Academic literature on the topic 'Terminal care – South Africa – Grahamstown'

Background: Community care workers (CCWs) inhabit a central role in the management of tuberculosis (TB) patients in South Africa. CCWs attend training courses, but training is not standardised at either the national or provincial level.Objective: To explore perceptions of CCWs of their role in TB care and TB information needs.Methods: CCWs working with TB patients were recruited from Grahamstown Hospice and local primary healthcare clinics in Grahamstown. Focus group discussions and semistructured interviews were conducted with 14 CCWs using a question guide. Data were thematically analysed.Results: Three themes emerged from data analysis. Firstly, altruism was identified as the major motivational factor, with a desire to help others often stimulated by previously caring for sick relatives. Some CCWs had experienced being patients needing care, which motivated them to become involved in offering patient care. Secondly, CCWs reported great fulfilment and pride in their work as they believed they made a meaningful impact on patients' lives and in the surrounding community, and were respected for this contribution. Thirdly, most identified a need for further training and access to additional information about TB, particularly MDR- and XDR-TB, in order to reinforce both their own knowledge and to educate patients about drug-resistant TB.Conclusion: CCWs were motivated and proud of their contribution to TB patient management and the education they provided to patients and to lay community members.Ongoing training was identified as a need, along with access to quality information materials to improve their knowledge and facilitate patient counselling.

AbstractRecent scholarship has explored the dynamics between families and colonial lunatic asylums in the late nineteenth century, where families actively participated in the processes of custodial care, committal, treatment and release of their relatives. This paper works in this historical field, but with some methodological and theoretical differences. The Foucauldian study is anchored to a single case and family as an illness narrative that moves cross-referentially between bureaucratic state archival material, psychiatric case records, and intergenerational family-storytelling and family photographs. Following headaches and seizures, Harry Walter Wilbraham was medically boarded from his position as Postmaster in the Cape of Good Hope Colony of South Africa with a ‘permanent disease of the brain’, and was committed to the Grahamstown Asylum in 1910, where he died the following year, aged 40 years. In contrast to writings about colonial asylums that usually describe several patient cases and thematic patterns in archival material over time and place, this study’s genealogical lens examines one white settler male patient’s experiences within mental health care in South Africa between 1908 and 1911. The construction of Harry’s ‘case’ interweaves archival sources and reminiscences inside and outside the asylum, and places it within psychiatric discourse of the time, and family dynamics in the years that followed. Thus, this case study maps the constitution of ‘patient’ and ‘family’ in colonial life,c.1888–1918, and considers the calamity, uncertainty, stigma and silences of mental illness.

In South Africa many people suffer from serious, incurable health conditions that may render them incapacitated and/or terminally ill. Such persons may inevitably require holistic care such as palliative care. The adoption in 2017 of the National Policy Framework and Strategy on Palliative Care 2017‒2022 (NPFSPC) in line with the Health Assembly Resolution 67.19 “Strengthening of Palliative Care as a Component of Comprehensive Care Throughout the Life Course” thus marked a significant milestone for advocates of palliative care, as well as for persons affected by terminal illness. Despite this positive step towards the fulfilment of the right to access healthcare, terminally ill persons who are inmates in South African correctional centres are not sufficiently protected by the NPFSPC. While the policy may be lauded for its detailed provisions aimed at affording appropriate care to free persons, it makes but a few fleeting references to inmates who are terminally ill – a very vulnerable group, given the often appalling conditions in correctional centres, the limited resources generally available to inmates and the stigma attached to them. It is therefore submitted that palliative care should be available to all inmates diagnosed with a terminal illness from the moment they are diagnosed. This article also analyses the stated purpose of the NPFSPC in relation to correctional settings, as well as the impact of disease on correctional centres, and the importance of fostering partnerships.

Aim: To examine the hypothesis that circular labour migrants who become seriously ill while living away from home return to their rural homes to convalesce and possibly to die. Methods: Drawing on longitudinal data collected by the Agincourt health and demographic surveillance system in rural northeastern South Africa between 1995 and 2004, discrete time event history analysis is used to estimate the likelihood of dying for residents, short-term returning migrants, and long-term returning migrants controlling for sex, age, and historical period. Results: The annual odds of dying for short-term returning migrants are generally 1.1 to 1.9 times (depending on period, sex, and age) higher than those of residents and long-term returning migrants, and these differences are generally highly statistically significant. Further supporting the hypothesis is the fact that the proportion of HIV/TB deaths among short-term returning migrants increases dramatically as time progresses, and short-term returning migrants account for an increasing proportion of all HIV/TB deaths. Conclusions: This evidence strongly suggests that increasing numbers of circular labour migrants of prime working age are becoming ill in the urban areas where they work and coming home to be cared for and eventually to die in the rural areas where their families live. This shifts the burden of caring for them in their terminal illness to their families and the rural healthcare system with significant consequences for the distribution and allocation of health care resources.

Since the start of the HIV and AIDS epidemic, very little research has been conducted on the older persons’ provision of HIV-related care to adult children. This is despite the fact that a large proportion of adults who die of AIDS-related illnesses stay with their elderly parents during the terminal stage of their illnesses. This paper explores how older persons in rural settings experience caring for their adult children with AIDS-related illnesses. In-depth interviews took place with older persons aged 60 years and above. The qualitative data analysis was informed by thematic approach to identify and report themes using inductive approach. The paper found that the older persons undertake the caring role without resources and support. As a result, they are burdened with having to care for adult children with AIDS-related illness. Fatigue arising from the hard work of physically caring for their sick adult children day and night adds to the physical burden on the older persons. Older persons will continue to carry the burden of caring for people with AIDS-related illnesses due to the increase in the number of new infections in South Africa. There is a need to involve them in HIV/AIDS programmes; their experience and wisdom would surely contribute positively and assist in addressing HIV prevention.

<p><strong>1. How can we maintain a sustainable private practice in the current political and economic climate?</strong></p><p>Eugene Allers</p><p><strong>2. SASOP Clinical guidelines, protocols and algorithms: Development of treatment guidelines for bipolar mood disorder and major depression</strong></p><p> Eugene Allers, Margaret Nair, Gerhard Grobler</p><p><strong>3. The revolving door phenomenon in psychiatry: Comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country</strong></p><p>U A Botha, P Oosthuien, L Koen, J A Joska, J Parker, N Horn</p><p><strong>4. Neurophysiology of emotion and senses - The interface between psyche and soma</strong></p><p>Eugene Allers</p><p><strong>5. Suicide prevention: From and beyond the psychiatrist's hands</strong></p><p>O Alonso Betanourt, M Morales Herrera</p><p><strong>6. Treatment of first-episod psychosis: Efficacy and toleabilty of a long-acting typical antipsychotic </strong></p><p>B Chiliza, R Schoeman, R Emsey, P Oosthuizen, L KOen, D Niehaus, S Hawkridge</p><p><strong>7. Treatment of attention deficit hyperactivity disorder in the young child</strong></p><p>Helen Clark</p><p><strong>8. Holistic/ Alternative treatment in psychiatry: The value of indigenous knowledge systems in cllaboration with moral, ethical and religious approaches in the military services</strong></p><p>J Dill</p><p><strong>9. Treating Schizophrenia: Have we got it wrong?</strong></p><p>Robin Emsley</p><p><strong>10.Terminal questions in the elderly</strong></p><p>Mike Ewart Smith</p><p><strong>11. Mental Health Policy development and implementation in Ghana, South Africa, Uganda and Zambia</strong></p><p>Alan J Flisher, Crick Lund, Michelle Frank, Arvin Bhana, Victor Doku, Natalie Drew, Fred N Kigozi, Martin Knapp, Mayeh Omar, Inge Petersen, Andrew Green andthe MHaPP Research Programme Consortium</p><p><strong>12. What indicators should be used to monitor progress in scaling uo services for people with mental disorders?</strong></p><p>Lancet Global Mental Health Group (Alan J Flisher, Dan Chisholm, Crick Lund, Vikram Patel, Shokhar Saxena, Graham Thornicroft, Mark Tomlinson)</p><p><strong>13. Does unipolar mania merit research in South Africa? A look at the literature</strong></p><p>Christoffel Grobler</p><p><strong>14. Revisiting the Cartesian duality of mind and body</strong></p><p>Oye Gureje</p><p><strong>15. Child and adolescent psychopharmacology: Current trends and complexities</strong></p><p>S M Hawkridge</p><p><strong>16. Integrating mental illness, suicide and religion</strong></p><p>Volker Hitzeroth</p><p><strong>17. Cost of acute inpatient mental health care in a 72-hour assessment uniy</strong></p><p>A B R Janse van Rensburg, W Jassat</p><p><strong>18. Management of Schizophrenia according to South African standard treatment guidelines</strong></p><p>A B R Janse van Rensburg</p><p><strong>19. Structural brain imaging in the clinical management of psychiatric illness</strong></p><p>F Y Jeenah</p><p><strong>20. ADHD: Change in symptoms from child to adulthood</strong></p><p>S A Jeeva, A Turgay</p><p><strong>21. HIV-Positive psychiatric patients in antiretrovirals</strong></p><p>G Jonsson, F Y Jeenah, M Y H Moosa</p><p><strong>22. A one year review of patients admitted to tertiary HIV/Neuropsychiatry beds in the Western Cape</strong></p><p>John Joska, Paul Carey, Ian Lewis, Paul Magni, Don Wilson, Dan J Stein</p><p><strong>23. Star'd - Critical review and treatment implications</strong></p><p>Andre Joubert</p><p><strong>24. Options for treatment-resistent depression: Lessons from Star'd; an interactive session</strong></p><p>Andre Joubert</p><p><strong>25. My brain made me do it: How Neuroscience may change the insanity defence</strong></p><p>Sean Kaliski</p><p><strong>26. Child andadolescent mental health services in four African countries</strong></p><p>Sharon Kleintjies, Alan Flisher, Victoruia Campbell-Hall, Arvin Bhana, Phillippa Bird, Victor Doku, Natalie, Drew, Michelle Funk, Andrew Green, Fred Kigozi, Crick Lund, Angela Ofori-Atta, Mayeh Omar, Inge Petersen, Mental Health and Poverty Research Programme Consortium</p><p><strong>27. Individualistic theories of risk behaviour</strong></p><p>Liezl Kramer, Volker Hitzeroth</p><p><strong>28. Development and implementation of mental health poliy and law in South Africa: What is the impact of stigma?</strong></p><p>Ritsuko Kakuma, Sharon Kleintjes, Crick Lund, Alan J Flisher, Paula Goering, MHaPP Research Programme Consortium</p><p><strong>29. Factors contributing to community reintegration of long-term mental health crae users of Weskoppies Hospital</strong></p><p>Carri Lewis, Christa Kruger</p><p><strong>30. Mental health and poverty: A systematic review of the research in low- and middle-income countries</strong></p><p>Crick Lund, Allison Breen, Allan J Flisher, Ritsuko Kakuma, Leslie Swartz, John Joska, Joanne Corrigall, Vikram Patel, MHaPP Research Programe Consortium</p><p><strong>31. The cost of scaling up mental health care in low- and middle-income countries</strong></p><p>Crick Lund, Dan Chishlom, Shekhar Saxena</p><p><strong>32. 'Tikking'Clock: The impact of a methamphetamine epidemic at a psychiatric hospital in the Western Cape</strong></p><p>P Milligan, J S Parker</p><p><strong>33. Durban youth healh-sk behaviour: Prevalence f Violence-related behaviour</strong></p><p>D L Mkize</p><p><strong>34. Profile of morality of patients amitted Weskoppies Psychiatric Hospital in Sout frican over a 5-Year period (2001-2005)</strong></p><p>N M Moola, N Khamker, J L Roos, P Rheeder</p><p><strong>35. One flew over Psychiatry nest</strong></p><p>Leverne Mountany</p><p><strong>36. The ethical relationship betwe psychiatrists and the pharmaceutical indutry</strong></p><p>Margaret G Nair</p><p><strong>37. Developing the frameor of a postgraduate da programme in mental health</strong></p><p>R J Nichol, B de Klerk, M M Nel, G van Zyl, J Hay</p><p><strong>38. An unfolding story: The experience with HIV-ve patients at a Psychiatric Hospital</strong></p><p>J S Parker, P Milligan</p><p><strong>39. Task shifting: A practical strategy for scalingup mental health care in developing countries</strong></p><p>Vikram Patel</p><p><strong>40. Ethics: Informed consent and competency in the elderly</strong></p><p>Willie Pienaar</p><p><strong>41. Confronting ommonmoral dilemmas. Celebrating uncertainty, while in search patient good</strong></p><p>Willie Pienaar</p><p><strong>42. Moral dilemmas in the treatment and repatriation of patients with psychtorders while visiting our country</strong></p><p>Duncan Ian Rodseth</p><p><strong>43. Geriatrics workshop (Psegal symposium): Medico-legal issuess in geriatric psyhiatry</strong></p><p>Felix Potocnik</p><p><strong>44. Brain stimulation techniques - update on recent research</strong></p><p>P J Pretorius</p><p><strong>45. Holistic/Alternative treatments in psychiatry</strong></p><p>T Rangaka, J Dill</p><p><strong>46. Cognitive behaviour therapy and other brief interventions for management of substances</strong></p><p>Solomon Rataemane</p><p><strong>47. A Transtheoretical view of change</strong></p><p>Nathan P Rogerson</p><p><strong>48. Profile of security breaches in longerm mental health care users at Weskoppies Hospital over a 6-month period</strong></p><p>Deleyn Rema, Lindiwe Mthethwa, Christa Kruger</p><p><strong>49. Management of psychogenic and chronic pain - A novel approach</strong></p><p>M S Salduker</p><p><strong>50. Childhood ADHD and bipolar mood disorders: Differences and similarities</strong></p><p>L Scribante</p><p><strong>51. The choice of antipsychotic in HIV-infected patients and psychopharmacocal responses to antipsychotic medication</strong></p><p>Dinesh Singh, Karl Goodkin</p><p><strong>52. Pearls in clinical neuroscience: A teaching column in CNS Spectrums</strong></p><p><strong></strong>Dan J Stein</p><p><strong>53. Urinary Cortisol secretion and traumatics in a cohort of SA Metro policemen A longitudinal study</strong></p><p>Ugash Subramaney</p><p><strong>54. Canabis use in Psychiatric inpatients</strong></p><p><strong></strong>M Talatala, G M Nair, D L Mkize</p><p><strong>55. Pathways to care and treatmt in first and multi-episodepsychosis: Findings fm a developing country</strong></p><p>H S Teh, P P Oosthuizen</p><p><strong>56. Mental disorders in HIV-infected indivat various HIV Treatment sites in South Africa</strong></p><p>Rita Thom</p><p><strong>57. Attendanc ile of long-term mental health care users at ocupational therapy group sessions at Weskoppies Hospital</strong></p><p>Ronel van der Westhuizen, Christa Kruger</p><p><strong>58. Epidemiological patterns of extra-medical drug use in South Africa: Results from the South African stress and health study</strong></p><p>Margaretha S van Heerden, Anna Grimsrud, David Williams, Dan Stein</p><p><strong>59. Persocentred diagnosis: Where d ps and mental disorders fit in the International classificaton of diseases (ICD)?</strong></p><p>Werdie van Staden</p><p><strong>60. What every psychiatrist needs to know about scans</strong></p><p>Herman van Vuuren</p><p><strong>61. Psychiatric morbidity in health care workers withle drug-resistant erulosis (MDR-TB) A case series</strong></p><p>Urvashi Vasant, Dinesh Singh</p><p><strong>62. Association between uetrine artery pulsatility index and antenatal maternal psychological stress</strong></p><p>Bavanisha Vythilingum, Lut Geerts, Annerine Roos, Sheila Faure, Dan J Stein</p><p><strong>63. Approaching the dual diagnosis dilemma</strong></p><p>Lize Weich</p><p><strong>64. Women's mental health: Onset of mood disturbance in midlife - Fact or fiction</strong></p><p>Denise White</p><p><strong>65. Failing or faking: Isses in the fiagnosis and treatment of adult ADHD</strong></p><p>Dora Wynchank</p>

Objective: To investigate the attitudes and knowledge of nurses towards traditional healing, faith healing and complementary therapies in the Northern Province in South Africa. Design: Survey of nurses. Setting: Registered professional nurses at health centres and clinics. Participants: 84 registered professional nurses Results: Nurse’s perceptions were basically positive toward ethnomedical therapy (traditional healing, faith healing and complementary medicine); this also included their integration into the primary health care system. Mean ratings for referral to a faith healer was 2.7, followed by complementary medicine (2.6) and traditional healing (2.2). Although low rates of referrals to ethnomedical therapists were practised, it was done so mainly in the patient’s interest and not as a last resort for chronic or terminal illness. Most did not discuss with a patient benefits of traditional healing but 71% discussed the possible harmful effects. However, the majority discussed the benefits rather than harmful effects of faith healing. With respect to mean ratings on knowledge, faith healing was considered the most important (4.3), followed by complementary medicine (4.2), and traditional healing (4.1). Conclusion: Faith healing was considered as more important than complementary medicine and traditional healing. Implications are relevant for nursing health care and policy.

The general aim of this study was to determine the experiences of a sample of terminally ill patients in using spiritually focused psychotherapy. This was a qualitative study conducted to a sample of 2 terminally ill patients from hospice in Grahamstown, South Africa. The research was conducted in 3 phases: an initial in-depth interview conducted to determine the participants' level of spirituality as well as the extent to which their terminal illnesses had affected their functioning. This was followed by a minimum of 6 spiritually focused therapy (SFT) sessions as a second phase of the research. To determine the participants' experiences of SFT, 2-3 in-depth interviews were conducted during the 3m phase of the research study. The research revealed that a belief in a higher power helps terminally ill patients cope better with their illness and that social disconnectedness is related to HIV / AIDS stigma. It also revealed that terminal illness is co-morbid with other psychiatric symptoms such as depression, evokes existential concerns, results in a change in the level of spirituality and affects the whole family. Participants blamed themselves for their illness, but found that engaging in the process of forgiveness of self and others brought about psychological healing for them. They experienced SFT as a coping resource that assisted them to deal with the fear of death as well as increased insight into the development of psychopathology and spiritual blockages. It is recommended that a comprehensive and holistic assessment during intake be undertaken so that where spiritual needs are available, therapy can be spiritually augmented to ensure that such needs/ struggles are addressed.
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The study is made in an attempt to evaluate a Non-Profit Organisation established 30 years ago. The organisation is called The St. Mary’s Development and Care Centre. This centre, amongst others, was established in 1982 by a true humanitarian, Mrs Thelma Henderson, and has since had more than 2250 children and lots more families in its care. The research aims to explore and evaluate the impact that the centre has had on the families and communities in Grahamstown. The evaluation is done as part of the current manager’s strategy to assess the strengths of the organisation and to build on the efficacy of the organisation. The researcher understands impact as any change whether positive or negative. This, from a social science perspective, is experienced by the person on a personal level and the effects in different families cannot be measured with a universal measure. Theory proves that because people are at varying levels of development, they therefore experience change and thus impact, differently. With the use of the grounded theory method comprising of systematic, inductive and comparative approaches for conducting inquiry for the purpose of constructing theory (Bryant & Charmaz 2007: 1) the research found that people have experienced change at different levels. This information, triangulated against previous research, validated the claims that child sponsorship at an NGO level indeed has benefits for the children involved in their programs. Therefore this evaluation paper draws the conclusion through similarities found and qualitative personal views that the St. Mary’s Development and Care Centre has indeed had an impact on the Grahamstown community.

South Africa is one of the countries hardest hit with the Human Immunodeficiency Virus (HIV) and Acquired Immuno Deficiency Syndrome (AIDS) epidemic. In response to the epidemic, the South African government adopted the Comprehensive HIV & AIDS Care, Management and Treatment programme strategic plan (CCMT) in 2000 (1) and developed the Operational Plan for CCMT for antiretroviral therapy rollout in 2003 (2). In order to monitor the progress of the implementation of CCMT, the National Department of Health (NDOH) adopted the Monitoring and Evaluation (M & E) framework in 2004 (3). The aim of this study was to assess the HIV & AIDS programme in Grahamstown‘s public sector health care system by using the national M & E indicators of the HIV & AIDS programme. The national M & E framework was used as the data collection tool and available information was collected from various sources such as the District Health Office (DHO), Primary Health Care (PHC) office, accredited antiretroviral sites and the provincial pharmaceutical depot. Group interviews were conducted with key stakeholder health care professionals at the District Health Office, Primary Health Care office, Settlers Hospital and the provincial Department of Health personnel. A one-on-one interview was conducted with the Deputy Director of HIV & AIDS Directorate, monitoring and evaluation in the National Department of Health. Available indicators such as budget and expenditure including antiretroviral procurement; human resources; nutrition-related indicators; prevention care and treatment indicators were collected. A group interview was conducted to document current practices, or where there was a lack of documentation, for indicators such as traditional medicines and pharmacovigilance. Most of the national M & E indicators are not required to be collected or collated by the district because the reporting format designed by the provincial Department of Health is different. Facilities, districts and provinces in South Africa are at different levels of implementation of the antiretroviral programme and hence a common format of the M & E indicators is not used by all provinces. Uniform data collection is not achieved due to human resources‘ constraints and other challenges such as continued use of manual reporting systems by the clinics. Districts are expected to report according to the formats drawn up by the provincial Department of Health (DOH) and there is a lack of awareness regarding the national M & E document amongst the Grahamstown Health Care Professionals. There is a need for training on the use of the M & E national framework so that the HCPs at the primary and secondary levels of the health care system are proficient with the process of M & E, and can provide inputs as well as take ownership of the process. The establishment of an M & E unit in Grahamstown is essential so that data collection and submission of the HIV & AIDS programme in the public sector according to the National M & E framework is addressed. However, despite all constraints and challenges in the public sector health care system in Grahamstown, available human and financial resources are being used effectively to maintain the HIV & AIDS programme.

The neo-liberal restructuring of state assets and facilities, which has taken place internationally over the past three decades, as well as in South Africa, has been a matter of great controversy. Privatisation, in particular, has been a polarising issue, especially when applied to fields like healthcare. Supporters of privatisation view it as cutting costs, mobilising funding, expertise and innovation, resulting in improved delivery, and opening possibilities for a spread of ownership. Critics claim the process involves retrenchments, declining services for the (poorer) majority of people, and a focus on the elites as citizens become transformed into customers, and with any economic empowerment going to the already prosperous. This thesis examines these issues by looking at the privatisation of hospitals in South Africa, with a case study of the Netcare-Settlers Public Private Partnership (PPP) (also known as the Settlers Private Hospital) in Grahamstown, South Africa. Netcare is South Africa’s largest private hospital company, and also has substantial operations in the United Kingdom. The thesis sets out the context: a highly inequitable healthcare system in the country, the rise of privatisation in the apartheid and post-apartheid eras, and healthcare privatisation. In terms of the Netcare-Settlers PPP, the thesis examines how the PPP was structured and developed, focusing on the impact of the PPP on non-clinical operations. The thesis argues that the results of the PPP are mixed, that it has greatly improved areas like facilities, maintenance, cleaning and catering, performed less well in increasing the doctor/ patient ratio or in attracting specialists, and is associated with the widespread and problematic use of outsourcing of service workers like cleaners and security. Overall, the PPP has improved healthcare, with some effective sharing of resources between the public and private parts of the hospital, but also relies on a pool of relatively low waged, under-unionised, labour. In terms of the general debate over privatisation, the Netcare-Settlers PPP shows that both supporters and critics have some valid points, and that privatisation in practice is not an either/ or, black/ white, good/ bad proposition, but something more complex. The success and failure of PPPs depend on the details of the contracts, and these can be used to maximise the performance of both the public and private partners. Better contracts may help avoid the uneven results seen at institutions like the Netcare-Settlers PPP.

One of the greatest challenges facing sub-Saharan Africa, which incorporates South Africa, is the AIDS pandemic. The devastation wrought by this disease is unsurpassed in recent times. The health and social development structures, already overburdened, are totally overwhelmed by the needs of povertystricken households and communities affected by AIDS. Caregivers attempting to support those affected and infected are also facing unique challenges and demands, particularly relating to dealing with the large numbers of deaths due to this disease. Experiences for these caregivers are likely to be varied, ranging on a continuum from positive to negative, for instance, the recovery of patients versus the death of patients. The objectives of this study are to explore and describe the lived experiences of caregivers working with AIDS patients, particularly patients who die from this disease whilst resident in a formal institution. The research is based on a qualitative, explorative, descriptive and contextual research design. The study is grounded in a phenomenological approach to inquiry. Caregivers working fulltime in a formal institution caring for patients who are dying from AIDS were interviewed in an in-depth, unstructured manner in order to gather spontaneous, rich descriptions of their experiences. Through this study the researcher wants their voices to be heard, the potential richness of their reflections acknowledged and the generated data to be applied to the benefit of the field of HIV/AIDS – both for staff and patients. Thirteen in-depth, unstructured interviews provided saturated data, which was then transcribed and coded to yield the central and sub-themes that were identified in this study. One central theme identified the fact that in their daily duties (at their place of work), caregivers experience various challenges as a result of having to deal with the death and dying of their patients suffering from AIDS. These caregivers face the death of their patients daily, from a disease that causes untold suffering to the patient, family members and to the caregivers themselves, who wish they could prevent the anguish, the pain and the inability of the medical profession to do more than they are at present towards curing this disease. ii By describing the lived experiences of these caregivers by means of the research interviews, the researcher gained a clear picture of the AIDS environment. The information shared by the participants formed the foundation of the broad guidelines that were formulated. These are intended to provide support for the caregivers centering around the equipping of mentors of the caregivers, to enable them to support the caregivers in their daily task of caring for patients dying from AIDS. These caregivers, thus supported, will then be in a position to provide optimal care for these dying patients. These broad guidelines are intended to provide support by focusing firstly on the physical environment in which these caregivers work; secondly in providing education for the caregivers to enable them to fulfill their duties, and thirdly to provide adequate counselling to ensure that they do not succumb to caregiver fatigue/burnout, a constant threat in this type of environment. The study concludes with recommendations regarding the areas of nursing practice, education and research.

Thesis (M. Tech.) -- Central University of Technology, Free State, 2010
South Africa currently faces one of the highest HIV prevalence rates in the world. As this prevalence rises, the strain placed on its hospitals is likely to increase due to the shortage of beds. The devastating effects of HIV/AIDS initiated the establishment of a hospice which is a non-governmental organisation whose goal is the provision of care for terminally ill patients, either in their homes, in hospitals or in a hospice’s own in-patients wards. Part of the hospice’s mission is to offer palliative care without charge to anyone who requires it. The basic elements of hospice care include pain and symptom management, provision of support to the bereaving family and promoting a peaceful and dignified death. This also includes the provision of cooked foods to the patients using the kitchen facilities of the hospices for this activity. It is well known that the kitchen is particularly important in the spread of infectious disease in the domestic environment due to many activities that occur in this particular setting. Food and water safety is especially important to the persons infected with the human immunodeficiency virus (HIV) or with immunodeficiency syndrome (AIDS).It is estimated that food-borne pathogens (disease–causing agents) are responsible for 76 million illnesses, some resulting in death, in the United States alone every year. In one study of patients with AIDS, two-thirds had diarrhoeal disease and in two-thirds of these, the following enteric pathogens were identified: Salmonella, Shigella, Listeria, Yersnia, Cryptosporidium, Entamoeba histolylica and Campylobacter sp. In an epidemiological study of patients with HIV infection a close association was found between consumption of raw or partially cooked fish and antimicrobial-resistant Mycobacterium avium complex. Antibiotic resistance in food-borne pathogens has become a reality and this poses a serious threat to the medical fraternity since it diminishes the effectiveness of treatment. This study was undertaken to determine the prevalence of foodborne pathogens including bio aerosols isolated from the kitchen surfaces and food handler’s before and after cooking. The antibiotic resistance of the isolated pathogens was further determined to assess their impact on treatment. The following microbiota were isolated: Total viable counts (TVC), Coliforms, Escherichia coli, Staphylococcus aureus, Pseudomonas and presumptive Salmonella. The hospices had high counts of E.coli and S.aureus on the cutting boards for the breakfast session compared to the traditional home based kitchens. It was speculated that this could have originated from crosscontamination via the foodhandler’s hands and the food served. It is evident from the results that hospices lack a management system regarding the prevalence of E. coli as it was present on the cutting boards throughout the food preparation sessions. Gram negative organisms (coliform and P. aeruginosa) were in particular both resistant to oxacillin and this pose a great challenge in this particular setting. This can be addressed by putting emphasis on hygiene as a strategy per se for reducing antibiotic resistance.

Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Design in the Faculty of Informatics and Design at the Cape Peninsula University of Technology, 2012
Home-Based Health Care (HBHC) is the provision of health services and social assistance to individuals in their homes. It is an indispensable service to communities in need; presently in South Africa, these health care services are provided by local non-profit and non-governmental organizations. It is mainly targeted at poverty-stricken and under resourced communities and is an important aspect of healthcare in South Africa. A lot of communities in South Africa are still under-resourced and live in impoverished conditions. This is reflected in poor living standards characterized by unemployment, uneasy access to basic amenities, unequal distribution of wealth, poor medical facilities in rural communities, etc. The prevalence of the HIV/AIDS endemic has also worsened the situation. However, the South African government has constantly supported initiatives to enhance better healthcare in rural communities. This research presents a case study of caregivers working in Du Noon, an informal settlement in Western Cape, South Africa. Du Noon is overpopulated and home to lots of foreigners who have migrated in search of better living standards thus stretching an already over-burdened community. Naturally, this development supports poor health practices which encourage the spread of diseases within the community. Health facilities do not sufficiently cater for the ever-increasing healthcare demands and as such lots of people depend on NGOs such as SALT (Sharing Abundant Life Together) who through the help of caregivers and community workers have been providing for some of the healthcare needs of the Du Noon community since 2000. Findings reveal that although caregivers in this community have lots of stories to share about their work practices, they do not have a platform to share these stories. This research focuses on identifying processes involved in capturing these stories and moderating them into educative and entertaining visual contents for the purpose of sharing the stories within the community. Using qualitative research methods, empirical and field study provides the needed data as well as understanding of the multi-dynamism of this community. Data analysis is done through interpretive methods for the purpose of understanding the data collected and analysed during the research process. Finally, as a possible research contribution, the research concludes by examining how other technology can enhance the storytelling experience using interaction design methods that enables caregivers participate in the entire design process. Suggestions are also given as to direction for further research within the subject area.

M.A.
In sub-Saharan Africa the importance of understanding the illness and dying experiences of people living with HIV/AIDS (PLWHAs) is underlined by the fact that some 30 million people are already infected with HIV. Yet, there has been precious little research on chronic illness and dying within the sociology of health and illness. This dissertation begins to address this gap by considering the question ‘how does care of AIDS patients inform a sociology of illness and dying?’ It is argued that AIDS related chronic illness and dying are best understood within the AIDS care context. A theoretical model of quality AIDS care (QACM) was constructed, and highlights access, physical and psychosocial aspects of care. This was evaluated in relation to two South African hospices, both located on the Witwatersrand. In addition, a telephonic survey was undertaken in order to situate the two case studies within a national context of hospice-based AIDS-care. Some of the valuable refinements made to the literature QACM include new staff motivators, self-contained funding, additional dietary concerns, more cost-effective treatments, the importance of stigma, patient-patient support and the advent of hospice day-care centres. It was concluded that caregiver and patient needs must be met to ensure quality care provision. Three noteworthy conclusions were drawn. Firstly, the QACM was found to be a sound reflection of hospice AIDS-care reality. Secondly, the case hospices sufficiently subscribed to the required care standards, but improvements are warranted. Thirdly, and most importantly, the study highlights the impact of stigma on the chronic illness and dying experiences of PLWHAs. This study has taken a small step in the right direction by providing some sociological insights into chronic illness and dying, by the application of Northern-centric literature to the developing context of South African hospice AIDS-care. Further investigations may serve to bear these conclusions out, in alternative care settings, in order to further develop the sociology of illness and dying.
Prof. J.M. Uys Prof. P. Alexander.

Dissertation submitted in fulfillment of the requirements for the Degree in Masters of Technology: Nursing, Durban University of Technology, 2011.
Background Working in the intensive care unit can be traumatic for nursing personnel. Critical care nurses are faced with repeated exposure to death and dying as they are involved in caring for patients who are actively dying or who have been told that they have a terminal illness and are faced with the possibility of impending death. Critical care nurses relate in different ways to the phenomena of death and dying within their nursing profession and their scope of practice. These nurses often have a difficult time coping with the stress that comes with caring for those who are dying or relating to loved ones of those that are dying. Aim of the study The aim of the study was to explore the critical care nurse’s experiences of death and dying. Methodology A qualitative, descriptive phenomenological approach was used to guide the study. Four nurses were recruited and rich descriptions of their experiences were gained through individual face-to-face interviews. One broad question was asked: ‘What are your experiences regarding death and dying of your patients in ICU?’ iii Results The findings of this study revealed that issues such as communication, multicultural diversity, education and coping mechanisms relating to caring for the critically ill and dying patient are essential in nursing education and practice. Critical care nurses need to have support networks in place, not only to assist in providing care, but also for their own emotional support
M

This thesis explores home-based care volunteer (HBCV) identity and how it is shaped by context in rural KwaZulu-Natal, South Africa. The literature on home-based care in Africa is dominated by the "burden of care narrative" which is supported by the themes of "women as caregivers", "poverty" and "stigma". The literature presents government and stakeholder collaboration as the general solution to alleviating the burden of care on women caregivers. A wider scope for research within the themes is necessary to discover alternative solutions to the problem of the burden of care. This study ventured to expand the scope of current research by exploring the area of HIV and AIDS home-based care volunteer (HBCV) identity and participation in care and support. Fifteen HBCVs were interviewed about their work and personal life stories and interviewed reflexively using narrative interviewing. Findings indicate that the women's stories were dominated by narratives of gender, poverty and sociopolitical factors (social field narratives). Meta-narratives influencing the women's lives were stories of communal motherhood, aspirations to service-oriented work and religious beliefs and commitment. The women's personal life stories revealed that they saw themselves as distinctively caring. Connections between the different aspects of identity and context revealed that the women made sense of their community participation through their personal identities as strong and loving mothers and the association with the group identity of community mothering. Home-based-care volunteerism was explored as a form of agency in response to a lack of recognition, support and acknowledgement for AIDS caregivers and their patients. Researcher reflexivity through autoethnography and poetry contributed to achieving depth in the study and to the understanding that HBCVs strive for space recognition, acknowledgement and validation for their work. In a resource strained context a balance must be found between material compensation and respect and recognition which can be effective in sustaining community initiated volunteerism.
Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2013.