Doctoral Degrees (Centre for Disability and Rehabilitation Studies)

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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.
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    Disability and health care access in an isolated quarter of the Karoo
    (Stellenbosch : Stellenbosch University, 2015-04) Visagie, Surona; Swartz, Leslie; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Centre for Rehabilitation Studies.
    ENGLISH ABSTRACT: Introduction: High quality comprehensive health care services contribute to community integration and participation of persons with disability. However, persons with disabilities often experience barriers with regard to health care access. Neither these barriers nor the concept of disability have been sufficiently explored in rural Global South settings. This study describes the experience of living with a disability in a remote, rural setting with a specific focus on barriers and facilitators to health care access. Method: A qualitative design utilising case study methodology and interpretative phenomenological analysis was used. The study population consisted of 283 persons with moderate or severe activity limitations, who lived in a rural town in the Northern Cape Province of South Africa. Eight of them were purposively sampled as anchor participants in eight case studies. Their significant others completed each case study. In addition data were collected from six service providers to the study community. Data were collected through 19 in-depth interviews and one focus group discussion, between March and October 2012. The principles of interpretative phenomenological analysis were used to analyse data and identify themes. Similar themes were clustered under superordinate themes. Cases were analysed separately after which patterns across cases were identified. Results: Participants conceptualised disability as an individual problem according to the moral or medical approaches and often interpreted disability as physical in nature. Participants’ level of participation and community integration varied from very little to being employed and well integrated. Self-belief and the attitude and support of significant others, community members and employers played an important role in the level of participation persons with disability achieved. Participants’ primarily utilised public, formal, health care services. These services were found to be mainly curative and preventative in nature. The provision of health promotion and rehabilitation were lacking. Users were not empowered to take control of their own health management and were not included in the health care team. Health system barriers identified included insufficient human and material resources, communication challenges, Stellenbosch University https://scholar.sun.ac.za iv and rigid protocols. The remoteness of the setting hampered health care service delivery. Free health care provision, high quality services at tertiary level, and outreach services to the community were identified as facilitators. A lack of products and technology, poverty, and low levels of education created further barriers to community integration and health care access. Implications: Suboptimal health care together with personal and environmental barriers might have resulted in poor health, functional, community integration, and participation outcomes for participants. Health care was provided reactively to individual users and not according to the principles of primary health care. The little rehabilitation that was provided was not enough to ensure improved functioning or community integration and participation. Recommendations: Since this was an inductive study with few participants recommendations centre on hypotheses for further study. The focus of these theories is on ways to provide health care according to the philosophy of primary health care and on introducing specific rehabilitation programmes in the community.