Face attack and patients’ response strategies in a Kenyan hospital¹

Abstract

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.

Situated Language Use in Africa

“…Thus, Irvine's seminal (1974) paper on status manipulation in Wolof greetings was followed by a steady stream of analyses of greeting rituals in other languages/communities, including Yoruba (Akindele 1990), Swahili (Omar 1992), Igbo (Nwoye 1993), Akan (Agyekum 2008), Setswana (Bagwasi 2012) and Sukuma (Batibo 2015). In time, it was supplemented with work on other speech acts (e.g., Irvine 1980 on requests in Wolof, Obeng 1999a and 1999b on Akan requests and apologies, Agyekum 2010 on expressions of thanks, also in Akan), as well as work on politeness phenomena and the notion of face (e.g., Nwoye 1992, Yahya-Othman 1994, Obeng 1994, Agyekum 2004, Ojwang et al 2010). Ameka and Breedveld (2004) account for the prevalence of specific communicative taboos and the spread of practices like triadic communication in terms of "cultural scripts" that extend over a larger West-African "speech area" (Hymes 1972), but their attempt remains inexorably rooted in an isomorphic, community-based approach.…”

The Palgrave Handbook of Linguistic (Im)politeness

“…In addition to focusing on relatively traditional institutionalised contexts (such as hospitals or general practices) where many studies are located (e.g. Agledahl et al, 2011;Ojwang et al, 2010;Zayts & Schnurr, 2013), (im)politeness research is increasingly conducted in other, perhaps slightly less mainstream, medical environments. For example, Woolhead et al (2006) and Backhaus (2009) analyse the use of (im)politeness in social care settings, Davis and Kelly (2012) focus on counselling services, and Bromme et al 2012, Graham (2009) and Locher (in press) look at different educational environments.…”

“…Gallardo & Ferrari, 2010;Harrison & Barlow, 2009;Harvey & Koteyko, 2013;Locher, 2006. Researchers have also started to expand on the literature on professional-lay interactions, such as those between nurses and patients (Zayts & Schnurr, 2013;Ojwang et al 2010), care home staff and clients (e.g. Woolhead et al, 2006;Temple et al, 1999), stroke patients and health professionals (Grainger et al 2005), and between tutors and medical students (Bromme et al, 2012)just to name a few.…”

“…Davis & Kelly, 2012;Iedema, 2005), Hong Kong (e.g. Zayts & Kang, 2009;Zayts & Schnurr, 2013), Kenya (Ojwang et al, 2010), Latin America (e.g. Gallardo & Ferrari, 2010), Norway (e.g.…”

“…These studies have identified and described some of the discursive strategies and pragmatic processes through which participants in these sociocultural contexts do (im)politeness in a wide range of healthcare settings. One of the few studies which specifically focuses on the phenomenon of impoliteness is Ojwang et al (2010). Their study of nurses in a Kenyan hospital discusses the frequent use of impoliteness and abuse uttered by the nurses towards their patients.…”