The initial stage of the international sojourn: excitement or culture shock?

This paper presents findings from an ethnographic study of the adjustment journey of international postgraduate students at a university in the South of England, which involved interviews and participant observation over a twelve-month academic year. It was discovered that the initial stage of the sojourn was not characterized by feelings of excitement, as suggested by the U-Curve model (and its successors): though such feelings were present, they were overwhelmed by negative symptoms more commonly associated with culture shock. The implications of these findings for support structures in Higher Education are discussed

Acquiring knowledge prior to diagnosis: a grounded theory of patients’ experiences

© 2019 The Authors. Published by Patient Experience Journal. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.35680/2372-0247.1317This paper will specifically consider one of the major findings of a wider study (previously reported in Roddis, Holloway, Bond and Galvin1), concerning how patients acquired knowledge and information about their condition before being formally diagnosed. The overall purpose of this research was to explore and explain how people make sense of long-term health conditions. Through the use of both purposive and theoretical sampling within a grounded theory design, experiences of individuals with thrombophilia and asthma were explored

Hidden Relationships: Perspectives on Leadership and Management in Afghan Maternity Services - An Ethnographic Exploration

ntroduction: Health system leaders have a vital role to play in ensuring the delivery of high-quality care. Improving the quality of healthcare, particularly in low-income countries often focuses on the performance of healthcare providers and the availability, acceptability, and uptake of services. The role that health service leaders play in facilitating effective care has received less attention in the literature. This study explored the perspectives of Afghan maternity care providers, managers and other stakeholders on leadership and the provision of quality maternity care. Methods: This ethnographic study used semi-structured interviews, participant observation, and background interviews for data collection. The research setting was a Kabul tertiary maternity hospital. Participants included doctors, midwives and care assistants who were employed in the hospital (n=23). Stakeholders from the health system, government, community and non-governmental organizations provided background interviews (n=41). A thematic framework analysis was conducted across all the data sets and different participants to maintain the context and perspectives of individual groups and identify themes. Results: The results of this study involves 1. Healthcare providers who described their managers as both autocratic and weak. They explained that their managers failed to enforce standards or listen to their concerns. 2. Managers who felt powerless to improve care because the government did not support their initiatives to reform the working environment or discipline staff members who were flouting the rules. 3. Background interviewees who concurred that hidden relationships influenced and undermined the health system at all levels. Conclusion: An unofficial system of connections with powerful people gave some staff privileges and power beyond their roles and undermined the power of managers who were responsible for standards of care. Strong, unwavering political will and tenacious leadership will be needed to address this. We suggest that initiatives to improve the quality of care in other low- and middle income countries (LMICs) look beyond individual staff and official systems to determine who holds the power and how that power is use

Parallel worlds: An ethnography of care in an Afghan maternity hospital

Aspirations of quality, equitable and respectful care for all women in childbirth have, so far, been unrealised. Sub-optimal care remains the norm in many settings despite decades of substantial investment, the introduction of evidence-based policies, procedures and training programmes. Improving the standard of institutional care for childbearing women in Afghanistan is an example. This ethnography of a large public Afghan maternity hospital explored the experiences, motivations and constraints of healthcare providers. The aim was to identify barriers and facilitators in the delivery of care. Participant observation, semi-structured interviews, and focus group discussions were used to gather diverse perspectives on childbirth and care between 2010 and 2012. The influences of the sociocultural setting and political economy on facility-based care are discussed in this paper. Under the surface of this maternity hospital, social norms were in conflict with the principles of biomedicine. Contested areas included the control of knowledge, equity and the primary goal of work. The institutional culture was further complicated by pressure from powerful elites. These unseen values and pressures explain much of the disconnection between policy and implementation, education and the everyday behaviours of healthcare providers. Improving the quality of care and equity in Afghan public maternity hospitals will require political will from all stakeholders to acknowledge these issues and find culturally attuned ways to address them. Furthermore, the notion of competing world-views on healthcare has relevance beyond Afghanistan

Villains or victims? An ethnography of Afghan maternity staff and the challenge of high quality respectful care.

BACKGROUND: Healthcare providers are the vital link between evidence-based policies and women receiving high quality maternity care. Explanations for suboptimal care often include poor working conditions for staff and a lack of essential supplies. Other explanations suggest that doctors, midwives and care assistants might lack essential skills or be unaware of the rights of the women for whom they care. This ethnography examined the everyday lives of maternal healthcare providers working in a tertiary maternity hospital in Kabul, Afghanistan between 2010 and 2012. The aim was to understand their notions of care, varying levels of commitment, and the obstacles and dilemmas that affected standards. METHODS: The culture of care was explored through six weeks of observation, 41 background interviews, 23 semi-structured interviews with doctors, midwives and care assistants. Focus groups were held with two diverse groups of women in community settings to understand their experiences and desires regarding care in maternity hospitals. Data were analysed thematically. RESULTS: Women related many instances of neglect, verbal abuse and demands for bribes from staff. Doctors and midwives concurred that they did not provide care as they had been taught and blamed the workload, lack of a shift system, insufficient supplies and inadequate support from management. Closer inspection revealed a complex reality where care was impeded by low levels of supplies and medicines but theft reduced them further; where staff were unfairly blamed by management but others flouted rules with impunity; and where motivated staff tried hard to work well but, when overwhelmed with the workload, admitted that they lost patience and shouted at women in childbirth. In addition there were extreme examples of both abusive and vulnerable staff. CONCLUSIONS: Providing respectful quality maternity care for women in Afghanistan requires multifaceted initiatives because the factors leading to suboptimal care or mistreatment are complex and interrelated. Standards need enforcing and abusive practices confronting to provide a supportive, facilitating environment for both staff and childbearing women. Polarized perspectives such as 'villain' or 'victim' are unhelpful as they exclude the complex realities of human behaviour and consequently limit the scope of problem solving

The stigmatisation of people with chronic back pain

This study responded to the need for better theoretical understanding of experiences that shape the beliefs, attitudes and needs of chronic back patients attending pain clinics. The aim was explore and conceptualise the experiences of people of working age who seek help from pain clinics for chronic back pain. Methods. This was a qualitative study, based on an interpretative phenomenological approach (IPA). During in-depth interviews in their homes, participants were invited to 'tell their story' from the time their pain began. Participants were twelve male and six female patients, aged between 28 and 62 years, diagnosed as having chronic benign back pain. All had recently attended one of two pain clinics as new referrals. The interview transcripts were analysed thematically. Findings. Stigmatisation emerged as a key theme from the narrative accounts of participants. The findings expose subtle as well as overt stigmatising responses by family, friends, health professionals and the general public which appeared to have a profound effect on the perceptions, self esteem and behaviours of those interviewed. Conclusions. The findings suggest that patients with chronic back pain feel stigmatised by the time they attend pain clinics and this may affect their attitudes and behaviours towards those offering professional help. Theories of chronic pain need to accommodate these responses, while pain management programmes need to address the realities and practicalities of dealing with stigma in everyday life

Living with a long-term condition: understanding well-being for individuals with thrombophilia or asthma

range of literature has explored the experience of living with a long-term condition (LTC), and frequently treats such experiences and conditions as problematic. In contrast, other research has demonstrated that it may be possible to adapt and achieve well-being, even when living with such a condition. This tends to focus on meaning and the qualitative experience of living with an LTC, and offers alternative perspectives, often of the same or similar conditions. As a result of these conflicting views, this study chose to consider two conditions which, though they may lead to life-threatening illness on occasion, do not appear to impact significantly the lives of all those affected on a daily basis. The aim of this research was to explore and explain how people make sense of two long-term, potentially life-threatening health conditions, namely, thrombophilia and asthma. In doing so, it specifically considered the contribution made by information about the condition. A constructivist grounded theory approach was adopted; this enabled the generation of a theory regarding how people make sense of their LTC, whilst acknowledging the social circumstances in which this was situated. Semi-structured interviews were conducted with 16 participants who had given consent to take part in the research. The findings demonstrate that participants undergo a two-stage process * gaining knowledge and living with a long-term condition . The theory based on these findings indicates that those who are knowledgeable about their condition, making informed decisions in relation to it, and accept their condition are able to live with it, whilst those who do not accept their condition do not fully adapt to it or integrate it into their live

Health and the Running Body: Notes from an Ethnography

This article aims to develop one of the major themes from an ethnographic study of the culture of distance running – the desire for health and fitness. Research was undertaken over a 2-year period using a variety of flexible qualitative data sources, most notably observation and in-depth interviews. The body, especially the ‘running body’, is seen by participants in this study as a source of health and well-being and affirmation of their identity. The results highlight the various contradictions and tensions that emerged whilst exploring the behaviour of distance runners in their desire to achieve a healthy body and mind