Context, culture and disability : a narrative inquiry into the lived experiences of adults with disabilities living in a rural area.

This thesis documents the everyday experiences of adults with disabilities living in a rural area of South Africa. Given South Africa’s tumultuous history, characterised by human rights violations incurred through cultural, political and racial disputes, and the country’s current state of socio-economic and political turmoil, violence has come to represent a core feature in the lives of many South Africans. This, together with the impact of unemployment, food insecurity and unequal power distribution, has significantly affected the ways in which many people make sense of their life experiences. Despite the fact that exposure to unequal power dynamics, violence, marginalisation and exclusion are documented to dominate the life experiences of people with disabilities, little is understood about the ways in which these aspects manifest in the interpretation and reconstruction of experiences. Previous research into the field of disability studies has depended primarily on quantitative measures, or on the reports of family members and caregivers as proxies, perpetuating the cycle of voicelessness and marginalization amongst adults with disabilities. Those studies which have adopted qualitative measures in order to explore the psychosocial experiences of disability have focussed largely on the limitations imposed by physical access, and have relied predominantly on the medical and social models of disability, or on the World Health Organisation’s International Classification on Functioning, Disability and Health (WHO ICF, 2001). These models consider the psychosocial experience of disability to be universal, and do not adequately take into account the impact of cultural and contextual variables. This has negatively impacted on the establishment of a research repository upon which evidence-based practice has been developed. This thesis aimed to explore and document the lived experiences of 30 adults with a variety of disabilities, living in 12 rural villages in the Mpumalanga Province of South Africa. A combination of narrative inquiry and participant observation was employed in order to examine the relationship between personal and social interpretations of experience. Data analysis was conducted using a combination of Clandinin and Connelly’s (2000) Three Dimensional Narrative Inquiry Space, Harré’s Positioning Theory (1990, 1993, & 2009), and Thematic Analysis (Braun & Clarke, 2006). Results revealed that narratives were plurivocal in nature, giving rise to a complex relationship between personal and social interpretations of experience. The findings highlighted the impact of cultural norms, values and roles on making sense of experiences associated with disability. Four new types of narrative emerged, none of which conformed to the current interpretations of lived experience as reported in the literature. All of the narratives were pervaded by the embodied experience of violence, including evidence of structural, physical, psychological and sexual violence, as well as violence by means of deprivation. This gave rise to a sense of moral decay and highlighted the ways in which abuse of power has become woven into lived experience. In this way insight was gained into the complex interplay between impairment, exclusion, high mortality rates, violence, and poverty in rural areas. Narrative inquiry proved to be a particularly useful tool for providing insight into disability as a socio-cultural construct, drawing attention to a variety of clinical, policy and theoretical implications. These gave rise to a number of broader philosophical questions pertaining to the role of memory, vulnerability and responsibility, and the ways in which all citizens have the potential to be complicit in denying the reality of lived experience amongst vulnerable members of society. These findings demand attention to the ways in which governments, communities and individuals conceive of what it means to be human, and consequently how the ethics of care is embraced within society

Speech-Language Pathology and Audiology in South Africa: Clinical Training and Service in the Era of COVID-19

Introduction and purpose: The novel coronavirus (COVID-19) presented new and unanticipated challenges to the provision of clinical services, from student training to the care of patients with speech-language and hearing (SLH) disorders. Prompt changes in information and communication technologies (ICT), were required to ensure that clinical training continued to meet the Health Professions Council of South Africa’s regulations and patients received effective clinical care. The purpose of this study was to investigate online clinical training and supervision to inform current and future training and clinical care provision in SLH professions. Methodology: A scoping review was conducted using the Arksey and O'Malley (2005) framework. The electronic bibliographic databases Science Direct, PubMed, Scopus, MEDLINE, and ProQuest were searched to identify publications about online clinical training and supervision and their impact on clinical service during COVID-19. Selection and analysis were performed by three independent reviewers using pretested forms. Results and Conclusions: The findings revealed important benefits of teletraining and telepractice with potential application to South African clinical training and service provision. Five themes emerged: (1) practice produces favorable outcomes, (2) appreciation for hybrid models of training and service delivery, (3) cost effectiveness is a “big win” (4) internationalization of remote clinical training and service provision, and (5) comparable modality outcomes. These findings may have significant implications for teletraining and telepractice in low-and-middle income countries (LMICs) in the COVID-19 era and beyond, wherein demand versus capacity challenges (e.g., in human resources) persist. Current findings highlight the need for SLH training programmes to foster a hybrid clinical training model.  Few studies were conducted in LMICs, indicating a gap in such research. &nbsp

In pursuit of best practice through contextually relevant, accountable and responsive research

In this year of recovery from the coronavirus disease 2019 (COVID-19) pandemic, the authors and editors of the South African Journal of Communication Disorders (SAJCD) have, once again, contributed towards the body of knowledge in our two professions of Speech-Language Pathology and Audiology. The year 2022 has offered professionals from these professions two valuable journal issues. Issue 1 included 17 articles aimed at improving knowledge on pertinent issues such as screening and provision of services. The authors followed various methodologies, which included original research papers, an opinion paper and 3 clinical perspective pieces. Issue 2 illustrates just how busy the researchers and practitioners in our professions were during the pandemic, with 22 articles that document the challenges as well as the valuable lessons learnt during the COVID-19 pandemic regarding research, training as well as clinical service provision. Go to: Volume 69, Issue No. 1 (2022)http://www.sajcd.org.zaam2023Speech-Language Pathology and Audiolog