Abstract
Through documenting an Action Learning- Action Research (ALAR) initiative in one site, the Meadowlands Clinic in Soweto, this study explores the role the gender division of labour and the gendering of reproductive work in the healthcare system plays in leading to and perpetuating violence in the healthcare system. The ALAR initiative focuses on what can be learnt by experimenting with actions that accords value to the work of healthcare workers and challenges the public perception that the “uncaring’’ healthcare worker is the reason for the rising levels of violence in the health system.
The ALAR in the Meadowlands Clinic in Soweto was initiated in response to the pervasive levels of violence in the clinic. The violence in the clinic is indicative of violence in the healthcare system in South Africa more generally, where healthcare workers describe being traumatised by the high levels of psychological and even physical violence they experience at the hands of patients as well as what they perceive as the general lack of concern and support for their wellbeing on the part of the Department of Health (DOH). Patients who are survivors of gender-based violence in turn speak of finding themselves facing secondary victimisation at the hands of healthcare workers.
An ILO 2011 Working Paper Gender-based violence in the world of work reports that health service workers are eight times more likely than workers in the manufacturing sector to have experienced the threat of physical violence with 70 per cent of incidents among nurses not being reported. Besides physical violence, healthcare workers are also exposed to verbal abuse, sexual offences and harassment, all negatively impacting on the quality of care healthcare workers are able to provide.
Trade unions like the Health and Other Services Personnel Trade Union of South Africa (HOSPERSA) have expressed concern about the effect this violence has on providing quality health care services. In 2015, in partnership with the Labour Research Service (LRS), a labour support organisation; Gender at Work, (G@W) an international feminist knowledge network and with financial support of the Joint Gender Fund (JGF) a collaborative funding mechanism, HOSPERSA initiated a pilot social action initiative in the Meadowlands Clinic in Soweto . The initiative focused on understanding the causes of gender-based violence and
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identifying appropriate responses in one pilot site, the Meadowlands Clinic. The idea was that the lessons from the Meadowlands Clinic would be used to inform union policy and advocacy strategies.
The Meadowlands Action Learning - Action Research (ALAR) process brought different healthcare system stakeholder representatives together into dialogical spaces to share their experience of violence and construct situated knowledges through experimenting with actions intended to give value to the reproductive work of healthcare workers, as a strategy for eradicating the violence in the clinic. The dialogical spaces were created by the two facilitators from the LRS and G@W and later by a core group of representatives from the trade unions as well as community and civil society organisations linked to the Meadowlands Clinic. This core group of representatives acted as a participatory focus group both reflecting on as well as guiding the initiative as it unfolded. It is in the reflection cycles of the ALAR initiative that facilitator and core group participant learnings were recorded and used as the basis for ongoing experimentation.
In this study I am located as a facilitator-researcher, reflecting on my own learning journey as well as the learning process of a group of twelve stakeholder representatives who formed the ‘’core group’’ driving the ALAR process at the Meadowlands Clinic between 2015 and 2017. This dissertation is an account of the three years of the ALAR initiative as well as the views of seven of the core group members, four years later in 2021, when they reflect on what they learnt about reducing gender-based violence in one healthcare institution.
The results of the study highlights the pervasive nature of violence in the healthcare system and its detrimental impact on individual role players as well as on the broader functioning of the healthcare system.
The study reveals how the gendered nature of violence has its roots in the gender division of labour , where the reproductive work of healthcare workers, the majority of whom are women, is perceived as an extension of the ‘’natural’’, unpaid and devalued work women are expected to do in the home. The ALAR initiative demonstrates that one effective way of reducing the violence is by taking up actions that give value to the reproductive work of healthcare workers. The ALAR initiative also demonstrates the effectiveness of a whole system response to gender-based violence where all role players like the patients, workers, civil society organisations, community formations and state institutions, take collective responsibility for addressing the violence.