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Copy of Anthropology of the Clinic: The Hospital as Fieldsite
Transcript of Copy of Anthropology of the Clinic: The Hospital as Fieldsite
Vol. 15, No. 2, August 2008, 79-89 "Negotiated Interactive Observation:
Doing Fieldwork in Hospital Settings"
- Gitte Wind How to convince staff (and patients) we are not wasting their time? Can we only ever achieve a partial view? - doing participant observation assumes you can become 'one of them'
- anthropologists recognise that the degree of participation will differ according to the fieldsite and activities therein
- Spradley 1980 (58-62): 'nonparticipation' - 'passive participation' - 'moderate participation' - active participation' - 'complete participation' ('going native')
- just as feminist anthropology has taught us to consider the personal background of the fieldworker in the situation, we must also consider it in hospital ethnography
- it seems sufficient to simply write 'participant observation without ever having to actually detail
what exactly that entails in your specific
situation Why are Hospitals tricky Fieldsites? - we must decide whether we are going to view the hospital as an island, or as a hub...
- access can be very stressful to secure...
- our work is often viewed as trivial by medical staff (and patients)...
- there are things we just cannot be privy to; we can only ever achieve a partial view...
- there is no designated 'ethnographer' role in a hospital...
- participant observation is difficult to achieve... Why are there no job adverts for 'hospital ethnographers'? - because there is no convenient role for ethnographers in hospitals - we don't always fit!
- a feeling of not being able to do 'proper' fieldwork because we don't have a neatly defined role in the setting
-successful ethnographers FIND "a credible role" (p.82)
- what roles could we take?
- a patient?
- a staff member?
- a relative/visitor?
(- a volunteer?)
(- a student?)
- 'A RESEARCHER' How To Secure Access to your Hospital Fieldsite? - gaining access usually takes a very long time:
- numerous ethical review boards to get through (University; NHS; the hospital itself... they all have their own requirements and limitations)
- difficult negotiations; you might get access, but on their terms, not yours
- often access comes through personal networks and institutional affiliation
- even when overall access was agreed, "my position was a daily on-going negotiation, which sometimes went well and at other times did not." (p.83)
- access is continually being
played out throughout the
whole research Hospital as Island vs.
Hospital as Hub - Hospital as 'a tight little island' - Coser 1962
- one of the first ethnographies of a 'normal American hospital'
- a place where people are cut off from the 'continent' of 'normal life'
- exists as its own society, with its own rules, roles, structures
- Hospital as 'hub of society' - Zaman 2005
- study of a Bangladeshi hospital ward
- a place invaded and shaped by the values, rules and ideas of the outside world
- a microcosm of the society it exists within
- "a domain where the core values and beliefs of a society come into view" (van der Geest and Finkler
2004) What are the barriers
to conducting participant observation in a hospital setting? Is it worth all that bother to do ethnography in hospitals? - Staff (and patients) are often suspicious of our fieldwork
- "The work of an ethnographer often appears trivial..."
- "...or as if the ethnographer is watching, monitoring or policing staff inappropriately." (p.83)
- "hanging around... drinking coffee, taking notes, chatting. These activities do not look like work and they definitely do not look like academic research." (ibid)
- "seen... as time wasting or even interfering with the real work of the health workers." (ibid)
- is it a quantitative/qualitative issue? --> There is a need to be
taken seriously... - some things we have to figure out:
- what is our 'role'?
- what is our occupation and place within the infrastructure?
- what activities will we perform?
- what do we tell people when they ask us 'what we are doing'?
- how to we negotiate access to be there?
- how to we participate on a day-to-day basis?
- how do others in the hospital view us?
- the answers to these questions
will be different for all field
sites and all projects Yes! "Negotiated
Interactive Observation"? - the question of degree of participation is not just relevant for hospital fieldwork - is has everything to do with today's ethnography as a whole method
- we know that "most people do not form neatly demarcated and closed social groups that can be entered and studied as cultural islands" (p. 84)
- as participant observation currently stands, it "accentuates the ethnographer's authority over the field and its people" (ibid)
- ethnographers will also be scrutinised by their informants
- participation means you get involved, and that brings INTERACTION (however, not all parties in the interaction are bound by the same strings)
- thus, "interactive observation goes both ways"! (p.85)
- "There will be a constant negotiation of when and
how the observation and interaction will and will
not take place." (ibid) - in hospitals, we can see all manner of things being played out:
- "Hospitals are places of intensity, of life-and-death drama, creating moments of truth, self-discovery and rites of passage. In being removed from 'normal' life, a patient is frequently given the opportunity - or confronted with the necessity - of taking stock of kinship, friendship, meaning, finitude, mortality and other core issues of life."
(Long, Hunter and van der Geest 2008:72) References:
- Long, D., Hunter, C. and S. van der Geest. 2008. 'Introduction: When the field is a ward or a clinic: Hospital Ethnography' in Anthropology & Medicine. Vol. 15, No. 2, Aug 2008, 71-78
- van der Geest, S. and K. Finkler. 2004. 'Hospital Ethnography: Introduction' in Social Science and Medicine. Vol. 59, No. 10. 1995-2001
- Wind, G. 2008. 'Negotiated Interactive Observation: Doing Fieldwork in Hospital Settings' in Anthropology & Medicine. Vol. 15, No. 2, Aug 2008, 79-89
- Zaman, S. 2005. Broken limbs, broken lives: Ethnography of a hospital ward in Bangladesh. Amsterdam: Aksant. Heather J. Murphy