Sense awareness

The image above was drawn on the 3D App on my iPad. It reminds me of the long, thin balloons that I used to love twisting and shaping in my play as a child. It introduces this blog post which considers the sensuality of learning.

What lingers after a learning experience such as Obstetrics? Barad’s (2007) concept of material-discursive practices seems to offer a valuable tool to unpack what is happening to our students in their curricular encounters. There are intra-actions that extend beyond the confines of the designed curriculum learning outcomes, even beyond the informal and hidden curricula (Hafferty 1998). Peterson (2014) explains that “agencies do not precede their intra-action but instead emerge through it”. In my understanding, each individual student is immersed in a process of learning in which they are affected and in which they affect their clinical encounters in a dynamic and uncontained way. Through a theoretical lens of new materialism the curriculum can be considered as an open-ended apparatus, defined by Barad (2007:148, cited by Peterson 2014) as “the material conditions of possibility and impossibility of mattering; [that] enact[s] what matters and what is excluded from mattering”.

One aspect that I explore here is the impact of the senses in Obstetrics curricular learning. For instance on the one hand the smell of the placenta lingers, the feel of a macerated foetus is discomforting, the sight of a foetal anomaly is both intriguing and upsetting, and hearing frightened teenage mums being scolded by angry midwives leaves students feeling guilty and disempowered. On the other hand the joyful touch of a healthy newborn, the sight of a blue neonate becoming pink as the body is aerated, and the pleasure embraced through hugs of gratitude bring a sense of elation, increased self-confidence and inner resourcefulness to students.

Recently a colleague has used the senses as the theme for third year students to prepare for their entry into Obstetrics the following year. She asked students to draw texts and images reflecting what they anticipate in terms of seeing, hearing, smelling, touching and occasionally tasting in Obstetrics. Surprisingly this activity did not make much impact, and was not well received by other educators.

What can we do differently to educate for the sensitivities of real world professional practice?

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

Hafferty, F. 1998. Beyond Curriculum Reform: Confronting Medicine's Hidden Curriculum. Academic Medicine. 73:4::403-407.

Peterson, K.S.  2014. Interviews as intraviews: A hand puppet approach to studying processes of inclusion and exclusion among children in kindergarten. Reconceptualizing Educational Research Methodology. 5:1:32-45.

Stillness of stillbirth

Death is “a point in a creative synthesis of flows, energies and becomings” (Braidotti 2006.235).

While there are many different cultural rituals associated with death, in the obstetrics’ environment other factors appear to surface exacerbating the loss of a newborn.  Death seems to have a particular force and intensity that contributes to a “pushing away” of some people. This often results in a lonely grieving process for the mother and those around her including students. Stories of neglect are not infrequent. In recent focus groups, students have indicated how they were shocked at times by the distancing of relationships when they expected support and care. 

Students have noticed an avoidance of death when it occurs and question themselves and each other about this practice. Nicola Fouche (2014) explains that even critical care nurses who frequently confront death, struggle with the discomfort, even after many years of exposure to dying patients. In her recent doctoral thesis she recommended that nursing training ought to include a special curricular module on death studies, named as Thanatology.

Braidotti (2001:121) puts forward an affirmative posthuman theory of death claiming that we “need to re-think death, the ultimate subtraction”, and rather to consider the death-life continuum that can blur the divide between life and death. Studying death is a relatively new interdisciplinary area emerging since the 1970s and is “under-examined as a term in critical theory” (Braidotti 2001:128). Braidotti (2001:121) criticizes the “forensic turn” for placing an “over-emphasis on death”. She refers to zoe, a generative force that creates a vital continuum with relationships of interconnectiveness that can be helpful for compassionate care.

The blurring of bodily boundaries is also part of Karen Barad's (2012:218) affirmative philosophy in which she relates materiality to indeterminancies that can be “a celebration of the plentitude of nothingness” rather than a lack or a loss. The image above shows a footprint illustrating a practice carried out by some midwives. This material-discursive practice promotes compassionate care through the mark of the deceased baby’s foot. There is an assemblage created by the baby’s skin-ink-print-paper-becoming that provides a lasting memory keeping alive the loss, rather than being a no-go sign. This image drawn on the Papers App on my iPad illustrates how spacetimemattering can be diffracted with different effects.

Barad, K. 2012. On touching: The inhuman that therefore I am. A Journal of Feminist Cultural Studies. 25:3:206-223.

Braidotti, R. 2006 Transpositions on nomadic ethics. Polity Press, Cambridge, UK.

Braidotti, R. 2013. The Posthuman. Cambridge: Polity Press.

Fouche, N. 2014. “We don't handle death well": Implications for a postgraduate nursing curriculum of intensive care nurses' experience of death in ICU. University of Cape Town. https://open.uct.ac.za/handle/11427/13185

Deciding on diffraction

When two stones or more are dropped into a pool simultaneously, the resultant ripples of water that appear in concentric circles, move outwards and interfere with each other. These ripples also produce patterns that move with the flow, in a process that can be described as diffraction (Barad 2007). In contrast, still water that has not been disturbed can create mirror-like reflections -- a static product, mediated by light waves. On the other hand, refraction refers to the bending and splitting of light when lights waves move through different mediums and change speed. In this process there is a separation or dispersion of the waves, sometimes visible through rainbow colours.

The interactions of all forms of matter are recognized as important contributors to our insights and our actions. Like waves interfering with each other through the diffractive process, we can pull our research theories and data through each other to distinguish different patterns. This offers a new, alternative approach that shifts away from separation and stasis. It can be informative in facilitating difference to make a difference (Barad 2007). There is a growing and emerging interest in using diffractive methodologies for research in different disciplines. This shift takes research beyond a “conventional humanistic qualitative methodology” by expanding into the non-human materiality of matter and the interrelating relationships (Denzin & Lincolm 2011).

Feminist scholar Donna Haraway first considered diffraction as a valuable metaphor for feminist research in 1992 (Kaiser & Thiele 2014).  The notion of diffraction as a process in physics that can be related to philosophical understandings was further picked up by Karen Barad and taken forward through observations in quantum physics. Barad draws on the experimental work of Niels Bohr and other influential physicists to explain diffraction as “not a set pattern, but rather an iterative (re)configuring of patterns of differentiating-entangling” (Barad 2014:168). She explains meanings from the relationships in the entanglement of patterns of interference describing how matter matters by going beyond the geometrics that is associated with the optics of diffraction. It is a strong move away from traditional binary conceptions that tend to relate difference to something that is not the same, an otherness that has led to limiting dualist viewpoints such as shadow versus light, cause/effect, human/non-human amongst others.

Diffraction pushes outwards in a powerful way to illuminate differences and the spaces in-between. Diffraction encapsulates the dynamic complexity of the entanglement of space, time and all kinds of matter and includes a strong ethical component embedded in the relationships of the patterns of difference. For instance Barad (2012:68)  asserts “that our responsibility to questions of social justice have to be thought about in terms of a different kind of causality”.

The notion of cause and effect is expanded. When waves in the ocean crash against an obstacle they become superimposed on each other and can produce bigger waves or other variations of amplitude that depend on their timing, positioning and force amongst other influences. There is a multitude of possible responses to the waves interacting with each other. How this is interpreted depends on our viewpoints, perspectives and measuring processes.

In my research project I plan to identify differences through the intra-acting patterns that emerge. I will explore insights through one another to find “new patterns of thinking-being” (Barad 2012:58). This diffractive methodology acknowledges that I as the researcher will be immersed in the data, and through my developing relationships will be likely to become transformed in indeterminate and different ways, rather than assuming a distance from the data in a neutral and objective manner. The researchers take up a “responsibility to the entanglements of which we are a part” (Barad  2012:52).

In this appealing process there is a positive component that develops in the construction and deconstruction of phenomena that make up the patterns, and relate to each other, through connections that form, what Deleuze and Guattari (1987) term assemblages. This contrasts with some other critical stances that can be undermining through their binary conceptions that give value to some data and knowledge and discard other. Kaiser and Thiele (2014:166) suggest that “thinking-with-diffraction” opens up affirmative potentials to be a “subject-shifter”.

The image above was created on my iPad using the Flowpaper App. The drawing was imported into the Paper App where additional elements were added like the text.

Barad, K. 2014. Diffracting diffraction: Cutting together-apart. Parallax. 20:2:168-187. 

Barad, K. 2007. Meeting the universe halfway: Quantum physics and the entanglement of

matter and meaning. Durham, NC: Duke University Press.

Barad, K. 2012. “Matter feels, converses, suffers, desires, yearns and remembers” Interview with Karen Barad. In Dolphijn & Van der Tuin, New Materialism: Interviews & Cartographies. Open Humanities Press.

Deleuze, G., & Guattari. F. 1987. A thousand plateaus: Capitalism and schizophrenia. Trans. B. Massumi. Minneapolis, MN: University of Minnesota Press.

Kaiser, B. M. & Thiele, K. 2014. Diffraction: OntoEpistemology, Quantum Physics and the Critical Humanities, Parallax, 20:3:165-167.

St Pierre, E. 2011. Post qualitative research: the critique and the coming after. 2011. In Denzin & Lincoln (Eds), 4th Ed. The Sage Handbook of Qualitative Research.

The stick

The in-between space in this doctoral research project seems to feel like a wandering in the forest with different paths to follow amidst the beauty of the vegetation. I stop, look, feel, smell, then move on with a varying pace. The route is uncertain and untracked. There is no well-trodden path to follow nor a Google map or GPS to guide me to a specific place.

Sitting down gives me a chance to reflect and digest the beauty and the movements around me but it does not lead me to my destination. Climbing a tree can offer an overview, a panoramic perspective of where I ought to be going or give clarity to potential possibilities. I need to move with intention yet I stumble as I question which way to go. Which desires do I follow? The maze of paths that connect in different ways can be compared to Deleuze and Guattari’s rhizome. The growth and life around me inhabiting the forest offer encounters that I am experiencing as I read the transcripts and listen to the audio-recordings of my interviews and focus groups.

As the light illuminates different parts of the forest, new insights become visible in differing ways. Through my being and becoming aware of the relevant patterns and interferences I am engaged in a diffractive approach to my research analysis. Various forces and intensities open up channels of evidence that can lead me to reach my destination, my research objectives.

As I sit in the midst of my research data, I feel a sense of entanglement, caught in the branches and the foliage that seem to be holding me back, yet affecting me in a manner that is pushing and pulling me to experiment, to find something new. McClure recommends that in post-qualitative research we need to be sensitive to the glow of the data, what “arrests our gaze and makes us pause” (2013:662). Davies suggests that in data analysis we engage with the “entanglement of intra-active encounters” (2014:2). I feel reassured as she contends that it is “ hard epistemological, ontological, and ethical work to enable the not-yet known to emerge in the spaces of the research encounter”.

What struck me this week was the significance of a stick. In an interview with a student he explained how difficult relationships play out in the medical hierarchy between midwives and medical students, where midwives appear to give preference to nursing students. This was also a strong theme in a recent student focus group. The student reflecting on his obstetrics experience said “you feel like there’s a certain judgment that comes with being a medical student that you must be a medical student so you must be like every other medical students or every other doctor I've met in my life. So we just carry the stick with us …  so everywhere we go we represent a bigger group of people”. The stick represents punishment that he relates to possible past experiences of relationship issues between nurses and doctors. The image above was drawn using Sketchbook Pro on my iPad.

Punishment seems prevalent in the maternity facilities. Kruger and Schoombee (2010) write about the various forms of punishment. There is neglect and abandonment, as well as physical and verbal abuse of women in labour. Kim and Motsei (2002) report that nurses themselves are victims of abuse/punishment by partners who feel threatened by the nurse’s professionalism and independent income generation. Beating is sometimes viewed as an acceptable form of discipline and punishment both in the home and in the workplace.

Earlier educational settings also carry “the stick” as a symbol of control and regulatory practices. Despite the South African Schools Act 84 in 1996 that bans corporal punishment and the protection offered by other legal frameworks such as our South African Constitution, it is still prevalent. Veriava’s (2014) report indicates that 15,8% of all learners experienced corporal punishment in schools in 2012. This sadly reflects societal “norms”.

In terms of obstetrics Kim and Motsei claim that “any educational intervention must move beyond the intellectual or technical level to address the deeper and more personal context of the nurses’ own experiences” (2002:1252). They assert that the starting point is to find a way for “acknowledging and exploring the nurses’ own experiences of abuse” (ibid), They recognized that a guiding principle to changing behaviours is to ‘‘first do no harm’’ and that both the medical and nursing curricula ought to be raising awareness and sensitivity to these matters in the early years of training.

Perhaps a creative approach to these problems may inform principles for changing attitudes and practices. As I seek to develop a socially just pedagogy in Obstetrics I recognize the value of drawing on the philosophy of children, an emerging academic field. Lenz Taguchi (2010) describes how stick-play amongst small boys was transformed by offering a different symbolic meaning of the stick. By giving sticks names and recognizing the sticks as part of a tree, rather than sticks as guns and weapons, new and positive relationships developed which materialized into changed attitudes and behaviours. The sticks became agents transforming shooting and shouting to curiosity and care that promoted inclusivity.

Lenz Taguchi recommends that “we want to be in a listening dialogue, where we negotiate our different understandings, and learn about the diversities and differences in meaning-making and strategies of doing things” (2010:34). Drawing on my own background in Physiotherapy, a stick can become a supporting mechanism to assist us to be respectful, caring and compassionate. By moving from a top-down approach where a person holding the stick signifies superiority, objects such as sticks can become collaborative tools when considered as intra-active resources for learning and practice.

Davies, B. 2014. Reading Anger in Early Childhood Intra-Actions: A Diffractive Analysis. Qualitative Inquiry.

Lenz Taguchi, H. 2010. Introducing an intra-active pedagogy in early childhood education: introducing an intra-active pedagogy . Routledge.

Kim, J. & Motsei, M  2002. Women enjoy punishment’’: attitudes and experiences of gender-based violence among PHC nurses in rural South Africa. Social Science and Medicine 54:1243–1254.

Kruger, L & Schoombee, C. 2010. The other side of caring: abuse in a South African maternity ward, Journal of Reproductive and Infant Psychology, 28:1:84-101.

McClure, M. 2013. Researching without representation? Language and materiality in post-qualitative methodology, International Journal of Qualitative Studies in Education, 26:6, 658-667.

Veriava, F. 2014. Promoting effective enforcement of the prohibition against corporal punishment in South African schools. Pretoria University Law Press.