Lauraine M H Vivian

Lauraine M. H. Vivian
Series: Routledge Studies in Health and Medical Anthropology
This book investigates amaXhosa circumcision and the
psychological processes involved. Lauraine Vivian employs
concepts such as resilience, orthodoxy, broken men, and
reciprocity to examine the experiences of men who have
developed mental health issues in relation to their initiation
into manhood. The chapters cover sensitive topics such as
physical injury, pain, harm, and women’s agency. Drawing
on the stories of over seventy amaXhosa men, the book
provides rare insight into circumcision and psychotic
experience.

On 31st January 2022, writes André Fauteux (2022), Justin Trudeau, the Canadian Prime Minister responded to truckers' peaceful protest against Covid-19 vaccinations in Ottawa by stating; "...the concerns expressed by a few people on Parliament Hill right now are not new, not surprising, are being heard, but [they] are a continuation of what we have unfortunately seen in misinformation and misinformation online-conspiracy theorists about microchips and God knows what else goes with tinfoil hats". Within two days Frank Clegg, the former President of Microsoft Canada, wrote Trudeau and asked him to clarify to whom he referred as ''tinfoil hats''. Clegg stressed that his remark was unacceptable if he was 'ridiculing people' who wore tinfoil hats to protect themselves from pulsed electromagnetic radiation (EMR) because they suffered from electrohypersensitivity (EHS).

L'auteure est une anthropologue médicale, docteure en psychiatrie et
électrohypersensible.
Le 31 janvier 2022, le premier ministre canadien, Justin Trudeau, a répondu à la manifestation pacifique des camionneurs s'opposant à leur vaccination obligatoire contre la COVID-19, tenue à Ottawa, en déclarant : « ... les préoccupations exprimées par quelques personnes sur la Colline du Parlement en ce moment ne sont pas nouvelles, ne sont pas surprenantes, sont entendues, mais [elles] sont une continuation de ce que nous
avons malheureusement vu dans la désinformation et la mésinformation en ligne - les théoriciens de la conspiration au sujet des micropuces et Dieu sait quoi d'autre qui vont avec les chapeaux d'aluminium ».
Deux jours plus tard, l'ancien président de Microsoft Canada, Frank Clegg, a demandé à M. Trudeau de préciser à qui il faisait référence en parlant des « chapeaux d'aluminium » (Trudeau désobligeant envers les personnes handicapées, Fauteux, 2022).

Le 31 janvier 2022, le premier ministre canadien, Justin Trudeau, a répondu à la manifestation pacifique des camionneurs s'opposant à leur vaccination obligatoire contre la COVID-19, tenue à Ottawa, en déclarant  : « ... les préoccupations exprimées par quelques personnes sur la Colline du Parlement en ce moment ne sont pas nouvelles, ne sont pas surprenantes, sont entendues, mais [elles] sont une continuation de ce que nous avons malheureusement vu dans la désinformation et la mésinformation en ligne - les théoriciens de la conspiration au sujet des micropuces et Dieu sait quoi d'autre qui vont avec les chapeaux d'aluminium ».

Purpose To elicit South African medical students' experiences of witnessing patient rights abuses and professional lapses during their clinical training in order to inform an appropriate and effective response. Method During June and July 2009 at the University of Cape Town Faculty of Health Sciences, the authors surveyed 223 fourth-, fifth-, and sixth-year medical students in selected clinical rotations concerning abuses they had observed. Volunteers were later interviewed individually. The authors coded interview transcripts for key themes using a constant-comparative grounded theory approach. Results Of 223 students surveyed, 183 (82%) responded, 130 (71%) of whom reported witnessing patient rights abuses and professional lapses, including physical abuse (38%), verbal abuse (37%), disrespect for patients' dignity (25%), and inadequately informing patients about their treatment (25%). Students attributed abuse to stressed health workers, overburdened facilities, and disempowered patients. Most students who witnessed abuse (59%) did not actively respond, and 64% of survey respondents felt unprepared or uncertain about challenging abuses in the future. Interviews with 28 students yielded detailed accounts of the abuses witnessed and of students' emotional reactions, coping strategies, and responses. Most students did not report abuses; they feared reprisal or doubted it would make a difference. Conclusions This study demonstrates the disjunction between what these students were taught about human rights and ethics and what they witnessed in clinical settings. The high prevalence of patient rights abuses witnessed by these students highlights the need to align medical ethics and human rights with medico-legal protocols in theory and clinical practice.

Her whole body encrusted in sarcoptes scabiei, a 50-year-old woman lay in foetal position on a hospital bed in Cape Town (Richards 2021). It was 2012 and I, a medical anthropologist, was accompanying a consultant on a clinical teaching ward round. She diagnosed her condition as Norwegian Scabies but the fissures in her flesh marked her HIV status. In preparation for our medical humanities tutorial, I asked the students to find out why her neighbours had not helped her?
file:///C:/Users/user/Documents/Publications/Writing/BMJBlog/Blog1_Jan22/Pandemic-divoc-91-suriv-disconnect%20-%20Medical%20Humanities.html

This article describes our qualitative research on the follow-up of 10 children, 5 years into recovery after cardiac surgery. The research was driven by a multi-disciplinary team of medical anthropologists, cardiologists, and an intensive care specialist and was based at the Red Cross War Memorial Children's Hospital where they underwent surgeries. The research sought to answer two questions; first, could we successfully maintain contact with and follow up the children; the second - which will be answered in future papers - asked what life was like for them and their families during surgery and later recovery. The results are presented as a discussion on the themes that arose in our engagement and analysis and not as clinical evidence. These showed that elective surgery although significantly delayed was successful, and all children were followed up at their medical appointments. The researchers, however, were unable to establish follow-up with all families over the duration of ...

Abstract
Purpose
To elicit South African medical students experiences of witnessing patient rights abuses and professional lapses during their clinical training in order to inform
an appropriate and effective response.
Method
During June and July 2009 at the University of Cape Town Faculty of Health Sciences, the authors surveyed 223 fourth-, fifth-, and sixth-year medical
students in selected clinical rotations concerning abuses they had observed.
Volunteers were later interviewed individually. The authors coded interview
transcripts for key themes using a constant-comparative grounded theory
approach.
Results
Of 223 students surveyed, 183 (82%) responded, 130 (71%) of whom
reported witnessing patient rights abuses and professional lapses, including
physical abuse (38%), verbal abuse (37%), disrespect for patients’ dignity
(25%), and inadequately informing patients about their treatment (25%).
Students attributed abuse to stressedhealth workers, overburdened facilities,
and disempowered patients. Most students who witnessed abuse (59%) did
not actively respond, and 64% of survey respondents felt unprepared or uncertain
about challenging abuses in the future. Interviews with 28 students yielded
detailed accounts of the abuses witnessed and of students’ emotional
reactions, coping strategies, and responses. Most students did not report
abuses; they feared reprisal or doubted it would make a difference.
Conclusions
This study demonstrates the disjunction between what these students were
taught about human rights and ethics and what they witnessed in clinical
settings. The high prevalence of patient rights abuses witnessed by these
students highlights the need to align medical ethics and human rights with
medico-legal protocols in theory and clinical practice.

This interdisciplinary study, within the fields of anthropology and medicine, describes my qualitative research as an anthropologist into the mental illness histories of five young Xhosa-speaking men who, within a year of their circumcision, suffered psychotic breakdowns. The study took place in Valkenberg Hospital for the Mentally Unwell and the surrounding disadvantaged, largely Xhosa-speaking communities in Cape Town, South Africa. Numerous admissions were screened over a two-year period, but only these five men met the study criteria. Their case studies describe how they perceived their circumcision and the stresses that may have contributed to the onset of their psychotic illness. Qualitative depth and ethnographic detail about practices was derived through interviews and fieldwork with family members, their social networks, and Xhosa-speaking people both in Cape Town and in the Eastern Cape. In addition, healthcare professionals were interviewed to provide insight into the cas...

Primary health care (PHC) is an equity-driven approach to health care1 that formed the foundation of South African national health policy under the new democratic government in 1994. In August 1994 the Faculty of Medicine (later renamed the Faculty of Health Sciences) at the University of Cape Town (UCT) adopted a policy on the PHC approach in order to equip its graduates with the values and skills necessary to meet the changing demands of the new national health system. This policy committed the Faculty to make the PHC approach central to its teaching, research, clinical service, and engagement with communities.2

... Lauraine MH Vivian. Pauline ... Blogs. Jason Strelitz: The fight to end child poverty (6 Dec 2011); Ike Anya: Tackling imported malaria in the UK (6 Dec 2011); Tiago Villanueva: The European union of general practitioners (5 Dec 2011); Martin ...

One of the most difficult elements of the ecological risk assessment of transgenic plants is investigation of their potential impact on biodiversity in complex non-target communities. This problem is particularly acute for pasture plants, since many have a track record of invasiveness. In this paper we develop an understanding of some aspects of the ecology of Trifolium repens L. (white

This interdisciplinary study, within the fields of anthropology and medicine, describes my qualitative research as an anthropologist into the mental illness histories of five
young Xhosa-speaking men who, within a year of their circumcision, suffered psychotic breakdowns. The study took place in Valkenberg Hospital for the Mentally Unwell and the surrounding disadvantaged, largely Xhosa-speaking communities in Cape Town, South Africa. Numerous admissions were screened over a two-year period, but only these five men met the study criteria. Their case studies describe how they perceived their circumcision and the stresses that may have contributed to the onset of their psychotic illness. Qualitative depth and ethnographic detail about practices was derived through interviews and fieldwork with family members, their social networks, and Xhosa-speaking people both in Cape Town and in the Eastern
Cape. In addition, healthcare professionals were interviewed to provide insight into the case studies and health system practices. A thematic analysis was used to interpret
the data whose strength lies in its anthropological description.
The thesis describes the nature of stress that may have precipitated the onset of psychotic illness in these vulnerable men, following circumcision. In respect of precipitating stressors, circumcision had relevance because it was a culturally prescribed, significant, life stage event around which distinctive psychosocial and environmental precipitating stressors clustered. Men were placed at risk for mental
illness, when the intimacy and social circumstances surrounding the circumcision as a patrilineal cultural practice, were jeopardised. When this happened, especially if the
youth’s father did not fulfil his traditional role or because of cultural dissonance, the stressors inherent within circumcision then became harmful. These stressors were described in local idioms of distress. The two psychiatric outcomes described were Schizophrenia or Bipolar Disorder in the cases of Unathi, Lindelo and Ayenda, and Cultural Bound Syndromes as transient psychoses in the cases of Mpumi and Xolile. The three men who suffered with more chronic, long-term mental illness had their worst experience of stress in the months
after they left circumcision. This was exacerbated by poverty and their being unsupported by family and extended kin. In respect of Cultural Bound Syndromes, precipitating stressors appeared to be inherent in circumcision. Their psychotic illness
happened immediately after circumcision and their psychotic symptoms went into remission when their cultural experience was therapeutically addressed. The study informs cross-cultural psychiatric research and promotes culturally sensitive practices in pathways to mental health care. This is particularly important given that Xhosa-speaking circumcision practices are well-established transitional rites of passage for manhood. The study thereby contributes to this already existing
discourse and whilst the Rev. Tiyo Soga’s (1880) writings are cited in the literature review, his descendant’s voice, Dr. Ju Ju Soga is heard in the interviews. In this respect, the literature and data persistently raise questions about values pertaining to
safety, injury, psychological harm, and stress. This thesis argues that primarily, it is families and culturally-intimate elders and officials who are responsible for the
psychological well-being of initiates. The ritual functions well when they perform their official roles; it is this that establishes the major protective mechanism against stress-related mental illness for initiates. It is in this family context that the health
system can provide appropriate mental health care services that address mental health care need.

This article argues that child deaths in the Paediatric Intensive Care Unit (PICU) generate profound moral struggle amongst caregivers. In it I deconstruct how caregivers manage the messy and at times problematic circumstances that clinical necessity requires from them in order to save children’s
lives. One result of this is that on many occasions they care for them at their time of death. When deaths are well managed compassion is engendered into the child’s dying and the death becomes restorative for the family and unit. In this, consultants – who are intensive-care specialists – play a critical role as they take responsibility for the clinical management of child deaths.
In doing so, they inform a team-based deliberation process to consider the child’s clinical assessment in the context of other ethical and moral issues. In addition, consultants must take part in the social negotiation of these events with family and caregivers. Nurses in contrast are more intimately
involved in child deaths and are shown to be more affected by the emotional, psychological and social consequences of deaths. The discussion further proposes that the nature of moral struggle is confounded by a complex of related factors that arise in a South African landscape, critical among
which are the past inequities brought by apartheid and this makes the deaths of children particularly sensitive. These inequities are now inherent in a geographical context influencing the demographic and epidemiological profile of disease that children suffer from and thereby, their chances of survival on admission to the hospital and the deaths that occur.

Abstract This paper reports on an epidemiological
study of common mental health and substance abuse
problems in a historically disadvantaged urban and
rural community in South Africa. In the rural Limpopo
Province of South Africa, and in a peri-urban township
near Cape Town, self-report instruments were used in
two random population samples and among respondents
at primary care and traditional healer settings, to
assess common mental health problems, substance
abuse problems and associated problems in social
functioning. A high prevalence of mental health and
substance abuse problems was observed in both communities,
with highest rates in the peri-urban township.
Even higher prevalences were found among respondents
at primary health care or traditional healers. The
study shows that mental health and substance abuse
problems constitute a considerable burden of disease
among disadvantaged communities in South Africa.
The study further underscores the integral role of traditional
healers in the mental health care system.

This article argues that child deaths in the Paediatric Intensive Care Unit (PICU) generate profound
moral struggle amongst caregivers. In it I deconstruct how caregivers manage the messy and at times
problematic circumstances that clinical necessity requires from them in order to save children’s
lives. One result of this is that on many occasions they care for them at their time of death. When
deaths are well managed compassion is engendered into the child’s dying and the death becomes
restorative for the family and unit. In this, consultants – who are intensive-care specialists –
play a critical role as they take responsibility for the clinical management of child deaths.
In doing so, they inform a team-based deliberation process to consider the child’s clinical assessment
in the context of other ethical and moral issues. In addition, consultants must take part in
the social negotiation of these events with family and caregivers. Nurses in contrast are more intimately
involved in child deaths and are shown to be more affected by the emotional, psychological
and social consequences of deaths. The discussion further proposes that the nature of moral struggle
is confounded by a complex of related factors that arise in a South African landscape, critical among
which are the past inequities brought by apartheid and this makes the deaths of children particularly
sensitive. These inequities are now inherent in a geographical context influencing the demographic
and epidemiological profile of disease that children suffer from and thereby, their chances of survival
on admission to the hospital and the deaths that occur.

Purpose: To elicit South African medical students’ experiences of witnessing patient rights abuses and professional lapses during
their clinical training in order to inform an appropriate and effective response.
Method: During June and July 2009 at the University of Cape Town Faculty of Health Sciences, the authors surveyed 223 fourth-, fifth-, and sixth-year medical students in selected clinical rotations concerning abuses they had observed.
Volunteers were later interviewed individually. The authors coded interview transcripts for key themes using a
constant-comparative grounded theory approach.
Results: Of 223 students surveyed, 183 (82%) responded, 130 (71%) of whom reported witnessing patient rights abuses
and professional lapses, including physical abuse (38%), verbal abuse (37%), disrespect for patients’ dignity (25%), and inadequately informing patients about their treatment (25%).
Students attributed abuse to stressed health workers, overburdened facilities, and disempowered patients. Most
students who witnessed abuse (59%) did not actively respond, and 64% of survey respondents felt unprepared or uncertain
about challenging abuses in the future. Interviews with 28 students yielded detailed accounts of the abuses witnessed and of students’ emotional reactions, coping strategies, and
responses. Most students did not report abuses; they feared reprisal or doubted it would make a difference.
Conclusions: This study demonstrates the disjunction
between what these students were taught about human rights and ethics and what they witnessed in clinical settings. The high prevalence of patient rights abuses witnessed by these
students highlights the need to align medical ethics and human rights with medico-legal protocols in theory and clinical practice.

Conference: Asia and Africa in Transition
Panel discussion: Engendering Humanity in Africa
Convener: Lauraine Vivian
Global Health Section, Department of Public Health, University of Copenhagen

For centuries male circumcision has been practiced amongst African autochthons, like the amaXhosa people. This happens as a rite of passage to bring youth into manhood and in reciprocity, girls to womanhood. The ritual celebration can only happen if mothers and fathers agree, the son consents for his circumcision, and the community participate in the event. This establishes safety in circumcision practices and resilience in youth who are prepared to take up mature sexual relations and familial and clan responsibilities. Circumcision thereby marks men, and childbirth those women who will on their deaths become clan ancestors by allocating gender-based religious authority and political belonging. Importantly, circumcision was once fundamental in an African practice of Ubuntu; a shared philosophy that a person is a person by virtue of other people. This embraces tolerance of diversity amongst all beings. Dr Thanduxolo Nomngcoyiya from Fort Hare University, Eastern Cape, South Africa will co-lead the panel to discuss gendered, cultural and human rights in its traditional practice. In this respect the panel will focus on amaXhosa women’s roles and rights to bring the rite of passage to fruition.
Although circumcision practices are under challenge, its practice connects the physical body to the spirit world and in Africa marks those who will become ancestors. As in Asia, circumcision rites allocate religious authority and political belonging. On both continents the engendering of spiritual beings and states of divinity raise individuals beyond ordinary human existence. These states of being have the potential to heal and restore people and the environment. Today human rights advocacy frequently contests circumcision practices, establishing a disjuncture between Europe and Africa/Asia. Decolonisation seeks however, to re-frame questions of gendered identity, race, and ethnic difference from the perspective of African and Asian autochthons. This panel seeks to acknowledge the tolerance shown by these peoples during centuries of European colonisation by engaging in debate on these socio-cultural, ideological, and religious practices.

Objective
To assess caregivers’ perceptions of the effects of intensive care and antiretroviral therapy (ART) on
the health and quality of life of critically ill HIV-infected children.
Design
Eight primary caregivers were interviewed within six months of discharge, and seven of these were reinterviewed 12-18 months later. Transcripts were analysed using qualitative research methodology and
the NVivo software package. Themes drawn from the analysis were used to structure the results as
quotes, summaries, tables and a model describing the subjects’ responses.
Setting
The Red Cross Children’s Hospital (RCCH) PICU, Cape Town, South Africa.
Patients
Eight ART-naïve children under 12 months old who were started on ART after discharge from the
Paediatric Intensive Care Unit (PICU).
Main Results
Results are presented under the following sets of themes: Socio-Economic Factors contains data on
Living Conditions, Household, Income, Diet; Medical Care and Child’s Health contains data on
Medical Care, Antiretroviral Therapy, Child’s Health and Behaviour, Health Beliefs, Quality of Care;
Community and Family Factors contains data on Stigmatisation and Disclosure, Family and Burden of
Care. A diagram (Figure 1) shows relationships between these themes.
Conclusions
Caregivers perceived ART as effective, the PICU as useful in improving their children’s health, and the
proximity of the hospital as essential to their children’s ongoing good health. There was an effective
continuum of care between the RCCH and family settings. However, there were major concerns about
the local clinics as sites of therapy. Issues arising in the children’s social, cultural and economic
background included stigmatization, poor infrastructure and resources, co-dependency with kin, and
language and culture-barriers as challenges to effective follow-up.

This book investigates amaXhosa circumcision and the
psychological processes involved. Lauraine Vivian employs concepts such as resilience, orthodoxy, broken men, and reciprocity to examine the experiences of men who have developed mental health issues in relation to their initiation into manhood. The chapters cover sensitive topics such as physical injury, pain, harm, and women’s agency. Drawing on the stories of over seventy amaXhosa men, the book provides rare insight into circumcision and psychotic experience.

amaXhosa Circumcision
Stories of Manhood and Mental Health

Lauraine M. H. Vivian
Series: Routledge Studies in Health and Medical Anthropology


This book investigates amaXhosa circumcision and the
psychological processes involved. Lauraine Vivian employs concepts such as resilience, orthodoxy, broken men, and reciprocity to examine the experiences of men who have developed mental health issues in relation to their initiation into manhood. The chapters cover sensitive topics such as physical injury, pain, harm, and women’s agency. Drawing on the stories of over seventy amaXhosa men, the book provides rare insight into circumcision and psychotic experience.

This medical humanities paper describes our qualitative research into pathways to care and informed consent for 10 children who had cardiac surgery in the Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Our multidisciplinary team consists of cardiologists, anthropologists, a social scientist and a general practitioner in two sites, South Africa and Australia. This paper builds on our first publication in a specialist cardiology journal on a ‘qualitative snapshot’ of these children’s life stories from 2011 to 2016 but turns to the medical humanities to explore a concept of ‘uncertainty’. Data analysis revealed that for the children’s parents and doctors, ‘uncertainty’ underscored procedures. Indeed, the literature review showed that ‘uncertainty’ is intrinsic to heart surgery and was integral to Barnard’s first heart transplant in Cape Town in 1967. We demonstrate that in meeting the challenges inherent in the ‘uncertainty dimension’, doctors established greater ‘medical certainty’about each operation. This happened as they encountered the difficult clinical and biopsychosocial factors that were fundamental to the diagnosis of children’s cardiac defects. It was doctors’ translation of these decision-making processes that informed parental decisions and described why, despite feelings of uncertainty, parents signed consent. To visually describe heart surgery in this locality we asked the South African photographer, Guy Neveling to record some children undergoing echocardiograms and surgery. These photographs qualitatively demonstrate what medical certainty entails, and parents’ trust in doctors and surgeons, whom they knew had ‘reasonable certainty’ that their child’s ‘heart is worth saving’.

To elicit South African medical students' experiences of witnessing patient rights abuses and professional lapses during their clinical training in order to inform an appropriate and effective response. During June and July 2009 at the University of Cape Town Faculty of Health Sciences, the authors surveyed 223 fourth-, fifth-, and sixth-year medical students in selected clinical rotations concerning abuses they had observed. Volunteers were later interviewed individually. The authors coded interview transcripts for key themes using a constant-comparative grounded theory approach. Of 223 students surveyed, 183 (82%) responded, 130 (71%) of whom reported witnessing patient rights abuses and professional lapses, including physical abuse (38%), verbal abuse (37%), disrespect for patients' dignity (25%), and inadequately informing patients about their treatment (25%). Students attributed abuse to stressed health workers, overburdened facilities, and disempowered patients. Most students who witnessed abuse (59%) did not actively respond, and 64% of survey respondents felt unprepared or uncertain about challenging abuses in the future. Interviews with 28 students yielded detailed accounts of the abuses witnessed and of students' emotional reactions, coping strategies, and responses. Most students did not report abuses; they feared reprisal or doubted it would make a difference. This study demonstrates the disjunction between what these students were taught about human rights and ethics and what they witnessed in clinical settings. The high prevalence of patient rights abuses experienced by these students highlights the need to align medical ethics and human rights with medico-legal protocols in theory and clinical practice.

Primary health care (PHC) is an equity-driven approach to health care that formed the foundation of South African national health policy under the new democratic government in 1994. In August 1994 the Faculty of Medicine (later renamed the Faculty of Health Sciences) at the University of Cape Town (UCT) adopted a policy on the PHC approach in order to equip its graduates with the values and skills necessary to meet the changing demands of the new national health system. This policy committed the Faculty to make the PHC approach central to its teaching, research, clinical service, and engagement with communities.

To elicit South African medical students' experiences of witnessing patient rights abuses and professional lapses during their clinical training in order to inform an appropriate and effective response. During June and July 2009 at the University of Cape Town Faculty of Health Sciences, the authors surveyed 223 fourth-, fifth-, and sixth-year medical students in selected clinical rotations concerning abuses they had observed. Volunteers were later interviewed individually. The authors coded interview transcripts for key themes using a constant-comparative grounded theory approach. Of 223 students surveyed, 183 (82%) responded, 130 (71%) of whom reported witnessing patient rights abuses and professional lapses, including physical abuse (38%), verbal abuse (37%), disrespect for patients' dignity (25%), and inadequately informing patients about their treatment (25%). Students attributed abuse to stressed health workers, overburdened facilities, and disempowered patients. Most students who witnessed abuse (59%) did not actively respond, and 64% of survey respondents felt unprepared or uncertain about challenging abuses in the future. Interviews with 28 students yielded detailed accounts of the abuses witnessed and of students' emotional reactions, coping strategies, and responses. Most students did not report abuses; they feared reprisal or doubted it would make a difference. This study demonstrates the disjunction between what these students were taught about human rights and ethics and what they witnessed in clinical settings. The high prevalence of patient rights abuses experienced by these students highlights the need to align medical ethics and human rights with medico-legal protocols in theory and clinical practice.