An investigation into the nature, extent, and experience of collaboration between the Eden District, Western Cape Department of Health and community-based service providers

A major component of the primary health care (PHC) system is the delivery of health services on a community level, at the core of which is the Home and Community Based Care (HCBC) programme. This study focuses on one element of the HCBC system, namely how those involved in the administration of the community-based health component of primary health care, understand their relationship from the perspective of both the government (WCG - DoH) and the NPO service providers in the Eden District of the Western Cape. Additionally, it analyses the nature and the extent of the collaboration between the two entities. A patient referral tool was facilitated in a collaborative process to assess the ability of the two entities to strengthen their relationship. The study methodology was undertaken utilising Insider Ethnography with the researcher as a participant observer. Ten semi-structured interviews of the key stakeholders and one focus group were conducted with the staff of four non-profit (NPO) service providers operating in the Eden District and with WCG - DoH staff managing the HCBC programme. The findings reflect a substantial disconnect and imbalance in the relationship between the two entities, highlighting a top-down, transactional process at higher levels of management, in contrast to the operational relationships at the local sub-district level which are more collaborative. This disjuncture often disempowers the NPO service providers involved in the implementation of the programme. A number of recommendations regarding communication, advocacy, and innovation are proposed. Regular meetings of government, from district to provincial levels, with the NPO service providers, to strengthen collaboration by all stakeholders, are crucial

Human Chorionic Gonadotrophin in the Treatment of Threatened and Recurrent Abortion

Early experience with the use of human chorionic gonadotrophin replacement therapy in a small number of progesterone-deficient pregnancies is presented. Twelve out of 15 pregnancies proceeded normally to term and 3 pregnancies were lost. The latter group was associated with blighted ova and a significant amount of trophoblastic tissue. The findings in this small preliminary trial appear to justify a broader controlled investigation into the value of HCG therapy in prevention of threatened or recurrent abortion associated with progesterone insufficiency.S. Afr. Med. J., 48, 769 (1974)

Menopause And Its Management The Physiopathologic Foundation

An historical survey of all issues relating to the menopause was considered integral to understanding attitudes and the existing state of knowledge at the time of my planning and designing my initial investigations. While the research literature up to late 1966 was essentially narrative in nature, there were many indirect areas of research that could help define both the level of existing knowledge as well as attitudes and perceptions at that time. Above all, by understanding and documenting a comprehensive historical survey, it became possible to define the pertinent questions that needed answers. Key papers in which I documented the history and summarized the state of the art at that time are references 1-5, 107, 109, and my monograph, “Menopause in Modern Perspective (Appleton, Century, Crofts, New York, 1979). I can best summarize the background to my future studies by quoting from my first published analysis of the literature in 1968.107 The critical review opened with the observation that “most of what is published is based on emotional and philosophical premises; the 'change of life' is an emotional subject not only to women, but to men and doctors.” The purpose of the review was then listed as: “1. To analyse the current thoughts regarding the menopause. 2. To draw attention to the paucity of authoritative research and published data. 3. To serve as an indication for the urgent need for research, particularly into the nature of the menopause and the methods for the relief of menopausal symptoms and disorders; the process of 'ageing' and, in particular, the occurrence of osteoporosis and atherosclerosis in postmenopausal women; and the metabolic and vascular changes following acute hormone withdrawal, e.g. after bilateral oophorectomy in the pre- and postmenopausal female.” The conclusions of that 1968 critical review determined my future career path: “Several questions urgently require answers: 1. Is the climacteric a normal physiologic stage in the life of the human female, or is it a simple result of ovarian failure and oestrogen deficiency? 2. Are the manifestations of ageing directly related to diminution of circulating sex hormones? 3. Can the administration of exogenous oestrogen or other sex hormones prevent the manifestations of ageing? 4. Are the oestrogens at present available for administration equivalent in effect to circulating endogenous oestrogens? 5. Does long-term oestrogen administration result in an increased incidence of breast or uterine carcinoma? 6. Do oestrogens have a direct effect on the psychological state and sense of well-being in the postmenopausal patient? To these ends the development of more precise diagnostic techniques and methods of evaluation is vital

Menopause and its management the physiopathologic foundation

An historical survey of all issues relating to the menopause was considered integral to understanding attitudes and the existing state of knowledge at the time of my planning and designing my initial investigations. While the research literature up to late 1966 was essentially narrative in nature, there were many indirect areas of research that could help define both the level of existing knowledge as well as attitudes and perceptions at that time. Above all, by understanding and documenting a comprehensive historical survey, it became possible to define the pertinent questions that needed answers. Key papers in which I documented the history and summarized the state of the art at that time are references 1-5, 107, 109, and my monograph, “Menopause in Modern Perspective (Appleton, Century, Crofts, New York, 1979). I can best summarize the background to my future studies by quoting from my first published analysis of the literature in 1968.107 The critical review opened with the observation that “most of what is published is based on emotional and philosophical premises; the 'change of life' is an emotional subject not only to women, but to men and doctors.” The purpose of the review was then listed as: “1. To analyse the current thoughts regarding the menopause. 2. To draw attention to the paucity of authoritative research and published data. 3. To serve as an indication for the urgent need for research, particularly into the nature of the menopause and the methods for the relief of menopausal symptoms and disorders; the process of 'ageing' and, in particular, the occurrence of osteoporosis and atherosclerosis in postmenopausal women; and the metabolic and vascular changes following acute hormone withdrawal, e.g. after bilateral oophorectomy in the pre- and postmenopausal female.” The conclusions of that 1968 critical review determined my future career path: “Several questions urgently require answers: 1. Is the climacteric a normal physiologic stage in the life of the human female, or is it a simple result of ovarian failure and oestrogen deficiency? 2. Are the manifestations of ageing directly related to diminution of circulating sex hormones? 3. Can the administration of exogenous oestrogen or other sex hormones prevent the manifestations of ageing? 4. Are the oestrogens at present available for administration equivalent in effect to circulating endogenous oestrogens? 5. Does long-term oestrogen administration result in an increased incidence of breast or uterine carcinoma? 6. Do oestrogens have a direct effect on the psychological state and sense of well-being in the postmenopausal patient? To these ends the development of more precise diagnostic techniques and methods of evaluation is vital

Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: A comprehensive review

Many women experience vasomotor symptoms at or around the time of menopause. Hot flushes and night sweats are considered primary menopausal symptoms that may also be associated with sleep and mood disturbances, as well as decreased cognitive function. All of these symptoms may lead to social impairment and work-related difficulties that significantly decrease overall quality of life. Hot flushes have shown a great deal of variability in their frequency and severity in women. In some women, hot flushes persist for several months; in others, they may last for more than 10 years. Traditionally vasomotor symptoms were reported to begin 5 to 10 years prior to the cessation of the final menstrual cycle, corresponding with the initial decline in circulating gonadal hormones; however, night sweats in particular most often begin in perimenopause. The pathogenesis of hot flushes has not yet been fully elucidated, but the circuitry involving estrogen and neurotransmitters, norepinephrine and serotonin specifically, are hypothesized to play a major role in the altered homeostatic thermoregulatory mechanisms underlying these events. Menopause-associated vasomotor symptoms are associated with significant direct and indirect costs. Overall costs of traditional pharmacotherapy or complementary and alternative medicine modalities, including over-the-counter treatments and dietary supplements, for managing menopause-related vasomotor symptoms are substantial and include initial and follow-up physician visits and telephone calls. Additional costs include laboratory testing, management of adverse events, loss of productivity at work, and personal and miscellaneous costs. Pharmacoeconomic analyses, including those that consider risks identified by the Women's Health Initiative, generally support the cost-effectiveness of hormonal therapy for menopause-associated vasomotor symptoms, which have been the mainstay for the management of these symptoms for more than 50 years. However, because many women now want to avoid hormone therapy, there is a need for additional targeted therapies, validated by results from controlled clinical trials that are safe, efficacious, cost-effective, and well tolerated by symptomatic menopausal women

Film festivals in Africa: a study in sustainability

The sustainable future of film festivals in Africa is a vital issue based on the critical role that film festivals play in African filmmaking, and yet has not been widely investigated. This thesis identifies four key factors that I argue are essential to this sustainable future. These factors are: community and identity, the various mechanisms by which a festival's selfdefined identity or brand is developed and expressed; physicality and place, the concept of the lived and physical spatial nature of film festivals; technology, how innovations in technology are having an impact on film festivals; and financing and funding, the ability of film festivals to attract funding and finance. Each of these factors is discussed from both a theoretical perspective that draws on the history of film festivals as well as relevant areas of scholarship. Additionally, this thesis draws upon my years of professional experience working with film festivals in Africa. Through this auto-ethnographic approach I am able to complement the theoretical analysis of each of these factors with real-world examples and applications. This investigation makes it clear that the trajectory of African film festivals is distinctly different to those in the West, mainly due to localised factors such as the lack of cinema infrastructure and accessible internet connectivity, but also due to the existence of a global film festival hierarchical network, within which film festivals in Africa sit near the bottom. It is also apparent from this analysis that to become sustainable film festivals in Africa must effectively leverage these four factors through authentic claims to community and identity, accessible physical spaces, adaptation and inclusion of technology and disruption, and a diversity of funding models

Cholesterol, coronary heart disease and oestrogens

Present concepts of the interrelationship between oestrogens, endogenous and exogenous, and the development of atheromatosis and coronalY heart disease in the human female are reviewed. Aspects of research conducted by me at Groote Schuur Hospital, Cape Town, are incorporated in the discussion. The current role of oestrogen replacement therapy in the prevention of coronary heart disease in postmenopausal females is presented. It is concluded that although this role at present is limited, there is hope for the development of new oestrogenic steroids with a more specific effect on cholesterol metabolism. Finally, a plea is made for conservatism with ovaries during gynaecological operations on young females

Oestrogens and Osteoporosis

The interrelationship between oestrogens, endogenous and exogenous, their effects on plasma calcium, phosphorus and alkaline phosphatase metabolism, and the pathogenesis of osteoporosis are reviewed. Aspects of research conducted by me at Groote Schuur Hospital, Cape Town are incorporated in the discussion. The current role of oestrogen therapy in the prevention of osteoporosis ,is presented. It is concluded that appropriate or specific , oestrogens are of value in the prevention of osteoporosis , but have little or no role to play once the process is fully developed. Finally, a plea is made for conservatism with , ovaries during gynaecological operations on young females