Pathways to Inhumane Care: Masculinity and Violence in a South African Emergency Unit.

Abstract

Inhumane treatment of patients by health care providers is reported around the world. A range of explanations has been proposed, indicating the complexity of the multiple factors involved. This article reports on an ethnographic study conducted in a South African public sector emergency unit, exploring the possible contribution of hegemonic discourses of masculinity to delivery of inhumane care in this context. Using ethnographic methods, including participant observation, interviews, audio-recordings of verbal interaction, and narrative analysis, the study on which this article reports explored the discursive practices surrounding incidents of abuse. The article argues that the pressure doctors experience to display strong masculine identities and simultaneous feelings of powerlessness in the face of material realities generates the potential for inhumane acts. It concludes that understanding the metaphors through which doctors interpret their experiences is important both to comprehending and subverting the forces that drive inhumane care.

A qualitative study of patients and healthcare workers’ experiences and perceptions to inform a better understanding of gaps in care for pre-discharged tuberculosis patients in Cape Town, South Africa

“…When there were efforts to provide health education, patients faced a number of critical barriers to communications. Lack of effective clinical communication is a pervasive problem in the South African public sector health system [ 26 , 27 ]. Communication problems are in part about linguistic challenges between HCWs and patients, which can lead to a patient’s inability to understand what is being said or a health worker’s inability to express what they mean, especially in an extremely multilingual context (South Africa has 11 official languages and many sub-dialects) [ 28 ].…”

“…Even when there is a shared language, though, health education can be seriously inadequate [ 26 ] leaving patients unclear on the implications of their diagnosis and the impending treatment journey. Finally, entrenched hierarchies between patient and provider and extremely high workloads among providers can leave many patients feeling incapable of asking HCWs for clarification or further information [ 27 ]. The impact of poor communication were clearly evident in this study, with many participants expressing inadequate treatment literacy and an inability to ask questions.…”

“…The impact of poor communication were clearly evident in this study, with many participants expressing inadequate treatment literacy and an inability to ask questions. Spending more time speaking with patients in a patient-centred manner so that they properly understand their diagnosis treatment is critical to allaying fears and anxieties, and contributing to the continuity of patients’ TB care [ 21 , 27 , 29 ].…”

La urgencia bajo la lupa: una revisión de la producción científica sobre servicios de emergencia en hospitales desde la etnografía

“…Most of them analyze violence by patients and/or family members or accompanying persons towards healthcare staff 117,118,119,120 . Only one article describes violence by medical staff against patients, expressed as "inhuman care" 121 . Many of these studies use the "risk" category, seeking to identify possible causes that can give rise to these situations 119,121 , such as waiting time for treatment and the impact of empathy on the process of care.…”

“…Only one article describes violence by medical staff against patients, expressed as "inhuman care" 121 . Many of these studies use the "risk" category, seeking to identify possible causes that can give rise to these situations 119,121 , such as waiting time for treatment and the impact of empathy on the process of care. Some of these studies also report the healthcare staff's perceptions and the fact that they take such violence for granted 118,120 , plus the reporting (or rather the underreporting) of such events in the institutions 117 .…”