Responsibility and accountability

“Questions of responsibility and accountability 

present themselves 

with every possibility; 

each moment is alive with different possibilities 

for the world's becoming 

and different reconfiguring of 

what may yet be possible” (Barad 2007:182).

The opening up of the possibilities of responsibilities presents many pedagogical challenges in medical education. In resource-constrained teaching environments, I wonder how far socially just pedagogies can extend?

This week I had the privilege of interviewing three midwives at a local Midwife Obstetrics Unit (MOU) -- part of the Public Health System’s Day Hospital group. These midwives teach our students during their busy duties. One key concern raised was that many women who arrive in labour to deliver their babies are hungry. The women come from impoverished conditions where food is scarce, and the birthing units do not supply anything to eat.

In terms of response/ability and accountability, is there scope for students in their Obstetrics learning block to engage with these basic needs that directly influence women’s health? The traditional approach to learning Obstetrics in Year 4 is to provide a service and to develop the skills and competence to become proficient doctors. However the comprehensive Primary Health Care approach taken up by the South African health system is more complex engaging with the broader societal issues such as the social determinants of health. When we acknowledge the entanglement of our relationships, different perspectives with potential possibilities may be helpful.

The lack of food is a material force that limits human flourishing. Barad (2014) claims that we need to acknowledge the material forces that play out in our intra-actions, moving away from a human-centred (anthropocentric) gaze. In support, Fenwick (2009) suggests that materiality is often dismissed when professional responsibility is analysed.  

With the increasing focus by medical schools on social responsibilty (SR) and social accountability (SA) these societal difficulties are now contributing to a more integrated approach towards healthcare in context. In the image above (drawn on my iPad using the Doodle Buddy App) I reflect on the entanglement of pedagogical practices in the context of multiple and divergent needs.

Barad, K. 2007. Meeting the universe halfway: Quantum physics and the entanglement of matter and meaning. Durham, NC: Duke University Press.

Barad, K. 2014. Diffracting Diffraction: Cutting Together-Apart, Parallax, 20:3, 168-187,

Fenwick, T. 2009. Rethinking professional responsibility. In Reconceptualizing professional learning: Sociomaterial knowledges, practices and responsibilities. (Eds) Fenwick & Nerland). Routledge. Abingdon.