The Practice of Medicine without the Care

Cape Times (South Africa), June 12, 2009 | Go to article overview

The Practice of Medicine without the Care


BYLINE: Lauren Muller

In her brave and insightful letter to the Cape Times (June 9), Philomene Luyindula described her 30 hours as a patient in the emergency ward at Groote Schuur Hospital. She describes a seeming paradox - medically competent doctors and nurses and an experience of "distress", "violence" and "abuse".

In particular, Luyindula points to the "attitudes" of the nursing staff, who, she reports, failed to meet basic nursing needs and provide human caring.

She describes how nurses "could speak of the patient's conditions and treatments as well as the doctor", but ignored patients' basic needs for food, access to toilets and dignity.

Luyindula compares nurses' uncaring behaviour and attitudes with that of "kindness and reassurance" from the ward doctors. She acknowledges that nurses' actions are the product of history, their working conditions and poor pay. The net result of this neglect was a lack of respect for the nursing profession - "people dead set against nurses" and incomplete medical care; "patients trying to get out (of the ward) before proper treatment".

As a woman, Luyindula described how she found the ward physically and sexually unsafe. Men were placed in stretchers next to women or walked about largely undressed. Women, she noted, enter these spaces with common histories of sexual abuse, valid fears and sensitivities, which are overlooked in a narrow focus on acute care. She concludes that it takes resilience, an external support network and a "strong will" to survive our public health system. Since people who seek health care are at their most vulnerable, this list of requirements excludes a great many people from so-called accessible health care.

Luyindula ends her letter with an appeal that "a place of healing has to remain a place of healing". Medical spaces of treatment, whether they be accessible emergency/trauma units, hospital wards or community health centres or clinics, are seldom understood as places for medical care. Luyindula repeatedly describes how her expectation of the meaning of these medical spaces - that is, to offer healing - was both disappointed and inverted. In these medical spaces she felt unsafe, dehumanised (a thing neglected on a chair for 10 hours) and re-traumatised.

In my own research a few years ago on places of public health care on the Cape Flats, I heard similar accounts of fear and threat from patients and staff. The safety of medical interventions is stressed in medicine, yet little consideration is given to medical spaces as safe and hospitable places. For the staff I interviewed, the lack of safety was associated with the entry of gang members into the day hospitals, but more broadly they were concerned about their personal integrity, dignity and "safety" from all forms of abuse.

Hospitals and wards were disputed territories which staff were no longer able to control, especially within chaotic emergency units. Movement through clinical spaces (and the lack thereof) was also a key aspect of patients' and staff's anxieties. Clinical spaces too often function like conveyor belts moving patients as quickly as possible, like objects, through and out of medical treatment. In between, patients and families often had to wait in corridors and queues which were too often the sites of physical and verbal abuse and violence.

What struck me then, as now, is the manner in which management and policy speak about public health services struggles to capture, and therefore plan for, these seemingly non-medical aspects of health care. The dominant narratives and planning tools focus on the funding and provision of technical tools - budgets, staff numbers, drugs etc. This technical language, while essential, does not provide us with the means to think and talk about the very issues that distressed staff and patients alike, namely spaces/ places, negative emotions, embodied feelings, relationships. …

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