Gaining access to the field in medical ethnography: Reflections on ethical, methodological, and structural challenges in the study of long-term care facilities

The article extends the discussion on the challenges in gaining access to the field in medical ethnographic research, focusing on long-term care (LTC) facilities. Medical institutions have been documented to be difficult sites to access. The reference, however, is to the recruitment of patients as informants. The challenges of recruiting practitioners as informants have not been investigated at all. The article presents the key issues that emerged in the process of gaining social access at the sites of two LTC facilities as part of a study on care workers’ identities. The main obstacles encountered during the fieldwork were organizational constraints and negotiating control over the process of recruiting the lower occupational tier of care workers with gatekeepers. The article presents the coping strategies implemented to overcome the ethical and methodological obstacles: continually reassessing the consent and cooperation of participants and developing a rapport with nurse’s aides during interviews.

SCOTTISH MEDICAL ETHNOGRAPHY: COLONIAL TRAVEL, STADIAL THEORY AND THE NATURAL HISTORY OF RACE, c.1770–1805

This paper will present a comparative analysis of the ethnographic writings of three colonial travellers trained in medicine at the University of Edinburgh: William Anderson (1750–78), Archibald Menzies (1754–1842) and Robert Brown (1773–1858). Each travelled widely beyond Scotland, enabling them to make a series of observations of non-European peoples in a wide variety of colonial contexts. William Anderson, Archibald Menzies and Robert Brown in particular travelled extensively in the Pacific with (respectively) James Cook on his second and third voyages (1771–8), with George Vancouver (1791–5) and with Matthew Flinders (1801–3). Together, their surviving writings from these momentous expeditions illustrate a growing interest in natural-historical explanations for diversity among human populations. Race emerged as a key concept in this quest, but it remained entangled with assumptions about the stadial historical progress or “civilization” of humanity. A comparative examination of their ethnographic writings thus presents a unique opportunity to study the complex interplay between concepts of race, savagery and civilization in the varied colonial contexts of the Scottish Enlightenment.

Medical Ethnography over Time

Too often, research into the health of a particular community is brief and superficial, focusing only on what is public and leaving the private health of women and children ‘foggy’. By contrast, long-term anthropology can offer access to processes taking place within a local culture of illness. Here, an account of a community’s experience of health over the past 50 years not only outlines the key changes as seen anthropologically but also shows how even close ethnography can initially miss important data. Furthermore, the impact of a researcher – both as a guest and as a source of interference – underlines how complex fieldwork can be in reality, especially if seen through the eyes of the researcher’s hosts.

Steps in Developing a Patient-Centered Measure of Hospital Design Factors

Patients and families are at the center of care and have important perspectives about what they see occurring surrounding their healthcare, yet organizations do not routinely collect such perspectives from patients/families. Creating patient-centered measures is essential to understanding what they perceive about the environment as well as achieving the goal of patient-centered care. We focus this research methodology column on describing a four-step medical ethnography approach that can be used in developing patient-centered measures of interest to those studying built environments. In this column, we use this approach to illustrate how one might develop a measure that can be used to understand parent perceptions of the safety culture in neonatal intensive care units.

BIRDS AND KHOESĀN: LINKING SPIRITS AND HEALING WITH DAY-TO-DAY LIFE

ABSTRACTIt is not surprising that animals have played a significant role in KhoeSān cosmology but identifying exactly what that role is and how it relates to different contexts of belief and action is more challenging. This article identifies a special role for birds in KhoeSān thought and practice, which is tightly bound to matters of spirit and healing, seems relatively cohesive and is distinctive and widespread, both culturally and historically. Working out from a detailed KhoeSān medical ethnography and using bird examples taken from a wide range of KhoeSān, I argue that bird relationships are best understood by re-framing popular ideas of ‘supernatural potency’ within persistent habits of perception and the opportunities or challenges they present. I further highlight how KhoeSān interaction with birds must be linked to particular relationships with knowledge in order to understand why birds are so salient. I conclude by emphasizing the dangers of explaining KhoeSān bird relationships within potentially distorting categories of ‘metaphor’.