Matter entangled with power

Joyner, Shefer & Smit 2014:45) state that “the discourses and practices shaping institutionalised nursing internationally, coupled with local historical legacies of gender, class, racial and socio-cultural inequalities, diminish the possibility of democratic, socially responsive and humane care in South African healthcare institutions”.

Matter is entangled in the power relations that play out in the health system and are particularly evident in Obstetrics. Our students, in their being and becoming doctors, get caught in these intra-actions. Materiality matters in maintaining the status quo of a system that is strongly influenced by surveillance and fear.

This hierarchical division of labour is entrenched in the South African health system in (Joyner, Shefer & Smit 2014:40). It is represented by symbolic emblems that mark the rank and status of each actor, and subsequent power. The white coats and stethoscopes indicate those with an MBChB qualification and beyond, while the nursing profession wear epaulette bars of different colours to show the categories of nursing in which they are registered and enrolled. These distinguishing devices, (as named by the South African Nursing Council) make visible their rank and responsibility. For instance a green bar signifies midwifery expertise.

Our students enter and exit from this system during their clinical block rotations. Their student cards give them access to the facilities where they learn the skills to become competent as indicated by the curriculum requirements. In Obstetrics, the sign-off of deliveries becomes the pot-of-gold that determines students’ agency. At times they feel helpless when caught in the entanglement of the web of relationships within the health team. When uncaring behaviours are witnessed, there is evidence that they emanate from all ranks within the hierarchy. While disciplinary processes are in place with complaints procedures through various mechanisms, the power relations do not encourage responsible responses to promote accountability.

This image (created on Adobe ideas) represents the entangled nature of the relationships present in the learning environment of Obstetrics. I was imagining a flattened relationship between all the actors in the Maternal Obstetrics Units. How different would it be if these markers of rank were removed?

Joyner, K., Shefe, T. & Smit ,E.  2014. Discourses and practices in institutionalised nursing in South Africa: Challenges for care, South African Review of Sociology, 45:3, 34-5.