Human activities and microbial geographies. An anthropological approach to the risk of infections in West African hospitals

Bodies in peril: Healthcare workers on the frontlines of global maternal health interventions

Drawing on long-term ethnographic fieldwork in maternity settings in Tanzania and Pakistan, we argue that 'bodywork' condenses all politically and practically at stake for maternal healthcare providers. Our research confronts how global health programmes expect paramedical providers working on the frontlines of obstetrics to implement interventions without also attending to violent everyday realities of providing care amidst structural constraint and precarity. We demonstrate this approach's dire aftermaths. Healthcare workers' bodies evidence risks and injuries not only attendant on care in lower-resource settings, but which unfold specifically from their efforts to meet the onerous demands of global health systems. Toxic hospital environments represent a paradox of care - medicine exposes patients and providers to greater risks than if medicine were not involved - but this inherent riskiness barely registers. Elisions of healthcare providers' experiences of harm are telling; they reveal global health's neglect of occupational risk and a racialised under-attention and under-valuing of the risks carried by bodies of colour, and women especially. We trace and corroborate providers' experiences of threats to their wellbeing while enacting global health agendas. We conclude with a provocation that social scientists' bedside witnessing must result in actionable evidence if a more sustainable global health is to prevail.

The experience of informal caregivers in providing patient care in hospitals in low- and middle-income countries: A qualitative meta-synthesis

OBJECTIVE

In low- and middle-income countries, informal caregivers frequently stay in hospitals and perform patient care tasks typically performed by nurses in other contexts. This article reviews qualitative research on these informal caregivers, to gain insight and understanding of their experiences.

METHODS

We undertook a qualitative meta-synthesis. Relevant literature was identified through searches of electronic databases in 2021. Thematic analysis was conducted to facilitate the identification of conceptual relationships to formulate synthesised findings.

RESULTS

Twenty-four studies met the inclusion criteria - 13 from Sub-Saharan Africa, five from Bangladesh, two from India, two from Iran, one from Brazil and one from Peru. Three themes were generated from the meta-synthesis: (1) The unwelcome but tolerated guest, (2) Enduring personal sacrifice and (3) Fulfilling familial obligations. These themes emphasised the significant burden associated with the hospital caregiving experience and highlighted the implicit reliance on informal caregivers in low- and middle-income countries.

CONCLUSIONS

Informal caregivers perform an essential caregiving role, yet occupy a peripheral and voluntary space in hospitals. There is a clear need to support informal caregivers so that they can safely perform their tasks.

[Innovations in medical waste management in a new referral hospital in Niamey, Niger]

INTRODUCTION

Public hospitals in Africa are experiencing major organizational dysfunctions, which are particularly acute in waste management. The opening of a new reference hospital in Niamey offers the opportunity to study the implementation of an innovative waste management system.

PURPOSE OF RESEARCH

The objective of this study was to document the agents’ representations, practices, and construction of waste management standards in a new tertiary hospital in Niamey. We sought to study the implementation of innovative materials in waste management and the progressive construction of protocols, habits, and levers of adaptation. This research was carried out using a socio-spatial approach and essentially mobilized the tools of qualitative investigation.

RESULTS

Our study highlighted that a hospital waste management culture is progressively established, thanks to an effort to plan activities, to promote the sector, the activities and the emergence of a profession organized around waste management. However, the distinct waste management sectors are struggling to stabilize due to the differentiated statuses and perceptions of the agents. Finally, the success of hospital waste management depends on waste collection at the city level.

CONCLUSIONS

The Niamey referral hospital is intended to be an infrastructure of excellence, a showcase for neighboring countries. In this respect, our study shows that it is crucial to invest in planning, the enhancement of the profession and the recognition of all the agents involved in waste management.

An ethnographic exploration of diarrheal disease management in public hospitals in Bangladesh: From problems to solutions

INTRODUCTION

Diarrheal disease is one of the most common causes of hospital admission globally. The barriers that influence guideline-adherent care at resource limited hospitals are poorly defined, especially during diarrheal disease outbreaks. The objective of this study was to characterize challenges faced in diarrheal disease management in resource-limited hospitals and identify opportunities to improve care.

METHODS

The study was conducted during a diarrheal disease outbreak period at ten public district hospitals distributed across Bangladesh. A rapid ethnographic approach included observations and informal interviews with clinicians, staff nurses and patients. In the first phase, observations identified common and unique challenges in diarrheal management at the ten sites. In the second phase, four hospitals were purposively selected for additional ethnographic study. Systematic observations over 420 total hours were collected from patient-clinician interactions (n = 76) and informal interviews (n = 138). Applied thematic analysis identified factors that influenced hospitalbased diarrhea management.

RESULTS

Normalization of guideline deviation was observed at all ten sites, including prescription of non-indicated antibiotics and intravenous (IV) fluids. Conflict between 'what should be done' and 'what can be done' was the most common challenge identified. Clinical assessments and patient treatment plans were established at admission in a median of 2 minutes (n = 76), often without a physical examination (57%; n=43/76). Factors that prevented adherence to clinical guidelines included human resource constraints, conflicts of interests, overcrowding, and inadequate hygiene and sanitation in the emergency department and wards.

CONCLUSION

This study identified challenges in hospital-based management of diarrheal disease and opportunities to improve care in seemingly change-resilient hospital settings. The results reveal important areas for intervention and policy engagement that may have additive benefit for both hospitals and their patients. These interventions include targeting barriers to clean-water, sanitation and hygiene that prevent clinicians from adopting guidelines out of concern for hospital acquired infections.

Emergence of Coronavirus (COVID-19) Outbreak: Anthropological and Social Science Perspectives

With the ongoing coronavirus (severe acute respiratory syndrome coronavirus-2, SARS-CoV-2), the entire community of health professionals is working to control disease and investing crores in vaccine development. The present discussion is to bring the focus on various social issues that emerge during outbreak and calls for equal attention as that of other health-care interventions. These issues are summarized in three categories: first, stigmatization due to lack of knowledge about the source of infection; second, speculations and their consequences around lack of knowledge about transmission; and finally, the concern regarding miscommunication during such a crisis. Most of these concerns emerge from press and social media coverage of the episode. The Ebola outbreak response is an example of how social scientists and anthropologists can work with other experts to solve questions of public health importance. Their approach toward the community with the objective to understand the sources, reasons, and circumstances of the infection will help to manage the current outbreak. In this context, we suggest collaboration of diverse scientific community to control and sensitize the people to tackle the misinformation in the affected and non-affected community during the outbreaks.

Collective strategies to cope with work related stress among nurses in resource constrained settings: An ethnography of neonatal nursing in Kenya

Kenyan neonatal nurses are asked to do the impossible: to bridge the gap between international standards of nursing and the circumstances they face each day. They work long hours with little supervision in ill-designed wards, staffed by far too few nurses given the pressing need. Despite these conditions, a single neonatal nurse can be tasked with looking after forty sick babies for whom very close care is a necessity. Our 18-month ethnography explores this uniquely stressful environment in order to understand how nurses operate under such pressures and what techniques they use to organise work and cope. Beginning in January 2015, we conducted 250 h of non-participant observation and 32 semi-structured interviews in three newborn units in Nairobi to describe how nurses categorise babies, balance work across shifts, use routinised care, and demonstrate pragmatism and flexibility in their dealings with each other in order to reduce stress. In so doing, we present an empirically based model of the ways in which nurses cope in a lower-middle income setting and develop early work in nursing studies that highlighted collective strategies for reducing anxiety. This allows us to address the gap left by prevalent theories of nursing stress that have focused on the personal characteristics of individual nurses. Finally, we extend outwards from our ethnographic findings to consider how a deeper understanding of these collective strategies to reduce stress might inform policy, and why, even when the forces that create stress are alleviated, the underlying model of nursing work may prevail.

Eye of the beholder? Observation versus self-report in the measurement of disrespect and abuse during facility-based childbirth

Human rights has been a vital tool in the global movement to reduce maternal mortality and to expose the disrespect and abuse that women experience during childbirth in facilities around the world. Yet to truly transform the relationship between women and providers, human rights-based approaches (HRBAs) will need to go beyond articulation, dissemination and even legal enforcement of formal norms of respectful maternity care. HRBAs must also develop a deeper, more nuanced understanding of how power operates in health systems under particular social, cultural and political conditions, if they are to effectively challenge settled patterns of behaviour and health systems structures that marginalise and abuse. In this paper, we report results from a mixed methods study in two hospitals in the Tanga region of Tanzania, comparing the prevalence of disrespect and abuse during childbirth as measured through observation by trained nurses stationed in maternity wards to prevalence as measured by the self-report upon discharge of the same women who had been observed. The huge disparity between these two measures (baseline: 69.83% observation vs. 9.91% self-report; endline: 32.91% observation vs. 7.59% self-report) suggests that disrespect and abuse is both internalised and normalised by users and providers alike. Building on qualitative research conducted in the study sites, we explore the mechanisms by which hidden and invisible power enforces internalisation and normalisation, and describe the implications for the development of HRBAs in maternal health.