POVERTY ALLEVIATION: THE NEED FOR A KNOWLEGEABLE, ACTIVE AND EMPOWERED CIVIL SOCIETY

Many poverty alleviation programmes have been established in South Africa in an effort to overcome poverty and inequality. This paper explores reasons as to why the problem has worsened, despite all these efforts. An overview of the literature suggests that most of these programmes are project based, with a focus on financial gain and the development of technical skills. The success of these projects has been limited. The author argues that the focus on these "hard" issues is insufficient in dealing with poverty, given the history and context in which it is occurring in South Africa. The neo-liberal macro-economic policy undermines the success of projects. It could in fact sustain poverty and the status quo. It is argued that poverty cannot be overcome without a knowledgeable, active and empowered civil society. People's capacity needs to be developed to challenge the economic, political and social organisation of society.  It is recommended that interventions be more holistic and skills for social empowerment be strengthened. Conscientisation, organising for collective action and skills for transformingpolicy frameworks are considered important. A list of components vital for social empowerment is presented. Recommendations are made that research be undertaken to explore ways in which these components could be operationalised as key performance indicators in the evaluation of programmes

PARTICIPATION, CIVIL SOCIETY AND SOCIAL WORK PRACTICE

In 1994 South Africa became a democracy with a government elected by the people for the people. Citizens taking control of their own lives is a general goal of a democracy. The Constitution (RSA, 1996), the Reconstruction and Development Programme (ANC, 1994) and subsequent policy documents all advocate the importance of participation and the role of civil society in democratising South Africa. South Africa has chosen the path of developmental social welfare as its reformist approach to explaining and overcoming social problems. Crucial to social change is active citizen participation at many different levels that will enable citizens to contribute to the process of change that will then lead to nation-building, reconciliation and reconstruction (Pretorius-Heuchert & Ahmed, 2001:32). The government has committed itself to collaborating with non-governmental organisations as representative organs of civil society and its entire people in the reconstruction and development of the country. The year 2002 has been declared the year of the volunteer. The Africa National Congress has also launched its matsema campaign or voluntary community service programme to empower communities

The effectiveness of social work intervention in promoting parental involvement in formal pre-school teaching.

Thesis (M.A.)-University of Durban-Westville, 1987.The study aimed firstly to explore whether there were any differences in the quality of parent-child interactions in those children who scored high and those who scored low on the Pupil Behavior Rating Scale. Sixty-five pupils were randomly selected and rated on the Pupil Behavior Rating Scale concurrently by the teacher and the researcher. Ten of the highest performers and 10 lowest performers were then studied predominantly by the use of a questionnaire constructed by the researcher. However, the results of the study was hampered by the use of the questionnaire in that, unlike participant observation, it only showed differences in a limited number of areas. Much useful information, however, was obtained about the two groups of families, especially relating to socio-economic variables and attitudes to pre-schoo1 education. A second aim was to investigate the role of the social worker in promoting parental involvement in pre-schoo1 education. Here, the utilization of a needs assessment profile indicated that groupwork and social work intervention aimed at teachers were possible ways to promote parental involvement in pre-school education. An intervention programme was thus planned and executed by the researcher which confirmed that the social worker can be a useful resource in promoting home-school relations. Recommendations were made in regard to the role of the social worker, how the school system can be improved to promote parental involvement, and suggestions on future research

POVERTY, DEVELOPMENT AND DISABILITY

Hendriks (1999:111) highlights the point that all studies during the past decade indicate, namelythat person’s with disabilities and their families are disproportionately represented amongst thepoorest of poor. With the change of perception of persons with disabilities, it is now realised thatenvironmental factors and the context in which such persons live are crucial in the success of theirbecoming productive members of society. As a result of this understanding, the socio-economicempowerment of persons with disabilities within a developmental framework is being advocated.The author will highlight the need for synergy between mainstream development and thosedevelopments specifically for persons with disabilities, given the South African context. In SouthAfrica the majority of the population lives in poverty and in underdeveloped communities withfew resources and opportunities. It is argued that it would be difficult to meet the needs of thedisabled in these circumstances. In such situations most disability issues are important to alldevelopment: equality, empowerment, human rights, poverty and marginalisation (Lee cited inYeo, 2001:8). In the light of this, the author stresses the need for, and the benefit of, integratingdisability issues into all development programmes at community level. The integration ofdisability issues into all development programmes is a cost-effective approach in dealing withpoverty and disability in resource-poor settings. Challenges in implementing this approach will bediscussed

The Gastrointestinal Exertional Heat Stroke Paradigm: Pathophysiology, Assessment, Severity, Aetiology and Nutritional Countermeasures

Exertional heat stroke (EHS) is a life-threatening medical condition involving thermoregulatory failure and is the most severe condition along a continuum of heat related illnesses. Current EHS policy guidance principally advocates a thermoregulatory management approach, despite growing recognition that gastrointestinal (GI) microbial translocation contributes to the pathophysiology. Contemporary research has focussed on understanding the relevance of GI barrier integrity and strategies to maintain it during periods of exertional-heat stress. GI barrier integrity can be assessed non-invasively using a variety of in vivo techniques, including active inert mixed-weight molecular probe recovery tests and passive biomarkers indicative of GI structural integrity loss or microbial translocation. Strenuous exercise is well-characterised to disrupt GI barrier integrity, and aspects of this response correlate with the corresponding magnitude of thermal strain. The aetiology of GI barrier integrity loss following exertional-heat stress is poorly understood, though may directly relate to localised hyperthermia, splanchnic hypoperfusion mediated ischemic injury, and alternations in several neuroendocrine-immune responses. Nutritional countermeasures to maintain GI barrier integrity following exertional-heat stress provide a promising approach to mitigate EHS. The focus of this review is to evaluate: (1) the GI paradigm of exertional heat stroke; (2) techniques to assess GI barrier integrity; (3) typical GI barrier integrity responses to exertional-heat stress; (4) the aetiology of GI barrier integrity loss following exertional-heat stress; and (5) nutritional countermeasures to maintain GI barrier integrity in response to exertional-heat stress

Vectorcardiogram of the 'Man-Frog'

New experimental evidence is adduced to show that the hypothesis of the single instantaneous equivalent or resultant cardiac vector-which forms the basic concept of vectorcardiography - no matter whether this is produced by a dipole or a combination of dipoles, or a multi pole, is no longer tenable. Chest electrodes from a man and from a frog are connected simultaneously to an oscilloscope - the one to the vertical and the other to the horizontal plates - and the resulting display observed. It consists of a loop, the interpretation of which is discussed, and the conclusion is reached that the presently held vector theory appears to be of historical value only. Nevertheless, electrocardiograms and 'vectorcardiograms' will continue to be of the greatest clinical value, albeit on a purely empirical basis.S. Afr. Med. J., 48, 1095 (1974)

Endotoxaemia in intestinal dysfunction in experimental animals : intestinal ischaemia and hyperthermia.

Thesis (Ph.D.)-University of Natal, Durban, 1988.Endotoxins or lipopolysaccharides (LPS), highly toxic component of the outer membrane of gram-negative bacteria, are normally present in the mammalian gut lumen.In this thesis, I investigated, in laboratory animals, whether these gut-derived endotoxins play a role in pathophysiology resulting from intestinal dysfunctions caused by intestinal ischaemia and heat-stress.In primates, reperfusion of the splanchnic region after a temporary ischaemia was followed by a rapid increase in LPS concentration, first in the hepatic portal plasma and, ten minutes later, in the systemic arterial plasma. Rises in plasma LPS concentrations during or following the temporary intestinal ischaemia was prevented by prophylactic administrations of corticosteroids, anti-LPS IgG antibodies and oral, non-absorpable, antibiotics agents which appear to stabilize cellular membranes, aid the reticuloendothelial system in removal of LPS from the circulation and destroy the intestinal aerobic gramnegative bacteria respectively. In addition, administration of therapeutic anti-LPS antibodies also rapidly reduced the plasma LPS concentrations to baseline during an endotoxaemia. In a control heat-stress model, elevations in plasma LPS concentration commenced at rectal temperatures greater than 41,SoC. Like the intestinal ischaemia model, this occurred first in the hepatic portal plasma, and 10-15 minutes later, in the systemic arterial plasma. Peak plasma LPS levels of about 0,3 ng/ml, measured in heat-stressed primates, have proved in previous studies, to be toxic. A rapid decline in mean arterial pressure was followed by increases in plasma LPS concentrations and heart rates. Reductions in splanchnic blood flow and consequent local ischaemia coupled with thermal injury to the intestinal wall and the liver, may have permitted rises in plasma LPS concentration. Furthermore, as in the ischaemia model, prophylactic administrations of corticosteroids, anti-LPS IgG antibodies, and oral, nonabsorbable antibiotics prevented a rise in plasma LPS concentration. Of importance, prophylaxis with intravenous corticosteroids and 'anti-LPS IgG antibodies increased the survival rates significantly in heat stroke in primates. In addition, monkeys having high titres of "natural" antiLPS IgG antibodies had lower plasma LPS concentrations and survived the induced-heat stroke. It is suggested that other pathophysiologic conditions which compromise the integrity of the gut wall would also lead to the development of an endotoxaemia, and that gutderived endotoxins contribute to the athogenesis of heat stroke and treatments with corticosteroids and anti-LPS IgG antibodies may prove beneficial in other endotoxinrelated disorders

Social policy: transformation and delivery: study of welfare agencies in Kwazulu-Natal.

Thesis (Ph.D.)-University of Durban-Westville, 2000.Welfare agencies are involved in a complex process of transformation and working to overcome the past unjust system of racial and social discrimination in welfare. Many new policies have been developed as instruments of transformation and reform. There has been a shift in welfare policy from a residual model of welfare to a developmental focus. This requires radical changes by those involved in the welfare sector. This study assesses the level of transformation in service delivery in welfare agencies in KwaZulu-Natal: the link between policy and implementation. The White Paper of Social Welfare (1997) and subsequent policies will form the criteria from which transformation will be evaluated. Child Welfare agencies in KwaZulu-Natal formed the sample in the study. A survey method was used. Management members and social workers the agencies were interviewed. Senior officials and staff being policy-makers of the National Council of Child Welfare were also interviewed. It is argued that welfare agencies are grappling with the process of transformation and that delivery of services is far removed from that which the policies intend. Change, it is argued, has to be handled holistically, by combing policy, organisational change, re-ciirecting of energy and social energy. The results of study illustrates that what appears to have occurred thus far has been limited, incremental and piecemeal. The global economy and the macro- . economic policy of GEAR has constrained achievement of the goals of developmental social wefare in that there has been minimal increases in social spending. Past policies have put a brake on the implementation of a relevant welfare system. It is unlikely that agencies have the capacity to deal with the intensity of policy change, organisational development and new client bases. Overall, it can be argued that change has been haphazard, too rapid and poorly managed. A proposed model towards transformation is recommended. There has to be a partnership in the public-civic interface based on synergy and co-production if welfare services are to be relevant and meet the needs of the majority of people of South Africa

Tuberculosis in medical doctors – a study of personal experiences and attitudes

Background. The concurrent TB and HIV epidemics in sub-Saharan Africa place all healthcare workers (HCWs) at increased risk of exposure to Mycobacterium tuberculosis.Aim. This study explores personal experiences, attitudes and perceptions of medical doctors following treatment for TB within the healthcare system.Method. Sixty-two medical doctors who were diagnosed with and treated for TB during 2007 - 2009 agreed to participate and complete a semi-structured questionnaire.Results. The response rate was 64.5% (N=40). The mean age of participants was 33.7 years (standard deviation ±10.6). A correct diagnosisof TB was made within 7 days of clinical presentation in 20% of  participants, and was delayed beyond 3 weeks in 52.5%. Non-routinespecial investigations and procedures were performed in 26 participants. Complications following invasive procedures were reported by 8 participants. Multi-drug resistant TB (MDR-TB) was diagnosed in 4 participants. Nineteen considered defaulting on their treatment because of drug side-effects. The majority (n=36) expressed concerns regarding lack of infection control at the workplace, delays in TB diagnosis and negative attitudes of senior medical colleagues and administrators. Ninety per cent of participants indicated that their personal illness experiences had positively changed their professional approach to patients in their current practice.Conclusion. The inappropriate delays in diagnosis in a large number of participants, coupled with a number of negative personal perceptions towards their treatment, are cause for concern. The results further amplify the need for improved educational and awareness programmes among all healthcare personnel (including hospital administrators), adherence to national health guidelines, effective infection control measures, pre- and post-employment screening in all HCWs, and changes in attitudes on the part of senior medical colleagues and administrators

The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

Background. In South Africa (SA), the Saving Mothers Reports have shown an alarming increase in deaths during or after caesarean delivery.Objective. To improve maternal surgical safety in KwaZulu-Natal Province, SA, by implementing the modified World Health Organization surgical safety checklist for maternity care (MSSCL) in maternity operating theatres.Methods. The study was a stratified cluster-randomised controlled trial conducted from March to November 2013. Study sites were 18 hospitals offering maternal surgical services in the public health sector. Patients requiring maternal surgical intervention at the study sites were included. Pre-intervention surgical outcomes were assessed. Training of healthcare personnel took place over 1 month, after which the MSSCL was implemented. Post-intervention surgical outcomes were assessed and compared with the pre-intervention findings and the control arm. The main outcome measure was the mean incidence rate ratios (IRRs) of adverse incidents associated with surgery.Results. Significant improvements in the adverse incident rate per 1 000 procedures occurred with combined outcomes (IRR 0.805, 95% confidence interval (CI) 0.706 - 0.917), postoperative sepsis (IRR 0.619, 95% CI 0.451 - 0.849), referral to higher levels of care (IRR 1.409, 95% CI 1.066 - 1.862) and unscheduled return to the operating theatre (IRR 0.719, 95% CI 0.574 - 0.899) in the intervention arm. Subgroup analysis based on the quality of implementation demonstrated greater reductions in maternal mortality in hospitals that were good implementers of the MSSCL.Conclusions. Incorporation of the MSSCL into routine surgical practice has now been recommended for all public sector hospitals in SA, and emphasis should be placed on improving the quality of implementation