Stillbirths at Khayelitsha Hospital : issues in the provision of care

Thesis (DPhil)--Stellenbosch University, 2020.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.AFRIKAANSE OPSOMMING: Hierdie proefskrif fokus op die verskaffing van sorg aan vrouens wat ‘n stilgeboorte by Khayelitsha Hospitaal in die Wes-Kaap, Suid-Afrika beleef het. Hierdie navorsing is op ‘n psigososiale paradigma gebaseer en ʼn psigoanalitiese verstaan van die dinamika van gesondheidsorgorganisasies is gebruik. Ek het ‘n kritiese organisatoriese etnografie, bestaande uit verskeie bronne van data naamlik waarnemings in die kraamsaal, onderhoude met die kraamsaalpersoneel, sowel as die vroue-pasiënte wat die saal benut het, gedoen. Sekondêre data is verkry uit hospitaaldokumentasie. My waarnemings en onderhoude het bevestig dat die pasiënte in Khayelitsha-hospitaal vanuit ‘n mediese oogpunt goed versorg word, en dat niemand openlik mishandel word nie. Alhoewel daar geen oënskynlike fisiese of emosionele mishandeling was nie, het ek wel ‘n stilte in die saal beleef, wat, soos ek later uitgevind het, deur die moeders as vervreemding ervaar is. Ek het opgemerk dat daar beperkte interaksies tussen die vroue en die mediese personeel was, behalwe vir ‘n bevoegde en sorgsame fokus op mediese probleme. Ek stel voor dat die beperkte interaksies tussen die pasiënte en die gesondheidsorgpersoneel deels op diep kulturele en sosio-ekonomiese verskille tussen baie van die personeel en pasiënte, asook wisselende grade van verwagting van sorg deur verskillende persone in die stelsel, gegrond is. In die oorlaaide gesondheidsorgstelsel (waar beide die personeel en pasiënte gereeld oorweldig of getraumatiseer is), kan stilte ‘n manier wees waarop ‘n stelsel hom verdedig teen iets wat dit weet dit nie kan bied nie. Terwyl die uitdagings in gesondheidsorgvoorsiening in Suid-Afrika se staatsinstansies kompleks is, verskaf hierdie navorsing insae rakende opleidingsgeleenthede en ‘n nuwe perspektief op geestesgesondheidsorgvoorsiening vir moeders wat ‘n stilgeboorte beleef het, en selfs wyer.Doctora