[Hospital deliveries in Morocco or how to reconcile different logics].
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Richard
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F
Département de Santé Publique, Institut de Médecine Tropicale Prince-Léopold, Nationalestraat 155, B-2000 Antwerpen, Belgique. frichard@itg.be
Filali
H
H
Lardi
M
M
de Brouwere
V
V
D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D036861:Delivery, Obstetric / Q000523:psychology; D004645:Empathy; D005260:Female; D017144:Focus Groups; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D008427:Maternal Health Services / Q000458:organization & administration*; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration; D017060:Patient Satisfaction; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000523:psychology; D011369:Professional-Patient Relations; D012923:Social Class; D014754:Violence