Care and the politics of shame: Medical practitioners and stillbirths in a South African district hospital

Lappeman, Maura; Swartz, Leslie

doi:10.1080/14753634.2019.1670093

Cited by 10 publications

(13 citation statements)

References 30 publications

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“…Given that much of what is written about spiritual care is from contexts in which there is commonly a cultural and religious majority similar to the demographics of those supplying care, it is appropriate that much of the literature calls on readers to recognise the importance of cultural differences. In SA, though, not uniquely, but crucially for our participants, the idea of protecting cultural differences has been used historically to justify segregation and even oppression [15]. There is a paradox in this -as our participants note, culturally appropriate care is important, but rigid ideas about inherent difference may problematically reinforce old stereotypes and not lead to the best care.…”

Section: Discussionmentioning

confidence: 93%

Spiritual Care Practices in Hospices in the Western Cape, South Africa: The Challenge of Diversity

Mahilall¹,

Swartz

2020

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Background: South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints. Methods: Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices were at play in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis. Results:Two prominent themes emerged: providing relevant spiritual care services in a religiously, culturally, and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial shortfalls. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust.Discussion:Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints. Conclusions:While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.

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Section: Discussionmentioning

confidence: 93%

Spiritual Care Practices in Hospices in the Western Cape, South Africa: The Challenge of Diversity

Mahilall¹,

Swartz

2020

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“…It is also important to acknowledge that in this context, as in others, the role and function of psychiatry itself is not just patient care but also working through the load of a large number of patientsin this context clinicians may feel pressured to complete tasks and to become 'irritated', as one of our participants put it, when language barriers slow things down. It would be all too easy to blame clinicians for not being the best clinicians they can be in a context like this, but as we have suggested elsewhere [4] and as other work in similar hospital settings in South Africa also suggests [51], it is more helpful to try to understand contexts and to change them than to blame front-line personnel. In this regard, it is important to work towards improved skilling of psychiatrists and similar personnel in how to work with interpreters, as we have discussed in other work [3,48].…”

Section: Understanding the Data In Contextmentioning

confidence: 90%

Ad hoc interpreters in South African psychiatric services: service provider perspectives

Hagan

Hunt

Kilian

et al. 2020

Global Health Action

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Background: Language and communication lie at the heart of good quality mental health care and are a vital, yet complex, part of the diagnostic and treatment process. In South African mental health care, ad hoc interpreting arrangements are the status quo. However, these can cause both clinician and patient shame and distress. Objective: Though this issue has been researched from the point of view of informal interpreters, relatively little is known about psychiatrists' experiences of working with ad hoc interpreters. This study is part of an attempt to bridge that gap. Methods: We made use of a cross-sectional qualitative interview design. We interviewed seven psychiatrists working at a psychiatric hospital in the Western Cape of South Africa. Data were analysed manually using thematic analysis. Results:Five main themes can be identified from the data: miscommunication and other difficulties associated with the language barrier; the language barrier between clinicians and patients and a need for language services; participants' views on interpreting; the role of age, culture and gender; and the use of trained and untrained interpreters and using staff as interpreters. Conclusions: Psychiatrists experience numerous difficulties in conducting their work due to the language barrier. This has an impact on their ability to provide adequate mental health care to patients. There is a need for better language services to ensure that everyone that seeks mental health care can receive the same level of care. Currently, one's ability to speak a certain language will have a significant impact on the quality of care received.

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“…It is also important to note that some participants indicated their rejection of a simplistic and neat categorisation, and some will also be troubled by the rather simplistic categorisation of people into separate boxes according to their ascribed cultural and religious status. In SA, given the legacy and continuing pain of its colonial and apartheid past [39], cultural differences map on to concerns about racial oppression and injustice. For South Africans committed to the best possible culturally appropriate spiritual care, it may be more di cult than elsewhere to come to terms with the fact that some people prefer spiritual care from people who are very different culturally and linguistically from them.…”

Section: Discussionmentioning

confidence: 99%

“…There is a paradox in this -as our participants note, culturally appropriate care is important, but rigid ideas about inherent difference may problematically reinforce old stereotypes and not lead to the best care. It is easy to say in the abstract that in spiritual care we wish to follow the lead of care recipients themselves, but in a context in which there is great anxiety about not wishing to impose [39] or to be culturally insensitive, it may be challenging to deal with people whose expressed needs violate common assumptions about what culturally-based needs are. The wish to be culturally sensitive may, paradoxically, make carers in a divided society anxious and hesitant to provide what patients want, for fear of appearing culturally insensitive.…”

Section: Discussionmentioning

confidence: 99%

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Spiritual care practices in hospices in the Western Cape, South Africa: The challenge of diversity

Mahilall¹,

Swartz

2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints. Methods: Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices existed in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis. Results:Two prominent themes emerged: the challenges of providing relevant spiritual care services in a religiously, culturally, linguistically and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial costs of employing dedicated spiritual care workers. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust.Discussion:Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints. Conclusions:While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.

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Care and the politics of shame: Medical practitioners and stillbirths in a South African district hospital

Cited by 10 publications

References 30 publications

Spiritual Care Practices in Hospices in the Western Cape, South Africa: The Challenge of Diversity

Spiritual Care Practices in Hospices in the Western Cape, South Africa: The Challenge of Diversity

Ad hoc interpreters in South African psychiatric services: service provider perspectives

Spiritual care practices in hospices in the Western Cape, South Africa: The challenge of diversity

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