Browsing by Author "Lappeman, Maura"
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- ItemRethinking obstetric violence and the “neglect of neglect” : the silence of a labour ward milieu in a South African district hospital(BMC (part of Springer Nature), 2019-10-30) Lappeman, Maura; Swartz, LeslieBackground: Research into the mistreatment of women during childbirth has increased over recent years. Overt violence is an important focus of research, but recently there has been increasing recognition that there are other ways in which women in labour may be uncared for or even hurt. As part of a larger study focussing on staff responses to stillbirths, we wanted to gain contextual information on how high risk pregnancies are handled in general in Khayelitsha Hospital, a district hospital in an impoverished urban setting in the Western Cape Province of South Africa. This health care system experiences an immense patient load, the poverty of the community it serves, and the numerous traumas affecting both patients and staff. Methods: In order to obtain rich exploratory data, a qualitative research methodology was used. The primary data source was observations in the labour ward, interviewing labour ward staff (doctors, nurse, and cleaners). The secondary data source was the analysis of hospital documents, specifically those related to labour ward policy. Results: From our numerous observations and discussions, it is clear that no one is being overtly mistreated in this hospital and patients are medically well attended to. Although we saw no physical abuse, we noted the silence in the ward. Beside medical related interactions, we also noted that there were limited interactions between the women and the health care providers. Conclusions: Silence can be a form of neglect as it leaves the women feeling uncared for and not seen. In an overburdened health care system where both staff and patients are often overwhelmed or traumatised, silence can be a way in which a system defends itself against what it knows it cannot provide.
- ItemStillbirths at Khayelitsha Hospital : issues in the provision of care(Stellenbosch : Stellenbosch University, 2020-12) Lappeman, Maura; Swartz, Leslie; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.ENGLISH ABSTRACT: This dissertation focuses on the provision of care to those who experience stillbirths at Khayelitsha Hospital in the Western Cape, South Africa. The research is based on a psychosocial paradigm and draws from a psychoanalytic understanding of healthcare organizations. I conducted a critical organizational ethnography with multiple sources of data including observations in the labour ward, interviewing labour ward staff, and the female patients who used the ward. Secondary data were sourced from hospital documents. From my observations and interviews, it is clear that no one is being overtly mistreated in Khayelitsha hospital and patients are medically well attended to. Although there was no apparent physical or emotional abuse, however, I noted a silence in the ward which I later learned was experienced as alienating by the mothers. I noted that there were limited interactions between the women and the healthcare practitioners, apart from a competent and caring focus on medical issues. I suggest that the limited engagement between patient and healthcare providers was founded partly on deep cultural and socio-economic differences between many staff and the patients, and on varying degrees of expectation of care on the part of different people in the system. In the overburdened healthcare system (where both staff and patients are often overwhelmed or traumatised), silence can be a way in which a system defends itself against what it knows it cannot provide. While the challenges in the provision of healthcare in South African state institutions are complex, this research provides a window into the opportunity for training and a new perspective on the provision of maternal mental healthcare for mothers who have stillbirths, and more broadly.