Fragmented, frustrated and trapped : nurses in post-apartheid transition at King Edward VIII hospital, Durban.

Abstract

This ethnographic study of nurses at King Edward VIII Hospital in Durban, South Africa was designed to seek insights into the lives of women as nurses during the socio-political transition of the 1990's. It suggests that this period of dramatic political change in the country created spaces for redressing uneven social relations and chronic disparities faced by nurses in their personal and professional lives, particularly those constructed through the social engineering of apartheid policies. The study describes the particular evolution of nursing in South Africa, the process undertaken to unify the professional nursing associations formed through the 1980's and the national labour unrest that rippled through the health care system between 1994 and 1996. It considers the diverse locations of nurses as the backbone of the healthcare system, primarily in their capacities as professionals, managers, care-providers, team-players and colleagues and describes practices that operate to constrain nurses as women and health care practitioners. Feminist, post-structural perspectives framed the theoretical approach taken in this qualitative study. These were guided by Foucauldian theories of knowledge, power and discourse, and feminist contributions regarding resistance and agency. Over the course of four years in the field, methods of participant observation and in-depth interviews were employed to develop insights into the subject locations of nurses in their private and public lives. Twenty-six nurses of the professional and subprofessional categories contributed to the main narratives. In addition, a series of interviews were undertaken with key informants from the medical, paramedical, nursing and administrative services. The study illustrates the practices of patriarchal, institutional and organisational relations of power that intersected and dominated the realities of the nurses in all spheres of their day-to-day lives. Within the post-colonial moment in South Africa, these were conceptualized as subaltern institutional relations. The study found that as a consequence of their subjugation within the subaltern institutional relations, the realities of nurses were diverse, divergent, and fragmented. It argues that these relations imbued a lack of professional and personal coherence that impaired the capacity of nurses to contest the chronic professional and work place disparities. Often multiple and compounding in their manifestation, these relations and practices reinforced the isolation of nurses, compounding their incapacity to meaningful challenge professional and personal obstacles during the socio-political transition of the 1990's.