Health Communication In Southern Africa ~ Using Pictograms In A Patient Information Leaflet To Communicate Antiretroviral Medicines Information To HIV/AIDS Patients In Rural South Africa

• by: Ros Dowse, Rhodes University

Part 3: Patient Information

Abstract
The objectives were to design a simple, illustrated patient information leaflet for the antiretroviral regimen of stavudine, lamivudine and efavirenz and to evaluate its readability and acceptability in the local Xhosa population. In order to achieve this, a further objective was to design and evaluate illustrations to include in the patient information leaflet which were culturally acceptable and well interpreted. Illustrations or pictograms were designed to illustrate selected instructions appearing in the patient information leaflet and were individually tested in 30 Xhosa participants who had a maximum of 8 years of formal schooling. Results were used to improve the pictograms for inclusion in the patient information leaflet. The patient information leaflet was designed and tested in sixty Xhosa participants with varied levels of education who had stated they could read. Demographic data were collected and they were then asked to read the patient information leaflet, available in both English and isiXhosa, and a series of questions was asked to assess its comprehension and acceptability. The overall average rate o f understanding was 95. Six of the 20 questions were located and understood by all participants, and only two questions resulted in less than an 85 correct response. Physical appearance and quantity of information were highly rated and all participants were enthusiastic about the inclusion of pictograms.

Introduction
The communication of health-related information in Africa has involved various media including theatre (Mbizvo, 2006), video (Mathews, 2002), television and radio (Health Communication Partnership, 2008) and folk media which includes poems, dance drama, story-telling, rhymes and sayings (Gokah, 2007). However, the most commonly employed method has been the use of print media (Peltzer, 2002). Low literacy rates coupled with inadequate infrastructure and poor technological development in African countries have favoured the use of posters, billboards and pamphlets for health promotion and patient education.

Medicine-taking behaviour is complex, multi-factorial, and depends on a dynamic interaction of several factors, including cognitive, behavioural, social, environmental and physiologic factors (WHO, 2003). A minimum requirement for using medicines safely and effectively is a basic understanding of the medicine instructions and the ability to recall this information. However, the communication of this information to the average patient in southern Africa presents a complex challenge to health professionals as poorly resourced health care systems result in minimal time spent with individual patients and the cultural, educational, socioeconomic and linguistic differences that often exist between health professionals and patients may further challenge successful communication. Limited reading skills, a poor knowledge of the body and its systems and inadequate insight into diseases and their treatment also disadvantage patients seeking to address their health problems. Read more

Health Communication In Southern Africa ~ Edutainment Radio Programmes: The Importance Of Culturally Relevant Stories

• by: Mia Malan, Stellenbosch University

Abstract
The ways in which journalists frame HIV stories can strongly contribute towards news consumers’ perceptions of the epidemic. This paper discusses the news values of HIV radio programmes in Ethiopia, Kenya and South Africa. It argues that the culturally appropriate ‘humanisation’ of HIV stories and the proper use of conflict as adding news value are paramount to the impact of stories. The skillful application of news values can make almost any HIV-related story newsworthy and therefore part of mainstream news. Moreover, it is maintained that HIV advocacy environments contribute to the newsworthiness of HIV stories in the media. The AIDS advocacy milieus of South Africa and Kenya are compared and related to the type of HIV stories that are published and broadcast in the respective countries. Journalism training methods are critically discussed in the context of the above. It is argued, that, in developing countries, where journalists often lack basic journalism skills, it is not sufficient to provide reporters with HIV-related information; HIV information sharing should be combined with general journalism training and mentoring.

Introduction
In December 2007, an excited Bashir Osman – a Somaligna-speaking journalist from Dire Dawa in the east of Ethiopia – broadcast a live call-in show on breastfeeding and HIV to his Somali audience on Dire 106.1 FM. According to the most recent Ethiopian government figures, Dire Dawa has the second highest HIV prevalence rate in the country, and almost doubles the national average. Each year there are almost 1, 000 HIV positive pregnancies with at least 230 children born with the virus. Yet this was the first HIV programme that Bashir had ever produced.

AIDS was so stigmatised in the region that Dire 106.1 FM hardly ever discussed it on air. And Osman had no problem following this route. A week before the
broadcast, the journalist – like most of his listeners – refused to be in the same room as people with HIV because he “didn’t want to risk breathing the same air” (Osman cited in De Masi, 2008) as them. He would never consider sharing a plate, or hosting an HIV positive person in his home, and thought it a deep insult to be tested for the virus.

But then Osman accessed what turned out to be a precious piece of culturally relevant information: he learned that babies of HIV positive women can get infected with the virus through their mothers’ breast milk (personal communication, December 6, 2007). All mothers with babies in his community breastfed their infants … including his very own wife. His own five-month old baby could be at risk, he perceived with shock, because  neither he nor his wife knew their HIV status. The realisation changed Osman’s entire view on AIDS, and HIV was suddenly a virus that had the potential to directly impact his own life and those of everyone else he knew, in ways he had previously vehemently denied (personal communication, December 6, 2007). In short, this piece of information made AIDS newsworthy to Osman, his community and his editors. It became something that was crucial and worthwhile to talk about.  Read more

Health Communication In Southern Africa ~ The Employment Of HIV Positive Young People For Health Promotion In Higher Education: A Case Study Of The DramAidE Health Promoters Project, South Africa

• by: Emma Durden, University of Cape Town and University of KwaZulu-Natal

Abstract
This paper explores two essential questions related to health promotion and HIV/AIDS  education.

1: Do HIV positive health promoters and peer educators have positive effects on students’ health attitudes, behaviours and HIV stigma reduction?

2: Which programme characteristics have better effects on health education performance? The paper seeks to address these questions with relation to the DramAidE Health Promoters Project run at a number of Higher Education Institutions in South Africa. The project makes use of HIV positive young people to live openly as role models with HIV on campus, to break stigma around the disease, increase prevention efforts, and encourage testing for HIV and positive living with HIV. A project evaluation conducted in 2007 included interviewing students, staff and the HIV positive health promoters working at nine campuses across South Africa, and forms the basis for this study.

Introduction
This chapter introduces the DramAidE Health Promoters Project and gives some background on its history and the rationale for its inception, with an overview of the current situation and response to HIV/AIDS at Higher Education Institutions in South Africa. The Health Promoter Project is rooted in the fields of peer education and entertainment education, and this chapter explores some of the theories that inform those practices, as well as an overview of some of the literature on similar projects that employ HIV positive people.

The chapter then explores two areas of study, namely the effect that HIV positive peer educators have on other students, and the programme characteristics that have better effects on health education performance; in an attempt to highlight good practice in the field of health promotion and HIV prevention efforts in South Africa. Some of the data relevant to the DramAidE Health Promoters Project are presented and discussed, with conclusions regarding the successes, challenges and potential of this strategy.

The DramAidE Health Promoters Project
The social impact of the HIV/AIDS epidemic in South Africa highlights the need to ensure that communities band together to deal with all aspects of the disease. Social behaviour change theories suggest that it is most effective to educate, sensitise and mobilise individuals by addressing the community in which these individuals find themselves, and to make HIV/AIDS a community concern (UNAIDS, 1999b). A number of commentators on HIV/AIDS behaviour change interventions agree that behaviour change can only happen in a supportive context where individuals are empowered to act within the group (Tomaselli, 1997; Airhihenbuwa & Obregon, 2000; Papa et al, 2000; Kelly, Parker & Lewis, 2001; Tufte, 2002).

The Health Promoters Project is a project running in Higher Education Institutions across South Africa, where these institutions are seen as able to respond to HIV/AIDS in a strategic and focused manner, as communities that find themselves within other broader communities. It is understood that the Higher Education sub-sector in South Africa may be disproportionately more affected by HIV/AIDS than other sectors, as the majority of students found on campuses across the country are in the in the age group with the highest prevalence of HIV infection (SAUVCA, 2006). According to a 2000 study conducted by the research organisation Abt Associates, the rate of HIV infection at a university undergraduate level was estimated to be roughly 22. This was expected to rise to 33 by 2005 (Thom & Cullinan, 2003). Read more

Health Communication In Southern Africa ~ Cell Phones For Health In South Africa

• by: Tanja E. Bosch - University of Cape Town

Abstract
There is widespread global use of technology in medicine and health communication, leading to terms such as telemedicine, telehealth and e-health. A wide range of information and communication technologies (ICTs) is used both in the provision of services, as well as for messaging and communication campaigns. In South Africa, limited Internet penetration has led to increased experimentation with cell phones as a tool for social change. This paper provides a discussion of three of such projects: The Teen SMS Helpline of the South African Depression and Anxiety Group (SADAG); SIMPill which assists patients with compliance to their tuberculosis medication; and CellLife’s Cell phones for HIV programme. The projects are described, and the paper reflects on the general possibilities for using cell phones in healthcare, weighing advantages and disadvantages, particularly in the local South African context.

Introduction
The global trend of using new technologies in healthcare and health communication has made its way to Africa. A range of healthcare initiatives makes use of palm devices, the Internet, and other information and communication technologies, giving rise to the terms e-health, tele-health, and telemedicine (see Oh, Rizo, Enkin & Jada, 2005, for a literature review on the topic).

While the growing body of literature on this subject explores both the Internet and cell phones as ‘new’ media in the use of health promotion efforts, it is cell phones that are emerging as most popular, and possibly most effective, in health communication on the continent. Internet penetration in South Africa is increasing steadily, but the numbers of people with access to high-speed Internet connectivity here and elsewhere across Africa are probably still too low to allow the widespread success of Internet based applications, outside of telecentres set up specifically for this purpose. Recent statistics indicate that only one in 700 Africans has access to the Internet, versus one in four Europeans (Chakraborty, 2008).

On the other hand, the number of mobile subscribers in Africa has increased dramatically over the last few years. In 2007 Africa added over 60 million new
mobile subscribers and mobile phones represented 90 percent of all telephone subscribers (African Telecommunication/ICT Indicators, 2008). Indeed, cellphone penetration in Africa has increased rapidly since the privatisation of telephone monopolies in the mid-1990s (LaFraniere, 2005). Between 2000 and 2006, the total number of subscribers to cellphone services increased from 10 million to 110 million, in the 24 countries of sub-Saharan Africa, and South Africa had more subscribers to cell phones than fixed lines (Buys, Dasgupta, Thomas & Wheeler, 2008). Similarly, an earlier study revealed that the number of mobile subscribers in 30 Sub-Saharan countries rose from zero in 1994 to more than 82 million in late 2004 and the rate of growth for the entire continent has been more than 58 per year (Mbarika & Mbarika, 2006). Clearly, Sub-Saharan Africa is the world’s fastestgrowing wireless market and the rate of growth for the entire continent has been more than 58 per year (Mbarika & Mbarika, 2006). In South Africa, cellphone use is widespread, particular with the introduction of pre-paid services; and there are over 30 million users (Shackleton, 2007). Read more

Reshaping Remembrance ~ Critical Essays On Afrikaans Places Of Memory

• by: Albert Grundlingh & Siegfried Huigen (Eds.)

Albert Grundlingh & Siegfried Huigen (Eds.) – Reshaping Remembrance. Critical Essays on Afrikaans Places of Memory – Rozenberg Publishers 2011 – Savusa Series 3 – ISBN 978 90 3610 230 8 – Editing: Sabine Plantevin.

In any society in the throes of transition, there is a particularly acute need to reflect upon aspects of the past that used to represent firm beacons enlighting the way ahead. This inevitably involves a broader re-appraisal of the processes which contributed to the formation of a specific historical memory in the first place.
Reshaping Remembrance includes a number of critical essays on dimensions of collective Afrikaans historical memory in South Africa. In the light of radical changes in the country, scholars from various disciplines reflect on the dynamics of historical consciousness symbolically present in various areas: the ‘volksmoeder’ image, historical events and monuments, language and music, rugby and architecture.
This work hopes to resound with a well-established intellectual tradition in Europe dealing with ‘places of memory’ or ‘lieux de mémoire’.

Contents
1. Siegfried Huigen & Albert Grundlingh – Koos Kombuis and Collective Memory
2. Elsabé Brink – The ‘Volksmoeder’ – A Figurine as Figurehead
3. Gerrit Olivier – The Location
4. Hein Willemse – A Coloured Expert’s Coloured
5. Kees van der Waal – Bantu: From Abantu to Ubuntu
6. Ena Jansen – Thandi, Katrina, Meisie, Maria, ou-Johanna, Christina, ou-Lina,Jane and Cecilia
7. Albert Grundlingh – Rugby
8. Marlene van Niekerk – The Eating Afrikaner: Notes for a Concise Typology
9. Lizette Grobler – The Windpump
10. Hans Fransen – Glorious Gables
11. Lou-Marié Kruger – Memories of Heroines: Bitter Cups and Sourdough
12. Lize van Robbroeck – The Voortrekker in Search of New Horizons
13. Christine Antonissen – English
14. Siegfried Huigen – Language Monuments
15. Rufus Gouws – The Woordeboek van die Afrikaanse Taal
16. Luc Renders – And the Greatest is … N.P.van Wyk Louw
17. Albert Grundlingh – Why have a Ghost as a Leader? The ‘De la Rey’ Phenomenon and the Re-Invention of Memories, 2006-2007
18. Stephanus Muller – Boeremusiek
19. Stephanus Muller – Die Stem
20. Annie Klopper – ‘In ferocious anger I bit the hand that controls’: The Rise of Afrikaans Punk Rock Music

Read more

Reshaping Remembrance ~ Koos Kombuis And Collective Memory: An Introduction

• by: Siegfried Huigen & Albert Grundlingh

As the year 2006 gave way to 2007, a song and an accompanying music video about the Boer general Koos de la Rey caused quite a stir in South Africa. When this song was played in bars and at barbecues, young white Afrikaners would stand with their fists clenched against their chests and sing along: ’De la Rey, De la Rey…’ And tears would flow. According to news reports, the ‘De la Rey thing’ had made many of them ‘proud’  of their roots. Worried ANC politicians expressed concern because they saw this as the start of an ethnic revival that could disrupt South Africa. The phenomenon even made it to the world press.

One of the more balanced reactions to the De la Rey song is an article by the Afrikaans beat poet Koos Kombuis on Litnet, ‘Bok van Blerk en die bagasie van veertig jaar’ (Bok van Blerk and the baggage of forty years).[i] In this article Kombuis confesses his conflicting reactions to the song. Rationally, he rejects the song and the Boer War elements in the music video. He sees it as ‘a call to war, a sort of musical closing of the ranks’. Some months before Kombuis had distanced himself publicly from his Afrikaner identity in a Sunday newspaper, from the ‘baggage that has been forced on me by people who have now been trying to prescribe for forty years who and what an Afrikaner is. What an Afrikaner is supposed to believe in. Whom he should vote for, which shit clothes he should wear and how he should spend his public holidays’.[ii] This notwithstanding, Kombuis is unable to offer any resistance to the emotional appeal of the song: ‘Why, if I experienced my resignation from Afrikanerdom as such a gloriously liberating step, do I feel so inexplicably profoundly touched by the De la Rey song? It is embarrassing’.

In reply to Kombuis’s question ‘why’, it can be surmised that both the song and the video, with their images of the leadership, a concentration camp and Boer fighters, draw on the collective memory of white Afrikaners, on something they learned within the family and, especially for the older ones, at school and in church. Kombuis’s reaction already points in this direction when he says that when he hears the song, he longs to be back at Sunday school and ‘feels like rejoining the army on the spot and shooting the hell out of the Kakies and other K stuff’.[iii]

The role of collective memories was first investigated seriously by the French sociologist Maurice Halbwachs in his ground-breaking works Les cadres sociaux de la mémoire (The social frameworks of memory) and La mémoire collective (The collective memory). These publications from 1925 and 1950 were rediscovered in recent years by historians doing research on memory. According to Halbwachs, every one of us obviously has his own memories, but at the same time we also share group memories. Read more