Richard F, Filali H, Lardi M, de Brouwere V
Département de Santé Publique, Institut de Médecine Tropicale Prince-Léopold, Nationalestraat 155, B-2000 Antwerpen, Belgique.
Rev Epidemiol Sante Publique. 2003 Feb;51(1 Pt 1):39-54.
In Morocco, the majority of maternal deaths and severe obstetrical complications occurs outside a health structure. If accessibility to a referral hospital is clearly a problem, this problem can be exacerbated by the perception that women and their family have of the quality of care received in these maternity services. The objective of this article is to explore how women who went through a severe obstetrical complication experienced their hospitalisation and to confront this experience with the caregivers'perception.
This study was carried out in Tetouan and Sidi Kacem between July 1999 and January 2001. Semi-structured individual interviews were held with 94 women who underwent an episode of severe morbidity, 91 family members, as well as 4 focus groups and 53 interviews with health staff members.
Though all show gratitude towards the hospital staff for having saved their life, half of the women and their relatives reported problems of behaviour and attitude of the staff: verbal violence, baksheesh, patronage, lack of empathy and discrimination against certain categories of the population. These result from a complex interplay of factors: the stress-load within the profession, the institutional context which by its failures leads to or allows these behaviours and the representations peculiar to each of the players, the providers and the users.
In order to be professionally more effective, it would be in the caregivers'interest to set up a system of communication that would place the patient back in the centre of hospital care.
在摩洛哥，大多数孕产妇死亡和严重产科并发症发生在医疗机构之外。如果转诊医院的可及性显然是个问题，那么妇女及其家人对这些产科服务所提供护理质量的看法可能会使这个问题更加严重。本文的目的是探讨经历过严重产科并发症的妇女如何看待她们的住院经历，并将这种经历与医护人员的看法进行对比。
这项研究于1999年7月至2001年1月在得土安和西迪卡塞姆进行。对94名经历过严重发病情况的妇女、91名家庭成员进行了半结构化的个人访谈，还组织了4个焦点小组，并对53名医护人员进行了访谈。
尽管所有人都对医院工作人员挽救了她们的生命表示感激，但一半的妇女及其亲属报告了工作人员的行为和态度问题：言语暴力、索要贿赂、恩赐态度、缺乏同情心以及对某些人群的歧视。这些问题是由多种因素复杂相互作用导致的：该行业的压力负荷、机构环境因自身缺陷导致或允许这些行为，以及每个参与者（提供者和使用者）特有的观念。
为了在职业上更有效率，建立一个将患者重新置于医院护理中心的沟通系统符合医护人员的利益。
