Saturday, November 1, 2008

Clinical Ethnography!

Yesterday morning, I was awoken from my restless sleep by the banging of plastic sheets against the outside wall. On the side of the terrace adjacent to the room where I sleep, the courtyard wall does not reach all the way up to the plastic roof. Two vertical plastic panels stretch across this gap, but one of them has become unfastened at one end. When it is windy, like it is today, this panel tends to be pulled back away from the wall with one gust of wind, and then slammed back by the next.

And so I got up a little earlier than I had planned, to get myself ready for my big appointment – with Dr. Chikri,* the director of the psychiatric clinic where I hope to do my research. I was not in the most ready of moods; after a restless night I felt a little on edge, without bread to be found anywhere I left the house hungry, and nervous about the meeting – and about finding the place, first of all – I left too late, forgetting first to brush my hair, then to brush my teeth, then to fetch my keys from my other bag.

But all went well – better than I could have hoped for, in fact. First of all, the Clinic has proven very, very easy to find. The bus I had been told to take stops right by the entrance, and picks up from there as well. It takes no more than 15 minutes – which left me there about 45 minutes early. I had taken a wide window of time: without existing bus schedules, having seen the traffic at that hour in the morning, and not knowing precisely where the clinic (let alone the doctor’s office) was, I had decided to play it safe. Spotting the entrance to the clinic right away, I walked around the area a bit to kill some time and survey what else was around here (mostly outpatient clinics and pharmacies, it seems), then headed back for the Clinic to find the doctor’s office.

The meeting itself went smoothly and perfectly. Sitting across from each other on comfortable couches in the doctor’s large and well-decorated office, I explained to him the basic gist of my research. I had just gotten about halfway through an overview of my research questions when I mentioned that I was interested in exploring what makes people choose for either psychiatry or traditional forms of healing, and he interrupted me with a confident, single word: “ignorance.” So I probed further – was this really the answer to this issue? Absolutely, he said. The entire problem was an issue of what he called “pedagogie sanitaire de masse” – public health education, basically. The Moroccan public is simply ignorant of the appropriate treatment for both physical and mental problems – ignorant also of the dangers of traditional healing practices – and unaware of the medical facilities available to them. Unlike many other countries with cultural healing traditions, not enough effort is made in Morocco to educate the public about issues of health and hygiene. I wanted to ask him more: does he think there is a responsibility here for psychiatry, as a discipline, to help raise this awareness, or is this the government’s job? How would one go about raising such awareness? And what about the other factors I’ve heard or read play into people’s choice for care – such as the issue of stigma, or the simply unavailability of medical care? But the doctor had already urged me to continue my spiel, and I decided there would be time to ask these questions at a later date; I was here now to sell myself.

I think that this perception of “ignorance” among the public explains Dr. Chikri’s interest in my research. Frequent media discussion about the state of psychiatry (and other specialties as well) in Morocco leads me to the impression that the collective discipline is working hard to raise awareness – not only among the public, but within government echelons as well – of the dire state the discipline is in, and the great need for better psychiatric care. Only 350 psychiatrists in Morocco for 300,000 mentally ill, a newspaper headline cried out a few weeks ago. 1900 beds for 100,000 psychiatric patients in Casablanca alone, lamented another, while a third pointed out that psychiatry is accorded a mere 1% of the health department budget.

This means that my research may come at a good time. My project will not be decrying the dangers of traditional healing practices – a strategy often used in these media reports about psychiatry – and this may be a point of debate with the psychiatrists I will be working with, but I am receiving very positive responses so far. Dr. Chikri, on his part, not only gave me permission to conduct extensive research at the Clinic (!) but even mentioned that he would like his clinic to be involved somehow, because this kind of research is important to them as well. For me, this is beyond perfect. Not only do I get to carry out an in-depth clinical ethnography for the psychiatric side of my research, but I also get a certain kind of institutional affiliation and cooperation; something that will, I hope, seriously help strengthen my case with grant foundations, as well as my American university’s human subjects review board.**

And so I floated back to the bus, back to Rabat, and back home to a steaming hot dish of couscous*** – happy, excited, and a little confident again that I’ll actually be able to do this project. All that remains to be done now is prepare interview protocols, work very, very hard to learn as much Arabic as I possibly can, submit an application to the IRB, and hope beyond all hope that the next grant-related news will be positive…

* This name, too, has been changed; from now on I will also refer to this clinic simply as ‘the Clinic’.
** Every university has a human subjects review board, or IRB (institutional review board). A university is liable for any research conducted in the university’s name – and this includes any PhD research like mine. The IRB therefore critically reviews all projects proposed by university-affiliated researchers in order to ensure the maintenance of ethical standards, and to minimize the risk of legal action. For a project like mine, that proposes to interview patients with mental illness, getting approval can be difficult – and means convincingly explaining why the benefits of this research are greater than the potential risks for those involved in participation.
*** The first couscous served at home, incidentally. Now that all women are (finally) done fasting, we have returned to the routine of “sksou” every Friday…

1 comment:

whitney l duncan said...

Amazing! That is so exciting, and sounds so very interesting...When can you begin?