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Ritual and the organisation of care in primary care clinics in Cape Town, South Africa

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  • Lewin, Simon
  • Green, Judith

Abstract

Few sociological studies have examined care organisation in primary health settings in low- and middle-income countries. This paper explores the organisation of health care work in primary care clinics in Cape Town, South Africa, by analysing two elements of clinic organisation as rituals. The first is a formal, policy-driven element of care: directly observed therapy for tuberculosis patients. The second is an informal ritual, seemingly separate from the clinical work of the team: morning prayers in the clinic. We draw on data from an ethnography in which seven clinics providing care to people with tuberculosis were theoretically sampled for study. These data include participant observation of clinic sessions, and interviews and group discussions with providers and patients, which were analysed using approaches drawn from grounded theory. Our findings suggest that rather than seeing the ritualised aspects of clinic activities as merely traditional elements of care that potentially interfere with the application of good practice, it is essential to understand their symbolic values if their contribution to health care organisation is to be recognised. While both staff and patients participate in these rituals, these performances do not demonstrate or facilitate cohesion across these groups but rather embody the conflicting values of patients and staff in these clinics. As such, rituals act to reinforce asymmetrical relations of power between different constituencies, and to strengthen conventional modes of provider-patient interaction.

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  • Lewin, Simon & Green, Judith, 2009. "Ritual and the organisation of care in primary care clinics in Cape Town, South Africa," Social Science & Medicine, Elsevier, vol. 68(8), pages 1464-1471, April.
  • Handle: RePEc:eee:socmed:v:68:y:2009:i:8:p:1464-1471
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    References listed on IDEAS

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    1. Salla A Munro, 2007. "Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research," Working Papers id:1107, eSocialSciences.
    2. Stein, Joanne & Lewin, Simon & Fairall, Lara, 2007. "Hope is the pillar of the universe: Health-care providers' experiences of delivering anti-retroviral therapy in primary health-care clinics in the Free State province of South Africa," Social Science & Medicine, Elsevier, vol. 64(4), pages 954-964, February.
    3. Petersen, Inge, 2000. "Comprehensive integrated primary mental health care for South Africa. Pipedream or possibility?," Social Science & Medicine, Elsevier, vol. 51(3), pages 321-334, August.
    4. Ogden, Jessica & Walt, Gill & Lush, Louisiana, 2003. "The politics of 'branding' in policy transfer: the case of DOTS for tuberculosis control," Social Science & Medicine, Elsevier, vol. 57(1), pages 179-188, July.
    5. Jewkes, Rachel & Abrahams, Naeemah & Mvo, Zodumo, 1998. "Why do nurses abuse patients? Reflections from South African obstetric services," Social Science & Medicine, Elsevier, vol. 47(11), pages 1781-1795, December.
    6. Kim, Julia & Motsei, Mmatshilo, 2002. ""Women enjoy punishment": attitudes and experiences of gender-based violence among PHC nurses in rural South Africa," Social Science & Medicine, Elsevier, vol. 54(8), pages 1243-1254, April.
    7. Salla A Munro & Simon A Lewin & Helen J Smith & Mark E Engel & Atle Fretheim & Jimmy Volmink, 2007. "Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research," PLOS Medicine, Public Library of Science, vol. 4(7), pages 1-16, July.
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    Cited by:

    1. Karina Kielmann & Nicole Vidal & Vija Riekstina & Maria Krutikov & Marieke J van der Werf & Evita Biraua & Predrag Duric & David A J Moore, 2018. ""Treatment is of primary importance, and social assistance is secondary": A qualitative study on the organisation of tuberculosis (TB) care and patients' experience of starting and staying o," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-18, October.
    2. Sarah Shelmerdine, 2017. "Pathways to Inhumane Care: Masculinity and Violence in a South African Emergency Unit," SAGE Open, , vol. 7(3), pages 21582440177, September.

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