Academic literature on the topic 'Shongwe Hospital'

Background: One of the reasons to develop training courses for medical mid-level workers in South Africa is a shortage of doctors. The introduction of this new profession has led to task sharing and redefining of professional boundaries. The primary aim of this study is to evaluate the introduction of new healthcare professionals in a rural hospital district. Methods: This multi-method qualitative research study used a semi-structured questionnaire to assess the effectiveness of Clinical Associates. A review of documents from 2012 to 2015 was done including a longitudinal study of the development of the Bachelor in Clinical Medical Practice (BCMP) programme at Shongwe hospital. Results: Three Clinical Associates in 2011 and six Clinical Associates in 2014 completed questionnaires. Student satisfaction increased as measured with the Med IQ tool. At the end of 2013 Shongwe Clinical Learning Centre (CLC) had improved from last position out of 17 CLCs in 2011 to position number eight in 2014. Casualty was run by Clinical Associates and during observations it became clear that Clinical Associates were able to take responsibility for outpatient departments (OPDs), the emergency unit and some wards with supervision by a doctor. Conclusion: The introduction of the BCMP programme and the establishment of a Clinical Learning Centre in Shongwe hospital have led to improved patient care and a more conducive environment for teaching and learning. With the availability of more Clinical Associates vacant medical officer posts can be converted to employ Clinical Associates to serve patients without an increase in the cost of total human resources. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1248144

In 1971, I was sent by the British Council to Nepal to teach and to operate. There, in the little town of Pokhra, I met the most extraordinary woman surgeon that I have ever encountered before or since. Her name was Ruth Watson. She was a slimly built, smiling young woman, dressed in a Nepalese sari and speaking to her staff in fluent Nepalese. She had arrived in Pokhra 20 years before, at the age of 25, and established a hospital there. Initially it was constructed out of matting, but this was soon replaced with corrugated iron Nissen huts. Because the metal walls shone in the blazing Nepalese sunshine the hospital came to be called the ‘Shining Hospital’ by the patients, and the name stuck. It served an enormous population from the far flung villages -mostly poor peasant farmers and their families. By the time of my visit, there were about 50 beds, a small operating theatre and a single-bedded labour ward. Ruth told me that she had once delivered two sets of twins synchronously on that one bed!

Background & Objectives: Congenital heart diseases are neglected especially in world’s poorest nations and appear to be ignored and unexplored dimension of health. The exact prevalence and spectrum of congenital heart diseases in Nepal is largely unknown. The aim of this study was to describe the local experience on the magnitude and the pattern of congenital heart disease in order to increase the awareness of the public and health policy makers on its burden in Nepal.Materials & Methods: This is an observational hospital based study carried out in a tertiary care hospital in Eastern Nepal. The duration of this study was from April 2015 to July 2016. The echocardiography reports of all patients clinically suspected of having congenital heart disease were retrieved, and their diagnostic details were extracted. Only patients of day one of life to 14 years of age were included. Congenital heart diseases like bicuspid aortic valve, mitral valve prolapse and various inherited cardiomyopathies were excluded.Results: A total of 330 echocardiograms were performed for clinically suspected congenital heart disease. The mean age of study population was 22.31±34.08 months with male to female ratio of 1.2:1. 23% of clinically suspected congenital heart disease cases turned out to have normal echocardiography. Acyanotic congenital heart disease was most common (81.5%) followed by cyanotic congenital heart disease (14.2%) and obstructive congenital heart disease (4.3%). Atrial septal defect was found to be the most common form of acyanotic congenital heart disease (52%) which was followed by ventricular septal defect (28.8%) and patent ductus arteriosus (14.8%). Tetralogy of Fallot and double outlet right ventricle were the most common form of cyanotic CHD representing 44.4% of all cyanotic patients. Pulmonary stenosis was the most common obstructive congenital heart disease observed in this study population (63.6%). Rarer entities, like d-transposition of great arteries, congenitally corrected transposition of great arteries, various types of total anomalous pulmonary venous drainage, double inlet left ventricle, interrupted aortic arch, Shone complex, etc. were also observed, however represented only the minority of the study population.Conclusion: The spectrum of congenital heart disease seen in this study very likely and only represents the tip of the iceberg. Public awareness programmes and training of health care personnel needs to be emphasized in order to facilitate its early diagnosis and improve its outcome.

Targeted nutritional therapy should be started early in severe illness and sustained through to recovery if clinical and patient-centred outcomes are to be optimised. The coronavirus disease 2019 (COVID-19) pandemic has shone a light on this need. The literature on nutrition and COVID-19 mainly focuses on the importance of nutrition to preserve life and prevent clinical deterioration during the acute phase of illness. However, there is a lack of information guiding practice across the whole patient journey (e.g., hospital to home) with a focus on targeting recovery (e.g., long COVID). This review paper is of relevance to doctors and other healthcare professionals in acute care and primary care worldwide, since it addresses early, multi-modal individualised nutrition interventions across the continuum of care to improve COVID-19 patient outcomes. It is of relevance to nutrition experts and non-nutrition experts and can be used to promote inter-professional and inter-organisational knowledge transfer on the topic. The primary goal is to prevent complications and support recovery to enable COVID-19 patients to achieve the best possible nutritional, physical, functional and mental health status and to apply the learning to date from the COVID-19 pandemic to other patient groups experiencing acute severe illness.

Background: Antiretroviral treatment (ART) improves the prognosis and quality of life for HIV patients by reducing the rate of disease progression and mortality. Although ART has been available in public health centres in South Africa since 2003, adherence to treatment still remains a challenge. To date, no study has investigated adherence and the factors that influence adherence to ART in rural settings in Mpumalanga Province.Objective: This study described adherence to, knowledge and beliefs about ART and other factors associated with adherence amongst patients registered at Shongwe Hospital in Nkomazi Local Municipality.Method: A cross-sectional survey of 184 randomly selected patients on ART between ages of 15 and 65 years was conducted.Results: The respondents completed a questionnaire on self-reported adherence, knowledge and beliefs about ART and other factors associated with adherence. The majority of the respondents were female (71.2%) and unemployed (83.7%). Most respondents reported optimal ART adherence (taking 95% or more of their medication as prescribed) over the past two (92.4%) and seven (84.2%) days, respectively. The level of knowledge about ART was high and most reported positive beliefs about the effectiveness of ART. However, slightly more than half (53.3%) believed that ART was harmful for the body. The most commonly-reported reasons for missing dosages were forgetfulness, business of the daily routine, having visitors, ‘visiting a bar’ and sleeping away from home.Conclusion: Although, the study found that most ART patients at Shongwe Hospital reported optimal adherence initially, the reasons for missing dosages, some incorrect knowledge and beliefs need to be addressed to ensure long-term adherence and persistence in care. Agterground: Antiretrovirale (ARV) behandeling verbeter die prognose en lewenskwalitiet van pasiënte wat besmet is met MIV, deur ‘n remmende effek op die ontwikkeling van VIGS te bewerkstellig. Alhoewel ARVbehandeling reeds sedert 2003 in openbare gesondheidsentrums in Suid Afrika beskikbaar was, bly die volgehoue en stiptelike navolging van die behandelingsplan ‘n grootse uitdaging vir pasiënte. Daar is egter min navorsing oor die faktore wat navolging van ARV behandeling deur pasiënte in landelike gebiede in Mpumalanga gedoen.Doelwitte: Hierdie studie ondersoek pasiënte se kennis, houdings en ander faktore wat die navolging van ARV behandeling beïnvloed by Shongwe-hospitaal in die Nkomazi distrik in Mpumalanga.Metode: ‘n Bestekopname van 184 pasiënte, tussen die ouderdomme van 15 en 65 jaar, wat ARV behandeling ontvang is gedoen. Hulle is lukraak gekies en het ‘n vraelys voltooi rakende hul kennis en oortuigings ten opsigte van ARV-middels, asook die faktore wat die stiptelike gebruik van die middels beïnvloed.Resultate: Die steekproef het hoofsaaklik uit vroue (71.2%) bestaan, en die meerderheid was werkloos (83.7%). Die meeste van die deelnemers het aangedui dat hulle hul ARV-medikasie die vorige twee dae (92.4%) en sewe dae (84.2%) grotendeels (ten minste 95% van medikasie) volgens voorskrif geneem het. Die meerderheid van die studie deelnemers het redelike kennis van en positiewe houdings teenoor ARV-behandeling getoon. Vergeetagtigheid, die besigheid van normale daaglikse roetine, die ontvang van besoekers, besoeke aan kroeë asook uitslaap was die redes wat aangevoer is vir vernalating om medisyne te neem.Gevolgtrekking: Alhoewel, die meeste pasiënte in hierdie studie aanvanklik redelik goed gevaar het met die navolging van die behandelingsplan, moet die probleme wat ervaar is met die neem van medikasie aangespreek word om lang-termyn navolging van behandeling en retensie te bewerkstellig.

This essay combines life writing with meditations on the significance of walking as integral to the ritual practice of pilgrimage, where the individual improves her soul or health through the act of walking to a shrine containing healing relics of a saint. Braiding together insights from medieval literature, contemporary ecocriticism, and memory studies, I reflect on my own pilgrimage practice as it impacts the land itself. Canterbury, England serves as the central shrine for four pilgrimages over decades: 1966, 1994, 1997, and 2003.The act of memory was not invented in the Anthropocene. Rather, the nonhuman world has taught humans how to remember. From ice-core samples retaining the history of Europe’s weather to rocks embedded with fossilized extinct species, nonhuman actors literally petrifying or freezing the past—from geologic sites to frozen water—become exposed through the process of anthropocentric discovery and human interference. The very act of human uncovery and analysis threatens to eliminate the nonhuman actor which has hospitably shared its own experience. How can humans script nonhuman memory?As for the history of memory studies itself, a new phase is arguably beginning, shifting from “the transnational, transcultural, or global to the planetary; from recorded to deep history; from the human to the nonhuman” (Craps et al. 3). Memory studies for the Anthropocene can “focus on the terrestrialized significance of (the historicized) forms of remembrance but also on the positioning of who is remembering and, ultimately, which ‘Anthropocene’ is remembered” (Craps et al. 5). In this era of the “self-conscious Anthropocene” (Craps et al. 6), narrative itself can focus on “the place of nonhuman beings in human stories of origins, identity, and futures point to a possible opening for the methods of memory studies” (Craps et al. 8). The nonhuman on the paths of this essay range from the dirt on the path to the rock used to build the sacred shrine, the ultimate goal. How they intersect with human actors reveals how the “human subject is no longer the one forming the world, but does indeed constitute itself through its relation to and dependence on the object world” (Marcussen 14, qtd. in Rodriguez 378). Incorporating “nonhuman species as objects, if not subjects, of memory [...] memory critics could begin by extending their objects to include the memory of nonhuman species,” linking both humans and nonhumans in “an expanded multispecies frame of remembrance” (Craps et al. 9). My narrative—from diaries recording sacred journey to a novel structured by pilgrimage—propels motion, but also secures in memory events from the past, including memories of those nonhuman beings I interact with.Childhood PilgrimageThe little girl with brown curls sat crying softly, whimpering, by the side of the road in lush grass. The mother with her soft brown bangs and an underflip to her hair told the story of a little girl, sitting by the side of the road in lush grass.The story book girl had forgotten her Black Watch plaid raincoat at the picnic spot where she had lunched with her parents and two older brothers. Ponchos spread out, the family had eaten their fresh yeasty rolls, hard cheese, apples, and macaroons. The tin clink of the canteen hit their teeth as they gulped metallic water, still icy cold from the taps of the ancient inn that morning. The father cut slices of Edam with his Swiss army knife, parsing them out to each child to make his or her own little sandwich. The father then lay back for his daily nap, while the boys played chess. The portable wooden chess set had inlaid squares, each piece no taller than a fingernail paring. The girl read a Junior Puffin book, while the mother silently perused Agatha Christie. The boy who lost at chess had to play his younger sister, a fitting punishment for the less able player. She cheerfully played with either brother. Once the father awakened, they packed up their gear into their rucksacks, and continued the pilgrimage to Canterbury.Only the little Black Watch plaid raincoat was left behind.The real mother told the real girl that the story book family continued to walk, forgetting the raincoat until it began to rain. The men pulled on their ponchos and the mother her raincoat, when the little girl discovered her raincoat missing. The story book men walked two miles back while the story book mother and girl sat under the dripping canopy of leaves provided by a welcoming tree.And there, the real mother continued, the storybook girl cried and whimpered, until a magic taxi cab in which the father and boys sat suddenly appeared out of the mist to drive the little girl and her mother to their hotel.The real girl’s eyes shone. “Did that actually happen?” she asked, perking up in expectation.“Oh, yes,” said the real mother, kissing her on the brow. The girl’s tears dried. Only the plops of rain made her face moist. The little girl, now filled with hope, cuddled with her mother as they huddled together.Without warning, out of the mist, drove up a real magic taxi cab in which the real men sat. For magic taxi cabs really exist, even in the tangible world—especially in England. At the very least, in the England of little Susie’s imagination.Narrative and PilgrimageMy mother’s tale suggests how this story echoes in yet another pilgrimage story, maintaining a long tradition of pilgrimage stories embedded within frame tales as far back as the Middle Ages.The Christian pilgrim’s walk parallels Christ’s own pilgrimage to Emmaus. The blisters we suffer echo faintly the lash Christ endured. The social relations of the pilgrim are “diachronic” (Alworth 98), linking figures (Christ) from the past to the now (us, or, during the Middle Ages, William Langland’s Piers Plowman or Chaucer’s band who set out from Southwark). We embody the frame of the vera icon, the true image, thus “conjur[ing] a site of simultaneity or a plane of immanence where the actors of the past [...] meet those of the future” (Alworth 99). Our quotidian walk frames the true essence or meaning of our ambulatory travail.In 1966, my parents took my two older brothers and me on the Pilgrims’ Way—not the route from London to Canterbury that Chaucer’s pilgrims would have taken starting south of London in Southwark, rather the ancient trek from Winchester to Canterbury, famously chronicled in The Old Road by Hilaire Belloc. The route follows along the south side of the Downs, where the muddy path was dried by what sun there was. My parents first undertook the walk in the early 1950s. Slides from that pilgrimage depict my mother, voluptuous in her cashmere twinset and tweed skirt, as my father crosses a stile. My parents, inspired by Chaucer’s Canterbury Tales, decided to walk along the traditional Pilgrims’ Way to Canterbury. Story intersects with material traversal over earth on dirt-laden paths.By the time we children came along, the memories of that earlier pilgrimage resonated with my parents, inspiring them to take us on the same journey. We all carried our own rucksacks and walked five or six miles a day. Concerning our pilgrimage when I was seven, my mother wrote in her diary:As good pilgrims should, we’ve been telling tales along the way. Yesterday Jimmy told the whole (detailed) story of That Darn Cat, a Disney movie. Today I told about Stevenson’s Travels with a Donkey, which first inspired me to think of walking trips and everyone noted the resemblance between Stevenson’s lovable, but balky, donkey and our sweet Sue. (We hadn’t planned to tell tales, but they just happened along the way.)I don’t know how sweet I was; perhaps I was “balky” because the road was so hard. Landscape certainly shaped my experience.As I wrote about the pilgrimage in my diary then, “We went to another Hotel and walked. We went and had lunch at the Boggly [booglie] place. We went to a nother hotel called The Swan with fether Quits [quilts]. We went to the Queens head. We went to the Gest house. We went to aother Hotle called Srping wells and my tooth came out. We saw some taekeys [turkeys].” The repetition suggests how pilgrimage combines various aspects of life, from the emotional to the physical, the quotidian (walking and especially resting—in hotels with quilts) with the extraordinary (newly sprung tooth or the appearance of turkeys). “[W]ayfaring abilities depend on an emotional connection to the environment” (Easterlin 261), whether that environment is modified by humans or even manmade, inhabited by human or nonhuman actors. How can one model an “ecological relationship between humans and nonhumans” in narrative (Rodriguez 368)? Rodriguez proposes a “model of reading as encounter [...] encountering fictional story worlds as potential models” (Rodriguez 368), just as my mother did with the Magic Taxi Cab story.Taxis proliferate in my childhood pilgrimage. My mother writes in 1966 in her diary of journeying along the Pilgrims’ Way to St. Martha’s on the Hill. “Susie was moaning and groaning under her pack and at one desperate uphill moment gasped out, ‘Let’s take a taxi!’ – our highborn lady as we call her. But we finally made it.” “Martha’s”, as I later learned, is a corruption of “Martyrs”, a natural linguistic decay that developed over the medieval period. Just as the vernacular textures pilgrimage poems in the fourteeth century, the common tongue in all its glorious variety seeps into even the quotidian modern pilgrim’s journey.Part of the delight of pilgrimage lies in the characters one meets and the languages they speak. In 1994, the only time my husband and I cheated on a strictly ambulatory sacred journey occurred when we opted to ride a bus for ten miles where walking would have been dangerous. When I ask the bus driver if a stop were ours, he replied, “I'll give you a shout, love.” As though in a P. G. Wodehouse novel, when our stop finally came, he cried out, “Cheerio, love” to me and “Cheerio, mate” to Jim.Language changes. Which is a good thing. If it didn’t, it would be dead, like those martyrs of old. Like Latin itself. Disentangling pilgrimage from language proves impossible. The healthy ecopoetics of languages meshes with the sustainable vibrancy of the land we traverse.“Nettles of remorse…”: Derek Walcott, The Bounty Once my father had to carry me past a particularly tough patch of nettles. As my mother tells it, we “went through orchards and along narrow woodland path with face-high nettles. Susie put a scarf over her face and I wore a poncho though it was sunny and we survived almost unscathed.” Certain moments get preserved by the camera. At age seven in a field outside of Wye, I am captured in my father’s slides surrounded by grain. At age thirty-five, I am captured in film by my husband in the same spot, in the identical pose, though now quite a bit taller than the grain. Three years later, as a mother, I in turn snap him with a backpack containing baby Sarah, grumpily gazing off over the fields.When I was seven, we took off from Detling. My mother writes, “set off along old Pilgrims’ Way. Road is paved now, but much the same as fifteen years ago. Saw sheep, lambs, and enjoyed lovely scenery. Sudden shower sent us all to a lunch spot under trees near Thurnham Court, where we huddled under ponchos and ate happily, watching the weather move across the valley. When the sun came to us, we continued on our way which was lovely, past sheep, etc., but all on hard paved road, alas. Susie was a good little walker, but moaned from time to time.”I seem to whimper and groan a lot on pilgrimage. One thing is clear: the physical aspects of walking for days affected my phenomenological response to our pilgrimage which we’d undertaken both as historical ritual, touristic nature hike, and what Wendell Berry calls a “secular pilgrimage” (402), where the walker seeks “the world of the Creation” (403) in a “return to the wilderness in order to be restored” (416). The materiality of my experience was key to how I perceived this journey as a spiritual, somatic, and emotional event. The link between pilgrimage and memory, between pilgrimage poetics and memorial methods, occupies my thoughts on pilgrimage. As Nancy Easterlin’s work on “cognitive ecocriticism” (“Cognitive” 257) contends, environmental knowledge is intimately tied in with memory (“Cognitive” 260). She writes: “The advantage of extensive environmental knowledge most surely precipitates the evolution of memory, necessary to sustain vast knowledge” (“Cognitive” 260). Even today I can recall snatches of moments from that trip when I was a child, including the telling of tales.Landscape not only changes the writer, but writing transforms the landscape and our interaction with it. As Valerie Allen suggests, “If the subject acts upon the environment, so does the environment upon the subject” (“When Things Break” 82). Indeed, we can understand the “road as a strategic point of interaction between human and environment” (Allen and Evans 26; see also Oram)—even, or especially, when that interaction causes pain and inflames blisters. My relationship with moleskin on my blasted and blistered toes made me intimately conscious of my body with every step taken on the pilgrimage route.As an adult, my boots on the way from Winchester to Canterbury pinched and squeezed, packed dirt acting upon them and, in turn, my feet. After taking the train home and upon arrival in London, we walked through Bloomsbury to our flat on Russell Square, passing by what I saw as a new, less religious, but no less beckoning shrine: The London Foot Hospital at Fitzroy Square.Now, sadly, it is closed. Where do pilgrims go for sole—and soul—care?Slow Walking as WayfindingAll pilgrimages come to an end, just as, in 1966, my mother writes of our our arrival at last in Canterbury:On into Canterbury past nice grassy cricket field, where we sat and ate chocolate bars while we watched white-flannelled cricketers at play. Past town gates to our Queen’s Head Inn, where we have the smallest, slantingest room in the world. Everything is askew and we’re planning to use our extra pillows to brace our feet so we won’t slide out of bed. Children have nice big room with 3 beds and are busy playing store with pounds and shillings [that’s very hard mathematics!]. After dinner, walked over to cathedral, where evensong was just ending. Walked back to hotel and into bed where we are now.Up to early breakfast, dashed to cathedral and looked up, up, up. After our sins were forgiven, we picked up our rucksacks and headed into London by train.This experience in 1966 varies slightly from the one in 1994. Jim and I walk through a long walkway of tall, slim trees arching over us, a green, lush and silent cloister, finally gaining our first view of Canterbury with me in a similar photo to one taken almost thirty years before. We make our way into the city through the West Gate, first passing by St. Dunstan’s Church where Henry II had put on penitential garb and later Sir Thomas More’s head was buried. Canterbury is like Coney Island in the Middle Ages and still is: men with dreadlocks and slinky didjeridoos, fire tossers, mobs of people, tourists. We go to Mercery Lane as all good pilgrims should and under the gate festooned with the green statue of Christ, arriving just in time for evensong.Imagining a medieval woman arriving here and listening to the service, I pray to God my gratefulness for us having arrived safely. I can understand the fifteenth-century pilgrim, Margery Kempe, screaming emotionally—maybe her feet hurt like mine. I’m on the verge of tears during the ceremony: so glad to be here safe, finally got here, my favorite service, my beloved husband. After the service, we pass on through the Quire to the spot where St. Thomas’s relic sanctuary was. People stare at a lit candle commemorating it. Tears well up in my eyes.I suppose some things have changed since the Middle Ages. One Friday in Canterbury with my children in 2003 has some parallels with earlier iterations. Seven-year-old Sarah and I go to evensong at the Cathedral. I tell her she has to be absolutely quiet or the Archbishop will chop off her head.She still has her head.Though the road has been paved, the view has remained virtually unaltered. Some aspects seem eternal—sheep, lambs, and stiles dotting the landscape. The grinding down of the pilgrimage path, reflecting the “slowness of flat ontology” (Yates 207), occurs over vast expanses of time. Similarly, Easterlin reflects on human and more than human vitalism: “Although an understanding of humans as wayfinders suggests a complex and dynamic interest on the part of humans in the environment, the surround itself is complex and dynamic and is frequently in a state of change as the individual or group moves through it” (Easterlin “Cognitive” 261). An image of my mother in the 1970s by a shady tree along the Pilgrims’ Way in England shows that the path is lower by 6 inches than the neighboring verge (Bright 4). We don’t see dirt evolving, because its changes occur so slowly. Only big time allows us to see transformative change.Memorial PilgrimageOddly, the erasure of self through duplication with a precursor occurred for me while reading W.G. Sebald’s pilgrimage novel, The Rings of Saturn. I had experienced my own pilgrimage to many of these same locations he immortalizes. I, too, had gone to Somerleyton Hall with my elderly mother, husband, and two children. My memories, sacred shrines pooling in familial history, are infused with synchronic reflection, medieval to contemporary—my parents’ periodic sojourns in Suffolk for years, leading me to love the very landscape Sebald treks across; sadness at my parents’ decline; hope in my children’s coming to add on to their memory palimpsest a layer devoted to this land, to this history, to this family.Then, the oddest coincidence from my reading pilgrimage. After visiting Dunwich Heath, Sebald comes to his friend, Michael, whose wife Anne relays a story about a local man hired as a pallbearer by the local undertaker in Westleton. This man, whose memory was famously bad, nevertheless reveled in the few lines allotted him in an outdoor performance of King Lear. After her relating this story, Sebald asks for a taxi (Sebald 188-9).This might all seem unremarkable to the average reader. Yet, “human wayfinders are richly aware of and responsive to environment, meaning both physical places and living beings, often at a level below consciousness” (Easterlin “Cognitive” 265). For me, with a connection to this area, I startled with recollection emerging from my subconscience. The pallbearer’s name in Sebald’s story was Mr Squirrel, the very same name of the taxi driver my parents—and we—had driven with many times. The same Mr Squirrel? How many Mr Squirrels can there be in this small part of Suffolk? Surely it must be the same family, related in a genetic encoding of memory. I run to my archives. And there, in my mother’s address book—itself a palimpsest of time with names and addressed scored through; pasted-in cards, names, and numbers; and looseleaf memoranda—there, on the first page under “S”, “Mr. Squirrel” in my mother’s unmistakable scribble. She also had inscribed his phone number and the village Saxmundum, seven miles from Westleton. His name had been crossed out. Had he died? Retired? I don’t know. Yet quick look online tells me Squirrell’s Taxis still exists, as it does in my memory.Making KinAfter accompanying a class on a bucolic section of England’s Pilgrims’ Way, seven miles from Wye to Charing, we ended up at a pub drinking a pint, with which all good pilgrimages should conclude. There, students asked me why I became a medievalist who studies pilgrimage. Only after the publication of my first book on women pilgrims did I realize that the origin of my scholarly, long fascination with pilgrimage, blossoming into my professional career, began when I was seven years old along the way to Canterbury. The seeds of that pilgrimage when I was so young bore fruit and flowers decades later.One story illustrates Michel Serres’s point that we should not aim to appropriate the world, but merely act as temporary tenants (Serres 72-3). On pilgrimage in 1966 as a child, I had a penchant for ant spiders. That was not the only insect who took my heart. My mother shares how “Susie found a beetle up on the hill today and put him in the cheese box. Jimmy put holes in the top for him. She named him Alexander Beetle and really became very fond of him. After supper, we set him free in the garden here, with appropriate ceremony and a few over-dramatic tears of farewell.” He clearly made a great impression on me. I yearn for him today, that beetle in the cheese box. Though I tried to smuggle nature as contraband, I ultimately had to set him free.Passing through cities, landscape, forests, over seas and on roads, wandering by fields and vegetable patches, under a sky lit both by sun and moon, the pilgrim—even when in a group of fellow pilgrims—in her lonesome exercise endeavors to realize Serres’ ideal of the tenant inhabitant of earth. Nevertheless, we, as physical pilgrims, inevitably leave our traces through photos immortalizing the journey, trash left by the wayside, even excretions discretely deposited behind a convenient bush. Or a beetle who can tell the story of his adventure—or terror—at being ensconced for a time in a cheese box.On one notorious day of painful feet, my husband and I arrived in Otford, only to find the pub was still closed. Finally, it became time for dinner. We sat outside, me with feet ensconced in shoes blessedly inert and unmoving, as the server brought out our salads. The salad cream, white and viscous, was presented in an elegantly curved silver dish. Then Jim began to pick at the salad cream with his fork. Patiently, tenderly, he endeavored to assist a little bug who had gotten trapped in the gooey sauce. Every attempt seemed doomed to failure. The tiny creature kept falling back into the gloppy substance. Undaunted, Jim compassionately ministered to our companion. Finally, the little insect flew off, free to continue its own pilgrimage, which had intersected with ours in a tiny moment of affinity. Such moments of “making kin” work, according to Donna Haraway, as “life-saving strateg[ies] for the Anthropocene” (Oppermann 3, qtd. in Haraway 160).How can narrative avoid the anthropocentric centre of writing, which is inevitable given the human generator of such a piece? While words are a human invention, nonhuman entities vitally enact memory. The very Downs we walked along were created in the Cretaceous period at least seventy million years ago. The petrol propelling the magic taxi cab was distilled from organic bodies dating back millions of years. Jurassic limestone from the Bathonian Age almost two hundred million years ago constitutes the Caen stone quarried for building Canterbury Cathedral, while its Purbeck marble from Dorset dates from the Cretaceous period. Walking on pilgrimage propels me through a past millions—billions—of eons into the past, dwarfing my speck of existence. Yet, “if we wish to cross the darkness which separates us from [the past] we must lay down a little plank of words and step delicately over it” (Barfield 23). Elias Amidon asks us to consider how “the ground we dig into and walk upon is sacred. It is sacred because it makes us neighbors to each other, whether we like it or not. Tell this story” (Amidon 42). And, so, I have.We are winding down. Time has passed since that first pilgrimage of mine at seven years old. Yet now, here, I still put on my red plaid wollen jumper and jacket, crisp white button-up shirt, grey knee socks, and stout red walking shoes. Slinging on my rucksack, I take my mother’s hand.I’m ready to take my first step.We continue our pilgrimage, together.ReferencesAllen, Valerie. “When Things Break: Mending Rroads, Being Social.” Roadworks: Medieval Britain, Medieval Roads. Eds. Valerie Allen and Ruth Evans. Manchester: Manchester UP, 2016.———, and Ruth Evans. Introduction. Roadworks: Medieval Britain, Medieval Roads. Eds. Valerie Allen and Ruth Evans. Manchester: Manchester UP, 2016.Alworth, David J. Site Reading: Fiction, Art, Social Form. Princeton: Princeton UP, 2016.Amidon, Elias. “Digging In.” Dirt: A Love Story. Ed. Barbara Richardson. Lebanon, NH: ForeEdge, 2015.Barfield, Owen. History in English Words. Grand Rapids: William B. Eerdmans Publishing, 1967.Berry, Wendell. “A Secular Pilgrimage.” The Hudson Review 23.3 (1970): 401-424.Bright, Derek. “The Pilgrims’ Way Revisited: The Use of the North Downs Main Trackway and the Medway Crossings by Medieval Travelers.” Kent Archaeological Society eArticle (2010): 4-32.Craps, Stef, Rick Crownshaw, Jennifer Wenzel, Rosanne Kennedy, Claire Colebrook, and Vin Nardizzi. “Memory Studies and the Anthropocene: A Roundtable.” Memory Studies 11.4 (2017) 1-18.Easterlin, Nancy. A Biocultural Approach to Literary Theory and Interpretation. Baltimore: Johns Hopkins UP, 2012.———. “Cognitive Ecocriticism: Human Wayfinding, Sociality, and Literary Interpretation.” Introduction to Cognitive Studies. Ed. Lisa Zunshine. Baltimore: Johns Hopkins UP, 2010. 257-274.Haraway, Donna. “Anthropocene, Capitalocene, Plantationocene, Chthulucene: Making Kin.” Environmental Humanities 6 (2015): 159-65.James, Erin, and Eric Morel. “Ecocriticism and Narrative Theory: An Introduction.” English Studies 99.4 (2018): 355-365.Marcussen, Marlene. Reading for Space: An Encounter between Narratology and New Materialism in the Works of Virgina Woolf and Georges Perec. PhD diss. University of Southern Denmark, 2016.Oppermann, Serpil. “Introducing Migrant Ecologies in an (Un)Bordered World.” ISLE 24.2 (2017): 243–256.Oram, Richard. “Trackless, Impenetrable, and Underdeveloped? Roads, Colonization and Environmental Transformation in the Anglo-Scottish Border Zone, c. 1100 to c. 1300.” Roadworks: Medieval Britain, Medieval Roads. Eds. Valerie Allen and Ruth Evans. Manchester: Manchester UP, 2016.Rodriquez, David. “Narratorhood in the Anthropocene: Strange Stranger as Narrator-Figure in The Road and Here.” English Studies 99.4 (2018): 366-382.Savory, Elaine. “Toward a Caribbean Ecopoetics: Derek Walcott’s Language of Plants.” Postcolonial Ecologies: Literatures of the Environment. Eds. Elizabeth DeLoughrey and George B. Handley. Oxford: Oxford UP, 2011. 80-96.Sebald, W.G. The Rings of Saturn. Trans. Michael Hulse. New York: New Directions, 1998.Serres, Michel. Malfeasance: Appropriating through Pollution? Trans. Anne-Marie Feenberg-Dibon. Stanford: Stanford UP, 2011.Walcott, Derek. Selected Poems. Ed. Edward Baugh. New York: Farrar, Straus and Giroux, 1997. 3-16.Yates, Julian. “Sheep Tracks—A Multi-Species Impression.” Animal, Vegetable, Mineral: Ethics and Objects. Ed. Jeffrey Jerome Cohen. Washington, D.C.: Oliphaunt Books, 2012.

Magister Public Health - MPH
Background: HIV and AIDS is one of the major public health problems facing South Africa today. In 2005, it was estimated that 5.54 million people were living with HIV in South Africa, which means that 18.8% of the population between the ages of 15 – 49 years are infected with HIV. This makes South Africa the developing country worst affected by the HIV pandemic. The severity of the HIV epidemic is closely linked to poverty and other socio-economic factors. The National Department of Health of South Africa launched the National Operational Plan for Comprehensive HIV and AIDS management, treatment, care, and support in 2007 to ensure that ART is freely available in the public health sector. It is estimated that by mid-2008 approximately 568, 000 HIV infected patients were receiving ART at South African hospitals. Suboptimal adherence to ART is pervasive despite specific protocols to prepare patients for long-term adherence prior to treatment initiation. Known barriers to ART adherence have been categorized as patient, socio-economic, service, therapy/regimen and communityrelated factors. Effective delivery of ART services requires an understanding of patients’ knowledge, attitudes, and beliefs about ART and how these influence their adherence. Aim: The aim of the study was to assess adherence to antiretroviral therapy and knowledge, attitudes and beliefs about ART among people on ART at Shongwe hospital in Nkomazi region in Mpumalanga province, South Africa. Methodology: A descriptive, cross-sectional survey was conducted among 184 patients receiving ART at Shongwe hospital in Mpumalanga. Data was collected through selfiv administration and face-to-face interviews. Quantitative data was analysed using the SPSS version 16.0 and for stratification Epi-Info version 3.4.1 was used. Results: All participants were on first line regimens: lamivudine/stavudine/stocrine or efivarenz (65.6%); and lamivudine/stavudine/nevirapine (34%). Self-reported adherence was high - 92.4% and 84.2% of participants reported optimal adherence over the previous two days and seven days, respectively. Disclosure of HIV status and being on ART was high among the respondents (97% and 97.3%) respectively. The most common barriers to missing doses were problems travelling to the clinic (22.3%), forgetting (19.6%), and sleeping away from home (18.5%). There was significant association between participants knowing that “missing doses of ART leads to disease progression”, and ART adherence on two day recall (p=0.00) and seven day recall (p=0.02). There was a significant association between disclosure of HIV status and ART adherence on two day recall (p=0.01). Significantly more participants who disclosed being on ART (98.2%) reported optimal adherence over the previous two days (p = 0.00) and seven days (p = 0.00) compared to those who did not disclose being on ART. Participants who reported forgetfulness were 76% less likely (95% CI: 0.09-0.65) and 92% less likely (95% CI: 0.04 – 0.17) to have optimal adherence over two and seven days, respectively, than participants who did not report forgetfulness to be a barrier. Conclusion: Adherence levels in Nkomazi region are to be comparable with those in other regions in South Africa, despite the fact that participants were facing financial constraints and high unemployment rates. These study findings emphasize the need for strengthening communication between patients and health care providers, and the need for overcoming access barriers related to the services, forgetfulness and sleeping away from home.

M.A. (Social Behaviour Studies in HIV/AIDS)
This study sought to investigate factors that influence adherence to treatment amongst rural people living with HIV and accessing antiretroviral therapy (ART) at Shongwe hospital in Mpumalanga. Both quantitative and qualitative methods were used. From patients’ case files, a sample of twenty-eight respondents was recruited for the completion of questionnaires. A focus group discussion with nine participants was held, followed by qualitative interviews with three key informants. Findings indicated that a complex web of factors unique to each patient’s social context plays a role in determining whether or not patients adhere to their regimens. Obstacles to adherence are poor social support, problems relating to disclosure, unemployment and economic hardship, traditional and religious beliefs, the quality and nature of adherence counselling and treatment side effects.
Sociology