Care: Translation

In 1995, I stood in the cavernous shadows of a linear accelerator treatment facility talking to a woman with advanced and fungating breast cancer. Her breast was an open ulcer and she was struggling to find the money to repeatedly change the charcoal dressings that helped her to retain a fragment of dignity by reducing the odour of necrotic flesh. The weekend was coming and the blood soaked curling bandage was clearly never going to last the distance. I reached into one of the stock cupboards and pulled out a large box of the clinic’s own supply of melolin bandages, stuffed them into a paper bag and passed them to her.   

At that moment, I heard the clipped stilettos of our clinic manager proceeding through the radiation maze and into the treatment room. The woman and I stood for a moment, frozen, and then in a fluid guilty movement, we slid up against each other, side by side, our backs shielding the bandages from the manager’s view, our arms interlinked and I silently passed the bag behind my back and into the women’s waiting hands. Just another day at work in a retreating welfare state.  

On my way home that evening, I recalled another moment a full decade earlier, as a young cadet radiographer, I had been admonished by the charge radiographer of my section for not ensuring that I had given an adequate supply of hospital bandages to another women in similar circumstances. In high dudgeon, the senior radiographer threw the bandages at me and made me sprint a kilometre in 40 degree centigrade heat to catch the patient before she reached the hospital carpark  and drove home without her weekend care package.  What had happened to the meaning of good care I mused, in those intervening decades? Something about it had changed completely (Fitzgerald, 2004). And so began my PhD.

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"A Positioning Laser used to align patients onto the treatment couch": All radiotherapy treatments are set up in the semi dark to allow these lasers to be easily viewed by staff and aligned to the treatment fields on the patient’s body. Patients must lie immobilised for between 10 and 20 minutes for each treatment, which can last for many weeks. Photo Credit: Ruth Fitzgerald

To draw back to Emily Yates-Doerr’s post, the field site of care for me has been my own life and I have at times been a part of that articulated assemblage of human and nonhuman actors, the discourses, institutions and practices, the patients and the staff who make up the ‘clinic’.  While the small and the specific have often figured in my attention – tumor cells, radiobiology, maximum permissible doses, spinal cords, eye lenses, kidneys etc – I have not always anatomised or internalised. Although, I have always striven to individualise. I have also tried to engage with the clients in my care as people in their social contexts. Thus, the seemingly routinized and mundane care in the clinic needs careful translation for it to be decoded as the complex orchestrations of both techne and emotional labour, occupationally specific and each with a characteristic professional habitus (Fitzgerald, 2008), which is what I consider such care practises to be.  

In reflecting on why they are so particularly difficult to perceive, I think back to Paul Atkinson’ s discussion of the constructed nature of the field, and I agree with him that this process is threefold. The first step is when you move in and out of a world, observing this and ignoring that, and responding to folk as they try to make sense of you as an anthropologist. In the next stage, you begin to write and to choose what to include and exclude in your writing framework. Finally, your field site is reconstructed again as a variety of audiences read your work and engage with it (Atkinson, 1991).  

At every one of these moments, one works at translating – a complex process identified by Shore (2005:16) as being conceived of from at least 4 different approaches -  the translation of words between languages and their sometimes incommensurable semantic fields; the experience of cultural comprehension as rationalities and concepts travel between worlds; the shift of ideas into action, and finally ‘the translation of institutional practice’ (Shore, 2005:17).  

In my studies of the emotional labour of embryologists (Fitzgerald Legge and Frank, 2013), I encountered Shore’s first element of translation in explaining to embryologists as they passed on ‘bad’ news, talked up slim chances of success and managed phone calls from clients who could not stop weeping at the news of ‘no fert’ that they were engaging in emotional labour. In their busy scientific lives, the care of such distressed clients was often mislabelled and denigrated as over involvement,  loss of boundaries or burnout. Recognising it as care allowed scientists the language to then value and nurture this emotional side of their labours.

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"Small Kete (a Māori word for basket)": Designed by embryologists to return thawed embryonic material to clients after they have decided to stop trying to conceive. In the local ethnoscape, the material from which the bag is created (flax) and the weaving itself are key symbols of care, attention, and ritual." Photo Credit: Ruth Fitzgerald

In the second sense of translation as the development of cultural comprehension, I struggled for many months to reconcile accounts of diagnostic radiographers who routinely prided themselves on good patient care with an external view of their work that emphasised busyness, the closing down of intimate conversation, and tight adherence to time scheduling (Park and Fitzgerald, 2011). Eventually, I understood that they prided themselves on running an efficient system. By having people wait the least amount of time in X-ray, patients could be returned faster to wards, outpatient clinics, or families where they could receive the care they needed.  The affective elements of care for radiographers were instead rerouted through X-ray machines and film processors – an example of affect routed through into action. The patients for whom they cared never knew that radiographers expressed compassion for their discomfort and anxiety by reducing unnecessary ‘views’ ordered by junior registrars, refusing to continue taking x-rays when people were in severe discomfort and applying all the tricks of their trade to coax a diagnostic quality image from a patient who could not tolerate the appropriate radiographic position.  

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"Embryologists checking the store of frozen gametes": Maintaining a level of technical cares that are as close as possible to perfection is part of a standard day at work." Photo Credit: Ruth Fitzgerald

Finally, it is a daunting task to successfully translate care through the shifting fields of power that create the clinic. Yet the sudden inversion of power relations when the clinician becomes the patient (Jaye & Wilson, 2003) can create the prism through which to view the purpose of the institution of clinical medicine in a different light.  Shifting occupational boundaries and the contrasts between urban and rural practice require subtle study to uncover the differences between apparent sameness in technique and duties (Fitzgerald, 2008).  

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"The delicate microscopic work of ICSI (intracytoplasmic sperm injection)": A technique that embryologists learn by working in their training period with frog eggs.  Training with human eggs is prohibited and so the first time one performs ICSI with human material, responsibility is keenly felt and stress levels are very high." Photo Credit: Ruth Fitzgerald 

The elusive, relational, individualistic, taken for granted-ness quality of good care is the quality most in need of successful translation in a busy hospital clinic. In environments marked by time constraints and a working context which holds the inevitable limits of personality and individual capacity for empathy, it becomes all to easy to misperceive the complexity of meanings embedded within an act as seemingly mundane as a doctor gently wiggling the big toe of a patient in farewell as he/she sweeps majestically onwards from bed to bed in the hospital grand round.

Biographical Note

Ruth Fitzgerald is an Associate Professor in the Department of Anthropology and Archaeology at the University of Otago. Fitzgerald's research interests include clinical anthropology, medical technologies, embodiment, and contemporary ideologies of health care. 

References

Atkinson, Paul. 1992. "The Field as Text". In Understanding Ethnographic Texts Qualitative Research Methods 25, 8-15. Newbury Park, CA: Sage.

Jaye, Chrystal, and Wilson, Hamish J. 2003. "When General Practitioners Become Patients". Health: An Interdisciplinary Journal for the Social Study of Health, Illness & Medicine 7, no. 2: 201-225.

Fitzgerald, Ruth P., Legge, M. and Nicholas Frank. 2013. "When Biological Scientists Become Health-Careworkers: Emotional Labour in Embryology". Human Reproduction 28, no. 5:1289-1296.

Fitzgerald, Ruth P. 2008. "New Zealand Rural Nurse Specialists and the Politics of Care". Medical Anthropology 27, vol. 3: 257-282.

Fitzgerald, Ruth P. 2004. "The New Zealand Health Reforms: Dividing the Labour of Care". Social Science and Medicine 58, vol.2: 331-341.

Park, Julie and Fitzgerald, Ruth P. 2011. “Biotechnologies of Care”. In Blackwell’s Companion to Medical Anthropology,edited by Merrill Singer and Pamela Erickson. Oxford: Wiley Blackwell, 425-442.

Shore, Cris. 2005. "All in the Translation: Interpreting the EU Constitution". Sites 2, vol. 2:10-32.