A poststructural glimpse at the World Health Organization's palliative care discourse in rural South Africa.
BACKGROUND
The World Health Organization (WHO) defines palliative care in terms of three constructs of care, namely, physical, psychosocial and spiritual, for a person who has a life-limiting illness. Life-limiting illness from WHO's perspective signifies and qualifies a patient for palliative care. Poststructuralism offers insights into how language constructs reality and sets up the limitations and possibilities of palliative care when it is practiced in a rural and remote area of the developing world, such as in South Africa.


METHODS
The study employed the qualitative method of photo-elicitation, which was used as a launching point for one-on-one discussion around photographs taken by participants. The participants, four palliative care nurses and two home-based care workers who work in rural homes in KwaZulu-Natal, South Africa, were purposively selected to provide rich information based on their personal experiences.


RESULTS
Defining palliative care in terms of a life-limiting illness may present challenges in rural areas where there is limited access to the diagnosis and prognosis of an illness. Limiting care to those with a life-limiting illness may not be culturally appropriate. Physical care did not prove to be a common care requirement and cultural care, which is not included in the WHO palliative care discourse, was common and necessary.


CONCLUSIONS
The WHO palliative care discourse can be thought of as not presenting a neutral way of looking at care and an irresolvable dichotomy may be set up in traditional rural, isolated areas. The question emerging is whether palliative care can be offered if it is not known whether an illness is life-limiting or not? Further poststructural work, in conjunction with exploration of palliative care practice, is required in this context.
University of KwaZulu-Natal, KwaZulu-Natal, South Africa.  laura@hss.co.za.
Laura M
LM
Campbell
Nyna
N
Amin
D001291:Attitude of Health Personnel; D015658:HIV Infections / Q000175:diagnosis / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D017051:Hospice Care / Q000941:ethics / Q000523:psychology*; D006801:Humans; D008962:Models, Theoretical; D009726:Nurses / Q000523:psychology; D010166:Palliative Care / Q000941:ethics* / Q000592:standards; D010781:Photography; D017410:Practice Guidelines as Topic; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012423:Rural Health / Q000941:ethics; D012944:Social Support; D013019:South Africa; D000078329:Workforce; D014944:World Health Organization