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Abstract
Few sociological studies have examined care organisation in primary health settings
in low- and middle-income countries. This paper explores the organisation of health
care work in primary care clinics in Cape Town, South Africa, by analysing two elements
of clinic organisation as rituals. The first is a formal, policy-driven element of
care: directly observed therapy for tuberculosis patients. The second is an informal
ritual, seemingly separate from the clinical work of the team: morning prayers in
the clinic. We draw on data from an ethnography in which seven clinics providing care
to people with tuberculosis were theoretically sampled for study. These data include
participant observation of clinic sessions, and interviews and group discussions with
providers and patients, which were analysed using approaches drawn from grounded theory.
Our findings suggest that rather than seeing the ritualised aspects of clinic activities
as merely traditional elements of care that potentially interfere with the application
of good practice, it is essential to understand their symbolic values if their contribution
to health care organisation is to be recognised. While both staff and patients participate
in these rituals, these performances do not demonstrate or facilitate cohesion across
these groups but rather embody the conflicting values of patients and staff in these
clinics. As such, rituals act to reinforce asymmetrical relations of power between
different constituencies, and to strengthen conventional modes of provider-patient
interaction.