Professional and lay care in the Tanzanian village of Ilembula

Anitta Juntunen

Department of Nursing and Health Administration
University of Oulu, FIN-90201 Oulu, Finland

Abstract

The purpose of this ethnographic study is to describe and analyse professional and lay care in the Bena cultural context in the Tanzanian village of Ilembula. The study focuses on care as a cultural phenomenon. The structure of the study is based on M.M. Leininger’s (1991) Culture Care Theory In the first phase of the study, care was described from a professional perspective. The data were collected by interviewing and observing trained nurses (n=6) in the wards of Ilembula Lutheran Hospital. The study material was complemented with the data obtained from informants’ diaries and institutional documents. The data were analysed by using qualitative ethnonursing analysis. In the second phase of the study, the focus was on lay care. The fieldwork was done in the Ilembula village and Ilembula Lutheran Hospital. The data were collected by interviewing villagers (n=49) and relatives (n=12) of patients admitted to Ilembula Lutheran Hospital, and by observing their care practices. The data were analysed by qualitative content analyses with regard to the cultural context.

Curing and caring were the characteristics of professional care, as described by the nurse informants. Curing was linked to skills and knowledge obtained in nurse training and it was demonstrated through technical interventions, medication and health education. Caring referred to a natural mother-child relationship and reflected the traditional cultural knowledge. Caring was demonstrated in primary care, meaning a mother’s responsibilities in taking care of a small baby, encouragement and comfort. The patient’s recovery and maintenance of health were the goals of professional care. Respect and protection were the characteristics of lay care, reflecting the worldview and cultural values of the Bena. The aim of respect was to maintain family unity and to ensure wellbeing, while protection focused on the sensitive phases of the Bena life span. The main meaning of lay care for the informants was health maintenance and improvement of health. Health included physical, mental and reproductive aspects, and enabled them to respond to the culturally determined role expectations.

The aim of this ethnographic study was to demonstrate that care is integral to much more comprehensive socio-cultural issues in the context of a Tanzanian village. The study demonstrates the meaning of cultural and social factors, such as cultural values and lifeways, kinship, economic, educational, and ethnohistory in both professional and lay care. The findings can be utilised in transcultural nursing education and in clinical nursing practice, especially in developing patient education from a transcultural perspective, not only in Tanzania, but internationally.

Tiivistelmä

Tämän etnografisen tutkimuksen tarkoituksena on kuvata ja analysoida ammatillista ja maallikkohoitamista benojen kulttuurisessa kontekstissa tansanialaisessa Ilembulan kylässä. Tutkimus kohdentuu hoitamiseen kulttuurisena ilmiönä. Tutkimuksen rakenne perustuu M.M. Leiningerin (1991) kulttuurisen hoitamisen teorialle. Ensimmäisessä vaiheessa tarkastelin ammatillista hoitamista. Keräsin aineiston haastattelemalla ja havainnoimalla sairaanhoitajia (n=6) Ilembulan luterilaisessa sairaalassa. Täydensin tutkimusaineistoa tiedonantajien päiväkirjoilla ja sairaalan toimintaa kuvaavilla dokumenteilla. Analysoin aineiston laadullisella etnonursing –sisällönanalyysillä. Toinen vaihe kohdentuu maallikkohoitamiseen. Keräsin aineiston haastattelemalla kyläläisiä (n=49) ja sairaalassa olevien potilaiden omaisia (n=12) sekä havainnoimalla omaisten toimintaa potilaiden hoitamisessa. Analysoin aineiston laadullisella sisällön analyysillä huomioiden kulttuurisen kontekstin.

Parantaminen ja huolenpito olivat luonteenomaista sairaanhoitajien kuvaamalle ammatilliselle hoitamiselle. Parantaminen liittyi taitoon ja tietoon, jota hankittiin sairaanhoitajakoulutuksessa ja se havainnollistui teknisissä toimenpiteissä, lääkehoidon toteutuksessa ja terveyskasvatuksessa. Huolenpito perustui luonnollisen äiti-lapsi –suhteen elementteihin ja heijasti perinteistä kulttuurista tietoa. Huolenpitoa havainnollisti äidin velvollisuus huolehtia pienen lapsen tarpeista ja terveellisestä ympäristöstä, sekä rohkaisu ja lohduttaminen. Potilaan toipuminen ja terveyden ylläpito olivat ammatillisen hoitamisen päämäärä. Maallikkohoitamiselle oli luonteenomaista kunnioitus ja suojelu, jotka heijastivat benojen maailmankuvaa ja kulttuurisia arvoja. Kunnioituksen päämääränä oli perheyhteyden ylläpito ja hyvinvoinnin vahvistaminen, kun taas suojelu kohdentui benojen herkkinä pitämiin elämänkaaren vaiheisiin. Maallikkohoitamisen päämäärä informanteille oli terveyden edistäminen ja ylläpito.

Tutkimuksen tavoitteena oli osoittaa, kuinka hoitaminen liittyy laajempaan sosiokulttuuriseen kontekstiin tansanialaisessa Ilembulan kylässä. Tutkimus paljastaa kulttuuristen ja sosiaalisten tekijöiden, kuten kulttuuristen arvojen ja elämäntavan, sukulaisuuden, taloudellisten ja koulutuksellisten tekijöiden ja etnohistorian merkityksen sekä ammatillisessa että maallikkohoitamisessa. Tuloksia voidaan hyödyntää transkulttuurisen hoitotyön koulutuksessa ja hoitotyön käytännössä, erityisesti potilasohjauksen kehittämisessä transkulttuurisesta näkökulmasta sekä Tansaniassa että kansainvälisesti.

Dedication

To Almaz and Tatu

Table of Contents
Acknowledgements
Abbreviations
List of original papers
1. Introduction
2. Care as a cultural phenomenon
2.1. Cultural care frameworks
2.2. Leininger’s Culture Care Theory
3. Cultural and social factors explaining care in Tanzania
3.1. Environment and population
3.2. Cultural values and lifeways
3.3. Religious and philosophical factors
3.4. Kinship and social factors
3.5. Political and legal factors
3.6. Economical factors
3.7. Technological factors
3.8. Educational factors
3.9. Tanzanian health care system
3.9.1. Present health situation
3.9.2. Development of present Tanzanian health care system and health policy
3.9.3. Traditional system of health care
4. Professional and lay care systems from cultural point of perspective
5. Purpose of the study and the research questions
6. Ethnography as a research approach
6.1. Character and background commitments to ethnography
6.2. Ethnonursing
6.3. Ilembula as the context of the fieldwork
6.3.1. Environment and population
6.3.2. Cultural lifeways
6.3.3. Religious factors
6.3.4. Kinship and social factors
6.3.5. Economical factors
6.3.6. Educational factors
6.3.7. Technological factors
6.3.8. Political and legal factors
6.3.9. Health care practices
6.4. Data collection and analysis
6.4.1. Professional nurses’ aspect
6.4.2. Villagers’ aspect
6.5. Ethical considerations
7. Results
7.1. Professional care as seen by the Bantu Nurses in Ilembula Lutheran Hospital
7.1.1. Curing
7.1.2. Caring
7.2. Lay care as seen by the villagers
7.2.1. Respect
7.2.2. Protection
7.3. Summary of findings
8. Discussion
8.1. Validity of the study
8.2. Discussion of the findings
8.2.1. Professional nurses’ aspect of care
8.2.2. Villagers’ aspect of care
8.3. Criticism of Leininger’s Culture Care Theory
8.4. Conclusions
8.5. Implications for nursing and suggestions for further studies
Bibliography
1. Map of Tanzania
2. Map of Ilembula Villages
List of Tables
1. Health Statistics. (Ministry of Health 1996.)
2. Summary of the comparison of professional and lay care systems.
3. Data collection and analysis, and reports.
List of Figures
1. Main stages of the research process.
2. Leininger’s Sunrise Model to depict the Culture Care Theory as applied in this study.
3. Summary of the theoretical framework of professional and lay care in the context of the Tanzanian village of Ilembula.
4. Village administration.
5. Summary of the meanings and expressions of professional care as reported by nurses.
6. Summary of the lay care activities focusing on health maintenance and health improvement among the Bena in the village of Ilembula (see articles III, IV)
7. Expressions, meanings and experiences of health maintenance and improvement of health for the Bena in Ilembula village.
8. The summary of characteristics of professional care as reported by nurses and lay care as reported by the villagers in Ilembula.
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