Doctoral Degrees (Centre for Disability and Rehabilitation Studies)

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    An exploration of lower limb prosthetics service delivery in Namibia in comparison to global standards
    (Stellenbosch : Stellenbosch University, 2023-03) Likando, Christopher Mubita; Visagie, Surona; Mji, Gubela; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
    ENGLISH SUMMARY: Background: In 2017, the World Health Organisation published prosthetics and orthotics standards that are aimed at improving prosthetics and orthotics services internationally. The standards are meant to assist member states to improve prosthetics service delivery. The prosthetics standards document calls for the comparison of “the national prosthetics systems and services with the complete set of standards to derive a baseline against which to monitor further development” (WHO, 2017: xxi). Aim: The aim of this study was to explore the status of lower limb prosthetics service delivery in the public healthcare system of Namibia and compare it against the World Health Organisation`s global standards for prosthetics and orthotics. Methods: A sequential mixed methods design was adopted for this study where qualitative (descriptive) and quantitative (cross-sectional survey) data were collected and analysed sequentially. The study was carried out in Namibia's Khomas (urban) and Oshana (rural) regions. Insufficient records necessitated non-probability sampling in both settings and phases. Qualitative data were collected through semi-structured interviews with two service managers, nine service providers, and 16 prosthetics service users guided by interview schedules. Quantitative data were collected from two service managers, ten service providers, and 120 lower limb prosthetics service users. A survey was developed for managers and providers while users completed the TAPES-R. Content analysis was used for the qualitative data. The 60 standards provided deductive themes. Quantitative data was mainly analysed descriptively. Data from the two phases was triangulated and presented together. Findings: Findings showed that 12 of the 60 standards were implemented in Namibia. A further 28 were partially adhered to, while 20 were not implemented at all. Namibia had national policies that guide prosthetic service delivery, but the policies were outdated and not well adhered to. The study established that funding was available but insufficient. There was a wide range of prosthetics products available at no cost to users. Users’ needs were mostly met by available prosthetic products except for the ability to perform vigorous activities and participate in sports, which were limited for 90.8% (n=109) and 87.5% (n=105) of users respectively. Service users 82.6% (n=99) were satisfied with their prosthetic devices and the prostheses allowed them to be economically active 75.0% (n=90). Service providers were well-trained but did not regularly participate in continuous professional development. Training to qualify as a prosthetics service provider was not available in Namibia and in-service training opportunities were scarce. The number of service providers was insufficient. Lower limb prosthetics services were provided to all in need but often this involved long travel distances (mean 258.38 km; sd 265.611) as services at the primary level were not readily available. Users were not involved in policy development and implementation. Experienced users had the choice of products and providers, but first-time users did not. Users were provided with training, follow-up, and repairs. There was little collaboration with other team members during prosthetic rehabilitation. Conclusion: The study showed that more efforts are needed toward improving the delivery of lower limb prosthetics services in Namibia and upgrading them to levels that are in accordance with the World Health Organisation standards. It was concluded that a systems approach, based on the ten ‘Ps’ of systems thinking in assistive technology, could be adopted as a conceptual framework to identify interventions that can be most effective and efficient in efforts to meet the required standards.
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    Experiences of persons with disabilities of Xhosa rituals and traditions, which contribute to health and wellbeing
    (Stellenbosch : Stellenbosch University, 2023-03) Dwadwa-Henda, Nomvo; Mji, Gubela; Ohajunwa, Chioma; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
    ENGLISH SUMMARY: The disability scholarship has always been dominated by Western literature (1)(2)(3)(4) which locates disability on the person and presents it as a tragedy without considering contextual factors which contribute to the various understandings of disability by people of the South. With a paucity of literature on disability by African scholars, some literature on disability in Africa is most of the time presented by people from the North who leave out the situations and things that existed in the past and are part of the people’s history – this is a missed opportunity on important aspects of disability of Indigenous peoples. The study explored the Xhosa rituals and traditions of Bomvana people (an Indigenous community in the Eastern Cape Province of South Africa) from birth to adulthood, and how persons with disabilities experienced these rituals. The study also explored the contribution of these rituals to the health and wellbeing of the person. Factors that contributed towards building a collective disability framework that is centred around the worldview of AmaBomvana for the health and wellbeing of the community were also explored. Data gathering methods included an exploratory case study with persons with disabilities, focus group discussions with knowledge holders, observations, one-on-one in-depth interviews, journaling, and informal conversations. Sampling of participants from the three Gusi village clusters comprised of 50 participants. Content analysis was used with the text divided into meaningful units – guided by the study aim and the research questions. The PhD study findings presented conceptualisation of disability by AmaBomvana, which demonstrated that their Indigenous worldview plays a role in how they interpret the world. Their understanding of disability is in contrast with Western approaches, and carries respect and dignity, which attests to their ancestral reverence – whereby spirituality takes precedence to the physical. Hence their disability ontology is quite unique and comforting. Ubuntu as the Bomvana guiding principle serves to examine and guide justification for their moral judgements in their community. The study concluded by proposing a disability framework that is modelled on collectivism which continues to express Ubuntu philosophy as principle.
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    An exploration of the development of community health forums as a strategy to improve communication between biomedical health professionals and an indigenous community : a rural participatory action research study
    (Stellenbosch : Stellenbosch University, 2021-12) Gxamza, Faniswa Desiree; Mji, Gubela; Reid, Steve; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
    ENGLISH SUMMARY : Rationale: Firstly, the existence of nine (9) clinics and a district hospital in Bomvaneland has been seen by people of this area as both a blessing and a problem as there is poor communication between allopathic health workers and the indigenous community. Allopathic health practitioners (AHP) chastise and marginalize patients who have used indigenous health (IH) prior to visiting allopathic healthcare services. Secondly, the complexity of understanding IH and that indigenous people have a concept of health that is eco-social and often communal, rather than individual. Thirdly, there is lack of institutional spaces where both indigenous knowledge system (IKS) and allopathic healthcare could be discussed for promoting wellness and quality of life of Bomvane people. Aim and Objectives: The study explored and described the development of a Community Health Forum as a strategy to improve communication between allopathic health practitioners and an indigenous community. The main study objectives were to explore and describe: • The process of establishing relationships and development of community partnerships. • Development of community health forums as a strategy to improve communication between allopathic health professionals and an indigenous community. Method: The main methods for data collection were ethnographic and participatory action research (PAR). Using participatory action research in cycles of reflection, the study covered four phases (1-4) to gain consensus on the main aim of the study, study objectives and data collection methods. During community entry and the three conferences (2016, 2018 and 2019), key community stakeholders from the nine (9) sub-municipalities of the research area participated. Mji’s critical research findings were used as a tool to initiate communication. Phase 5 focused on the development of a community health forum and data was collected from four sub-municipalities (Xhora, Gusi, Hobeni and Nkanya). Purposive and snowball sampling was used to select n=37 study participants (12 being allopathic health practitioners, eight indigenous healers and 15 community members). Data-gathering methods for phase 5, included focus group discussions, in-depth interviews, (Chilisa, 2012), journaling and photography. Phase 6 was the last method of data collection which was a conference in 2019 to pilot a community health forum. Findings: The study findings further affirmed the earlier propositions of challenges of communication and poor relationships between allopathic and indigenous health practitioners. When sick, the indigenous community uses both the indigenous and allopathic health practitioners. Some attempts had been made to improve these poor relationships by introducing a referral system, unfortunately this attempt was still not sufficient as it appears only the indigenous health practitioners refer their patients to allopathic health practitioners. This caused indigenous health practitioners to feel they are still not trusted by allopathic health practitioners. An outline was given by participants on the nature of future communication, including a framework that will drive the communication process between allopathic and indigenous health practitioners. At the core of this outline is a need for the communication process to be underpinned by respect for each other’s human dignity. One of the major findings of the study is the development of an Interim community health forum which was achieved in Phase 6 of this study. Mji’s critical research findings further affirmed negative social determinants of health (NSDH) that were blighting AmaBomvane. Unfortunately, it appears that with passage of time these had become worse with fighting of children and sickly older males suffering from ailments due to working in the mines. What gave hope out of this concerning situation is the draft MOU that was developed by the indigenous health practitioners. Within this MOU are guiding principles which are positive social determinants of health (PSDH) to support AmaBomvane to turn around the NSDH to PSDH. Conclusion: The dual health-seeking behaviour of AmaBomvana should not be seen in a negative light by allopathic health practitioners, instead they should try to understand more about indigenous health and its practises. The chastising of indigenous patients when they have consulted indigenous healers results in the silencing of indigenous patients. Communication is at the core of proper diagnosis and subsequent care for the sick patient. The paradigmatic differences that exist between allopathic and indigenous health practitioners might need time to be resolved. The community health forum seems to offer a bridge for these two constituencies to work together in a respectful manner despite their differences. These two healthcare systems need to acknowledge their different practices and come to a realisation that working together may not be possible but working in parallel and focusing on certain areas, such as social determinants of health, would improve the health of Bomvane people. In the wake of Covid-19 Pandemic, the suggested model (CHF) is a way forward for the area.
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    Reconnecting with Indigenous knowledge in education : exploring possibilities for health and well-being in Xhora, South Africa
    (Stellenbosch : Stellenbosch University, 2019-04) Ned, Lieketseng Yvonne; Mji, Gubela; Ramugondo, Elelwani; Devlieger, Patrick; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
    ENGLISH SUMMARY : Owing to coloniality, Eurocentric and western thinkers have been privileged in knowledge production while African indigenous thinkers and knowers have been subjugated. Consequently, western knowledge has been described as universal knowledge, while indigenous people’s knowledges remain characterized as backward and primitive. In this arrangement, the current education system reproduces inequities of knowledges. How this knowledge arrangement influences the persisting negative health status among indigenous people, and the role of formal schooling in this, remains unexplored in South Africa and beyond. There is a need to explore and describe from the perspectives of indigenous people the potential relevance of indigenous knowledges in transforming the formal education system for better health and well-being. Using case study design supported by narrative inquiry as methodological frameworks, I facilitated a case of narratives with AmaBomvane in Xhora (Eastern Cape province, SA) to: • describe AmaBomvane’s rural experience of the influence of the formal education system on their Indigenous traditions and knowledges and their links to health and well-being; • explore what stakeholders in these communities (elders, youth and teachers) identify as some of the Indigenous knowledges and ways of teaching and learning; and • explore how the identified knowledges and teaching and learning strategies of AmaBomvane can inform curriculum development and implementation in the formal schooling system. The case study provided contextual boundedness and situatedness to the research, while narrative inquiry uncovered the stories that formed the basis for exploring and describing the case in question. The participants played an active role in guiding the research process. Indigenous methods (talking circles and storytelling using the sagacity approach) were used to collect narrative, primary data from residents of four sampled villages. In-depth interviews with teachers and principals from schools across the villages and other methods such as researcher observations and spontaneous conversations were used. The sagacity approach, reflexivity, reciprocity and continuous relationship-building grounded these methods. A case of seven co-constructed narratives highlighted three typologies (Amaqaba, Amagqobhoka, and Agonizers: the uncomfortable in-betweeners) related to the complex interactions and dynamics between formal schooling and the communities and/or homes. These typologies reveal the intersecting operations of coloniality of power, being, knowledge and doing. The literacies of AmaBomvane challenge the academy by bringing considerable insight into our understanding of knowledge itself, learning and the purpose of education and curriculum. The inseparable link between everyday doing, knowing and being was highlighted as central to knowledge production. AmaBomvane’s conceptualization of knowledge also highlighted an inextricable link between health and education, thus advocating for an education that enhances living well. In conclusion, colonial education emerged as a potential negative social determinant of AmaBomvane’s health as it produces people who are deeply alienated from themselves, their lands, cultures, ancestors, languages and knowledges. Its historical roots, forced assimilation and the unquestionable characteristic of curriculum create a colonising attitude amongst learners and educators. I therefore argue that coloniality and colonial education be recognised as broader social determinants of ill health. I argue that centering indigenous knowledges and cultures within the formal schooling curriculum may contribute to strengthening positive indigenous identities, thus contributing to better physical, social, mental, emotional and spiritual health and well-being. There is an urgent need to prepare educators who are socially conscious and competent to facilitate a health-enhancing curriculum that enables learners to live well. Given the revealed inextricable link between health and education, I also recommend that South African national curriculum immerse health and well-being as a core area of learning. I have thus developed an indigenous-decolonial framework for reconstructing curriculum for health and well-being as a guide.
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    Understanding, interpretation and expression of spirituality and its influence on care and wellbeing : an explorative case study of a South African indigenous community
    (Stellenbosch : Stellenbosch University, 2019-04) Ohajunwa, Chioma Ogochukwu; Mji, Gubela; Kalenga, Rosemary; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
    ENGLISH SUMMARY : With the historical entrance of western spirituality and healthcare into Africa, and the philosophical frameworks they embody, tensions have been created within South African indigenous contexts that impact negatively on the social determinants of health and community wellbeing. Indigenous South African communities assert that western healthcare and spirituality have sidelined their indigenous spiritual practices. This sidelining has created divisions within the community which have informed this case study and the need to explore spiritual understandings that contribute to a collective wellbeing for this community. This study is focused on exploring the ways that indigenous communities understand, interpret and express their spirituality and how these ways of seeing spirituality influence care and wellbeing. The study also aims to explore what factors can contribute to building a collective spirituality framework that contributes to community wellbeing. The study is positioned within a constructivist interpretive paradigm using an exploratory ethnographic case study approach. Data-gathering methods include focus group discussions, observations, one-on-one in-depth interviews, opportunistic conversations (Chilisa, 2012), journaling and photography. Purposive sampling with n=52 study participants from the four Gusi village clusters of the Elliotdale district in the Eastern Cape was carried out. An analytical strategy of theoretical propositions (Yin, 2009) stemming from the guiding proposition and research questions guided the analysis. The Bomvana communities understand spirituality as a multi-level process that involves caring relationships within all of nature. These understandings are influenced by history, context and access to spiritual resources to position the four communities within the subliminal, liminal and supraliminal spaces on a continuum of wellbeing, supporting cultural disruption or supporting cultural continuity to influence wellbeing. The first community still resides within the ideal spirituality space at the start of the continuum although it is beginning to move towards the liminal space, while the other three communities have moved on the continuum into the liminal spirituality space. The communities are experiencing tensions and a lack of wellbeing due to the different ways of expressing their spiritualities. Narratives of participants regarding Ubuntu are utilised to build a thesis on an understanding of African Indigenous Transcultural Spirituality to inform wellbeing. This concept is proposed as a collective spirituality framework that has the potential to support a community-led approach when engaging with African indigenous communities.