Call edition 2012
A new edition of the Prize of the Belgian Development Cooperation has been launched. This call is open until March 31st, 2011. You can read in the regulations whether you comply with the criteria for participation.
Sendwe Hospital is the foremost government hospital in the province of Katanga. The applicant chose this hospital as the subject of research on how medical care is negotiated. He spent several months there, observing and interviewing healthcare providers, patients, and/or members of their family. The author uses the information from specific patient case studies and the content of interviews to conduct a qualitative analysis of the relationships between the different stakeholders in the healthcare provider-consumer relationship.
Sendwe hospital is underequipped and has a lack of organizational structures. As for the patients, most come from the poorest segments of the population with no means to pay for various expenses.
The author shows the parallels in the interactions and tensions between hospital workers and patients and those that exist between administrative civil servants and citizens. But in the hospital setting, the life or death of patients may depend on the result of these interactions. Healthcare providers must deal with several restrictions, including the need to provide optimal patient care despite the system’s shortcomings while earning a living. This context explains in part why corrupt practices exist at all levels of interaction. It is a two-tier healthcare system, where the intervention of healthcare providers is influenced by the socio-economic status of patients: good treatment with the ‘return of favours’ when the patient has enough financial resources or when providers and patients belong to the same social network, versus poor treatment or indifference, with ‘extortion’ of patients when there is a wide social gap between healthcare provider and patient. Other criteria are also taken into account: patients may be held responsible for their disease (sexually transmitted, for instance); they may be deemed ‘good as dead’, etc. Even though patients themselves are capable, in return, of categorising healthcare providers as ‘good’ or ‘bad’, and while they end up forming relationships with healthcare providers, if not acquire some medical knowledge during prolonged hospital stays, their influence on the quality of the care received from providers remains limited.
The patient’s rights are also short-changed. As interpretations and knowledge on suffering, treatment, and healing are often different between healthcare workers and patients, the former end up imposing their ‘professional’ reference system over the patient’s ‘profane’ system. The patient is reduced to the role imposed by medical workers and must submit to professionals. They are also victims of silence regarding the diagnosis or prognosis of their disease.
Despite the specific nature of the area of investigation, the situations and relationships between healthcare providers and consumers encountered at Sendwe hospital are typical of other hospital institutions in the country, if not Africa itself. Hospitals are neglected by public authorities and dominated in an absolute manner by medical personnel in the absence of any countervailing mechanism. Dr Kakudji Kyungu’s approach – that of a socio-anthropological investigation in a hospital setting – is not common. Nonetheless, his work demonstrates that such research can yield precious information that can be used as a basis for reforming hospital and healthcare management in African countries, after the manner of similar efforts in Western hospitals, for instance through greater involvement by civil society and more explicit protocols or regulations.
Report: Prof. K. Mubagwa, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium