indifferent to my reasons, but just welcomed the chance for a chat with an outsider. A small minority rejected my advances outright and in keeping with the experiences of other ethnographers, some participants became close allies and main contributors of insider knowledge (Glick, 1998: Punch, 1993). After all my precautions regarding confidentiality and consent I was fairly surprised at first that few patients seemed particularly bothered by this. More important to most patients on the ward was my ability to keep a secret when it came to whispered confidences about a particular ‘scam’ or an incident of abusive behaviour from a certain member of staff.
Gaining consent for interviews with individual patients did not completely ensure a smooth passage to fieldwork and here problems were threefold. First of all the director’s consent was generally broadcast via a memorandum that apparently was not circulated to all members of staff, and therefore my presence needed to be explained, clarified and re-checked on numerous occasions throughout the field-study period. It was quite common for my credentials to be inquired into time and again, and occasionally pointed inquiries were made about whether the Dr T.W.’s permission had really been granted.
Secondly, this form of generalised consent from a superior did not necessarily guarantee willing participation from respondents, exemplifying the simple observation by Miles and Huberman, that ‘weak consent leads to poorer data’ (1994: 291). This could additionally be seen when initially, in a bid to be helpful, some members of staff tried to coerce patients into cooperating with me. Although I quickly discouraged such practices, I was also aware of a possible double game being played by staff, in that this could also act as an effective strategy of diversion away from them.
Finally, and connected to the point of weak consent, despite the director’s consent, it was nonetheless quite difficult to engage in a further process of negotiation with staff members acting as ‘gatekeepers’ to their wards. I often found that staff were reluctant to discuss terms with me and seemed to prefer this to be confined to my discussions with the director, and then mandated by him. This seemed to be particularly true of female nursing members of staff and junior male counterparts, both groups sharing a common and lowlier status in the medical hierarchy. Yet by not being able to negotiate openly with members of staff, I felt that their concerns were not specifically addressed, and frequently I perceived their unspoken or indirectly conveyed resentment and anxiety about my research role. I was regularly directed to talk to a more senior member of staff in corresponding male or female wards, under the pretext that this person was a more knowledgeable and experienced individual. In reality a formal repository of professional knowledge was usually not the best informant, as in this role such individuals tended to deliver set pieces of information concerning policies governing the management of the hospital that rarely provided useful insights into the lived experience. Instead it seemed to be that this role was largely a symbolic one designed to keep parties from the outside at bay, as well as providing the authority to speak, so clearly lacking among many women workers and inexperienced younger men.
Unfortunately, I found that discomfort and hostility towards my presence on the ward were not uncommon features of fieldwork. Like Van Maanen I did on occasions experience something approaching ‘unambiguous rejection’, although not as bluntly expressed as his examples quoted from hard-bitten New York cops (Van Maanen, 1991: 36-7). On one occasion Sister Magdalene, a senior member of staff, audibly instructed a subordinate to inform me that she was far too busy to talk to me when, so far as I could see, the ward was very quiet and she did not seem to be specifically engaged in work. It should be noted that this conversation took place within a few feet of where I was standing and delivered in a tone of annoyed dismissal, to be subsequently delivered in evident embarrassment by the auxiliary nurse. Two further examples taken from my field notes illustrate this rejection; the first takes place in an episode on Male Ward 1 where, as usual, a patient is helping two medical assistants with medication to be dispensed to patients on the locked section.
Field notes. Male Ward 1:
Ahi, a Malay MA (Medical Assistant) turned up (he’s not too friendly towards me most of the time) just as I was writing down the patient audit from the nursing chart. He starts helping Bong to hand out medication to the locked section with Hui Ling helping. As usual I am surprised by how compliant and passive people are when they take their meds. One poor man in the open section keeps asking to go back home in Malay: ‘balik kampung, bila?’ (When do I go home to my village?). The MAs ignore him. He then appeals to me, maybe because I am White and possibly influential, to take him back to his remote Iban kampung in X. Bong, another patient, helps with translation.
| Bong: | He says that he has had ECT so now wants to go back home. |
| Researcher: | Has it helped him? |
| Bong: | Yes, he is much more stable now. [To Ahi] How many more? |
| Ahi: | Three more, course of six. |
While I am taking to Bong a patient in the locked section is hanging around the grill and talking incessantly, non-stop and apparently unintelligibly. After some time of this I comment on it to Bong.
| Researcher: | This must be hard for people to cope with. |
| Ahi: | [overhearing] That’s why he is here. He talks all through the night. The brother says it drives them ‘up the wall’. Non-stop talking, the words don’t hang together though. [Pause] He talks so much he should get a job as a lecturer. |
| Researcher: | Yes, he’d be perfect - all he’d have to do is make sense. |
[Ahi gives me a sly, side-look and laughs. Later as I am leaving]
| Researcher: | Well, I must go now. |
| Ahi: | I hope this is worth your time. |
| Researcher: | I know it seems strange. |
| Ahi: | Yes. |
| Researcher: | But it is very interesting … you learn a lot by observing. |
This interaction with Ahi is a typical encounter representative of our relationship, in which in the space of a couple of hours he manages to get in two digs, the first conveying that I talk so much rubbish that I am no different from a particularly incoherent psychiatric patient. The second that I am wasting my time just hanging around watching the staff and no doubt, the message is also that I am wasting their time as well. Not surprisingly I never enjoyed spending time on the ward when Ahi was present, as I usually found myself in the position of trying to observe the ward while wincing at the pinpricks he delivered - when he was willing to acknowledge my presence at all. The second extract from my field notes highlights the difficulties of gathering data while in a state of awkward discomfort at being pointedly ignored by members of staff.
Field notes. Female Ward 2:
I wanted to follow up with the nurses on incidents of violence but was unable to get far. The staff sister, a handsome Iban woman, didn’t seem at all pleased to see me despite a polite but frozen half-smile and made no attempt to talk to me or make me feel welcome. She sat with her back to me the whole time and ignored me throughout. After a while of this I went out onto the veranda to strike up conversation but the other two nurses seemed unwilling or unable to talk to me (perhaps they felt the bad vibes from the sister in charge or maybe their English wasn’t up to it). These incidents made to feel unwelcome, to say the least!
I see this as all part-and-parcel of the research process and in fact research does act as both a wonderfully protective umbrella when it comes to all this negative grist to the mill. Yet there is a human dimension to all this, which I feel and is not easily shrugged off - it is this aspect in part which makes going into the field, an uncomfortable, anxiety-making business where you feel vulnerable, inquisitive - rarely wise and often foolish - an ambivalent position of unwelcome visitor and anticipated guest. As usual I often feel far more accepted by the patients than by the staff, today some seemed mildly interested and even pleased to see me.
Despite
