A research report submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Public Health.
Johannesburg, April 2017 / Introduction
Men and women working in the mines are exposed to health hazards that lead to disability and even death. The Occupational Diseases in Mines and Works Act (ODMWA) provides compensation to families of deceased mineworkers with autopsy-diagnosed occupational lung disease(s). Written consent is required from the next kin before the organs are examined. In the last couple of decades, the numbers of autopsied miners has declined and this may be related to the manner in which consent is requested from families. This study described and compared consent processes autopsy uptake, processes for obtaining consent and the experiences and perceptions of personnel involved in these processes in selected South African mines.
Methods
A sequential mixed-methods study was conducted. Autopsy uptake was determined using NIOH and hospital records, followed by exploratory qualitative research investigating the processes for obtaining consent in three mining hospitals among relevant staff. Transcripts of 14 audio recorded interviews and one focus group were coded and analysed using ATLAS.ti 7. Thematic content analysis was applied using a deductive and inductive approach.
Results and discussion
There was an overall 38% decline in autopsy uptake from 183 in 2009 to 113 in 2012 among the participating hospitals. Over the five-year period, the average autopsy uptakes for two of the hospitals were low: 34% and 12%, respectively. The third hospital recorded a high autopsy uptake of 86%. Procedures for offering autopsies were similar among the three hospitals but differed in the categories of personnel performing the tasks. In one of the hospitals with poor autopsy uptake, autopsies were offered to families only if officials thought the deceased miner had a compensable disease. A receptionist who had other competing responsibilities was responsible for offering autopsies in the other hospital. In the hospital with good uptake, the offer of autopsies was done by a prosector who was also a mine union representative and therefore understood the autopsy process and was trusted by the families.
Service providers identified lack of knowledge and awareness of ODMWA autopsies as an important factor that influenced family consent amongst a basket of many other factors including language barriers; distrust in the poorly functioning compensation system; traditional, religious beliefs and practices; and the lack of access to autopsy facilities especially in rural areas of South Africa. Some participants were dissatisfied or frustrated with the legal requirements for consent as it is a time consuming task that interfered with their other duties.
Conclusion
This study has shown that obtaining consent for ODMWA autopsy is a tedious and long process and can be a barrier to autopsy uptake. The personnel involved in offering autopsy play a very important role and need to understand the benefits and processes of autopsy compensation. The major recommendation of this study is the training of personnel involved in offering autopsies to improve their communication skills and, understanding of the purpose and provisions of the ODMWA in order to promote autopsy uptake. / MT2017
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/23176 |
| Date | January 2017 |
| Creators | Mthombeni, Julian |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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