Abstract #190  -  Multiple ways of caring for patients in an ARV clinic in Botswana
Authors:   Presenting Author:   Ms Fanny Chabrol - EHESS
Additional Authors:  Mrs Fanny Chabrol,
Aim: Botswana is one of the countries with the worst HIV epidemic worldwide. By 2007 the adult HIV prevalence was 24.1%. In the face of this dramatic generalised epidemic, the Botswana government, in conjunction with international public and private partners has been able to implement a program of free access to antiretroviral therapies for HIV patients in need of treatment, the first of its kind in Africa. Study objective: The main objective of my study is to describe the implementation of the national antiretroviral treatment program in Botswana and analyse the organisation of health care delivery in the public health system in this context.
Method / Issue: Methodology: This study is based on nine cumulated months of qualitative field research (more than 200 hours of observations and around 30 interviews) in Botswana looking at the organisation of medical delivery and health care practices and more specifically how health care professionals experience it.
Results / Comments: Results: A qualitative analysis of doctor-patient interactions and the medical consultation show that the overload of patients creates tensions and stress among health care professionals in an environment that is particularly sensitive to bureaucratic changes or initiatives coming from health care practitioners. In a context of cruel shortage of doctors, nurses have come to occupy a central role in attending and caring for patients.
Discussion: Discussion: The study results prove that the organisation of medical care is orientated and based on the condition of the patient. However, key to understand health care practices are the crucial importance of gender and of the physician’s professional status and institutional belonging. In this paper I will present the multiple ways of caring in a continuum of care practices in which the respective role of nurses, doctors and other professionals plays a role to define how patients are considered, categorised, treated and cared for. Particularly, I wish to explore these ways of caring one encounter by drawing on literature on ethics of care (C. Gilligan, J. Tronto) to better underline the importance of gender.
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