"Stepped-on like a floor-mat": human experience of hospital violence in the Northeast of Brazil

Abstract

Despite recent efforts to improve the quality of public health services in Brazil, inequalities and institutionalized violence persist in hospitals. This critical anthropological study investigates the human experience of hospitalization from the viewpoint of patients of a public hospital located in Fortaleza, capital city of the state of Ceará, in the Northeast of Brazil. A qualitative method, "The Patient's Pathway," was created and utilized. It blends ethnographic interviews, patient's narrative collected prospectively during the entire hospitalization - from admittance to discharge - and participant observation. The pathway of 13 key-informant patients was followed. Results reveal that our patients narrated 225 distinct hospitalization experiences. The majority (83.6%) was interpreted by patients as "degrading" and "humiliating" their sense of personhood; only 16.4% were seen as "caring" for the patient, contributing to the recovery of their health. A progressive demoralization of the "suspect patient" is revealed, beginning with his/her reception by uniformed guards and confiscation of personal belongings. Hospitalization is characterized as abandonment, loneliness and imprisonment, due to the imposition of norms, rules and procedures which ignore patients' autonomy, subjectivity and personal conditions. Despite the oppressive hospital structure, patients manage to resist, drawing upon multiple strategies: personal traits, creative imagination, social solidarity and religious faith. Humanizing public hospitalization in the Northeast of Brazil requires including the patient's voice and experience while removing harmful stigmas.