Social power can be exercised by face attack where power differentials are sufficiently great and significant retaliation or sanctions are unlikely. Such exercise of social power is common in military contexts. It is not commonly observed in hospital settings yet some nurses in Kenya's public hospitals routinely attack the face of their patients. Using data from interactions observed in a provincial hospital, it is illustrated how nurses initiate conflict and how patients counter the face-attacking moves. The investigation shows that nurses use a high frequency of utterances that violate the dignity of patients while the latter prefer conflict avoidance strategies. Nurses generally make no attempt to mitigate the impact of most of their face-threatening utterances while patients demonstrate awareness of the need to preserve mutual face and reclaim dignity. Three strategies used by patients to reclaim dignity -namely silence, retaliatory face damage and face repair -are illustrated. Nguvu za kijamii zinaweza kutekelezwa kwa kushambulia uso mahali kadri zanguvu ni mazito mno na ulipizaji kisasi wala vikwazo haviruhusiwi. Utekelezaji huu wa nguvu hudhihirika sana katika mazingira ya kijeshi. Hauonekani sana katika hospitali. Ingawaje, baadhi ya manesi katika hospitali za umma nchini Kenya mara kwa mara hushambulia uso ya wagonjwa wao. Huku tukitumia data ya miingiliano iliyotazamwa katika hospitali moja ya mkoa, twaonyesha jinsi manesi hubuni migogoro na vile wagonjwa hukabiliana nayo. Uchunguzi huu unaonyesha kuwa manesi hukiuka hadhi ya ubinafsi ya wagonjwa pakubwa ilhali wagonjwa huchagua mikakati ya kuepuana na migogoro. Kwa ujumla, manesi hawaonyeshi nia ya kupunguza athari za shambulio la uso katika matamshi yao ilhali wagonjwa huonyesha ufahamu wa kuhifadhi heshima na kudai tena hadhi. Mikakati mitatu ya wagonjwa ya kudai tena hadhi ikiwemo kimya, ulipizaji kisasi na urekebishaji uso inaelezwa humu.

The region inhabited by the Luo ethnic group in Kenya is disease endemic. However, disease awareness initiatives register low acceptance due to the sociocultural images of disease and illness conceptualized in the local Dholuo language in ways that may contradict modern biomedical knowledge and practice. This article evaluates the sociocultural basis of encoding descriptions of disease in the Luo indigenous knowledge system and their implications for modern medical practice. The methodology entailed use of qualitative interviews of purposively sampled Dholuo-speaking patient escorts in a provincial referral hospital. Nonparticipant observation was also conducted at funerals to monitor contextualized usage of the discourse of disease, illness, and death. The data were analyzed using qualitative content analysis and categorized into emergent themes and categories. The results revealed that Dholuo is replete with expressions that emphasize the vulnerability and discrimination of the sick. Such attitudes cause rejection of interventions and negatively influence health-seeking behavior. The expressions were relevant and acceptable to cultural insiders; hence, they could determine their understanding of health conditions thereby influencing how they make medical decisions. It emerges that the unique Luo worldview controls their perceptions on the causes of disease and prescribes community-driven remedies which may depart from the expectations of the biomedical model.

No abstract

No abstract