Reflecting on reflections

In the drawing above (using an iPad pen and Explain Everything) I’ve tried to demonstrate the tenuous lines of communication and relationships that are evident in our State health system’s birthing facilities. The medical undergraduate students traverse this netting. For educators, there are many challenges. We are all vulnerable through our interdependence.

Zembylas (2012:8) claims that “a pedagogy of discomfort is valuable in uncovering and questioning the deeply embedded emotional dimensions that shape some individual and group privileges ...through daily habits and routines” then he adds that by “problematizing these emotional habits and routines and their attachments to  … structural injustices, it is shown that teachers and students in a posttraumatic context can begin to identify the invisible ways in which they comply with dominant ideologies”.

When we stand in front of a class giving a lecture, we tend to create and maintain a physical and emotional distance between us and the students. When we engage with interactive participatory pedagogies there is a dynamic and fluid arrangement where we as educators aim to facilitate learning rather than teach in a didactic manner. However when we shift to the online space inviting students to engage in critical reflection through their real life clinical encounters, a different dynamic occurs. The comfort of distance is disturbed. Our roles and responsibilities become less clear and less comfortable, particularly when working with ‘troubled knowledge’.

Like the stories from women in labour wards in our State facilities (Chadwick, Cooper and Harries 2014), students reveal many narratives of distress. A question that sits with me as I read students’ reflective commentaries is: how bad is bad?

Reflective commentaries have become an increasingly popular pedagogical tool, now used in various ways and through several mediums. For instance in Obstetrics it offers an opportunity for debriefing. Many students have expressed the value in hearing about the experiences of their colleagues – a sense of shifting from individual discomfort and at times trauma, to a collective recognition for changing the normalized structural injustices that pervade practices in our health care system.

As I, the educator and researcher, acknowledge the students’ experiences and offer support, sometimes taking matters further through the institutional mechanisms, I sometimes sit with uncertainty struggling with the emotional labour that accompanies my role.

How much do we support and report? Every move on and in the net has an impact.

Chadwick, R., Cooper, D. & Harries, J. 2014. Narratives of distress about birth in South African public maternity settings: a qualitative study. Midwifery. 30. 862-858. 

Zembylas, M. 2012. Critical pedagogy and emotion: working through ‘troubled knowledge’ in posttraumatic contexts, Critical Studies in Education. 1-14.

Opening meanings

This photo was taken on the main campus of the University of Cape Town during the summer vacation. I used Adobe Ideas, a new App for me - one that is particularly helpful for developing different layers of images and text. The photo shows the stairway between the university main library and the students’ cafeteria.  On the one side is the space for gaining formal knowledge and on the other side the informal space designed for eating and talking. There seemed a strong connection with the binaries expressed by 2 recent educators who I interviewed. One spoke about the need in medical education for an equal division of focus between health information and healthy well-being, while the other discussed the requirement for skills and knowledge to be balanced by “soul” matters.

As students return to campus after their summer vacation, this physical campus space is much busier. Some students are coming to encounter the first year experience or to begin another year of their studies. For many students, the transition from school is extremely difficult and challenging as the curriculum structure and design is often very different. Medical undergraduate students face a second acknowledged and difficult transition when they begin their clinical years after 3 years of mostly theoretical training.

While these challenging curricular moments are acknowledged, the emphasis is on skills development and competence training. Student support is available at UCT and valued by many. First year students in the Health Sciences have the benefit of possibly entering an intervention programme. Students in later years can access support through several channels. Yet, I question what changes are visible in the curriculum to smoothen these later rough curricular transitions. My research is aiming to open up new meanings to difficult issues that students confront in Obstetrics. Students’ insights and experiences of dissonance can help to shape and to drive change.

Jackson and Mazzei (2012:34) point out that “[i]f we purposefully seek the snags that trip us up and let ourselves fall, then meanings have the potential of presenting themselves from our view on the floor. If we keep our heads down in order to anticipate the snags, thereby avoiding a fall, we risk a foreclosure of that which is a new concept, as named by Derrida”.

Jackson, A. & Mazzei, L.  2012. Thinking with theory in qualitative research. New York. Routledge.

Time matters

In medical encounters, time matters, yet in different ways in different interactions. During doctor-patient consultations, specific time slots are the usual often creating tensions from both parties. However in Obstetrics, time extends into the unknown along with many other uncertainties. Due to this frequently expanded time, there are tensions in terms of monitoring the progress of labour, managing the pain related to childbirth and ensuring the safe arrival of the newborn without complications to both mother and child.

Issues around time provoke tensions from the mother to be and the healthcare workers / students who intuitively question how long they have to be present and to what extent. What happens when the needs of the mother conflict with the needs of the care-workers? Does lunchtime take precedence over other responsibilities?

The image above is created using Skitch on my iPad. The strips drawn on each side overlap to illustrate the many layers of relationships and matter that influence and are influenced by time as students learn Obstetrics. The photo of my watch reflects the importance of every minute and second. For instance when the neonate is ready to pop out, there is an urgency not to linger. Experiences from students and midwives reflect that at times there is no time to put on gloves - getting splashed by amniotic fluid is not uncommon. Such occupational hazards with possible harmful consequences usually result at unexpected times and can be exacerbated by the tiredness of those in attendance. Time for sleep is a treasured aspect of this 8 week student rotation in Year 4. Time tensions call for different skills to the usual. These challenges are shaping student learning in unpredictable ways.

Patterning interconnectedness

This quilt that I made a few years ago, resulted from piecing together many fabrics. It was fun to design and to sew, and now fulfilling to enjoy the finished product on a bed in my home. However since reading Karen Barad’s work, I look at it in a different way. Is this a finished product? What does it tell me and what more could I have done or still do? How does it influence my thoughts?  For instance, the backing has a very different force on me with a bright orange energy. To continue to sit with these questions, I have kept the photo in its raw state choosing to let it facilitate my diffractive thinking.

Similarly in my research proposal I stated the type of data collection that would suit my research and the appropriate analysis that I anticipated would elicit the best results. Now I wonder how reading diffractively will change and influence how I consider the multiple intra-actions that occur in my classroom and online pedagogical practices, and the clinical context of student learning. It feels that my thoughts are shifting in an unexpected way. Where will this lead and how does one capture the different differences when all matter matters?

Deleuze and Guattari (1987) write about the relational aspects in a pieced quilt - considered as a smooth space without a centred focus. Lenz Taguchi (2010:145).expands on how different patterns and fabrics relate to each other “in different and infinitely possible ways”. In working with and on my research data, I will need to make choices in defining the “agential cuts”, or will the choosing be a consequence of other forces (Barad 2007). I wonder what patterns, possibilities and potentialities will emerge?

Boundary break-in

“The nature and existence of boundary spaces is both challenging and troublesome because they are borderland spaces, spaces where diverse and related concerns both overlap and collide” (Savin-Baden 2008:115).

Maintaining safe spaces is an important concern in my research and work. In creating such spaces for dialogue and reflection, I recognize that boundaries become increasingly relevant and important.

From my own point of view, I am in a "liminal space" engaging in troublesome knowledge and dissonance. I am challenging established practices as an outside insider - not an Obstetrician, midwife or a full-time educator. In facilitating student learning in and through health and human rights workshops at several levels of the undergraduate medical curriculum, I bring an alternative “liquid curriculum” that provides a smooth space in a generally crowded striated curriculum.

Yet the issues are complex, troublesome and difficult. Connections between the university, the province and non-governmental organizations are sensitive. Furthermore, the relationships between the students, nurses and doctors is fragile. Part of my research is to explore the impact of students’ learning on the already stressed and overworked nursing staff in the Obstetrics facilities.

In terms of changing educational practices, Savin-Badin (2008:116) recommends that we provide 2 types of boundary spaces - space creation in the curriculum and space production referring to “gaps for students thinking, reflecting and student-led discussion”. New boundary spaces can be considered as in-between spaces, “where criticality, debate and deliberative democracy can grow and flourish” (2008:127).

The photos in the Picframe collage, were taken while I was walking in my neighbourhood. The barbed fences are not uncommon in South Africa. However this and many other strategies to “keep out crime” have limited value in a country where poverty and inequality provoke high incidents of crime.

Looking through the looped coils, I see many stories unraveling as my research progresses. Collegial support is likely to help me to develop the resilience to overcome the barbs. My new iPad also contributes to shield me from other limitations.

Savin-Baden, M. 2008. Learning Spaces: Creating opportunities for knowledge creation in academic life. McGraw-Hill.

Towards different differences

A nudge from my supervisors has led me to consider my research as an institutional ethnographic study. This appeals to me because it is “about looking out beyond the everyday [practices] to discover how it came to happen as it does” (Smith 2006:3). This approach aims to illuminate organizations and relationships and to understand the “embodied actualities” of the work people do that I can then relate to student learning. Dorothy Smith suggests that we begin with ourselves which is usually something that I tend to avoid.

Taking a selfie on the first day of 2015 (and adding some graphics on Notability) helps me share some thoughts about the data collection that is planned for the next few months. What will the unintended consequences be as I shift into this phase of the PhD? There are likely to be many entanglements through the interactions of different actors and the intra-actions that I am able to identify and discern or possibly miss.

Although like others, I usually choose not to be different, my visual impairment does impact on my research. It is frequently an invisible disability to others only surfacing when I need to read text or reach a destination with assistance. Transport to outlying places is a concern. In terms of my data collection I recognize that in small groups I can miss visual cues. Therefore I need to rely on the transcribed text and on the images I hope to produce as a research product of my own and others. If I asked an observer to be present during my interviews and focus groups, my sense is that it will negatively impact on the rapport between me and my research participants.

More broadly there is recognition that the past plays out in the present. I come from a previous workplace situation where fair labour practices were sometimes questionable. I became conscious of the different value given to truthfulness by different people and the powerlessness of some to promote change. These personal experiences acted as a catalyst to my research trajectory.

Now I am curious, cautious and cognisant of the responsibilities that I carry as a researcher, educator, learner and change agent as the new year unfolds with all its possibilities.

Smith, D. 2006. Institutional ethnography as practice. Rowman & Littlefield Publishers