we managed to teach the essentials, most importantly the utilization of the Statistical Package for Social Sciences (SPSS) that students could not graduate without. As for the more serious problem of lack of access to the Institute and University libraries, this was dealt with, when possible, through periodic movements of faculty and students to Birzeit only to search for and loan books. However, these periodic moves to Birzeit began to be increasingly difficult, compromising our teaching scheme even further. We are currently only able to reach the libraries once in a while, and have managed to organize ourselves and our needs in such a way as to transport required materials back and forth as necessary (we rent carriages for the crossing, and have not yet moved to the donkey mode). But the situation is far from ideal.
With the increasing and continuous incursions, curfews and siege imposed on all Palestinian cities, students began to miss much of class-time during the first semester of 2001-2002. At some point, administration began to seriously consider semester cancellation. However, this was too high a price to pay by truly admirable students who had taken it upon themselves to go through great lengths and dangers to complete the semester. To solve our problem, several intensive weeks of teaching were held in Ramallah to compensate for lost time, and the Institute again helped in arranging for the housing of those who came from far. While this scheme succeeded to a considerable extent, the toll on administration was very high. There were several times when plans to conduct an intensive week were cancelled or interrupted because of severity of onslaught, only for them to be once again re-planned and rescheduled, with rooms reserved and, equipment lugged, in the hopes that the new date would be more suitable. However, the conditions became so much worse by the summer of 2002 that, after having planned at least 4 times to launch the summer course and not succeeding, it was cancelled, and the two courses that were scheduled to be taught in the summer were weaved into the first and second semesters of the current academic year 2002-2003. At this stage, we suspect that graduation will be delayed this year, perhaps by three months, and maybe even more.
Several of our physician and nurse students were working in ambulances or were on 24-hour shifts covering emergency medical care or primary health care clinics during curfew and siege. At one point, we noted that some have been so traumatized given that they witnessed unbelievable human tragedies (as they often described after one of many traumatic incidents): picking up pieces of bodies, bumping into charred and un-recognizable ones, brains splashed all over, blood, even the death of colleagues in ambulances …This was too overwhelming, so at times we ended up not having class, and instead focused on trauma management using CISM (critical Incident Stress Management), a technique that we had learned from volunteer US psychologists that to train us and others in solidarity with Palestine the summer before. Other students were imprisoned at home experiencing incursions and other traumas, lack of cash, lack of food, electricity and water cuts that came along with these events. In effect, students faced similar problems as the rest of the population: they experienced serious harassment by the Israeli army; some were arrested for extended periods of time (we would count the students when we managed to get to class and begin the search for those who were missing, only to realize that some had, in fact, been arrested); some were shot at, while others witnessed major military operations where innocent civilians were killed and houses demolished. At one point, we realized that most students even began to look traumatized and depressed, either being very quiet or sometimes even crying, men and women. One doctor, who witnessed the death of a colleague sitting behind him in the ambulance during one severe shelling episode, came to class to cry – not to study. All day he described to us how he knew his colleague had been badly injured when he felt the blood splashing all over the back of his head and ears, immediately after the impact of something hitting the ambulance. One of our top students, a teacher, was shot in the abdomen while heading home after work. We never saw him again, as he continues to be in hospital, suffering from a major disability, which has devastated his life forever. Other students escaped death only by miracle, and yet others had their homes blown up, their kin arrested, and became refugees in other areas. Many men were separated from their families because of work location and siege. This meant by necessity that we had to sometimes postpone classes and begin with counseling sessions, gradually working our way towards getting back to the teaching mode.
Emerging Distance Learning
The initiation of distance learning as a complement to ongoing teaching had already been part of our plan of operation for 1999-2004, especially in fulfillment of alumni continuing education goals. The project began by sending a student to study computers/distance learning to Great Britain in the year 2000. Graduating with honors, this staff member came back one year later and concentrated on upgrading the computer and network infrastructure at the institute to allow for the feasibility of distance learning schemes. This was completed during the academic year 2000-2001, although slowly, due to events.
By the academic year 2001-2002, it became very clear that this distance-learning scheme was assuming not only a new meaning, but also an urgency that everyone at the University at large, and not only at the Institute felt. We first started by becoming a mirror site to the cyberspace Epidemiology training scheme operated by the University of Pittsburgh. We launched a few distance learning lectures on selected topics of interest, geared towards our students, our alumni for continuing education purposes, and also towards others who were interested in the field worldwide. This was achieved by a faculty member who had been trained previously in distance learning, and by the staff member trained in Great Britain. In fact, some of the Masters students participated in posting lectures that they had worked on devising as part of their course requirement, under supervision of this faculty member.
By then, faculty and staff had acquired some experience, although not sufficient, as the entire approach to distance learning requires retraining on pedagogic aspects that are more suitable for the purposes than what faculty knew. We attempted to plan for such training at least twice, and each time, we failed to realize our plan because of the increasing severity of the conditions in the country generally, and in Ramallah in particular. As a result, some faculty simply picked up experience through practice, by making mistakes and learning how to better avoid them in the future, as well as through the assistance of the two key persons at the Institute and via the support of the University computer Center.
During this period, what seemed to be continual onslaughts resulted in endless delays in the completion of the first, and then second semester of 2001-2002. By May of 2002, it was becoming clear that the second semester could not be completed neither before the end of July, nor by relying solely on contact with students. The prevailing conditions of course threatened the entire university operations, and related to the need to solve some of the problems of both under-graduate and post-graduate students. At that stage, the idea of generalized distance learning utilizing the network scheme RITAJ was developed by the University Computer Center with the blessing of the University Administration. This scheme was developed to include all courses offered at the University. This initiative of the computer center, super-imposed on our already developing distance learning scheme, pushed us suddenly all the way into this part of our project as a matter of project survival.
Thus many departments began to post outlines and actual lectures on the web, hoping that students would be able to gain the needed access to the Internet. During the curfew lifts, teachers and students would meet to discuss, identify problems and work out difficulties, in addition to answering student questions. Given that we had managed to organize and complete a few intensive weeks of teaching, we only needed to post a few actual lectures on the web, however at that stage, the final examinations remained problematic. With the agreement of Administration, it was decided that conducting final examinations using distance learning methods would be endorsed, but only temporarily in these strenuous times, as the usual University regulations do not allow for examinations to be held other than under the supervision of faculty and on site.
The fortunate part of the story is that by then, and given that we had been working for two years on developing distance learning capacity and schemes, the vast majority of our students were already computerized and networked. This had become a mandatory part of joining our programmes by the year 2001.
Preparation and Implementation
Once we obtained the permission from the University Administration to conduct our final examinations via cyberspace, preparations began. Lists of students’ emails, phone numbers and addresses were compiled. Students were contacted to ensure that their emails were operational. Three students had no access whatsoever, as they were living in remote villages. So we allowed these students to access a fax machine instead, through a friend or a colleague. The tasks at hand included the administration of three written examinations to the Diploma students, and the handing in of two project papers by the Masters students.
Diploma student exams proceeded based on an assigned schedule, with examination questions posted on a specific date and time that was known to all, with clear instructions on when and how students should post their answers. Furthermore, exam questions entailed reading and signing a paragraph below vouching that the students would neither seek nor give information pertaining to the exam to other colleagues.
To complete their projects, the Masters students worked individually in one course, and organized themselves into groups based primarily on geographic location, and secondarily on interest in the topic, as we were certain that this would facilitate learning in these trying times. Communication between faculty and students took place by phone, e-mail and RITAJ, to handle questions and process. Students were asked to feel free to call faculty at any reasonable time. In the main, this worked well, although the question of what reasonable time became an issue. But these were manageable problems, and were accepted by faculty as part of the struggle for education.
Group work was arranged in such a way that every student had to be part of a project focusing on one issue that several students were working on. Yet the final project work had to be written individually by each student and sent to the instructor of the course. The instructor would read the work and send comments back. Once students made the needed corrections or re-adjusted the essay in line with the instructor’s comments, the document was sent to the group for compilation and editing. A fixed date was assigned for the presentation of the projects, again mostly by way of email and Internet, but also by fax.
Once the projects and the exams were corrected, the grades were sent to the coordinator of higher education at the Institute, and endorsed by the Faculty Council, as usual. When the grades were endorsed, they were posted on RITAJ or given to the students by phone if they inquired. If the students had any questions regarding either the grades or the exam, they contacted the instructor directly.
An assessment of the experience
Distance learning used by the Institute in emergency constitutes one of several methods of education and learning known and operational worldwide. Our own version of distance learning was primarily based on the web, Internet and email, in addition to fax and phone connections, and used for limited purposes in a defined period of time. Distance learning has taken various other forms elsewhere, including the use of audio and video conferencing as well as the utilization of computer compact disk training packages aimed at the self learner.
Many of the promises of distance learning are financial in nature. The theory is that class size increases while the overhead remains the same. However, some universities use distance-learning techniques to reach those that would by any other means be unreachable.
Clearly, the utilization of distance learning depends on context and the purpose for which the training is devised. Distance learning can satisfy the promise to deliver classes to a geographically broad and diverse population in more effective ways than others, depending on the contexts and given some purposes. In the case of ICPH, distance learning has indeed helped in completing a semester during emergency, when a forced separation was dictated between students and faculty, and between both and their natural learning habitat.
But there are questions that need to be raised in relation to ICPH’s experience in the area of distance learning. The first pertains to whether distance learning can in fact suit the Institute’s mission and strategy for learning. The second relates to effectiveness; the third, to the problem encountered with students completing their work by soliciting or even purchasing the helping hand of others to complete the work for them, alternatively called ‘cheating’. A fourth question addresses the considerable infrastructural and administrative support requirement to complete this particular type of teaching of a relatively small population of students. Finally, the fifth question relates to the ability of all students to purchase costly computers, learn how to use them, access the web and deal with the materials at hand, given the relative novelty of the computer world in this country, the failing phone lines and electrical currents due to incursions and destruction, and the spiraling poverty and unemployment - a consideration of cost and serious burden on probably the majority of students.
To answer the first question, the Institute’s mission rests on the notion of helping health human resources in building up an alternative view of health and health care delivery, one that is rooted in the broader social context as opposed to only biomedical explanations of health and disease. ICPH’s mission furthermore entails working to build the concept and the practice of team work, especially among health care providers who have learned to operate as solo performers, and expanding the team to include personnel working in other sectors, such as education, agriculture, social services and the like. It entails helping students in building a new body of knowledge, complementary to what they already know, in ways that can assist them in realizing that they, together, form part of a broader team that is working to build an equitable system of appropriate and quality health care delivery for Palestine.
Strategically, then, ICPH has incorporated into its programmes personnel working in the different sub-sectors of health as well as other related sectors, and sought to help them form themselves into a group through the regular use of the classroom, and through regular contacts and discussions among each other and with faculty members and guest lecturers. It is in this particular context that they learn to appreciate what the other is doing to assist in improving health status; it is in this way that they learn to respect each other, to develop friendships and work together. Their active participation, based on a classroom and personal contact setting, enriches discussions as they bring in their varied experiences into the framework of learning, and as their views of the inter-relatedness of the different types of work that they do is being gradually developed and consolidated. In other words, this process requires face-to-face contact and group presence at the same time in the same place. Our programmes, then, cannot operate utilizing distance learning alone. This would undermine the very ethos of the programme.
To look at effectiveness, designers of distant learning usually start and probably end with empirical and/or technical knowledge: objects, events, and practices, all of which mirror the everyday environment of their designated learners. Then, with a firm theoretical grounding, they develop a presentation, which enables learners to construct appropriate new knowledge by interacting with the instruction. Our experience with distance learning, although successful for a particular goal, cannot be used to fulfill other goals. For instance, while some faculty members did post their lectures on the web, they knew that, in fact, not all students would be able to construct new knowledge out of the distance-learning package in ways that would allow applicability to surroundings. This was due to several reasons: some Diploma students neither had a sufficient body of knowledge related to health as a biological phenomenon but also social construction to be able to achieve this goal, nor the ability to be critical about the type of knowledge that they were pondering. That is, such a scheme is workable only if students already have the knowledge and experiential background to be able to learn in this particular way, and possess an ability to effectively utilize their critical faculties. Given the generally rote memorization context that schools and universities here still must tackle, one wonders about the utility of this particular type of knowledge transfer. As a result of this realization, none of the lectures that were posted on the web were included in the exam, since the quantity of rote knowledge may have been the outcome, but certainly not the quality or the critical examination of this knowledge and its application to the context. The only exception was three Epidemiology lessons, organized in a self- learning format, posted in RITAJ and included in the exam.
In contrast, web learning worked well with the Masters’ students, precisely because they had been through the Diploma programme and had undergone a gradual but systematic build-up, not only of classical and alternative knowledge, but a new way of thinking that rests on critical reading, an understanding of the broader context, and a grasp of the elements required to put this knowledge into practice. Nonetheless, even then, not all students managed to realize this goal this year, just as not all students had achieved this goal in the past, before distance learning emerged and despite intensive classroom assistance. This is because in our experience, some in fact never learn. Somehow, the serious impediments of a historically defective educational experience that rests on rote memory alone, compounded by the severe constraints on critical thinking and innovation in some of the students’ jobs, simply come in the way of this particular way of learning. But those also generally graduate, through extremely hard work, and do make some difference in the field, as we have observed in our field visits to alumni during the past few years.
At another level, to reduce dishonesty in online assessment, students were asked to sign a form as mentioned before. This test of integrity was backed up with mastery-type questions which required the student to know more than the subject matter, and requesting students to relate the subject matters covered to their own personal/professional/life experiences, focusing on process rather than a final product. An example of a process-oriented assessment would be to require students to submit thesis statements, outlines, and rough drafts so that they can see the project grow. Assessments were also oriented toward higher ordered thinking skills, requiring application, evaluation, and synthesis rather than mere factual recall. All the instructors included such questions, making it difficult, but not impossible, to cheat.
For the projects in the Master’s class, high level of instructor-student interaction was maintained through an ongoing dialogue aimed at sensing a student’s ability, as well as reviewing drafts of work projects for every student. This process was more satisfactory for the instructors as more in depth assessment of the students was carried out. But it would not have been possible to apply such a process with the Diploma students, as stated earlier, precisely because they had not quite yet begun to be individual critical learners.
As for infrastructural, managerial and technical support, our experience indicates that if distance learning is to succeed, much infrastructural development at the country level (phone lines that do not get cut, quick, cheap and easy access internet services; and presence of internet services at the different locale’s level) is required. Furthermore, substantial administrative support and backup is also needed to assist the faculty in completing their tasks. Our experience also indicates that to be effective, a significant amount of phone contact with students was imperative, adding considerably to management and contact costs of completing the project successfully. Given the general state of curfew, the administrative and communications load of faculty grew considerably, increasing further the load of already over-burdened personnel, who still persisted in doing their utmost both as a matter of maintaining their sanity, and continuing non-violent resistance to occupation. Faculty often used their own resources to manage the tasks at hand, including at times asking their children and other family members to help out in receiving faxes and phone calls, and in printing out projects so that they can be corrected ( only hard copies were allowed for a final presentation to the University) . Some faculty report that in the end, the tasks at hand assumed nightmarish proportions as students were increasingly unable to reach internet cafes because of severe curfews and siege, and had to resort to the fax – the fax phone was ringing until midnight sometimes, and very early in the morning as well, with the fax jamming and retrials and more retrials having to be attempted. In the end, it became clear that the fax could not be used for distance learning purposes at large. On the other hand, the fact that in the end, all students did receive their exam papers and successfully returned them, is a testimony to not only the endurance of all parties involved, but also to the fact that IPCH students have indeed learned the skill of computer and internet use, a great achievement by any local standard.
The initiation of distance learning schemes to assist students at IPCH in completing their studies has proven to be a learning experience for all. From the faculty’s perspective, it proved to be frustrating, with heavy burdens, but was manageable and rewarding as it worked reasonably well in the end. From the student’s perspective, despite great difficulties, it proved to be a lifeline, a form of non-violent resistance to the destruction that is taking place around them, and a refusal against being labeled victims – an expression of agency par excellence.
Despite the achievements made, it is clear that, given ICPH’s goals, distance learning cannot replace the classroom, although it may be a very effective method of student support at particular junctures, and an excellent support for the continuing education of alumni as was originally planned. But even then, to be effective, distance learning requires national level infrastructural development in the area of phone and computer networks, email Internet service provision, as well as substantial subsidization of these systems to allow a larger group than those who can afford these links to join the educational process. For after all, it is equity in education that we also strive for, and not merely education for those who can afford it. However, in view of the continuing emergency conditions in the country, with no end in sight, distance learning remains one of the mains instruments we have at hand that can address some of the consequences of constant educational interruptions in war-like conditions.