Pastoral power in HIV prevention: Converging rationalities of care in Christian and medical practices in Papua New Guinea.

In his conceptualisation of pastoral power, Michel Foucault argues that modern healthcare practices derive a specific power technique from pastors of the early Christian church. As experts in a position of authority, pastors practise the care of others through implicitly guiding them towards thoughts and actions that effect self-care, and towards a predefined realm of acceptable conduct, thus having a regulatory effect. This qualitative study of healthcare workers from two Christian faith-based organisations in Papua New Guinea examines the pastoral rationalities of HIV prevention practices which draw together globally circulated modern medical knowledge and Christian teachings in sexual morality for implicit social regulation. Community-based HIV awareness education, voluntary counselling and testing services, mobile outreach, and economic empowerment programs are standardised by promoting behavioural choice and individual responsibility for health. Through pastoral rationalities of care, healthcare practices become part of the social production of negative differences, and condemn those who become ill due to perceived immorality. This emphasis assumes that all individuals are equal in their ability to make behavioural choices, and downplays social inequality and structural drivers of HIV risk that are outside individual control. Given healthcare workers' recognition of the structural drivers of HIV, yet the lack of language and practical strategies to address these issues, political commitment is needed to enhance structural competency among HIV prevention programs and healthcare workers.

Republished paper: Bad stars or guiding lights? Learning from disasters to improve patient safety.

BACKGROUND: Cross-fertilisation of ideas across industries, settings and contexts potentially improves learning by providing fresh insights into error pathways. OBJECTIVES AND HYPOTHESES: To investigate six cases of human error drawn from disasters in the space, shipping, aviation, mining, rail and nuclear industries, and to apprehend similarities and differences in the antecedents to errors, the way they manifest, the course of events and the way they are tackled. The extent to which human intervention can exacerbate the problems by introducing new errors, how the cases are resolved and the lessons learnt were examined. DESIGN, SETTING AND PARTICIPANTS: Exemplar disaster events drawn from a very large sample of human errors. Results It is possible to identify and model a generic disaster pathway that applies across several industries, including healthcare. CONCLUSIONS: Despite differences between industries, it is clear that learning from disasters in other industries may provide important insights on how to prevent or ameliorate them in healthcare.

Bad stars or guiding lights? Learning from disasters to improve patient safety.

BACKGROUND: Cross-fertilisation of ideas across industries, settings and contexts potentially improves learning by providing fresh insights into error pathways. OBJECTIVES AND HYPOTHESES: To investigate six cases of human error drawn from disasters in the space, shipping, aviation, mining, rail and nuclear industries, and to apprehend similarities and differences in the antecedents to errors, the way they manifest, the course of events and the way they are tackled. The extent to which human intervention can exacerbate the problems by introducing new errors, how the cases are resolved and the lessons learnt were examined. DESIGN, SETTING AND PARTICIPANTS: Exemplar disaster events drawn from a very large sample of human errors. RESULTS: It is possible to identify and model a generic disaster pathway that applies across several industries, including healthcare. CONCLUSIONS: Despite differences between industries, it is clear that learning from disasters in other industries may provide important insights on how to prevent or ameliorate them in healthcare.