The Burden of Drowning: Issues in Selected Countries – Africa
Springer eBooks, Oct 26, 2013
The data submitted to the World Health Organization (WHO) used to measure the burden of drowning ... more The data submitted to the World Health Organization (WHO) used to measure the burden of drowning on the health of the African region are limited. Of the 54 African countries represented in the WHO’s global burden of disease estimates for 2008, country-specific data were derived from cause of death modeling rather than direct reporting for every country except Egypt, Mauritius, the Seychelles, and South Africa [1]. Aside from this important caution, these data and models show that drowning is a significant health burden in Africa. Country-specific studies that could supplement these data remain scant. Much of what is known about the incidence, prevalence, and burden of drowning in Africa is grounded in a small number of fairly recent and well-represented studies undertaken in South Africa, Egypt, Tanzania, and Uganda. Much of the literature on injuries in Africa comes from hospital databases and therefore, tends to exclude drowning fatalities. Drowning victims in this region often die before reaching the hospital [2–4]. In this chapter, drowning in three countries on the continent of Africa is described: Tanzania, South Africa, and Uganda.
An exploratory study of psychological and developmental issues facing HIV and AIDS affected adolescents living in a residential care facility
Journal of Child & Adolescent Mental Health, Aug 14, 2011
This article explores the psychological issues experienced by adolescents affected by HIV and liv... more This article explores the psychological issues experienced by adolescents affected by HIV and living in a residential care facility. This was a multi-method, exploratory study. Data were collected through one focus group discussion with adolescents at the residential care facility, individual interviews with caregivers and ethnographic observation. Data were obtained from a residential care facility for HIV affected and infected children and mothers in Gauteng. Findings suggest that for adolescents in this study, living in a residential care facility offered both opportunities and challenges. Adolescents at the facility enjoyed material and, to some extent, emotional support. Association with a facility known as a HIV and AIDS care facility, however, had a negative impact on the adolescents. Additionally, the lack of significant attachment figures, asserting their independence and challenging the authority and the expectations of the facility appeared to be significant developmental challenges. Adolescents reported experiencing a range of emotional and psychological problems, some of which were present before they arrived at the facility. Living in a care facility can be both a protective and a risk factor; additional studies on the availability and the impact of alternate forms of care are suggested.
For those invested in violence prevention, the 17 Sustainable Development Goals (SDGs) formally a... more For those invested in violence prevention, the 17 Sustainable Development Goals (SDGs) formally adopted in September 2015 for the UN's 2030 Agenda for the Sustainable Development 1 represent a welcome change from their forerunners, the Millennium Development Goals (MDGs). The MDGs provided only a framework within which the impacts of violence could be measured against other dimensions of development. Violence, an important contributor to the burden of disease 2 was not targeted nor addressed directly, despite the rather obvious implications of violence for development in all eight MDGs, and MDG3 (Promoting gender equality and empowering women) and MDG4 (Reducing child mortality) in particular. The new SDGs have 169 targets, several of which are specific to violence and its prevention. SDG5, which seeks to 'achieve gender equality and empower all women and girls'a legacy of MDG3now includes targets to eliminate all forms of violence against women and girls, including trafficking and sexual and other types of exploitation. (Target 5.2) It targets harmful practices, such as child, early and forced marriage, and female genital mutilation (Target 5.3). Under SDG16, which promotes peace, justice and strong institutions for sustainable development, Target 16.2 calls for an end to all forms of violence against children. Compared with its predecessor in MDG4, it places violence prevention as a key item on the sustainable development agenda. The SDGs extend the violence prevention ambit substantially by calling for the reduction of 'all forms of violence everywhere' (Target 16.1). In so doing they not only recognize men and boys as vulnerable and at-risk, both as perpetrators and as victims, but also as worthy recipients of prevention efforts. This is unusual in the United Nations system, which tends to focus resolutions and declarations on violence directed against women and children as illustrated by a recent 67th
Children, Pathology and Politics:Genealogical Perspectives on the Construction of the Paedophile in South Africa
Through an analysis informed by the genealogical method as derived from Foucault (1980a), this st... more Through an analysis informed by the genealogical method as derived from Foucault (1980a), this study examines the discourses and material conditions that have produced the South African paedophile. Archival texts and contemporary discursive matter are critically analysed against the backdrop of the material conditions of political possibility with which they intersected to construct the paedophile of the South African present. The study traces constructions of the paedophile as a relatively innocuous nuisance in a selected ...
For lesbians, "coming out" or disclosing one's sexual orientation has come to be seen as a marker... more For lesbians, "coming out" or disclosing one's sexual orientation has come to be seen as a marker of self-acceptance, actualization, and the imperative first step in the authentication of a liberated subjectivity and social identity. However, other critical schools of thought, largely informed by Foucault's middle writings, have argued that "coming out" is merely a confessional response to an incitement to discourse about sex. This study explored constructions of coming out by a group of self-identified lesbians in South Africa. Data were collected via eight semistructured interviews and subjected to discourse analysis. Although the comingout stories appear to conform to some discursive practices characterizing confessional modes of response to incitements to speak, they are also de-emphasized as central to the constitution of selfhood. The changing conditions of possibility for the production of sexual subjectivity in contemporary South Africa seem to disrupt understandings of coming out as either solely a confessional or liberatory practice.
A profile of students receiving counselling services at a university in post-apartheid South Africa
Journal of Child & Adolescent Mental Health, Dec 1, 2011
The purpose of this study was to describe a profile of students seeking counselling at a racially... more The purpose of this study was to describe a profile of students seeking counselling at a racially diverse university in post-apartheid South Africa as a means to demonstrate the importance of routinely collecting and analysing student counselling data at university-based centres across the country. Student data were extracted from the only two counselling centres based at the University of the Witwatersrand in Johannesburg that provided services to 831 students during 2008. The 26 243 students that did not seek counselling during this period formed the comparison group. These data were analysed using logistic regression. Black, female and students within the 21-25 year age category were more likely to receive counselling, and presenting problems varied by population group. Given the country's past and continued levels of social asymmetry, we argue that the development of standardised university-based reporting systems able to describe the characteristics and presenting problems of students seeking counselling across South African universities should be prioritised by its higher education sector. Timely access to information of this kind is crucial to the generation of evidence-based mental health interventions in a population that is especially important to the country's development vision.
Pandemics are by definition public health threats so significant that they demand a coordinated g... more Pandemics are by definition public health threats so significant that they demand a coordinated global response that fundamentally alters the human, social, and economic dynamics of everyday life through heavily regulated restrictions of the movement of people, products, and capital. The primary goal of such interventions is to minimize the potential for the transmission of the pathogen within and across communities. Public spaces, transit areas, and the ordinariness of everyday life are fundamentally recalibrated so that the pathways of pathogen transmission are disrupted. Yet, it is in the context of the COVID-19 pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in which 'struggling to breathe' is a key symptom, that the world has witnessed widespread protests against the killing of George Floyd, who like Eric Garner was suffocated to death as part of systematic violence perpetrated against African-American men by the US policing system. Protests against these violent deaths have often been accompanied by chants of 'I can't breathe' which is both a repetition of the dying words of those killed and an emphasis on the literal and metaphorical difficulties that Black men encounter as targets of systemic racism (Aymer, 2016). These protests represent the very antithesis of the recalibrations required to contain the spread of the disease, and it is precisely this juxtaposition of transmission risk for a respiratory disease through protest against the suffocating effects of police violence that the full force of the brutally racialized social determinants of violence and vulnerability to the communicable disease (COVID-19) is starkly apparent. Thus, a reading of the biopolitics (Foucault, 1997) linking the social epidemiology of the pandemic to protests against the transnational crisis of racism may provide a potentially useful resource for better understanding the governing logic binding race, violence and the virus at this critical historical moment. While the data describing the social epidemiology of COVID-19 are at best provisional, the rapid re-engineering of our temporal, spatial, economic, and social architectures under lockdown provides us with an important moment to situate the scourge of state violence within a global and local public health response mobilized to protect lives . In identifying SARS-CoV-2 virus as an 'invisible enemy', global governments guided by the public health logic
An increasing body of literature shows that HIV/AIDS and mental health issues are closely related... more An increasing body of literature shows that HIV/AIDS and mental health issues are closely related. In spite of this, the mental health correlates of HIV and AIDS remain largely unacknowledged and under-researched in sub-Saharan Africa. Furthermore, despite guidelines by the World Health Organization insisting that counselling with integrated psychological or mental healthcare helps people living with HIV or AIDS (PLHIV) to deal with their disease status and thus increases their quality of life, the services and interventions to address this significant health burden are still lacking, making the HIV/AIDS and mental-health nexus a sizeable social services and health problem. As part of an ongoing research programme at the University of the Witwatersrand to address this, the article reports on a baseline study that sought to identify the nature and extent of counselling and support services available to PLHIV in Gauteng Province. The study found that available counselling and support services are focused largely on voluntary counselling and testing for HIV (VCT), which appears to be primarily an educational intervention rather than a therapeutic modality. Service providers within this framework have inadequate knowledge and capacity to identify mental health problems. The findings of this study point to a strong need for integrated HIV/AIDS services that include assessment of mental health and substance abuse problems and their appropriate management. Appropriate training and supervision of healthcare workers and counsellors is an essential component in the identification and referral of HIV patients with mental health problems.
By the early 1990s the paedophile as a 'type' of child sexual abuse (CSA) perpetrator was priorit... more By the early 1990s the paedophile as a 'type' of child sexual abuse (CSA) perpetrator was prioritised for study and intervention by the South African socio-medical sciences and cases of paedophilia featured prominently in the media reporting of the time. Drawing on the genealogical method as derived from Michel Foucault, this study aimed to account for this relatively recent emergence of the paedophile as an object of socio-medical study and social anxiety within the South African archive. Based on an analysis of archival texts against the backdrop of international biopolitics and local conditions of political possibility, the genealogy contends that the early figure of the paedophile was an instrument and effect of apartheid biopolitics. The paedophile was prioritised for research and escalated as social threat in the public imagination as part of the broader apartheid project aimed at protecting white hegemony through the ongoing surveillance of and health interventions directed towards South Africa's white children. While the apartheid project constructed black children as posing fundamental threats to white supremacy, discourses beginning in the mid-1980s repositioned them as vulnerable victims of apartheid itself. It was from within these discourses that child sexual abuse (CSA) as a public health concern began to crystallise. By locating blackness within the fields of discipline and desire, the material conditions for an ever-expanding net of sexual surveillance were established. The study thus demonstrates that even the paedophile cannot be effectively researched without considering the historical coordinates that so powerfully contoured its emergence as an important object of study and social intervention within South Africa's highly racialised systems of thought.
Promoting access to higher education in an unequal society
South African journal of higher education, 2015
This short paper serves as an introduction to the collection of papers in this special issue of T... more This short paper serves as an introduction to the collection of papers in this special issue of The South African Journal of Higher Education. First, the editors set the scene by commenting on access and throughtput in South African higher education, showing how these continue to be racially skewed, and linked to an inequitable education system. It is then observed that some of the intervention programmes that are offered at tertiary level do not always achieve their intended goals, and that interventions are increasingly being sought at secondary school level. Second, the editors introduce and briefly comment on the seven papers selected for this special issue, noting the particular contribution each makes to an understanding of the theme of promoting access to higher education in an unequal society. Third and in conclusion, the editors point to three issues that they believe emerge from the papers, and which are argued to be important in mapping the way forward. These are: the nee...
ABSTRACTBackgroundSouth Africa has homicide rates six times the global average, predominantly amo... more ABSTRACTBackgroundSouth Africa has homicide rates six times the global average, predominantly among men, but little is known about male victims. As part of the country’s first ever study of male homicide we compared 2017 male and female victim profiles for selected covariates, against global averages and previous estimates for 2009.MethodsWe conducted a retrospective descriptive study of routine data collected through postmortem investigations, calculating age-standardised mortality rates for manner of death by age, sex and province and male-to-female incidence rate ratios with 95% confidence intervals. We then used generalised linear models and linear regression models to assess the association between sex and victim characteristics including age and mechanism of injury (guns, stabs and blunt force) within and between years.Findings87% of 19,477 homicides in 2017 were males, equating to seven male deaths for every female, with sharp force and firearm discharge the most common exter...
The Burden of Drowning: Issues in Selected Countries – Africa
Springer eBooks, Oct 26, 2013
The data submitted to the World Health Organization (WHO) used to measure the burden of drowning ... more The data submitted to the World Health Organization (WHO) used to measure the burden of drowning on the health of the African region are limited. Of the 54 African countries represented in the WHO’s global burden of disease estimates for 2008, country-specific data were derived from cause of death modeling rather than direct reporting for every country except Egypt, Mauritius, the Seychelles, and South Africa [1]. Aside from this important caution, these data and models show that drowning is a significant health burden in Africa. Country-specific studies that could supplement these data remain scant. Much of what is known about the incidence, prevalence, and burden of drowning in Africa is grounded in a small number of fairly recent and well-represented studies undertaken in South Africa, Egypt, Tanzania, and Uganda. Much of the literature on injuries in Africa comes from hospital databases and therefore, tends to exclude drowning fatalities. Drowning victims in this region often die before reaching the hospital [2–4]. In this chapter, drowning in three countries on the continent of Africa is described: Tanzania, South Africa, and Uganda.
An exploratory study of psychological and developmental issues facing HIV and AIDS affected adolescents living in a residential care facility
Journal of Child & Adolescent Mental Health, Aug 14, 2011
This article explores the psychological issues experienced by adolescents affected by HIV and liv... more This article explores the psychological issues experienced by adolescents affected by HIV and living in a residential care facility. This was a multi-method, exploratory study. Data were collected through one focus group discussion with adolescents at the residential care facility, individual interviews with caregivers and ethnographic observation. Data were obtained from a residential care facility for HIV affected and infected children and mothers in Gauteng. Findings suggest that for adolescents in this study, living in a residential care facility offered both opportunities and challenges. Adolescents at the facility enjoyed material and, to some extent, emotional support. Association with a facility known as a HIV and AIDS care facility, however, had a negative impact on the adolescents. Additionally, the lack of significant attachment figures, asserting their independence and challenging the authority and the expectations of the facility appeared to be significant developmental challenges. Adolescents reported experiencing a range of emotional and psychological problems, some of which were present before they arrived at the facility. Living in a care facility can be both a protective and a risk factor; additional studies on the availability and the impact of alternate forms of care are suggested.
For those invested in violence prevention, the 17 Sustainable Development Goals (SDGs) formally a... more For those invested in violence prevention, the 17 Sustainable Development Goals (SDGs) formally adopted in September 2015 for the UN's 2030 Agenda for the Sustainable Development 1 represent a welcome change from their forerunners, the Millennium Development Goals (MDGs). The MDGs provided only a framework within which the impacts of violence could be measured against other dimensions of development. Violence, an important contributor to the burden of disease 2 was not targeted nor addressed directly, despite the rather obvious implications of violence for development in all eight MDGs, and MDG3 (Promoting gender equality and empowering women) and MDG4 (Reducing child mortality) in particular. The new SDGs have 169 targets, several of which are specific to violence and its prevention. SDG5, which seeks to 'achieve gender equality and empower all women and girls'a legacy of MDG3now includes targets to eliminate all forms of violence against women and girls, including trafficking and sexual and other types of exploitation. (Target 5.2) It targets harmful practices, such as child, early and forced marriage, and female genital mutilation (Target 5.3). Under SDG16, which promotes peace, justice and strong institutions for sustainable development, Target 16.2 calls for an end to all forms of violence against children. Compared with its predecessor in MDG4, it places violence prevention as a key item on the sustainable development agenda. The SDGs extend the violence prevention ambit substantially by calling for the reduction of 'all forms of violence everywhere' (Target 16.1). In so doing they not only recognize men and boys as vulnerable and at-risk, both as perpetrators and as victims, but also as worthy recipients of prevention efforts. This is unusual in the United Nations system, which tends to focus resolutions and declarations on violence directed against women and children as illustrated by a recent 67th
Children, Pathology and Politics:Genealogical Perspectives on the Construction of the Paedophile in South Africa
Through an analysis informed by the genealogical method as derived from Foucault (1980a), this st... more Through an analysis informed by the genealogical method as derived from Foucault (1980a), this study examines the discourses and material conditions that have produced the South African paedophile. Archival texts and contemporary discursive matter are critically analysed against the backdrop of the material conditions of political possibility with which they intersected to construct the paedophile of the South African present. The study traces constructions of the paedophile as a relatively innocuous nuisance in a selected ...
For lesbians, "coming out" or disclosing one's sexual orientation has come to be seen as a marker... more For lesbians, "coming out" or disclosing one's sexual orientation has come to be seen as a marker of self-acceptance, actualization, and the imperative first step in the authentication of a liberated subjectivity and social identity. However, other critical schools of thought, largely informed by Foucault's middle writings, have argued that "coming out" is merely a confessional response to an incitement to discourse about sex. This study explored constructions of coming out by a group of self-identified lesbians in South Africa. Data were collected via eight semistructured interviews and subjected to discourse analysis. Although the comingout stories appear to conform to some discursive practices characterizing confessional modes of response to incitements to speak, they are also de-emphasized as central to the constitution of selfhood. The changing conditions of possibility for the production of sexual subjectivity in contemporary South Africa seem to disrupt understandings of coming out as either solely a confessional or liberatory practice.
A profile of students receiving counselling services at a university in post-apartheid South Africa
Journal of Child & Adolescent Mental Health, Dec 1, 2011
The purpose of this study was to describe a profile of students seeking counselling at a racially... more The purpose of this study was to describe a profile of students seeking counselling at a racially diverse university in post-apartheid South Africa as a means to demonstrate the importance of routinely collecting and analysing student counselling data at university-based centres across the country. Student data were extracted from the only two counselling centres based at the University of the Witwatersrand in Johannesburg that provided services to 831 students during 2008. The 26 243 students that did not seek counselling during this period formed the comparison group. These data were analysed using logistic regression. Black, female and students within the 21-25 year age category were more likely to receive counselling, and presenting problems varied by population group. Given the country's past and continued levels of social asymmetry, we argue that the development of standardised university-based reporting systems able to describe the characteristics and presenting problems of students seeking counselling across South African universities should be prioritised by its higher education sector. Timely access to information of this kind is crucial to the generation of evidence-based mental health interventions in a population that is especially important to the country's development vision.
Pandemics are by definition public health threats so significant that they demand a coordinated g... more Pandemics are by definition public health threats so significant that they demand a coordinated global response that fundamentally alters the human, social, and economic dynamics of everyday life through heavily regulated restrictions of the movement of people, products, and capital. The primary goal of such interventions is to minimize the potential for the transmission of the pathogen within and across communities. Public spaces, transit areas, and the ordinariness of everyday life are fundamentally recalibrated so that the pathways of pathogen transmission are disrupted. Yet, it is in the context of the COVID-19 pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in which 'struggling to breathe' is a key symptom, that the world has witnessed widespread protests against the killing of George Floyd, who like Eric Garner was suffocated to death as part of systematic violence perpetrated against African-American men by the US policing system. Protests against these violent deaths have often been accompanied by chants of 'I can't breathe' which is both a repetition of the dying words of those killed and an emphasis on the literal and metaphorical difficulties that Black men encounter as targets of systemic racism (Aymer, 2016). These protests represent the very antithesis of the recalibrations required to contain the spread of the disease, and it is precisely this juxtaposition of transmission risk for a respiratory disease through protest against the suffocating effects of police violence that the full force of the brutally racialized social determinants of violence and vulnerability to the communicable disease (COVID-19) is starkly apparent. Thus, a reading of the biopolitics (Foucault, 1997) linking the social epidemiology of the pandemic to protests against the transnational crisis of racism may provide a potentially useful resource for better understanding the governing logic binding race, violence and the virus at this critical historical moment. While the data describing the social epidemiology of COVID-19 are at best provisional, the rapid re-engineering of our temporal, spatial, economic, and social architectures under lockdown provides us with an important moment to situate the scourge of state violence within a global and local public health response mobilized to protect lives . In identifying SARS-CoV-2 virus as an 'invisible enemy', global governments guided by the public health logic
An increasing body of literature shows that HIV/AIDS and mental health issues are closely related... more An increasing body of literature shows that HIV/AIDS and mental health issues are closely related. In spite of this, the mental health correlates of HIV and AIDS remain largely unacknowledged and under-researched in sub-Saharan Africa. Furthermore, despite guidelines by the World Health Organization insisting that counselling with integrated psychological or mental healthcare helps people living with HIV or AIDS (PLHIV) to deal with their disease status and thus increases their quality of life, the services and interventions to address this significant health burden are still lacking, making the HIV/AIDS and mental-health nexus a sizeable social services and health problem. As part of an ongoing research programme at the University of the Witwatersrand to address this, the article reports on a baseline study that sought to identify the nature and extent of counselling and support services available to PLHIV in Gauteng Province. The study found that available counselling and support services are focused largely on voluntary counselling and testing for HIV (VCT), which appears to be primarily an educational intervention rather than a therapeutic modality. Service providers within this framework have inadequate knowledge and capacity to identify mental health problems. The findings of this study point to a strong need for integrated HIV/AIDS services that include assessment of mental health and substance abuse problems and their appropriate management. Appropriate training and supervision of healthcare workers and counsellors is an essential component in the identification and referral of HIV patients with mental health problems.
By the early 1990s the paedophile as a 'type' of child sexual abuse (CSA) perpetrator was priorit... more By the early 1990s the paedophile as a 'type' of child sexual abuse (CSA) perpetrator was prioritised for study and intervention by the South African socio-medical sciences and cases of paedophilia featured prominently in the media reporting of the time. Drawing on the genealogical method as derived from Michel Foucault, this study aimed to account for this relatively recent emergence of the paedophile as an object of socio-medical study and social anxiety within the South African archive. Based on an analysis of archival texts against the backdrop of international biopolitics and local conditions of political possibility, the genealogy contends that the early figure of the paedophile was an instrument and effect of apartheid biopolitics. The paedophile was prioritised for research and escalated as social threat in the public imagination as part of the broader apartheid project aimed at protecting white hegemony through the ongoing surveillance of and health interventions directed towards South Africa's white children. While the apartheid project constructed black children as posing fundamental threats to white supremacy, discourses beginning in the mid-1980s repositioned them as vulnerable victims of apartheid itself. It was from within these discourses that child sexual abuse (CSA) as a public health concern began to crystallise. By locating blackness within the fields of discipline and desire, the material conditions for an ever-expanding net of sexual surveillance were established. The study thus demonstrates that even the paedophile cannot be effectively researched without considering the historical coordinates that so powerfully contoured its emergence as an important object of study and social intervention within South Africa's highly racialised systems of thought.
Promoting access to higher education in an unequal society
South African journal of higher education, 2015
This short paper serves as an introduction to the collection of papers in this special issue of T... more This short paper serves as an introduction to the collection of papers in this special issue of The South African Journal of Higher Education. First, the editors set the scene by commenting on access and throughtput in South African higher education, showing how these continue to be racially skewed, and linked to an inequitable education system. It is then observed that some of the intervention programmes that are offered at tertiary level do not always achieve their intended goals, and that interventions are increasingly being sought at secondary school level. Second, the editors introduce and briefly comment on the seven papers selected for this special issue, noting the particular contribution each makes to an understanding of the theme of promoting access to higher education in an unequal society. Third and in conclusion, the editors point to three issues that they believe emerge from the papers, and which are argued to be important in mapping the way forward. These are: the nee...
ABSTRACTBackgroundSouth Africa has homicide rates six times the global average, predominantly amo... more ABSTRACTBackgroundSouth Africa has homicide rates six times the global average, predominantly among men, but little is known about male victims. As part of the country’s first ever study of male homicide we compared 2017 male and female victim profiles for selected covariates, against global averages and previous estimates for 2009.MethodsWe conducted a retrospective descriptive study of routine data collected through postmortem investigations, calculating age-standardised mortality rates for manner of death by age, sex and province and male-to-female incidence rate ratios with 95% confidence intervals. We then used generalised linear models and linear regression models to assess the association between sex and victim characteristics including age and mechanism of injury (guns, stabs and blunt force) within and between years.Findings87% of 19,477 homicides in 2017 were males, equating to seven male deaths for every female, with sharp force and firearm discharge the most common exter...
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Papers by Brett Bowman