Pathways to psychiatric care in Harare, Zimbabwe

A clinical study on psychiatric care in Zimbabwe.A study was carried out on the pathways to psychiatric care in Harare, Zimbabwe. Encounter forms were completed on 48 patients admitted to psychiatric beds. Analysis indicated that there was a by-pass of primary care facilities, with a significant number presenting directly to tertiary care facilities, here were lengthy delays before seeking care, but delays while receiving care were moderate. The sample as a whole was composed of major disorders, displaying severe symptoms, and there was a suggestion that some patients become more disturbed along the pathway. As a whole, the sample is very different to samples screened from primary care settings, and the consequences of this are discussed

A preliminary investigation into psychological disorders in Mozambican refugees: prevalence and clinical features

A CAJM preliminary investigation into psychological disorders among refugees in Mozambique.Psychological disorders are common in refugee samples, with several studies showing high rates of Post Traumatic Stress Disorder. The present study examined the prevalence and factors associated with psychological disorders in Mozambican refugees in Zimbabwe. The findings indicated a very high prevalence rate (62 pc), which is considerably higher than that obtained from other settings within Zimbabwe. The demographic characteristics were similar in most respects to other Zimbabwean samples, but there was a trend towards greater social adversity (more relationship difficulties, less schooling and higher employment). Clinically, refugees were severe, with high scores on the SRQ-20, a presenting picture of multiple somatic complaints, and a high rate of rated suicidal risk. There were a significant number of refugees who had had an experience with violence in their recent past, as well as there having been frequent life events in the past six months. The implications of these findings are discussed with reference to Post Traumatic Stress Disorder, and the management of psychological disorders generally

Labour migration and its impact on non-capitalist social formations : a comparative study of the Tonga and Ngoni-Tumbuka in Malawi, circa 1880 to 1940

This thesis is a study of labour migration from Malawi, specifically an examination of the impact of immigrants on the non-capitalist social formations of the Tonga and Ngoni-Tumbuka under colonial-capitalism .until 194-0. It is an attempt to locate and analyse transformations of the major social. Relations which structured and organised the lives of the Tonga and Ngoni ... Turnbuka at the rural, ·village level during the period under review. An academic thesis of this nature has severe limits in that it cannot begin to grasp the day-to-day lived experience of those who were subjected to the. profiteering onslaught of colonial capitalism. · The separation of husbands from wives and children, this hunger and fear, the drudgery and humiliations and the brave . . ' Resistance and struggles of ordinary· people to maintain their self-dignity under conditions of increasing impoverishment do not emerge clearly from official colonial reports concerned with tax returns, law and order and economic development for Imperial expansion. Without a presentation and understanding of these experiences an analysis of this nature is necessarily incomplete. i This is not merely an ideological standpoint but one that recognises that social transformations are forged by people, day by day, reacting to conditions that confront their livelihood, their security ty and mental well-being. As such it is through these · lived experiences that historical change takes place . . The economic development of Malawi has taken place along three major lines. Under colonialism, the north of Malawi, where the Tonga and Ngoni-Tumbuka lived and still live, developed rapidly into a labour-reserve economy serving mines and farms all around the southern sub-continent. In the centre and south developed peasant cash-cropping with some labour-migration and a weak capitalist plantation economy. More recently, labour migration to neighbouring countries has been dramatically reduced and the labour redirected to peasant cash-cropping and to the capitalist plantation economy undergoing expansion in the central and northern regions. This has occurred under the direction of multinationals and a tiny national bureaucratic bourgeois class indistinguishable from the present regime. Labour migration thus remains a crucial phenomenon in the present development and underdevelopment of the Malawian economy. Although migration is now more internal than external it still bears the same characteristics, in that migrants have retained material links with non-capitalist economies where their families undertake subsistence agriculture for their own survival, thus enabling plantation owners to pay single men's wages. The political and social forms arising out of these relations are thus crucial in the make-up of the State and for the future trajectory of the economy. It is in the context of this that a historical study of the impact of labour migration on non-capitalist social formations in northern Malawi has relevance. Chapter One sets out a broad theoretical position within which the relationship between capitalist and non-capitalist modes of production can be analysed. This is argued in terms of the debate between those who opt for seeing a social formation as an articulation of constituent modes of production and those · who see a social .formation as ._containing one mode of production. The former position is seen here as the most useful. Chapter Two theoretically defines and elaborates on wh.at I have - called the domestic non-capitalist mode of production. 'This sets out the theoretical basis for my analyses rn Chapter Three and Four of the Ngoni-Tumbuka and Tonga domestic modes of production and social formations. This chapter looks at the relations and forces of production in terms of the agricultural cycle, relations of exploitation between elders and juniors and marriage organisation. Chapter Three gives a concrete analysis of the Tonga social formation before colonialism, in order to locate major social relations later transformed under colonial-capitalism and the impact of labour migrancy studied in Chapter 7 . As such it concretises relations posited in Chapter 2. Chapter Four gives a similar analysis to Chapter Three, studying the Ngoni-Tumbuka social formation before colonialism as a pre-- cursor to Chapter Eight.· Chapter Five sets out some theoretical arguments on the nature of labour migration. The first. Part locates the available surplus labour-time in domestic economies. The second part looks at the appropriation of this surplus labour-time and the nature of exploitation of domestic producers under the system of migrant labour in terms of the reproduction of migrant .labour- . power by migrants' families. Lastly the various concrete forms of labour migration in colonial Malawi are examined. Chapter Six begins with some theoretical observations on the Colonial State and the nature of Imperialist intervention in Africa in the late· 1800 s. This is followed by a schematic analysis of the Colonial State formation in Malawi from 1890 to 1940 in terms of the development of labour migration. Chapter Seven studies the impact of labour migration on the Tonga social formation until 1940. The first part gives background information on the patterns of labour migration from Tongaland. This is followed by an analysis of the. role of missionaries, after which is a study of the role of the Colonial State and the political struggles, at the level 0£ the. local state, involved in the transformation of Tonga social ~elations. The next section deals with the social processes of migrancy within Tonga villages until 1917. After this subsistence and market production relations from 1917 to 1940 are examined followed by a study of the processes of dispersal of homesteads consequent upon shifting power relations from elders to junior migrants. Finally, the re-organisation of marriage relations involved in the shifting of power relations is examined in greater depth. chapter Eight is a similar analysis to Chapter Seven, studying the case of the Ngoni-Tumbuka. The first three sections (patterns, missions, and local state) are similar in approach to the previous chapter. The fourth section studies the underdevelopment of the subsistence economy, followed by an examination of the transformations of relations linking the cattle economy to marriage organisation, with the development of labour migration. The chapter ends with a study of the dispersal of villages within the context of struggles between the Ngoni 'aristocracy' and Ngoni-Tumbuka commoners. Comparisons and contrasts between developments in the two social formations are given in Chapters Seven and Eight

From rehabilitation to prevention: The need to move one step further

In the 30 years in which Torture has been the flagship publication on organised violence and torture the world no longer can be oblivious to the prevalence or consequences of torture. The existence of documented torture provides the hardest indicator of the absence of human rights in any given country, but does this demonstration still evoke the same sense of shock or same as it did thirty years ago? This is an important question to address currently with so much evidence suggesting that democracy worldwide may be in decline and that authoritarianism is on the increase. This article looks briefly at the current situation, the role of the antitorture movement and the Torture journal

Oral History Interview: Ruby B. Reeler

This interview is one of series conducted concerning Oral Histories of African-American women who taught in West Virginia public schools. Mrs. Ruby B. Reeler first started teaching at Grandview School in West Virginia in 1952 and has been employed in several other schools since then. She gives us detailed information about her family throughout the interview, including family life, her feelings about each of her parents, a story about a woman taking advantage of her mother, meeting and marrying her husband, her children, and her current relationship with her husband, who she takes care of because of his sickness. Her childhood is another large topic, and she recalls growing up on a farm, Christmas during her childhood, her growing awareness of racism, and punishments she faced as a child. She also tells us about her education in detail. She remembers prom, sports, music, academics, and teachers during high school, and then her time at Storer College, a black college in West Virginia. She then moves on to her career in teaching, telling us why she chose a career in elementary education, the desegregation of schools, racial tensions at her schools, tensions between her and other teachers & school administrators, her teachings methods, how teaching has changed over time, and why she retired. She also had a career in the City Council and belonged to a number of organizations. Race relations is another important focus, and she tells us about segregation, racial slurs and a lesson she gave about them in her class, the racial climate of Harper\u27s Ferry (West Virginia), and problems African-Americans face because of their race. There are numerous other discussion points as well, such as: moving to Charles Town; church and religion; comic books; old time radio shows; World War II (including the Pearl Harbor attack); women\u27s rights; her self-perceptions and her perceptions on her life; as well as many other topics.https://mds.marshall.edu/oral_history/1587/thumbnail.jp

Risk of acquired drug resistance during short-course directly observed treatment of tuberculosis in an area with high levels of drug resistance.

BACKGROUND: Data on the performance of standardized short-course directly observed treatment (DOTS) of tuberculosis (TB) in areas with high levels of drug resistance and on the potential impact of DOTS on amplification of resistance are limited. Therefore, we analyzed treatment results from a cross-sectional sample of patients with TB enrolled in a DOTS program in an area with high levels of drug resistance in Uzbekistan and Turkmenistan in Central Asia. METHODS: Sputum samples for testing for susceptibility to 5 first-line drugs and for molecular typing were obtained from patients starting treatment in 8 districts. Patients with sputum smear results positive for TB at the end of the intensive phase of treatment and/or at 2 months into the continuation phase were tested again. RESULTS. Among 382 patients with diagnoses of TB, 62 did not respond well to treatment and were found to be infected with an identical Mycobacterium tuberculosis strain when tested again; 19 of these patients had strains that developed new or additional drug resistance. Amplification occurred in only 1.2% of patients with initially susceptible or monoresistant TB strains, but it occurred in 17% of those with polyresistant strains (but not multidrug-resistant strains, defined as strains with resistance to at least isoniazid and rifampicin) and in 7% of those with multidrug-resistant strains at diagnosis. Overall, 3.5% of the patients not initially infected with multidrug-resistant TB strains developed such strains during treatment. Amplification of resistance, however, was found only in polyresistant Beijing genotype strains. CONCLUSIONS: High levels of amplification of drug resistance demonstrated under well-established DOTS program conditions reinforce the need for implementation of DOTS-Plus for multidrug-resistant TB in areas with high levels of drug resistance. The strong association of Beijing genotype and amplification in situations of preexisting resistance is striking and may underlie the strong association between this genotype and drug resistance

Spatial patterns and behaviour at Dunefield Midden

An analysis of the spatial patterning present in the arrangement of material and features at the site of Dunefield Midden, is presented in this thesis. All items from the site are analysed, except the remains of large fauna. The site of Dunefield Midden is situated about two kilometres north of Eland's Bay on the Cape West coast, South Africa. Radiocarbon dates indicate that the site was occupied about 670 years B.P. The nature of the food remains and artefacts from this site suggests a single occupation, for a limited period, by a group of hunter-gatherers. Features from the site examined in detail include ash features (such as hearths, roasting pits and ash dumps) and dumps (in particular, a feature called the 'main dump'). Comparisons with ethnographic and ethnoarchaeological material are made to aid the process of interpretation. Other features common to ethnographic hunter-gatherer campsites, but for which there is no evidence at Dunefield Midden (such as structures), are discussed. The type of site, possible length of occupation and number of people are discussed from the analysis of features and other material. Suggestions are made that the site was a base camp occupied by between ten and twenty-five people for a month to a month and a half. Finally, conclusions are made about the nature of the behaviours which caused the spatial patterning evident on the site. The level of detail reached in the interpretations of patterning and behaviour is far greater than that possible from more complex, deeply stratified sites. Thus, the value of researching different kinds of sites is shown. The use of a Geographic Information System to analyse information and create distribution maps is unique in spatial archaeological studies. The use of this system shows its value as a new technology of great potential use to all archaeologists. The spatial autocorrelation test of randomness of distributions is also introduced and is compared to other statistical tests used by archaeologists previously. This test is applied to distributions of items from the site, produced with the aid of the Geographic Information System. The use of site indices describes a method of normalising distributions, with the possibility of using satellite technology to analyse these distributions. This thesis, therefore, reaches a deeper level of interpretation of human behaviour at one particular site, than generally has been achieved previously. It also introduces new techniques and technologies particularly suited to this analysis and potentially of use to other archaeologists, even in different fields of study

Experience of Initial Symptoms of Breast Cancer and Triggers for Action in Ethiopia

Objective. This study assessed the initial experiences, symptoms, and actions of patients in Ethiopia ultimately determined to have breast cancer. Methods. 69 participants in a comprehensive breast cancer treatment program at the main national cancer hospital in Ethiopia were interviewed using mixed qualitative and quantitative approaches. Participants' narratives of their initial cancer experience were coded and analyzed for themes around their symptoms, time to seeking advice, triggers for action, and contextual factors. The assessment was approved by the Addis Ababa University Faculty of Medicine Institutional Review Board. Results. Nearly all women first noticed lumps, though few sought medical advice within the first year (average time to action: 1.5 years). Eventually, changes in their symptoms motivated most participants to seek advice. Most participants did not think the initial lump would be cancer, nor was a lump of any particular concern until symptoms changed. Conclusion. Given the frequency with which lumps are the first symptom noticed, raising awareness among participants that lumps should trigger medical consultation could contribute significantly to more rapid medical advice-seeking among women in Ethiopia. Primary care sites should be trained and equipped to offer evaluation of lumps so that women can be referred appropriately for assessment if needed