The gaps in the gaze in South African hospitals

Analysis of health care systems, especially hospitals, could benefit from Foucault's description of the medical gaze and the panopticon. Foucault's perspective sheds new light on the South African transformation from an oppressive to a more democratic State and is played out in particular ways in hospital settings. Analyses of the South African health care system and its interface with patients in hospitals seldom draw on the work of Foucault, despite its pertinent description of the diffuse and insidious forms of social surveillance (the 'gaze') and processes of 'normalization' brought about in panoptical settings. The gaze has become a metaphor for the processes whereby disciplinary 'technologies', together with the emergence of a normative social science, discipline both the mind and body of the individual, as in my example of a medicalised institutional setting. Transformation from an oppressive State system to a democratic South Africa has impacted in particular ways on the hospital setting. Instead of being subject to the constant surveillance of the gaze of the State or of medicine, there are numerous instances where patients to all intents become 'invisible', and end up beyond its perimeters. In the hospital, as in the heterogeneous South African community, there is a continuous process of adjustment, with patients, services and staff being rotated in an attempt to provide redress and equal access to health services for all. A large, long-standing lack of funds forces the medical staff to make decisions as to who should get access to beds and to optimal care, and this permeates the everyday experience of institutionalisation and care-giving. It also militates against neutral policy objectives, consistent surveillance or a homogenised system of care.