Proceso de elaboración

Social scientists are often not easily accepted to carry out research in hospitals because of the perception that their data collection approaches do not meet biomedical standards of scientific research. It was not surprising that health workers in the hospital were reluctant to accept me as an anthropologist. Initially, I was often confronted with the question “What is your professional background in health?” Whenever I explained to health workers that I was a social scientist who was interested in knowing more about how VCT and ART services are provided, I observed some reservations in the facial expression of care providers. The qualitative research approaches I used to collect data further strengthened their doubts about the study and its motives. Similar observations have been made in ethnographic studies in a hospital elsewhere. For instance, Mulemi (2010) reported that health care providers had reservations about his study in a Kenyan hospital cancer ward. He attributed this to the low awareness of the value of qualitative research in promoting patient care among health professionals. Albert et al. (2008)

pointed out that biomedical scientists or health care professionals’ doubts about qualitative research in the health care setting is due to the perception that its methods are devoid of any scientific foundation. This, according to the authors, is due to three opinions: its results cannot be reproduced, the researcher’s subjectivity interferes at all stages of the research process, and there is no effective way to control for biases. Besides, the question whether quantitative research is as objective as its practitioners claim, or what objectivity or its so-called lack thereof means, has been a much discussed issue since Latour & Woolgar’s (1979) classic study of laboratory work. Health professionals, however tend to overlook social and cultural

aspects of disease and care-seeking which do not always lend themselves to quantitative research.

The initial doubts of health workers gradually changed to cooperation with the researcher as they began to appreciate the contribution the study could make towards improvement of service provisioning and patient care. The use of qualitative research methods like informal conversations helped to bring health workers and clients together to share their views and opinions on how services are provided. The informal nature of such conversations enabled clients in particular to freely express their perceptions on the quality of services provided. Clients also used the conversations to express their pent-up emotions about certain practices of some health workers towards them. For instance, in a conversation which involved two clients, a health worker and myself, a client complained about the disclosure of her status to her grandmother by a nurse in the delivery ward. According to the client, the disclosure led to her rejection by the grandmother. The client had not been able to express her frustration in a clinical encounter for fear of being labelled as a bad or uncooperative client. The present study, however, has shown that clients felt comfortable discussing issues on service provision with health workers in informal conversations. This may encourage health workers to more often engage in conversations with clients outside clinical encounters and know more about their problems or challenges in care and treatment. Moreover, the personal views of clients in this study gave strong evidence about areas of client care and treatment that need improvement.

Doctors and nurses tend to be reluctant to allow non-medical observers to their work for the fear that as outsiders in the health care setting they may pass judgment on what they do in hospital (see Van der Geest & Sarkodie 1998:1374). Health professionals dislike being watched by outsiders such as ethnographers who do not always reveal their motive in the hospital research and will later put their observa- tions on paper criticizing them. Medical professionals therefore tend to be suspicious about qualitative research.

This study has shown that ethnography in the hospital does not end up criticizing or antagonizing biomedicine per se. It has provided information about clients’

individual level health care needs beyond figures that health workers often use as indicators to improve upon quality of services to satisfy clients. The study has established that health workers were mostly kind and supportive towards clients in their interactions, contrary to the often-held view in earlier studies that health workers tend not to treat them well. This finding recognises the efforts of health workers to provide quality care and treatment to the satisfaction of clients. It also serves as a boost to health workers to continue dealing with clients favourably and encourage more clients to use services.

Ethnography gives health workers the opportunity to learn about clients and find ways of cooperating with them and provide the services they need. The participation of both health workers and clients in conversations with the researcher helped to improve health worker-client communication. The study has shown that medicine is more than the application of scientific knowledge. Personal observation, reflection and judgment, which are akin to qualitative research, are also important for the translation of scientific results into the care and treatment of individual patients (Albert et al. 2008). It is for this reason that Long et al. (2008) point out that

hospital-based ethnographic work offered a collaborative approach in which the ethnographer must take into account a broader range of experiences of hospital encounter. The present study shows that the ethnographer can be relevant to clients, health workers, families and other stakeholders in healthcare delivery rather than an advocate for only one interest group.

The dual role I played in the centres and clinics in some cases also facilitated the collection of relevant data despite its possible negative implications. As explained earlier, in Chapter Three, I was compelled in some situations in the facilities to deviate from the chosen role of academic researcher to be reasonably neutral of health workers and clients. The researcher role was meant to collect objective data as much as possible. However, I had to help health workers to carry out some of their duties whenever they were overwhelmed with heavy workload. For instance, I helped them by filling registration forms for new clients in the clinics. It was possible that this might have led some clients to think that I was a health worker and subsequently withheld some vital information from me. The opposite seems likely, however. On a couple of occasions, some clients approached me with questions about their treatment for explanation. Through my role as a quasi-health worker, I obtained useful data for the study. In the process of filling registration forms for new clients, I engaged in conversations with them about their experiences in the centres and clinics through which I obtained relevant information for the study. Besides, as a ‘health worker’, I got complaints from clients expressing their dissatisfaction with certain aspects of service provision. Such misgivings served as useful information for the study since they gave clues to clients concerns about how services are provided. In one instance, a client complained that I should talk to a colleague ‘health worker’ who was wasting too much time in conversation with a visitor while clients were waiting in a long queue to be attended to. I drew the health worker’s attention to the client’s concern and he readily stopped the conversation to attend to clients waiting in the queue. More importantly, the willingness to help health workers led to a good rapport between the researcher and care providers. Conse- quently, I received the needed support from most of them in the centres and clinics throughout the data collection period.

It must be emphasised that the role I played as health worker does not suggest that I abandoned the original role of an academic researcher in the facilities. In fact, I often reminded clients and others that I was ‘only’ a researcher. It is also worth noting that I did not carry out the core activities of health workers. I was involved in activities which any non-professional health worker could carry out. Unlike the academic researcher role, the limited health worker role was clearly not assumed in order to collect data, as some researchers have done. Those researchers played the liminal role (Van der Geest & Finkler 2004) by putting on the doctor’s coat in the hospital like a staff and collected data (see Gerrits 2010, Zaman 2005). Through the limited dual role, I was able to oscillate between clients and health workers without serious problems to gather data in the centres and clinics while maintaining good rapport with both groups.