title: Social dynamics in rural Sri Lankan hospitals: revelations from self-poisoning cases.
abstract: Different hospitals produce different cultures-products of relationships between people of different staff categories and people from external community groups. These relationships demonstrate unique social dynamics in rural peripheral hospitals that form a major part of the health care system in Sri Lanka and other developing countries. Understanding the existing social dynamics might be useful when trying to implement new treatment guidelines that can involve behavior change. We aimed to explore the existing social dynamics in peripheral hospitals in rural Sri Lanka by examining the treatment related to cases of acute self-poisoning that is a common, highly interactive medical emergency. These hospitals demonstrate higher levels of community influence in treatment decisions and closer interactions between hospital staff. We argue that health care teamwork is effective in peripheral hospitals, resulting in benefits to all staff, who see these hospitals as better places to work and train, in contrast to a commonly held belief that such rural hospitals are disadvantaged and difficult places.
authors.affiliation: 1University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Lalith
authors.initials: L
authors.lastname: Senarathna
authors.forename: Cynthia
authors.initials: C
authors.lastname: Hunter
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Dawson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dibley
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003159:Community-Institutional Relations; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008297:Male; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration; D011041:Poisoning / Q000523:psychology* / Q000628:therapy*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D013188:Sri Lanka; D013406:Suicide, Attempted / Q000523:psychology*
keywords: group interaction; health care, culture of; health care, interprofessional; health care, remote / rural; health care, teamwork; research, qualitative; self-harm