Une approche socioculturelle de l'hygiène au Cambodge : pratiques soignantes et risques de transmission virale

Les modalités de la transmission nosocomiale du VIH, du virus de l'hépatite B (VHB) et le virus de l'hépatite C (VHC), et les logiques socioculturelles sous-jacentes qui la favorisent semblent assez mal connues et peu étudiées à l'échelle mondiale. La question de l'hygiène en milieu sanitaire a été abordée à l'heure actuelle, essentiellement d'un point de vue biologique [1,2].Or, celle-ci est traversée et modelée par des normes et des représentations socioculturelles qui sous-tendent les pratiques favorisant ou limitant la transmission des pathologies, toujours inscrites au sein de relations sociales [3-5]. De 2006 à 2009, une équipe d'anthropologues du centre de recherche cultures, santé, sociétés de l'université d'Aix- Marseille a conduit un projet de recherche1 dont l'objectif était de produire des connaissances sur les conditions de la transmission iatrogène des VIH, VHB, VHC, en s'intéressant aux dimensions socioculturelles de l'hygiène hospitalière au Cambodge. Ce projet contribue à montrer comment, dans une perspective d'application, il est indispensable de mieux connaître les logiques sous-jacentes aux pratiques d'hygiène pour adapter des formations destinées aux professionnels de santé, voire aux populations

Transmission of HIV, HBV, HCV in health settings: an anthropological approach on hygiene in Cambodia

International audienceBackground: The modalities of HIV, HBV, HCV healthcare-associated infections and the underlying social and cultural logics contributing to this transmission are not precisely known, since hospital hygiene has mainly been studied from a biological point of view until now. However, hospital hygiene is shaped by norms and social-cultural representations, which increase or limit the transmission of infectious agents, always taking place within social relations. In 2006-2009, an anthropological research project (ANRS 12102) aimed at documenting those issues in various health settings in Cambodia. Practices related to hygiene were analyzed from a cultural point of view, especially since norms are interpreted at local level according to social and symbolic logics.Methods: We collected qualitative data in formal and informal sectors of care, mainly in general hospital services, maternity wards, primary health centers and in traditional practitioners’ private clinics. We interviewed many participants regarding hygiene practices and social relationships amongst the staff and between health care workers and patients. We also investigated the local representations of hygiene, their impact on the relationships between health care workers and patients and perceptions of transmission risks by health care workers.Results: In a context were hygiene practices were limited by the lack of adequate materials and equipments, other factors were identified, which influence and distort hygiene practices. They include: (1) informal and formal social relationships in hospitals, (2) major infection control roles played by cleaners in absence of professional acknowledgment, (3) lack of consideration for hygiene by health professionals that rely on low-ranking staff for hygiene practices. Besides these issues, various questions emerged regarding social science theory. Indeed, doing research on infectious disease transmission led us to include investigations and interpretations related to anthropology of development, historical and social perspectives on public health institutions, and social organization in hospital settings. The social condition of working class (the workers), the legal and illegal systems of care, various aspects related to the politics of reproduction were issues at stake, which leads to more general issues on social changes in Cambodia. Moreover, hygiene issue may be seen as an encounter of the biological body and the social body, whose construction and effects are deeply inscribed in the historical and contemporary forms of social organization and power distribution in Cambodia.Conclusion: Our anthropological findings illustrate the importance of comprehensive understanding of hygiene practices; they need to be considered when designing intervention to improve infection control practices in a Cambodian medical setting

Social and cultural dimensions of hygiene in Cambodian health care facilities

<p>Abstract</p> <p>Background</p> <p>The frequency of bloodborne pathogen healthcare-associated infections is thought to be high in developing Southeast Asian Countries. The underlying social-cultural logics contributing to the risks of transmission are rarely studied. This report provides some insights on the social and cultural factors that shape hygiene practices in Cambodian health care settings.</p> <p>Methods</p> <p>We conducted qualitative surveys in various public and private health facilities in Phnom Penh, the capital city and in provinces. We observed and interviewed 319 participants, health care workers and patients, regarding hygiene practices and social relationships amongst the health care staff and with patients. We also examined the local perceptions of hygiene, their impact on the relationships between the health care staff and patients, and perceptions of transmission risks. Data collection stem from face to face semi-structured and open-ended interviews and focus group discussions with various health care staffs (i.e. cleaners, nurses, midwives and medical doctors) and with patients who attended the study health facilities.</p> <p>Results</p> <p>Overall responses and observations indicated that hygiene practices were burdened by the lack of adequate materials and equipements. In addition, many other factors were identified to influence and distort hygiene practices which include (1) informal and formal social rapports in hospitals, (2) major infection control roles played by the cleaners in absence of professional acknowledgment. Moreover, hygiene practices are commonly seen as an unessential matter to be devoted to low-ranking staff.</p> <p>Conclusion</p> <p>Our anthropological findings illustrate the importance of comprehensive understanding of hygiene practices; they need to be considered when designing interventions to improve infection control practices in a Cambodian medical setting.</p

Grossesses et accouchements chez les femmes Businenge (Guyane française)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Ethnographie d’un hôpital cambodgien

Dès le protectorat français et depuis l’indépendance, l’hôpital a été la « vitrine » politique de santé au Cambodge. Aujourd’hui, l’hôpital fait l’objet d’enjeux politiques, économiques et sociaux qui traversent la société cambodgienne contemporaine. Cet article propose une analyse de l’espace physique et social qui régit le quotidien hospitalier dans le cadre d’une ethnographie d’une maternité de Phnom Penh. Une description ethnographique des espaces de l’hôpital permet de le définir comme un espace ouvert à compartiments clos ; espace ouvert à l’intérieur duquel se dessinent des pôles professionnels et domestiques ou en lien avec la saleté et la propreté. Les frontières entre ces différents pôles délimitent des espaces clos où les accès sont strictement contrôlés. Cet emboîtement des espaces permet de comprendre la dynamique de la gestion de l’espace physique mais également social. L’organisation hospitalière est régie par une double hiérarchie, à la fois professionnelle et sociale. Cette hiérarchisation se retrouve dans la répartition des tâches quotidiennes où le « sale boulot » demeure attribué au personnel au plus bas de l’échelle hospitalière et sociale. Si l’organisation sociale à l’hôpital reflète en partie la hiérarchie de la société cambodgienne, nos observations montrent que le jeu social est plus subtil, faisant parfois intervenir le pouvoir acquis par l’appartenance politique des soignants ou l’origine sociale des malades. De même, il n’est pas uniquement question de pouvoir et de hiérarchie dans les rapports sociaux intra-hospitaliers : les usages de l’argent et son partage entre les divers soignants estompent les rapports de pouvoir entre les personnels soignants et participent à l’élaboration de sociabilité soignante au sein de l’hôpital.In Cambodia, hospitals have been the stage of public health politics since the establishment of the French Protectorate. Today, hospital is still at the center of political, economical and social issues that spread across the whole Cambodian society. The theme of the present work is based on the ethnography of a public hospital in Phnom Penh, capital of Cambodia. Fieldwork was conducted in a maternity ward by two researchers. While the first fieldwork observations concentrate on the workers’ tasks, the second ethnographic fieldwork, conducted in the delivery ward of this hospital, examines more specifically the medical staff work. The hospital space can be described as “an open space with closed sections”. Within this open space, some areas are characterised by cleanness/dirtiness polarity, as well as domestic/professional polarity. This polarization delimits margins within the hospital space and controlled closed sections, as the “in camera” of a delivery ward. This hospital space analysis points out some issues linked to the social control of space in a hospital. In addition, the study deals with social interactions that organize the health workers lives and work. A double hierarchy, both professional and social, governs the hospital work organization. This hierarchy is reflected through the analysis of the distribution of the dirty work in the day-to-day life of the wards. The assumption could be made that hospital hierarchy partially reflects the social Cambodian hierarchy itself. However, social interactions are more subtle and complex, since the hierarchy can be affected by health workers’ length of service, their political affiliation or even the patients social status. Despite the weight of this hierarchy, hospital employees adopt strategies of financial cooperation among themselves, which contributes to create a healthworkers-specific sociability. Hence, we can say that social interactions within the hospital are largely defined by a complex series of interactions between hierarchy and social cooperation

La santé : miroir des sociétés d'Asie du Sud-Est

Ce numéro thématique est consacré à la santé en Asie du Sud-Est. A travers 9 articles originaux et 3 notes de recherche, il présente la pluralité de l’offre thérapeutique et la diversité des pratiques de soin et de santé, spécifiques ou non, à cette partie du monde. Les dimensions culturelles et sociales des maladies et des épidémies y sont développées dans une approche comparative. La santé et la maladie sont considérées dans la diversité de leurs interprétations, de leurs prises en charge, des interactions entre soignés et soignants, qu’ils soient biomédecins, moines, devins ou médiums. Elles sont aussi le miroir des sociétés sud-est asiatiques, à la fois continentales et insulaires, bouddhistes, confucéennes et musulmanes, partagées entre traditions séculaires et modernité accélérée