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

Gxamza, Faniswa Desiree (2021-12)

Thesis (PhD)--Stellenbosch University, 2021.

Thesis

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.

AFRIKAANSE OPSOMMING : Rasionaal: Eerstens is die bestaan van nege (9) klinieke en 'n distrikshospitaal in Bomvaneland deur mense van hierdie gebied gesien as beide 'n seën en 'n probleem omdat daar swak kommunikasie tussen allopatiese gesondheidswerkers en die inheemse gemeenskap is. Allopatiese gesondheidspraktisyns (AHP) tugtig en marginaliseer pasiënte wat inheemse gesondheid (IH) gebruik het voordat hulle allopatiese gesondheidsorgdienste besoek het. Tweedens, die kompleksiteit van die begrip van IH en dat inheemse mense het 'n konsep van gesondheid wat eko-sosiale en dikwels gemeenskaplike, eerder as individu. Derdens is daar 'n gebrek aan institusionele ruimtes waar beide inheemse kennisstelsel (IKS) en allopatiese gesondheidsorg bespreek kan word vir die bevordering van welstand en lewensgehalte van Bomvane-mense. Doelstellings en doelwitte: Die studie het die ontwikkeling van 'n Gemeenskapsgesondheidsforum ondersoek en beskryf as 'n strategie om kommunikasie tussen allopatiese gesondheidspraktisyns en 'n inheemse gemeenskap te verbeter. Die hoofstudiedoelwitte was om die volgende te verken en te beskryf: • Die proses om verhoudings en ontwikkeling van gemeenskapsvennootskappe te vestig. • Ontwikkeling van gemeenskapsgesondheidsforums as 'n strategie om kommunikasie tussen allopatiese gesondheidswerkers en 'n inheemse gemeenskap te verbeter. Metode: Die belangrikste metodes vir data-insameling was enografiese en deelnemende aksienavorsing (PAR). Met behulp van deelnemende aksie navorsing siklusse van nadenke, die studie gedek vier fases (1-4) konsensus te kry oor die hoofdoel van die studie, studie doelwitte en data-insameling metodes. Tydens gemeenskapsinskrywing en die drie konferensies (2016, 2018 en 2019) het sleutelgemeenskapsbelanghebbendes van die nege (9) submunisipaliteite van die navorsingsgebied deelgeneem. Mji se kritieke navorsingsbevindinge is gebruik as 'n instrument om kommunikasie te inisieer. Fase 5 het gefokus op die ontwikkeling van 'n gemeenskapsgesondheidsforum en data is van die vier submunisipaliteite (Xhora, Gusi, Hobeni en Nkanya) ingesamel. Purposive en sneeubal monsterneming is gebruik om n=37 studie deelnemers te kies (12 is allopatiese gesondheidspraktisyns, agt inheemse genesers en 15 gemeenskapslede). Data-insameling metodes ingesluit fokusgroep besprekings, in-diepte onderhoude, (Chilisa, 2012), joernaal en fotografie. Fase 6 was die laaste metode van data-insameling wat in 2019 'n konferensie was om 'n gemeenskapsgesondheidsforum te loods. Bevindinge: Die studiebevindings het verder die vroeëre voorstelle van uitdagings van kommunikasie en swak verhoudings tussen allopatiese en inheemse gesondheidspraktisyns bevestig. Wanneer siek, gebruik die inheemse gemeenskap beide die inheemse en allopatiese praktisyns. Sommige pogings is aangewend om hierdie swak verhoudings te verbeter deur 'n verwysingstelsel in te stel, ongelukkig was hierdie poging steeds nie voldoende nie, aangesien dit blyk dat slegs die inheemse gesondheidspraktisyns hul pasiënte na allopatiese gesondheidspraktisyns verwys. Dit verhoog weer die kwessie dat inheemse gesondheidspraktisyns voel hulle word nie deur allopatiese gesondheidspraktisyns vertrou nie. 'n Uiteensetting is deur deelnemers gegee oor die aard van toekomstige kommunikasie, insluitend 'n raamwerk wat die kommunikasieproses tussen allopatiese en inheemse gesondheidspraktisyns sal dryf. Die kern van hierdie uiteensetting is 'n behoefte aan die kommunikasieproses wat ondersteun moet word deur respek vir mekaar se menswaardigheid. Een van die belangrikste bevindinge van die studie is die ontwikkeling van 'n tussentydse gemeenskapsgesondheidsforum wat in Fase 6 van hierdie studie behaal is. Mji se kritieke navorsingsbevindings het verder negatiewe maatskaplike determinante van gesondheid (NSDH) bevestig wat AmaBomvane aan die lig gebring het. Ongelukkig blyk dit dat dit met verloop van tyd erger geword het met bakleiery tussen kinders en siek ouer mans weens die werk in die myne. Wat hoop hieruit gegee het rakende die situasie, is die konsep-MOU wat deur die inheemse gesondheidspraktisyns ontwikkel is. Binne hierdie MOU lei beginsels wat positiewe sosiale bepalings van gesondheid (PSDH) is om AmaBomvane te ondersteun om die NSDH na PSDH om te draai. Gevolgtrekking: Die dubbele gesondheidssoekende gedrag van AmaBomvana moet nie in 'n negatiewe lig deur allopatiese gesondheidspraktisyns gesien word nie, in plaas daarvan moet hulle probeer om meer oor inheemse gesondheid en sy praktyke te verstaan. Die tugtiging van inheemse pasiënte wanneer hulle inheemse genesers geraadpleeg het, lei tot die stilmaak van inheemse pasiënte. Kommunikasie is die kern van behoorlike diagnose en daaropvolgende sorg vir die siek pasiënt. Die paradigmatiese verskille wat tussen allopatiese en inheemse gesondheidspraktisyns bestaan, het dalk tyd nodig om opgelos te word. Dit lyk of die gemeenskapsgesondheidsforum 'n brug vir hierdie twee kiesafdelings bied om op 'n respekvolle wyse saam te werk ten spyte van hul verskille. Hierdie twee gesondheidsorgstelsels moet hul verskillende praktyke erken en tot 'n besef kom dat saamwerk dalk nie moontlik is nie, maar parallel werk en op sekere gebiede fokus, soos sosiale bepalings van gesondheid, die gesondheid van Bomvane-mense sal verbeter. In die nasleep van Covid-19 Pandemie is die voorgestelde model (CHF) 'n pad vorentoe vir die gebied.

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