A woman’s duty

The incident

A hospital in Debrecen, Neonatal Ward.

Visit with a young female resident doctor. We enter a room with one bed, occupied by a young Roma mother who had given birth a few hours earlier. This young mother is having sexual intercourse with her partner.

We closed the door and continued our tour. Later the doctor in charge asked the mother how she could do such a thing. The answer was amazingly simple: “Because he is my man and he was missing it”. This answer shocked me more than the scene itself.

1. Identities of the actors in the situation

Nurse is a woman, in her early 30s. Married, mother of 1child. Middle class, Hungarian speaking, Hungarian as mother tongue

Education: high school and she has been working as a nurse for 8 years.

She’s a city dweller (born and living in Budapest) from the 3^rd district.

Patient is a woman in her early 30s. She is from a Roma background. Hungarian nationality, but we don’t know if her mother tongue is Hungarian. She has a partner but we do not know if she is married. She appears to have a low level of education and her employment status is unknown. She appears to be working class although she has enough money to pay for a VIP room. Her husband’s employment is unknown. She is living in Budapest, in the 8^th district.

They are both women of a similar age, both women have experienced giving birth, this should bring them closer. However their individual perceptions of giving birth, are so far that the similarities in their life experiences function as obstacles to mutual understanding rather than a potential bridge. The nurse represents the norm system of the majority society, which includes a negative view of the Roma, in general, are often seen as representing a lower level of “civilization”. She is also the professional in the story, in the position of being able to define the norms for the “Other” – if not to coerce them. Their relationship is not only distant but also hierarchical.

2. Context of the situation

The situation occurred in a hospital ward, within a neonatal department. It is part of the hospital with its complex institutional system, patients come and go, and during their stay they are expected to adapt to the temporary situation and to its expressed and implicit norms. However, the Roma mother has a VIP room, i.e. a room with only one bed (paid for by the family), which, for the time of her short stay in hospital, is her private space. The encounter happens awkwardly on the doorstep and ends with the withdrawal of the professional staff.

3. Emotional reaction

At first the nurse is shocked, embarrassed, not only for herself but for her colleagues. As a health professional she sees the situation dangerous and harmful for the mother but embarrassment stops her (and the others) to intervene. They are compelled to abandon their professional role and withdraw. She also feels both pity and contempt for the mother and is angry with the husband that she sees barbaric and selfish. She is more shocked by the submission of the woman than by the scene.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

Delivery: it is a medicalised state, with some health risk for the mother, who is treated, therefore as a patient, she needs calm both physically and mentally.
Pain: is considered as an inevitable but highly unpleasant part of the delivery, which should be avoided or at least mitigated as much as possible.
Sexual intercourse: for these reasons it is unimaginable immediately after child birth, even at home.
Space: The hospital is not an intimate space for the patients, some behaviors, like sexual intercourse that would be normal at home, are not tolerated.
Gender roles and sex: sexual relations between the couple should be based on an equal relationship between the partners and on mutual consent.
Professional roles: processes in the hospital are routine and these processes serve as a guarantee of professionalism. Any obstacle that interferes with the routine, questions the capacity of the professional to control the situation, and therefore challenges his/her professional identity, especially when he/she lacks means to re-establish the order.
Roma patients: are expected to be problematic, exhibiting “unruly” behavior, which is attributed to their cultural difference.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

Negative image, she attributes the patient’s behavior to inferiority and ignorance. Image based on one’s experience and lack of knowledge of the mother’s background story.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.

Hospital: it represents a somewhat hostile environment for her where reprimand and discrimination are possible.
VIP room: she has “bought” her right to privacy and exemption from hospital rules.
Delivery: it is not a medical issue or a health state, just a fact of life (she does not consider herself to be a patient)
Sexual intercourse: might be actively sought for pleasure and at the same time it is a duty of the woman towards her partner. The two aspects are not necessarily in contradiction. Pleasing her man is a proof of her femininity reestablished after the pregnancy. Also, it might be a form of revolt against her medicalisation. In a hostile environment for both of them it can be understood as a declaration of allegiance towards her husband. It is also possible that she does not have the ability to differentiate between rape and consented sexual intercourse due to previous mistreatment in the family. What should be clear from the above that it is almost impossible for a third person to understand what this situation represents for her.
Gender roles: A man is expected and accepted to impose his will in this relationship and this is not necessarily felt like oppression.
Individualism-collectivism: Individual freedom to choose is less important than relationships and socially valued behavior?

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

Many so called cultural differences do not belong to an ethnic group but a socio-cultural view, and are ethnicised retrospectively by the majority society. This is prone to attribute all “deviance”, including idiosyncratic, to the culture of the despised minority.

Suspected but not known cultural differences might petrify the professional: how should I behave in this situation? To which point is what I see normal?

One way to deal with such situations and clarify the question of culture is to interview a cultural specialist (anthropologist or member of the group) to find out if we are facing a current cultural pattern. Cultural patterns are easier to deal with because it is possible to prepare for them.

In some cases though, it is less interesting to know if a non-typical behavior is “cultural” than how to deal with that: how to re-establish the norm without unnecessary humiliation or frustration for the patient.

In order to check our existing hidden prejudices in such situations, it is interesting to ask the question: should I react differently if the other in this situation is like me? (a middle class non-Roma woman).