Suspicious Minds: Apportioning and Avoiding Blame for Distrustful Relationships and Deferring Medical Treatment in South Africa

摘要

This paper examines elements of mistrust, blame and suspicion among patients and providers inthe South African health system which affect practice and policy development. Using stories toldby patients and providers in Cape Town, Johannesburg and Bushbuckridge, it examines how suspicionis constructed and how others are blamed for adverse outcomes. This paper sets a conceptualframework which examines the attribution of blame in contemporary social and politicallife, the narratives of 45 patients receiving HIV/AIDS, TB or maternal delivery services andthose of 63 providers dealing with similar treatments and arranged across a series of facilities,clinics, hospitals and mobile vans were constructed and shared with participants. These narrativesform the basis of the results sections which examines suspicions among both providers andpatients with the former seeing the latter as having no respect and regard and providing poor careand access to grants. Providers saw themselves as highly stressed but diligent with service challengesbeing blamed on patient ignorance, unreasonable demands and failure to follow medicaladvice. The paper ends with a discussion on how to limit mistrust and reduce suspicion throughmore co-operative provider-patient relations and what this kind of evidence means for decisionmakers