Experiences of Black South African widows regarding mourning rituals following the death of their spouses: Upholding cultural practices or violating human rights?

Within South African cultures, bereavement rituals are intended to promote healing on the part of the widow and demonstrate respect for the deceased. We explored the experiences of 10 Black South African widows regarding cultural mourning rituals and whether they were perceived to violate human rights or were necessary cultural practices. Findings from telephone interviews revealed that the widows experienced restrictions on movement, certain activities, mode of dress, and seating arrangements; used separate utensils; and engaged in cleansing rituals. While they were aware of their rights being violated, they felt that cultural practices needed to be respected to appease their ancestors.

Comparison of Quantitative Versus Qualitative Assessment of Single Right Ventricular Function for the Prediction of Midterm Outcomes.

Multiple studies have shown that quantitative evaluation of right ventricular (RV) systolic function in children with hypoplastic left heart syndrome (HLHS) is associated with outcomes. However, the most widely used method is qualitative, or subjective echocardiographic evaluation. Tricuspid annular displacement (TMAD) is a quantitative method and has been shown to be associated with transplant/death in a cohort of pediatric patients with HLHS. In this study, the same echocardiograms used in the quantitative TMAD study were qualitatively evaluated to see if the assessment correlated with midterm outcomes. We hypothesized that TMAD measures would outperform qualitative measurements. A previously published retrospective study of patients with systemic right ventricle demonstrated that TMAD measurements of function prior to the Glenn procedure were associated with midterm mortality/transplant (mean TMAD 12.4% for survivors and 10.0% for non-survivors/transplant, p = 0.03). Echocardiographic images used in that study were re-evaluated using qualitative assessment of function. A score between severely depressed (0) and supra-normal (7) was assigned independently by three cardiologists. A chart review included short-term clinical outcome measures in addition to midterm mortality/transplant. Spearman correlations and logistic regression were used to estimate the associations between function scores and clinical outcomes. Function scores were measured with acceptable inter- and intra-rater reliabilities in 47 patients who had echocardiograms used in the prior analysis before their bidirectional Glenn. The mean functional score was 5.3 ± 1.32 in survivors and 5.0 ± 1.02 in non-survivors/transplant. Subjective echocardiographic scores of function were not predictive of mortality (p = 0.23). Scores were correlated with length of cardiac intensive care unit stay (Spearman's rho = - 0.31, p = 0.04), but not post-Glenn total length of hospital stay (p = 0.4). A sub-analysis was performed for each individual operator. Only one of three operators produced scores with a significant association with mortality/transplant (p = 0.01, p = 0.25, p = 0.22, respectively). Averaged subjective measurement of function by three pediatric cardiologists in children with single right ventricle prior to the Glenn procedure was not associated with midterm outcomes. Previous work based on the same echocardiograms showed that quantitative analysis was associated with midterm outcomes. This suggests quantitative analysis may be more useful in prognostication. Future studies could confirm these results and identify which quantitative methods are most helpful.

Biomedical healthcare and African traditional healing in the management of HIV and AIDS: complimentary or competing cosmologies?

In South Africa, African traditional healers and biomedical practitioners play important roles in the management of HIV and AIDS, but provide healthcare services in isolation of each other, despite legislative recognition of both types of healing. An interpretive, qualitative research approach was employed to elicit the views of both groups regarding the feasibility of collaboration. Semi-structured interviews were conducted with a sample of 20 participants with 10 persons from each group. Key findings were that African traditional healers referred their patients to hospitals but never received referrals from biomedical health care practitioners. The traditional healers took precautions to avoid drug interactions between their medicines and antiretrovirals (ARVs). Biomedical healthcare practitioners recommended that traditional medicine only be used externally to avoid interaction with ARVs. Lack of shared knowledge, poor dosages and medical complications due to the use of African traditional medicine were viewed as threats to the collaboration between the two groups, while open communication, research into the efficacy, scientific administration and proper dosages of African traditional medicine were articulated as facilitating factors. The main conclusion was that biomedical practitioners, traditional healers and government officials responsible for formulating healthcare policies need to be involved in devising a framework that would facilitate ways of encouraging collaboration between these two healthcare systems.

Disparities in physical access and healthcare utilization among adults with and without disabilities in South Africa.

BACKGROUND: In South Africa barriers to accessing health services by persons with a disability would appear to be exacerbated by the overburdened state of public healthcare. OBJECTIVES: /Hypotheses: The study examined physical access to and utilization of healthcare services by persons with and without a disability. It was hypothesized (1) that households with disabled members were less likely than households with non-disabled members to have good physical access to healthcare; and (2) households with disabled members were less likely to have visited a health facility in the preceding 12 months. METHOD: A secondary analysis of adult data from the South African General Household Survey (GHS) (2014) was conducted. Data were analysed using the Stata statistical programme. Analyses included frequencies and percentages, X2 tests of association and Cramer's V. RESULTS: Findings from the individual level of data analysis indicated that 11% of adults were people with a disability with the most common disability being seeing difficulties. Households with disabled members were more likely to have poorer physical accessibility to healthcare in terms of having no medical aid, using public healthcare facilities, walking to the health facility and taking longer travelling time compared with non-disabled households (p=<0.05), thereby confirming hypothesis 1. Despite having poorer physical access, households with disabled members were more likely to have visited a health facility during the preceding 12 months (p=<0.05), thereby rejecting hypothesis 2. CONCLUSIONS: These findings highlight inequities in physical accessibility to healthcare and the need for National Health Insurance for all citizens.

Tracking preleukemic cells in vivo to reveal the sequence of molecular events in radiation leukemogenesis.

Epidemiological studies have demonstrated an increased leukemia incidence following ionizing radiation exposure, but to date, the target cells and underlying mechanisms of radiation leukemogenesis remain largely unidentified. We engineered a mouse model carrying a different fluorescent marker on each chromosome 2, located inside the minimum deleted region occurring after radiation exposure and recognized as the first leukemogenic event. Using this tailored model, we report that following radiation exposure, more than half of asymptomatic CBA Sfpi1 GFP/mCh mice presented with expanding clones of preleukemic hematopoietic cells harboring a hemizygous interstitial deletion of chromosome 2. Moreover, following isolation of preleukemic hematopoietic stem and progenitor cells irradiated in their native microenvironment, we identified the presence of Sfpi1 point mutations within a subpopulation of these preleukemic cells expanding rapidly (increasing from 6% to 55% in 21 days in peripheral blood in one case), hence identifying for the first time the presence of such cells within a living animal. Importantly, we also report a previously undescribed gender difference in the phenotype of the preleukemic cells and leukemia, suggesting a gender imbalance in the radiation-induced leukemic target cell. In conclusion, we provide novel insights into the sequence of molecular events occurring during the (radiation-induced) leukemic clonal evolution.

Right ventricular outflow tract growth in infants with palliated tetralogy of fallot.

BACKGROUND: In symptomatic neonates with tetralogy of Fallot with pulmonary stenosis (TOF/PS), limited contemporary data exist regarding the effect of a modified Blalock-Taussig shunt (mBTS) on pulmonary valve (PV) and pulmonary artery (PA) growth and on the incidence of PV preservation at the time of complete repair. METHODS: We retrospectively studied patients who underwent repair of TOF/PS from 2000 to 2012 at our center. In neonates with TOF/PS palliated with an mBTS, we assessed PV annulus, main PA (MPA), and branch PAs (left PA [LPA] and right PA [RPA]) size by echocardiography before mBTS and surgical repair. RESULTS: Of 172 patients with TOF/PS, 40 (23%) were palliated with an mBTS at a median age of 23 days, and 31 met criteria for echocardiographic analysis. Palliated patients had hypoplastic PV, MPA, RPA, and LPA at baseline. All structures had significant absolute growth before surgical repair (p < 0.001). PV and MPA Z scores were unchanged, whereas branch PAs showed significant improvement (RPA, p = 0.03; LPA, p = 0.008). A PV-sparing repair was performed in 116 of 132 primary repairs (88%) and in 10 of 31 palliated patients (32%). At a median follow-up of 4.0 years (range, 0.7 to 12.6 years), no palliated patients required reintervention for right ventricular outflow tract obstruction. CONCLUSIONS: Significant absolute growth of the PV, MPA, RPA, and LPA occurs after an mBTS in neonates with TOF/PS. Branch PA size normalizes before complete repair. In one-third of patients with hypoplastic PVs, absolute growth after an mBTS may have facilitated valve-sparing repair.

Being black in a white skin: Beliefs and stereotypes around albinism at a South African university.

Background: Partly because of the legacy of apartheid, and despite being a constitutional democracy, South Africa continues to be a deeply divided society, particularly along racial lines. In this context many people with albinism do not fit neatly into black and white categories and are likely to experience social discrimination and marginalisation. Objectives: The study endeavoured to explore the beliefs and practices regarding albinism within a South African university, and the availability of support services. Method: The research was located within an interpretive qualitative paradigm and was framed within the theories of stigma, discrimination and 'othering'. Interviews were conducted with five students with albinism and 10 students without albinism. Results: Findings confirmed the existence of myths and stereotypes regarding albinism. Students with albinism tended to exclude themselves from the rest of the student community to avoid discrimination and stereotypes around their condition. Conclusion: People with albinism can teach us about social constructions of race, colour and relations between minority groups and the majority culture. Results have implications for schools, disability units at universities, and albinism societies in terms of opening up channels of communication between people with albinism and the general public and fostering knowledge and awareness thereof.

Engaging diverse social and cultural worlds: perspectives on benefits in international clinical research from South african communities.

The issue of benefits in international clinical research is highly controversial. Against the background of wide recognition of the need to share benefits of research, the nature of benefits remains strongly contested. Little is known about the perspectives of research populations on this issue and the extent to which research ethics discourses and guidelines are salient to the expectations and aspirations existing on the ground. This exploratory study contributes to filling this void by examining perspectives of people in low-income South African communities on benefits in international clinical research. Twenty-four individuals with and without experience of being involved in clinical research participated in in-depth interviews. Respondents felt that ancillary care should be provided to clinical research participants, while a clinical study conducted in particular community should bring better health to its members through post-trial benefits. Respondents' perspectives were grounded in the perception that the ultimate goal of international clinical research is to improve local health. We argue that perspectives and understandings of the respondents are shaped by local moral traditions rather than clinical research specificities and require attention as valid moral claims. It is necessary to acknowledge such claims and cultural worlds from which they emerge, thus building the foundation for equal and embracing dialogue to bridge different perspectives and handle contradicting expectations.

Developing personal attributes of professionalism during clinical rotations: views of final year bachelor of clinical medical practice students.

BACKGROUND: Medical professionalism as a set of behaviours that transcends personal values, beliefs and attitudes to incorporate ethical and moral principles is considered a covenant between society and the practice of medicine. The Bachelor of Clinical Medical Practice (BCMP) a three year professional degree was launched at the University of the Witwatersrand in January 2009 in response to a documented shortage of doctors especially in the rural areas of South Africa. The BCMP programme is unique in its offering as it requires a teaching approach that meets the needs of an integrated curriculum, providing for an accelerated transition from the classroom to the patient's bedside. METHODS: Following five week attachments in designated District Education Campuses, 25 final year BCMP students were required to reflect individually on the covenant that exists between society and the practice of medicine based on their daily interactions with health care workers and patients for three of the five rotations in a one page document. A retrospective, descriptive case study employed qualitative methods to group emerging themes from 71 portfolios. Ethical clearance was obtained from the Human Research Ethics Committee at the University of the Witwatersrand. RESULTS: As an outcome of an ethical analysis, the majority of BCMP students reflected on the determinants of accountable and responsible practice (N=54). The commitment to the Oath became significant with a personalised reference to patients 'as my patients'. Students acknowledged professional health care workers (HCWs) who demonstrated commitment to core values of good practice as they recognised the value of constantly reflecting as a skill (n=51). As the students reflected on feeling like 'guinea pigs' (n=25) migrating through periods of uncertainity to become 'teachable learners', they made ethical judgements that demonstrated the development of their moral integrity. A few students felt vulnerable in instances where they were pressured into 'pushing the line'. CONCLUSIONS: Through their portfolio narratives, BCMP students showed a willingness to shape their evolving journeys of moral growth and personal development. This study has highlighted as an ongoing challenge the need to identify a process by which professionalism is sustained by HCWs to benefit health sciences students.

Realizing or relinquishing rights? Homeless youth, their life on the streets and their knowledge and experience of health and social services in Hillbrow, South Africa.

Poverty and youth unemployment are critical issues in South Africa with homeless persons begging at traffic light intersections in all major cities. Support services represent one way of empowering homeless youth. The study therefore examined the experiences of 10 homeless young adult males in Hillbrow, Johannesburg and whether they were aware of local health and social services. Qualitative interviews revealed that participants experienced poor health, addiction, physical violence, psychological trauma, and public hostility. Despite limited education, they were aware of and utilized local health and social services. Findings are discussed in terms of their implications for social work.

Parents' perceptions of HIV counselling and testing in schools: ethical, legal and social implications.

In view of the high prevalence of HIV and AIDS in South Africa, particularly among adolescents, the Departments of Health and Education have proposed a school-based HIV counselling and testing (HCT) campaign to reduce HIV infections and sexual risk behaviour. Through the use of semi-structured interviews, our qualitative study explored perceptions of parents regarding the ethico-legal and social implications of the proposed campaign. Despite some concerns, parents were generally in favour of the HCT campaign. However, they were not aware of their parental limitations in terms of the Children's Act. Their views suggest that the HCT campaign has the potential to make a positive contribution to the fight against HIV and AIDS, but needs to be well planned. To ensure the campaign's success, there is a need to enhance awareness of the programme. All stakeholders, including parents, need to engage in the programme as equal partners. 

Sanctuary or double-edged sword? Challenges confronting adolescents living at Nkosi's Haven in Johannesburg, South Africa.

Living in an institution associated with HIV and AIDS is likely to exacerbate difficulties experienced by teenagers who have to cope with the normal stresses of adolescence. The aim of the study was to explore the challenges that adolescents living at Nkosi's Haven encounter and whether they experience any problems when interacting with their peers and other members of the community. The study was located within a qualitative research paradigm and utilised a purposive, non-probability sample of 15 participants recruited from two Nkosi's Havens. A semi-structured interview schedule was employed as the research tool, with in-depth one-on-one interviews adopted as the method of data collection. Thematic content analysis was used to analyse the data collected during the interviews. The main finding that emanated from the study was that Nkosi's Haven is indeed a place of care and nurturing as adolescents are afforded the opportunity to continue with their educational needs while basic and psychosocial needs are also addressed. However, it also emerged that rejection, discrimination, social exclusion and stigmatisation associated with the setting make it difficult for resident adolescents to integrate freely with their peers at school and in the community. The conclusion drawn is that Nkosi's Haven can be regarded as a double-edged sword as it presents both positive and negative factors that impact on its resident adolescents. Results are discussed in terms of their implications for community awareness programmes, policies and practice changes regarding employment and training of staff, and visiting of parents as well as future research.

Metabolic profiling of the rat liver after chronic ingestion of alpha-naphthylisothiocyanate using in vivo and ex vivo magnetic resonance spectroscopy.

Certain human diseases affecting the biliary tree can be modeled in rats by ingestion of the hepatobiliary toxin alpha-naphthylisothiocyanate (ANIT). Phosphorus magnetic resonance spectroscopy (MRS) allows the noninvasive monitoring of cell dynamics through detection of phosphodiesters (PDE) and phosphomonoesters (PME). Hepatic (31)P MRS techniques were therefore used to study the toxic effects of low-dose chronic ANIT ingestion, with a view toward providing biomarkers sensitive to hepatobiliary dysfunction and cholestatic liver injury. Rats were fed an ANIT supplemented diet at three doses (ANIT_0.05%, ANIT_0.04%, and ANIT_0.025%) for 2 weeks. Data from in vivo MRS were compared with results from pair-fed controls (PFCs). Blood and tissue samples were collected at 2 weeks for clinical chemistry, histology, and (1)H magic angle spinning MRS. Increases in PDE, relative to total phosphorus (tPh), were detected in both the ANIT_0.05% and ANIT_0.04% groups (0.07 ± 0.01 and 0.08 ± 0.01, respectively) relative to PFC groups (0.03 ± 0.01 and 0.05 ± 0.01, respectively). An increase in PME/tPh was observed in the ANIT_0.05% group only (0.17 ± 0.02) relative to PFC_0.05% (0.12 ± 0.01). Ex vivo (1)H MRS findings supported this, wherein measured phosphocholines (PCs) were increased in ANIT_0.05% and ANIT_0.04% groups. Increases in relative total choline (tCho) distinguished the ANIT_0.05% group from the ANIT_0.04% group. Markers of hepatotoxicity such as raised total bilirubin and alkaline phosphatase were found at all ANIT doses. Histological findings included a dose-related increase in both severity of biliary hyperplasia and focal hepatocellular necrosis. Here, we found that ANIT-induced moderate hepatobiliary dysfunction was associated with a relative increase in phosphodiesters in vivo and PCs ex vivo. Raised PME/tPh in vivo and tCho ex vivo were also present at high doses corresponding to a higher incidence of marked biliary hyperplasia and moderate hepatocellular necrosis.

Gift of life or cultural taboo: effects of an educational pamphlet on young adults' knowledge and attitudes regarding organ donation.

As a result of a shortage of organs that can be used for transplantation in South Africa, as well as a lack of awareness and cultural taboos around organ donation, many individuals do not receive the organs they need and are sent home to die, raising questions about distributive justice and the right to life. The study therefore investigated whether an educational pamphlet might change perceptions of young adults regarding organ donation. A questionnaire comprising a knowledge scale, an attitudinal scale, and open-ended questions was administered to 18 young adults from Johannesburg via individual interviews before and after providing them with an educational brochure on organ donation. Findings suggested that the brochure changed participants' knowledge and attitudes regarding organ donation. The study enhances understanding of factors influencing organ donation and highlights the role of social workers in this regard.

Traditional healing in South Africa: ethical implications for social work.

Within health-care settings, culturally competent practice presupposes an understanding of the socio-cultural meanings attached to illness and disability and the people who are likely to be consulted with respect to providing health care and restoring well-being. Large numbers of South Africans are known to consult with traditional healers in preference to or in conjunction with western, allopathic health-care professionals. The present study represents a secondary analysis of data from various studies conducted on Black African, Muslim, Hindu and Chinese traditional healing systems in South Africa. Common themes that emerged from the analysis included the attribution of illnesses and disorders to spiritual factors, punishment and superstitious beliefs. Treatment approaches included the use of natural substances, prayer and rituals, and procedures that were designed to restore equilibrium. The participants also articulated their views on medical pluralism, collaboration between western and traditional health-care practitioners, and reasons why people consulted with traditional healers. The findings are discussed in terms of their ethical implications for social work.

Swallowing difficulties reported by adults infected with HIV/AIDS attending a hospital outpatient clinic in Gauteng, South Africa.

OBJECTIVE: Swallowing difficulties can exert a profound effect on quality of life, may result in reduced nutritional intake and place individuals at risk of aspiration. However, there is little data available on the swallowing difficulties occurring within the HIV/AIDS population in South Africa. A descriptive study was therefore conducted to document the presence of reported swallowing difficulties in a sample of adults with HIV. PATIENTS AND METHODS: One-to-one semi-structured interview schedules were administered to 120 adults with HIV attending a clinic in Gauteng, and medical records were evaluated to document the presence of reported swallowing difficulties. RESULTS: Participants described a range of swallowing difficulties and the number of swallowing difficulties reported by participants was negatively correlated with CD4 count. Swallowing difficulties were significantly associated with various opportunistic diseases and related medical pathologies. Prescribed medications were associated with reported swallowing difficulties. Treatment of swallowing difficulties was mainly medical in nature. Swallowing difficulties had affected quality of life. CONCLUSIONS: From the results it was concluded that speech therapists have a role to play in the assessment and treatment of swallowing difficulties in individuals with HIV/AIDS.

A tale of two systems: beliefs and practices of South African Muslim and Hindu traditional healers regarding cleft lip and palate.

OBJECTIVES: This South African study compared the views of 15 Muslim and 8 Hindu traditional healers regarding the etiology and treatment of craniofacial clefts, reasons for people consulting with them, and collaboration with Western professionals. DATA ANALYSIS: The original data were collected via individual interviews. Secondary data analysis was conducted to highlight common themes. RESULTS: Four Hindu and 12 Muslim healers believed that the condition was God sent. Both groups acknowledged the existence of various superstitions within their communities. For example, if a pregnant woman handled a sharp object during an eclipse, her infant could be born with a cleft. All Hindu healers also attributed clefts to karma. All the Muslim healers counseled patients and families. Fourteen referred people for medical help, 10 emphasized the importance of prayer, and 3 recommended the wearing of amulets containing a prayer. No Hindu healers provided direct treatment. Three advised parents to fast, six arranged fire and purification ceremonies in the temples, and three consulted the person's astrological chart to dispel any bad karma. Both groups of healers advised people to give to charity. Eight Hindu healers and eight Muslim healers believed that people consulted with them because of cultural influences and because they alleviated feelings of guilt. Four Hindu and 13 Muslim healers favored collaboration with Western practitioners. CONCLUSIONS: Findings highlight the need for culturally sensitive rehabilitation practices, collaboration, referrals, and information sharing between Eastern and Western health care practitioners.

Western and traditional medicine: cultural beliefs and practices of South African Muslims with regard to Down syndrome.

The aim of the study was to investigate the beliefs and practices of caregivers and traditional healers within the South African Muslim community regarding Down syndrome. An exploratory-descriptive research design was utilized which incorporated individual interviews with 10 caregivers of persons with Down syndrome as well as 10 traditional healers from the South African Muslim community. Common beliefs emanating from both groups relating to the cause of Down syndrome included the notion that this condition was genetic in origin and that such children were perceived to be gifts from God. Others attributed Down syndrome to a punishment from God or the result of curses from people. Treatment included the use of inscriptions from the Quraan, water that had been prayed over and herbal medicines. Some caregivers seemed reluctant to approach western health care professionals due to negative past experiences. The main reasons for consulting traditional healers were cultural beliefs and pressure from family members, their holistic approach and the personal nature of their interventions. Collaboration between allopathic medicine and traditional healing was advocated by almost all of the traditional healers. These findings underline the need for culturally sensitive rehabilitation practices in speech-language pathology and audiology; and collaboration between western health care practitioners and traditional healers.

Traditional and western medicine: cultural beliefs and practices of South African Indian Muslims with regard to stroke.

OBJECTIVES: To investigate the beliefs of caregivers and traditional healers within the South African Indian Muslim community regarding the etiology and treatment of stroke and the persons likely to be consulted in this regard. DESIGN: A descriptive case study design was employed which incorporated two groups and was located within a qualitative paradigm. SETTING: Data were collected within the homes of caregivers and the consulting rooms of traditional healers. PARTICIPANTS: Ten caregivers of persons who had sustained strokes and 10 traditional healers were interviewed. INTERVENTIONS: Individual interviews were held with participants. OUTCOME MEASURES: Responses to semi-structured interview schedules were analyzed using thematic content analysis and descriptive statistics. RESULTS: For both groups, religion and faith in God played a pertinent role in beliefs regarding etiology of illnesses such as stroke. Caregivers used a combination of traditional and Western medicine approaches. For traditional healers, treatment was based on the premise of restoring the balance between hot and cold in the body, which had been placed in disequilibrium by the stroke. Participants expressed disillusionment with referrals to Western healthcare professionals whose treatment was often regarded as culturally inappropriate. They also emphasized the integral role played by family members in the treatment of illness and disease. CONCLUSIONS: Results have implications for: culturally sensitive management of stroke patients in the South African Indian Muslim community; collaboration between Western and traditional healers; involvement of families in the remediation process; and further research.

Beliefs and practices of Black South African traditional healers regarding hearing impairment.

The study investigated beliefs and practices of Black South African traditional healers regarding hearing impairment. Fifteen Black South African traditional healers were interviewed using a semi-structured interview schedule. An exploratory-descriptive research design incorporating a mixed qualitative/quantitative method was employed and data were collected via individual interviews. Traditional healers reported being consulted for what could possibly reflect a variety of audiological and otological problems, and using a wide range of diagnostic and treatment techniques. Although the healers mentioned infection, organic deterioration, noise exposure, and congenital aspects as cause of hearing impairment; they tended to anthropomorphise the cause of the disease, and the reason for becoming ill was often sought in a supernatural realm. These findings have implications for culturally sensitive practice, collaboration between traditional healers and audiologists, sharing of information regarding hearing impairment, mutual referrals, and involvement of traditional healers in hearing health care.