Browsing by Author "Swartz, Leslie"
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- ItemAccess to healthcare for people with disabilities in South Africa : bad at any time, worse during COVID-19?(AOSIS, 2021-07) McKinney, Emma L.; McKinney, Victor; Swartz, LesliePeople with disabilities, especially those living in low- and middle-income countries, experience significant challenges in accessing healthcare services and support. At times of disasters and emergencies, people with disabilities are further marginalised and excluded. During the coronavirus disease 2019 (COVID-19) pandemic, many people with disabilities are unable to access healthcare facilities, receive therapeutic interventions or rehabilitation, or gain access to medication. Of those who are able to access facilities, many experience challenges, and at times direct discrimination, accessing life-saving treatment such as intensive care unit admission and ventilator support. In addition, research has shown that people with disabilities are at higher risk of contracting the virus because of factors that include the need for interpersonal caregivers and living in residential facilities. We explore some of the challenges that people with disabilities residing in South Africa currently experience in relation to accessing healthcare facilities.
- ItemAfri-Can Forum 2(Biomed Central, 2016-07-12) Mukudu, Hillary; Martinson, Neil; Sartorius, Benn; Coetzee, Jenny; Dietrich, Janan; Mokgatswana, Kgaugelo; Jewkes, Rachel; Gray, Glenda E.; Dugas, Marylene; Behanzin, Luc; Guedou, Fernand A.; Gagnon, Marie-Pierre; Alary, Michel; Rutakumwa, Rwamahe; Mbonye, Martin; Kiwanuka, Thadeus; Nakamanya, Sarah; Muhumuza, Richard; Nalukenge, Winfred; Seeley, Janet; Atujuna, Millicent; Wallace, Melissa; Brown, Ben; Bekker, Linda G.; Newman, Peter A.; Harryparsad, Rushil; Olivier, Abraham J.; Jaspan, Heather B.; Wilson, Douglas; Dietrich, Janan; Martinson, Neil; Mukudu, Hillary; Mkhize, Nonhlanhla; Morris, Lynn; Cianci, Gianguido; Dinh, Minh; Hope, Thomas; Passmore, Jo-Ann S.; Gray, Clive M.; Henrick, Bethany M.; Yao, Xiao-Dan; Rosenthal, Kenneth L.; Henrick, Bethany M.; Yao, Xiao-Dan; Drannik, Anna G.; Rosenthal, Kenneth L.; Chanzu, Nadia; Mwanda, Walter; Oyugi, Julius; Anzala, Omu; Mbow, Moustapha; Jallow, Sabelle; Thiam, Moussa; Davis, Alberta; Diouf, Assane; Ndour, Cheikh T.; Seydi, Moussa; Dieye, Tandakha N.; Mboup, Souleymane; Goodier, Martin; Rilley, Eleanor; Jaye, Assan; Yao, Xiao-Dan; Omange, R. W.; Henrick, Bethany M.; Lester, Richard T.; Kimani, Joshua; Ball, T. B.; Plummer, Francis A.; Rosenthal, Kenneth L.; Behanzin, Luc; Guedou, Fernand A.; Geraldo, Nassirou; Mastetse, Ella G.; Sossa, Jerome C.; Zannou, Marcel D.; Alary, Michel; Osawe, Sophia; Okpokoro, Evaezi; Okolo, Felicia; Umaru, Stephen; Abimiku, Rebecca; Audu, Sam; Datong, Pam; Abimiku, Alashle; Nyange, Jacquelyn; Olenja, Joyce; Mutua, Gaudensia; Jaoko, Walter; Omosa-Manyonyi, Gloria; Farah, Bashir; Khaniri, Maureen; Anzala, Omu; Cockcroft, Anne; Tonkin, Kendra; Girish, Indu; Mhati, Puna; Cunningham, Ashley; Andersson, Neil; Farah, Bashir; Indangasi, Jackton; Jaoko, Walter; Mutua, Gaudensia; Khaniri, Maureen; Nyange, Jacquelyn; Anzala, Omu; Diphoko, Thabo; Gaseitsiwe, Simani; Maiswe, Victoria; Iketleng, Thato; Maruapula, Dorcas; Bedi, Keabetswe; Moyo, Sikhulile; Musonda, Rosemary; Wainberg, Mark; Makhema, Joseph; Novitsky, Vladimir; Marlink, Richard; Essex, Max; Okoboi, Stephen; Ssali, Livingstone; Kalibala, Sam; Birungi, Josephine; Egessa, Aggrey; Wangisi, Jonathan; Okullu, Lyavala J.; Bakanda, Celestin; Obare, Francis; Boer, I. M. S.; Semvua, Hadija H.; Van den Boogaard, Jossy; Kiwango, Krisanta W.; Ngowi, Kennedy M.; Nieuwkerk, Pythia T.; Aarnoutse, Rob E.; Kiwelu, Ireen; Muro, Eva; Kibiki, Gibson S.; Datiri, Ruth; Choji, Grace; Osawe, Sophia; Okpokoro, Evaezi; Okolo, Felicia; Umaru, Stephen; Abimiku, Rebecca; Datong, Pam; Abimiku, Alashle; Fomsgaard, A.; Karlsson, I.; Jensen, K. J; Jensen, S. S.; Leo-Hansen, C.; Jespersen, S.; Da Silva Te, D.; Rodrigues, C. M.; Da Silva, Z. J.; Janitzek, C. M.; Gerstoft, J.; Kronborg, G.; Okpokoro, Evaezi; Osawe, Sophia; Daitiri, Ruth; Choji, Grace; Umaru, Stephen; Okolo, Felicia; Datong, Pam; Emily, Nyariki; Joyce, Olenja; Robert, Lorway R.; Anzala, Anzala; Viljoen, Katie; Wendoh, Jerome; Kidzeru, Elvis; Karaoz, Ulas; Brodie, Eoin; Botha, Gerrit; Mulder, Nicola; Gray, Clive; Cameron, William; Stintzi, Alain; Jaspan, Heather; Levett, Paul N.; Alexander, David; Gulzar, Naveed; Grewal, Prabvir S.; Poon, Art F Y.; Brumme, Zabrina; Harrigan, P. R.; Brooks, James I.; Sandstrom, Paul A.; Calvez, Stryker; Sanche, Stephen E.; Scott, Jamie K.; Swartz, Leslie; Kagee, Ashraf; Lesch, Anthea; Kafaar, Zuhayr; De Wet, Anneliese; Okpokoro, Evaezi; Osawe, Sophia; Daitiri, Ruth; Choji, Grace; Umaru, Stephen; Okolo, Felicia; Datong, Pam; Abimiku, Alashle; Dietrich, Janan; Smith, Tricia; Cotton, Laura; Hornschuh, Stefanie; Van der Watt, Martin; Miller, Cari L.; Gray, Glenda; Smit, Jenni; Jaggernath, Manjeetha; Ndungu, Thumbi; Brockman, Mark; Kaida, Angela; Akolo, Maureen; Kimani, Joshua; Gelmon, Larry; Chitwa, Michael; Osero, Justus; Cockcroft, Anne; Marokoane, Nobantu; Kgakole, Leagajang; Maswabi, Boikhutso; Mpofu, Neo; Ansari, Umaira; Andersson, Neil; Nakinobe, Elizabeth; Miiro, George M.; Zalwango, Flavia; Nakiyingi-Miiro, Jessica; Kaleebu, Potiano; Semwanga, John R.; Nyanzi, Emily; Musoke, Saidat N.; Nakinobe, Elizabeth; Miiro, George; Mbidde, Edward K.; Lutalo, Tom; Kaleebu, Pontiano; Handema, Ray; Chianzu, Graham P.; Thiam, Moussa; Diagne-Gueye, Diabou; Ndiaye, Mame K.; Mbow, Moustapha; Ndiaye, Birahim P.; Traore, Ibrahima; Dia, Mamadou C.; Thomas, Gilleh; Tour-Kane, Coumba; Mboup, Souleymane; Jaye, Assan; Nyanzi, Emily; Mbidde, Edward K.; Kaleebu, Pontiano; Mpendo, Juliet; Kimani, Joshua; Birungi, Josephine; Muyindike, Winnie; Kambugu, Andrew; Sebastian, Hachizovu; Ray, Handema; Mike, Chaponda; Bertin, Kabuya J.; Modest, Mulenga; Thiam, Moussa; Janha, Omar; Davis, Alberta; Amambua-Ngwa, Alfred; Nwakanma, Davis C.; Mboup, Souleymane; Jaye, Assan; Jespersen, Sanne; Hønge, Bo L.; Esbjornsson, Joakim; Medina, Candida; Te, David Da Silva; Correira, Faustino G.; Laursen, Alex L.; Ostergaard, Lars; Andersen, Andreas; Aaby, Peter; Erikstrup, Christian; Wejse, Christian; Dieye, Siry; Sarr, Moussa; Sy, Haby; Mbodj, Helene D.; Ndiaye, Marianne; Ndiaye, Amy; Moussa, Seydi; Jaye, Assan; Mboup, Souleymane; Nyombi, Balthazar M.; Shao, Elichilia R.; Chilumba, Innocent B.; Moyo, Sikhulile; Gaseitsiwe, Simani; Musonda, Rosemary; Datong, Pam; Inyang, Bucky; Osawe, Sophia; Izang, Abel; Cole, Chundung; Okolo, Felicia; Cameron, Bill; Rosenthal, Kenneth; Gray, Clive; Jaspan, Heather; Seraise, Boitumelo; Andrea-Marobela, Kerstin; Moyo, Sikhulile; Musonda, Rosemary; Makhema, Joseph; Essex, Max; Gaseitsiwe, SimaniENGLISH ABSTRACT: We are pleased to present peer reviewed forum proceedings of the 2nd synchronicity forum of GHRI/CHVIfunded Canadian and African HIV prevention and vaccine teams Forum objectives ∙GHRI-funded capacity building and HIV prevention research teams presented highlights of achievements ∙Teams discussed how to jointly build on achievements for sustainability ∙Provided an opportunity for inter-team collaboration, synchronize best approach to capacity building, mentoring of new researchers and building leadership ∙Provided opportunities for informal discussions and networking among the teams. ∙Teams learnt about recent advances in the area of African regulatory and ethics review process ∙The forum proceedings was a special supplement in an openaccess journal was produced
- ItemAlcohol use in South Sudan in relation to social factors, mental distress and traumatic events(BioMed Central, 2016-09-06) Lien, Lars; Hauff, Edvard; Martinez, Priscilla; Eide, Arne H; Swartz, Leslie; Ayazi, TourajENGLISH SUMMARY : Background: Alcohol use is a major public health problem with vast implications for poor, war-torn countries. The objective of this study was to describe prevalence of alcohol use and risky drinking across socio-demographic factors in South Sudan, and to determine the association between risky drinking, traumatic events and mental distress. Methods: This is a randomized, population based, cross-sectional study from the north-western part of South Sudan with nearly 500 participants. We used the Alcohol Use Disorders Identification Test (AUDIT) as main outcome variable, the General Health Questionnaire (GHQ-28) for mental distress and five questions to assess traumatic events. Results: the mean AUDIT score was 2.7 (SD 0.3) with 14,2 % in the high risk problem drinking category. Being male, lack of a regular income and psychological distress were significantly associated with higher AUDIT score. Traumatic events, however, was not associated with higher score on AUDIT. Conclusion: Despite decades of civil war and great poverty the alcohol use in this population was at the same level as other countries in Southern Africa. Traumatic events were not related to risk of problem drinking.
- ItemAssociation between exposure to traumatic events and anxiety disorders in a post-conflict setting : a cross-sectional community study in South Sudan(BioMed Central, 2014-01) Ayazi, Touraj; Lien, Lars; Eide, Arne; Swartz, Leslie; Hauff, EdvardAbstract Background The negative effect of exposure to traumatic events on mental health is well known. Most studies of the effects of trauma on mental health in war-affected populations have focused on post-traumatic stress disorder (PTSD) and depression. Although some studies confirm the existence of anxiety symptoms in war-affected populations, the extent to which exposure to traumatic events is independently associated with anxiety diagnoses (other than PTSD) has received less attention. The study aimed to determine whether having an anxiety diagnosis, other than PTSD, was associated with experiencing traumatic events in a post-conflict setting, across genders and after controlling for demographic and socio-economic variables. Methods In this cross-sectional community study (n = 1200), we applied the Harvard Trauma Questionnaire (HTQ) to investigate the extent of trauma exposure and PTSD. The Mini-International Neuropsychiatric Interview (MINI) was used to investigate the prevalence of anxiety disorders: generalized anxiety disorder (GAD), panic disorder (PD), social phobia, obsessive-compulsive disorder (OCD), and agoraphobia. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, and socio-economic factors. Results The participants were 56.4% male and 43.6% female. The age ranged between 18 and 73 years old (Mean 34.63, SD = 12.03). The estimated rates of GAD-only and PD-only (without comorbidity with PTSD) were 5.5% and 3.1%, respectively. Exposure to traumatic events and socio-economic disadvantage were significantly associated with having one or more anxiety diagnoses. After controlling for age, sex, rural/urban setting, and socio-economic disadvantage, exposure to trauma was independently associated with anxiety diagnosis. There were gender differences in the pattern of risk factors for having PTSD, GAD or PD. Conclusion In individuals with a history of war-related trauma exposure, attention should be given to symptoms of GAD and PD, in addition to PTSD symptoms.
- ItemAssociations of premorbid adjustment with type and timing of childhood trauma in first-episode schizophrenia spectrum disorders(AOSIS, 2021-06) Smit, Anna M.; Kilian, Sanja; Emsley, Robin A.; Luckhoff, Hilmar K.; Swartz, Leslie; Seedat, Soraya; Asmal, LailaBackground: Childhood trauma may contribute to poorer premorbid social and academic adjustment which may be a risk factor for schizophrenia. Aim: We explored the relationship between premorbid adjustment and childhood trauma, timing of childhood trauma’s moderating role as well as the association of clinical and treatment-related confounders with premorbid adjustment. Setting: We conducted a secondary analysis in 111 patients with first-episode schizophrenia (FES) disorders that formed part of two parent studies, EONKCS study (n =73) and the Shared Roots study (n =38). Methods: Type of childhood trauma was assessed with the Childhood Trauma Questionnaire, short-form and premorbid adjustment using the Premorbid Adjustment Scale. Timing of childhood trauma was assessed using the Life Events Checklist and life events timeline. Linear regression analyses were used to assess the moderating effect of timing of childhood trauma. Clinical and treatment-related confounders were entered into sequential hierarchical regression models to identify independent predictors of premorbid adjustment across key life stages. Results: Childhood physical neglect was associated with poorer premorbid academic functioning during childhood and early adolescence, and poorer premorbid social functioning during early and late adolescence. By hierarchical regression modelling (r2 = 0.13), higher physical neglect subscale scores (p = 0.011) independently predicted poorer premorbid social adjustment during early adolescence. Timing of childhood trauma did not moderate the relationship between childhood trauma and premorbid functioning. Conclusion: In patients with FES, childhood physical neglect may contribute to poorer premorbid social functioning during early adolescence. This may provide us with an opportunity to identify and treat at-risk individuals earlier.
- ItemAttitudes toward condom education amongst educators for deaf and hard-of-hearing adolescents in South Africa(AOSIS Publishing, 2014-08) Mall, Sumaya; Swartz, LeslieBackground: Disabled adolescents are at a critical time in their psychosocial and sexual development. Aim: This study explores the attitudes of educators working in schools for Deaf and hard-ofhearing pupils in South Africa toward condom education for their pupils. Methods: We conducted a combination of individual in-depth and joint interviews with a total of 27 participants. The sample comprised educators, school psychologists, school nurses and teaching assistants. Results: Results showed that educators were aware of the HIV risk for their pupils and reported the risk of sexual abuse or premature sexual activity as being risk factors for HIV infection. None of the schools had a written condom education policy. Whilst some schools were integrating condom education in existing school curricula, others faced moral or religious dilemmas in doing so. There were differences in attitudes, both amongst schools and amongst educators in the same schools. Conclusions: Given the context of a burgeoning HIV epidemic, it is vital to address adequate condom education in schools.
- ItemBarriers to the participation of people with psychosocial disability in mental health policy development in South Africa : a qualitative study of perspectives of policy makers, professionals, religious leaders and academics(BioMed Central, 2013-03) Kleintjes, Sharon; Lund, Crick; Swartz, LeslieAbstract Background This paper outlines stakeholder views on environmental barriers that prevent people who live with psychosocial disability from participating in mental health policy development in South Africa. Method Fifty-six semi-structured interviews with national, provincial and local South African mental health stakeholders were conducted between August 2006 and August 2009. Respondents included public sector policy makers, professional regulatory council representatives, and representatives from non-profit organisations (NPOs), disabled people’s organisations (DPOs), mental health interest groups, religious organisations, professional associations, universities and research institutions. Results Respondents identified three main environmental barriers to participation in policy development: (a) stigmatization and low priority of mental health, (b) poverty, and (c) ineffective recovery and community supports. Conclusion A number of attitudes, practices and structures undermine the equal participation of South Africans with psychosocial disability in society. A human rights paradigm and multi-system approach is required to enable full social engagement by people with psychosocial disability, including their involvement in policy development.
- ItemBeyond the checklist : understanding rural health vulnerability in a South African context(Taylor & Francis Open, 2016) Vergunst, Richard; Swartz, Leslie; Mji, Gubela; Kritzinge, Janis; Braathen, Stine HellumBackground: Vulnerability in the past has sometimes been measured and understood in terms of checklists or common understanding. It is argued here that vulnerability is a more complex issue than this. Although checklists of vulnerable groups are important, they do not capture the essence and dynamics of vulnerability. Objective : The case of rural health vulnerability in South Africa is discussed to show that classifying people into vulnerable groups does not portray the complexity and intricacies of what it means to have vulnerability. We also wish to show that there are different kinds of vulnerabilities, and the difference between access vulnerability and illness vulnerability is highlighted. Methods : As part of a larger study, this case study is presented to show how vulnerability in a poor rural community in South Africa has to be understood in a contextual and dynamic manner as opposed to a static manner. Results : Family and social dynamics can influence health. For example, fractured families were seen as a vulnerable issue within the community, while being a person with a disability can lead to isolation and callous attitudes towards them. It is these family and social dynamics that lead proximally to vulnerability to ill health. Conclusions : A contextual approach can assist in giving a more layered understanding of vulnerability than a checklist approach can do. Interventions to change health cannot be addressed simply by medical means. Social conditions need to be changed, and part of changing social conditions is the process of assisting those who are isolated or experience themselves as vulnerable to reconnect with others in the community. Poverty leads to social exclusion; social and family inclusion may be key to well-being.
- ItemChallenges and opportunities for spiritual care practice in hospices in a middle-income country(BMC (part of Springer Nature), 2021-04-22) Mahilall, Ronita; Swartz, LeslieBackground: Spiritual care is a key component of palliative care, but it has been overlooked and understudied in low- and middle-income country contexts, especially in Africa. In this study we sought to establish what the current spiritual care practices are in hospice palliative care settings in South Africa with a focused view on what spiritual care training is currently offered and what training needs still remain unmet. Methods: We explored spiritual care practices, and training needs, through a national quantitative online study of palliative care organisations in South Africa registered with the Hospice Palliative Care Association of South Africa. A survey was sent to representatives of all member organisations listed on the national database of Hospice Palliative Care Association of South Africa. Viable data from 41% (n = 40) member organisations were analysed through the use of simple statistics. Results: An expressed need (75%; n = 30) was recorded for the development of a national spiritual care curriculum. Although 48% (n = 20) of the member organisations were willing to participate in the development of a spiritual care curriculum, 37% (n = 14) could not participate, citing financial (n = 27), time (n = 31) and expertise constraints (n = 22). A set of hard and soft skills were suggested to suit the diverse South African context. Conclusions: Spiritual care was seen by participants as a key component of palliative care. International curricula in spiritual care, while useful, do not offer easy adaptation to the diversities of South Africa. A bespoke spiritual care curriculum was called for, for diverse South Africa.
- ItemChallenges in the use of the mental health information system in a resource-limited setting : lessons from Ghana(BioMed Central, 2018-02-08) Kpobi, Lily; Swartz, Leslie; Ofori-Atta, Angela L.Background: One of the most successful modes of record-keeping and data collection is the use of health management information systems, where patient information and management plans are uniformly entered into a database to streamline the information and for ease of further patient management. For mental healthcare, a Mental Health Information System (MHIS) has been found most successful since a properly established and operational MHIS is helpful for developing equitable and appropriate mental health care systems. Until 2010, the system of keeping patient records and information in the Accra Psychiatric Hospital of Ghana was old and outdated. In light of this and other factors, a complete reforming of the mental health information systems in three psychiatric hospitals in Ghana was undertaken in 2010. Four years after its implementation, we explored user experiences with the new system, and report here the challenges that were identified with use of the new MHIS. Methods: Individual semi-structured interviews were conducted with nine clinical and administrative staff of the Accra Psychiatric Hospital to examine their experiences with the new MHIS. Participants in the study were in three categories: clinical staff, administrator, and records clerk. Participants’ knowledge of the system and its use, as well as the challenges they had experienced in its use were explored using an interpretative phenomenological approach. Results: The data suggest that optimal use of the current MHIS had faced significant implementation challenges in a number of areas. Central challenges reported by users included increased workload, poor staff involvement and training, and absence of logistic support to keep the system running. Conclusions: Setting up a new system does not guarantee its success. As important as it is to have a mental health information system, its usefulness is largely dependent on proper implementation and maintenance. Further, the system can facilitate policy transformation only when the place of mental health in district, regional and national health discourse improves.
- ItemChronic pain as a human rights issue : setting an agenda for preventative action(Taylor & Francis Open, 2017) Frenkel, Louise; Swartz, LeslieBackground: Historically, chronic pain has been viewed primarily as a medical issue, and research has been focused on the individual and predominantly on pain sufferers in highincome countries. Objectives: This article argues the need for a broader understanding of the context of chronic pain and its complex aetiologies and maintenance. It is suggested that the interaction between chronic pain and social context has been inadequately explored. Methods: A single case study is used of a man living in a violent urban environment in South Africa accessing a pain clinic at a tertiary hospital. Following the case-study approach, as used in the chronic traumatic stress field by Kaminer et al., the case material is utilised to develop an argument for a new research agenda. Results: Analysis of the case material demonstrates the complex interplay between bodily and psychological experiences, with chronic pain being contextually maintained and exacerbated by very difficult life circumstances, ongoing violence, and marginalisation. Conclusions: It is suggested that a research agenda be developed which explores the links between chronic pain and ongoing chronic traumatisation in contexts of continuous violence, oppression, and disempowerment – common features of much of the contemporary majority world.
- ItemCognitive behaviour therapy-based early intervention and prevention programme for anxiety in South African children with visual impairments(AOSIS, 2019) Visagie, Lisa; Loxton, Helene; Swartz, Leslie; Stallard, PaulBackground: Anxiety is the most common psychological difficulty reported by youth worldwide and may also be a significant problem for children with visual impairments. Cognitive behaviour therapy (CBT) interventions have proven to be successful in treating childhood anxiety; however, mostly these are not suitable for children with visual impairments, as the materials used are not sufficiently accessible to this population. Objectives: The present study was motivated by the dearth of research on this topic and aimed to examine the effects of a specifically tailored, group-based, universally delivered, CBT intervention for anxiety in children with visual impairments and to examine the influence of three predictor variables (i.e. age, gender and level of visual impairment) on prevention effects. Method: A randomised wait-list control group design with pre-, post- and follow-up intervention measures was employed. The final sample of 52 children (aged 9–14) with varying degrees of visual impairment received the anxiety intervention. Participants were followed over a course of 10 months during which their anxiety symptoms were assessed quantitatively at four time points (T1–T4). Results: The results indicated that the anxiety intervention did not significantly decrease symptoms of anxiety within the intervention groups. However, the intervention appeared beneficial for girls, younger children and legally blind participants. Conclusion: This study demonstrated how CBT interventions can be adapted for use in children with visual impairments. Results obtained provide a foundation upon which future updated anxiety intervention programmes can be built, meeting the need for further research in this area.
- ItemCognitive rehabilitation groups : a thematic analysis of feasibility and perceived benefits for clients with moderate to severe traumatic brain injury living in the Western Cape(AOSIS Publishing, 2015--08-20) Wilson, Abigail; Wills, Peta; Pretorius, Chrisma; Swartz, LeslieBackground: Traumatic brain injury (TBI) has a significant impact on the burden of care within the South African setting, impacting on the individual, the family, and the community as a whole. Often the consequences of TBI are permanent, resulting in numerous financial and emotional stressors. Objective: This research focusses on the experience of outpatient cognitive rehabilitation groups for individuals who have suffered moderate to severe brain injuries within the South African setting. Method: Participants with moderate to severe brain injury were required to attend five cognitive rehabilitation groups and engage in a semistructured interview. Qualitative data were examined via thematic analysis, to determine participants’ subjective experiences of group participation. Results: There is a need within the South African setting for cognitive rehabilitation and support groups for individuals who have experienced a TBI. The benefits were notable for both the individuals attending and their support systems. In spite of the benefits there were notable limitations to attendance, including financial restrictions and transport limitations. Conclusion: According to participants and their families, there is a scarcity of resources within the Western Cape for clients who have sustained a TBI. Despite limitations in capacity to attend there appears to be a need for structured outpatient cognitive rehabilitation programmes integrating the complex cognitive and emotional challenges faced by individuals with TBI and their families.
- ItemCOVID-19, disability and the context of healthcare triage in South Africa : notes in a time of pandemic(AOSIS, 2020-08-18) McKinney, Emma L.; McKinney, Victor; Swartz, LeslieDuring disasters, when resources and care are scarce, healthcare workers are required to make decisions and prioritise which patients receive life-saving resources over others. To assist healthcare workers in standardising resources and care, triage policies have been developed. However, the current COVID-19 triage policies and practices in South Africa may exclude or disadvantage many disabled people, especially people with physical and intellectual impairments, from gaining intensive care unit (ICU) access and receiving ventilators if becoming ill. The exclusion of disabled people goes against the principles established in South Africa’s Constitution, in which all people are regarded as equal, have the right to life and inherent dignity, the right to access healthcare, as well as the protection of dignity. In addition, the triage policy contravenes the United Nations Convention on the Rights of Persons with Disabilities, which the South African government has signed and ratified. This article raises debates about whose lives matter and whose lives are ‘worth’ saving over others, and although the focus is on South Africa, the issues may be relevant to other countries where life-saving resources are being rationed.
- ItemDecolonising research methodologies : lessons from a qualitative research project, Cape Town, South Africa(Taylor & Francis Open, 2017) Keikelame, Mpoe Johannah; Swartz, LeslieBackground: It is becoming increasingly important for researchers to critically reflect on approaches that can have a positive impact on the health outcomes of indigenous people. Such issues are of great importance and perhaps of special relevance to researchers in the Global South, and to the African context in which we work. Objective:To share some lessons learned from our fieldwork to contribute to current knowledge and conversations on decolonising research process. Methods: We used an African lens to critically reflect upon some issues raised from individual interviews and focus group discussions with our participants which we deem to be important for consideration in a decolonising research process. Results: The major issues that we raise are about important structures such as power, trust, cultural competence, respectful and legitimate research practice and recognition of individual and communities’ health assets in a decolonising research process. Conclusions: Our paper argues for alternative approaches which are culturally appropriate for health research and for improved health outcomes of marginalised groups. In addition, we argue that participatory and transformative research methods which recognises individual and communities’ assets are needed. We hope that the lessons that we share in this paper can contribute towards a respectful and good research practice among the marginalised population groups in our context.
- ItemDisability : the forgotten side of race science(African Sun Media, 2020) Swartz, Leslie; Bantjes, Jason; Lourens, Heidi; Watermeyer, BrianThe impetus for this book was an article, the first line of the abstract of which reads: “Colored women in South Africa have an increased risk for low cognitive functioning.”1 There is no question that the article reproduces racist ideas, and we are in agreement with the authors of the other chapters in this book. There is, however, another side to this article that has been less discussed. What does it mean to describe a group of people as having “increased risk for low cognitive functioning”? In much that has been written about the article, there has been almost no discussion of the social context in which the idea of somebody having, or being at risk of, “low cognitive functioning” is seen, automatically, as a form of insult.
- ItemDoing their best : strategies used by South African clinicians in working with psychiatric inpatients across a language barrier(Co-Action Publishing, 2015-10-26) Kilian, Sanja; Swartz, Leslie; Chiliza, BonginkosiBackground and objectives: South Africa has 11 official languages, but most psychiatrists can speak only English and Afrikaans and there are no formal interpreter posts in the mental healthcare system. As a result clinicians communicate with patients who have limited English language proficiency (LEP) without the use of interpreters. We present case material, constituting recordings of interactions between clinicians and LEP patients in a public psychiatric institution. The aim is to have a better understanding of how these clinical encounters operated and what communicative strategies clinicians used. Design: We used the Roter interaction analysis system (RIAS) to evaluate clinicians’ conversational strategies and to analyze interactions between clinicians and patients. Results: Clinicians showed a high degree of tenacity in trying to engage patients in the clinical conversation, build rapport, and gather crucial diagnostic information. However, patients often responded briefly and monosyllabically, or kept quiet. In psychiatry where commonality of language cannot be assumed, it is not possible to determine the clinical significance of these responses. Discussion: Clinicians went to great lengths to understand LEP patients. It is also clear that patients were often not optimally understood. Clinicians would try to gain valid information in a polite manner, but would abandon these attempts repeatedly as it became clear that proper communication was not possible. Conclusions: Our findings suggest that in the absence of interpreter services, the communication between clinicians and LEP patients is sparse and yields limited clinical information. The lack of proper language services stands in the way of optimal clinical care and requires urgent attention.
- ItemDie effek van 'n troeteldier-ondersteunde leesprogram op woordherkenningsvaardighede van graad 3-kinders(Suid-Afrikaanse Akademie vir Wetenskap en Kuns, 2015-06) Le Roux, Marieanna; Swartz, Leslie; Swart, EstelleDie doel van die huidige studie was om die effek van ’n troeteldier-ondersteunde leesprogram (TOL) op die woordherkenningsvaardighede van graad 3-kinders te bepaal. Al die kinders wat met behulp van die ESSI Leestoets as nievaardige lesers (N=102) geïdentifiseer is, is ewekansig toegewys aan drie eksperimentele groepe en een kontrolegroep. Een maal per week vir 10 weke lank het die Leeshondgroep (n=27) vir ’n leeshond in die teenwoordigheid van ’n Pets as Therapyvrywilliger gelees, die Volwassenegroep (n=24) het slegs vir ’n volwassene gelees terwyl die Teddiebeergroep (n=26) vir ’n teddiebeer in die teenwoordigheid van ’n volwassene gelees het. Die Kontrolegroep (n=25) het voortgegaan met hul normale skoolaktiwiteite. Die kinders in die drie eksperimentele groepe het individueel vir ongeveer 20 minute gelees uit graad 1-, 2- en 3-vlak boekies. Data-insameling het plaasgevind voor die aanvang van die leesprogram (Tyd 1), direk ná voltooiing van die leesprogram (Tyd 2) en met ’n opvolgmeting agt weke later (Tyd 3). Die resultate het getoon dat die kinders in die Leeshondgroep op ’n beduidend hoër graadvlak gelees het tydens Tyd 2 en Tyd 3 as die ander drie groepe.
- ItemExploring partnerships between Academia and Disabled Persons’ Organisations : lessons learned from collaborative research in Africa(Institute of Development Studies, 2019) Kett, Maria; Carew, Mark T.; Asiimwe, John-Bosco; Bwalya, Richard; Gitonga, Anderson; Nyehn, Boakai A.; Olenja, Joyce; Swartz, Leslie; Groce, NoraENGLISH ABSTRACT: In this article, we discuss how our academic research on disability and international development in five African countries has benefited hugely from active collaboration with advocates, practitioners, and policymakers, ultimately ensuring that research evidence is used to inform policy and practice. Whilst building such partnerships is seen as good practice, it is particularly important when working on disability issues, as the clarion call of the disability movement, ‘nothing about us without us’, attests. This is not just a slogan. Without the active and critical engagement of disabled people – as researchers, participants, advocates – the evidence gathered would not have the same impact. This article discusses experiences from research in Liberia, Kenya, Uganda, Sierra Leone, and Zambia. It highlights the challenges and opportunities such partnerships can bring in achieving the goals of leaving no one behind and doing nothing without the active engagement and inclusion of persons with disabilities.
- ItemExploring the interaction of activity limitations with context, systems, community and personal factors in accessing public health care services : a presentation of South African case studies(AOSIS Publishing, 2017-02) Mji, Gubela; Braathen, Stine H.; Vergunst, Richard; Scheffler, Elsje; Kritzinger, Janis; Mannan, Hasheem; Schneider, Marguerite; Swartz, Leslie; Visagie, SuronaBackground: There are many factors that influence access to public health services, such as the context people live in, the existing health services, and personal, cultural and community factors. People with disabilities (activity limitations), through their experience of health services, may offer a particular understanding of the performance of the health services, thus exposing health system limitations more clearly than perhaps any other health service user. Aim: This article explores how activity limitations interact with factors related to context, systems, community and personal factors in accessing public health care services in South Africa. Setting: We present four case studies of people with disabilities from four low-resource diverse contexts in South Africa (rural, semi-rural, farming community and peri-urban) to highlight challenges of access to health services experienced by people with activity limitations in a variety of contexts. Methods: One case study of a person with disabilities was chosen from each study setting to build evidence using an intensive qualitative case study methodology to elucidate individual and household experiences of challenges experienced by people with activity limitations when attempting to access public health services. In-depth interviews were used to collect data, using an interview guide. The analysis was conducted in the form of a thematic analysis using the interview topics as a starting point. Results: First, these four case studies demonstrate that equitable access to health services for people with activity limitations is influenced by a complex interplay of a variety of factors for a single individual in a particular context. Secondly, that while problems with access to public health services are experienced by everyone, people with activity limitations are affected in particular ways making them particularly vulnerable in using public health services. Conclusion: The revitalisation of primary health care and the introduction of national health insurance by the Health Department of South Africa open a window of opportunity for policy makers and policy implementers to revisit and address the areas of access to public health services for people with activity limitations.