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Paper short abstract:

This paper explores how clinicians, patients’ relatives and anthropologists affect diagnostic pathways and distribute responsibility when a young pregnant woman presents with fever in a government referral hospital in Sierra Leone.

Paper long abstract:

This paper examines how diagnostic tests structure patients’ diagnostic navigations across different levels of the health system in Sierra Leone. By following 15 patients presenting with fever in the country’s largest referral hospital, we analysed patients’ diagnostic pathways before, during and after their visit to the hospital. Our research revealed that diagnostics are just one part of the diagnostic process. Through a detailed discussion of the diagnostic pathway of a young pregnant women presenting with fever, who is send back and forth between two referral hospitals, we show how responsibility for diagnosis was distributed across different people (patients, patient’s relatives, nurses, clinicians, laboratory workers, procurement agencies and record keepers) and across different spaces (e.g. hospital triages, consultations, hospital laboratories, private laboratories and wards). We found that diagnosis is not a singular event, rather it emerges over time. Often, patients were reported by health workers as “being managed” for the initial diagnosis, and received treatment until tests could be done to allow a differential diagnosis. For admitted patients, this process could take several weeks when tests were unavailable, either because of stock outs of tests or limited funds by patients. The majority of the admitted patients and their relatives claimed they had not been informed about test results or diagnosis, at times because there was no final diagnosis made. Additionally, we reflect on the ethical queries and hesitations we encountered about our own responsibility in affecting the diagnostic pathways of patients when conducting “participant-observation” in severely resource-constrained settings.