Meet the Qualitative Researcher: Hannah Cowan
Hannah is a medical anthropologist and sociologist, currently looking at how we could bring non-academic communities and medical researchers together to shape research agendas and find everyday ways of resisting the reproduction of inequalities in medical practice. She is funded by the Guy’s and St Thomas’ NIHR Biomedical Research Centre, a centre that works between the hospital and the university. Recently, she conducted the Utopia Now! Research project, that invited young people to share their hopes and fears for the future through a series of arts-facilitated workshops and activities. She talks about that in our Qualitative Open Mic podcast.
Sohail: Please tell me a bit about yourself and what you do.
Hannah: I am thinking about how you do participation well, and how you acknowledge the power dynamics in medical institutions. We’re in an old medical school, set up as a philanthropic endeavour. The thing about philanthropy, is that it’s about giving some resources, but not enough that you lose any substantial power over the person you’re giving to – in fact in many ways you reinforce that power. I’m interested in how we can challenge that legacy and test the limits of how power can be distributed between researchers and the public.
As a sociologist and anthropologist of medicine you can see how the social structures in which we live get folded into science. So we called our recent project Utopia Now!, and ran a number of utopian exercises, to help us to escape and think outside the current frameworks in which we live.
Sohail: How did you start doing this work?
Hannah: Well thinking about how inequalities get reproduced in the medical world actually stems back to my PhD work. There is a debate on privatisation in the NHS and I was part of a campaign to try to save the NHS. But in my PhD, I realised that the NHS we’re trying to save is full of these old school hierarchies. Certain professions get paid a lot more than those that are traditionally paired with women and about care. People talk about care like it’s some innate attribute to some humans (mainly women) and not others. And actually, it’s just something that people are trained to do from a very young age in their household. It’s just free training!
Sohail: Did you feel like you were trained to care and how did that feed into your research?
Hannah: Well, as a qualitative researcher you always end up reflecting on your own positionality. Probably one of the reasons why I was interested in NHS healthcare in the first place was because I grew up with a single mum who was a nurse. She was a nurse caring for a team and running that team as well as being a full-time mum and doing that care role. That then kind of led to me being brought up to be a carer, or a caring person, and all the labour that entails. When I then came to do some ethnographic work in the NHS, I was surprised to see how this care work got divided up between staff. I spent a lot of time with orthopaedic surgeons, some of the most macho in the medical profession, and the banter that comes with that - some of it felt like a parody just how clear some of the everyday sexism was.
One of my favourite ethnographic stories was when I was with a surgeon in theatre, working on a patient. He asked a nurse to come in, and after the necessary work chat, he asked about the football match they were both going to at the weekend. She supported one team, he the other. General football banter. He said, “are you going with your husband to the football?” And she said, “no he doesn’t really like football, it’s me and my daughter who go.” His response was “Oh, is he gay?”. She was miffed. Obviously, he was joking, but it was such an old school playground joke.
Then just as she kind of shook it off, he came back again with another ‘joke’, “Oh, he’s probably at home doing the knitting, something went seriously wrong there.” It was almost like he was totally oblivious that no one else was laughing. The best bit about it was, that at the same time he made a joke about knitting, he was sewing up a patient. The parallel of these two skills… him sewing up human flesh and mocking the idea of knitting as a feminine, homosexual activity kind of summarises what I’m saying. Both are necessary for life – especially clothing people in cold climates. But one is paired with feminine and one with masculine, even though they are very similar activities. Obviously, the male activity gets paid a lot more!
Sohail: A bit of a “Carry On” films vibe there. When you came across these issues, did you feel like you should take on an advocacy role?
Hannah: Rather than go back to the campaign strategy, I looked for activist practices within everyday life, just within people’s working lives. Even if it was just doing their best to keep a patient in for another night or two if they need it, to try and provide them the care. Often people are going out of their way to do that and they could get negative repercussions, these practices deserve the label activism. There were other things like those who sterilise the instruments in the basement, campaigning to get recognised as “health scientists” which would see them paid on a better grade. They have to know about all the different instruments across the whole hospital, but for a long time they were seen as unskilled and “ancillary” workers.
A lot of what I was am doing now is to ask questions to challenge these hierarchies, get people to rethink what they know as okay. I used to go on a lot of marches, “Save the NHS” protests. But now, I am not so sure about the use of these slogans. They can be quite dangerous when you don’t realise it. There’s a lot of nationalism behind the NHS, even on the left. I am interested in more complex activism, thinking about how we can do activism in our everyday lives.
So now when I think back to the work I’m doing on participation in research, I’m trying to suggest that inequalities shouldn’t just come as an afterthought – like questions on who has access to this or that medical advancement. Rather, just as I am thinking about activism as something I do through my research, rather than thinking of it as a side-line I do in addition to my job, I want to think about how we embed concerns about inequalities in the everyday production of new medical knowledge.