A qualitative exploration of the challenges and support needs of orientation and mobility practitioners in South Africa

Ponte Academic JournalNov 2020, Volume 76, Issue 11 A TRANSCONTINENTAL COMPARISON OF TRADITIONAL MEDICINE PRACTICES IN THE MANAGEMENT OF FRACTURES: THE CASE OF ZULU MEDICINE (SOUTH AFRICA) AND MAORI MEDICINE (NEW ZEALAND)Author(s): Nireshnee Ramchundar ,Manimbulu NlootoJ. Ponte - Nov 2020 - Volume 76 - Issue 11 doi: 10.21506/j.ponte.2020.11.17 Abstract:Despite the historical marginalization of traditional health practitioners in both South Africa and New Zealand, traditional medicine practices are still thriving. Many countries have made great efforts to advance traditional medicine practices by regulating, researching and integrating its products, practitioners and practice into health systems, while improving access to and the rational use of traditional medicines. The comparison of traditional practices between the two countries would give us an affirmation in the absence of clinical trials from which we may recommend strategies and ideas for the improvement of health systems. Additionally, we would be able to identify plant species used as herbal medicines for the treatment of fractures on two continents. A survey was conducted among herbalists (Izinyanga) practising Zulu traditional medicine in KwaZulu-Natal, South Africa and Māori practitioners who are experts in medicine and healing (Tohunga-Rongoā), in the North Island of New Zealand. Data was collected by a survey and a moderator with a single focus group of three traditional health practitioners, resulting in qualitative research on their practices between October 2018 and September 2019. An analysis of findings was conducted to affirm similarities and differences in traditional health practices on two continents. Except for a few differences in demographics, the traditional management of fractures by traditional health practitioners in South Africa and New Zealand were largely similar. Practitioners in both countries identified fractures following taking a history of the trauma and conducting a physical examination when a patient presents with open fractures (visibly broken bones), acute pain, inflammation and bleeding. In both countries, traditional health practitioners do not seem to practice traditional bone-setting any longer, though they continue to use a wide range of traditional medicines (mostly derived from plants, with a few animal products) to manage bruises, wounds, dislocations, sprains, strains and fractures. The topical treatment of traditional medicines from several known plant families was preferred in New Zealand, whereas in South Africa oral treatment options were preferred. In total, 74 traditional medicines from 26 plant families with presumed fracture-healing activity were identified in this study. The chemical compositions and biological activities of the plant families Rubiaceae (Pentanisia prunelloides in South Africa and Coprosma robusta in New Zealand) and Xanthorrhoeaceae (Aloe ferox in South Africa and Phormium tenax in New Zealand), found on both continents, are recommended to be studied further. Traditional health practitioners are aware of the serious impact that fractures could have on a patient, and while traditional remedies do assist in healing, they are open to using Western medicines for analgesia and as anti-inflammatories should their patients choose this treatment option. Furthermore, they often referred patients to hospitals for a more accurate diagnosis and subsequent treatment which shows that there is already integration and collaboration between traditional health practitioners and biomedically-trained health professionals in the management of fractures. Traditional health practitioners believed that an interventional tool for the treatment/management of fractures would be beneficial in their practices in traditional settings. Download full text:Check if you have access through your login credentials or your institution Username Password

INTRODUCTION The paucity of research originating from low- and middle-income countries, particularly in the field of emergency care, demands that those entrenched in the healthcare system go on to make meaningful contributions to the knowledge economy of low- and middle income countries. While the rest of the world builds an appetite for highly skilled South African prehospital practitioners, the emergency care field in South Africa desperately needs practitioners who can engage with research and advance the profession through evidence-based practice. Achieving this requires emergency care practitioners to embark on postgraduate education programmes to learn research skills. Given the shortage of emergency care practitioners in South Africa, the paucity of prehospital-specific research and the large number of paramedics that pursue employment and education abroad, understanding the factors that influence emergency care practitioner’s agency in pursuing or eschewing postgraduate education is extremely important as this affects the paramedic workforce and the development of the field in South Africa. AIM The study aimed to formulate a deeper understanding of why ECPs pursue or eschew postgraduate education. METHODS The study made use of a mixed method exploratory sequential research design. Using both quantitative and qualitative methods generated a thorough understanding of the research problem in the given context. The qualitative phase constituted Phase 1 of the study and used focus group discussions and one-on-one interviews with key stakeholders in the emergency medical services. The findings of this phase informed the quantitative phase (Phase 2) of the study, in which an online structured questionnaire was administered to emergency care practitioners. 5 FINDINGS More than half (54%) of the sample of emergency care practitioners pursued postgraduate education. Among the 46% of emergency care practitioners who eschewed postgraduate education, the majority applied their profession in South Africa. This study, therefore, found a decrease in the likelihood of pursuing postgraduate education among emergency care practitioners working in South Africa compared to those working abroad (OR 0.57, CI: 0.25–1.25). The largest proportion (81%) of those who pursued postgraduate education occupied roles within academia. Those emergency care practitioners within operational (72.1%) and managerial (15.6%) roles constituted the largest proportion of those who eschewed postgraduate education. Structural conditions owing to the paucity of financial incentives (86%), support (57%) and career progression pathways (92%) predominantly motivated emergency care practitioners within the South African prehospital milieu to eschew postgraduate education. Cultural conditions motivated emergency care practitioners, regardless of location or area of speciality, to pursue postgraduate education. The constructs of the individual or collectively held ideals, beliefs, and values were identified as the cultural conditions, which are not easy to change and have lasting conditional influence among emergency care practitioners. CONCLUSION In conclusion, the study established and presented, from the emergency care practitioners’ point of view, the cultural and structural conditions that influence their agency: motivations to pursue or eschew postgraduate education. The findings highlight the structural and cultural dynamic and interchangeable nature and the overlap of the prehospital milieu's values, practices and behaviours. It notably identified the interconnections as all the practices and behaviours underpinned by the motivations emerging from the prehospital milieu. The study further demonstrated that a comprehensive and deeper understanding of how individuals interpret their structural and cultural conditions, is essential. The objective goal of developing the profession is interlinked with establishing institutional and cultural norms that capacitate and support those within the profession.

The professionalism debate in South African public relations

The potential to improve the diagnosis quality, reduce diagnosis errors, while improving the patient safety and reducing cost in health care by implementing information systems (IS) has been established by prior studies while the high rate of missing records, the absence of communication amongst doctors, poor communication between doctors and pharmacists, mistaken diagnoses and an inadequate number of medical professionals in South Africa have made the search for precise storage and access of medical information a priority. The study is undertaken as part of the M-tech course. The study is inspired by the manual systems that are currently used by medical practitioners in South Africa to capture, store and access patient's records. The objective of this study is to determine the factors that influence the adoption of electronic patient's records management systems, the risk, creditability, and the usefulness of adopting this technology and to make recommendations to practitioners, policy makers, researchers, and other stakeholders regarding the adoption of electronic patients' record management system particularly in South Africa. This country has shown a slow adoption of such technologies. The slow adoption indicates the need for research in this field.

Social representation of PR activism: Perceptions of early career public relations professionals in South Africa

The health care system of South Africa is growing exponentially and providing patients with various treatment options. Recently, Ayurveda has become popular because of its nature-based and spiritual approach to ailments. Neck pain has been researched to a great extent in allopathic medicine, but not in the context of Ayurvedic medicine. Although there is a wealth of information regarding Ayurveda and its basic principles, there are limited publications on the Ayurvedic approach to common musculoskeletal conditions such as neck pain. Therefore, the aim of this study was to determine the Ayurvedic approach to the diagnosis and management of neck pain by Ayurvedic practitioners in South Africa. Method A qualitative exploratory descriptive study was conducted using standardized open-ended questions. Eight Ayurvedic practitioners, from South Africa, from the provinces of KwaZulu-Natal and Gauteng, were interviewed to establish their methods of diagnosis and management of neck pain. The interviews were semi– structured and conducted in English and later transcribed verbatim. The transcripts were then analysed using thematic analysis to establish codes, categories and themes. Results Eight out of thirteen registered Ayurvedic practitioners in South Africa participated in the study. Five main themes emerged from the data: the Ayurvedic approach to management of neck pain, the Ayurvedic diagnosis of neck pain, the Ayurvedic treatment of neck pain, the use of modalities in the Ayurvedic profession for the management of neck pain and the basis of referral in the Ayurvedic profession to manage a patient with neck pain. Participants discussed the importance of the three dosha principle and the importance of knowing the “root cause” of an ailment as an integral part of the management of a patient with neck pain. The three dosha principle focuses on vata, pitta and kapha, which are the constituents of the human body. It is essential that there is homeostasis of the three doshas to maintain good health and a disease-free state. The participants, in this study, discussed the root cause of an ailment as being the underlying factors that bring about pain in the body. Participants stressed the importance of the “pulse diagnosis,” the integration of modern technology and the threefold principle of darshana, sparshna and prashana in order to properly diagnose a patient. These diagnostic tools emphasize the holistic approach of the Ayurvedic system of medicine. The treatment method varied amongst participants. Although each practitioner practices differently, the basic principles of the profession are still applied when administrating treatment to a patient. Treatment focused on panchakarma therapy, greeva basti, shirodhara, massage and potli therapy, herbal oils and medication. The goal of Ayurvedic treatment is to pacify the aggravated doshas, utilizing these various treatment options. Participants in this study focused on yoga, marma therapy and patient education as modalities that are utilized by the profession to assist in the management of neck pain. They discussed the importance of referral to the appropriate health care professional, so that the patient receives the best possible care. The results of this study revealed that the Ayurvedic system of medicine is a holistic system of medicine that addresses all aspects of the mind, body and spirit. In Ayurveda, the management of a patient relies on the patient, practitioner and the “three dosha principle”. The foundation of the “three dosha principle” focuses on vata, pitta and kapha. Essentially, various ratios of vata, pitta and kapha exist in every individual, however, when there is lack of homeostasis between these three elements, disease occurs in the body. The therapeutic goal in Ayurveda is to restore doshic balance in the body. Conclusion This is the first South African study to be conducted on the Ayurvedic management and diagnosis of the musculoskeletal condition, neck pain. This study will add to the body of literature and enable other practitioners to have a better understanding of Ayurveda, thus giving the patient the best, appropriate care available. The foundation of Ayurveda is the “three dosha principle” which the profession applies to holistic patient management, focuses on the mind, body and spirit of the patient, rather than the disease per se.

Management of Polycystic Ovarian Syndrome: A Qualitative Inquiry among Complementary and Alternative Medicine Practitioners in South Africa.

Globalisation requires ever closer co-operation between legal professionals hailing from different national jurisdictions. This interactive global environment has fostered growing international training and mobility among legal practitioners and the internationalisation of legal education. Increasing numbers of law students get trained in other countries as part of their undergraduate degrees or even come to foreign shores to obtain law degrees. Many students hailing from other African countries study towardsLLBdegrees at South African universities. Major commercial law firms ensure that they can offer in-house expertise on major foreign legal systems and co-operate with partner firms in other parts of the globe. The General Agreement on Trade in Services (GATS), to which South Africa is a party, is a multilateral agreement focusing on the liberalisation of trade in services amongst member countries. Services under the GATS system include legal services. The commitments made by South Africa under this agreement require that South Africa allows foreign legal practitioners to establish a commercial presence or be transferred to South Africa. The Bill of Rights entrenched in Chapter 2 of the South African Constitution guarantees fundamental rights including the right to equality and freedom of trade, occupation and profession. With the coming into force of the new Legal Practice Act 28 of 2014, which provides a legislative framework for regulating the affairs of legal practitioners, including their admission and enrolment, it is necessary to assess the extent to which the Act complies with the GATS rules and the South African Constitution. This paper examines the new Legal Practice Act 28 of 2014, and examines whether the Act addresses the conflicts that have always existed between the regulation of the legal profession and the admission of legal practitioners in South Africa with South Africa's commitments under the GATS system. Using the doctrinal legal method, it analyses and evaluates the rules governing the admission of foreign attorneys in South Africa from two perspectives. First, it considers them in the light of the international law obligations of the country and second it evaluates whether or not they comply with the South African Constitution, and more specifically with the Bill of Rights entrenched in the South African Constitution. While the new legislation may assist in ensuring the compliance of South Africa with the relevant GATS rules, it will depend on the regulations which still have to be promulgated to what extent the new legal framework will achieve the full compliance of South Africa with all relevant GATS rules. The paper concludes with recommendations for the reform of the Legal Practice Act. It argues that while the requirement to be a South African permanent resident in order to qualify for admission as an attorney may be justifiable in terms of GATS and in terms of South African constitutional law, it is not in South Africa's best interest to retain it. Consequently, the paper calls for the repeal of the permanent residence requirement for admission as an attorney in the county.

Orientation and mobility (O&M) practice is important because the population of persons with visual impairments is large enough to warrant planned action on measures to help them acquire independence and sustain their livelihoods. Most O&M practitioners in South Africa are full-time employees in nongovernmental organizations. The few who work in public service work in schools. The research presented here sought to explore and describe the current state of O&M practice in South Africa as perceived by O&M practitioners, so as to determine factors that could contribute to its improvement. Although the study was conducted in South Africa, its findings could inform O&M practitioners in other parts of the world, particularly in developing countries. The research was deemed necessary because O&M is central to the independence of persons who are visually impaired (those who are blind and those with low vision), since it enhances their physical access to desired places and resources for living without them overly depending on other people. The problem of a high client-to-practitioner ratio is exemplified in South Africa, where an estimated 1% of the population of 50,586,757, or 505,867, are visually impaired (Statistics South Africa, 2011). Since 1974, about 100 O&M practitioners have been trained in South Africa (College of Orientation and Mobility, 2010). That is, 12 groups of 80&M practitioners have been trained in the past 36 years, each group taking 3 years. The size of each class is small but not unthinkable, considering that in Uganda, Kyambogo University trained 36 certificate-level O&M practitioners in 3 years, at an average of 12 students per year. For a 3-year diploma, the same university initially trained an average of 14 students in the first two groups (1999-2001 and 2002-2004) and reduced the number to 9 per class in the next two groups (2003-2005 and 2004-2006) (Bayo, n.d., Table 1). Thus, it would take 3 years to produce one group of 9 diploma-level O&M practitioners. In both countries, class sizes are small. However, since Uganda managed to train 82 practitioners in 7 years, its rate of training is faster than that of South These shortages are not unique in the provision of services to persons with visual impairments, especially in Africa, where, according to Sommer (2004), there is one ophthalmologist for every 1 million people. Shortages were also lamented by the South African National Council for the Blind (2009, p. 13) when it alluded to a rehabilitation service delivery crisis in South Africa. The Natal Society for the Blind (1993) also lamented the lack of O&M skills among children who are visually impaired during their school years. At least in developing countries, organizations identify an unmet need for O&M services. Cognizant that staff shortages are common in many countries, it was important to gather the perceptions of O&M practitioners with regard to their practice with a view to informing readers. Practitioners' opinions on the strengths and needs of their profession could offer useful insights to other practitioners in similar circumstances the world over. The College of Orientation and Mobility (2010) estimated that the ideal number of clients a practitioner could train per annum was 24. Perhaps the college's estimate is based on the general observation that O&M practitioners who visit clients and train them in their homes reach out to an average of 6 clients every three months. The estimate is much higher than the Ugandan trend, in which 82 O&M practitioners trained 400 clients between 1996 and 2006 (Bayo, n.d., Table 1). In the study presented here, the estimate (24 clients) is loosely referred to merely as a comparative baseline. Literature from different organizations and the experiences of various practitioners largely differ with the college's estimate, although figures issued by Pioneer Institute for the Blind (2007, p. …

Ponte Academic JournalNov 2020, Volume 76, Issue 11 A COMPARATIVE STUDY OF THE TYPES OF FRACTURES IDENTIFIED AND DIAGNOSED BY TRADITIONAL HEALTH PRACTITIONERS IN KWAZULU-NATAL (SOUTH AFRICA) AND THE NORTH ISLAND (NEW ZEALAND)Author(s): Nireshnee Ramchundar ,Manimbulu NlootoJ. Ponte - Nov 2020 - Volume 76 - Issue 11 doi: 10.21506/j.ponte.2020.11.16 Abstract:Fractures are the most common large-organ, traumatic injuries in humans, which can lead to complications, disability and/or deformity. The prompt identification and treatment of fractures is critical for improved outcomes and to avoid long term complications, morbidity or even mortality. However, the treatment of fractures by traditional health practitioners in South Africa and New Zealand is not well known. One of the objectives of this study was to determine the types of fractures identified and diagnosed by traditional health practitioners in KwaZulu-Natal (South Africa) and the North Island (New Zealand). A survey was conducted among herbalists (Izinyanga) in Kwazulu-Natal, South Africa and Māori practitioners who are experts in medicine and healing (Tohunga-Rongoā) in the North Island of New Zealand, between October 2018 and September 2019. In addition, a single focus group, with a moderator and three (3) traditional health practitioners, was held in Kwazulu-Natal, South Africa in the same study data collection period resulting in qualitative research based on their traditional practices to treat fractures. Most of the South African respondents were males (14/26, 53.8%), aged between 51-60 years (8/26, 30.8%) and spoke Isizulu as a first language (24/26, 92.3%). They practiced mainly as Herbalists or Izinyanga (22/26, 84.6%). In New Zealand, there were similar respondents who were male and female (6/12, 50%). They were aged between 31-40 years old (5/12, 41.7%) and spoke English as a first language (7/12, 58.3%). They practiced only as Tohunga-Rongoā or Māori practitioners (12/12, 100%). Overall, 44 responses were received by 38 respondents for the most common criteria to diagnose fractures. 21 out of 44 responses indicated that acute pain at the site of injury was the most common criterion to diagnose fractures. Most of the respondents (19/38; 50%) treated all types of fractures presented to them, with limb fractures being the most common site of fractures treated (15/38; 39.5%). Traditional health practitioners in this study were aware of the delicate nature of fractures and their potential life-threatening effect which prompted them to refer their patients to biomedically-trained health care professionals for an accurate diagnosis to be made. Traditional health practitioners in South Africa and New Zealand identified fractures when a patient presented with acute pain, inflammation bleeding, visibly broken bones and/or immobility. Even though they managed almost all types of fractures presented to them, limb fractures were the most common site of fractures treated. Further studies are needed to investigate future collaboration between traditional health practitioners and biomedically-trained health care professionals for the diagnosis and treatment of fractures. Download full text:Check if you have access through your login credentials or your institution Username Password

Unani Tibb is a holistic form of medicine, which highlights the interconnectedness of mind, body and soul. Despite this, there is very little evidence of spiritual care practices by Unani Tibb practitioners in South Africa. This protocol outlines a proposed process for developing guidelines to integrate spirituality and spiritual care in Unani Tibb practice. In phase one, a document review will be conducted on spirituality and spiritual care in complementary and alternative medicine and Unani Tibb. A series of quantitative and qualitative enquiries will follow to obtain the perspectives of various stakeholders in the Unani Tibb profession. Phase two will rely on the findings of phase I to develop guidelines according to the Delphi method. Experts in the relevant fields will be soliciting their opinions on the nature and content of the proposed guidelines. The data will be analysed using descriptive statistical analyses, thematic analysis and narrative synthesis. Ethics clearance has been obtained from the ethics committee of the university.

Assertiveness is arguably one of the strongest predictors of success among business leaders and professionals. The study focuses on imposter phenomenon (IP), which occurs when an individual, normally considered to be a high achiever, undergoes an internal experience of feeling like an intellectual fraud or experiences a fear of failure upon achieving success, and the relationship of IP with assertiveness. Due to an absence of research on the relationship between IP and assertiveness, particularly in professionals in South Africa, this study investigates the way these two variables relate to each other. The purpose of this study is to 1) investigate whether IP is prevalent in female professionals in South Africa, 2) investigate whether IP and assertiveness are correlated and 3) determine whether IP is a predictor of assertiveness. The study was conducted on working professionals in South Africa (N = 165) and questionnaires were distributed online. The instruments used were the Clance Imposter Phenomenon Survey and elements of the Adaptive and Aggressive Assertiveness Scales. The professionals assessed were drawn from different industry sectors and across all job functions. The results suggest that IP is prevalent in professionals in South Africa and bears a moderately negative relationship to assertiveness. Another finding was that IP is a negative predictor of assertiveness. Gender also had an effect on the relationship between the two variables; the relationship was only found to be significant among women when the sample was split.

Assertiveness is arguably one of the strongest predictors of success among business leaders and professionals. The study focuses on imposter phenomenon (IP), which occurs when an individual, normally considered to be a high achiever, undergoes an internal experience of feeling like an intellectual fraud or experiences a fear of failure upon achieving success, and the relationship of IP with assertiveness. Due to an absence of research on the relationship between IP and assertiveness, particularly in professionals in South Africa, this study investigates the way these two variables relate to each other. The purpose of this study is to 1) investigate whether IP is prevalent in female professionals in South Africa, 2) investigate whether IP and assertiveness are correlated and 3) determine whether IP is a predictor of assertiveness. The study was conducted on working professionals in South Africa (N = 165) and questionnaires were distributed online. The instruments used were the Clance Imposter Phenomenon Survey and elements of the Adaptive and Aggressive Assertiveness Scales. The professionals assessed were drawn from different industry sectors and across all job functions. The results suggest that IP is prevalent in professionals in South Africa and bears a moderately negative relationship to assertiveness. Another finding was that IP is a negative predictor of assertiveness. Gender also had an effect on the relationship between the two variables; the relationship was only found to be significant among women when the sample was split.

Mental health literacy on the part of medical practitioners is an important component of mental healthcare. General practitioners (GPs) are typically the first doctors consulted by a person who is ill. Exploration of their perceptions regarding mental illness, aetiological issues and treatment is important. To investigate perceptions of mental illness in a sample of ten South African Muslim GPs (five male, five female) in the Lenasia area (Johannesburg, South Africa). Using a qualitative approach, semi-structured interviews were conducted with each GP. The questionnaire encompassed 37 questions relating to the context in which the GPs practised, perceptions of mental illness, understanding of religion and culture, and treatment of mental illness (including aspects of spiritual illness). Thematic content analysis was used to analyse the data. Six dominant themes were identified, namely GPs' understanding of mental illness and its causation; stigma, secrecy and somatisation; the beneficial effects of religion in mental illnesses; perceptions of spiritual illnesses; collaboration with traditional healers; and collaboration with psychiatrists and psychologists. Greater awareness regarding the stigmatisation of mental illness is needed. Furthermore, it is important that healthcare professionals have an understanding of religious and cultural taxonomies of illness as well as the use of traditional healing as a mode of treatment. Participants identified a need for increased collaboration between healthcare professionals, including traditional healers.

This thesis develops an approach to ethical decision-making for legal practitioners in South Africa that, it is argued, meets the ends and values of its relatively new constitutional democracy. The thesis starts by identifying that neutral partisanship was, and continues to be, the prevailing conception of role for legal practitioners in South Africa. The study focuses on how this approach is problematic for a number of reasons, the most important of which are: (1) because neutral partisanship allows lawyers to become ethically disengaged, and (2) the approach does not fit with the values of South Africa’s Constitution. The study proceeds to consider alternatives to the neutral partisanship model, analysing their underlying premises and ‘fit’ with the South African context. The study argues that the work of William Simon, a US scholar, is the most suitable approach to adopt in South Africa. This is because of its emphasis on the need for legal practitioners to exercise discretion in ethical decision-making, to take responsibility for their actions, and ultimately to seek justice as understood within the legal system in which they operate. The study then shifts to a consideration of how Simon’s approach needs to be contextualised given that it has been developed from a western/Global North perspective. To do this, I consider the content of the indigenous value of Ubuntu and its incorporation into the South African legal system. I then consider how Ubuntu could assist in the development of legal practitioners’ understanding, purpose and execution of their duties within a transformative constitutional democracy. In doing this, I develop inward- and outward-looking factors based on traditional and constitutional values directing legal practitioners in their ethical decision-making. Finally, the study closes with a consideration of how the approach can be institutionalised. The study proposes certain ways in which code regulation and education can support the success of the approach.