Future Community Health Extension Workers (CHEWs) are taught the sciences of health in the classrooms: anatomy, pharmacology, public health, maternal care and disease prevention. These are the formal curriculum which is measurable and organised. However, in the clinical field (throughout clinical rotations, community postings, and outreach campaigns), students learn a different set of lessons. They are not described in any syllabus or the books and they too are very required in practical life.
These tacit and informal forms of learning are what the experts’ term as the hidden curriculum. It involves such experiences as coping with the lack of resources, addressing ethical issues, developing emotional protective calluses, and working through bureaucracy. This hidden curriculum is something a CHEW will never see; however, this invisible aspect can eventually become the most indicative part of CHEWs professional personality.
Find out about community health extension workers and how hands-on learning experiences are moulding their careers.
In this article, we disentangle the elements of the hidden curriculum, pointing out what really influences CHEWs on the street as public health workers.
Understanding the Hidden Curriculum
The hidden curriculum can be defined as unwritten, unofficial and frequently unintentional curriculum that students acquire at their places of professional training. Although treated as a separate syllabus, these lessons relate to the way students view their role, react to the situation, and develop on an emotional and moral level.
For CHEW students, these case lessons become very apparent in field placements where real life doesn’t go by the book. Classrooms can only teach theory, the field is where you find contradictions, missing pieces and grey areas. It’s here in these spaces that the hidden curriculum makes its home—and real learning happens.
- Navigating Resource Scarcity
Among the earliest and most eminent lessons that CHEWs learn when they are placed on their community postings is how to work in environments where even the bare necessities are unavailable. Supplies like gloves, syringes, antiseptics or even electricity can be missing or unreliable in most of the rural health centers.
That they learn:
- Improvisation: CHEWs are accustomed in adapting. When there is no blood pressure cuff, they train themselves to estimate using the palpitation and symptoms that the patient had. In case of non-availability of gloves, they are taught the technique of careful hand washing.
- Prioritization: This has made students learn how to determine cases which need urgent attention when the available resources are scarce.
- Creative Education: When there are no educational materials, they are taught how to use storytelling or song or drawing to educate communities about hygiene and prevention.
The learning described in this type cannot be presented in a lecture hall; it is learnt when students have to take care decisions under pressure and when they have few tools available and when they have a lot at stake.
- Facing Ethical Dilemmas in Real Time
Ethics in their theoretical form appear so simple; never tell a lie, just honor patient autonomy, do not violate confidentiality. However, in the real world, ethical dilemmas are intricate, and in most cases, they involve emotions.
Typical scenarios include:
- An adolescent female asks to get birth control without discussing it be with her parents. Does the CHEW have to respect confidentiality or disclose the information to the parents?
- One patient pays a present to get access to the care sooner. Is it acceptable?
- Another old practice or even dangerous one is carried out by a senior health person. Should he/she report it?
What they learn:
- Moral Judgment: Students learn to be able to evaluate the situations of the clash between ethics and expedience.
- Courage and Diplomacy: They should frequently disagree with the rules or interrogate the seniors without causing aggression.
- Cultural Sensitivity: They are taught how to use ethical principles and at the same time, take into consideration the local customs and beliefs.
They are very powerful lessons in how to be ethical in the gray areas of health care activity of a CHEW.
- Building Emotional Resilience
No course puts a CHEW at the podium tuned to the sound of a malnourished child struggling to breathe and calming a mother who lost her child because of not making a referral on time. These scenes are heart wrenching and very human.
What they learn:
- Compassion with Boundaries: Students have to care a lot but they should not get burnt out due to their emotional state.
- Grief Processing: They get to learn how to debrief, reflect, and console each other following challenging experiences.
- Staying Strong in Crisis: The CHEWs gain the ability to remain calm in an emergency or an outbreak.
This emotional coping turns out to be one of their most powerful resources in the further practice.
- Understanding Community Dynamics and Power Structures
Community engagement can be taught in the textbooks; however, the politics of real communities cannot be simulated in the textbook. Students of CHEW soon learn that healthcare is seldom neutral but touches upon power, gender specifications and conventional ideology.
Examples of hidden lessons:
- There are traditional leaders who can be involved in determining the health campaign adoption or rejection.
- A young CHEWs advice may be ignored by the elders due to their opinions though it may not be accurate.
- Religious leaders could be against family planning.
What they learn:
- Negotiation Skills: They are taught how to be a good listener, develop trust, and mold health messaging.
- Respecting Gatekeepers: Learners learn how they can access influential people so as to reach the wider community.
- Real World Cultural Competency: They use medical knowledge which is culturally significant and community accepted.
This knowledge makes CHEWs communicate better and better agents of change.
- Dealing with Bureaucracy and Systemic Frustration
In most low resource environments, healthcare is characterized by bureaucratic delays, competing priorities and strict hierarchies. The following are some of the things CHEWs on practicum placement may experience:
- Vaccine arrival or refilling delays of medicine
- Health records misplaced owing to bad record keeping systems
- A lack of clarity between who is responsible in follow-up care
What they learn:
- Patience and Persistence: Students come to realize that transformation of the system is gradual and that it takes hard work to achieve it.
- Advocacy from Within: By remaining involved and reporting their difficulties many start to realize how they can make systems better.
- Administrative Savvy: They are taught how to fill in forms, send reports and chase ministries or NGOs.
This wisdom helps create professional maturity in order to operate under broken systems and still be able to treat patients.
- Learning from Non-Verbal Cues and Human Behaviour
CHEWs are not only being disease observers in field work they are disease observers who are people observers. The unsaid, a sigh by the caregiver, hesitation on the part of a patient, the silence of a community leader, can say so much.
What they learn:
- Non-Verbal Communication: They sense hurt, fear or stigma without the patient ever speaking a word.
- Behavioural Psychology: They are taught that they should be able to know the reason as to why some people might not want treatment, or vaccinations, or just hate medical employees.
- The Importance of Empathy: Such experiences educate students on how to relate to people not as cases.
In the long-term, this assists CHEWs in establishing a better connection and in becoming more caring professionals.
- The Power of Teamwork and Peer Support
Students of CHEW usually work separately but they form integration into wider health teams. Under this environment, they acquire informal yet important lessons concerning team work.
What they learn:
- Respect for Every Role: Be it a janitor, a lab tech or an elder volunteer, they realize that they have their part to play in the delivery of healthcare.
- Shared Stress Management: Discussing with colleagues of similar experiences of hard times in practicum also becomes a healing process.
- Leadership by Action: There are some students by default who will volunteer when things are going on the wrong track- they learn to take charge without actually holding any positions.
These team-based course work cultivates lowliness and readiness for interdisciplinary work in the future.
- Improvisation and Problem Solving in Unexpected Situations
In field practicums, things do not always work out as intended. A patient can collapse at an outreach programme. There can be a transportation strike that will postpone the delivery of vaccines. A fridge powered by solar energy can break down during a heatwave.
What they learn:
- Quick Decision Making: CHEWs are taught to evaluate possibilities and take immediate decisions.
- Using What’s Available: They learn to do with what is available using empty water bottles for health demos or teaching a lesson on sanitation using a bucket and some soap.
- Confidence Under Pressure: Those experiences prepare CHEWs to operate under pressure with cool heads.
- Professional Identity and Personal Growth
The most effective part of the hidden curriculum perhaps is the way it transforms the person. Students that might have begun with confusion and fearfulness have become assured health workers with the sense of mission.
What they learn:
- Why They Chose This Path: In the course of field work their dedication to serve is reinstated.
- Their Strengths and Limits: The students learn what they are good at and where there are weaknesses.
- Adaptability: They are more elastic, imaginative, and ready to work with the contingencies in the face of public health.
It is not graded development but it is life-changing.
Integrating the Hidden Curriculum into Formal Training
Although this process encompassing the lessons hidden curriculum is not formal, an educator can assist through:
- Facilitating Reflection: Making students write journals or taking part in discussions.
- Providing Mentorship: Providing field mentors that impart knowledge on how to resolve a situation involving ethics or emotions.
- Creating Safe Spaces: Encouraging the students to open up without being afraid to be criticized.
Recognizing the presence of the hidden curriculum, institutions render the training of CHEW to be more whole some and humanistic.
Conclusion
Not everything that is taught is necessarily the valuable lesson to a Community Health Extension Worker, as they are often lived. The unseen curriculum, brimming with skills, intuitive, moral, and practical wisdom as well as being systematic, equips CHEWs in the way of the intensely human endeavors of public health practice.
Since it is about making do with little, to wading through a cultural landscape, to doing what is ethically upright, to being an emotionally strong person, they are the silent classes that construct the backbone of an effective health worker. They go out not only equipped with the technical expertise but with the wisdom, ability and compassion that can only come with experience.
When identifying and accepting the hidden curriculum, we equip CHEWs to a greater state of readiness to live in and serve the world into which they have been called and a world oft far too beyond the script but always in service of the heart.
