An Ethnographic Study of Palliative Care in a Nigerian Hospital

Palliative care has become an important public health issue in recent years and has been declared a universal human right. A wealth of literature can be found describing its effectiveness and numerous benefits, yet significant disparities exist in worldwide palliative care development between, and within, countries. To date, previous studies indicate that it has steadily improved in the more economically developed countries, although its utilisation remained uneven in western societies between the blacks compared with the white people. In low- and middle-income countries, palliative care has continued to be less available, underutilised and not integrated in many of the healthcare systems, especially in the African countries such as Nigeria. This qualitative study using an ethnographical approach to understand the cultural, socio-political, environmental, and organisational dynamics which influenced the provision of palliative care, and the patients’ and relatives’ behaviour towards its utilisation in a Nigerian hospital. Data was collected using participant observation, ethnographic interview and review of documentary sources, involving 43 participants, comprising healthcare professionals, members of the hospital management, patients and their families. The findings show a dominant discourse of culturally-based perceptions rooted in belief systems and inadequate knowledge of palliative care associated with insufficient education and training which manifested in several ways, such as conceptualisation of palliative care as a ‘dead end’. The service-users predominantly used their belief systems in decision-making, whereas dichotomy existed amongst the professionals about using either ethno-religious knowledge or biomedical knowledge to inform practice. These culturally-based perceptions were found to be contributory to, and a result of, a political and organisational culture that did not value palliation. Thus, the insensitivity of the bureaucrats was displayed in numerous ways, such as lack of funding for palliative care. Consequently, the environment for care represented space rather than a place that could promote the wellbeing of the service-users, which thereby contributed to various organisational cultures, such as weak interdepartmental collaboration and work-stoppage, with negative impacts for the service-users. The findings also suggest that the customary code of behaviour used by the service users was conditioned mainly by complex interactions of economic conditions, social relationships and lack of a governmental social support system. The professionals, therefore, used their personal resources as well as provided physical cash to the patients to cushion the effect of government inadequacies and to improve their wellbeing. These findings indicate the need for a cultural shift towards a mind-set that values palliative care in Nigeria in order to enhance its development. This study adds to the knowledge of this field and provides clinicians around the world with further understanding of meaning making in illness from the perspective of the Nigerian culture, which may be applicable to other people of African ancestry and could be used to boost cultural competence in palliative care.