From shared values through creative refusal and contemporary pragmatism: Enacting culturally and contextually appropriate palliative care services in a South African hospice service

As part of a larger study, we explore a hospice service delivered in Cape Town as part of a leading hospice organization. The hospice service was established during the apartheid era but is committed to inclusion and celebrating South African diversity. We conducted an organizational ethnography at a day hospice service in a formerly excluded, ‘Black’, part of Cape Town, using observation and interview methods. We found that the concept of culture is enacted in a number of ways in this context: through reference to constructed historically shared values, through a form of creative refusal though mobilization around a traumatizing apartheid past, and through a service provider’s deft and pragmatic negotiation of bureaucratic hurdles of contemporary service provision. Though there is considerable literature on culture and diversity in palliative care, we suggest that our more complex and contextual understanding may assist more broadly for the provision of appropriate care. • Palliative care in South Africa, is intertwined with the apartheid past • Cultural change is enacted through changing services in South Africa • The concept of culture used in palliative care literature globally is restrictive • Political legacies, and current bureaucracy must be considered as part of culture