Home is where the heart is: Women's experiences of homemaking and self care after aortocoronary bypass surgery

Several authors argue that women's everyday lives are structured in ways that limit their access to the resources which create and sustain health (see for example, Annandale & Hunt, 2000; Clarke & Olesen, 1999). How do these features of women's lives interact with the relations of health care in the diagnosis and ongoing management of particular health problems such as heart disease? The purpose of this institutional ethnography (Smith, 1987, 1999) was to examine the social relations reflected in women's experiences after aortocoronary bypass surgery (ACBS). Eighteen women were interviewed twice after ACBS: once after they had been home from hospital for four weeks, and once after four months. Eleven health professionals participated in the study as informants.;Four distinct periods in the women's encounters with heart disease and treatment were prominent in their narratives: diagnosis, hospitalization for surgery, the first month after surgery and four months after surgery. Each point was suffused with social and bodily displacements or relocations. Diagnosis marked entry into the social category, 'women with heart disease' and assumption of moral responsibility for self care. Hospitalization removed the women from familiar social contexts and embedded them within social relations which effected a sense of bodily dispossession. Homecoming was an occasion of relocation within a division of responsibility which was poorly designed to meet their needs, and in which they were still responsible for the needs of others. In the months following homecoming the women struggled to situate themselves at the intersection of two often conflicting discourses: the discourse of homemaking and the discourse of self care.;I conclude that a new approach to cardiovascular health education is required. This approach would of necessity place the learner in the position of expert participant and informant (Anderson, 1998; Tang & Anderson, 1999). I further argue that the contractionist discursive foundations of home care policy evade the problem of finding care, homemaking assistance and financial support for the family caregiver when she is ill herself (McKeever, 1996).