Browsing by Author "Levine, Susan"

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    A historiography of South Africa's public health care governance affecting health system strength from the 1940s to 2023
    (2025) Martin, Jade; Levine, Susan
    Segregationist minority rule socially engineered a system built on the brutality of black and brown people in South Africa leading to the aggravation of opportunistic infections. Centuries of white capitalist governance enslaved Black populations through settler colonialism and continued to inflict violence through the apartheid regime. Circulatory migrant labour and various forms of racist economic, health and land policies entrenched deliberate social disintegration in the country. The political economy formalised the maldistribution of health by ensuring the expansion of debilitating diseases like tuberculosis (TB) and HIV/AIDS throughout the twentieth century. Systemic violence by state government structures exploited Black vulnerabilities through the demonstration of structural violence. This shows how government-sanctioned policies affect not only health institutions within health systems, but also in wider constructions of power and health inequalities in South Africa. So, the unequal distribution of life-threatening diseases were contingent on the racialised dimensions of state power that impacts our contemporary health system. After the materialisation of democracy, scepticism arose toward the ANC's ambitious and unstable re-articulation of social justice and equity, particularly in its propulsions for development and economic growth. In some way, this offers a retrospection on the ANC-led public health system and their shortfalls in redressing deep-rooted health inequities since the injection of systemic racism. In the thesis, I provide openings to question the strength of South Africa's health system through an assemblage of the Health Systems Research and the Health Humanities. These linkages deepen the scholarship and relationship between subjectivities (experiences) of health and the connections to public health legislature among its regulatory bodies. I navigate the histories of the colonial and apartheid public health systems through to the advent of liberation to consider how layers of structural violence plague negative experiences of health, and factors inhibiting access to health facilities and efficient treatment. Engaging with Foucault's theorisation on governmentality is necessary to frame a critique of the structure and scope of state power and its role in the regulation of health. The effects of neoliberal policies directly inspired transnational activism during the HIV/AIDS epidemic by compromising the fundamental freedoms and rights to health outlined in South Africa's Constitution. The thesis thus concentrates on neoliberalism as practiced during apartheid and post-apartheid contexts which has prominently targeted marginalised and vulnerable populations within the wider arrangements of globalisation and global public health. To do so, the project illustrates how democratic governance and health systems designed in South Africa are inextricably connected to neoliberalism which affects the potential for liberatory, equitable and transformed iterations of health care. Therefore, the thesis aims to contribute to the growing literature on health systems research and the health humanities through the construction of a historical account of the public health care system and its impact on the implementation of equitable programs for health and improved health outcomes provincially.
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    An examination of the implementation of the World Health Organisation's anti-tuberculosis treatment, the Directly Observed Treatment Short Course (DOTS), in poor South African communities
    (2004) Jacobs, Nasolo Monifa; Levine, Susan
    This dissertation examines the implementation of the anti-tuberculosis treatment, the Directly Observed Treatment Short Course, of the World Health Organisation (WHO) in poor South African communities. Research for this dissertation was carried out over a two-year period in one poor community, a tuberculosis (TB) quarantine hospital and several primary care clinics. This dissertation argues that the DOTS programme is culturally inappropriate and consequently unsuccessful in meeting the WHO's TB treatment targets. It will show that the design of the DOTS programme assumes access to basic resources such as food and shelter and focuses its attE11tion on ensuring regular access to anti-TB medication. However, TB patients in many poor South African communities do not have access to basic resources and thus experience the DOTS programme and the treatment protocol as a burden. Although TB patients face these challenges to meeting their treatment goals, many of them view the DOTS programme in their communities as a source of resources from which they can access jobs, food, money and general social services. The thesis will demonstrate that there is a wide gap between what the DOTS programme offers and what the TB patients and community members expect. It will also show that this gap limits the ability of TB patients to adhere to the treatment and thus renders the DOTS programme culturally inappropriate and unsuccessful in these South African communities.
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    At the foot of Table Mountain: paediatric tuberculosis patient experiences in a centralised treatment facility in Cape Town, South Africa
    (2014) Abney, Kate Christine; Levine, Susan
    The following thesis traces one year of ethnographic research within a contemporary Tuberculosis (TB) treatment facility in Cape Town, South Africa. Brooklyn Chest Hospital (BCH) is considered to be a provincial TB centre of excellence in the Western Cape (Parsons et al 2010) and as such, caters to both adult and paediatric TB patients. While there are other similar facilities in South Africa, BCH specializes in paediatric TB and is the only facility of its kind in the Western Cape Province. Many (but not all) paediatric patients at BCH came from troubled social circumstances. Poverty, violence, substance abuse, and illness featured prominently in their lives. The thesis documents the many entanglements TB presents to patients, their physicians, teachers, and nursing staff in the context of Cape Town. Throughout the thesis, my argument is multi-faceted. Children are configured and classified in different ways: via Biomedicine, children rights and ethics discourse, volunteers working at the hospital, the hospital school space, and through the metaphorical and real burden of time and tedium one experiences within an institutional setting. While focused on children and their experiences, this thesis does not claim to be solely 'childcentred'. Rather, I bring together different perspectives from nurses, doctors, volunteers, family members, and children themselves to re-create the social and material life of a hospital. In doing so, I focus on the category of the child. Configurations- how people make sense of children and their experiences- underlie the process of paediatric patient making. The child is formulated into different categories which are unstable and unsettled. The 'child' appears here in many forms: the child as a biomedical object, a student patient, the child 'in need', and one who is burdened by time.
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    Bodies over Borders and Borders over Bodies: the 'Gender Refugee' and the imagined South Africa
    (2016) Camminga, Bianca; Posel, Deborah; Matebeni, Zethu; Levine, Susan
    This thesis tracks the conceptual journeying of the term 'transgender' from the Global North - where it originated - along with the physical embodied journeying of transgender asylum seekers from countries within Africa to South Africa, and considers the interrelationships between the two. With regards to the term 'transgender', it is the contention of this thesis that it transforms as it travels, taking on meaning in relation to bodies, national homes, institutional frameworks and imaginaries. More specifically, that it has materialised in South Africa - first as a discourse and following this as a politics - due to a combination of social, political and cultural conditions peculiar to the country. In direct correlation to this movement, this thesis argues that in recent years South Africa has seen the emergence of what can be usefully termed 'gender refugees' - people who can make claims to refugee status, fleeing their countries of origin based on the persecution of their gender identity. This study centers on the experiences and narratives of these gender refugees, gathered through a series of life story interviews, highlighting the ways in which their departures, border crossings, arrivals and perceptions of South Africa have been both enabled and constrained by the contested meanings and politics of this emergence of transgender, particularly in relation to the possibilities of the South African Constitution. Through such narratives, this thesis explores the radical constitutional-legal possibilities for transgender in South Africa, the dissonances between the possibilities of constitutional law - in relation to the distinction made between sex and gender - and the pervasive politics/logic of binary 'sex/gender' within South African society. In doing so, this thesis enriches the emergent field of Transgender Studies, and challenges some of the current dominant theoretical and political perceptions of transgender, by offering complex narratives regarding sex, gender, sexuality and notions of home in relation to particular geo-politically situated bodies. This thesis speaks to contemporary international concerns and debates regarding migration and asylum, identity politics, the control of borders, human rights and protections, documentation and the ongoing bureaucratisation of sex/gender.
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    A call to care : exploring the social politics of compassionate care and rescue in the context of a care programme for children in contemporary Swaziland
    (2013) Marshak, Naomi; Levine, Susan
    This paper draws on ethnographic research conducted in 2011 and 2012 in an abandoned mining town in Northern Swaziland. In 2001 the isolated 'ghost town' was bought by a Faith Based Organisation and transformed into what the organisation terms a vibrant 'sustainable orphan village'. Against a backdrop of political uncertainty, deepening economic-crisis related poverty, increasing numbers of children in need of extra-familial care and the parallel proliferation of humanitarian organisations being set up to deal with these systemic vulnerabilities, this thesis explores the practices and politics of childcare and rescue in contemporary Swaziland. Focusing on a single extended case study, I trace the material affects and effects of interventionist help. Situating this study in a broader global, particularly Christian philanthropic preoccupation with the project of 'saving children', this study forms part of a burgeoning body of anthropological theory and research that critically explores the logic and practice of what Didier Fassin (2011) calls 'humanitarian government'.
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    Children on the move : experiences of children living in a temporary relocation camp in Cape Town, South Africa.
    (2013) Prah, Efua; Levine, Susan
    This thesis focuses on six children’s experiences from various backgrounds who lived in temporary relocation areas in Cape Town, South Africa. The research was conducted over a three-year period from February 2010 to February 2013, with a one-year field-research period from October 2010 to October 2011. Themes identified examined the effects of forced removals, displacement, marginality and the prevalence of violence in Bluewaters Refugee Camp Site C and Symphony Way Temporary Relocation Area. Exploring pathways and patterns of identity, embodiment and experiences of health and illness, and the expressive, revealing quality of theatre, delivered rich data that produced an ethnographic account of children’s experiences in these sites.
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    Creating personas, performing selves – gazing beyond the masks of drag and neo-burlesque performance
    (2021) Prince, Lindy-Lee; Levine, Susan; Matebeni, Zethu; Pather, Jay
    What if gender is not in the body, but happens to it through a combination of tangible and intangible means – through the coverings that mask, as well as the translations of and on the body? What if gender was malleable? If we cannot break gender, smash it to pieces, then, hopefully we might be able to bend it and fashion it into something that is more useful in the world, desirable, and something functional for an immediate need, or purpose. This thesis introduces the reader to the performance of drag and neo-burlesque, as these take place in bars and nightclubs in Cape Town. I use the concepts of the gaze and the mask in this research to unpack and understand the feminine and hyper-feminine performances by drag and neo-burlesque performers. I argue that contemporary understandings of the “male” gaze, as posited by Laura Mulvey, have become inefficient in addressing the complexities of viewing gendered performances and audience interpretation thereof. I ask the reader to consider how audiences are set up to look at a performance and performing body and what they are meant to interpret about the person, or their character, by looking at the performance. I want to look beyond the stereotypical “male” gaze. I attempt to add to the conversation on objectification in performance, by arguing that the performances that take place on drag and neo-burlesque stages, possess the ability to challenge dominant ideals and social regulations regarding the ways in which gendered bodies ought to perform in public and private space through the prescriptions of a hetero-dominant society. In this thesis I discuss gendered performance, and expression, and the ways in which these performances and expressions work alongside prescribed perceptions of femininity and feminine performance. These prescriptions inform the ways in which individuals are allowed to perform a homogenous idea of gender, and work against gender variance, which in turn, informs the manner in which individuals are allowed to perform sexuality in relation to what is socially mandated and allowed in the heterodominant society. In this thesis, I also explore the creation of the staged performance, and discuss themes of stigma and shame as it is used to discipline those who attempt to perform potentially subversive content in publicly accessible spaces. Further, I explore understandings of beauty and performance, making 7 connections to race, class, and aspirational performance by those who perform drag and neoburlesque in Cape Town. This leads to an exploration of the potential ways in which life outside of the performance might inform the life on stage, and vice versa – asking what is feminine performance, in what ways are feminine performances meant to be viewed, as well as questioning what kinds of feminine performances are socially acceptable?
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    Deaf Futures: Challenges in Accessing Health Care Services
    (2019) Swannack, Robyn Danielle; Levine, Susan
    The purpose of this research is to explore the structural forces that limit the access to health care services for Deaf people. Literature has acknowledged the disconnection between the Deaf and hearing worlds, particularly in health care. Much of the existing literature exploring these fields have failed to include input from the Deaf community members. As such, hearing perspectives dominate the research and hence also in the lives of Deaf individuals. The narrative presented indicates that hearing people need to be made more aware of Deaf people’s own perspectives and respect the policy of self-representation so that laws and regulations do not negatively affects Deaf people’s lives. Using ethnographic methods, including narratives, participant observation, informal and semi-structured interviews, and photo-elicitation interviews, this study highlights the structural violence experienced in accessing health care by six Deaf people in Cape Town, South Africa. The findings confirm previous studies’ assertions that the dominant biomedical view towards deafness negatively affects Deaf people overall, particularly because of lack of communication access to health care.
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    The experience of students in the South African-Cuban medical training program : an encounter with medical pluralism
    (2011) Lungelow, Danielle; Levine, Susan
    The Cuban Medical Training program is an initiative that provides bursaries to international students from disadvantaged backgrounds. Understanding the experiences of South African participants, particularly those who complete their transitional component at University of Cape Town (UCT), and how they are prepared to meet the aims of the South African-Cuban Medical Training Program (SACMTP), the needs of their local communities, and ultimately, the needs of the South African health system, is the focus of my research.
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    Fragile yet unbreaking : an ethnographic exploration into young people's entangled experiences of traditional healing and HIV
    (2011) Pentz, Stephen; Levine, Susan
    The following study is an ethnographic exploration into young people’s entangled experiences of health and illness in relation to both HIV/AIDS and traditional forms of healing. The research employed a creative, didactic methodology based around a series of workshops conducted with two non-governmental organisations based in Grahamstown’s peri-urban townships: The first, Siyapumelela, maintains a focus on youth and HIV/AIDS; the second, Sakhuluntu, is a cultural group aimed at keeping young people off the streets. The argument begins by challenging the dichotomous relationship that is maintained between Modern Scientific Medicine and traditional forms of healing and calls for a dual standard system in which both epistemologies can be free to operate according to their own medical standards. The study explores young people’s therapeutic environments and tracks, in particular, how young people talk about and represent HIV/AIDS. HIV/AIDS is discussed as a concept metaphor; a domain term that orients a person towards areas of shared exchange and meaning. It is clear that most young people have a well-informed biomedical understanding of HIV/AIDS, yet metaphorically, they see it as a dangerous and destructive force; an uncertain threat in the world. The research poses the question as to why young people continue to put themselves at risk of contracting HIV by exploring the social environments which many young people are subject to – environments that are often characterised by extreme social structural violence. The argument examines the nature of social structural violence as it plays itself out in the everyday lives of the participants and identifies the kinds of challenges that many of them face on a day-to-day basis. Due to fragmented avenues of support and conditions of domestic fluidity, many young people from structurally violent communities are left with feelings of vulnerability and insecurity. Alongside experiences of social and structural insecurity, young people also harbour a sense of spiritual insecurity that stems from the dissolution of the ancestral cult as a result of the historical, yet persisting, fragmentation and reorganisation of the African family unit. The research discusses a form of spirit possession known as Amakhosi that young people engage in in order to (re)gain a sense of security and protection from forces beyond their control.
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    HIV/AIDS, food insecurity and the burden of history: An ethnographic study from North-eastern Tanzania
    (2011) Mangesho, Peter Ernest; Levine, Susan; Ross, Fiona C
    The main argument in this study draws on ethnographic research conducted in Maramba, a rural community in north eastern Tanzania, with poor people living with HIV/AIDS who struggled to obtain food, care and support in spite of the availability of free treatment.
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    Let me be quiet' : HIV disclosure, stigma and denial in Imizamo Yethu, Cape Town
    (2008) Haricharan, Hanne Jensen; Levine, Susan
    Includes abstract. Includes bibliographical references (leaves 81-86).
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    Medicine and the Arts Week 1 - Welcome to the course
    (2015-01-21) Reid, Steve; Levine, Susan
    In this video, Associate Professor Susan Levine and Professor Steve Reid from the University of Cape Town introduce the purpose and design of the Medicine and the Arts Massive Open Online Course. They introduce the concept of medical humanities as a pedagogy to assist in the education and training of medical students in South Africa, addressing the specific social and cultural experiences of healthcare in South Africa and how an interdisciplinary approach between the humanities and medical science can provide a useful lens for addressing the healthcare needs of the country. This is the first video in Week 1 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 2 - In dialogue about children's voices
    (2015-01-21) Levine, Susan; Callaghan, Nina; Abney, Kate; Hendricks, Marc
    In this video, Associate Professor Susan Levine pose questions to Dr. Hendricks, Dr. Kate Abney, as well as Nina Callaghan in an attempt to unlock some of the synergies that brings their various perspectives into focus. Marc Hendricks is asked how doctors take care of themselves in dealing with the deaths, illness and victories of their patients’ stories. Kate talks about how she has used art as part of her research methodology and discusses how the issue of time surfaced in her work at the TB hospital. Nina provides an example of a child she had worked with. This is the fifth video in Week 2 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 2 - Issues of children's voices
    (2015-01-21) Levine, Susan
    In this video, Associate Professor Susan Levine makes the point that we need a better understanding of how children experience chronic illness in institutional settings. She argues that the medical humanities can help us to listen to children's voices and to better understand their experiences of illness. She introduces three guest speakers, all of whose work focuses in one way or another on listening to the stories of youth and young people. This is the first video in Week 2 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 3 - In dialogue about mind, art and play
    (2015-01-21) Levine, Susan; Ndlovu, Malika; Ramugondo, Elelwani; Solms, Mark
    In this video, Susan Levine asks Elelwani Ramugondo, Mark Solms, and Malika Ndlovu to elaborate on several aspects of play from their unique disciplinary perspectives. Elelwani reflects on how what people do has a fundamental influence on health. Mark expands on the way modern urban society has changed the traditional ways we live, work, and play. Malika details how the applied arts can be used as part of patient-centred treatment. This is the seventh video in Week 3 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 3 - Issues of mind, art and play
    (2015-01-21) Levine, Susan
    In this video, Associate Professor Susan Levine introduces Elelwani Ramugondo, an occupational therapist, Mark Solms, a neuropsychologist, and Malika Ndlovu, an applied artist who all have different perspectives on the mind, art and play.
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    Medicine and the Arts Week 6 - Death and the corpse
    (2015-01-21) Levine, Susan
    In this video, Associate Professor Susan Levine introduces the topic of death and the corpse. She outlines how a multi-disciplinary approach will be used to address questions related to the topic and introduces the guest educators who will feature in subsequent videos: Professor Lorna Martin, a forensic pathologist. Professor Deborah Posel, a prominent sociologist. And Kathryn Smith, a fine and forensic artist from Stellenbosch University. This is the first video in Week 6 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 6 - In dialogue about the corpse
    (2015-01-21) Levine, Susan; Posel, Deborah; Smith, Kathryn; Martin, Lorna
    In this video, Susan Levine reflects on how each of the three speakers in previous videos used their different perspectives to address the topic of death and the corpse and poses additional questions to them. Lorna is asked about her interaction with the families of the deceased. Deborah is asked to elaborate on the concept of 'discipline'. Kathryn is asked how her work interfaces with art presentation and representation. This is the sixth video in Week 6 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 6 - What we have learnt and thanks to everyone
    (2015-01-21) Levine, Susan; Reid, Steve
    Professor Steve Reid and Associate Professor Susan Levine reflect on the 'Medicine and the Arts' course as a whole and discuss what they have learned and found interesting in creating and sharing the course with others. This is the eighth video in Week 6 of the Medicine and the Arts Massive Open Online Course.