The violence of curriculum: Dismantling systemic racism, colonisation and indigenous erasure within medical education.

BACKGROUND: Epistemic violence is enacted in medical curricula in mundane ways all the time, negatively impacting learners, teachers and patients. In this article, we address three forms of such violence: White supremacy, indigenous erasure and heteronormativity. METHODS: In this article, we examine the knowledge systems of medicine as a global phenomenon, impacted by Western and European ideologies of race and colonisation, both produced by them, helping to reproduce them through authoritative and hegemonic ideologies. We seek not only to problematise but also to propose alternative teaching approaches rooted in the Global South and in Indigenous ways of knowing. Taking inspiration from Paulo Freire, we advocate for the development of critical consciousness through the integration of critical pedagogies of love, emancipation and shared humanity. Drawing on Irihapeti Ramsden, we advocate for cultural safety, which emphasises power relations and historical trauma in the clinical encounter and calls for a rights-based approach in medical education. Deliberately holding space for our own vulnerabilities and that of our students requires what Megan Boler calls a pedagogy of discomfort. CONCLUSIONS AND SIGNIFICANCE: Our perspectives converge on the importance of critical consciousness development for culturally safe practice in medical education, acknowledging the need to emphasise a curriculum of shared humanity, introducing the concept of Ubuntu from Southern Africa. Ubuntu can be encapsulated in the phrase 'I am because we are', and it promotes a collective approach to medical education in which there is active solidarity between the profession and the diverse populations which it serves.

Delivering a psychosocial program for older people living in retirement homes during the Covid-19 pandemic: A process evaluation and recommendations for community interventions.

The Covid-19 pandemic lockdown regulations caused retirement homes to temporarily ban in-person visitation potentially increasing the mental health risks of older people. An opportunity arose for a multistakeholder community collaboration to design a mental health program for older people. To evaluate the process of delivering a 12-week psychosocial program aimed at preventing loneliness, countering boredom, and providing older people in restricted settings with education about Covid-19 during the lockdown, in Durban, South Africa. A qualitative retrospective design was used. Data from two focus groups and six semistructured individual interviews conducted with stakeholders (volunteers, social workers, and residents) postproject were analyzed using reflexive thematic analysis. Stakeholders had varied experiences of the project, in terms of content, processes of engagement, and implementation, resulting in five themes. The study concluded with recommendations. A strong need exists for multistakeholder community collaborations when implementing a program where the context restricts physical access.

Queering global health: an urgent call for LGBT+ affirmative practices.

This Viewpoint was submitted in response to the call for papers on the theme "What is wrong with global health?". We answer the question simply: global health under-represents the experiences of LGBT+ people. Queer contexts are missing from the pages of this journal-a strange exclusion given the journal's commitment to diversity and inclusion of marginalised voices. Indeed, there is a general neglect within global health scholarship of the intersection between health inequities and LGBT+ populations in low-income and middle-income countries in Africa. This Viewpoint discusses the utility of LGBT-affirmative scholarship developed in South Africa, and its use and application in Nigeria and Cameroon.

Major Depression and Stigma among Individuals with Multidrug-Resistant Tuberculosis in South Africa.

Stigma is an important social determinant of health-seeking behavior; however, the nature and extent of its association with depression among people living with multidrug-resistant tuberculosis (MDR-TB) are not well-understood. We enrolled 200 microbiologically confirmed MDR-TB inpatients at a TB specialist hospital in KwaZulu-Natal Province, an area considered the epicenter for MDR-TB coinfection in South Africa. Four aspects of stigma and their association with major depression were assessed through individual interviews: 1) community and 2) patient perspectives toward TB, and 3) community and 4) patient perspectives toward HIV. A major depressive episode (MDE), HIV coinfection, and low income were significantly associated with greater stigma subscales. Based on an adjusted regression model, the MDE was the only factor independently associated with (all aspects of) stigma. These results indicate the potential utility of addressing stigma associated with the MDE as an important step in improving health-seeking behavior to promote adherence and retention in care.

Queering the history of South African psychology: From apartheid to LGBTI+ affirmative practices.

This article constructs a brief history of how lesbian, gay, bisexual, transgender and intersex (LGBTI) issues have intersected with South African psychology at key sociopolitical moments, filling a gap in current histories. Organized psychology-a primary focus of this analysis-since its first formations in 1948, mostly colluded with apartheid governments by othering queerness as psychopathology or social deviance. The National Party, both homophobic and racist, ruled the country from 1948 until the first democratic elections in 1994. The acceleration of antiapartheid struggles in the 1980s saw progressive psychologists develop more critical forms of theory and practice. However, LGBTI+ issues remained overshadowed by the primary struggle for racial equality and democracy. Psychology's chameleon-like adaptation to evolving eras resulted in a unified organization when apartheid ended: the Psychological Society of South Africa (PsySSA). Democratic South Africa's Constitution took the bold step of protecting sexuality as a fundamental human right, galvanizing a fresh wave of LGBTI+ scholarship post-1994. However, LGBTI+ people still suffered prejudice, discrimination, and violence. Additionally, psychology training continued to ignore sexual orientation and gender-affirmative health care in curricula. PsySSA therefore joined the International Psychology Network for Lesbian, Gay, Bisexual, Transgender and Intersex Issues (IPsyNet) in 2007, catalyzing the PsySSA African LGBTI+ Human Rights Project in 2012 and two pioneering publications: a position statement on affirmative practice in 2013, and practice guidelines for psychology professionals working with sexually and gender-diverse people in 2017. This article traces a neglected history of South African psychology, examining the political, social, and institutional factors that eventually enabled the development of LGBTI+ affirmative psychologies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).