Academic literature on the topic 'Transcultural medical care – South Africa'

Background: The COVID-19 climate has seen a shift in the manner that patients seek care. Lockdown measures and COVID-19 regulations, and the fear of contracting the virus at a health care facility has also changed health seeing behaviour among patients. The COVID-19 climate has seen a significant increase in the utilisation of virtual platforms to consult with providers. Objectives: The objective of this chapter was to conduct the descriptive analysis of telephonic consultations by members of medical schemes who consulted general medical practitioners. Methods: The study entailed a descriptive analysis of medical scheme claims data for the 2020 review period. The inclusion criteria were all National Pharmaceutical Product Interface (NAPPI) codes associated with a telephonic consultation consulting general medical practitioners. The ICD-10 code primary diagnosis was used to describe the diagnosis. The study mainly focused on outpatient patients with service dates between March and December 2020. Results: The analysis covered claims data from a total of 12 medical schemes. The schemes analysed accounted for 1,6 million lives. The total number of telephonic consultations was 17 237. The mean (SD) claimed amount for telephone consultation for a general medical practice consult was R2821 (SD = 20). This was slightly lower than the scheme tariff of R2872 (SD = 19). The study found that most telephonic consults were for Acute bronchitis, unspecified; Acute upper respiratory; Emergency use of U07.1 (Confirmed diagnosis); Emergency use of U07.2 (Suspected Diagnosis); Follow-up examination; Special screening. Conclusion: The study found evidence of patients utilising telephonic consultations for general medical practitioner services. The effect of COVID-19 in this respect was seen in the three main primary diagnoses that were associated with the consult, Acute upper respiratory, Emergency use of U07.1 (confirmed diagnosis) and Emergency use of U07.2 (suspected diagnosis). Even though the average telephonic consult was claimed at just under R3003, few general medical practitioners claimed between R4004 and R5005 which were higher than the industry average. There is a need to develop telephone consult guidelines at industry level, these should also address reimbursement rate differentials.

This chapter looks at the personal experience of a Neurologist in caring for people with Non-Epileptic Seizures (NES) and illustrates the profession’s shortcomings. Like every other patient who presents to a health care professional, people with NES want a clear diagnosis, with a detailed explanation of how and why they developed the condition, and a clear therapeutic plan. Although there are limits to the understanding of NES, that may also be said of all medical conditions. Since emotionally difficult, deeply personal experiences typically lie at the heart of their condition, people with NES need no less empathy and understanding than any other person with a medical condition. However, numerous patients have recounted stories about how they abandoned the medical profession for help with their seizures after their experience of seeing a neurologist. The amount of harm done by medical professionals in the way that they interact with people with NES has yet to be quantified.

The clinical encounter with a patient who is suffering from chronic pain and a psychiatric disorder is challenging. This can become a clinical conundrum if the patient has a different cultural background than the physician and says he or she has a mysterious culture-bound syndrome. This chapter discusses a Quichua-Inca illness experience called Jaki, a frequent condition that is well-known by millions of Quichua patients in the Andes, South America. Biomedically trained doctors usually dismiss it as a condition without any medical importance experienced by superstitious and primitive people. In contrast, Jaki patients believe it is a complex and threatening illness that could lead to death. They recognize four types of Jaki and believe the causes are related to “evil spirits” and that proper treatment should address them. The author conducted a transcultural psychiatry study showing that most Jaki patients are suffering from depression, anxiety, somatoform disorders, psychological factors affecting a physical condition, and adjustment disorders. Jaki patients are suffering indeed from comorbid chronic pain and psychiatric disorders. The chapter concludes with clinical recommendations for the practitioner who is willing to avoid racial bias, improve cultural competency, and offer culturally sensitive and better quality medical care.

The name BACIS combines the names basic antenatal care checklist and information systems. This is to highlight the fact that the BACIS program is an information system that implements the guidelines for maternity care in South Africa and the basic antenatal care checklist process. The BACIS program was conceptualised by the author and the study obstetrician as a tool that could be used at primary healthcare level to improve compliance to maternal health protocols and the BANC checklist. The author's role was that of knowledge engineer and software developer with the study obstetrician acting as the medical domain expert. This chapter presents the technical architecture of the BACIS program. This includes the technology used in creating the system's rule base, as well as the system's data model and software classes and its interface.

Telemedicine could effectively aid hospital referral systems in bringing specialized care to rural communities. South Africa has identified telemedicine as part of its primary health care strategic plan, but similar to many other developing countries, the successful implementation of telemedicine programs is a daunting challenge. One of the contributing factors is the insufficient evidence that telemedicine is a cost-effective alternative. Furthermore, many telemedicine services are implemented without a thorough needs assessment. Throughout this chapter, the authors investigate the use of medical informatics in quantitative telemedicine needs assessments. A framework is introduced to direct implementation policies towards a proven clinical need rather than pushing technology into practise. This clinical-pull strategy aims to reduce the amount of failed projects, by providing decision support to implement appropriate technologies that have the potential to contribute towards better quality healthcare.

This chapter highlights the current state of HIV/AIDS care that fits Lewis Thomas’s 1971 definition of a “halfway technology.” It explains halfway technology as an intermediate stage between “nontechnology” and as a supportive medical care that does little to affect the course of disease, while “high” or “transformative technology” depends on advances in basic sciences. It also clarifies that transformative technology included immunization, chemotherapy, and antibiotics, while halfway technologies included dialysis, organ transplants, and mechanical ventilation. The chapter focuses on AIDS, which is as much a concern in the twenty-first century as it was forty years ago. It elaborates how the AIDS epidemic is ravaging African countries, such as South Africa and Nigeria; spreading in parts of Asia, such as Thailand and the Philippines; in Eastern Europe in countries like Russia and Ukraine; and in Caribbean and Central American countries.

Background: Recently there has been a steady increase in the use of Instant Messaging (IM) as a means of providing health and healthcare services. This growth has been particularly rapid during the ongoing COVID-19 pandemic. Many reports indicate informal services using IM, in particular WhatsApp, have arisen spontaneously, in the absence of any formal guidelines and little consideration of consent. This study documents the consent practices of healthcare professionals using IM for clinical activities in District Hospitals in KwaZulu-Natal, South Africa and compares these practices with the literature. Methods: As part of a larger audit of telemedicine activity in KwaZulu-Natal a survey questioned clinicians’ use of IM, including consent practices and awareness of regulatory guidelines. Concomitantly multiple electronic databases were searched for papers on WhatsApp use in clinical service. Inclusion criteria were: papers written in English, reported on WhatsApp in clinical use or potential clinical use, and addressed consent. Results: The survey confirmed anecdotal reports of widespread informal use of WhatsApp in District Hospitals. Most clinicians were unaware of regulatory guidelines, and few obtained consent for taking photographs or sharing of images and information with colleagues for consultation. The literature review found that consent was mentioned in only 28 papers. Of these 11 reported that written consent was obtained, of which 5 were for taking photographs and 4 for sharing information with colleagues. Discussion: The survey showed that more than half of the respondents who used IM did not consider this to be telemedicine, with the corresponding ethical requirements governed by national guidelines, thereby risking legal exposure. However, South Africa’s regulatory guidelines do not align with common clinical practice. The literature shows that the majority of doctors shared patient information by IM without obtaining any form of consent. Conclusion: Practical guidelines are urgently required in South Africa and worldwide that balance practical conduct of medical care with sound contemporary ethical principles. Prudent guidance will ensure clinicians do not inadvertently breach patient privacy and confidentiality laws whilst permitting continued health-related use of instant messaging.

Gender equality and information and communication technology are important in the achievement of the Millennium Development Goals (MDGs) in policy, planning, and practice. The 2000 Millennium Declaration of the United Nations (UN) formed an international agreement among member states to work toward the reduction of poverty and its effects by 2015 through eight Millennium Development Goals: 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and the empowerment of women 4. Reduce child and maternal mortality 5. Improve maternal health care 6. Combat HIV and AIDS, malaria, and other major diseases 7. Ensure environmental sustainability 8. Develop global partnership for development Progress toward gender equality and the empowerment of women is one goal that is important to achieving the others. Poverty, hunger, illiteracy, environmental threats, HIV and AIDS, and other health threats disproportionately affect the lives of women and their dependent children. Gender-sensitive ICT applications to education, health care, and local economies have helped communities progress toward the MDGs. ICT applications facilitate rural health-care workers’ access to medical expertise through phones and the Internet. Teachers expand learning resources through the Internet and satellite services, providing a greater knowledge base for learners. Small entrepreneurs with ICT access and training move their local business into world markets. ICT diffusion into world communication systems has been pervasive. Even some of the poorest economies in Africa show the fastest cell-phone growth, though Internet access and landline numbers are still low (International Telecommunications Union [ITU], 2003b). ICT access or a lack of it impacts participation, voice, and decision making in local, regional, and international communities. ICTs impact the systems that move or inhibit MDG progress. UN secretary general Kofi Annan explained the role of the MDGs in global affairs: Millennium Development Goals are too important to fail. For the international political system, they are the fulcrum on which development policy is based. For the billion-plus people living in extreme poverty, they represent the means to a productive life. For everyone on Earth, they are a linchpin to the quest for a more secure and peaceful world. (UN, 2005, p. 28) Annan also stressed the critical need for partnerships to facilitate technology training to enable information exchange and analysis (UN, 2005). ICT facilitates sharing lessons of success and failure, and progress evaluation of work in all the MDG target areas. Targets and indicators measuring progress were selected for all the MDGs. Gender equality and women’s empowerment are critical to the achievement of each other goal. Inadequate access to the basic human needs of clean water, food, education, health services, and environmental sustainability and the support of global partnership impacts great numbers of women. Therefore, the targets and indicators for Goal 3 address females in education, employment, and political participation. Progress toward the Goal 3 target to eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015, will be measured by the following indicators. • Ratio of girls to boys in primary, secondary, and tertiary education • Ratio of literate females to males who are 15- to 24-year-olds • Share of women in wage employment in the nonagricultural sector • Proportion of seats held by women in national parliaments (World Bank, 2003) Education is positively related to improved maternal and infant health, economic empowerment, and political participation (United Nations Development Program [UNDP], 2004; World Bank, 2003). Education systems in developing countries are beginning to offer or seek ways to provide ICT training as a basic skill and knowledge base. Proactive policy for gender equality in ICT access has not always accompanied the unprecedented ICT growth trend. Many civil-society representatives to the World Summit on the Information Society (WSIS) argue for ICT access to be considered a basic human right (Girard & Ó Soichrú, 2004; UN, 1948). ICT capability is considered a basic skill for education curriculum at tertiary, secondary, and even primary levels in developed regions. In developing regions, ICT access and capability are more limited but are still tightly woven into economic communication systems. ICTs minimize time and geography barriers. Two thirds of the world’s poor and illiterate are women (World Bank, 2003). Infant and maternal health are in chronic crisis for poor women. Where poverty is highest, HIV and AIDS are the largest and fastest growing health threat. Ninety-five percent of people living with HIV and AIDS are in developing countries, partly because of poor dissemination of information and medical treatment. Women are more vulnerable to infection than men. Culturally reinforced sexual practices have led to higher rates of HIV infection for women. Gender equality and the empowerment of women, starting with education, can help fight the spread of HIV, AIDS, and other major diseases. ICT can enhance health education through schools (World Bank). Some ICT developers, practitioners, and distributors have identified ways to incorporate gender inclusiveness into their policies and practice for problem-solving ICT applications toward each MDG target area. Yet ICT research, development, education, training, applications, and businesses remain male-dominated fields, with only the lesser skilled and salaried ICT labor force approaching gender equality. Successful integration of gender equality and ICT development policy has contributed to MDG progress through several projects in the developing regions. Notable examples are the South-African-based SchoolNet Africa and Bangladesh-based Grameen Bank Village Pay Phone. Both projects benefit from international public-private partnerships. These and similar models suggest the value and importance of linking gender equality and empowerment with global partnership for development, particularly in ICT. This article reports on developing efforts to coordinate the achievement of the MDGs with policy, plans, and practice for gender equality beyond the universal educational target, and with the expansion of ICT access and participation for women and men. The article examines the background and trends of MDG 3, to promote gender equality and the empowerment of women, with particular consideration of MDG 8, to develop global partnership for development, in ICT access and participation.