Verbal autopsy in the death reporting process in the locality: Linking mandates, practices, and interactional struggles

• Main Author: Cadiente, Glenda D.
• Format: text
• Language: English
• Published: Animo Repository 2019
• Subjects: Conversation analysis; Autopsy—Language
• Online Access: https://animorepository.dlsu.edu.ph/etd_doctoral/1436
• Institution: De La Salle University

This study is an analysis of institutional talk, in the form of verbal autopsy, a death reporting activity that forms the core of mortality data surveillance in Philippines. Studies focusing on institutional talk in Philippine setting is scarce and this condition extends to verbal autopsy studies. This study fills the gap by treating verbal autopsy as an interactional data of institutional talk. Specifically, this study aims to describe the structure of verbal autopsy, and the interactional struggles found in verbal autopsy through the differing frames of expectation, and the linguistic strategies used among participants. The features of verbal autopsy utilized Haworth’s (2006) interview analysis focusing on the following foci of analysis: (1) topic, (2) question-type, (3) question-answer sequence, and (4) alignment/identification to institutional status. The exchanges were further categorized using Morales-Lopez et al.’s (2005) categories of communicative strategies: (1) depersonalizing strategies, and (2) personalizing strategies. The asymmetrical roles of the participants in the study revealed that the doctor-participants dictated the topics in the interrogation and the informants were simply subjected to provide the responses. Question-types utilized by the doctor in the interrogation included confirmation-question, information-seeking questions, and explanation-seeking question types as the most commonly used question type while the accusative question-type is the least used question. The doctor-participants, being the interrogator and gatekeeper were highly recognized by the informant as institutional authorities. The use of honorifics, apologies, and expressions of gratitude showed the death informant’s attempt to maintain institutional alignment and were used to compensate for the subjective nature of their responses. The tensions felt in the doctor-informant talk were primarily sourced from the conflicting frames of expectation between the doctor and the informant. The doctor expected clear, precise, direct and short responses but which contradict the informants responses that were vague, imprecise, indirect, and lengthy. The linguistic strategies revealed in the analysis were categorized into personalizing and depersonalizing strategies. These linguistic strategies attempted to compensate for and mitigate the tension and interactional struggles reproduced by the conflicting frames. All of these outcomes were explored using a multi-method analytic approach, utilizing Blommaert’s (2010) historicity and the critical stance of ethnography, wrapped within a social-realist perspective. This approach revealed how historicity showed the layered roles of the doctor-participants—strict protocol providers, interrogators, gatekeepers, staunch counsels—and who identified their institutional role with a medicalized orientation, endorsing an objectified frame of interrogation. Death informants also portrayed layered roles being the legitimate representative, the dependable female, and as informant with streetwise literacy. But while these roles proved to be practical, their subjective orientation was continually in conflict with the demands of the institutional authority. The lived practices of death reporting were characterized by institutional protocols that were created in order to maintain institutional order but which were implemented in an institution-oriented approach characterized by a lack of information-giving. Hence, such approach clashes with the death informants marginalized historicity. Viewed within the socio-political context of death reporting, the obscured death informant requirements and the uncoordinated regulatory procedures become by-products of the mandates, inadvertently reproducing the tension and interactional struggles of participants.