Despite medical guidelines delineating respect towards patients, many encounters between patients and clinicians are problematic, in which patients feel disrespected, unheard, shamed or abused. This ...article uses an anthropological lens to focus on the imbrication of humour and humiliation as forms of shame and obstetric violence within obstetric encounters. Humour as a form of speech play creates a substrate for the occurrence of humiliation and shaming of obstetric patients. Humour enhances patients' feelings of shame, making them vulnerable to verbal and physical forms of obstetric violence. Ethnographic methods of observation and interviews were performed in two hospitals in the Mexican city of Puebla to uncover clinicians' perceptions and narratives about their patients as problematic others. Narratives about patient worth underscored interactions. Humour and humiliation were centrally present within these interactions. Ultimately, both humour and humiliation functioned as shaming mechanisms that increased the presence of obstetric violence in these encounters. The article examines whether an understanding of shame can improve clinical practice and concludes with implications to clinical practice.
Through rich ethnographic narrative, Becoming Gods
examines how a cohort of doctors-in-training in the Mexican city of
Puebla learn to become doctors. Smith-Oka draws from compelling
fieldwork, ...ethnography, and interviews with interns, residents, and
doctors that tell the story of how medical trainees learn to wield
new tools, language, and technology and how their white coat,
stethoscope, and newfound technical, linguistic, and sensory skills
lend them an authority that they cultivate with each practice,
transforming their sense of self. Becoming Gods
illustrates the messy, complex, and nuanced nature of medical
training, where trainees not only have to acquire a monumental
number of skills but do so against a backdrop of strict hospital
hierarchy and a crumbling national medical system that deeply shape
who they are.
Birthing experiences for low-income and marginalized women have frequently been framed within explanatory models of authoritative knowledge and power dynamics. Many of these explanatory models have ...pointed out the structural violence inherent in the biomedical model of birth. The research on which this article is based suggests that clinicians' stressful work environment and class-based stereotypes of low-income women resulted in the routinizing of inhumane medical practices. Hospital overcrowding due to health reforms led to clinicians being primarily concerned with moving patients swiftly through the system. Clinicians increasingly relied on the cervical examination as a marker for labor's progress and a shorthand method to track cervical dilation. Using ethnographic data collected in the obstetrics ward of a public hospital in Mexico, in this article I explore the emergence of a bureaucratic routinizing of obstetricians' everyday practice. I provide a new understanding of the encoding and entrenching of everyday medical practices and their effect on the reproductive rights of women. El parto de mujeres marginadas y de bajo ingreso generalmente se explica por medio de modelos de conocimiento autorizado y por las dinámicas de poder. Muchos de estos modelos explicativos han hecho hincapié en la violencia estructural intrínseco dentro del modelo biomédico de parto. La investigación en la que está basada este artículo sugiere que el estrés del ambiente laboral de los portadores de salud al igual que los estereotipos sobre mujeres de bajo ingreso resultan en la rutina de prácticas médicas inhumanas. La saturación del hospital por cambios en la ley de salud significa que la preocupación de los médicos está enfocada en mover las pacientes rápidamente por el sistema. Los portadores de salud dependen cada vez más sobre el examen vaginal para medir el desarrollo del trabajo de parto. Basado en datos etnográficos recolectados en la sala de tococirugía en un hospital público de México, en este artículo se explora el surgimiento de una forma de burocracia alrededor de las prácticas diarias de los obstetras. Este análisis provee una nueva manera de entender la codificación e incorporación de las prácticas médicas diarias y el efecto que tienen sobre los derechos reproductivos de la mujer.
ABSTRACT
Bodies are useful instruments for understanding the reproduction of inequalities. In this article, we investigate why and how bodily, social, intimate, and physical boundaries are crossed ...and what this can tell us about individual and social bodies. We unpack how seeing and being seen, touching and being touched, or feeling and being felt are conditioned in very particular ways by the broader political economy. Participants in this ethnographic research in Mexico used the term manitas to describe how they trained their senses (hands, ears, eyes) during medical practice; how they learned through practice on the bodies of less‐agentive populations (female, raced, or impoverished); and how they crossed intimacy, structural, and physical boundaries through what we term somatic translation: seeing others’ bodies with their own. Manitas was developed unconsciously by doctors, never explicitly taught or learned in practice, reproducing social difference. These forms of learning highlight a friction between the violence of knowing and the importance of touch as a legitimate mode of care. This form of tactile and sensorial learning entails not only a form of boundary crossing that is medically useful, but it is also a form of boundary crossing that surfaces social inequalities by taking advantage of them. hospital ethnography, anthropology of reproduction, embodiment, social boundaries, Mexico
RESUMEN
Los cuerpos son instrumentos útiles para entender la reproducción de las desigualdades. En este artículo, investigamos por qué y cómo los límites corporales, sociales, íntimos y físicos son cruzados y qué nos puede decir este proceso acerca de los cuerpos individuales y sociales. Analizamos en detalle cómo los procesos de ver y ser visto, tocar y ser tocado, o sentir y ser sentido están condicionados en modos muy particulares por la economía política más amplia. Los participantes en esta investigación etnográfica en México utilizaron el término manitas para describir cómo ellos entrenaron sus sentidos (manos, oídos, ojos) durante la práctica médica, cómo aprendieron a través de la práctica sobre los cuerpos de poblaciones con menos agencia (mujeres, racializadas, o empobrecidas), y cómo cruzaron varios límites (intimidad, estructurales y físicos) a través de lo que llamamos traducción somática: ver los cuerpos de otros con el de uno mismo. Manitas fue desarrollado inconscientemente por doctores, nunca explícitamente enseñado o aprendido en la práctica, reproduciendo las diferencias sociales. Estas formas de aprendizaje recalcan una fricción entre la violencia del saber y la importancia del tocar como un modo legítimo de atención. Esta forma de aprendizaje táctil y sensorial implica no sólo una forma de cruzar límites que es útil médicamente, sino también una forma de cruzar límites que aflora desigualdades sociales al aprovecharse de ellas. etnografía de hospital, antropología de la reproducción, corporeización, límites sociales, México
This article deepens the current understanding of the sources of obstetric violence and iatrogenesis through an analysis of cesareans. The data are drawn from ethnographic research in 2018 at a ...public maternity hospital in Mexico. Data collection methods included observation, semi-structured interviews, and free lists with 12 senior obstetrics residents. Analysis of the data revealed that: (1) doctors used perceptions of high risk to justify their use of cesareans even when not clearly medically indicated; (2) doctors responded to scarcities of time and resources in the system by viewing cesareans as a less than ideal but acceptable solution; and (3) doctors practiced medicine defensively as a way to control their fear of risk and to pre-empt legal consequences from patients’ demands. The discussion suggests that the relative ease of cesareans and the benefit they provided the doctor and medical system rather than the patient constituted forms of obstetric violence and iatrogenesis. These often arise as a consequence of either too much intervention or not enough in situations in which providers seized on unclear or presumed indications as pretexts to perform cesareans that were not clearly medically indicated.
•Builds upon studies on obstetric violence and research on iatrogenesis.•The ease of cesareans constitutes forms of obstetric violence and iatrogenesis.•Explores how obstetricians justify performing unnecessary cesareans.•Iatrogenesis can arise as a consequence of too much or not enough intervention.
This article examines the role of microaggressions in the interactions between biomedical personnel and marginalized patients to addresses the constitutive property of medical interactions and their ...contribution to a class-differentiated and discriminatory local social world. Based on ethnographic fieldwork over the course of three months (2008–2011) the study examined the clinical relationships between obstetric patients and clinicians in a public hospital in the city of Puebla, Mexico. It reveals four factors present in the social hierarchies in Mexico that predispose clinicians to callous interactions toward “problematic others” in society, resulting in microaggressions within clinical encounters: (a) perceptions of suitability for good motherhood; (b) moralized versions of modern motherhood inscribed on patient bodies; (c) a priori assumptions about the hypersexuality of low-income women; and (d) clinician frustration exacerbated by overwork resulting in corporeal violence. This work concludes by questioning the efforts for universal health rights that do not address underlying social and economic inequities.
•Ethnography on physician–patient relationship in a Mexican hospital.•Builds upon studies on obstetric violence and research on microaggressions.•Medical interactions construct a class-differentiated and discriminatory environment.•Enactment of microaggressions on impoverished populations reflect societal structures.
This article focuses on rural indigenous Mexican women's experiences with uterine prolapse, particularly the illness's expression of social suffering. Drawing on ethnographic research conducted ...during 2004–2005 and 2007 in a Nahua village in the state of Veracruz, the article analyzes the multifactorial nature of women's social suffering. Results show that the roots of uterine displacement for the women lie in lack of social relations and in perceptions of bodily vigor. Additionally, inequality present in the women's interactions with mainstream Mexico brings into focus the larger structural factors that shape their reproductive health. The implications of research on the effect of social support on women's embodiment of social suffering can extend beyond one illness, linking it to broader issues shaping the health of marginalized populations.
In Kenya, indirectly caused maternal deaths form a significant portion of all maternal deaths within the health system. Many of these deaths are avoidable and occur during delivery and labor. Poor ...quality health service has been a recurring concern among women in Kenya, with women reporting interactions with healthcare workers that are often demeaning and abusive. This paper explores the experiences and perceptions of both female patients and healthcare workers regarding mistreatment during childbirth. This study aims to provide recommendations on how dignified care can be made the norm, specifically focusing on a peri-urban setting in Kenya.
The research was accomplished using qualitative research methods with focus group discussions and in depth interviews with women and healthcare workers. The aim was to gain a deeper understanding of the manifestations of mistreatment within the context of a peri-urban setting in Kenya.
Female patients reported different forms of mistreatment, such as verbal abuse, physical abuse, neglect, discrimination, abandonment, poor rapport and failure of the health system to uphold professional standards. The healthcare workers described a health system that was weak and fragmented with poor policy support particularly for the new free maternity services policy leading to the mistreatment of women.
Newly formed County Governments need to provide resources for a functioning health system to ensure an enabling environment for the provision of high quality maternal health services. This process can include feedback loops with maternity clients to ensure woman-centered services. Policy makers need to strengthen oversight for the implementation of the free maternity services Community health volunteers can be trained to provide this information. Professional associations that govern the standards of quality care for healthcare workers need to address the mistreatment through retraining and norms transformation.
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