Читать книгу Rainforest Asylum - Sara Ashencaen Crabtree - Страница 15

Hospital Tranquillity stands in a certain amount of isolation compared to policy developments, funding and political focus, which are concentrated in Peninsular Malaysia, despite it being an important regional resource. Currently the hospital is facing the dilemma of how to address the practicalities of ideological developments in health care within the context of contemporary political debate in Malaysia. This in turn represents significant challenges for the future direction of the hospital and its community services - critical issues that were revisited in conversations with staff on several occasions during the fieldwork process.

In commencing fieldwork permission was initially sought from the Jabatan Kesihatan Negeri X (the State Department of Health), but it was the Director’s personal consent as the main gatekeeper that would prove crucial for work to proceed. I am doubtful whether my position as a foreigner actually assisted in the facilitation of this process of consent, as Punch (1993) discovered in his study of an Amsterdam police force, although it is clear that my status as a local lecturer was quite definitely helpful. Fortunately the Director of the hospital, Dr T.W., was already known to me from my previous research projects, and furthermore we both served on the committee of a local mental health NGO (non-governmental organisation). Burgess describes how an attempt to return to a previous field site for further studies was not welcomed by the principal gatekeeper (Burgess, 1991). By contrast, in my own case I found that the Director was amenable to further work at the hospital, since familiarity with my prior activities worked in my favour, and proved to be very valuable in allaying concerns about my integrity and ability as a researcher.

This alliance proved to be extremely helpful on numerous occasions in smoothing the path of obstacles in relation to access to wards and interviews. In his role as the main gatekeeper of the site, Dr T.W. was in a position to grant a general consent on behalf of his staff, and to a large extent in practical terms those of his patients as well. This proved to be less helpful than I anticipated in terms of ethics and practical assistance. Roger Homan for instance raises issue with the ethics of such generalised consent, the right of consent by, for instance, individual staff members is effectively withheld (Homan, 1991). Pragmatically Burgess points out that even where the consent of main gatekeepers is obtained this does not remove the need to negotiate terms with individual staff informants as informal gatekeepers who may otherwise provide blocks to adequate research (Burgess, 1995).

Naturally, responses to participation varied, many patients expressed positive opinions, although others were clearly quite indifferent to my reasons, but just welcomed the chance for a chat with an outsider. A small minority rejected my advances outright and in keeping with the experiences of other ethnographers, some participants became close allies and main contributors of insider knowledge (Glick, 1998: Punch, 1993). After all my precautions regarding confidentiality and consent I was fairly surprised at first that few patients seemed particularly bothered by this. More important to most patients on the ward was my ability to keep a secret when it came to whispered confidences about a particular ‘scam’ or an incident of abusive behaviour from a certain member of staff.

Gaining consent for interviews with individual patients did not completely ensure a smooth passage to fieldwork and here problems were threefold. First of all the director’s consent was generally broadcast via a memorandum that apparently was not circulated to all members of staff, and therefore my presence needed to be explained, clarified and re-checked on numerous occasions throughout the field-study period. It was quite common for my credentials to be inquired into time and again, and occasionally pointed inquiries were made about whether the Dr T.W.’s permission had really been granted.

Secondly, this form of generalised consent from a superior did not necessarily guarantee willing participation from respondents, exemplifying the simple observation by Miles and Huberman, that ‘weak consent leads to poorer data’ (1994: 291). This could additionally be seen when initially, in a bid to be helpful, some members of staff tried to coerce patients into cooperating with me. Although I quickly discouraged such practices, I was also aware of a possible double game being played by staff, in that this could also act as an effective strategy of diversion away from them.

Finally, and connected to the point of weak consent, despite the director’s consent, it was nonetheless quite difficult to engage in a further process of negotiation with staff members acting as ‘gatekeepers’ to their wards. I often found that staff were reluctant to discuss terms with me and seemed to prefer this to be confined to my discussions with the director, and then mandated by him. This seemed to be particularly true of female nursing members of staff and junior male counterparts, both groups sharing a common and lowlier status in the medical hierarchy. Yet by not being able to negotiate openly with members of staff, I felt that their concerns were not specifically addressed, and frequently I perceived their unspoken or indirectly conveyed resentment and anxiety about my research role. I was regularly directed to talk to a more senior member of staff in corresponding male or female wards, under the pretext that this person was a more knowledgeable and experienced individual. In reality a formal repository of professional knowledge was usually not the best informant, as in this role such individuals tended to deliver set pieces of information concerning policies governing the management of the hospital that rarely provided useful insights into the lived experience. Instead it seemed to be that this role was largely a symbolic one designed to keep parties from the outside at bay, as well as providing the authority to speak, so clearly lacking among many women workers and inexperienced younger men.

Unfortunately, I found that discomfort and hostility towards my presence on the ward were not uncommon features of fieldwork. Like Van Maanen I did on occasions experience something approaching ‘unambiguous rejection’, although not as bluntly expressed as his examples quoted from hard-bitten New York cops (Van Maanen, 1991: 36-7). On one occasion Sister Magdalene, a senior member of staff, audibly instructed a subordinate to inform me that she was far too busy to talk to me when, so far as I could see, the ward was very quiet and she did not seem to be specifically engaged in work. It should be noted that this conversation took place within a few feet of where I was standing and delivered in a tone of annoyed dismissal, to be subsequently delivered in evident embarrassment by the auxiliary nurse. Two further examples taken from my field notes illustrate this rejection; the first takes place in an episode on Male Ward 1 where, as usual, a patient is helping two medical assistants with medication to be dispensed to patients on the locked section.