“It was like a bad dream”: Making sense of violent hand amputation and replantation in South Africa

Abstract

BackgroundSouth Africa is faced with one of the highest rates of violent crime in the world. Accordingly, therapists treat high numbers of deliberate hand injuries. There is, however, a paucity of literature exploring the lived experiences of these survivors. PurposeThe aim of this study was to describe and interpret the meaning of living through a violent hand amputation and replantation, the impact on occupational adaptation and to reflect on therapeutic intervention, within the context of South Africa. Study DesignAn exploratory embedded single case study using a qualitative approach. MethodsInterpretative phenomenological analysis was used to analyze data from: 8 interviews with the primary participant, over a period of 33 months; an interview with his work colleague; interviews with 5 health professionals; a review of the occupational therapy rehabilitation file and a review of the audio-visuals, recorded over 2-years. ResultsThis narrative reveals a man who understood his terrifying assault to be part of a southern African ritual of spiritual origin - using human body parts for traditional medicine (muti crime) or witchcraft. He perceived his expensive hand replantation and therapy as surreal and violence as normal. Challenges highlighted the importance of being attentive to the psychosocial sequelae of violence; and the most valuable part of therapy was perceived as occupational engagement. ConclusionsThe perception of attempted muti murder situates this extreme and unusual case study as a novel contribution to the medical and rehabilitation literature. South African therapists are urged to be actively involved in changing the culture of violence, and hand therapists are reminded of the importance of applying holistic and occupation-based intervention.