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Brenna Marshall

Gligorije Rakocevic

Ahmed Alhashmi

Mohammed Al Khalifa

Saif Alhajri

South Africa: Weekly Report #4

South Africa has one of the most diverse cultures in the world an aspect which has the country the name “Rainbow Nation”. The diversity in languages has seen the country recognized eleven official languages bringing vibrancy into the diversity. Some of the dominant cultures are among the Khikhoi, the Zulu, the Zhosa, the Shagaan, the Nedebele and the Sotho, among other cultures. A majority of South African are still inhabiting the rural parts of the country where they lead an impoverished life. Notably cultural traditions survive the most among the rural inhabitants. While English and Afrikaans are the common languages among the urban populations in South Africa, the native languages also prevail in urban settings. Despite the recognition of over ten official languages, some languages and traditions such as the Khoisan are endangered and only spoken by a few people (South African Culture, Customs, and Traditions, 2018).

Notably, many members of the middle class in South Africa who include both white and people of color lead lifestyles and cultural style similar to those in Europe and North America. There is also the Indian South African’s who have preserved their own cultural heritage and religion by practicing Islam, Hinduism or Christianity. The heterogeneous South African culture is characterized by a common cuisine which is heavily meat-based and the distinctively South African gathering called Braai. Maize and Indian foods such as Curry are also common cuisines in South Africa. The periperi is also common among the Portuguese community. Thus, the South African has been influenced by different cultures as a result of immigration creating more diversity in Art, Music, and Cuisine among other aspects (Defining culture, heritage, and identity, 2017).

Culture is the framework that influences a group of people’s behaviors and beliefs towards certain aspects of life. Accordingly, culture also influences the health practices of a population causing them to exhibit variations in health articulation. Medical practitioners acknowledge the fact that cultural beliefs have a significant role in how health practices are undertaken. Cultural views affect people’s beliefs about disease, means of treatment, and health practices. For instance, in South Africa, there are multilingual cultures that express their need for medical care in varying ways. However, one specific culture is common among the general population; there is a tendency of neglecting pain among individuals with an illness. Individuals rarely communicate about pain in South Africa leaving practitioners with the task of finding other symptoms of a disease. In South Africa, it is a cultural norm for individuals to face all body pain in two ways; quiet endurance or verbal complaint. As a result, the patient’s ability to cope with pain in South Africa is heightened due to their silent resilience. The poor communication of pain among South African patients has become so widespread that even school-going children are adopting the culture. In order to understand the role of culture in the health practices of South Africa, evaluation of the culture-bound syndromes in their specific societies must be done.

Culture-bound syndromes refer to a number of psychosocial features that are observable among a group which is bound by special relationships in their location setting. Culture-bound syndromes are classified according to common signs and symptoms shared by cultural individuals. In South Africa, the culture-bound syndrome identifies pain as normality in human beings that should not be a cause for alarm within the specific region. Most individuals accept the pain as normal and hardly report the symptom, which could be exhibiting itself due to a developing ailment. Children with mental health problems such as severe cerebral palsy are greatly affected by this culture-bound syndrome (Johnson, Nilsson & Adolfsson, 2015). The lack of communication between children with mental illness in South Africa has seen many school-going children tolerating pain as a daily experience. The children may have communication difficulties but the inability to raise alarm when facing such anguish makes the non-Western disorder a dangerous culture-bound syndrome. Since South Africa has many cultures, it is believed that the individuals displaying the kind of tolerance for pain described above are from the Afrikaner culture. Non-white South Africans prefer seeking treatment from traditionalists while the English-speaking South Africans prefer Western treatment. The variations in these subgroups reveal that culture-bound syndromes do exist for special classifications of people in living within similar limitations.

Healthcare providers need to be constantly aware of the culture-bound syndromes in various localities because they influence how people articulate disease-diagnosis and treatment. Among the South African ethnic groups with deep Afrikaner cultures, patients will hardly seek a timely diagnosis of disease due to their high tolerance for pain, which impacts the healthcare plan (Nortjé & Albertyn, 2015). The individuals will constantly endure pain and rarely seek medical attention from professionals until the condition becomes devastating and too much to bear. Although pain is not culture-based, the endurance of pain among the Sotho and South African Nguni is a culture-bound syndrome. Preconceived ideas about the normality of pain in South African cultures influence how people in distress seek medical care during the early stages of an ailment. The seemingly high pain endurance has led the health practitioners in the country to seek other ways of interpreting pain and distress within the population. School professionals concerned about the wellbeing of children with cerebral palsy went ahead to introduce augmentative and alternative communication (AAG) techniques (Johnson, Nilsson & Adolfsson, 2015). There seems to be a great necessity for health professionals in South Africa to identify pain-related vocabulary among multilingual groups in order to conduct a timely diagnosis of ailments.

From the interpretation of the lack of direct communication among numerous subgroups in South Africa, alternative communication methods identified include; body expression, non-verbal signs, and behavior change. In South Africa, culture is not static due to the movement of people and multiple interactions with Western health professionals. Westernization in South Africa has seen several Afrikaner cultures become receptive to western medical treatment. Similarly, the level of exposure among subgroups living in the urban areas of South Africa has enabled the adoption of numerous Western medical practices (Nortjé & Albertyn, 2015). However, there are those individuals still operating within their culture-bound syndrome and completely resistant to foreign medical procedures. There is a strong belief among some individuals that only their traditional healers understand the condition affecting people in their specific location. Caution should be taken in this setup to ensure that proper diagnosis and treatment is presented in both scenarios. The final choice on whether to seek medical treatment from Western medical practices or traditional healers still stands with the individual patient after considering several factors. Controversy still exists on how unique cultures adopt special medical attention and support from different alternatives based on availability and exposure of the specific subculture. In most regions, culture-bound syndromes exist in health systems that remain foreign to the population causing them to mistrust it and trust their own unique ways. Variations within a culture also influence their receptiveness towards health practices. It is, hereby, very important for health practitioners to understand the culture-bound syndromes of the region they serve so as to conduct timely diagnosis and provide the essential treatment at all times.

The Health Belief Model (HBM) is a primarily used to guide health promotion and disease prevention programs. In South Africa, risky sexual behaviors have lead to the biggest HIV and AIDS epidemic in the world (AVERT, 2017) There are approximately 7.2 million people living with HIV in South Africa (AVERT, 2017) . In order to promote safe sexual behaviors and reduce the prevalence of HIV and AIDS in South Africa, the HBM has been used to understand HIV-risk behavior.

The HBM is based on the belief that a person's willingness to change is based on the perceived susceptibility, perceived severity, perceived benefits and perceived barriers. Perceived susceptibility refers to the idea that people will not change their health behaviors unless they believe they are as risk. Perceived severity refers to the probability that a person will change their health behaviors to avoid a consequence depends on how serious they consider the consequence to be. Perceived benefits is whether or not there it something in it for them for not. Last but not least, perceived barriers are one of the main reasons people do not change their behaviors because they think it might be physically or socially difficult or because it may cost time, effort and money.

In South Africa, 90% of South Africans knew the severity of HIV and AIDS, but even then the methods of transmission and ways to prevent HIV and AIDS were unknown. Many people in the this particular study believed that they were not susceptible to the disease and only 20% perceived a high risk (Eaton, Flisher and Aarø, 2003). Most South Africans had very wrong ideas on prevention methods. Some misconceptions South Africans had about prevention were that hormonal contraceptives and intrauterine contraceptive devices offer protection against HIV infection, or that the same condom may be used more than once (Eaton, Flisher and Aarø, 2003). As for perceived benefits, many young men felt that refraining from sex leads to poor health and that it keeps people from showing their ability to procreate, or reproduce. Traditionally, young South African men feel they have to “prove their virility” by being fathers to children, and South African women feel they have to “prove their love and fertility” by having babies (Eaton, Flisher and Aarø, 2003). Lastly, some potential barriers that South Africans face are negotiating condom use because it is often an awkward conversation. Another barrier is male-dominated relationships. In those relationships it is common for men to be violent towards their female partner, and physically force them to have sex with them. Peer pressure for both men and women to have sex, lack of adult support, lack of resources, lack of access to the media and recreational facilities and poverty are all barriers that may keep people from practicing safe sexual behaviors (Eaton, Flisher and Aarø, 2003).

In order to “cue action”, accelerated prevention is the main priority now. Although there has been a very slow start, South Africa has made huge strides to controlling the epidemic (Maurice, J. 2014). South Africa is now financing its own AIDS program through domestic resources and currently invests $1 billion per year on AIDS programs. The Emergency Plan for AIDS Relief has also played a big part in controlling the epidemic (Maurice, J. 2014). By educating the communities about the risks, benefits and providing solutions to overcome barriers, South Africa is making huge improvements in declining the rates of HIV and AIDS. For those who have already been diagnosed 90% are aware of their HIV status, which 68% of those are being treated and of those 68% being treated, 78% are virally suppressed. The hope it to progress each of those 3 categories towards 90 90 90 targets (AVERT, 2017).

Resources:

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https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/south-africa

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Social Science & Medicine, 56(1), pp.149-165.

Johnson, E., Nilsson, S., & Adolfsson, M. (2015). Eina! Ouch! Eish! Professionals’

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