Brief comment: "Being in the ward" - Patients' perspectives on hospitalization

by Gideon Lasco, MD, MSc

“To be on this ward means I have to be ready to agree, always pretending I know nothing and that my body does not react to medications in ways that the doctor will interpret as my hidden resistance. Therefore, I may not even ask to change the medicines that are hurting me. (Mr Ndege, 54, multiple myeloma) in "Patients’ perspectives on hospitalisation: Experiences from a cancer ward in Kenya" by D. Mulemi

This quotation - actually from one of the cancer patients interviewed - captures what the author wishes to convey, which is the deprivation of agency and a passive role in the healing process that lead to disillusionment and despair. By demonstrating that the health care providers’ version of care actually leads to a form of hidden suffering that coexists with the suffering brought about by illness, Mulemi makes the point that dissonant expectations between doctors and patients can lead to poor outcomes, construed broadly to include decreased quality of life. Moreover, his insight that "patients’ acquiescence might not be consistent with the medical perspective of compliance” has implications for clinical practice, problematizing notions of compliance and consent even when on the surface it is “voluntary and informed”. 

In reading the text, I am somewhat reminded of Foucault’s The Birth of the Clinic in which the hospital was seen a site where medicine and disease blurs in the process of making each other visible. What Foucault lacks in his master narrative, however, is how such transformations of the clinic (and thus of ‘care’) is experienced by patients, and hospital anthropology affords us this view.

The context here is important: the hospital is for poor, charity patients who do not have financial leverage and healthcare choices are very limited. These structural constraints, as alluded to in the paper, can be explored further. Following Geest and Finkler’s contention that “the hospital is not an island but an important part of the mainland” (2004:1998), what social realities does the hospital in this particular setting reproduce? Or is there a relation of power between doctor and patient that is produced independently of their cultural and socio-economic divide -  a uniqueness of place that suspends social relations to some extent, as Taussig (1980) might suggest? I think these questions can be answered by further characterizing the patients in this study, not simply as “poor” but looking into their different backgrounds, as poverty is not a fixed category, but a spectrum of categories. Or perhaps studying other socio-economic classes in the same area. Have poor people, amidst the commonness of their predicament, become a “marginalized majority” (de Certeau, 1984)?

Amsterdam
December 2013