This thesis presents the findings of an exploratory study undertaken to investigate the illness experience of fibromyalgia in the context of South Africa. It contains the literature review and conceptual framework that guided the study. The theoretical discussions reflect the approaches to health and illness, illness experience and narrative study, context, diagnosis, prognosis, sickness, illness career, treatment, institutional interactions and social support. Following this, the methodological approaches and tools used in conducting this study are explained. In-depth interviews and diaries were used to collect narratives from 15 participants and one practitioner. Additionally, a brief media content analysis was included in order to assess the public perceptions of fibromyalgia in South African news articles. The themes of legitimacy, credibility, flexibility, and accommodation are continually developed throughout the thesis. The Analysis of Findings chapter presents and discusses the evidence gathered from the investigations undertaken in this study. This chapter shows how the contested and confusing illness experience of fibromyalgia can be understood, by viewing the interactions that patients have with their practitioners, families, peers and colleagues. The meanings ascribed to fibromyalgia as a label, and the uncertain prognosis attached to the diagnosis, as well as infrequently effective treatment options are explored here. The gains found in successful practitioner-patient interactions, and the limitations of medical aid coverage for chronic conditions like fibromyalgia in South Africa are discussed in this chapter. The role of family and peers, as well as workplaces and colleagues in offering support to those living with fibromyalgia is analysed. Finally, the conclusions arising from this study are presented, and recommendations for areas of future engagement and research are offered in order to attain a better understanding of the experience and impact of fibromyalgia in the South African context.

Thesis (MSocialWork)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: The aim of this study was to compile practical guidelines to assist medical practitioners in utilizing social work services in their practices. Exploratory, descriptive and applied research was done to determine and describe medical practitioners' knowledge of psychosocial problems and their present and potential utilization of social work services. Results were generalized in respect of the population as a whole. In the theoretical study social functioning was conceptualized by the description of micro, mezzo and macro levels of functioning. The approach towards rendering of services (in the Medical field) and intervention (in the Social Work field) was described, followed by recommendations for the eclectical utilization of the approaches. The eclectical application of the intervention approaches requires that social workers should have certain knowledge, values and skills to interpret certain roles. This occurs within certain social work areas, with the achievement of the aims and functions of Social Work as goal. The ethical and value basis of Social Work and Medical Science shows certain similarities and disparities. The values of Social Work, as contained in the Behavioural- and Ethical Code for Social Work and the Oath of Hippocrates, in Medical Science, are described in this study. In the empirical study qualitative and quantitative information was gathered, inter alia, about the existence of psychosocial problems of patients in medical practitioners' practices, how medical practitioners handled them, how well equipped they were to do it, their present and potential utilization of Social Work services, the role of third parties in the rendering of services and referral procedures. Thirty nine (39) medical practitioners, selected by random sampling procedure, were involved in the study and completed selfadministered questionnaires. The majority respondents indicated that their undergraduate training was inadequate in enabling them to handle psychosocial problems of patients. The entire spectrum of psychosocial problems existed in all the respondents' practices. The majority of respondents handled such problems themselves, while specialists, psychologists and psychiatrists were at times used as resources. The majority of respondents indicated that they could perhaps utilize Social Work services and that there is a great need for such a resource. Most medical practitioners preferred to send written referrals via patients, with the responsibility being with the patient for making an appointment with the social worker. Minimal use was made of third parties in the patients' frame of reference in the assessment and treatment of patients. Third parties, within the reference framework of patients, were used minimally by medical practitioners in the making of assessments and the rendering of services. Respondents had divergent opinions regarding their competence in the psychosocial field of service rendering. The majority of respondents indicated the need for training programs focusing on the handling of patients' psychosocial problems. Limited time for attending such training programs was however mentioned as the biggest obstacle. These findings of the empirical study, together with the theoretical framework, were used as a guideline for the composition of a practical guideline for the referral of services to social workers in private practice. / AFRIKAANSE OPSOMMING: Die doelstelling van hierdie studie was om praktykriglynne te ontwikkel, waarvolgens geneeshere in privaat praktyk maatskaplike werkers as ondersteuningshulpbron kan benut. Verkennende, beskrywende en toegepaste navorsing is gedoen, ten einde geneeshere se kennis van psigososiale probleme en hul huidige en potensiele benutting van maatskaplikewerkdienste te bepaal en te beskryf. Bevindinge is ten opsigte van die populasie as geheel veralgemeen. In die teoretiese studie is maatskaplike funksionering deur die beskrywing van mikro-, meso- en makrovlakfunksionering, gekonseptualiseer. Die benaderings tot dienslewering (in Geneeskunde) en intervensie (in Maatskaplike Werk) is beskryf. Daarna is 'n aanbeveling vir die eklektiese benutting van die benaderings gedoen. Die eklektiese benutting van die intervensiebenaderings vereis dat maatskaplike werkers oor sekere kennis, waardes en vaardighede moet beskik en sekere rolle moet vertolk. Dit geskied binne sekere maatskaplikewerkvelde en het as mikpunt die verwesenliking van die doelstellings en funksies van Maatskaplike Werk. Die etiese en waardegrondslag van Maatskaplike Werk en Geneeskunde toon sekere ooreenkomste en verskille. Die waardes van Maatskaplike Werk, soos vervat in die Gedrags- en Etiese Kodes vir Maatskaplike Werk, en van Geneeskunde, soos vervat in die Eed van Hippocrates, word in hierdie studie bespreek. In die empiriese studie is kwalitatiewe en kwantitatiewe inligting ingesamel oor, onder andere, die voorkoms van psigososiale probleme by pasiente in geneeshere se praktyke, geneeshere se hantering daarvan, hul bekwaamheid om sodanige probleme te hanteer, hul huidige en potensiele benutting van maatskaplikewerkdienste, die rol van derde partye by dienslewering en verwysingsprosedures. Nege-en-dertig (39) geneeshere, geselekteer deur ewekansige steekproeftrekking, is by die ondersoek betrek en het self die vraelyste ingevul. Die meeste geneeshere het aangedui dat hul voorgraadse opleiding hulle nie voldoende toegerus het om psigososiale probleme by pasiente te hanteer nie. Die hele spektrum van psigososiale probleme het in respondente se praktyke voorgekom. Die meeste respondente het sodanige probleme self hanteer, terwyl spesialiste, sielkundiges en psigiaters soms as hulpbronne benut is. Die meeste respondente het aangetoon dat hulle moontlik van maatskaplike werkers gebruik kan maak en dat daar 'n groot behoefte aan sodanige hulpbron bestaan. Die verwysingsprosedure wat deur die meeste geneeshere verkies is, was die stuur van skriftelike verwysings saam met pasiente. Derde partye, in pasiente se verwysingsraamwerk, is minimaal deur geneeshere by assessering en dienslewering betrek. Geneeshere het uiteenlopende menings gehad oor hul bevoegdhede in die psigososiale veld van dienslewering. Die behoefte aan opleidingsprogramme, wat fokus op die hantering van psigososiale probleme by pasiente, is deur die meeste respondente aangedui. Beperkte tyd is egter as die grootste struikelblok vir die bywoning van sodanige opleidingsessies aangevoer. Hierdie bevindinge van die empiriese studie, saam met die teoretiese raamwerk, is as riglyn benut vir die ontwikkeling van 'n praktykriglyn vir verwysing van dienste na maatskaplike werkers in privaat praktyk.

Thesis (MPhil)--Stellenbosch University, 2000. / Some digitised pages may appear illegible due to the condition of the original hard copy. / ENGLISH ABSTRACT: Medicine in our country is under severe stress, brought about by internal and external forces that need a response from the medical profession. The profession's attempts and response will fall short unless the profession itself is aligned with the new social ethos and the responses are based on the profession's inherent values. Problem Statement: Medical doctors have always been highly valued in society because of the duty they have when illness and disease set in. As individuals, doctors have fulfilled other important roles in the communities where they work. These include giving advice to young people on career choices, counseling on various matters and provision of material help where there is need. This profession has for a long time been shrouded in mystery, being a trade learnt by a few. All these factors contributed to their social standing increasing phenomenally. There is a view that this has also led to public perceptions that doctors are the rich untouchable elite who have no interest or are unconcerned about problems faced by society. The medical profession faces a challenge that is more significant because of the value placed on it by society. The numerous submissions by the victims of human rights abuses to the Truth and Reconciliation Commission have cast a shadow of doubt on the medical profession for its complicity in these acts. The present government has declared transformation of health care as one of its top priorities. The response of the medical profession to this initiative has so far not led to any significant changes of public perception that the profession is unwilling to participate in the transformation of our society. The challenge and subject of discussion in this thesis therefore is: "What is the ideal role of the medical profession in a transforming South African society?" The medical profession, being the nerve centre of health care, has a big responsibility in social transformation. Doctors stand accused as a collective for failing to protect the human rights of patients and not living up to the standards of ethics required of them when patients' rights were violated. The Truth and Reconciliation Commission record of the hearings into the role of the professional organisations in health is used in this thesis to illustrate how serious society views the medical profession's role in the human rights abuses of the past. Based on the T. R. C's report and the assumption that society traditionally places high value on the medical profession, I conducted a survey among South African doctors to test their attitudes towards a range of policy and transformational issues. The unit of analysis was the medical doctors who are in active practice in South Africa in whatever mode of practice. The survey sought to explore the awareness of the respondents about a range of transformation policy changes and invite their comments on the role that they envisage for the medical profession in the process of transformation of society. There is unfortunately scarcity or a lack of applicable South African literature on this topic thus limiting local material for referencing. The search of international literature only yielded the subject of the study of professional values and not necessarily the role of a medical profession in a transforming society. The medical profession has to re-visit its foundations, analyse its history and map out its future in the context of the South African realities. It must find a way of aligning itself with the new ethos and diverse cultures South Africa possesses. Medicine has its own traditional goals and values derived and adapted from society's diverse cultural value systems. With its national and international networks, the inherent knowledge and skills that it possesses, guided by an ethical code, the Hippocratic Oath that serves as a public promise, it influences policy on the country's health care system - a mechanism that government uses to provide a basic human need. The medical profession therefore has to be responsive to the needs of society as much as society needs to support the profession. This thesis explores the role that the profession should play in a transforming South African society. The argument is that this can only be done through the profession examining its values and aligning itself with broader societal value systems, the moral and social norms. It is further argued that visible realistic commitment by the profession to public health will lead to an improvement in its public image. It is the actions or non-actions of the majority that the public notices. The majority of respondents to the survey have indicated that they approve of the transformation policies in health but that they may differ in the way they were introduced. / AFRIKAANSE OPSOMMING: Die geneeskunde in ons land is onder geweldige druk as gevolg van interne en eksterne faktore en dit is nodig dat die mediese beroep reageer. Dit sal die beroep egter nie help om te reageer indien sy lede hulle nie met die nuwe maatskaplike etos vereenselwig nie en die reaksie op die inherente waardes van die mediese beroep geskoei word nie. Probleemstelling Mediese dokters is nog altyd baie hoog geag deur die gemeenskap as gevolg van die verpligting wat hulle het om na mense om te sien wanneer hulle siek word. In hulle individuele hoedanigheid het dokters ook ander belangrike bydraes tot hulle gemeenskappe gelewer. Dit sluit in: advies aan jong mense oor loopbaankeuses, berading en die verskaffing van finansiele hulp waar nodig. Die beroep as sulks was egter vir baie lank ietwat van 'n misterie omdat dit 'n vakrigting is waarin baie min mense hulle kon bekwaam. Al hierdie faktore het die maatskaplike aansien/waarde van dokters geweldig verhoog. Daar is ook diegene wat van mening is dat hierdie faktore aanleiding gegee het tot die openbare mening dat dokters 'n ryk en onaantasbare elite is en glad nie in die probleme van die gemeenskap belangstel nie. Die etlike voorleggings deur die slagoffers van menseregtevergrype aan die Waarheids- en Versoeningskommissie het ook vrae rondom die beroep se betrokkenheid by sodanige gevalle laat ontstaan. Die huidige regering het die transformasie van gesondheidsorg as een van sy grootste prioriteite verklaar. Die reaksie van die beroep hierop het tot dusver nie tot enige noemenswaardige veranderinge in die openbare mening dat dokters nie bereid is om aan die transformasie van ons gemeenskap deel te neem gelei nie. Wat is die ideale rol van die mediese beroep in die transformasie van die Suid- Afrikaanse gemeenskap? As die senusentrum van gesondheidsorg het die mediese beroep 'n groot verantwoordelikheid in maatskaplike transformasie. Dokters word kollektief beskuldig dat hulle nagelaat het om die menseregte van pasiente te beskerm en nie voldoen het aan die nodige etiese standaarde wat van hulle verwag word in die tyd toe pasienteregte geskend is nie. Die rekord van die verhore van die Waarheids- en Versoeningskommissie oor die rol van professionele gesondheidsorganisasies is vir die doeleindes van hierdie tesis gebruik om te illustreer hoe ernstig die gemeenskap voeloor die mediese beroep se rol in die menseregte vergrype van die verlede. Gegrond op die WVK-verslag en die aanname dat die gemeenskap die mediese beroep hoog ag, het ek 'n meningsopname onder 300 Suid-Afrikaanse dokters gedoen om hulle houding jeens 'n aantal beleids- en transformasiekwessies te toets. Die eenheid van analise was mediese dokters wat in die aktiewe praktyk staan, ongeag hulle praktykgebied. Die opname het gepoog om te bepaal wat die vlak van bewustheid by die respondente oor 'n aantal beleidsveranderinge gerig op transformasie is, en hulle uit te nooi om kommentaar te lewer op die rol wat hulle meen die mediese beroep behoort in die proses te speel. Ongelukkig is daar nie toepaslike Suid-Afrikaanse literatuur oor die onderwerp beskikbaar me. 'n Internasionale literatuursoektog het net studies rondom waardes opgelewer, en nie oor die rol van 'n mediese beroep in die transformasie van 'n gemeenskap nie. Die mediese beroep moet die grondslag van sy wese in oenskou neem, die geskiedenis analiseer en sy toekoms in die konteks van die Suid-Afrikaanse realiteite uitstippel. Die beroep moet 'n manier vind om homself met die nuwe etos en uiteenlopende kulture van Suid-Afrika te vereenselwig. Die geneeskunde het sy eie tradisionele doelwitte en waardes gekry en aangepas vanuit die uiteenlopende kulturele waardestelsels van die gemeenskap. Deur middel van sy nasionale en internasionale netwerke, inherente kennis en vaardighede, die leiding van 'n etiese kode, die Eed van Hippokrates wat as 'n belofte aan die publiek dien, beinvloed die mediese beroep die land se gesondheidsorgstelsel - 'n meganisme van die regering om in 'n basiese menslike behoefte te voorsien. Die mediese beroep moet daarom ingestel wees op die behoeftes van die gemeenskap in dieselfde mate as wat die gemeenskap die beroep behoort te ondersteun. Hierdie tesis ondersoek die rol wat die mediese beroep behoort te vervul in 'n Suid-Afrikaanse gemeenskap waar transformasie besig is om plaas te vind. Daar word geargumenteer dat dit net gedoen kan word indien die beroep sy waardes ondersoek en hom met die breer maatskaplike waardestelsels vereenselwig. Daar word verder geargumenteer dat 'n sigbare realistiese verbintenis van die mediese beroep tot openbare gesondheid tot die verbetering van sy openbare beeld sal lei. Dit is die optrede of nie-optrede van die meerderheid wat die publiek raaksien. Die meerderheid respondente in die meningsopname het aangedui dat hulle die transformasiebeleid vir gesondheid ondersteun, maar dat hulle verskil van die wyse waarop dit in werking gestel is.

M.A. (Social Work) / Accountability and competence are two important attributes needed by medical social workers in the changing social, political, economic and organizational situation in South Africa, In order -to be accountable and competent, medical social workers must be in possession of scientific knowledge, skills and the correct attitude regarding assessment, intervention and evaluation. The change in emphasis from long-term to short-term hospitalization and the importance of primary health care, means that within the limitations of the present organization structure, assessment is often the most important and sometimes the only, aspect in the helping process. The knowledge and skills of the medical social workers need to be extended; this study therefore focuses on effective assessment that will equip the medical social worker to render an effective service through linking resources within the patient, hospital and within the community. The aim of this study is the development of a training programme for medical social workers to extend their knowledge and skills in assessment.

A Research Report submitted to the Faculty of Arts, Department of Sociology, University of the Witwatersrand, Johannesburg, in partial fulfillment for the degree of Master of Arts. Johannesburg, 1994 / This research report seeks to explore the issues surrounding the organisation of traditiional healers and how their world views can be contextualised within tradtionalism and modernity. [Abbreviated Abstract. Open document to view full version] / MT2017

This study of 449 newspaper articles from South Africa from 1997 provides an analysis of the representations of obesity evinced in the corpus. The research argues that obesity is overwhelmingly framed as being diseased and that there are four main refrains within this frame, namely, statistics on obesity, the naturalisation of negative assumptions about fat, the social dysfunction of fat and the use of crisis metaphors to describe fatness. This framing lends itself to representations of obesity which are raced, gendered and classed. Fat bodies are portrayed as being in deficit and fat people as lacking agency. The disproportional focus on black bodies in the corpus can be attributed to assumptions of ‘incivility’ which are premised on racial stereotypes which construct black people as being unintelligent, irrational, lacking agency and being largely dependent on others to survive. This disproportional focus on black bodies can also be understood in the context of emerging markets. This study argues that the medicalisation of obesity has contributed to many oversimplifications and contradictions in the representation of obesity in the corpus, which seem to go unquestioned, such as the conflation of weight and health, something I argue is one of the main contributors to the negative consequences of the dominant framing of obesity. Framing obesity as medicalised also promotes fat shaming and acts as a form of social control which maintains existing power relations through the use of discursive practices for the identification and control of deviants. These representations are problematic chiefly because they promote the dehumanisation of fat people, but also because that they do not promote good health as they claim to do.

A higher infant mortality rate and shorter life expectancy, coupled with a high prevalence of a variety of diseases commonly associated with malnutrition, are usually a reflection of the social conditions of poverty in a society. By arguing that apartheid formed the basis of inequality and therefore the main underlying cause of an unacceptable burden of the diseases of poverty among black South Africans, this thesis, Poverty, Health and Disease in the Era of High Apartheid: South Africa, 1948-1976, locates these health problems within their social, economic and political context. It further argues that if health and disease are measures of the effectiveness with which human beings, using the available biological and cultural resources, adapt to their environment, then this relationship underpins the convergence of medical and cultural interests. Under the impact of modern technology and society's dependence upon it, profound cultural changes have taken place and issues of health and the etiology of disease are among the areas most affected by these changes. This thesis explains why, in a pluralistic medical setting, where only modern (scientific) medicine was recognised as legitimate medicine by the apartheid government, for the majority of black South Africans the advent of modern medicine was viewed not so much as displacing indigenous (African) medicine but as increasing the medical options available to them. It is therefore contended here that for most black South Africans, indigenous medicine has played a critical role; it has mitigated the impact of apartheid medicine. Since differences that people perceive in these two medical systems are crucial to the medical choices that they make at the onset of illness, this thesis argues that knowing and understanding the reasons for making such choices would not only have practical value for health authorities in their efforts to improve local, regional and national health service delivery, but would also contribute to a general understanding of human therapy-seeking behaviour in this age of the HIV/AIDS pandemic. / History / Thesis (D. Litt. et Phil. (History))

A higher infant mortality rate and shorter life expectancy, coupled with a high prevalence of a variety of diseases commonly associated with malnutrition, are usually a reflection of the social conditions of poverty in a society. By arguing that apartheid formed the basis of inequality and therefore the main underlying cause of an unacceptable burden of the diseases of poverty among black South Africans, this thesis, Poverty, Health and Disease in the Era of High Apartheid: South Africa, 1948-1976, locates these health problems within their social, economic and political context. It further argues that if health and disease are measures of the effectiveness with which human beings, using the available biological and cultural resources, adapt to their environment, then this relationship underpins the convergence of medical and cultural interests. Under the impact of modern technology and society's dependence upon it, profound cultural changes have taken place and issues of health and the etiology of disease are among the areas most affected by these changes. This thesis explains why, in a pluralistic medical setting, where only modern (scientific) medicine was recognised as legitimate medicine by the apartheid government, for the majority of black South Africans the advent of modern medicine was viewed not so much as displacing indigenous (African) medicine but as increasing the medical options available to them. It is therefore contended here that for most black South Africans, indigenous medicine has played a critical role; it has mitigated the impact of apartheid medicine. Since differences that people perceive in these two medical systems are crucial to the medical choices that they make at the onset of illness, this thesis argues that knowing and understanding the reasons for making such choices would not only have practical value for health authorities in their efforts to improve local, regional and national health service delivery, but would also contribute to a general understanding of human therapy-seeking behaviour in this age of the HIV/AIDS pandemic. / History / Thesis (D. Litt. et Phil. (History))