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Dissertation Proposal Defense for Evan Guay

April 25 @ 1:00 pm - 3:00 pm

Perspective on Expanding Medical Services in Malawi: Insights on Employment, Training and Practice

Date:               Tuesday, April 25, 2017

Time:              1:00-3:00 p.m.

Location:        Room 454 Baker Hall

Student:          Evan Guay

Abstract: Malawi’s high rates of infectious diseases, under-five and maternal mortality are compounded by one of the world’s most severe shortages of healthcare providers. Malawi’s history of insufficient training programs and general poverty throughout the colonial period, followed by heterogeneous growth, make this problem especially pronounced in rural areas, as dissatisfied clinicians flock to urban and international agencies, or leave the health care sector altogether. Research have shown that clinicians’ grievances center around insufficient staffing, facilities, resources, training and support, all of which impair clinician-patient interactions and leave clinicians feeling as though they cannot perform to their potential. To address these problems, a concerted effort has been made to increase clinicians’ compensation packages and domestic training opportunities—programs that have shown some success— yet limited resources and institutional ataxia impair planning, execution and monitoring. To rectify this issue, the Sustainable Development Goals (SDGs), unveiled in 2016, put a premium on increasing skilled health care providers and improving the coherency of domestic and international efforts, such that programs and policies should have synergistic rather than competitive agendas. Unfortunately, the SDGs lack monitoring or enforcement mechanism, and the perspectives of clinicians, students and administrators have not been adequately explored with respect to the coherency of programs and policies. In addition to such national and international challenges, it has been shown that workplace culture and patient experience are as central to biomedical quality of care as are clinical efficacy and patient safety, and that interpersonal interactions greatly affect patient approval and clinician satisfaction. Research has shown that clinicians are acutely aware of how policy or funding changes can alter their practices, and patients have been shown to extrapolate from clinical experiences to make assessments of government policies and ideologies, thereby highlighting the importance of clinical experiences for either fueling or quelling political opposition, and strengthening our understanding of how the intricacies of behavior influence social movements and political change. Anthropologists have drilled down into this topic, displaying how interpersonal interactions produce deeply textured processes of embodiment and affective meaning, which alter both patients’ and providers’ senses of successes, failures and fulfillment. It has been suggested that these patterns of expectations and behaviors differ between cultures, yet basic questions remain about how clinicians and patients relate to one another, and what effect that has on subsequent behaviors and opinions, especially in non-Western settings. For these reasons, among others, poor clinical outcomes reflect deeply personal and social phenomena, and improving outcomes cannot be accomplished without addressing sociocultural concerns and understanding clinical practices in resourcestrapped settings. This research seeks to address these issues on two fronts: 1) by investigating perspectives on both social planning and daily work, in order to gain insights into the interplay of projects with broader policies and specific clinical practices; and 2) by directly observing clinical activities, so as to gain insight into how the components of clinical practice combine to form clinical experiences, and how those experiences relate to reports. Gaining these insights will contribute to improved policies, workplace interactions, and patient care. Additionally, this project draws together threads of social organization, cultural variability and embodiment, thus providing a rich understanding of the perspectives and daily experiences of Malawian healthcare workers.


April 25
1:00 pm - 3:00 pm


454 Baker Hall

United States