Electronic Theses and Dissertations (PhDs)

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Occupational Stress and Burnout among Clinical Officers at Public Hospitals in Malawi: Impact Shifting to the General Public
(University of the Witwatersrand, Johannesburg, 2023-08) Chinguwo, Paliani; Kenny, Bridget; Matshiditsho, Rajohane; Scully, Ben
In Malawi, there is a cadre of mid-level health workers called clinical officers who undertake duties conventionally designated for medical doctors in the wake of an acute shortage of the latter. The use of clinical officers as substitutes for medical doctors is one example of a strategy called task shifting that is implemented as a temporary remedy for the shortage of human resources in healthcare. This is a study on the experiences of clinical officers with occupational stress and burnout at public hospitals in Malawi. The study adopted a qualitative research design with a case study as a research strategy. The study was conducted at four district hospitals and one central hospital, all of which are state-owned. One shortcoming of the framing of occupational safety and health in Malawi is the narrow scope and coverage of the regulation on occupational safety and health. This narrow scope of the regulation of occupational safety and health is limited to physical, chemical, and biological hazards. The psychosocial hazards are therefore neglected by the regulation on occupational safety and health. Another shortcoming of the framing of occupational safety and health in Malawi is that the coverage of the regulation on occupational safety and health exempts service sectors like healthcare. This exemption, therefore, gives the impression that healthcare in Malawi is immune to occupational safety and health hazards. This study challenges the narrow scope and coverage of the regulation on occupational safety and health in Malawi that neglects psychosocial hazards and exempts healthcare. The overall aim of the study was to expose the impacts on public health that can be associated with the neglect of psychosocial hazards and the exclusion of healthcare from the regulation of occupational safety and health. This study demonstrates that there are psychosocial hazards at public hospitals that predispose clinical officers to occupational stress and burnout. These are excessive workload, long hours of work, poor interprofessional relations, restructuring, COVID-19 responses, and the absence of occupational and safety management systems. The study further illustrates that psychosocial hazards at public hospitals are a breeding ground for various health problems among clinical officers that emanate from occupational stress and burnout. These health problems include emotional and cognitive effects; injuries; high blood pressure (hypertension); muscle tension or pain; and severe headaches. These health problems negatively affect the quality of life among clinical officers and their performance on the job. The study, therefore, concludes that occupational stress and burnout among clinical officers ultimately affect health outcomes in the broader population. For instance, the study demonstrates how the consequences of OS and burnout among clinical officers are consequently externalised to patients and the general public through the poor quality of healthcare services. In this study, the externalisation of the negative effects of occupational stress and burnout on clinical officers to the patients and the general public, is referred to as impact shifting. This study conceptualises and proposes a theoretical framework for analysing occupational safety and health in Malawi, with a particular focus on psychosocial hazards at public hospitals. The theoretical framework comprises three theoretical perspectives, namely: attribution theory, job demands-resources model, and fundamental cause theory. This study, therefore, offers a theoretical foundation and empirical evidence drawn from the experiences of clinical officers with occupational stress and burnout. The theoretical foundation and empirical evidence can inform the reframing of the scope and coverage of the regulation on occupational safety and health. Finally, this study also conceptualises and proposes a framework for the formulation of a comprehensive policy on occupational safety and health for public health facilities in the context of Malawi.
Strikes and eventful identities: South Africa’s public sector strikes, 2007 and 2010
(University of the Witwatersrand, Johannesburg, 2023-06) Ceruti, Claire Helen Mary; Kenny, Bridget
This is a study of rupture and its deflection in public striker identities over two politically charged strikes in 2007 and 2010. The thesis reconstructs each strike as a series of possibilities, taking a dynamic and temporal view attuned to the development of contradictions in a way sensitive to what else might realistically have developed out of these given ‘moments’ or conjunctures of forces. The data was gathered longitudinally in each strike and across the two strikes, which were three years apart, via interviews, observation and analysis of toyi-toyis and particularly photos, which were used to track slogans and their development. The thesis uncovers eventful identities beneath the rehabilitation or reconstitution, twice, of the strained Tripartite Alliance amongst the ruling party, the ANC, the main trade union federation (Cosatu) and the South African Communist Party; it also uncovers peculiarly relational classed imagery suggestive of exploitation even in simple strike-ready identities, entwining and subtly altering people’s more common everyday consumption-based models of class. The thesis traces strikers’ identities against the histories of each strike to find identities in punctuated dialogue with larger forces, thereby restoring the role of this kind of contradiction in processes of identity destabilisation as well as in eventfulness. The thesis finds that strikers’ identities were deformed in relation to the alliance by successive shocks over the course of the two strikes. The strikes did not rupture, but did puncture, the practice of the alliance. Despite a variety of deflections, faint reinterpellations percolated through these experiences. In the first strike, in 2007, the shock to identification with government, experienced by the strikers as well as the union officials, intensified as the strike continued and drove one aspect of a ‘power flip’ which I noted in the development of strikers’ discourse over the strike in a shift from entreating government, to asserting mutual dependence, to reversing the dependency - wanting to turn on its head the actually existing practice of the alliance by demanding a government that listens to workers – and at the same time conceiving the centrality of the strikers’ own work in relation to these powers. At the end of the first strike, the shock to identities with government was truncated by pragmatism and diverted and to the political kingdom, in the person of Zuma. But that deflection built up expectation for the restored alliance, and the second strike burst forth from disappointed expectations (a second shock to identities with government) to put Zuma to the test. This strike expressed mainly the political dimension of the power flip. The end of the strike incurred a third shock: a divergence in the strategic views of union officials from those of strikers, which occurred partly because the union leaders who had re-established loyalties and, they believed, influence within the alliance (partly because of the first strike). The de-identifications towards the end of this strike were deflected in more complicated ways. Although it appeared from a distance that the alliance had worked again to let off steam and iron over damage, that view overlooked how strikers’ identifications had taken damage in the double test of the ANC; at least some were in a liminal state I call identity damage, not having re-identified themselves but forced to imagine life outside the ANC. So the thesis overall illustrates the development of these eventful identities, which may survive the failure of an event to develop (a near event). The thesis thus, first, returns contradiction (and agency) to the study of eventfulness (rupture), as well as, through a finer view of deflection, examining why eventfulness often fails to develop; second, it foregrounds subjectivity in contradictory circumstances to stretch studies of classed identities and identity processes into an under-examined arena (strikes); and thereby, third, it adds an under-examined dimension -strikers’ subjectivities - to study of the cohesion/disintegration of the alliance and the unravelling of ANC hegemony to show that the alliance’s mechanisms of maintenance were also ‘storing up’ contradiction and damage to its future integrity. The concepts of misidentification and identity damage were developed to present identity processes in contradictory situations as punctuated and to refine understanding of rupture at the subjective level.
The ‘social life’ of digital money: User experiences of mobile money in Manzini, Eswatini and Masvingo, Zimbabwe
(University of the Witwatersrand, Johannesburg, 2023-07) Mavodza, Emma; Katsaura, Obvious; Kenny, Bridget
Digital financial service innovations have long been hailed as a catalyst for financial inclusion and empowerment for the unbanked (Beck, et al, 2007; Anderlone and Vandone, 2010; Johnson and Arnold, 2012; Lahaye, et al. 2015; Jack and Suri, 2016; Dermiguc-Kunt et al, 2018; World Bank, 2018;). However, most of these studies assume that the current state of exclusion and lack of access to transformative financial services is a natural state in these communities. While socio-anthropological perspectives have helped to acknowledge the place of money in the socioeconomic lives of communities (Granovetter,1985; Callon, 1998; Zelizer, 1997; Comaroff and Comaroff, 2005; 2010; 2012; Maurer, 2008; Dodd, 2014), digital financial service innovations remain a bewilderment to many who attempts to understand them. Therefore, to examine the social life of mobile money, I gathered data for this qualitative study (in 2018 and 2019) in selected informal markets in Manzini where money supply and financial institutions are stable but inaccessible to many and Masvingo where liquidity constraints are the new order of the day. My qualitative analysis of the social life of mobile money from the global South is based on the in-depth interviews, photo voice and observational data sets. Drawing from a range of literature and my empirical data on the social cultural aspects of money, I argue that mobile money usage in the informal market spaces was articulated and imagined through existing social meanings, and it was used within specific socio-cultural constraints. The thesis presents this through an examination of four overarching themes; namely, mobile money sociality at the backdrop of informality and precarity, mechanisms of building trust and solidarity, the gendered layers of mobile money usage as well as the subtle, unscripted ways employed by participants to resist subjectification and full financialisation of their everyday lives. An important finding of this study is how mobile money continues to play a critical role in the ways through which these communities’ monetary repertoires are produced, historicised, and reproduced. Drawing on the evidence I gathered, I argue that, despite their assumed vulnerability, informal market participants were not docile adopters of mobile money but rather active constructors of their own digital money usage footprints in ways not envisaged by the service providers at inception. They showcased great ingenuity through their established cultural habits and sacred traditions on money use. Therefore, instead of taking assumed and imagined vulnerability as incapacitation and lack of agency, this study has implication for financial policy that focuses on the individual and mundane financial practices of the unbanked as critical for building transformative financial behaviours among this resourceful population segment. This research contributes to an understanding of how informal markets workers make sense of mobile money as they incorporate it in alignment with existing social meanings and existing financial practices at the backdrop of socio-economic precarity. Therefore, I bring new qualitative evidence and analysis from the global South to expand the definition of social life of digital money and financial inclusion (Ahmad et al., 2020). The study also highlights how the ubiquitous proliferation of mobile money and its intimate ties to the social lives of the participants has precipitated the rise of new forms of voluntary, freely given unwaged, immaterial labour which is unconsciously performed by the users as a collective.
Wartime Rape, Gender, and Militarism: The Bukavu People’s Conceptualisation of the Emergence of Wartime Rape in the 2004 Kivu Conflict in Contrast to the 1996 First Congo War
(University of the Witwatersrand, Johannesburg, 2023-03-15) Mushagalusa, Alice Karhikalembu; Stevens, Garth; Von Holdt, Karl
For more than a decade, armed conflicts in the eastern Democratic Republic of the Congo (DRC) have been characterised by widespread wartime rape against civilians. The purposeful utilisation of wartime rape as a weapon of war has owed to the country unflattering labels, such as the “rape capital of the world, the worst place to be a woman, or again the dark hole”. The armed unrest in the DRC is rooted in the Belgian colonisation’s land administration policies that shaped some groups as native (autochthones) while constructing others as foreigners. Following an anti-war feminist perspective, this PhD explores the Bukavu people’s conceptualisation of the emergence of wartime rape in the 2004 Kivu Conflict in contrast to the 1996 First Congo War. I used participatory research methods, as dictated by the Covid-19 pandemic, to collect the data through focus groups and in-depth individual interviews with ordinary community members, former military officers, members of the civil society and community leaders in Bukavu (South Kivu Province, eastern DRC). The collected data made it possible to firstly recognise the absence of wartime rape as a weapon of war in the 1996 First Congo War; and to show that wartime rape has not always been ubiquitous in the DRC but became a lexicon that the perpetrators utilised to place divergent claims related to their customary land, military, political power ambitions, gendered ethnic identity, and citizenship aspirations. Secondly, the data allowed for disaggregating wartime rape into three categories based on the perpetrators’ motivations and claims. The thesis maintains that the Hutu-dominated Interahamwe militia, also recognised as the main authors of the 1994 Rwandan genocide, resorted to rape in the eastern DRC for revenge and to (re)masculinise their troops while feminising the Congolese state. Next, this study demonstrates that the Rally for Congolese Democracy rebels, which claimed the Tutsi Congolese ethnicity, strategically resorted to wartime rape to claim customary land rights and citizenship recognition. Following, this thesis puts forward that the Mai-Mai militia, seen as native, erpetrated wartime rape to claim military respect and recognition while furthering the political agendas of their patrons. I maintain that patriarchy – as the shared norm between the perpetrators, the state and the victims (women, girls, men and boys) – makes it possible for wartime rape to be utilised as a lexicon and a destructive weapon against the victims’ sexual subjectivities and the whole community’s symbolic order. Hence, this study articulates a three-fold argument. This thesis firstly argues that the 2004 wartime rape is rooted in the Belgian colonisation and its lingering effects on forms of ethnicity, gender, land distribution and recognition of political rights in the present. Next, this thesis argues that wartime rape is a strategic weapon perpetrators utilise for revenge and to claim military recognition. Lastly, this study argues that the extreme violence of rape as an act of war aims to destroy the victims’ subjectivities and their community’s symbolic order. As such, this thesis weaves together three levels of analysis and examines wartime rape as multi-dimensional violence that interlaces into one act of wartime rape: the historical dimension (centring on land), the broader strategic considerations, and the destruction of victims’ subjectivities and the community’s symbolic order. At the same time, the combination of these dimensions varies considerably between the Hutu-dominated Interahamwe militia, the Rally for Congolese Democracy rebels, and the Mai-Mai militias – that is, the context even in one province within DRC produces variations in motive and form.

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