Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Neck pain is a common complaint and a common source of disability in the general population with a point prevalence of nearly 13%. Reports indicate that industry related neck disorders (lifetime incidence of nearly 50%) account for as many days of absenteeism as low back pain; one could compare the two clinical conditions in terms of these trends on a global scale. To investigate whether similar trends do exist, 200 participants with neck pain and 200 asymptomatic participants (stratified sampling according to age and gender) that consented to the research were clinically assessed. These participants also completed a questionnaire addressing the factors that have been identified as related to neck pain at the consultation where they were assessed. This research did not involve the treatment of the participants, although a free treatment was given for patients that opted for one or to those that required it post participation in the study. If treatment was outside the scope of the chiropractic clinic, the participants were referred to the appropriate health care provider. The aim of the study was to investigate factors associated with neck pain in the indigenous African population in the greater Durban area. Data was analysed according to the following: Descriptive statistics were interpreted by means of frequency tables, pie charts, bar graphs and / or in a tabular format in order to describe the sample characteristics of the population under study. Inferential statistics included regression analysis in order to determine any relationships between the patient‟s neck complaint characteristics and factors associated with the complaint. SPSS version 11.5 was used for data analysis (SPSS Inc, Chicago, Ill, USA). A p value of <0.05 was considered as statistically significant. Descriptive analysis involved presenting or graphing categorical variables as counts and percentages, and quantitative variables as medians and interquartile ranges due to the skewness of the data. Associations between factors and neck pain were examined bivariately using Pearson‟s chi square or Fisher‟s exact tests as appropriate for categorical factors, or Mann-Whitney tests in the case of quantitative non-parametric data. Finally in order to examine the adjusted independent effects of all factors which were found to be individually significant in the bivariate analysis, multivariate binary logistic regression analysis was done. A backwards elimination modelling technique was used, based on likelihood ratios, with entry and exit probabilities set to 0.05 and 0.010 respectively. Results were reported as odds ratios, 95% confidence intervals and p values. Chi squared analyses was utilised to assess the strength of the relationship and the degree of significance of the relationship. All statistics were analyzed at a confidence interval of 95% and a level of significance where α ≤0.05 (pvalue). The symptomatic participants seemed to be less well educated than the controls. The cases seemed to be less in full time employment, less unemployed, and more self employed than the controls. Income was unevenly distributed among cases and controls. The cases who were working seemed to earn less than the controls who were working. The duration of having neck pain was mainly 1 month. The majority of cases classified their pain as mild. Most participants felt that their pain was worst in the afternoons or related to activities, while they felt their pain was least in the mornings. Frequency of neck pain was mainly constant (36.5%), followed by frequent (32.5%) and seldom (25%). Symptomatic participants mostly reported that their pain began without injury, gradually in 67.5% and abruptly in 13.5%. Fewer symptomatic participants reported pain beginning after an injury (n=22 gradually and n=7 abruptly). The majority reported their neck pain to be stable (38%), while 34% felt it was getting worse and only 19% getting better. More than half of the cases reported difficulty with work due to neck pain. Fewer reported difficulties with daily activities such as washing (30%), sleeping (26%), and lifting (24%). Almost half of the cases rated their disability as none (48%). Only 16% reported severe disability. Thirty-three percent (n=66) reported having been absent from work due to neck pain. The duration of absence in those who were absent was mainly 0-1 week (89.4%). 59 (29%) reported being bed-ridden with neck pain. The most frequent duration was also 0-1 week (81.4%). Ninety three point five percent reported no change in occupational status, while 6 (3%) were demoted, 5 (2.5%) boarded, and 2 (1%) fired. With respect to associated signs and symptoms, 156 (78%) reported to suffer from headaches. In addition, symptomatic participants were asked if they associated their neck pain with any other activities. The most commonly reported factor was stress (22%), followed by bad posture (17%). The other reported factors were reported infrequently. Participants who worked in occupations that involved driving, turning neck, answering the telephone, working in an air-conditioned room, and bending over a desk were significantly more at risk of being cases than controls. Non-occupational factors which were associated with neck pain were worrying a lot, motor vehicle accident, not enough bed support, not using arms to support a book, sitting without back or arm support, not watching TV a lot, and exercising. The results of the study suggest that neck pain within the indigenous African population is associated with the level of education, income, stress levels, bad posture, repetitive movements of the neck, and motor vehicle accidents. It was also found that most of neck pain patients do suffer from headaches. The findings show that neck pain is mostly classified as mild in nature with 1 month duration. Although neck pain was reported to be responsible for at least 7 days of absenteeism from work, causing difficulty with daily activities, most patients reported no disability as a result of neck pain.

While accounting for less than 5 percent of the Canadian population, Indigenous peoples represent more than 30 percent of the federal prison population of Canada. In a prairie province like Manitoba the numbers are even more extreme, with over three-quarters of the prison population being Indigenous. This contemporary “Indian Problem” has been theorized in recent decades as an outcome of the colonial history of Canada. Indigenous Studies scholarship has critiqued the temporal political imaginary of the subsequent reconciliation discourse that locates colonial violence, and, thus, culpability and responsibility of the Canadian state, to an ‘event’ of history. Such national stories not only diminish the interrogation of ongoing structures of colonial violence but relegate any meaningful political processes of accountability and justice to the dustbin of history. This ‘legacy’ framework of historicizing colonial violence has created fecund conditions for (re)apprehending Indigenous bodies at the junctures of legal and medical reasoning, where questions of punishment, containment and rehabilitation for criminal actions become uneasily blurred with questions of healing and repair of damaged bodies and minds. The uptake of ‘Fetal Alcohol Spectrum Disorder’ (FASD) in the Canadian justice system in recent decades operates precisely at this juncture of treating Indigenous peoples as uniquely medicalized, or disabled, criminals, and has created further capacities for deepening this ‘legacy’ framework for apprehending and containing Indigenous peoples as offenders, or even as potential offenders of a social and legal order. FASD is an umbrella term describing the range of lifelong physical, mental, behavioral and learning disabilities that can occur in an individual who was exposed to alcohol while in utero. It is typically thought of as a neurocognitive disability that affects memory, executive reasoning, and the ability to learn from or think consequentially about one’s actions. As such, it has become a broad institutional discourse for predicting criminal behaviors through a medicalized conception of risk of violence. FASD is typically raised as an ethical problem in the criminal justice system, provoking important questions as to whether we punish crimes (for which one is culpable) or disabilities (for which one is not). In addition, if FASD represents a permanent neurocognitive disability without any hope of cure, how should the rehabilitative and reintegrative tenets of the criminal code be imagined and implemented? These problems are compounded further by the regular speculation that Canada is in the midst of a hitherto unknown epidemic of this “invisible disorder” of FASD. Important as these ethical and political problems are, the dissertation argues that the specific institutional urgency surrounding the medicalization of criminal offenders with FASD has been enabled by diagnostic logics of deferral and certainty that pertains to the “Indian Problem.” These logics allow FASD to relocate and bury questions of colonial responsibility within the Indigenous body itself which is tragically doomed to permanent brain damage and cognitive disorder and an incorrigible lifestyle of dysfunction and crime. The ‘colonial legacy’ predicates a foreclosure on Indigenous futurity. This dissertation is based on 24 months of fieldwork in a non-profit community outreach program for justice-involved individuals with FASD in Winnipeg, Manitoba. As an FASD community outreach worker, my job was to assist individuals to navigate the complexities of criminal justice and social welfare systems that might pose challenges to those with cognitive disabilities associated with FASD. I learned very quickly, however, that actors as diverse as lawyers, probation officers, doctors, social workers, FASD researchers and even my community outreach colleagues and supervisors, operated within a diagnostic imaginary that quite often assumed without proof the presence of an FASD diagnosis for our almost exclusively Indigenous clientele. The dissertation analyzes the everyday procedures of FASD knowledge formation and circulation beginning with a basic ethnographic question: how does one know that another has FASD? This line of questioning was situated within the broad institutional apparatus of the criminal justice system in Canada, which I examine thematically and temporally as four separate stages of encounter: 1) the initial crime and related discourses of accusation; 2) the trial setting; 3) the sentencing trial; and, finally, 4) the post-carceral release phase. This temporal framework emerged naturally out of my experience of ethnographic work as a community outreach worker and innumerable casual and professional encounters with social workers, slum landlords, and my many hours spent in courts, probation offices, and jail visitations. In addition, I had a four-month placement with an assessment team at an FASD diagnostic clinic and did extensive work in the archive of legal cases and decisions pertaining to Indigenous offenders and the unique problematic of FASD in the legal system. Breaking down the minute social and legal details that attend to determinations of FASD at these various stages unmasks the ways in which FASD comes to explain Indigenous criminality as a congenital condition that is an expression of biological and cultural dysfunction, while strategically ignoring any examination of ongoing structures of colonial violence.

Thesis (MPH.) -- University of Limpopo, 2022 / Background: Substances abuse is affecting many young people in rural communities of Limpopo Province. There are no effective measures to combat substance abuse. Therefore, there is a need to strengthen substance abuse prevention and treatment services through the integration of indigenous health care practices. The Indigenous Health Practitioners Act No.22 of 2007 permits IHPs to provide prevention and treatment services to combat substance abuse. However, there is a lack of literature on the roles of IHPs in combating substance abuse. This paucity of literature necessitates the need to explore the perceived roles of IHPs in combating substance abuse. Objectives: The study aimed at exploring the perceived roles of IHPs in combating substance abuse at Mohodi Ga-Manthata in Limpopo Province. Method: A qualitative research approach using a case study design was conducted among IHPs of RDHA at Mohodi Ga-Manthata in Molemole Local Municipality of Limpopo Province. The purposive sampling technique was used in order to select IHPs that serve the aims of the study best to ensure that data saturation was reached. Data was collected through semi-structured one-to-one interviews with selected IHPs. Braun and Clarke’s six-phase framework for doing a thematic analysis was used to analyse data. An independent coder confirmed the findings. Results: The study findings revealed that IHPs perform demand reduction activities such as conducting awareness campaigns and involving young people in sporting and behavioural sessions for prevention of substance abuse. Furthermore, the findings show that IHPs perform harm reduction activities such as assessment and diagnosis, in-patient rehabilitation, counselling, diet therapy and prescription of indigenous medicines for treatment of substance abuse. Conclusion: The Indigenous Health Practitioners Act No.22 of 2007 permits IHPs to provide prevention and treatment services to combat substance abuse. The current study shows that IHPs have a significant role in demand reduction, harm reduction and supply reduction of substance abuse in rural communities. Therefore, there is a need for the Departments of Health and Department of Social Development to develop strategies to effectively train and integrate IHPs into the health system to ensure the provision of quality substance abuse continuum of care services and the strengthening of the health system.

This dissertation compares and connects the parallel histories of two indigenous community-controlled health services, the Seattle Indian Health Board (SIHB) and The Aboriginal Medical Service (AMS) of Sydney. These were among the first clinics of their kind to be established and run by and for urban indigenous communities in the U.S. and Australia. Formed in the 1970s within months of each other, I bring their seemingly disconnected histories together to illuminate a larger transnational history about the political ramifications of twentieth-century postwar urbanization (and the associated growth of an indigenous diaspora) on native people’s concepts and practices of political sovereignty. By considering how these clinics provided a key forum for new urban pan-indigenous forms of political and cultural identity—and claims to indigenous rights—to be expressed and recognized, my work makes two significant contributions. First, it reveals the importance of health as an arena of indigenous political action in the twentieth century. Second, it underscores that indigenous sovereignty, as a political project, must be understood as both adaptive and responsive to change. Drawing on archival research and oral histories conducted over two years across Australia and the United States—including interviews with activists and health workers who were on the front lines of indigenous politics in the 1950s-1970s—I explain why in their pursuit of self-determination, urban pan-indigenous communities steadily turned away from a purely western conception of sovereignty as jurisdiction over land. The health struggles of urban indigenous peoples since the Second World War are a pointed demonstration of how the loss of even limited territorial sovereignty (that is, relocation from reserves and reservations) led to damaging structural invisibility, discrimination, and neglect within the social welfare system. Thus, this dissertation shows how and why the communities in Seattle and Sydney were driven to pursue other forms of practiced, or what I call “deterritorialized”, sovereignty centering on their rights to self-governance through the creation and transformation of various social organizations (in this case health clinics) in line with distinctive cultural perspectives. This is the first book-length study to take healthcare reform seriously as an arena in which indigenous political actors worked to redefine the reach and the meaning of indigenous sovereignty for communities without recourse to land or nationhood in the assertion of their sovereign rights. Moreover, by bringing a comparative view to this historical inquiry, my work reminds us that trans-Pacific networks of ideas and people formed a shared context for these peoples and histories. I argue that indigenous health activists in the U.S. and Australia became active at precisely the same moment, because each saw their struggle for recognition and self-determination as part of a global challenge to racism during the Civil Rights era. Moreover, these indigenous community-controlled clinics should be recognized as part of broader changes taking place in grassroots health advocacy at the time, as reflected in the contemporaneous community and women’s health movements, and the movement to form People’s Free Clinics by the Black Panthers. In its consideration of the unique problems of recognition faced by urban pan-indigenous communities, “Sovereign Bodies” also contributes towards an understanding of processes of ‘place-making’ in a period of great mobility following the Second World War. This dissertation argues that the indigenous urban health clinics very quickly came to represent the social production of a new kind of political space: not a tribal homeland or even a mosaic of different homelands, but a generic native space in the city that gave physical form to new ideas of a non-territorial, or ‘deterritorialized’ sovereignty. Moreover, it shows that at work in the efforts of Seattle and Sydney’s urban indigenous health activists, was the idea of a ‘portable’ or ‘mobile’ indigenous status. This was intended, among other things, to allow indigenous people to live in cities—or wherever they choose for that matter—without having to give up their identity, cultural practices, or their legal status as indigenous people and ensuing ability to make special claims on the government. At stake in their health activism, this dissertation argues, was a form of place-making that aimed to make indigenous people at home everywhere within the national spaces of the U.S. and Australia.