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thesis entitled

COUNSELING BY TELEPHONE AS A FORM OF
COMMUNICATION IN SUPPORT OF HUMAN
DEVELOPMENT

presented by

WESLEY ROTARY SMITH

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COUNSELING BY TELEPHONE AS A FORM OF COMMUNICATION IN
SUPPORT OF HUMAN DEVELOPMENT
BY

Wesley Rotary Smith

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS
Departments of Telecommunication and Urban Studies

2005

ABSTRACT
COUNSELING BY TELEPHONE AS A FORM OF COMMUNICATION IN
SUPPORT OF HUMAN DEVELOPMENT
BY

Wesley Rotary Smith

In the effort to support the human development and advance the
empowerment of those in developing countries, this thesis outlines the
steps necessary to implement telephone crisis intervention counseling
call centers and information and referral services for the Third World.
In the effort to do so, the effective use of telephone counseling in the
highly developed regions of the world is examined and telephone
counseling is defined. Both implementation barriers and
implementation bolstering factors from the developing world are
discussed. Finally, a section of this thesis has been used to present an
implementation process that can be put into use in any country with
functioning telecommunications infrastructure.

This implementation process contains elements from the fifty
years of telephone counseling in developed world, as well as being
informed by an intensive interview with an experienced practitioner in
the field of consulting for a development firm with experience from

several projects throughout the global South.

To the children of Rafah, Gaza Strip, the Occupied Palestinian

Territories and for the memory of Rachel and Tom.

iii

ACKNOWLEDGMENTS

I wish to express my most sincere appreciation to everyone who
offered me support, guidance, motivation, inspiration, encouragement,
patience, and kindness throughout the process of producing this
document. Without the loving help and wisdom of these people I
would be nowhere.

I thank the mentors, professors, and staff who ushered me
through my programs, especially Drs Marvel Lang, Robert LaRose,
Nicole Ellison, Mohammed Ayoob, Richard Thomas, and Bernard
Finifter. I extend my every good wish to Dr Bella Mody who took me
under her wing inside the classroom and over Masala Dosas. There
are not adequate words to describe my gratitude for all the care and
advice given to me by Anna (Fran) Fowler. All my thanks to Andy,
Colleen, and Nicolas who would read anything I wrote; I am in your
debt

For my family, my friends, my brothers, the staff of The
Listening Ear and The Michigan Peace Team, my pen pal, my dogs, and
all others who have kept me smiling, you mean everything to me. I
thank my family for their love, my friends for filling my life with the
music of laughter, and my colleagues for continuing to amaze me with

their dedication. Your contributions have made me who I am.

iv

TABLE OF CONTENTS

SECTION ONE

Introduction .......................................................................................................... 6
Method ...................................................................................................... 14
Instruments ............................................................................................. 15
Procedures .............................................................................................. . 1 5

SECTION TWO

Telephone Counseling in the Developed World ........................................ .16
A History of the Use of Telephone Counseling ............................... .16
Effectiveness of Counseling by Telephone ....................................... 23

SECTION THREE

Barriers to Telephone Counseling in the Developing World .................. .27
Telephone Access as a Barrier .......................................................... .31
Cultural Barriers .................................................................................... .35

SECTION FOUR

Implementation Bolstering Factors ............................................................... 47
TCIC as a Communication Process .................................................... 48
The Benefits of Telephone Use ............................................................ 54

SECTION FIVE

Call Center Implementation in Developing Countries .............................. 58

SECTION SIX

Conclusion ......................................................................................................... .71

APPENDICES ....................................................................................................... 79

REFERENCES ...................................................................................................... 85

SECTION ONE
Introduction

From the time we are small children we are socialized to feel
sympathy for the people suffering from underdevelopment in far off
places around the globe. Who cannot recall the motherly request to
eat Brussels sprouts being framed around those unfortunate children
starving in China or Ethiopia? Who is unfamiliar with advertisements
calling on us to save a sick child's life for the price of a cup of coffee a
day? These messages strike a sour chord because poverty and
starvation of such intensity seem less than human to most of us. The
sad truth is that preventable disease is the most prodigious killer of
the world’s children and hunger is the everyday condition for billions of
people (UNDP, 2003). People in rich countries can continue to feel
upset, eat their vegetables, and donate their spare change, but it has
long been understood that sustainable human development requires
more thoughtful strategies.

Underdevelopment is not a flashflood. This problem has not
sneaked up on the world. Early conquests in the name of exploration,
colonization, and eventually evangelical missionary work had always
sought to civilize the savages (Harris, 1997). The United States

stepped to the world stage initially hoping to foster economic

development in poor countries where miserable conditions, continuing
unchecked, might allow communism to flourish (Mody, 2003).
Communication strategies were first applied to development initiatives
in the form of propagandistic messages designed to inspire changes in
“social attitudes and economic practices and relationships” in hopes of
enhancing economic development sufficiently to modernize developing
nations (Mody, 2003, 8). The communication paradigm of
modernization has been labeled propaganda because underlying its
guidelines for economic development for all were messages about
“specific cultural, economic, and political practices” that represented a
desire to limit communism’s spread (Mody, 2003). The results of the
modernization model of development were disappointing but valuable
lessons were learned.

While there is no denying that economic development and
human development go hand-in-hand; the single focus on economic
growth as the path to development was not working. Rethinking the
importance of “people-oriented development” led to the new paradigm
of Development Support Communication (Wilkins, 2000, 40). Whereas
modernization viewed communication as a factor capable of altering
people’s behaviors to favor quick economic growth, this new paradigm
visualized “communication as a support for self-determination of

people” (Wilkins, 2000, 40). This new focus rests on the assumption

that an empowered people are more capable of the kind of social
change needed to produce improvements in sustainable human
development which, in turn, produce sustainable economic growth.

At issue in the earliest attempt at using mass communication for
development was the fact that such initiatives often overlooked the
people whom were to benefit, and, as such, alienated them adding
another burden to the already difficult task of fostering economic
development. The strength of empowerment is that it holds the key to
bringing new voices into the development dialogue. Development has
been shown to affect men and women differently (Wilkins, 2000).
Indeed, it affects different racial and ethnic groups, as well as different
religious groups unevenly. Empowering these previously overlooked
groups of people can only strengthen attempts at development. It has
come to be thought that racial, gender, and religious equality will not
be the byproduct of economic development, but rather, they are the
vital ingredients for healthy and sustainable development (Wilkins,
2000).

The forms that development support communication projects can
take are limited only by the imaginations of those who seek to
implement new projects. The form suggested here is both well known
in developed countries and reinforces the vision to use communication

for empowerment. Counseling by telephone, often referred to as

Telephone Crisis-Intervention Counseling (TCIC), has been
successfully and effectively practiced throughout the wealthiest
countries of the world for decades (Lester, 1977). It covers every
imaginable problem area and has been guided by the principle that
people are capable of solving any crisis, given access to the
appropriate resources (Training Manual, 2001).

In the developed world the use of counseling by telephone has
been shown to be appropriate for myriad applications, and its
accessible placement and empowering characteristics are
complimentary to the reconfiguring of communication initiatives in
support of human development. It is the purpose of this thesis to
make the case for the implementation of TCIC in the underdeveloped
countries of the world as a form of communication in support of
sustainable human development. To do so it is necessary to
conceptually define “human development” as a term. Reading this
document it is crucial to understand that “human development is
about people, about expanding their choices to ilve full, creative lives
with freedom and dignity” (UNDP, 2003, 28). Human development
uses people as the unit of analysis and focuses on any individual’s
quality of life. This represents a paradigm shift from economic
development and its use of a nation’s gross domestic product as the

unit of analysis with fast economic growth as its focus.

The quality of life that is fundamental to human development
comprises four elements: living a long and healthy life, being
educated, having a decent standard of living, and enjoying political
and civil freedoms (UNDP, 2003). These elements may seem
amorphous but they may be measured in terms of factors that can be
addressed by TCIC services. For example, gauging human
development gains in terms of living a long and healthy life may be
measured by citing reductions in child mortality, improvements in
maternal health, and efforts to combat major diseases (UNDP, 2003).
Education can be looked at in terms of achieving universal primary
education, or the promotion of racial and gender equality and
empowerment (UNDP, 2003, 28). By focusing on reducing poverty
and hunger one could affect improvements in the standard of living for
developing countries (UNDP, 2003). Political and civil freedoms might
be demonstrated by measuring the presence or absence of avenues for
political participation available per country and which types of people
(by race, gender, class, religion, ethnic grouping, etc.) utilize that
access. Conceptualizing human development thusly illuminates a
litany of ways that TCIC could be implemented (see Appendix A for
examples).

It is projected that a population empowered to take ownership of

their country’s sustainable development will better enforce

environmentally reasonable policies than disaffected agencies of
governments or international agencies (UNDP, 2003). In the global
South, where most people do not interact with government, it is
especially crucial that they have alternative methods to seek help and
information resources. The proposal to implement counseling by
telephone in support of development does not suggest that it will
stand alone and have positive effects. Instead, one should imagine a
variety of development resources connected by networks of aid and
relief agencies and accessible through telephone counseling and
referral services with access to valuable information and extensive
databases placing callers in contact with the services that best fit their
particular needs. In the developed world, one is never more than a
phone call away from the necessary resources to take the initial steps
toward dealing with any circumstance. A similar situation for the
people of the developing world would have dramatic impact on
fostering the empowerment of the population needed to bolster human
development.

There are many factors that weigh in on the practicality of
implementing such a development initiative. As a point of departure,
this thesis begins by examining the history of counseling by telephone
in the United States from its initial and limited attempts to its present

state of universal penetration and acceptance. Any application of

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telephone counseling in the developing world will be able to build on
this foundation and benefit from the lessons acquired over more than
fifty years of practice in the countries of high development.

Taking the discussion fully into the realm of the developing
world, the state of human development (or the reality of the
consequences of underdevelopment) is introduced, paying close
attention to the ways in which telephone counseling could offer relief.
However simple it may be to highlight the need for such a
development initiative, it is important to realize the barriers that exist
in the global South that stand in the way of the effective
implementation of telephone counseling services. While the foremost
impediment to implementation is the low level of telephone
penetration, there also exist several other barriers stemming from
differences that exist between the developed and developing nations.
These differences are labeled “cultural barriers” and include such
limiting factors as resistance to new technology, negative attitudes
toward help-seeking, and inequality in terms of race, ethnicity, class,
gender, and religion.

In the attempt to answer the serious questions raised by these
potential barriers, an examination of the factors that enhance the
likelihood of successful usage of telephone counseling in support of

development follows. The traits of telephone counseling that act to

lower barriers are discussed along with an introduction of the
welcoming characteristics of telephone use. The unique
communication process utilized by telephone counseling, combined
with the positive attributes of telephone use are shown as capable of
addressing the cultural and access barriers against implementation.

A final section segues from the constraining and energizing
factors of the process to implement telephone counseling as a
communication application in support of human development to a
practical guide for accomplishing such an implementation.
Constructing this guide applied a variety of methodologies that
included histories and literature review as well as the evaluation of a
practitioner from the world of international development consulting.
The resulting model represents an amalgam of knowledge representing
not only what is known from theory but also that invaluable insight
that can only come from experience. That said, it must be noted that
this list is not intended to be thought of as exhaustive. Rather, it
provides a basic outline within which country-specific information can
be added. By adding a section that explicitly lays out the necessary
steps in the procedure, the practicality of telephone use for counseling

is further demonstrated.

mm

The method of data collection for this project was comprised of
an intensive interview. Selection of an appropriate sample was a
delicate process. In order to strengthen the development proposal, it
was necessary to interview an experienced practitioner in the field. To
ensure protection of the anonymity of the study’s participant, a
general description will now be given of this individual’s occupation.
The respondent was selected from a non-governmental consulting firm
that supervises and implements projects for sustainable economic
growth and human development throughout the developing world.
This firm has successfully sought bids and received grants to promote
development projects on every continent. The firm currently has
projects underway in Eastern Europe, the former Soviet Union, North
Africa and the Middle East, Latin America, Africa, and the Far East.

The participant’s experience includes supervising projects in
Bosnia, Sarajevo, Argentina, and Morocco. A major part of this
individual’s career has involved the implementation of third world
development projects, which made for a perfect match with the needs
of this intensive interview. The respondent consented to voluntarily
participate in this study and was in no way compensated for joining
the study. Knowledge of the participant’s identity was limited to the

author and three committee members, and throughout the remainder

of this thesis the respondent will be referred to by the pseudonym

Parker Speedland.

Instruments

Parker Speedland was first given a draft of the thesis’ proposed
development project and asked to read it carefully. Next the same
information was presented in an abbreviated form, resembling a
checklist of sorts. What followed was a series of reflection questions
that Parker Speedland was asked to respond to. These questions
related to the respondent’s perception of the strengths and
weaknesses of the proposal. After reading the complete section and
the abbreviated checklist, Parker Speedland was able to give an
informed evaluation of the practicality and completeness, as well as
the strengths and weaknesses of the proposed idea. The questions
were designed to be open-ended and were intended to inspire
qualitative responses that would potentially help the organization and
framework that led to the development proposal, as well as acting to

supplement the data collected through reviewing literature.

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The respondent was recruited online after a survey of websites

limited the recruitment pool to a short list of qualified firms.

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Recruitment emails were sent and consent obtained before the
respondent received the interview questionnaire via electronic mail.
The instrument of data collection was intended to be completed by the
respondent in one hour. The finished version of this thesis’
development proposal has been redrafted to include the insights
gleaned from the interview data and includes quotations from the
respondent that have been cited under the pseudonym Parker

Speedland.

SECTION TWO
Telephone Counseling in the Developed World
Hi f he s fT le h n unselin

That the telephone is a powerful tool that has had a substantial.
effect on the developed world is hardly a debatable point. Use of
telephones has profoundly altered the way we work; the ways in which
we interact within networks of our families and acquaintances; it has
helped shape consumeristic behaviors; facilitated closing gaps in
international dialogue; it has increased the speed and effectiveness of
first responders in emergency situations; and has even revolutionized
the communication methods required to wage and win wars. From the

perspective of uses and gratifications, a person’s use of the telephone

1]

can be “explained in terms of its ability to gratify psychological and
social needs” (Sawhney and Barnett, 4,1998). The telephone has, for
example, forever changed the ways we seek help and information in
times of need. In most cases, telephone use has resulted in increased
efficiency, which can be considered a positive effect. From quickly
summoning police officers or firefighters to phoning-in restaurant
reservations, telephones make life easier.

Some would say that the depersonalization associated with
communication via the telephone has accelerated what Ferdinand
Tonnies referred to as the Gesellschaft (DeFleur and Ball-Rokeach,
1989). In this theory, mass society emerges, having been facilitated
by social bonds based around impersonal contracts. This bleak
scenario was conceptualized long before Alexander Graham Bell’s
fortunate mishap, but such ideas have had an impact on the way mass
communication is perceived. One could speculate and research
endlessly on the social impact of the telephone over time, but in the
realm of prosocial media effects, it is clear that the application of
telephones to counseling has been improving communities for decades
(Lester, 1977).

Counseling by telephone has a unique history and followed an
unlikely path in arriving at the present state of its widespread and

effective use. This is a history that begins in the heat of the Second

12

 

 

 

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World War. Enlisted fighting men suffering from combat fatigue (what
we now refer to as post-traumatic stress disorder) needed short term
counseling delivered immediately to regain for themselves the stability
needed for the front lines (Parad & Parad, 1990). What resulted was
the preliminary incarnation of Crisis Intervention Counseling, then
called B.E.P. or brief emergency psychotherapy. At this stage, the
services were delivered by licensed counselors who set only a few
short appointments with their patients while the crisis was occurring,
usually in a hospital setting.

The next step in the evolutionary process of Crisis Counseling
came with the opening of The Trouble-Shooting Clinic at Elmhurst City
Hospital in New York (Parad & Parad, 1990). This walk-in clinic was
the first offering of twenty-four hour, psychiatric emergency services
in the United States. This development highlighted the fact that
people experience very serious problems outside of a nine-to-five,
Monday through Friday timeframe. Out of necessity, the introduction
of the telephone into this unique counseling model would soon follow
(Parad & Parad, 1990).

Certain problems are highly time sensitive and call for responses
with an immediacy that may not even allow a trip to the hospital as a
viable option. More practical in these situations was a telephone

answered by a trained counselor. The first application of telephone

13

 

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counseling was a suicide hotline and in 1958, the Los Angeles Suicide
Prevention Center (LASPC) was opened. The second area where
telephone use and counseling were combined was in poison control
information centers, and from these two pioneering call centers would
eventually come thousands more in virtually every community in the
devel0ped world (Lester, 1977). It is at this stage in the development
of Crisis Counseling is where the history of telephone counseling really
begins.

Implementing telephone use for the purposes of counseling
people in such serious states was not an easy process. One of the first
hurdles to overcome was convincing the counseling community that
therapeutic integrity could be maintained when the interaction was
mediated by the telephone (Lester, 1977). At this time, professional
counselors manned all hotlines, so it was not the paradigm of crisis
intervention counseling that was coming into question, it was the new
technology. Fifty years ago, as today, there existed “the tendency to
find fault and make dire predictions as any new technology is
introduced" (Gackenbach, 1998, 123). Many professionals doubted
that the value of therapy by phone could compare with counseling in a
face-to-face environment. Another major consideration was how the

services would be received by the public.

14

an

In 1958, when the LASPC became operational it was not known
if people would incorporate use of the telephone into their help-
seeking behaviors. There are other formal and informal networks that
(although not as expert) are often sought first when one experiences
crisis. At the time there was skepticism over whether an unseen
stranger at the other end of a telephone line could compete with one’s
family, friends, church, co-workers, or local public resources (Lester,
1977). Suicide prevention centers seemed a needed development in
spite of this doubt, however, as rates of suicide had been drastically
increasing during the 19505 (Parad & Parad, 1990).

By 1966, call volume at suicide prevention centers was growing
substantially enough for a seemingly drastic measure to be
considered. In the face of serious concerns and strong resistance from
the community of professional counselors, it was proposed that non-
professional volunteers could be introduced as Phone Call Answerers
(PCAs) in suicide prevention centers (Parad & Parad, 1990). Indeed,
this modification to the model, more than any other factor, has made
telephone counseling as we know it today possible. All the initial
questions about the feasibility of counseling by telephone were very
quickly answered in the affirmative. The mediated counseling was, in
fact, effective; people were willing to use technology for help-seeking,

and non-professionals proved to be competent under proper and strict

IS

selection, training, and supervision. All that remained was the
experience necessary to discover areas for improving and tweaking the
programs.

With telephone counseling, as with any fledgling program, there
was an initial period of trial and error, vast success and major
overhauls, evaluation and pragmatic evolution, and policy analysis that
has led to the services we have today. Before even launching the
LASPC there was a four-year period of research and preparation, and
yet the call center was still simply an experiment, nothing more than a
work in progress. Within the service’s first five years it had switched
from providing services forty hours per business week to the year-
round, twenty-four hour coverage that has become the standard
model (Parad & Parad, 1990). Within a decade of the implementation
of telephone crisis centers in the United States, there were thousands
of call centers operating in most major urban areas and expanding into
many other communities as well.

The early lessons learned by the LASPC paved the way for other
SPCs throughout the country, but the implications of counseling by
phone had now surpassed the realm of suicide prevention. The Los
Angeles experience provided a flexible model that could be applied
nationwide in communities of different sizes, and providing myriad

services (Palmatier, 1998). Within a single decade, telephone

16

counseling exploded from a few small, unknown and isolated suicide
counseling centers and poison control hotlines to a large, recognized,
nationwide network of service providers that responded to many
community needs. From suicide call centers sprang depression and
teen hotlines. From poison control centers came drug and alcohol
overdose and addiction hotlines. Abuse, runaway, and rape hotlines
became common, as did a closely related type of service know as
information and referral (I&R) call centers that could aid underserved
demographic groups such as the elderly, teenagers, and people with
disabilities (Palmatier, 1998). I&R services call centers, which are
often incorporated in telephone counseling services, act as a
middleman between community members and the public resources
that are available to them. In this way many people who don’t know
where to turn are given concrete leads quickly and effectively (Training
Manual, 2001).
Effegiveness of Counseling by Telephone

Although the road was rough and strewn with many pitfalls, it
was those early, hard lessons that have enabled counseling by
telephone to develop into the success it has become. Now,
approaching a half century since its first use, telephone counseling in
the United States is almost universally available, widely used, cost-

effective, empowering to the communities it serves, enduring, and

I7

extremely versatile (Lester, 2002). These achievements
notwithstanding, there are several areas which, over the years, have
proven to call for constant improvement such as increasing awareness,
deconstructing taboos, and reaching those demographic groups that
are at the most risk.

In terms of access to services, the United States boasts an
impressive network of agencies that cover nearly its entire population.
The same can be said of Canada, Europe, and other highly developed
areas throughout the world. Anyone with a telephone can easily reach
out to any of several nation-wide, toll-free call centers and, in most
areas, there exist extensive local services as well. This enables an
enormous amount of people to enjoy the benefits of crisis counseling
and information services at nearly no cost to them. Whereas the
incredible cost of health care and the inconvenience of scheduling time
to utilize health care services poses a barrier to millions, the low cost
and ready availability of functional equivalents provided by telephone
services opens up doors in a way that empowers underserved
populations such as the poor, the young, and those living far from
away from service providers. As will be demonstrated, there are
several other characteristics of such services, which are derived from
the use of telephones, which empower callers as well. Speaking to the

enduring viability of these programs, it is now several decades after

18

the inception of counseling by telephone and the number of call
centers that persist from year to year remains steady while new
services continue to be added (Rosenfield, 1997).

One of the most striking features of telephonic counseling is the
incredible range of topics and services that are put within reach of
users. Inspired by initial successes, a “bandwagon” effect has
occurred in crisis intervention resulting in its use for an ever-widening
ring of applications (Parad, 1974, 5). This manner of counseling is
now considered appropriate for those ongoing issues in society, such
as depression or runaway children, as well as for short-term problems
that spring up unexpectedly, such as flash floods or disease outbreaks.
Information referral services can be a point of entry to connect people
with general aid in finding resources for any crisis, or can themselves
be providers of extensive knowledge on specific topics or for specific
groups. These referral services act to connect the vast and versatile
chain of call centers and community resources that people may or may
not be aware of. In this way, a caller’s initial crisis (say,
homelessness) is not needlessly exacerbated by his or her not realizing
that the resources are readily available within that person’s community
(perhaps a variety of charitable organizations, homeless shelters, food,
clothing, health, and employment aid services) and all reachable from

any phone booth. It is often the case that finding help is the

19

 

overshadowing crisis of a problem that can effectively be dealt with
once counselors put callers in touch with the appropriate aid
organization or governmental program (Training Manual, 2001). This
is a phenomenon that reminds us that even with successful programs
there may be room for improvement.

Although many people enjoy the services provided by telephone
counseling, there are scores of others that could benefit from such
services but are unaware that they exist. A major issue of the field is
increasing awareness and marketing these services as options for first-
time callers (Parad & Parad, 1990). Such issues have faced those in
the field since its very first days and persist in posing challenges as
new call centers and hotlines continue to arise. Early evaluations of
telephone counseling services in the United Kingdom quickly
determined that “publicity should be directed” toward those groups of
people who “fail to make contact, in the hope of changing their beliefs”
(Rutter’s emphasis) (Rutter, 1987, 27). This has been a constant
battle and one that must be fought on multiple fronts. Aside from
simply raising awareness of the call centers and all they have to offer,
the issues dealt with and topics discussed also require special
treatment to ensure that people will feel that seeking outside help is

appropriate.

20

Here there is the challenge to attempt a more delicate form of
social marketing. In many cases there are deeply held taboos within a
society that prevent people in crisis from seeking help. For crisis
counseling by telephone to function at its peak capacity these social
taboos need to be deconstructed so that people feel comfortable
enough to speak out. Combating these perceptions is another issue
that has plagued crisis counseling since its inception. Initially,
discussing suicide was unheard of, but over time it has lost some of its
shock value (Parad & Parad, 1990). Even as this has happened, new
taboos have come and gone, while others have persisted. Some that
carry commonly held myths and call for social marketing to
deconstruct taboos have been HIV/AIDS, abortion, mental health,
depression, and illiteracy. To this short list could be added many
more. For callers to utilize telephone counseling, they must feel safe
and comfortable in doing so. While these may become more palatable
over time it can be assured that new issues will come into the social
consciousness as hot potatoes and forbidden topics.

Related to these unspeakable topics are the groups who
needlessly suffer from them. It has proven most difficult for telephone
counseling to reach those who are in most need of help. However,
target marketing of certain hard-to-reach groups could improve the

reach of telephone counseling services. Whether it is retired white

21

males, poor persons who speak Spanish, or teen-age women with
eating disorders, at times it is the case that those in critical need of
help do not receive that help. Improved agency between call centers
to this end can only increase the effectiveness of telephone counseling.
By raising awareness in general, especially in those areas that people
will be apprehensive in discussing, and specifically targeting at-risk or
underserved populations, telephone counseling could be an even
greater gift to the communities it serves. Furthermore, it could offer
hope of increased human development to the majority of the
communities of the world: those that are still in the process of

development in the global South.

SECTION THREE
Barriers to Telephone Counseling in the Developing World

It has been observed that paradigm shifts are occurring across
the landscapes of development and mass communication. The
concepts of international economic development and development
communication aimed at modernization have been largely supplanted
by those of international human development and development
support communication aimed at improving quality of life for those
billions of people in the global South. The notion now prevails that

sustainable economic devel0pment must be achieved as a byproduct of

22

human development, but this presents the imposing “chicken or egg?”
question that stymies many attempts at truly reforming the ways in
which we allocate development aid (Graham, 1997). If it is given that
economic development is more sustainable when attempted in areas of
high human development, how can that set of issues be addressed
before impoverished regions improve economically? This question
represents a puzzling dilemma fraught with vexing complexities. One
proffered means of working past this roadblock is through
development support communication, one example being counseling
by telephone.

Telephone counseling could be of great benefit to a large section
of human development issues. There are several obvious areas that
come to mind. Call centers in the developed world that focus on
disease outbreaks, suicide, drug and alcohol addiction, family matters,
and reproductive health issues provide a model that may be
transferable to those areas slowly climbing in the direction of
development. All these issues are present in the global South.
Indeed, most of them are drastically worse there. The prevalence of
HIV/AIDS in the developing world is at best a cause for concern,
usually alarming, and sadly has reached pandemic proportions in
several countries (UNDP, 2003). Harsh living conditions contribute to

heavy prevalence of social pathogens including suicide, addiction, and

23

abuse, and these display a pejorative trend (UNDP, 2003).
Furthermore, reproductive health is at issue much more amidst the
mushrooming populations of the global South than it is in the
developed world. Women throughout the developing world are several
hundred times more likely to suffer a reproduction-related death than
their sisters in the North (Gallin, et al., 1989).

Other fairly obvious areas whereby telephone counseling could
energize human development efforts are the realms of general and
focused I&R services. The sometimes-labeled Third World could
benefit from increases in the availability of relevant information for
specific demographic groups and about a wide range of topics.
Perhaps the elderly need a general helpline, or teens need a sexual
health information call center, or perhaps yet women need a resource
for legal or marital advising. Again, existing, successful models from
the developed world could pave the way for Southern services.

Counseling by telephone can also be used to support
development in ways that are not necessary in most developed
countries. While security issues now seem to be highly salient to even
the safest countries, the effort at advancing human development in
the Third World countries is often hindered by violent conflict, whether
from tensions between ethnic or religious groups, resulting from

political unrest, or at the hands of a foreign aggressor (UNDP, 2003).

24

This represents an opportunity to expand the use of telephone
counseling services in a way that would be particularly useful in
counteracting what has become a major obstacle to development.
Among the types of telephone counseling normally thought of, such
services are rare, although not without precedent. For a brief list of
possible TCIC uses in the developing world consult Appendix A at the
end of this document.

Although services such as these offer hope for producing positive
effects on the efforts toward human development, there are several
potential barriers to successful implementation and effective start-up.
Before implementation of such services is possible, it is important to
recognize and discuss the obstacles. The first type of barrier to
consider will need to be that of access; after all, to persons not able to
use a phone at all, the potential benefit of telephone counseling is a
moot point. Beyond this rather blatant simplification of the discussion
of access, there are many more implications that have relevance for
any proposal to use telephony in support of development programs.
Examined will be the phenomena of uneven access and gaps in access,
in terms of urban and rural differences, geographic and market
considerations, prohibitive costs, and the uptake of new technology.
Aside from the barriers to implementing telephone counseling that

relate to concerns over access, there are several other potential

25

stumbling blocks to consider. For the purposes of this discussion, it
will be necessary to separate social and cultural barriers from those
that relate strictly to access. Among these cultural barriers, issues
such as technology acceptance, help seeking behavior, religion, race,
class, and gender are considered.
Telephene Aeeeee as e Berrier

Access is a very serious issue in the discussion of using
information technologies in support of human development. Exactly
what type of benefits could be provided by increased access and what
kind of roadblocks are in the way of increasing access is a matter of
endless speculation and debate. When difficult or technical questions
arise it is often the wisest course of action to consult an expert. As it
happens, there are very few experts in the field of telecommunications
for human development. Were that list to be drafted, the name of
Sam Pitroda would be foremost among the non-scholarly practitioners
mentioned. Pitroda is an Indian who had a successful career as a
telecommunications entrepreneur in the United States of America
before returning to the Subcontinent with the hopes of using the
telephone as a tool for nation building. In the past decade, he has
shifted his focus from India specifically to telecommunications in
developing countries. It is his belief, and the belief of many others,

that it will be difficult to achieve “sustainable development with

26

freedom” without proper telecom institutions and infrastructure, and
that without development in these areas, three quarters of the world’s
population will never know the “civilization of the information age”
(Sankar, 1994). He speaks about the issue of access and the gap
between rich and poor countries.

One of the major gaps between developed and developing
nations is in the access to information technologies, including the
telephone. The Secretary General of the United Nations, Kofi Anan, is
all-too-well acquainted with the divides that exist between rich and
poor countries in terms of access to food, water, jobs, housing, and
health services. He states that, “today, being cut off from basic
telecommunications services is a hardship almost as acute as these
other deprivations, and may reduce the chances of finding remedies to
them” (Norris, 2001). That there is a North-South technology gap
should surprise no one. A barrier of similar seriousness, and one that
also poses a threat to development, is the presence of gaps within
countries.

Technology disparities within countries exist for various reasons.
One major incarnation of the access gap within many developing
countries is between urban and rural areas. The International
Telecommunication Union (ITU) publishes an index of

telecommunication indicators that break down access on many levels.

27

While a trend towards greater concentration of technology in urban
areas exists throughout the world, even in the most affluent countries,
this phenomenon is highly exaggerated in those areas referred to by
the IT U as Low Income Countries (ITU, 2002). What this amounts to
is that the level of access in much of the developing world is skewed in
favor of those living in cities (ITU, 2002). This fact highlights the
larger trend of uneven development in terms of urban and rural
populations.

The urban-rural gap can result from any of a number of other
factors. A developing country’s geography, for example, can limit its
opportunities for development (UNDP, 2003). Perhaps a country is
large and expansive with isolated population centers contributing to
uneven access and development. Some developing countries are too
mountainous or thickly foliated for development projects to have
impact on rural areas. Other countries are prone to natural disasters
and harsh weather conditions that deter attempts to increase access.
And, of course, there are many areas where lacking infrastructure and
adverse geography combine to retard development, such as those
places without roads or electricity.

In these areas of least development another problem looms.
The urban-rural gap in access and human development threatens to

endure by nature of the concurrent urban-rural gap in economic

28

development. This is a factor that has never been more relevant than
it is now with the North-South push to privatize formerly national
telecommunications sectors (Thussu, 2000). At present there are
market considerations attached to any plans to increase access for
poor countries. Private telecommunications companies may be
unwilling to invest in areas where small populations or low economic
development eliminate the market environment to create substantial
profits (Norris, 2000). The high costs of implementing new
telecommunications infrastructure may be thought of as prohibitive in
such situations. Furthermore, with a majority of markets now opened
up to competition worldwide, it may be far more attractive to private
companies to wrangle for a piece of large and wealthy markets in
areas that have already established high rates of telephone
penetration (Thussu, 2000).

It should not be forgotten that low rates of access and shabby
telecommunication infrastructure in the developing world were handed
down from the often poorly-managed public telecoms at the time of
privatization. In fact, a major propelling argument for the push to
liberalize international markets was the hope that private companies
were capable of running with more efficiency, and the spirit of
competition would help bring more and better services to the market

with a quickness unheard of for publicly administered programs

29

(WTDR, 2002). Among these new services, none have done more to
increase access and chip away at the technology gap than the
introduction of mobile communications into the developing world. The
rise of mobile has raised access to communications in an incredibly
short time and has seen its sharpest increases in places the IT U refers
to as Least Developed Countries (LCDs) (WTDR, 2002). The
continuation of the trend toward increased access for developing
countries shines a light of hope on the prospect of implementing
telephone crisis counseling services for millions of people in need.
However, access is not the only barrier to implementation.

l r r i

It is important to conceptually define the use of the term

“culture” in the context of this section. Rather than dealing with
aspects that are specific to a group of people (a race, a nationality, a
political group, an economic class), the concept of culture here will
refer to those general aspects that impact the implementation and
usage of telephone counseling services in developing countries. The
areas to be introduced and discussed include cultural attitudes toward
the acceptance of new technology; attitudes governing help-seeking
behavior; religion and development; race, class, and gender
considerations; and finally political climates and conditions. While

there are assuredly more factors worth studying, and a nuanced

30

understanding of culture would be instructive to specific countries and
groups, such an undertaking is far beyond the scope of this project.
The intention here is to present a general overview.

One of the cornerstones of the belief that human development is
essential for sustainable development is respect for and understanding
of the importance of culture as an element of developing countries.
Dealing with certain aspects of culture is also very relevant to the topic
of implementing telephone counseling in such societies. This is
because some cultural factors present possible barriers to the
introduction of new technology-mediated services. For example, even
in cases where access to telephones is not an issue there may be
culturally held beliefs or practices that prevent individuals from
utilizing that access. Consider the beautiful Mediterranean beaches of
Gaza City. Palestinian women are not seen lounging in the sun or
bathing in the surf because they are expected to conform to gender
roles strictly enforced by their traditional culture. At times, no men or
children can be found there either because military occupation and
forced curfews have become part of their culture.

The use of the telephone as a tool for counseling has thus far
been presented sitting on a pedestal. That is, there are many aspects
of telephone use for this application that are among its greatest

strengths. In some cases, however, those very features pose a

31

potential weakness. Whereas telephones are a mainstay of developed
countries, they are an emerging technology in some developing
nations. In such locations it is vital to consider attitudes toward
technology acceptance before attempting to launch a development
support communication program. Simple access is not always enough.
Development failures result when communities are not involved in the
design and application of communication technology “in the
participatory mode” (Mody, 2003).

In some cases, it is not that phones are unavailable as much as
that people do not choose to use them. While telephones could
represent a key to progress, they may still be seen in a different light
by different cultures. To many, phone availability is unappealing
because they are seen as luxury items, not thought of as essential to
everyday life, or might simply be a low priority (Sankar, 1994). There
are also places where available telephones are just not popular and
people do not wish to talk to strangers over the phone (Palmer, 1997).
In these places the attitude toward technology use does not seem
conducive to the implementation of counseling by telephone at first
glance. However, it is worth remembering that telephone counseling
in the United States began almost fifty years ago, at a time when main
line penetration was not as pervasive as it now has become. Here the

social learning theory or Social Cognitive Theory provides the

32

explanation that “we learn that we can use the telephone to avoid or
ameliorate the dire consequences of emergency situations that effect
ourselves and our loved ones” (LaRose, 1998, 16). People’s attitudes
toward technology are bound to change over time in the developing
world as well. “[R]apid economic growth in non-Western societies is
leading to local and regional media” that better suits the tastes and
attitudes of developing countries (Huntington, 1997, 76). This
phenomenon could positively impact cultural attitudes toward the
acceptance of new communication technology.

Another cultural factor that applies here is attitude toward
seeking help. Even though all people experience crises from time to
time, there is no universal set of behaviors that govern how a person
should seek help at the time of crisis. Differences in this area have
implications for the discussion of telephone counseling. The
“psychological cost” of seeking help within societies may be high and
for these people “hotlines can serve an extremely important role in
crisis intervention" (Gilat, et al., 1998). The cost associated with
seeking help can also lead people away from use of relief services. In
cases such as this, a cultural “silence” about taboo topics can be
created to the detriment of the population (Chandiramani, 1998, 5).
Within areas having unfavorable attitudes toward seeking help, or

within stigmatized problem areas, anonymity of callers and counselors

33

may be able to counteract this barrier to uptake of call centers
(SEICUS, 2002). Furthermore, it may be highly beneficial to introduce
counseling by trained experts in areas with strong family help seeking
networks because the seeking of help strictly from peers and family
members can contribute to the dissemination of false information
(Chandiramani, 1998).

Religion is another aspect of culture that bears on the feasibility
of implementing new technology-based human services. Before
examining this topic, it is crucial to point out that no attempt is being
made to categorize religious beliefs as somehow incompatible with
either technology or human development gains. Rather, for
development initiatives to be attractive to the countries they are
targeting, it is important that they are conceptualized in a way that
incorporates respect for traditional cultures. If one considers that
development projects flow from the secular cultures of the developed
world it is not hard to understand why religion is downplayed. Further,
for scholars and practitioners in the West, “our consideration of
religion in global dialogue and development is usually absent or
negative” because they originate from cultures where spiritual
concerns exist as separate from the tangible world (Wilkins, 2000).
This is not a separation that exists in most of the world, and especially

so in developing countries.

34

Understanding and harnessing this knowledge to produce new
programs informed by culture- and religion-sensitive ideas would go a
long way to bolster efforts at establishing successful development
initiatives. However, in countries where religion provides the basis for »
all other aspects of culture, it poses a barrier to development
initiatives in the sense that secularly socialized individuals involved in
the creation and implementation of communication projects have
lacked the sensitivity necessary to capitalize on opportunity (Wilkins,
2000). While some are beginning to recognize and admit this
shortfall, there are others who pass the buck and point to religious
differences as a bump in the road to development. These are people
who have witnessed a resurgence of religions worldwide in the past
quarter century, including “the rise of fundamentalist movements” that
reinforce not only differences between religions, but also between the
developed and developing worlds (Huntington, 1997, 75). Perhaps it
is in societies that have seen increased fundamentalism where the
need to embrace religion in the push for development is most crucial.

Whereas scholars from the West have tended to give religion the
backseat in many fields of study, they have leaped headlong into
related areas such as considerations of gender, race, and class as
components of culture. For the discussion of development support

communication it is of great importance to view these cultural aspects

35

in such a way as to highlight their role as possible barriers to
communication access. Once again, the availability of telephones is
only one side of the access picture in any given society, and the
availability of telephone counseling will have limited impacts on human
development if it is only used by select members of a country based
on gender, racial and class groupings.

A major dilemma in development involves trying to use it to
generate gender equality. This presents a serious problem because
many believe that sustainable development is not even a possibility
without the participation of women from the outset (UNDP, 2003).
Citing past development attempts that have led to mixed results, the
belief has been posited that looking at issues of gender equality as
women’s issues rather than as development issues has occurred at a
cost to development as a whole (Wilkins, 2000). Critics of
development’s history have noted that in many areas of the
developing world, Western “patriarchal values” have themselves led to
women’s loss of power (Iglitzin, 1976, 186). Women now suffer from
underdevelopment at a disproportionate rate throughout most of the
world. In the areas of education, poverty and health they are worse
off than men across the board and their mortality rates have risen due

to discrimination in access to resources (UNDP, 2003). Counseling by

36

telephone is one way to bridge this gap by supplementing these crucial
areas where women suffer needlessly.

Another side of the discussion of gender as a barrier to
telephone counseling stems from the fact that culture often imposes
strict gender roles in many developing countries. In such areas it is
entirely feasible that, given the opportunity, women would utilize such
services much more frequently than men would on account of the
“cultural fact that men have less ligitimation (sic) to express fear and
anxiety than women” (Shamai, 1994). At the same time, however,
there are strict cultural gender norms that can dictate the expected
behaviors of women. In much of the Arab world, for example, a
woman’s primary support network “continues to be that of family,
husband, and children" while men are now less beholden to traditional
. values (Iglitzin, 1976, 186). It now seems clear that gender
considerations will factor considerably on the effort to implement
telephone counseling. On the one hand, gender norms may pose a
barrier, while at the same time the unique characteristics of help-
seeking interactions by anonymous telephone contact could act to
loosen the grip of stifling gender roles.

In a similar vein as gender considerations, there are looming
racial barriers. The United Nations Development Programme has

found that, especially in traditional cultures, a strong divide exists

37

between racial and ethnic groups both in urbanized and rural areas
(UNDP, 2000). Again, this can manifest itself as an outright access to
communication issue or as a matter of uneven access to resources
resulting from discrimination. When an ethnic group becomes the
target of discrimination it can often become saddled with falsely-
appointed, negative and stereotypic characteristics that can act to
further limit that group’s opportunities for development. The reality in
most of these cases is that race and ethnicity are not causal factors as
much as markers of environmental factors (Palmatier, 1998). In this
way of seeing, the causes of ethnic or racial stereotypes are seen in a
more accurate light as resulting from class differences. For example,
an ethnic group might be more likely to represent a lower economic
class. That class may be concentrated in a particular area (say urban/
inner city or rural and isolated). Perhaps people from those areas are
more likely to represent a certain type of family system (single parent,
abusive, many children) and a particular range of educational
attainment. All these factors are likely to manifest in behaviors that
are then wrongly associated with race or ethnicity as if none of the
class-based factors existed.

As far as development support communication projects are
concerned, success of development initiatives and attention to class

considerations are inseparable. For people in the developing world

38

“class is created by development and communication” (Wilkins,
2000). Attempts at implementing new development initiatives often
overlook the class indicators most relevant to developing populations.
For example, lower classes may lack access to communication due to
economic conditions. They are more likely to have less free time to
devote to seeking access, and less likely to have the necessary level of
educational attainment to capitalize on the resources that are available
(Wilkins, 2000). New development efforts must consciously avoid the
past mistake of targeting the most privileged members of developing
countries and engage those who need development assistance most
desperately, encouraging them to enter into the dialogue (Norris,
2000). This is simple to pledge but more complex to deliver, though,
because economic class barriers to communication access encompass
gender based barriers as well as racial and ethnic barriers.
Furthermore, class barriers are also affected by another cultural
barrier that will be referred to here as political barriers to
communication access.

The culture of a country is shaped and impacted by the political
climate and conditions that are present there. That a repressive
regime can produce a particular culture while a democratic system
produces another is a fact that is highlighted repeatedly, in one

American news broadcast after another. Development is hampered in

39

countries under totalitarian rulers due to the fact that in order for
efforts at sustainable progress to have success, there must be sincere
determination by leaders as well as participation by the population
(UNDP, 2000). The barrier to development support communication
then arises from poor governance that is unable or unwilling to open
up avenues of political participation to the people.

There is an interplay here with other barriers. While in one
country the political climate is unfriendly to dissent, and so
participation in general is stifled, there are other countries where the
class and educational inequality limit a person’s ability to join the
dialogue, or where gender or racial inequality permit only privileged
groups the chance to petition their government (UNDP, 2000). In
such circumstances, a push for responsible governance must be
coupled with a campaign to politically empower developing
populations. However, this process is not guaranteed to work in favor
of development projects. Some cultures, and their governing bodies,
“feel threatened by the incursions” of Western-centric development
initiatives (Rosenau, 1997). Situations such as these heighten the
barrier to implementation of development projects to the detriment of
underdeveloped areas, but at the same time offer an invitation to
rework such projects while gaining valuable insight into improving the

perception of human development efforts.

40

A final political barrier exists in areas where conflict has
diminished or destroyed the efforts at making gains in human
development. Whether from internal civil wars, racial and ethnic
violence, revolutionary uprisings, punitive sanctions, or attacks on
soveriegnity from foreign aggressors, conflict stands in the way of
progress (UNDP, 2000). A sad trend is that those who suffer most are
the same people already at high risk from other factors related to
underdevelopment (UNDP, 2000). The promising aspect of this barrier
lies in the fact that every conflict has a potential resolution, and the
outcome of such conflicts sometimes include the creation of new and
more responsible governing bodies. Peace is essential for progress in
terms of human development.

These barriers, like most others, have but one purpose: to be
overcome. Whether it is through increased investment in
infrastructure to improve communications access, or through social
campaigns aimed at bolstering equality and empowerment, the
material and cultural stumbling blocks in the way of development beg
for practical and sustainable solutions. Whereas shortfalls in access,
whatever their source, present imposing and complex solutions, new
and better-informed human development projects can continue

attempting to constructively answer these challenges.

41

SECTION FOUR
Implementation Bolstering Factors

There are several serious barriers to the implementation and use
of telephone counseling services for developing nations, but there is
also reason to believe that these problems will be dealt with
effectively. This optimism stems from the presence of several factors
that would lower such barriers and, in fact, could bolster the chances
for successful projects aimed at human development. The present
conditions in most developing countries include a high occurrence of
the type of problems that have traditionally been dealt with by
telephone counseling in the developed world, as well as several
problem areas that are unique to the global South. This tendency of
displaying chronic shortcomings in human development is just one
crucial element increasing the demand for services. There are several
other factors that actually combat the barriers threatening the success
of telephone counseling projects.

The positive characteristics can be separated into two
categories: factors related to telephone counseling as a communication
process, and factors that arise from the use of telephones. Telephone
counseling as a communication process offers the kind of empowering
attributes that would be essential to gaining acceptance among people

in the developing world. These attributes include telephone counseling

42

as anonymous, client-controlled, and using active listening. This
process has been in place in the developing world for decades and will
be referred to as Telephone Crisis Intervention Counseling (TCIC).
The factors that specifically deal with TCIC as a telephone-mediated
service will focus on those attributes that lower barriers to access.

T I mm i i Pr ce

Communication is a complex process, and it does not become
any simpler when people are experiencing some overwhelming
problem, or are in an anxiety-producing crisis. Further complicating
this process is the fact that some pe0ple may feel ashamed or afraid to
admit that they are in need of help. Perhaps the problem might
concern a topic area that is not acceptable to mention with their
supportive networks of family and peers. Their problem could be
dismissed as insignificant or silly, or they could be given incorrect
information. As discussed, these concerns are especially salient to
those in the developing world and present serious barriers to the use
of counseling services.

The first aspect of TCIC that lowers barriers to its use is that it
implies anonymity. It has been argued that “the most important
feature of the telephone” is the “absence of social cues” (Rutter, 1987,
81). The phenomenon of cuelessness leads to many variations of

theory that inform the application of telephones to such personal ends

43

as counseling. Seeds of this concept can be found in the discussion of
rich and lean communicationor media and when their use is
appropriate. Richness or leanness of communication refers to the
number of available “channels” through which personal information
can be conveyed (Walther, 1996, 7). Face to face communication
would be rich, for example, while computer mediated communication
would be lean. The telephone is unique in that it rests in the middle of
this continuum, which enhances its practicality as a medium to provide
counsefing.

Speaking to telephone mediated counseling’s relative richness, it
is beneficial for counselors to have voice-based communication that
offers tonal and emotional input which can both increase the accuracy
of the counselor’s assessment and provide a channel for the counselor
to present empathetic qualities (Gackenbach, 1998). However,
telephones are also a lean medium that creates “perceived anonymity”
leading to the disinhibiting effect whereby users “talk more openly and
freely about their problems” than they would under other conditions
(Gackenbach, 1998, 129). Walther notes that a key effect of this
anonymity is that it is especially beneficial for individuals of “low-
status” who experience greater freedom to communicate as a result of
“optimized self-presentation" (1996). The appropriateness of

telephone use for counseling hotlines is made most clear by Rutter’s

explanation. With TCIC, “the whole point of the system is that the
telephone allows and encourages the very psychological proximity and
intimate content” possible with rich communication such as face-to-
face, however, in this case “it is the anonymity which produces
psychological proximity" (Rutter’s emphasis) (1996).

The feeling of anonymity can be very psychologically rewarding
and most call centers maintain that the identities of their callers and
the nature of their problems be kept as strictly confidential
(Gackenbach, 1998). There are very few exceptions where protocol
would dictate that privileged information could not be held in
confidence, as when someone’s life is at stake (Wright, 1985).
Ensuring the caller’s anonymity protects against that person feeling
threatened, ridiculed, abused, censured, or hurt because of the
evaluation of the listener (Pool, 1977). Developing world concerns.
with help seeking, as well as race, class, and gender inequality could
be largely alleviated by the caller never having to disclose that they
have used the service. Similarly, taboo tOpics are more likely to be
dealt with through anonymous interaction with a stranger than by
utilizing a support network that may punish or humiliate the help
seeker, while lacking the knowledge to provide reasoned advice. This

is a factor that has never been as important as it is today when so

45

many are suffering horrible consequences from preventable problems,
such as HIV/AIDS and other reproductive health issues.

An anonymous caller would not feel threatened and would be
more able to access the help and information resources to improve
her/his quality of life (Training Manual, 2001). Perhaps young people
could discover how to prevent the spread of sexually transmitted
infections where they would normally remain silent and put themselves
at risk. Elderly people could freely express their concerns over
depression and failing health. Class, religious, and caste differences
would no longer be a barrier to communication. Women would not be
subject to the discrimination of exclusion, and men could use their
anonymity to lower the psychological cost that is involved with
admitting ownership of problems.

Closely related to caller anonymity is a TCIC characteristic
known as client control (Pool, 1977). Client control also has strong
significance in terms of lowering the cultural barriers to the use of
telephone counseling for development. A fairly straightforward
concept, client control involves a unique and rare balance of power in
counseling interactions that swings in favor of the caller. It is the
caller who initiates the counseling interaction, the caller who
determines the subject matter of the session, and the caller who can

terminate the call at any time. Much like anonymity, client control is a

46

powerful characteristic of TCIC in terms of fighting cultural barriers.
Client control is very empowering to the caller which itself might
increase the likelihood of use for TCIC services. Furthermore, client
control is especially empowering “for first-time callers who may
otherwise not seek counseling” (Pool, 1977, 460). In developing
countries everyone would be a first-time caller, and perhaps client
control would encourage the acceptance of new technology in new
applications.

Another TCIC mainstay is nonjudgmental active listening. Active
listening is the set of several basic skills that combine to produce the
unique communication process that is utilized by telephone counseling
(Lester, 1977). This method of listening is actually as much about
responding and interacting as it is about listening. Active listening
incorporates paraphrasing, empathizing, self-disclosure, and feedback
into a highly effective way of communicating with callers in crisis. This
manner of communicating quickly establishes a rapport with callers
and helps soften the initial impact felt by those who have no one else
to turn to (Training Manual, 2001).

Active listening’s first ingredient is paraphrasing, in which the
counselor proves that they understand the nature of the caller’s
situation by restating it his or her own words. Paraphrasing brings

many benefits into the counseling interaction including increases in the

47

accuracy of communication, demonstrating to the caller that the
counselor is interested in helping, and setting a tone of mutual
understanding for the call (ibid.). Closely related to the skill of
paraphrasing are empathy and self-disclosure. Empathy is another
way to highlight understanding and TCIC relies on it to label the
feelings of the caller in judgment-free terms. In crisis theory, helping
someone identify and deal with complicated feelings is the most
important way a counselor can facilitate the client’s ability to deal with
the larger issue (Parad, 1990). By using neutral terms to label
feelings, TCIC avoids expressing approval or disapproval, thereby
highlighting understanding which encourages callers to continue
(Training Manual, 2001). Self-disclosure also deals with the labeling of
feelings and fosters a connection with the caller. In a TCIC interaction,
self-disclosure occurs when the counselor labels his or her own feelings
about what the caller is experiencing, or about a personal experience
that is relevant (Training Manual, 2001). Self-disclosure, along with
empathy and paraphrasing set the stage by establishing a connection
between the counselor and the client that quickly enables the
counselor to offer feedback.

Feedback is the last of the main skills comprising active
listening. Feedback can be an especially helpful communication tool in

crisis situations. It is a nonjudgmental, simple and concise way of

48

expressing a behavior-effect relationship (Training Manual, 2001). The
key to this type of communication is that it does not condemn or
blame, but rather it states the relationship in its simplest terms, for
example: “When you said/did X, the effect I see is _Y.” Feedback is the
point in the telephone counseling communication process where the
counselor can either reinforce or seek to modify behavior without
adding any value statements to the intended message (Training
Manual, 2001). Together with paraphrasing, empathizing, and the use
of self-disclosure, feedback contributes to a powerful and effective
communication strategy that is commonly utilized in telephone
counseling situations. These communication skills are used to lower as
many barriers as possible to potential callers so that they will feel
comfortable enough to seek help while they are in the midst of their
crisis when “a small amount of effort leads to a maximum amount of
lasting response” (Parad, 1974, 304).
The Benefite ef Telephene Use

Even if telephone counseling did not offer an unique
communication process to bolster its use among the peoples of the
developing world, it could still fall back on several other characteristics
that lower material and cultural barriers to uptake of new human
development programs. These are characteristics that stem directly

from the use of telephones for support of development. By utilizing

49

the telephone, counseling can be offered in a way that maximizes
effectiveness in terms of comfort, cost, and even accessibility. It is
not a question of whether or not developing nations cold benefit from
telephone counseling. It is undeniable that such services could
provide a great advantage to human development throughout the
nations where it is needed most. The question now is whether or not
implementation of these helpful services is practical, and if the
services offered would be used or if the resource would go to waste.
One way that telephones can improve the chances of counseling
services becoming widely used is by making help-seekers feel
comfortable. Telephone use is what makes the anonymity and
disinhibiting effects of the TCIC communication process possible. The
telephone makes people feel comfortable in situations where they
might normally feel inhibited because it implies distance (Rosenfield,
1997). When people perceive distance they feel safe and this
contributes to lowered inhibitions. This perception is crucial to new
telephone counseling services in the developing world, as they will be
up against a multitude of limiting barriers. Telephones are also perfect
for those least developed areas because very little training or
education is required to use the technology, and in cases where
human operators are present even functional literacy is unnecessary.

Further more, special equipment and services can be obtained to make

50

the telephone completely barrier free to people with physical
disabilities such as the blind and the deaf (Rosenfield, 1997).

Telephone use for the delivery of counseling services to aid
human development is also particularly well suited to developing areas
because the services can be provided at low cost. In developed
countries, TCIC models range from very reasonable to free of charge
(Pool, 1977). This is a major mode in which barriers to TCIC use are
lowered. The promise of low costs to those in developing countries is
only strengthened by the trend of high growth in telephone
penetration fueled by investment in mobile telephony. With the cost
of increasing mobile infrastructure at a fraction of land line expenses,
and with a wider variety of billing schemes, cheap telephone access is
becoming available to those in the global South at unheard of speeds
(Saez, 2001). This rapid-fire method has not only increased access,
but in some countries has changed the way people think about
communications (ITU, 2002). Development of this sort bolsters the
attempts to harness the telephone as a tool to improve quality of life
in developing countries, and the rapidness with which certain
technologies are gaining acceptance shows promise for leap-frogging
past certain stages.

Just as telephone use can imply distance and create a sense of

comfort, it can simultaneously nullify distance and bring people closer

51

together. This is a characteristic that is of enormous importance for
the developing world. Many of the least developed countries are
marked by an interplay of vast expanses of land and scarce resources
(UNDP, 2003). Situations such as this are tailor-made to be effectively
dealt with by telephones. People who might otherwise never have the
ability to seek help from a trained counselor would be put in touch with
experts without any inconvenience. Even in areas where telephone
access is particularly poor, the chances are still very strong that
telephones are more nearby than other potential help resources. For
example, walking an hour to the nearest telephone kiosk is much more
practical than walking several days to the nearest clinic. This
represents the other side of the access barrier. In the developing
world, universal access is not a prerequisite for telephone counseling
projects to be useful and successful.

The fact that telephones can shrink distances opens up many of
the cultural and material barriers to TCIC implementation in the
developing world. Whereas the costs of traveling distances to clinics,
hospitals, or other human development resource centers may be
prohibitive to many, a short phone call yielding valuable information
represents a much more effective use of time. Furthermore, for
persons whose gender, religious, racial, or class group membership

might limit their opportunities to travel or publicly seek help, the

52

resource of telephone counseling would offer them an alternative that
would be available at a moment’s notice.

Realistically looking at the possibility of implementing human
development initiatives in the form of telephone counseling service in
the third world, one has to acknowledge the presence of some very
serious roadblocks. However, it seems just as realistic to proffer that
the characteristics of counseling by telephone would counteract the
barriers against its use. No one would say that the majority of
humans hailing from a multitude of developing nations represent a
monolith. On the contrary, the developing world represents an
incredible range of diversity in terms of race, religion, language, and
culture. What is more universal are the problems shared by these
diverse populations. These problems are faced also by the community
of peoples and organizations that seek to improve human
development. Shared problems have persisted, and in many instances
become worse, in spite of decades of attempts at development aid
programs. A shared solution in the form of telephone counseling is

now ready to be implemented.

SECTION FIVE

Call Center Implementation in Developing Countries

53

While overcoming the barriers that stand in the way of
implementing telephone counseling is a tall order, there can be no
denying that there is as great a need now as ever there has been to
address the issue. The proper perspective with which to view any
particular attempt at human development (or development support
communication, for that matter) is as just one small step in a much
larger process of sustainable national development. Doing so quickly
reduces such barriers to set of manageable variables within a
malleable system. Starting from scratch is never easy, but in the case
of counseling by telephone there are more than fifty years of
experience to light the way. In this amount of time patterns have
emerged and protocols have been put in place in such a way as to
maximize the success rates of new call centers. Concurrently, there
have been great leaps in both the theory and practice of delivering aid
to lesser developed countries and regions of the world. Emerging is a
process for implementing telephone counseling services that is
adaptable to a wide variety of specialized services as well as general
crisis intervention centers and also information and referral hotlines.
Adapting this process to fit the needs of the present illuminates the
potential for achieving similar successes in the underdeveloped regions

of the world.

54

With the proper process in place it is relatively straightforward to
start a telephone counseling call center covering any topic area. This
is not to say that the work to be done is easy, but the steps
themselves are relatively basic. For those developing nations where
cultural barriers loom there would certainly be some very serious and
delicate issues to take into consideration, but even here the precedent
set by so many developed nations could be instructive if implementers
can resist the tendency to reinvent the wheel. The existing, proven
method from the developed countries of the world, combined with the
experience of practitioners from the field, breaks down the startup of
new call centers into a loose progression of steps that encompass a
simple and useful model that “can be applied in almost any country
with a functioning telecommunications system” (Speedland, 2004).

Among the steps included in the model are the most initial
stages where the future call center will plan a statement of purpose
and form an implementation management team; the designing of a
system of data collection for monitoring and evaluation of the call
center; the staffing of the call center; funding, real estate and capital
requirements; and the marketing of the new service. While these
steps are presented in a chronological fashion, it should be stressed
that the ordering of these steps is not necessarily written in stone.

The model’s design draws its strength from “its simplicity and

55

generality” (Speedland, 2004) and rather than prescribing a rigid
sequence which could create impediments to a call center’s startup a
more flexible approach is outlined. However, that much said, the
implementation process must begin somewhere.

As has been plainly stated earlier, there are more than enough
dire causes of human suffering present in the lesser-developed parts
of the world that could be positively impacted through the introduction
of telephone counseling services. Matching a call center’s services
with a “social issue for which there is actual perceived need on the
part of civil society” will be the likely first move in any application of
the model (Speedland, 2004). Once a problem area has been
identified that is deemed actionable and appropriate, a gathering of
minds must take place. For thoughtful and effective discussion to
take place, a management and implementation team must be
assembled. The size and makeup of such a group can vary, but
certain essential members would be needed in every case. Included
among the required members would be an individual or committee
given the managerial power to take action on financial decisions. A
public health expert and a telecommunications specialist are also
necessary. Again, it may be decided to have small teams or
committees of stakeholders in each of these areas. For performing

organizational tasks and delegating responsibility a middle manager is

56

also called for. Next, a human resources manager or staffing specialist
is needed. The final key member would be a clinical specialist who
could act as a consultant for those areas that require more than
administrative attention (Stark, 1994).

To this list could be added several more stakeholders not
recognized as vital in the literature. In the effort to present a
universal method for implementation, it can not be forgotten that the
developing nations of the world comprise an incredibly diverse set. To
deal with this reality, the implementation team should also include a
native-born consultant who is sensitive to the cultural factors that
effect development projects including considerations of race, gender,
religion, and class. Perhaps a native lawyer could fill these shoes,
especially at the very early stages. Additionally, an individual would
need to focus on fundraising. This might mean mobilizing the
community members themselves, reaching out to the local and
international community of private business and non-profit
organizations, and or employing a person with grant seeking and grant
writing capabilities. Ideally, as many members of this group as
possible would be members of the community that the proposed
service would cover. That being the case, there would be the most
likelihood that telephone counseling projects would be conceived in a

manner with sufficient cultural sensitivity as to attract high interest.

57

The members of this team would create the atmosphere in which the
groundwork for implementation of quality services could begin. For
maximum effectiveness this team should also draw its membership
from “civil society organizations” such as gender advocacy groups,
youth groups, and faith-based organizations; “donor organizations;"
and members of “local government” (Speedland, 2004).

Once this implementation team is established it should
immediately set out to reach a consensus on the specific purpose of
the service. The team should craft a detailed and explicit statement of
purpose that covers several key areas (Stark, 1994). Telephone
counseling services can be implemented to deal with a wide range of
problems, they can be temporary or permanent, they can operate
during normal business hours or be continuous, and there are many
more variations. It is important for the implementation team to
include in their statement of purpose what will be the focus of the
services as well as issues that are outside of the sc0pe of the particular
service. It will need to be determined at the most initial stages if the
service will have a set termination date, such as disease-outbreak call
centers or services set up as a resource during natural disasters. The
more explicit the statement of purpose, the better the line will be able

to address community needs, adequately manage staffing, and avoid

58

confusion over the appropriateness of roles attributed to the service
(Poindexter, 2002).

Another consideration in the statement of purpose should be the
establishing of procedures and protocols that will guide the new
telephone counseling service. These must include a set of emergency
procedures, staffing protocols, evaluation procedures, as well as
consent, responsibility, and liability protocols (Stark, 1994). Setting
high expectations and adhering to them are important not only to the
running of an efficient call center, but also to creating and maintaining
a reputation of professionalism within the community. Once the
statement of purpose has been drafted, evaluated and agreed upon by
the team, the real nuts and bolts work of implementing new services
can commence.

Although it is vital that a team of stakeholders is established to
draft a document outlining the new telephone counseling project’s
purpose before anything else is done, the rest of the steps can be
attempted in a variety of possible sequences. All the steps are
essential but their ordering has some flexibility and will be decided by
the implementation team. Where possible and appropriate they can
be attempted simultaneously, given that there is sufficient manpower
to accomplish all the necessary tasks. There will be no shortage of

work to be done.

59

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A needful and possible next step in the implementation of a
telephone counseling service is to design a functioning system for data
collection and call tracking. This will be necessary to evaluate call
volume and thus inform staffing needs over time (Stark, 1994). This
data collection system will also be a tool to monitor the effectiveness
of the call center and can be a crucial way to demonstrate how much
benefit the community receives from the service. Being able to
produce and interpret this information can play a role in procuring new
funding and continuing any commitment from established funding
sources. Monitoring and logging calls is also of importance in terms of
maintaining a well-informed staff. Records from call tracking
databases can communicate useful information to counselors such as
information on repeat callers or handling suggestions for particular
problem areas (Training Manual, 2001). This brings to mind the issue
of staffing, which is another needed step in the process of
implementing telephone counseling services.

The staffing of a telephone counseling service actually
encompasses two required steps: the hiring of staff and the training of
hirees. It should be obvious that at some point before the first phone
call to a new call center there will need to be quite a few interviews.
Potential phone call answerers (PCAs) will need to be screened based

on predisposed criteria created by the implementation team. It will be

60

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essential that proper care be taken to ensure the staffing procedure
yields a competent and professional batch of new counselors.
Applicants must meet qualifications, have certain experience, posses
the proper attitude, and have the ability to build a rapport with the
caller quickly (Conte, 1996). Only those who are up to snuff should
proceed past the initial screening to the stage where intensive training
takes place.

The training of telephone counselors involves several key
components. First and foremost, trainees should be informed of the
call center’s purpose and socialized in terms of the particular service’s
protocols. Doing so will prevent confusion down the line and
contributes to the call center’s ability to maintain its initial integrity.
Once that is out of the way, new hires will be indoctrinated into the
unique communication process which has been elaborated earlier.
Role-playing sessions will allow the trainees to drill and practice this
new skill set. Because telephones lack face-to-face qualities, the role-
playing exercises should include stressful scenarios that highlight
listening skills and sensitivity (Conte, 1996). By mimicking realistic
and difficult problem situations on the telephone, trainees will become
sensitized to the fact that burnout and strain can occur and will have
an opportunity to practice setting personal limits (Boehm, 1991). Of

course these role-playing sessions will be conducted and evaluated by

61

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an experienced training staff who will be able to reinforce appropriate
actions or suggest more effective behaviors.

Training manuals and workbooks for such purposes are already
in existence throughout the developed world (“Hotlines”, 2001).
Furthermore, corporate call centers for many customer-service and
data-entry applications have been off-shored in recent years which
demonstrates that similar training programs for telephone counseling
could have matching success in the developing world. A last, yet
critically important step in the training of PCAs is ensuring that they
have competency in the use of a referral database for community
resources. One suggested model is that trainees master the use of a
simplified directory for quick situations (such as those that arise in
typical calls to counseling call centers) and compliment that with a
highly detailed directory that is all-inclusive (Training Manual, 2001).

A final consideration in the staffing and training stage of the
model is orienting the PCAs to the use of telecommunications
equipment. While in the developed world it is taken for granted that
everyone has a telephone and, therefore, understands how to properly
use it, such an assumption might be misguided in underdeveloped
regions. In the case of telephone counseling call centers,
sophisticated telecommunications equipment is required which may

mean additional training for potential counselors. It would be ideal if

62

everyone was already an expert, but this might be an overly
presumptuous expectation. Acquiring such equipment brings up
another key step in the model.

The implementation team will need to pay particular attention to
the concern of raising the funds necessary for the real estate and
capital requirements needed to sustain a new call center for there is
“no greater hurdle to overcome than the identification of funding for
such projects” (Speedland, 2004). Funding will need to be secured for
several vital components of the new call center. For example, there
will need to be a physical space to house the call center and its staff
and this means that the budget will have to reflect the substantial cost
that renting or purchasing entails.

Finding a suitable location should not be overlooked as an
obvious step. This is in part because call center will have special
needs and these have to be given consideration before new services
can be implemented. Ideal call centers need to be quiet, able to be
occupied twenty-four hours a day, and need to be able to support a lot
of telecommunications equipment (Stark, 1994). This equipment may
also require the generation of substantial funds. It seems obvious,
and may go without saying, but a telephone counseling center needs
to have telephones. This may include grant writing, seeking donations

of new or used equipment, or purchasing. Securing these funds calls

63

for contact with a number of sources, such as “domestic or
international donors, civil society organizations, government” and
others (Speedland, 2004). These costs will be ongoing, for example,
as new technologies become available, they can also be applied to the
benefit of call centers. Computers and web-based databases could
greatly enhance the usability of information and referral resources as
well as enabling networks of development support projects (Lester,
2002). There are also several features that could be added to the call
center’s roster of equipment such as hands-free headsets, rollover
lines for heavy call volume services, and toll-free telephone numbers
(Rosenfield, 1997).

Another vital step that requires substantial funds is the creation
of a publicity campaign introducing the new service to the community.
New services also need to be publicized in order that the target
recipients are aware of the services offered. This can take whatever
form fits best in a particular country or community. Marketing
strategies can include newspaper, television, and radio
announcements (in areas where such offerings are available), or could
be done through posters and flyers (SIECUS, 2002). Popular
celebrities or governmental officers could act as spokespersons for
telephone counseling services. The name of the service or telephone

number could be selected in a way to be memorable, trendy, or

attractive. Any strategy that might convey to the target audience that
services are accessible to them. The marketing campaign should also
educate the community about the services offered, and how they help
to solve local or national problems. Further, the services should be
marketed in a way that highlights the anonymous and judgment-free
nature of the counseling interaction, so those cultural barriers against
use are lessened. In cases where cultural barriers are especially high
for a particular group (for example, for women or racial/ethnic groups
that are discriminated against), the marketing strategy should react by
aggressively targeting them and deconstructing myths that prevent
populations from seeking help (SIECUS, 2002). Even with the best of
intentions, a counseling service can have no effect if it has no clients.
It would be an oversimplification to claim that the above list
encompasses every last detail that goes into implementing a new
telephone counseling services. Of course there are many other
responsibilities that will fall on implementation teams, as well as
having to worry about the inevitable yet unexpected foibles that
typically accompany the implementation of new projects. That said, it
should be remembered that oversimplification is the aim of this
exercise. By keeping the model general and flexible the aim is to
produce a document that can serve a practical purpose for the

maximum number of communities and the maximum number of

65

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problem areas. Please refer to Appendix A for a brief introduction to
some specific uses of TCIC in the developing world. What has been
attempted is to develop a basic list of the bare essentials required to
start a telephone counseling service in the developing world. This list
has adapted over the past half-century, and it is bound to adapt
further in the next fifty years, but it does represent a useful map to
navigate those pioneering efforts at using telephone counseling

services in support of human development.

SECTION SIX
Conclusion

Underdevelopment throughout the world currently robs the
majority of humanity of the opportunity to enjoy fundamental human
rights. Within this frame we see billions of people (disproportionately
women and children) locked in a poverty the depths of which we would
shudder to imagine (UNDP, 2003). From continent to continent, the
world's majority, the poor, are denied the most basic dignity of
existence. Sadly, there exists no magic wand to wave, no universal
remedy, no quick fix. Furthermore, any prescriptions offered are
shaped by the systems they would be placed into. Options addressing
the larger problem, underdevelopment, must compliment these

systems or at least have the capability of functioning in spite of such

66

systems. Briefly, solutions must be applicable to the prevailing
economic, cultural, religious, and political environment in which they
are implanted.

Refusing to heed such systems has led to many of the
development failures and contributed to the development reversals
being witnessed in the least developed countries of the global South.
The tendency has been, rather than to better equip development
projects to cope in specific realities, to blame the poor for their
poverty. Cited have been areas too slow to adapt to liberalized
markets as well as areas with cultural (gendered, religious, political)
characteristics unfriendly to development (UNDP, 2003). On the other
hand, perhaps it has been that development schemes have failed
because their design has not taken into account whether or not they
have the necessary ingredients for success amidst imperfect
conditions.

It has been pointed out that development projects have suffered
from a western-centrism that stifles their ability to be practical in the
developing world (Wilkins, 2000). The next step to take is breaking
such a statement down into its actual elements. We do have examples
of development support communication that are practical and
effective. We also have experience in pioneering projects in adverse

conditions. The use of telephones for counseling and to organize aid

67

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and support projects has stood as a towering achievement throughout
the developed world. It has done so in the face of dubious certainty
that such an application would have effect and it has flourished in a
multitude of problem areas because it possesses characteristics that
lower barriers to its usage. Perhaps most important for the discussion
of international human development is that such services lend
themselves to a process of implementation that is relatively universal
and simple.

The history of telephone counseling in the developed world is
instructive for the discourse of new development support
communication. Whereas the United States was already a highly
developed nation by the 1950’s, it still offers insights for the
developing world today. Counseling services had to contend with both
an air of skepticism about their practicality and a population
unaccustomed to the use of new technologies in help seeking. Much
the same could be said about the hurdles that counseling by telephone
must face in the developing world. Armed with the lessons learned
from the case of the developed world’s history and current effective
use, new initiatives for poor countries may be able to bypass some of
the early hard lessons and accelerate toward the goal of establishing

cheap, useful, and accessible services with a minimum of foibles.

68

The success of counseling by telephone enjoyed by those in
developed countries hint at the promise of equal success elsewhere.
Constant improvement and refinement in areas such as awareness
raising, marketing of services, and social taboo deconstruction have
strengthened the effectiveness and sustainability of telephone
counseling over the past half century. These are also areas of great
need for development support projects (SEICUS, 2002). There is no
shortage of issues that would greatly benefit from the implementation
of counseling by telephone in the developing world. All the heart-
wrenching causes of human suffering are accounted for. An
abbreviated listing includes growing hunger, poor levels of education,
high levels of violent conflict, increases in disease, decreases in access
to healthcare, racism, sexism, abuse, alcoholism, drug addiction,
suicide, susceptibility to natural disasters, and low levels of basic
human rights.

What complicates the issue of using telephone counseling to
alleviate such development problems is that barriers to its
implementation exist in the developing world, just as they did in the
United States. Primary among these barriers is low levels of telephone
access in much of the developing world. This is the most fundamental
problem in the way of development support communication projects

that call for telephone use. Obviously, one can not use a telephone if

69

there are none. The current trends in telephone penetration for the
developing world offer some hope for improvement in this area.
Especially promising are factors such as the liberalization of
telecommunications operators in many countries and the explosion in
popularity of new technologies such as mobile telephony. These
developments have already led to a shrinking in the access gap
between rich and poor countries and projections that the
underdeveloped countries will continue to be the fastest growing
telecommunications markets (WTDR, 2002). Access gaps, however,
are not the sole problem.

Another critical concern of development support communication
in general, and telephone counseling use specifically, are the barriers
to development initiatives that stem from cultural differences. This
blanket term grossly generalizes a complex set of factors that will vary
from country to country, but that may be simplified and stated in a
useful way for the discussion of new telephone counseling services in
the developing world. The relevant cultural topics introduced have
included attitudes toward technology acceptance and help-seeking
behaviors, religious attitudes relating to development, the cultural
implications of class, race, and gender inequality, and the political-

cultural characteristics of developing countries.

70

These problems are commonly viewed as serious contributors to
the failure of development projects. They are seen as pitfalls to be
sidestepped. Rather than perpetuate that mode of thought, this set of
circumstances can be viewed as an invitation to develop initiatives that
are tailored to fit around such problem areas. It has been suggested
that increased cultural sensitivity is highly important to the
implementation of successful development campaigns (Steeves in
Wilkins, 2000). Addressing the cultural barriers to the uptake of
telephone counseling not only increases our understanding of the need
for human development throughout the global South but also
highlights the characteristics of such counseling that actually lower
barriers.

One of the existing factors that bodes well for telephone
counseling is that the poor countries of the world are heavily laden
with the kinds of problems that could be effectively addressed through
counseling (consult Appendix A). In terms of the actual characteristics
of telephone-mediated counseling for human development that lower
barriers to its use are both those related to the specialized
communication process utilized by phone counseling, and those arising
from interacting through telephones. Between these two sets of
factors, most of the barriers to telephone use for counseling in the

developing world are removed or at least lowered. What then remains

71

is taking the devel0pment support project from the drawing board to
the switchboard.

The principal goal of this review has thus far been exploration.
To seek out and illuminate the most concise elements of the discourse
on telephone counseling for international human development. Taking
the exploration into the realm of practicality, a blueprint of sorts has
been drawn up. With the goal in mind to develop a general and
universal model for the implementation of new telephone counseling
services, a brief and simple list of the necessary components has been
illustrated. The intention of the section was to provide a skeleton on
which to hang the muscle behind this development proposal, namely a
nuanced and respectful understanding of the particular cultural
characteristics of the target community.

. In the struggle to improve the state of human development
through communication applications there is a high demand for
creativity in the design of new and suitable projects. Here it is
important not to overlook those avenues that are already in existence
in developed countries. A new opportunity for communication in
support of human development awaits in the combination of telephone
counseling with underdeveloped nations. The belief upheld by
telephone counseling is that people are more than capable of solving

their own problems given access to the appropriate resources, and this

72

belief shifts the paradigm of dependency on rich countries for human
development to one of empowerment of underdeveloped populations
to effect a positive and sustainable change for their own lives. There
is much reason to believe we can accomplish all this through picking

up the phone.

73

APPENDIX A

This appendix will suggest some specific applications that lend
themselves to the effective use of TCIC. Up to this point the exercise
has been one of generality, driven by the thought that a single type of
intervention could have widespread effect in the field of global human
development. Now the focus will shift briefly to the task of giving
tangible examples of problem areas, demographic groups, geographic
regions or cultural characteristics that should foster the
implementation of TCIC services.

Consistent with human development's component of increasing
life opportunities through education, TCIC is a particularly well-suited
intervention. Information referral services that put people in contact
with accurate, up to date information in a judgement-free environment
would provide a quick, method for making education accessible. There
are several examples of this type of intervention.

Teen hotlines represent a tool capable of reaching a massive
population as the developing world is demographically marked by an
adolescent majority (UNDP, 2003). Furthermore, teens are a group
that typically display more openness to technology than older
generations (Cruz, 2001). Teen lines that focus on reproductive health
and are staffed by knowledgeable counselors would have a very real

impact on addressing the growth of sexually transmitted infections. In

74

the United States (a culture that is comparatively open when placed
next to most developing countries) research on teen lines has shown
that teens often seek advice or need help with problem solving skills,
but feel as if there is no one to safely talk to in their circle of family
and peers (Boehm, 1991). It is arguable that this finding would be
even more prevalent in the more traditional cultures of the developing
world. Furthermore it is beyond doubt that the services would reach a
population of teens at a much greater risk from poor reproductive
health than anywhere in the developed world (UNDP, 2003).

TCIC services that manifest themselves in the form of
information and referral centers focused on the needs of women in the
developing world would also be an extremely salient intervention in
terms of addressing human development concerns. The
empowerment and equality of _women is a central theme of the push to
define global sustainable development in terms of quality of human
life, especially given the reality that those suffering most from the ill
effects of underdevelopment have been and continue to be women
(UNDP, 2003). Examples of problem areas that TCIC could effectively
address for this demographic group include counseling for marriage
and other family concerns (including but not limited to spousal abuse
and legal matters), as well as employment counseling and, of course,

sexual and reproductive health counseling (Palmer, 1997). All of these

75

are fertile grounds for human development initiatives as it is now
recognized that gender inequality in the developing world has become
a huge barrier to the success of projects aimed at making sustainable
gains (UNDP, 2003). Another area of critical concern where TCIC
services could offer help is information and referral services for women
with HIV/AIDS and, in particular, mothers of HIV infected babies
(Wiener, 1998).

HIV/AIDS is likely the best problem area within which to
implement TCIC services for a number of reasons touched on in the
body of this thesis. It is undeniable that the developing world faces a
crisis in terms of HIV/AIDS that threatens to reach pandemic levels in
certain regions and is a growing concern almost universally (UNDP,
2003). TCIC would be ideal for this application because it offers
people a chance to openly discuss taboo topics that, left unaddressed,
pose a problem to the larger society. Also, TCIC could act to
deconstruct myths and stigmas that prevent people from dealing with
HIV-related concerns. As stated before, when traditional cultures stifle
dialogue on important issues the result is that people are forced to
remain silent or (worse) receive false information from peer groups
that lack reliable information (Chandiramani, 1998). The most

effective interventions in the developing world should reflect the “need

76

for health care professionals to concentrate their work at the level of
already held beliefs” (Chandiramani, 1998, 6).

In terms of cultural characteristics that seem to hinder human
development, there are a few that TCIC seems apt to combat. Areas
that are embroiled in violent conflict, whether spanning generations or
coming about suddenly, have suffered serious development reversals
that are not easy to recover from (UNDP, 2003). Here crisis
counseling could be used to help individuals and families cope as well
as relieve the fear and anxiety associated with conflict by providing
support and valuable information in emergency situations (Shamai,
1994). These services could be set up quickly and dismantled once
the conflict has subsided or they could become a more lasting form of
support for perpetually war-torn areas. Such interventions have been
applied successfully in developed-world conflictzones such as in Israel
during the first Gulf War (Shamai, 1994).

Another cultural characteristic having negative impact on human
development is the tendency for underdeveloped communities to be
situated in harsh, extreme, or dangerous locales. The recent Tsunami
is a drastic example of the fact that the developing world countries are
more at risk of suffering from natural disasters and are less capable of
dealing with natural disasters (UNDP, 2003). TCIC could be imposed

to aid the clean-up and recovery efforts of areas suffering from natural

77

disasters, and once again information referral services would be
extremely important at such times, helping to coordinate the available

resources that victims would need to rely upon.

78

APPENDIX B

 

CALL CENTER IMPLEMENTATION FLOWCHART

 

 

 

Formation of Implementation Management

Team

0 Essential Stakeholders

0 Optional Members

 

 

/

 

 

Statement of Purpose

. Detailed, explicit protocols and

 

 

 

 

Marketing

Publicity of services

 

 

 

 

 

 

\

 

I—

 

standards ""'> directed at target
market
.0
.0
g!
Staffing System of Data Funding-
Collection Capital Requirements
. Recruitment . Call Tracking 0 Real Estate/Rent
. Screening 0 Service 0 Telecom Equipment
0 Training ' Evaluation 0 Marketing and

Publicity

 

 

,7

 

Implementation of Service I

79

 

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