The Adom hospital head’s perception of my identity was transformed from a neutral research student to a spy, who was in the hospital to spy and report activities to the GHS authorities. Most of the frontline workers on the other hand perceived me in three different identities: a spy for a higher authority, an ‘Anas’ [investigative journalist] and a research student linked to power structures in the hospital and the national level.
The head of Adom hospital’s perception of my identity as a spy
Prior to the onset of the study, I had met the head of Adom hospital at a different forum, where I was introduced to her as a student of the then regional director of health of the region that the hospital is located in. My Ghanaian supervisor being the regional director of the region that the hospital is located in, was administratively the Adom hospital head’s superior. So I took the opportunity to inform her that her hospital had been selected for a research study, and she encouraged me to come over to conduct the study. Thus on the onset of the research I enjoyed a good relationship with her. She had been very receptive and even agreed to my request to sit in management meetings, which was a close-door meeting of senior hospital managers. However my identity as a student eroded with time, as I continued to conduct interviews and conversations with workers that was reported to her, which she described as gossip. A comment she made with regards to illegal charges bore credence to this perception: ‘You see, me I am somebody I don’t like gossip. That is why
when you came I said I wasn’t going to take part [in the interview]. Because I knew all the things you were going to say, anyway. I have heard about it.’4
Her perception that I was a spy came out strongly in the interview when I sought clarification on administrative issues. She repeatedly became defensive by suggesting that the administrative questions that I posed could better be responded to by the regional director of health - my supervisor - her superior.
After the interview with her, I left the hospital crushed and demotivated. Being distrusted and perceived as one who engaged in gossip and a spy for a higher authority, shocked me. I felt humiliated, embarrassed and misunderstood. This development was a stark contrast to the warm reception that I received on the onset of the research.
Frontline health workers’ perception of my identity
So it is clear that some research participants like the head of Adom hospital perceived me as a spy, planted in the hospital by the regional and national health authorities, to observe and report workers’ activities to them. As a result, some frontline workers were very strategic and cautious in conversations and interviews, as the following conversation reveals:
Ethnographer: ... so what motivates you?
Midwife: I don’t want to talk to you. I do not want you to write down my name and be observing what we are doing and go and write bad things about us, write good things about us.
Ethnographer: How can you say something like that?
Midwife: That is what our superiors have made us to believe. They told us that you are here to observe what we are doing and to find out our faults and report us
to the authorities.5
Additionally, some ward and department managers who perceived me as a spy of the regional and national health authorities sometimes explained to me why they had to take certain disciplinary actions against particular workers. This was to ensure that I gave a favourable report about the hospital to the regional and national authorities.
The perceived identity as a spy was exploited by some of the ward and department managers, who used my presence as a confirmation to their subordinates that their work was being observed and reported to the regional and national health authorities. So they admonished their subordinates to put up positive attitudes and to work hard, for such managers by giving such information, helped to strengthen their power and control over their subordinates. Accordingly, such managers drew me into the local power struggle between them and the frontline workers.
Some research participants perceived me as an ‘Anas’ [an investigative journalist - Anas is the name of a popular investigative journalist whose name has become synonymous with investigative journalism in Ghana], who was in the hospital to spy on
their activities in order to report to media houses and the general Ghanaian populace. This suspicion was played out in conversations with research participants as some openly called me ‘Anas’. Also, some demonstrated their suspicion through their body language [some midwives stopped conversing with their colleagues when I appeared in the ward or went into the nurse’s room]. In one of the wards that I worked in it was common for the midwives to discuss in my presence that ‘Anas’ could be visiting the hospital. It was also common for the ward manager to say to clients in my presence during routine health education talks: ‘Some of you are journalists, but because you are not in uniform, we do not
know.’6
Some of the research participants also perceived me as a student researcher, who had links to the hospital, the regional and national health authorities. They felt that they could use me to convey their concerns to their superiors in the hospital, at the regional and national levels. They demonstrated this perception especially in times when there were challenges that needed to be addressed. For instance on one occasion I was sitting in one of the specialist wards and the workers were overwhelmed with a high client turnout. The doctor on duty appearing frustrated asked me to include this occurrence in my report, so that I could draw the attention of their superiors at the hospital and national levels to
address it.7
Initially I brushed these perceived multiple identities off, however when I realised that research participants’ perceptions of such identities influenced their interaction with me, I felt frustrated and demotivated. So I resolved to negotiate my identity by sometimes addressing workers’ fears and distrust. I reassured them that I was a research student and the motive for the research was academic and for national policy interest. I also assured them that I was bound to abide by the ethical guidelines of protecting the identity of my informants. As additional proof, I gave out copies of the study’s consent forms to most of the research participants, whether they were scheduled to be interviewed or not. Such negotiations helped to allay the fears of some of the workers, but others remained evasive in their responses during conversations and interviews.
6 Adom hospital, field notes, 24/05/2012. 7 Adom Hospital, observation notes, 06/03/2012.