The effects of a language barrier in a South African district hospital

BACKGROUND

Communication between health workers and patients at Hottentots Holland Hospital (HHH) is hindered by staff and patients not speaking the same language. HHH is a district hospital in the Cape Town Metropolitan District of the Western Cape where staff mainly speak Afrikaans or English and a large number of patients mainly Xhosa.

OBJECTIVES

The study aimed to explore the effects of this language barrier on health workers and patients at HHH.

DESIGN

Three focus group interviews were held with 21 members of staff and 5 in-depth patient interviews were conducted.

RESULTS

The language barrier was found to interfere with working efficiently, create uncertainty about the accuracy of interpretation, be enhanced by a lack of education or training, cause significant ethical dilemmas, negatively influence the attitudes of patients and staff towards each other, decrease the quality of and satisfaction with care, and cause cross-cultural misunderstandings.

CONCLUSION

The effects of the language barrier were considerable and persistent despite an official language policy in the province. The training and employment of professional interpreters as well as teaching of basic Xhosa to staff are recommended.

'Holding it lightly': the co-operative inquiry group: a method for developing educational materials

SETTING

The purpose of this research was to adapt the World Health Organization's educational programme Mental Disorders in Primary Care for South African general practitioners.

AIM

This paper describes how to organise and facilitate a co-operative inquiry group as a form of participatory action research aimed at developing or adapting educational materials. Specific quality criteria for this type of action research are defined. The experience of our own co-operative inquiry and the lessons learnt are discussed.

CONCLUSION

In the field of medical education participatory action research methodology is relatively new. This article shows how the co-operative inquiry group can be used effectively to develop educational materials. It is intended to encourage and support others in using similar methods of action research in their own settings.

Development of the programme Mental Disorders in Primary Care as Internet-based distance education in South Africa

SETTING

This innovative educational programme was developed in the South African context for general practitioners (GPs).

AIM

This short report describes the process of designing an Internet-based distance education programme Mental Disorders in Primary Care.

LEARNING METHODS

The article discusses relevant educational principles and then describes four stages in the instructional design process: design, development, evaluation and revision.

CONCLUSION

The design and development of an Internet-based distance education programme for GPs in South Africa was a potent learning experience for me as an academic family physician with no prior experience in this area. I hope that this short report will assist other people and contribute to an ongoing dialogue on this topic.

Participatory development of a minimum dataset for the Khayelitsha district

BACKGROUND

Traditional 'data-led' information systems have created excessive amounts of poor-quality and poorly utilised data. The Health Information Systems Pilot Project (HISPP), a Western Cape project that started in 1996, initiated a process in one of its three pilot sites to model an alternative approach to developing a district health information system.

OBJECTIVE

To develop a minimum dataset for Khayelitsha as part of an action-led district health and management information system in a participatory 'bottom-up' process.

METHOD

The HISPP, in conjunction with health workers in the proposed Khayelitsha district, developed a minimum dataset through a process of defining local goals, targets and indicators. This dataset was integrated with data requirements at regional and provincial levels.

RESULTS

A minimum dataset was produced that defined all the data needed according to the frequency of reporting and the level at which it was required.

CONCLUSION

The HISPP has demonstrated an alternative model for defining health information needs at district level. This participatory process has enabled health workers to appraise their own information needs critically and has encouraged local use of information for planning and action.

Inhaled vs oral steroids for adults with chronic asthma

OBJECTIVES

To determine therapeutically equivalent doses of inhaled versus oral steroids for adults with chronic asthma.

SEARCH STRATEGY

The Cochrane Airways Group trials register was searched using the terms: (drug delivery systems OR ((nebuli* OR inhal* OR MDI) AND oral*)) AND ( steroid* OR corticosteroid* OR glucocorticoid* OR beclomethasone OR betamethasone OR fluticasone OR cortisone OR dexamethasone OR hydrocortisone OR prednisolone OR prednisone OR triamcinolone).

SELECTION CRITERIA

Randomised controlled trials were selected of at least 4 weeks duration and included patients over the age of 15 years with chronic asthma. Trials compared inhaled steroids and oral prednisolone or prednisone; where the maximum dose for inhaled steroids was 2000 mcg/day and prednisolone 60 mg (on alternate days).

DATA COLLECTION AND ANALYSIS

Two independent reviewers screened 1285 titles and abstracts from the electronic search, bibliography searches and other contacts. Of these, 10 trials met previously defined inclusion criteria. Two reviewers independently extracted study characteristics, and outcome measures.

MAIN RESULTS

All trials were small and no data could be pooled. Carry-over effects were present in at least one cross-over trial. Data from six trials produced the same pattern, in which prednisolone 7.5-12 mg/day appeared to be as effective as inhaled steroid 300-2000 mcg/day. In two trials, inhaled steroid 300-400 mcg/day was more effective than prednisolone 5 mg/day. All doses of inhaled steroid appeared to be more effective than alternate day doses of prednisolone up to 60 mg on alternate days. Side-effect data were reported too variably to permit comparisons. A 30% incidence was reported in one study in patients receiving prednisolone 5 mg/day, none were reported in patients on inhaled steroids.

REVIEWER'S CONCLUSIONS

A daily dose of prednisolone 7.5-10 mg/day appears to be equivalent to moderate-high dose inhaled corticosteroids. Side-effects may be present on low doses, so if there is no alternative to oral steroids, the lowest effective dose should be prescribed.

Community-based training in family medicine--a different paradigm

INTRODUCTION

Community-based education is an important strategy for training students appropriately for delivering primary health care services. A community-based training rotation in Family Medicine and Primary Care was introduced at the University of Stellenbosch, South Africa, in January 1998.

OBJECTIVE

The aim of this study was to explore the perceptions of final year medical students about the new rotation and to provide feedback on the value of this experience to the Faculty. In this article we explore the influence of differing world views held by biomedically oriented training institutions and the systems view of life adhered to by the discipline of Family Medicine on attempts to reform medical education.

METHOD

Quantitative and qualitative curriculum evaluation methods, including a questionnaire and focus groups discussions, were used. Students rated the value of the block as 7.8 out of 10.

RESULTS

Eighty-eight percent of students felt that there should be an earlier exposure to Family Medicine and Primary Care in their training. The main themes identified from the qualitative results supported the literature findings and included the difference in type of practice between tertiary and primary levels of care and the value of learning a new approach to patient care. Despite the fact that the results emphasized the importance of including community-based training in Family Medicine and Primary Care at an early stage in the medical curriculum, resistance to implementation was encountered. This led to reflection on possible reasons on why the recommendations of the study were not immediately adopted into the curriculum.