Fragile encounters: exploring public healthcare in Boulgou Province, Burkina Faso

This dissertation explores the dynamics of social relations between state-employed health workers and patients in public health facilities in rural Burkina Faso and the role of trust in these relations. Based on ethnographic fieldwork in the Boulgou Province, one of the poorest and most marginalized places in the world, Lise Rosendal Østergaard explores how public health care is practiced in times of strikes, sub-regional Ebola outbreaks and political fragility. Østergaard approaches public healthcare as:

• A place
• A group of people
• An idea

In doing so, Østergaard describes empirically how public healthcare is done as a collaborative effort by healthcare providers and healthcare users. By adopting a combined perspective, Østergaard challenges the commonly held focus on power asymmetry and unequal positions. She unfolds a space of collaboration and of coordinated interaction that is often under the radar in the literature that adopts a singular perspective.

Healthcare in a context of material and technological limitation

In the small, state-sponsored clinics, health workers must carry out biomedical healthcare with recourse to improvisation and tinkering rather than to advanced diagnostic technologies. Østergaard shows that local social relations become critical for patients because they mediate access to services, medicines and health technologies. These social relations are challenged by a number of moral and medical risks that frontline health workers and patients, both in precarious positions, are exposed to. 

Trusting health sector relations

Based on peopled accounts of how public healthcare is done, Østergaard argues that trust in healthcare encounters is differentiated and is multiple. Trust can pertain to interpersonal relations, technologies and to institutions and to any combination of these. Furthermore, she argues that there should be no taken-for-granted of trust in health sector relations without empirical analysis. It is far from evident that full trust always serves the patient better than some balance of trust, mistrust, criticism and skepticism.

Lise Rosendal Østergaard defended her PhD dissertation "Fragile encounters: exploring public healthcare in Boulgou Province, Burkina Faso" in February 2016