South African Doctors Research Articles

Sociodemographic and work-related factors associated with psychological resilience in South African healthcare workers: a cross-sectional study

BackgroundPsychological resilience facilitates adaptation in stressful environments and is an important personal characteristic that enables workers to navigate occupational challenges. Few studies have evaluated the factors associated with psychological resilience in healthcare workers.ObjectivesTo determine the prevalence and factors associated with psychological resilience in a group of South African medical doctors and ambulance personnel.Materials and methodsThis analytical cross-sectional study used secondary data obtained from two studies conducted among healthcare workers in 2019 and 2022. Self-reported factors associated with resilience, as measured by the Connor-Davidson Resilience Scale-10 (CD-RISC-10), were evaluated. R statistical software was used for analysing the data and performing statistical tests.ResultsA total of 647 healthcare workers were included in the study, of which 259 were doctors and 388 were ambulance personnel. Resilience scores were low overall (27.6 ± 6.6) but higher for ambulance personnel (28.0 ± 6.9) than for doctors (27.1 ± 6.0) (p = 0.006). Female gender (OR 1.94, 95%CI 1.03–3.72, p = 0.043), job category (OR 6.94 95%CI 1.22–60.50, p = 0.044) and overtime work (OR 13.88, 95%CI 1.61–368.00, p = 0.044) significantly increased the odds of low resilience for doctors. Conversely, salary (OR 0.13, 95%CI 0.02–0.64, p = 0.024) and current smoking status (OR 0.16, 95%CI 0.02–0.66, p = 0.027) significantly reduced the odds of low resilience amongst doctors. In addition, only previous alcohol use significantly reduced the odds of low resilience for ambulance personnel (OR 0.44, 95%CI 0.20–0.94, p = 0.038) and overall sample (OR 0.52, 95%CI 0.29–0.91, p = 0.024).ConclusionsResilience was relatively low in this group of South African healthcare workers. The strong association between low resilience and individual and workplace factors provides avenues for early intervention and building resilience among healthcare workers.

Prevalence and determinants of burnout among South African doctors during the COVID-19 pandemic.

Burnout, resulting from chronic workplace stress that has been unsuccessfully managed, has previously been documented in doctors. The coronavirus disease 2019 (COVID-19) pandemic has increased occupational challenges faced by doctors, potentiating their risk for burnout. This study aimed to determine the prevalence and determinants of burnout among medical doctors during the COVID-19 pandemic. Three public sector hospitals in Gqeberha, South Africa. A cross-sectional study of 260 voluntary participants was conducted. Participants completed self-administered electronic questionnaires. Logistic regression analysis was performed to explore the determinants of burnout. The prevalence of burnout in this study was 78%. Burnout was significantly associated with being a medical intern or community-service medical officer (adjusted odd ratio [AOR] = 6.72, 1.71-26.40), being in the lowest income band (AOR = 10.78, 2.55-45.49), and using alcohol to manage work-related stress (AOR = 3.01, 1.12-8.04). Job-related factors associated with burnout were experiencing high conflict at work (AOR = 5.04, 1.92-13.20) and high role ambiguity and role conflict (AOR = 4.49, 1.98-10.18). Low support at work (AOR = 9.99, 3.66-27.23), medium job satisfaction (AOR = 5.38, 2.65-10.93) and medium support at work (AOR = 3.39, 1.71-6.73) were positively associated with burnout. Participants with medium (AOR = 0.28, 0.10-0.80) and high levels of resilience (AOR = 0.08, 0.03-0.25) were protected against burnout. Coronavirus disease 2019-related factors were not significantly associated with burnout. The burnout prevalence among South African medical doctors at public hospitals during the COVID-19 pandemic was high and strongly associated with job stress factors. Given the increased prevalence of burnout among doctors and the strong associations with job stress factors, mitigation of burnout requires targeted organisational interventions.

Variations in intravenous fluid management for paediatric hypernatraemia in South Africa: A survey of junior and senior South African paediatric doctors

Background. Paediatric hypernatraemia is a severe and life-threatening electrolyte abnormality that is associated with considerable morbidity and mortality. Although intravenous (IV) fluid therapy is a crucial component of management, there are no management guidelines, and varying approaches to IV fluid therapy are commonplace in clinical practice. Objectives. To determine the variance in IV fluid therapy in the management of paediatric hypernatraemia among paediatric registrars and consultants in South Africa. Methods. A self-administered online survey was conducted from November 2020 to February 2021. The survey assessed paediatricians’ management of three typical clinical scenarios of community-acquired hypernatraemia seen in South Africa. Descriptive results were presented as proportions, frequencies and medians with interquartile ranges. Comparisons were done using contingency tables. Results. Responses from 119 participants were analysed. Most respondents worked in the state sector (69.8%), and were based mainly in Gauteng (46.2%) or Western Cape (25.2%) province. Most (60.2%) respondents considered a serum sodium level ≥146 mmol/L indicative of hypernatraemia, and 43.6% (n=51/117) reported seeing >10 cases of paediatric hypernatraemia in 2019. For all three cases, at least eight different types of infusate (of varying sodium concentrations) were chosen as maintenance fluids. Fluid deficits were calculated using either the free water method or based on the perceived degree/percentage of clinical dehydration. Conclusion. There is considerable variability in the management of hypernatraemia among paediatricians in South Africa. There is an urgent need to develop a standardised guideline for the treatment of paediatric hypernatraemia.

Competencies of junior medical doctors in managing seriously ill and injured children: time to rethink our current training approach?

The correct treatment of very ill and injured children is critical, yet little is known about the competencies of South African (SA) junior doctors in managing these children. This survey documents SA junior doctors' reported resuscitation training opportunities, experience, skills and knowledge. A total of 118 doctors (interns, medical officers and registrars) from paediatric departments affiliated with 7 medical schools, participated. Resuscitations were not rare events with 71% (84/118) reporting participation in >10 resuscitations during the preceding 2 years. Yet a third of doctors have not attended an accredited resuscitation training course within the last 2 years; 34% (12/35) medical officers and 29% (18/63) registrars, respectively, with 42% (49/118) of all participants never receiving any formal resuscitation training during employment. Feedback on performance is not standard practice with only 8% (10/118) reporting consistent debriefing after a resuscitation. Although 72% (85/118) reported their resuscitation knowledge as adequate, 56% (66/118) passed the knowledge test. This study recognized missed learning opportunities in junior doctors' training, assessment, debriefing and knowledge which may adversely affect the quality of care in managing paediatric emergencies. This has implications for departmental and post-graduate training programmes.

The Global North Culture as a Palimpsest.

This is a reflection from three Black South African doctors - two women and a man. We studied at the institution that we are currently working in, which is a former white university that was not permitted to train Black medical students by the apartheid government. We experienced the segregation in healthcare and witnessed how our communities did not have access to it. The COVID-19 pandemic unearthed major challenges and asymmetries, particularly for the Black race and poor countries. For countries such as South Africa, it brought back memories of the apartheid past with the history of segregation and discrimination.

Empirical Bioethics and the Health ‘Brain-Drain’: a qualitative study of the experiential and ethical landscape of compulsory community service for a group of South African doctors

The health ‘brain drain’ (HBD) is an issue of significant global bioethical concern, resulting in severe maldistribution of healthcare workers (HCWs) and gross inequities in health service provision. The ethics...

Overtreatment and benevolent provider moral hazard: Evidence from South African doctors

Overtreatment is widespread in health, with potentially dire consequences for patients, health systems and public health. It may be fueled by providers when they do not bear the cost of treatment (moral hazard), even they do not profit financially from it (i.e. benevolent providers). We test this hypothesis by creating an exogeneous change in the incentives faced by private doctors in South Africa. We find that provider moral hazard has no effect on overtreatment in volume but fuels overtreatment in cost. By contrast, when they bear the marginal treatment cost, doctors choose cheaper drug. While these results suggest that provider moral hazard contributes to overtreatment in primary care, we consider other plausible channels, such as responses to a perceived demand for high-quality drugs or market segmentation. We discuss the potential scope for supply-side cost-sharing incentives to reduce inefficiency in future health system reforms in South Africa.

Vonnisbespreking: Die strafregtelike vervolging, skuldigbevinding en kwytskelding van ’n verloskundige en ginekoloog Van der Walt v S [2020] ZACC 19

To date, few South African doctors have been found guilty of medical negligence in a criminal court (see e.g. R v Van Schoor 1948 4 SA 349; S v Mkwetshana 1965 2 SA 493 (N)). In the field of gynaecology and obstetrics, the unreported case of S v Nell 1987 TPD (see Strauss 1991:280–1) is relevant. In this case, a general practitioner was found guilty of culpable homicide on the ground of negligence during a birth process for attempting to remove the patient’s placenta without the assistance of an obstetrician. The court a quo’s sentence of five years imprisonment, of which three years were conditionally suspended, was changed by the full bench of the Transvaal Provincial Division (TPD; to which the accused appealed) to a fine of R5 000 or to two years’ imprisonment. In Van der Walt v S 2019-4-11, case no. A13/2018, the High Court dismissed an appeal against the merits and the sentence of the Regional Court and sentenced the gynaecologist-obstetrician to five years imprisonment after he was found guilty of culpable homicide. An appeal to the Supreme Court of Appeal was dismissed, but the Constitutional Court in Van der Walt v S [2020] ZACC 19 allowed the doctor’s appeal against the judgment on the ground of alleged irregularities in the handling of the case in the court a quo. His contention was that his right to a fair trial, as protected in section 35(3)(i) of the Constitution, was violated in that the magistrate pronounced on the admissibility of only certain exhibits during her judgment. She had also relied on medical textbooks in her judgment that were not disclosed during the trial. His appeal against his sentence was moreover based on the fact that it violated section 12(1)(a) of the Constitution. The Constitutional Court subsequently allowed the appeal against the fairness of the trial but dismissed the appeal against the sentence. In order to better contextualise the judgment of the Constitutional Court, the judgment of the High Court requires closer inspection. The High Court judgment detailed the specialist’s negligence towards one of his patients, whose death after giving birth was found to have been caused by severe blood loss not being attended to by the specialist. Both the Regional Court and the High Court (sitting as a court of appeal) found him guilty on a charge of criminal negligence. Regrettably, the Constitutional Court’s focus was limited to the alleged irregularities by the court a quo and not the context in which said irregularities occurred. The Constitutional Court therefore upheld the appeal and directed that the case be referred back to the Director of Public Prosecutions for a decision on whether or not to reinstitute action in a Regional Court in front of another magistrate. As a consequence, the specialist’s sentence fell away following the Constitutional Court’s declaration that the trial in the Regional Court was unfair.

Seven Lessons on Phosphorescence

Seven Lessons on Phosphorescence Nkateko Masinga (bio) This poem is written in response to a news story in Spotlight (South Africa), headlined as follows: “What the Charlotte Maxeke fire tells us about health and safety in Gauteng hospitals, 13th May 2021.” I Remember all you have been taught about fire: ceremonial bonfire, Dante’s Inferno, Hades, the Burn Wounds practical in the skills lab. II Remind yourself that this is not an airplane: There will be no oxygen mask descending from above, no option to stabilize yourself. III Run to the Pediatrics Ward. Think about what you learnt in physics: energy transfer, speed. Hold children in your arms. Cry when alone. Hold smoke in your mouth. Cough when alone. IV Make your mandatory check-in phone call. Say to your partner, Honey I’ll be home late. Don’t wait up. Say nothing about the flames. Remember that this fire is not unlike you; fluorescent and phosphorescent; burning beyond the call of duty. The scabs remain. V Watch the fire die down. No more combustion. No more perceptible heat. The scabs remain. Some evidence is indestructible. Speak. VI Tell your lover what the fire did to you. Count on your fingers the ones it took. Stop holding smoke in your mouth. Heal. VII Tend to what remains in the aftermath; reestablish the scaffolding of your body, brittle but relearning the beauty of water. Click for larger view View full resolution DEREJE DEMISSIE (ETHIOPIA), PSYCHSCAPE (2009) [End Page 37] Nkateko Masinga Nkateko Masinga is a South African doctor and writer. She is a 2019 Fellow of the Ebedi International Writers Residency, a 2018 Mandela Washington Fellow, and a Golden Key Scholar. She was nominated for a Pushcart Prize in 2018. Her most recent chapbook, psalm for chrysanthemums, was selected by the African Poetry Book Fund and Akashic Books for publication in the 2020 New-Generation African Poets box set. Copyright © 2022 World Literature Today and the Board of Regents of the University of Oklahoma

‘Fake news’ or trust in authorities? The problems of uncertainty at a time of medical crisis

This article examines the complex boundaries between ‘fake news’, speculation, hypothesis, gossip and whistleblowing during the COVID-19 pandemic. It shows that apparently authoritative sources and experts gave information or policy recommendations that have turned out to be wrong, sometimes dangerously so, and explores the kinds of bias that enter medical advice and planning decisions. The article then diagnoses a WhatsApp voice-note from a young South African doctor that went viral and was denounced as ‘fake news’ because of obvious errors. This note, however, revealed behind the scenes medical thinking about subjects that professional bodies and authorities usually avoid discussing publicly. In highlighting what apparently authoritative sources omit and distort, the article suggests that journalists should report medical advice, even from authoritative sources, with caution and shows that apparently ‘fake’ news may reveal issues other news sources neglect.

Reflecting on the current scenario and forecasting the future demand for medical doctors in South Africa up to 2030: towards equal representation of women

BackgroundIncreasing feminization of medical professions is well-acknowledged. However, this does not always equate to equitable representation of women within medicine, regarding their socio-demographic indicators, regions, sectors and fields of practice. Thus, this paper quantifies the gap in supply of female medical doctors in relation to demand, towards reaching different gender equity scenarios.MethodsA retrospective review of the Health Professions Council of South Africa’s (HPCSA) database on registered medical doctors (medical practitioners and medical specialists) from 2002 until 2019 was utilized as an indicator of supply. Descriptive statistics were used to summarize data, and inferential statistics (considering a significance level of 0.05) were utilized to determine the association between the number of male and female doctors, disaggregated by demographic variables. We forecasted future gaps of South African male and female doctors up to 2030, based on maintaining the current male-to-female ratio and attaining an equitable ratio of 1:1.ResultsWhile the ratio of female doctors per 10 000 population has increased between 2000 and 2019, from 1.2 to 3.2, it remains substantially lower than the comparative rate for male doctors per 10 000 population which increased from 3.5 in 2000 to 4.7 in 2019. Men continue to dominate the medical profession in 2019, representing 59.4% (27,579) of medical doctors registered with the HPCSA with females representing 40.6% (18,841), resulting in a male-to-female ratio of 1:0.7. Female doctors from the Black population group have constantly grown in the medical workforce from 4.4% (2000), to 12.5% (2019). There would be a deficit of 2242 female doctors by 2030 to achieve a 1:1 ratio between male and female medical doctors. An independent-samples t-test revealed that there was a significant difference in the number of male and female doctors. The Kruskal–Wallis test indicated that there was a sustained significant difference in terms of the number of male and female doctors by population groups and geographical distribution.ConclusionsBased on the investigation, we propose that HRH planning incorporate forecasting methodologies towards reaching gender equity targets to inform planning for production of healthcare workers.

COVID 19: are South African junior doctors prepared for critical care management outside the intensive care unit?

Introductionthe coronavirus disease 2019 (COVID-19) pandemic has negatively impacted countries across the globe. Infected individuals will seek aid at various health care facilities. Many patients will recover without requiring specialised treatment. A significant percentage of infected individuals will need critical care management, which will begin in the emergency department, generally staffed by junior doctors. Junior doctors will need to stabilize, triage and manage these patients prior to referral to specialized units. Above and beyond the usual occupational demands that accompany junior doctors in state facilities, this pandemic will thrust further responsibility on them. The objectives were to describe crisis preparedness of junior doctors in the areas of triage decision-making and critical care management, outside the intensive care unit.Methodsthis is a descriptive, cross-sectional study, utilizing a web-based survey. Junior doctors in South Africa, being doctors in year one or year two of internship and community service, were invited to participate anonymously via various social media platforms. Results: a total of 210 junior doctors across South Africa answered the survey. Junior doctors expressed confidence with knowledge of intubation drugs, to perform intubation and cardiopulmonary arrest resuscitation without supervision. Only 13.3% of respondents expressed comfort with setting and adjusting ventilator settings independently. 57% of participants expressed discomfort with making critical care triage decisions. Ninety-three percent (93%) of participants expressed benefit from a telemedicine intervention.Conclusionjunior doctors in South Africa indicate that they are prepared to initiate management of the critically ill patient outside the intensive care unit but remain uncertain in their ability to provide ongoing critical care management. The COVID-19 pandemic has highlighted the need to prepare junior doctors with the ability to manage critical care triage and management in emergency rooms. Leveraging of the workforce in South Africa may be potentiated by telemedicine interventions.

A biblical evaluation of Healing begins with sanctification of the heart by M.K. Strydom (2013)

Dr Michelle Strydom is a South African trained medical doctor whose conferences and writings have gained her and her ministry, known as ‘Eagles’ Wings’, a large following in South Africa and beyond. Her aim is to open up for her followers ‘the Bible from a medical perspective’ and ‘medicine from a Biblical perspective’. Her views are comprehensively laid out in a book of 751 pages, titled Healing begins with the sanctification of the heart . In this article, the theological premises of Healing begins with the sanctification of the heart are evaluated from a Reformed biblical perspective. Three theological ‘leaps’ in Strydom’s interpretation of the Bible are discussed and three examples are given which illustrate her a-contextual reading of the Bible. The conclusion is that, although Strydom’s book contains some valuable insights, her theological framework is largely unbiblical and contrary to the gospel. The purpose of this article is to caution Christian readers against false guarantees of healing such as these offered by Strydom and Eagles’ Wings Ministries.

Freedman-Bernstein musculoskeletal competence testing of South African intern doctors: is there a difference between health science faculties?

ABSTRACT BACKGROUND: Basic competency in musculoskeletal medicine is necessary for all graduating doctors due to the growing burden of disease. Globally and nationally research has shown deficiencies in musculoskeletal knowledge according to the Freedman-Bernstein test. In South Africa, different health science faculties show different approaches to training; this article considers if any of these demonstrate adequate training and whether significant differences exist between the faculties' results. The aim of the study is to determine whether there are significant differences between musculoskeletal learning outcomes between graduates from different health science faculties METHODS: A multi-centre, cross-sectional study was performed in which medical interns completed the Freedman-Bernstein test after graduation and prior to commencing their formal two-month block in orthopaedics. Data was then analysed to determine whether significant differences existed between the test scores of the eight health science faculties' graduates RESULTS: A total of 259 completed tests were analysed. The mean score was 46% (range 4-88%, 95% CI 44-48%), and 244 of the 259 interns failed the test (94% failure rate). The lowest and highest mean scores, by health science faculty, was 34% (95% CI 28-40%) and 60% (95% CI 55-64%) respectively. An ANOVA test indicated statistically significant differences between test scores of the different health science faculties (p<0.001 CONCLUSION: We have demonstrated competency scores consistent with previous literature from South Africa and shown that there are statistically significant differences between the health science faculties based on Freedman-Bernstein test scores. This evidence suggests differing levels of musculoskeletal knowledge attained at health science faculties in South Africa, and no improvement in undergraduate education in the last decade Level of evidence: Level 4 Keywords: musculoskeletal, competence, Freedman-Bernstein, undergraduate training

Interprofessional knowledge and perceptions of selected South African healthcare practitioners towards each other

Background. Interprofessional collaboration is internationally and popularly envisioned as a successful paradigm for the management of disease, disabilities and injuries. Despite this, the opinion of South African (SA) healthcare practitioners towards this idea is incoherent; this division of opinion needs to be changed to serve the common goal of better patient care. Objective. To provide a narrative overview of literature-based evidence of interprofessional knowledge and perceptions of SA doctors, nurses, physiotherapists, occupational therapists, dieticians, speech and hearing therapists, as well as biokineticists regarding interprofessional collaboration. Methods. An electronic search of Google Scholar, Crossref, PubMed and Sabinet databases identified 701 records, which were synthesised to 11 articles that were published during 2005 - 2016. Individual article quality was appraised using the modified Downs and Black scale. Results. Of the 11 records, 3 were Master’s theses reviewing the interprofessional knowledge and perceptions of doctors, physiotherapists and biokineticists towards the profession of chiropractic therapy; 3 examined the perceptions of chiropractic therapy, occupational therapy, speech and hearing therapy and biokinetics towards physiotherapy and chiropractic therapy; while the remaining 5 were supportive of interprofessional collaboration. The nature of the research designs of the selected studies were: survey ( n =6), short communication ( n =1), clinical commentary ( n =1), randomised controlled trial ( n =1) and focus group interview ( n =2). An incoherence underlies the perceptions of the abovementioned practitioners regarding interprofessional collaboration owing to lack of interprofessional knowledge regarding each given discipline’s scope of profession (SoP). This is compounded by uneasiness with regard to patient competition. Some physiotherapists are against collaborative relationships, while occupational therapists, biokineticists and chiropractors are inclined to support the notion of a multidisciplinary physical rehabilitation team. There is a paucity of literature-based evidence reviewing the knowledge and perceptions of medical doctors, nurses and physiotherapists with regard to the SoP of occupational therapists, speech and hearing therapists, biokineticists, dieticians and chiropractors, thereby warranting future investigation. Conclusions. There are mixed perceptions of interprofessional collaboration among the selected healthcare practitioners owing to negative perceptions.

The Filmmaker's Triage: The Doctor Figure and Images of Trauma

ABSTRACTWhile writing a fictionalised feature film screenplay set around the character of a South African doctor during his year of compulsory community service in a rural hospital, I began researching how this figure has been represented in other narrative films, particularly those stories told in an African setting. A number of films and television dramas, some made by African filmmakers and others by filmmakers from outside of Africa, have been produced around the medical encounter. My interest lies not in assessing the health messaging found in these films and programs, which is better left to the health educationalists and medical sociologists, but in examining the fictional doctor figure as the main protagonist in these films. While the sociocultural and political dimensions of medicine, health and illness are relevant, I refer to them only in passing while exploring the fictional imagery of the doctor figure within the imagined filmed-Africa as it appears in the films The Last Face, Beyond Borders and Le grand blanc de Lambaréné.

Practicing medicine on the high seas: a review of South African doctors' careers in cruise ship medicine.

There has been an increase in the number of South African doctors working in the field of maritime medicine on board cruise ships. Despite this, there is a paucity of literature available addressing the epidemiology, level of expertise and continued medical education (CME) activities of cruise ship medicine. We aim to describe the demographics, qualifications and level of experience of South African doctors embarking on a career as a cruise ship doctor and assess ongoing CME and the future careers of doctors post cruise ship medicine. A survey was distributed to doctors either currently employed or previously employed as a cruise ship doctor from July 2012 to June 2017. The data obtained was used to describe the characteristics of South African doctors working in the field of cruise ship medicine. Of the 65 respondents, 61.5% were female. The majority of doctors were aged between 25 and 40 years. All South African doctors held a Bachelor of Medicine and Bachelor of Surgery degree, or equivalent, as a primary medical qualification and 46% held a Diploma in Primary Emergency Care prior to working at sea. The majority of doctors obtained certification in Basic Life Support, Advanced Cardiac Life Support, Paediatric Advanced Life Support and Advanced Trauma Life Support prior to joining cruise ship medicine. A wide range of courses and diplomas were undertaken by these doctors whilst working at sea. The majority of doctors opted for short to medium term contracts before returning to South Africa to pursue a land-based career, often by enrolling in postgraduate specialist training programmes. Maritime medicine is an emerging field of emergency medicine in South Africa and requires a high standard of competence. A robust CME programme exists whilst working at sea. Most South African doctors return to South Africa to pursue a land based career, alleviating the potential concern that South Africa is permanently losing doctors to cruise ship medicine.

A Boy Asked the Wind by B. Nickel

Nickel, Barbara. A Boy Asked The Wind. Illustrated by Gillian Newland. Red Deer Press, 2015.Not every publication in “picture book” format is written for preschool and primary school children. Barbara Nickel’s poetic conception of the voices of the wind would appeal to a wide range of older students. Her text is based on the scientific realities of the North American Chinook, the Central American Papagayo, the South African Cape Doctor, the Middle Eastern Shamal, and the worldwide zephyr. She writes in free verse, using variation of line length and cadence for emphasis. In stanzas replete with onomatopoeia, with the rush and repetition of words and sounds, she creates the liveliness that ensues when Papagayo meets the Pacific Coast. ... the boy followed the warm down swirling, cold upflowing, seething, rolling, swelling, howling paths Papagayo stirred… ...wish, swash---fish ate fish ate fish ate fish ate fish ate fish ate fish ate fish… In writing of the Shamal as it sweeps through the Tigris and Euphrates river valley, she focuses on the symbols of warfare: Blinded by dust, the boy could only hear: a blast and clashing swords, a bomb, fist on jaw, and spears clashing for thousands of years,... Shamal said, “I’m hit each time they fire through me, the moving air. I hurt, I hear a boy your age crying in fear for his soldier father gone. Here, the illustrator, Gillian Newland, chooses to reveal the modern reality of the valley: armoured trucks and tanks move through city streets; soldiers with helmets and assault rifles battle in a windswept desert; a helicopter hovers in the dusty skies. The text, of course, alludes to the area’s ancient history as well as its more recent crises. Thus, it becomes the Shamal, the wind that links the past and present. Likewise, throughout the book, the voices of the winds link the artistic visions of author and illustrator.Newland’s ability to depict any kind of landscape—urban, mountain, prairie, oceanic, or desert is astonishing. Her illustrations feature realistic perspective. Working in watercolour, ink, and pencil, she can create the detail of a human face, or a panoramic view of a night sky—“stars upon stars.” Nothing is beyond her. Each illustrated page is exquisite, a work of art that would engage both children and adults.In sum, then, this is a book with intellectual, artistic, and literary depth. It demands a considerable level of sophistication on the part of the reader. Certainly, by high school—if not junior high—students should have the requisite intellectual maturity and educational background to appreciate its meaning. An obvious choice for use in a classroom setting, it would be, as well, a beautiful choice for home and public libraries.Highly Recommended: 4 out of 4 starsReviewer: Leslie AitkenLeslie Aitken’s long career in librarianship involved selection of children’s literature for school, public, special, and university collections. She is a former Curriculum Librarian at the University of Alberta.

Life Esidimeni psychiatric patients in Gauteng Province, South Africa: Clinicians’ voices and activism – an ongoing, but submerged narrative

After the first 45 days and beyond, the Life Esidimeni (LE) debacle may be slipping from public awareness. Despite ample evidence of clinicians’ attempts to communicate their concern about this, as well as active steps to try to prevent it prior to the termination of the contract with LE, the question to South African doctors of ‘What have you been doing about this?’ has again been raised by some role players. This made it necessary to consider the notion of a ‘submerged clinicians’ narrative’ in terms of the facts regarding: ( i ) the actual involvement of individual clinicians and professional societies collectively; ( ii ) individual doctors’ responsibility as clinical decision-makers;( iii ) other examples of clinicians’ ongoing and repeating narrative; and ( iv ) possible conflict of interest between clinicians’ relationships with their patients, and as employees, with a third party, whether a state or private employer or funder. Considering the evidence available, it does seem that despite a sustained level of communication and action by clinicians, and in particular by psychiatrists, on this matter, their communication and activism largely remained submerged, and as such, outside of public awareness and acknowledgement by politicians and managers, who were in all instances the final decision-makers on clinical matters pertaining to these patients.

EDITORIAL CALL FOR PAPERS By Francesco Inchingolo PDF A WORLD OF RURAL HEALTH SHARING IDEAS FOR THE FUTURE WORKFORCE POLICY, EDUCATION AND PRACTICE This Editorial Highlights about the World of Rural Health Conference which is going to be held at Cairns in April 2017. Photo by Freedigitalphotos By Jennene Ann Greenhill PDF THE OVERCOMING OF THE OUTDATED IDEA OF TRADITIONAL

EDITORIAL CALL FOR PAPERS By Francesco Inchingolo PDF A WORLD OF RURAL HEALTH SHARING IDEAS FOR THE FUTURE WORKFORCE POLICY, EDUCATION AND PRACTICE This Editorial Highlights about the World of Rural Health Conference which is going to be held at Cairns in April 2017. Photo by Freedigitalphotos By Jennene Ann Greenhill PDF THE OVERCOMING OF THE OUTDATED IDEA OF TRADITIONAL