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Experiences of emergency care technicians with regards to inter-facility transfers of critical patients in Mangaung Metro, Free State
(University of Fort Hare, 2023-06) Mohoto, Nokwanda Teddy-Bear; Nkuthu, N.T.
Background: Over the years, the increase in the number of inter-facility transfers of critically ill or injured patients has placed a burden on the healthcare system. Critically ill or injured patients are transferred to higher level facilities/hospitals so that they can receive specialist care. The inter-facility transfers require a multi-disciplinary healthcare system which includes the referring physician/nurses, emergency medical services and the receiving physician/nurses. The nature of these critical transfers has placed great emphasis on the high quality treatment and management required from emergency services. This has pushed emergency services to introducing new qualifications with better capabilities of treating and managing critically ill or injured patients. In Mangaung Metro, Free State, EMS personnel with the required capabilities have not been employed within operations post 2011. This has left personnel (ECT) with lower qualifications and capabilities employed within operations to be the ones undertaking inter-facility transfers of critically patients.
The purpose of the study was to explore the current operational ECT’s experiences on inter-facility transfers of critically ill or injured patients. Objectives were to explore the ECT’s experiences on inter-facility transfers of critical patients in Mangaung; to describe the challenges encountered by ECTs concerning inter-facility transfers of the critical patients in Mangaung and to describe the strategies that can be implemented to improve the experiences of ECTs during inter-facility transfer of critically ill patients.
Methods: A qualitative approach with a exploratory design was used throughout the research to explore the ECT’s experiences with regards to inter-facility transfers of critically ill or injured patients. Interviews were held with 9 consenting ECT’s under strict COVID-19 protocols. The ECT’s/participants were coded. An interview guide was used to explore the ECT’s experiences, challenges and strategies to enhance outcomes. A tape recorder was used to record the interviews. The interviews were then transcribed verbatim and sent to a co-coder for verification and analysis.
Results: Four themes emerged: 1) Experiences of ECT’s conducting inter-facility transfers of critical patients, 2) lack of knowledge regarding inter-facility transfers of critical patients, 3) challenges experienced by ECT’s regarding inter-facility tranfers of xii critical patients and 4) strategies required to enhance safe inter-facility transfer of critical patients. Majority of the participants expressed negative experiences with regards to interfacilility transfers. These negative experiences were due to a lack of proper equipment to undertake critical tranfers, poor management, lack of capabilies or limited scope of practice, poor pre-hospital and in-hospital relationships and communication, amongst other things. The study revealed that critical patients required highly qualified EMS personnel with a broader scope of practice and capabilities to undertake inter-facility transfers of critical patients.
Conclusion: ECT’s revealed how overwhelmed they felt undertaking inter-facility transfers of critical patients and expressed the need for more highly qualified personnel to be employed operationally. More focus should also be put on training/refreshing the ECT’s to current protocols. Communication between the multidisciplinary system needs to be improved. The Department of Health needs to procure more and better equipment for ECT’s to be able to perform their duties as well as invest in proper managerial strategies.
The relationship between clinician compliance with national TB drug sensitive tuberculosis management guidelines and treatment outcomes at Mdantsane Correctional Centre, Eastern Cape
(University of Fort Hare, 2023-08-07) Mjijelwa, Vuyolwethu; Giyose, P.; Mandeya, A.
Tuberculosis (TB) is an inflammatory infectious disease caused by Mycobacterium tuberculosis which affects any tissue of the body. The most common site of disease is the lungs (World Health Organisation, 2023). WHO developed guidelines for managing this disease and South Africa developed its own context specific guidelines. However, compliance with these guidelines is not always possible for various reasons, especially in sub-Saharan Africa. This study was conceptualised with the intention of assessing TB management practices in correctional centres and determining how those practices may be related to treatment outcomes. The main objectives were to determine the compliance of correctional centre clinicians with TB management guidelines and to see if there is a relationship between compliance with guidelines and treatment outcomes. A cross sectional study design was used and data was extracted from 106 patient files. Frequency distributions were used to determine the extent of compliance and the chisquare test was used to test for relationships between different compliance aspects and treatment outcomes. Odds ratios and 95% confidence intervals were used to measure the strength and direction of detected relationships. While there was high compliance in most of the aspects of TB management as per the guidelines, there was lack of justification of deviations, whenever they occurred. The patients who were more likely to have positive treatment outcomes were those whose baseline smear results were known (OR=4.8; 95%CI (1.22;22.59)), whose weight was monitored (OR=1.5; 95%CI (1.27;1.71)) and whose treatment duration was known (OR=6.1; 95%CI (1.39;26.81)). The Department of Correctional Services health management should develop a comprehensive capacitation plan that will include mentoring and monitoring of compliance with TB guidelines. An effective linkage to the care system within correctional services and DOH facilities must be developed to ensure continuity of care and improve treatment outcomes. Tuberculosis case-finding and contact tracing require more research to understand the trends of infection and inform comprehensive infection control policies.
Investigation of the Covid-19 pandemic impact on Child Health and Nutrition Services in Primary Health Care facilities, Mnquma Local Municipality: A retrospective study
(University of Fort Hare, 2023-08-31) Mdingi-Buqa, Namhla Linda; Murray, D.; Mayeye, F.
Introduction
The Coronavirus-19 (COVID-19) pandemic, a global phenomenon with multiple waves of infection, significantly disrupted livelihoods and health services worldwide. While evidence suggested children were less susceptible to severe illness and death from the virus itself, the pandemic’s indirect effects put them at risk. many countries including South Africa, responded by declaring a state of disaster and implementing movement restrictions to control the spread of the virus. This study investigated the impact of these measures on child health and nutrition services in the Mnquma subdistrict of the Amathole District, South Africa.
Methods
This study employed an explanatory sequential mixed method of quantitative and qualitative designs. In terms of quantitative data, retrospective data was analysed in two parts. Firstly, Part One involved reviewing twenty health patient records from 2019/20 to 2020/21 period. Part Two (2) focussed on twelve child health and nutrition indicators for children aged two years old, extracted from the District Health Information Management System (DHIS). This allowed for a comparison of trends in service utilisation between pre-pandemic and pandemic periods. On the other hand, qualitative research explored factors contributing to reduced access to health care and disruptions in services. The researcher used purposive sampling to select the five clinics for convenience and proximity. During data collection at each clinic, caregivers were recruited and interviewed until data saturation was reached.
Results
The study revealed the negative consequence of the COVID-19 pandemic on child health service utilisation. Data from the District Health Information System (DHIS) for 2019/20 showed generally lower immunisation rates in 2020 compared to 2019 except for the first dose Diphtheria, Tetanus, and Pertussis (DTaP) vaccine. Interestingly the variations in proportions between the two years for DTaP (first dose), DTaP (third vi dose), and measles vaccination were statistically significant (chi -square=3668.5, pvalue<0.0001). Analysis of the data also indicated a decline in the number of children fully immunised. These decreases ranged from 1.9% to 4.4% in Mpukane, Nqancule, and Zazulwana clinics. Conversely, Hebe-Hebe and Ndabakazi clinics reported increases of 4.8% and 1.6% respectively. Reviews of children’s medical records revealed coughs as the most prevalent illness affecting 50% of children’s visits. Vomiting was a less frequent issue accounting for15% of consultations for this symptom. Notably, the study found no significant changes in the nutritional status during the pandemic. Caregiver interviews identified challenges during the pandemic that likely hindered access to child health and nutrition services. These challenges included movement restrictions due to COVID-19 regulations, temporary clinic closures, fear of contracting COVID-19, and clinic staff shortages that further strained the services. Additionally, the high cost of private health care made it difficult for some caregivers to access necessary care for their children.
Conclusion
This study concluded that the COVID-19 pandemic significantly disrupted access to and utilisation of child health and nutrition services in the Mnquma sub-district, South Africa. Children primarily presented with COVID-19-related symptoms like cough, gastroenteritis, and eye/ear infections. Several factors hindered service utilisation, including movement restrictions due to lockdown, clinic closures, and caregiver fear of contracting the virus. Furthermore, the reported hunger, household food insecurity, school closures, and long queues at grocery stores negatively impacted the nutritional status of children.
The state of the performing arts in Buffalo City: Past, Present, and Future. An analysis of the Guild Theatre and Steve Biko
(University of Fort Hare, 2020) Vunukwa, Siyanda; Connor, T.
South Africa has changed dramatically over the last 25 years. This study explores how these changes have affected the performing arts at the grassroots level. The Guild Theatre and Steve Biko Centre’s theatre in Buffalo City Metropolitan Municipality are used as case studies to illustrate how performing arts institutes in small towns stay relevant and financially sound in the face of significant social and economic change. The hope is that other emerging performing art organisations can learn from the experiences of these two successful ones. The study made use of mixed methods in the form of in-depth interviews with key individuals within the theatres and questionnaires for patrons and performers. The results show that the performing arts play a substantial role in society. They do not just provide entertainment but social commentary, education and economic opportunities. Both theatres have social outreach programmes that help the youth by teaching them new skills and creating new opportunities for them to develop in character. Even though the performing arts play such an important role, they are still underfunded. The inconsistency of government and private funding is a threat to the financial sustainability of the performing arts and undermines their ability to play their role in community building. More studies need to conducted on the topic of the role of the arts in small towns as there is great potential for economic and social development in these areas.
A decent work-needs-professional development model: A case of rural teachers at Raymond Mhlaba Local Municipality in the Eastern Cape Province of South Africa
(University of Fort Hare, 2024-11) Dlaza, Zikhona; Chinyamurindi, W; Chudzikowski, K
This study aims to test a decent work, needs-professional development model of rural teachers to determine the effect of decent work on teacher professional development. Specifically, the study explores the role of need satisfaction (i.e., survival, social contribution, and self-determination) in the relationship between decent work and rural teacher’s professional development. Rural teachers face distinct challenges that are unique to their environment. These challenges stem from several sources linked to impoverishment, lack of resources, isolation, and overcrowded classrooms. Subsequently, this determines the degree to which teachers participate in professional development activities that impact the provision of quality education. Therefore, this study seeks to understand how improving work conditions (decent work) can influence teachers' professional growth in these settings. Data was collected through a self-administered questionnaire from a sample of 330 rural teachers in Raymond Mhlaba Municipality, located in the Eastern Cape Province of South Africa. The study analysed the data using structural equation modelling (SEM). The results of the SEM indicated that decent work has a positive but non-significant effect on teacher professional development. Moreover, decent work positively and significantly predicted the needs satisfaction of rural teachers. Survival need satisfaction mediated the effect of decent work on rural teachers' professional development, while social contribution and self-determination need satisfaction had no significant mediating effect. The findings of this study suggest that the more the rural teachers perceive their work as decent and feel that their survival needs are fulfilled, the more they participate in teacher professional development activities. Furthermore, the study extends the literature on the antecedents of teacher professional development, and the results can offer some implications. Specifically, it can guide policymakers in developing targeted interventions to address the specific challenges that rural teachers face and impact their access to professional development programmes. Practitioners and educational stakeholders can use the study’s findings to advocate for the work conditions that fulfil the needs of rural teachers as a strategy to enhance teaching practices and career development prospects. In the epilogue, this study is critical because it highlights the importance of addressing decent work conditions that fulfil the needs of rural teachers as a strategy to enhance their professional development.