Browsing by Author "Reid, Steve"

Now showing 1 - 19 of 19
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    An investigation into the nature, extent, and experience of collaboration between the Eden District, Western Cape Department of Health and community-based service providers
    (2018) Utian, Brett; Reid, Steve; Hamann, Ralph
    A major component of the primary health care (PHC) system is the delivery of health services on a community level, at the core of which is the Home and Community Based Care (HCBC) programme. This study focuses on one element of the HCBC system, namely how those involved in the administration of the community-based health component of primary health care, understand their relationship from the perspective of both the government (WCG - DoH) and the NPO service providers in the Eden District of the Western Cape. Additionally, it analyses the nature and the extent of the collaboration between the two entities. A patient referral tool was facilitated in a collaborative process to assess the ability of the two entities to strengthen their relationship. The study methodology was undertaken utilising Insider Ethnography with the researcher as a participant observer. Ten semi-structured interviews of the key stakeholders and one focus group were conducted with the staff of four non-profit (NPO) service providers operating in the Eden District and with WCG - DoH staff managing the HCBC programme. The findings reflect a substantial disconnect and imbalance in the relationship between the two entities, highlighting a top-down, transactional process at higher levels of management, in contrast to the operational relationships at the local sub-district level which are more collaborative. This disjuncture often disempowers the NPO service providers involved in the implementation of the programme. A number of recommendations regarding communication, advocacy, and innovation are proposed. Regular meetings of government, from district to provincial levels, with the NPO service providers, to strengthen collaboration by all stakeholders, are crucial.
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    Health sciences undergraduate education at University of Cape Town: a story of transformation
    (Health & Medical Publishing Group, 2012) Hartman, Nadia; Kathard, Harsha; Perez, Gonda; Reid, Steve; Irlam, James; Gunston, Geney D; Janse van Rensburg, Vicki; Burch, Vanessa; Duncan, Madeleine; Hellenberg, Derek; Van Rooyen, Ian; Smouse, Mantoa; Sikakane, Cynthia N; Badenhorst, Elmi; Ige, B
    Undergraduate education and training in the Faculty of Health Sciences at the University of Cape Town has become socially responsive. A story of transformation that is consonant with wider societal developments since the 1994 democratic elections, outlining the changes in undergraduate curricula across the faculty, is presented.
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    Medicine and the Arts Week 1 - In dialogue about the heart
    (2015-01-21) Reid, Steve; Brink, Johan; Anderson, Peter; Henkeman, Stanley
    In this video, Professor Steve Reid poses additional questions to Professor Johan Brink, poet Peter Anderson, and heart transplant recipient Stanley Henkeman to try to tease out the different disciplinary perspectives on the heart and heart transplantation. This is the seventh video in Week 1 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 1 - Interdisciplinarity in the medical humanities
    (2015-01-21) Reid, Steve
    In this video, Professor Steve Reid describes how when looking at the practices of healthcare and medicine there are two perspectives we could consider, namely from the outside-in and from the inside-out. He explains how the outside-in perspective comes from the social sciences and arts while the inside-out represents the medical sciences. This is the eighth video in Week 1 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 1 - Role of the Medical Humanities in humanising healthcare
    (2015-01-21) Reid, Steve
    In this video, Professor Steve Reid describes the various understandings of the field of medical humanities. He explains that the most common understanding of the field is as a dialogue between science and medicine but also highlights other understandings such as art therapy and the applied arts. This is the second video in Week 1 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 1 - The Heart of the Matter
    (2015-01-21) Reid, Steve; Brink, Johan
    In this video, Professor Steve Reid describes how the course will use the extraordinary medical intervention of the heart transplant as a means of understanding the interdisciplinarary nature of the medical humanities. He explains how the heart transplant will be presented from three different perspectives: Professor Johan Brink, a cardiac surgeon, will discuss the medical aspects of the heart transplant, such as the surgery itself and the risks and benefits of the procedure. Peter Andersen, a poet, will discuss the heart from a literary perspective, in terms of metaphor and symbolism. And Stan Henkeman, a heart transplant recipient, will share his personal story of hope and renewal. This is the third video in Week 1 of the Medicine and the Arts Massive Open Online Course.
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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 4 - Creative process
    (2015-01-21) Reid, Steve
    In this video, Steve Reid introduces the ideas of human reproduction and creativity while highlighting that such ideas are crucial in order to make the most of what is available in a situation of limited resources for health in an African context. He introduces three guest speakers: Professor Silke Dyer, a gynecologist and an expert in assisted reproductive techniques. Professor Alireza Baghai-Wadji, an engineer. And Doctor Francois Bonnici, a medical doctor involved in social entrepreneurship. This is the first video in Week 4 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 4 - In dialogue about creativity
    (2015-01-21) Reid, Steve; Dyer, Silke; Bonnici, Francois; Baghai-Wadji, Alireza
    In this video, Steve Reid poses additional questions to Alireza Baghai-Wadji, François Bonnici, and Silke Dyer around the topic of creativity. Silke taslks about new developments in reproductive health, François comments on how to create new ways of thinking to tackle complex problems, and Alireza discusses how the biological conception in humans is analogus to the creation of new ideas. This is the fifthvideo in Week 4 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 5 - An insider view
    (2015-01-21) Reid, Steve
    In this video, Professor Steve Reid reflects on the various issues covered in the previous set of videos, namely the insider view of mental illness and how poetry and music can serve to improve the public's understanding of mental illness. This is the sixth video in Week 5 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 5 - Art speaks to and from silence
    (2015-01-21) Reid, Steve; Dowling, Finuala; Baumann, Sean
    In this video, Professor Steve Reid continues his conversation with Finuala Downling and Sean Baumann about how art can be used to bring public attention to difficult and hidden areas of mental illness. Finuala discusses the methods he uses to catch her audiences attention and Sean talks about methods he uses to 'dislocate' the senses of his audience while emphasising the continued problem of stigma around mental illness. This is the fifth video in Week 5 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 5 - In dialogue about mental illness
    (2015-01-21) Reid, Steve; Baumann, Sean; Dowling, Finuala
    In this video, Professor Steve Reid engages in discussion with Finuala Downling and Sean Baumann about how poetry and music can help us understand and talk about mental illness. They discuss the insider-outsider view of mental illness, experience of the world through the eyes of psychosis, and the role of imagination and empathy when listening to first-hand accounts of mental illness. This is the fourth video in Week 5 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 5 - Insights into mental illness in art
    (2015-01-21) Reid, Steve
    In this video, Steve Reid introduces the topic of mental illness and art and how it will be explored through dialogue with two artists, Finuala Downling and Sean Baumann. This is the first video in Week 5 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.
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    Pathways to care for critically ill or injured children: A cohort study from first presentation to healthcare services through to admission to intensive care or death
    (Public Library of Science, 2016) Hodkinson, Peter; Argent, Andrew; Wallis, Lee; Reid, Steve; Perera, Rafael; Harrison, Sian; Thompson, Matthew; English, Mike; Maconochie, Ian; Ward, Alison
    Purpose Critically ill or injured children require prompt identification, rapid referral and quality emergency management. We undertook a study to evaluate the care pathway of critically ill or injured children to identify preventable failures in the care provided. METHODS: A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation to healthcare services until paediatric intensive care unit (PICU) admission or emergency department death, using expert panel review of medical records and caregiver interview. Main outcomes were expert assessment of overall quality of care; avoidability of severity of illness and PICU admission or death and the identification of modifiable factors. RESULTS: The study enrolled 282 children, 252 emergency PICU admissions, and 30 deaths. Global quality of care was graded good in 10% of cases, with half having at least one major impact modifiable factor. Key modifiable factors related to access to care and identification of the critically ill, assessment of severity, inadequate resuscitation, and delays in decision making and referral. Children were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 185 (74%) of children, and death prior to PICU admission was avoidable in 17/30 (56.7%) of children. CONCLUSIONS: The study presents a novel methodology, examining quality of care across an entire system, and highlighting the complexity of the pathway and the modifiable events amenable to interventions, that could reduce mortality and morbidity, and optimize utilization of scarce critical care resources; as well as demonstrating the importance of continuity and quality of care.
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    Professionalism in medicine in South Africa - a focus on medical students and their educators
    (2019) Olckers, Lorna; Draper, Catherine; Reid, Steve
    The notion of ‘professionalism in medicine’ has become increasingly topical globally. It is a complex and ‘slippery’ concept that is variously understood – from ideas of values or virtues that reflect aspects of ‘being’, to those that are more closely associated with behaviour and aspects of ‘doing’. More recently, issues of ‘identity formation’ have added a third dimension to these two broad areas of understanding. The lack of a shared and coherent understanding of what actually constitutes professionalism has resulted in challenges with the teaching, learning and assessment of professionalism in medicine. This has been widely reflected, including within the medical curriculum at the University of Cape Town (UCT) in Cape Town, South Africa, which provides the context for this research. The aim of this study was to explore how medical students and their educators understand and experience professionalism in medicine in the South African (SA) context. The specific objectives in relation to professionalism in medicine were to explore how aspects of being or character are understood and experienced; how aspects of doing or practice are understood and experienced; how global and profession-specific changes have influenced its understandings and experiences; how the SA context is understood and experienced in relation to professionalism in medicine; and how it is understood and experienced within the Health Sciences Faculty at UCT. The research was framed within an interpretive theoretical paradigm in order to illuminate issues of context, difference and power. Qualitative methods, specifically focus groups and individual interviews, were used with participants including medical students studying at UCT, interns who had graduated from UCT, and educators from within the university. Results from the study revealed themes that were considered against physician and philosopher Dr Edmund Pellegrino’s virtue-based understanding of professionalism in medicine that shaped the conceptual framework for the study. Four key issues formed the focus of discussion – the understanding of professionalism; its development alongside emerging identity; its relationship to power and hierarchy; and the implications of context. Unlike the discrete vision of professionalism as embedded within virtues or values as expressed by Pellegrino, the understandings and experiences of study participants reflected a multi-faceted view of professionalism in medicine as a combination of values, knowledge and skills, behaviour, and responsibilities, linked to a core relationship founded on trust between doctors and patients. This understanding was informed by issues of emerging identity, influenced particularly by the ‘hidden curriculum’ and role models, as well as experiences of power and hierarchy within the university and practice settings. Contextual realities included the commercialisation of medicine, and the increasing impact of the internet and social media. The South African context, reflected by the healthcare system and patient population, further informed this multi-faceted understanding of professionalism in medicine. What became clear was that professionalism in medicine was understood and experienced by participants as complex in both theory and practice, and that curriculum design processes and medical practice must therefore be cognisant of the interdependence of the key issues.
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    The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system
    (2012) Kuehne, Jan; Reid, Steve
    Continuity of care (COC) is a fundamental concept in Family Medicine. The rollout of antiretrovirals in the primary care setting of the public health care system in South Africa was 'vertically' isolated from the other clinics. This isolation provides a rich environment to research COC. The present project describes the longitudinal COC in the Ubuntu ART/TB Clinic in Site B, Khayelitsha, which is one of the oldest clinics with a total of 6000 patients on ARVs since May 2001. An observational period of the last five visits of patients to the clinic was used to measure the COC as a simple Continuity Fraction (CF)(alternatively called the Usual Provider Continuity/UPC), which was compared with more complex formulas for measuring COC including the K-index, SECON, COC-index and Alpha-index. The nature of the appointments was also explored, in terms of whether the patient was attended to by a nurse or a doctor and whether it was a proxy visit. Since viral loads are a very good indicator of adherence, they were compared to the COC over the observation period of the last five visits. The data showed a nurse-driven clinic achieved a CF below 50% (0.5). The 0.5 COC score seems to be a benchmark for good COC, yet it is difficult to statistically verify. The CF scored higher than the other COC formula scores, yet correlated well with other COC formulae. The CF scores with nurses were more positively related to better virological outcomes than the other COC formulae, though none were statistically significant. Unscheduled and proxy visits were not associated with higher VLs. The statistical test of General Linear Modelling with Poisson Regression with robust error variance could be an alternative way of proving that better COC has a measure of impact on the outcomes. Due to the different role of doctors, doctor visit(s) resulted in higher sequentiality scores, but a decrease in suppressed VL. These COC scores also do not completely explain the good virological outcomes in this clinic, which is considered a well managed public sector clinic in Khayelitsha. The CF places a simple tool in the hands of a clinician at the primary level to measure individual provider continuity; however there is need to test its reproducibility in other contexts of chronic care in order to develop standards. The K-index emerged as a simple measure of the dispersion of the longitudinal COC within the nurse team managing the stable chronic patient. In a broader perspective, this study has put the measuring of COC onto the 'radar' of the public health system in South Africa.
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    Tackling the First COVID-19 Wave at the Cape Town Hospital of Hope: Why Was It Such a Positive Experience for Staff?
    (Multidisciplinary Digital Publishing Institute, 2023-03-29) Reid, Steve; Nana, Mitan; Abrahams, Theo; Hussey, Nadia; Okun-Netter, Ronit; Ras, Tasleem; von Pressentin, Klaus
    Background: In contrast to alarming reports of exhaustion and burnout amongst healthcare workers in the first wave of the COVID-19 pandemic, we noticed surprisingly positive staff experiences of working in a COVID-19 field hospital in South Africa. The 862-bed “Hospital of Hope” was established at the Cape Town International Convention Centre specifically to cope with the effects of the first wave of the COVID-19 pandemic in Cape Town. Methods: We aimed to systematically describe and assess the effects on staff and the local health system. A cross-sectional descriptive study design was employed using mixed methods including record reviews and interviews with key informants. Results: Quantitative results confirmed high job satisfaction and low staff infection rates. The emerging themes from the qualitative data are grouped around a “bull’s eye” of the common purpose of person-centeredness, from both patient and staff perspectives, and include staff safety and support, rapid communication, continuous learning and adaptability, underpinned by excellent teamwork. The explanations for the positive feedback included good disaster planning, adequate resources, and an extraordinary responsiveness to the need. Conclusions: The “Hospital of Hope” staff experience produced valuable lessons for designing and managing routine health services outside of a disaster. The adaptability and responsiveness of the facility and its staff were largely a product of the unprecedented nature of the pandemic, but such approaches could benefit routine health services enormously, as individual hospitals and health facilities realize their place in a system that is “more than the sum of its parts”.
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    “The graduates of the Postgraduate Diploma in Community Eye Health: how do they manage?”
    (2020) Minnies, Deon; Reid, Steve; Cook, Colin; Hartman, Nadia
    The Postgraduate Diploma in Community Eye Health (PgDCEH) has been offered at the University of Cape Town, South Africa since 2009 to develop management capacity in support of the delivery of effective and efficient eye care services in sub-Saharan Africa. We investigated how graduates applied the PgDCEH-acquired management competencies and the factors that enabled or constrained them to apply these competencies. A multiple case study design was used, employing mixed methods of data collection and analysis. Data collection comprised of a questionnaire survey, in-depth interviews and review of various supporting documents, including assignments submitted by students. Twenty-six of the 34 students who graduated from 2009 to 2014 submitted completed questionnaires. Of these, 15 purposively selected graduates and their secondary key informants participated in in-depth interviews. We found that the PgDCEH elicited some positive effects on the graduates, especially in their ability to perform management tasks and the level of confidence they have in their abilities. There were some personal achievements, but no significant programme improvements were observed. This study provided evidence that the PgDCEH as a health system strengthening intervention struggled to generate the anticipated response of improved eye care programme performance. Personal motivation, suitability of the training and opportunity to apply were the main factors determining how graduates apply management competencies. The utilization of the project management approach, a greater focus on health system maintenance and attention to the dynamic of change in people's lives are critical determinants of success in eye health programmes. The research also highlighted the importance of health care workers' personal motives and motivations as drivers of success and achievement on programme level, and that line management support, supervision and proper performance management are required to attain this. This research broadened understanding of how PgDCEH graduates interact with their work environment and uncovered ways to improve the design and delivery of management training for eye health workers in the future. Revision of the criteria for selection, strengthening focus on leadership, project and relationship management topics, and integrating the training into health professions' education programmes may substantially improve the impact of health management education. The study concluded that the constituent elements of the health system are not inanimate objects, as commonly portrayed, but people, who are connected in intimate, complex and multi-dimensional ways through communication, relationships and team dynamics to deliver health outcomes.