3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item An ethnography of adults living with aphasia in Khayelitsha.(2010-11-09) Legg, Carol FrancesThis thesis is concerned with the experience of aphasia in Khayelitsha, a township on the outskirts of Cape Town characterised by poverty, violence, limited resources and a culture and language that differs from the setting of most speech and language services in South Africa. It is based on three years of intermittent fieldwork that entailed participant observation of the everyday life of five adults living with aphasia and interviews with participants, kin and healthcare workers in various settings. Grounded in sociocultural theory, this thesis has aimed to provide an ethnographic account of cultural frameworks of interpretation of communication impairment following stroke and of the daily reality of life for adults living with aphasia in this setting. An exploration of causal notions in this setting provided interesting commentary on social and cultural processes and how people, caught up in these processes, search for meaning and for cure. Participants entertained plural notions of causation of aphasia and explored numerous therapeutic avenues. The wide variation in causal notions included biomedical causes, social and behavioural determinants, and the influences of supernatural powers, such as witches and ancestors. Similarly participants experienced aphasia through multiple healing systems, including traditional, biomedical and religious therapy options. All however seemed to be ambiguous sources of help. Whilst encounters with the health system presented serious challenges to participants, traditional and religious avenues for help were obscured by a burgeoning and not always ethical open market offering miracle cures. An articulation of the circumstances of this group of adults provided further commentary on the influence of the social context on aphasia. In a context where sociopolitical processes have had a disintegrating effect on social cohesion, questions of support, care and security were of primary concern. Prejudices towards the elderly and women were more acutely felt and vulnerability, isolation, insecurity and fluidity of circumstance emerged as overarching themes. The central argument in this thesis is that the genesis of these experiences can be found in contextual factors in Khayelitsha, such as poverty, inequality, urbanisation and changing cultural paradigms. These emerging themes highlight the disjunctions between the medical alignment of the discipline of speech language therapy in South Africa and the capacity for socially-engaged practice. They also highlight the socio-cultural complexity of the experience of aphasia, specifically the influences of culture and poverty. There is thus theoretical and clinical relevance in using anthropological objectives to explore the world of the adult living with aphasia and the interface between context and service provision. Interventions and healthcare communications that will make a meaningful difference to adults with aphasia in a setting such as Khayelitsha are proposed.Item The experience of caring for a child with cerebral palsy in Tonga, Mpumalanga : caregivers' stories.(2008-06-10T07:00:25Z) Barratt, Joanne FrancesCerebral palsy is a condition primarily defined by damage to the developing brain primarily resulting in a physical impairment, although the affected individual may present with concomitant impairments. The number of children presenting with cerebral palsy appears to be increasing, and while the medical effects of this disability have been well documented in the literature, a paucity of knowledge exists on the parental experience of caring for a child with cerebral palsy, particularly in rural South Africa. This dissertation will report on a study conducted in Tonga, a rural area of South Africa, which assessed caregivers’ experiences of caring for a child with cerebral palsy. Qualitative methods, including participant observation and narrative interviews were used and the SiSwati narratives of 27 participants were transcribed and analysed using theoretical coding. A number of recurrent themes emerged including the impact of gender on caregiving, the influence of traditional beliefs and practices and the experience of western medicine. However, the pervasive nature of poverty served to influence all aspects of caring for a child with cerebral palsy. These themes are discussed in relation to current healthcare policies, the influence of the HIV/AIDS pandemic, the concept of ‘ubuntu’ and socio-political aspects of healthcare. The findings highlight the value of using cultural narratives and participant observation as a means of exposing aspects related to the experience of disability that cannot be portrayed using quantitative methods. It emphasizes the nature of disempowerment amongst marginalized communities and draws attention to the need for both multisectoral and community involvement to bring about transformation.