Alexander Butchart

Perceptions of injury causes and solutions in a Johannesburg township: implications for prevention.

As with other diseases, citizen perceptions of injury causes and solutions are important determinants of their response to the problem. This study explores qualitative responses to questions about the causes and solutions for injuries due to violence, transport, and unintentional burns, falls and other causes from 1,075 residents in six neighbourhoods of a low-income area in Johannesburg, South Africa. These included council houses, council apartment blocks and informal settlements. Data were analysed using content analytic procedures. Perceived causes of injury varied sharply between neighbourhoods. Violence was seen as an outcome of unemployment, socialisation, drug abuse and drug dealing in the formal housing areas, while in the informal settlements it was attributed to unemployment, poor housing and environmental conditions, and excessive alcohol consumption. In the formal housing areas, suggested solutions for violence emphasised increased policing and other repressive measures that contradicted the attribution of causes to environmental factors. In the informal areas, solutions were more congruent with perceived causes, emphasising housing development, education and employment. Perceived causes and solutions for transport injuries reflected the specific context of each neighbourhood, and indicated strong support for the implementation of environmental modifications to reduce the speed of motor vehicles and thus the number of pedestrian injuries. Where perceived causes and solutions for violence and transport-related injuries were located beyond the community in the broader environment, unintentional injuries due to other causes were seen as more in the sphere of potential personal control, except in the informal areas where electrification and formal housing provision were the most commonly suggested solutions. Popular constructions of the causes and solutions for major categories of injury are important in shaping injury prevention responses, and their careful assessment can increase the likelihood that safety promotion programmes will succeed.

Non-fatal injuries due to interpersonal violence in Johannesburg — Soweto: Incidence, determinants and consequences

A prospective, hospital based sampling procedure conducted between June 8th, 1989 and August 24th, 1990 identified 1592 victims of interpersonal violence in six state and five private hospitals serving the Johannesburg magisterial district (which includes Soweto). For the 1282 victims resident in the area, this corresponded to crude annualised incidence rates per 100,000 population of 3821 for coloureds, 1527 for blacks, 467 for whites, 433 for asians and 1380 for all residents. Males, most of whom were aged 20-24 years, constituted 83.9% of all victims and were most often attacked on the streets. The majority of females were attacked at home by a spouse or lover, and most incidents occurred between dusk and midnight on weekends. Sharp violence was the most frequent type, involving 52.2% of the male and 51.4% of the female victims. Analysis by racial classification of the overall findings for mechanism of injury and relationship to aggressor showed dramatic differences. Limitations of the findings are discussed. After comparison with similar data for two United States cities and Copenhagen, Denmark, it is hypothesised that the racial differences in the present findings reflect the interplay of universal structural determinants and a specific colonial factor rooted in the sociology and psychology of oppression. Some implications of these findings and hypothesised determinants for violence prevention initiatives are mentioned.

Estimating the South African trauma caseload

A survey of medical superintendents revealed that an estimated 1.5 million trauma cases presented to South Africas 356 secondary and tertiary level hospitals in 1999. Injury rates for traffic, violence and other injuries showed considerable inter-provincial variation, with violence accounting for more than half of the trauma caseload. This type of survey is a simple low cost alternative for monitoring injury patterns and supplementing burden of disease and injury costing studies.

Objects without Origins: Foucault in South African Socio-Medical Science

Despite being freely available in English language translation since the late 1970s, the writings of Michel Foucault have only faintly imprinted themselves within the work of South African socio-medical scientists. Where references to Foucault do stray beyond mere name dropping, they frequently distort the lines of his thought by pressing it into precisely the liberal-humanist and Marxist analyses Foucault himself was so concerned to dispel. How is this possible, and what is being done by this failure to accurately understand and apply Foucault? Deploying a Foucaultian methodology of strategic questioning, this paper explores the phenomenon to conclude that the failure of Foucault in South African socio-medical discourse is only apparent, the very impermeability of these disciplines to his ideas itself confirmation for the Foucaultian thesis that while sovereignty is the preserve of an elite, discipline is within the grasp of us all.

Imaginary constructions and forensic reconstructions of fatal violence against women: implications for community violence prevention

The almost exclusive media focus on political violence in South Africa has deflected attention from the high levels of interpersonal violence in areas of socioeconomic deprivation. In order to explore the tension between an at-risk communitys perspective and the current reality of violence against women, imaginary constructions of their own violent death produced by 45 African female interview respondents were examined in conjunction with forensic data relating to 73 African female homicide victims in Cape Town, South Africa. The prototypical account of an imagined homicide involved a female commuter being approached by a group of men, taunted and assaulted, raped and then killed. The majority of actual homicides occurred at or in the vicinity of the residence of the victim, with the attacker being known to the deceased. Whilst only 1 of the imagined homicide narratives depicted the use of alcohol by the victim, over half the actual homicides had elevated postmortem blood alcohol levels. These and other disjunctions and convergencies between lay and forensic constructions of violent female death should be viewed in the wider context of enmeshment in social circumstance, and could provide some understanding of how at-risk communities perceive violence against women, thereby providing a foundation for appropriate prevention programmes.

'A bothersome death' : narrative accounts of infant mortality in Cape Town, South Africa

Traditional measures of health status such as mortality rates and cause-of-death information give limited insight into the role of caregivers and health care providers in infant illness and death. To the extent that the behaviours of these parties can be accurately mapped, they may reveal important sites for effective community interventions and the improvement of medical care. This possibility is explored in relation to infant mortality in Cape Town, South Africa, by analysing verbal histories provided by the caregivers of 70 infants in the course of obtaining police death certification. From these verbal histories it appears that acute respiratory infection and diarrhoeal disease caused the majority of deaths. Infants with a respiratory condition were likely to have been taken for medical attention prior to death. By contrast, the parents of infants with diarrhoeal disease, while more active towards these infants, were less likely to seek medical care--these infants typically being found dead in bed or dying en route to the hospital or clinic. A story of infant death at home following recent medical care was obtained in over half the cases. This study demonstrates a simple method for the examination of the content and structure of lay accounts of illness and death. The implications for health care of such accounts are discussed in terms of the behavioural antecedents of infant mortality due to acute respiratory infections and diarrhoeal disease.

The "Bantu Clinic": a genealogy of the African patient as object and effect of South African clinical medicine, 1930-1990.

This paper is about power, medicine andthe identity of the African as a patient of westernmedicine. From a conventional perspective and asencoded in the current ’’quest for wholeness‘‘ thatcharacterises South African biomedical discourse, theAfrican patient – like any other patient – has alwaysexisted as an authentic and subjectified being, whosetrue attributes and experiences have been denied bythe ’’mechanistic,‘‘ ’’reductionistic‘‘ and ’’ethnocentric‘‘practices of clinical medicine. Against this liberalhumanist perspective on the body as ontologicallyindependent of power, this paper offers a Foucaultianreading of the African patient as – like any otherpatient – contingent upon the force relations immanentwithin and relayed through the clinical practices ofbiomedicine. A quintessential form of disciplinarymicro-power, these fabricate the most intimaterecesses of the human body as manageable objects ofmedical knowledge and social consciousness to makepossible the great control strategies of repression,segmentation and liberation that are the usual focusof conventional investigations into the place andfunction of medicine in society. Since the 1930s whenthe African body first emerged as a discrete object ofa secular clinical knowledge, these have repeatedlytransformed the attributes and identity of the Africanpatient, and the paper traces this archaeology ofSouth African clinical perception from then until the1990s to show how its “quest for wholeness” is not anend point of “discovery” or “liberation,” but merelyanother ephemeral crystallization of socio-medicalknowledge in a constantly changing force field ofdisciplinary power.