Care and the luxury of trauma: A South African story

Crip the elders and get out of white privilege free

The question of identity positioning in relation to engagement with issues of social exclusion is complex. I am a white non-disabled South African man working on disability and care issues. I reflect on my representation of my parents, through memoirs and of Elsa Joubert, a doyenne of African writing. My depiction of these people as profoundly affected by disability and illness provides me as a privileged white scholar a way of marking my difference from stereotypical oppressive positioning. Though my rhetorical manoeuvres do not undercut the intention of my work, they point to broader, difficult questions about positioning and identity politics. I use my links to and concern with disability and illness to signal my appreciation of difference and exclusion, but questions of power and positioning remain.

Socio-cultural contexts of end- of- life conversations and decisions: bereaved family cancer caregivers' retrospective co-constructions

Background

End-of-life communication becomes increasingly difficult in terminal cancer, which inevitably entails conversations around dying and death. In resource-limited areas, the context of end-of-life communication is usually home-based palliative care comprising mostly women in the family who play critical roles as informal caregivers. This article examined the content and contexts of family end-of-life conversations and decisions based on the retrospective accounts of a sample of bereaved women family cancer caregivers in Nairobi, Kenya.

Method

An interpretative phenomenological analysis approach was utilized to explore pertinent end-of-life communication themes. Four mini focus group interviews with a total of 13 participants [n = 5; n = 3; n = 3; n = 2] were conducted.

Results

Two end-of-life themes, advance directives as preparedness for death, and initiating death talk were examined. Findings (a) illustrate the role of family dynamics in influencing the nature of end-of-life conversations and decisions (b) demonstrate the transitional nature of family caregiver roles, and (c) underscore the paradox of the critical role played by family members in palliative care versus their ill preparedness in dealing with end-of-life issues.

Conclusions

Findings are relevant in informing palliative psychosocial interventions and specifically the concerns and decisions of cancer patients and their families. This prompts further engagement with the question of how to equip family caregivers in resource-limited contexts for end of life care. Methodologically, these results demonstrate the possibility of simultaneous elucidation of individual experiences, interactive co-constructions and the socio-cultural contexts of experiences and meaning making processes in IPA research.