Challenging the official approach to health care through reflective practice: a case study of a community health NGO in Bolivia

Abstract

The community health non‐governmental organisation (NGO), CODÍGO Bolivia aims to foster two forms of critical reflective practice in its staff and trainees – critical practical reflectivity (perspective transformation) and critical political reflectivity (conscientisation). Reflective practice is seen as an integral aspect of the organisation’s aim to counter a narrow biomedical view of health with what is termed ‘integrated health’. This paper will analyse CODÍGO’s ability to achieve its aims through using Yip’s four levels of reflective practice (0 = absence of reflectivity, 1 = basic practical reflectivity, 2 = reflectivity in action, and 3 = critical practical reflectivity – perception transformation) and four categories of interlocking factors: philosophical/ideological, politico‐economic, sociocultural and practical/pragmatic. A tool based on the four categories of factors is also discussed as a means of making explicit and mitigating against some of the potential difficulties surrounding CODÍGO’s approach.

Keywords:

• biomedicine
• critical reflective practice
• health worker training
• integrated health

Notes

1. CODÍGO is a pseudonym, as are all names and places directly associated with it.

2. The aim of my Ph.D. research was: Through investigating a southern non‐governmental organisation (SNGO); the geographical community with whom it works; and in relation to diarrhoeal diseases, explore how the hegemony of the dominant development paradigm informs and affects the transmission, integration and use of health ‘knowledges’ by local community based health promoters.

3. Pseudonyms.

4. In 1978 a conference in Alma Ata declared ‘Health for all by the year 2000’ through primary health care (PHC).

5. Cochabamaba is the third largest city in Bolivia and attracts many migrants.

6. ∗ = My translation.

7. To convey what Stobart and Howard (2002) mean by a nurturing dialogue we need to look at the role textiles play in Andean culture. The production of textiles is a form of language that can be likened to bringing together and interweaving different forms of knowledge into a web or network. Weaving is not an isolated practice but is accompanied by the production of knowledge through music, singing and storytelling in a form of reciprocity that links the learner to their teacher as well as the learner to the object of their work.

8. One of the two main Andean languages.

9. No he eschuchado.

10. Raquel: No pude recordar nada. Katie: Pero con su mama ahora, sí?

11. Orejasqa is the same as orejado – diahorrea caused by the smell of a dead animal.

12. Sipi chupasqa isdiarrhoea caused when a child learning to walk falls and hits the base of their spine.

13. R: Con qué otros nombres conoces en quechua cuando hace las causas diarrea?

 F: k’echelera, k’echelera, no más.

 R: k’echelera pero la wawita está con orejasqa dice no ve?

 F: orejasqa no más, k’echelera orejasqa.

 K: Cuando los ninos se caen de traserito, hay un nombre? Se dana su cóccix?

 F: sipi chupasca.

14. No lo dan importancia.

15. Aymara and Quechua are the first languages of Andean communities, especially rural women.