Southern Sudan Medical Journal: Vol 15 No 3

Dear reader,

The August issue is online here. See details below.
 
SSMJ is now included in the EBSCO scientific research collection. Our articles are also listed in  African Journals Online (AJOL) and the Directory of Open Access Journals (DOAJ) as well as on our website.
 
Questions:
Could you contribute to SSMJ by:

• Sending items for future issues: e.g., research, case studies, news, photos, and/or letters?
• Helping to edit or peer review articles?
• Suggesting topics relevant to health professionals in South Sudan?
• Sharing SSMJ with colleagues and sending us their feedback?

Write to us at southsudanmedicaljournal@gmail.com
 
Thanks to everyone who supports SSMJ - authors, editors, and especially our peer reviewers.

In this issue

EDITORIAL

• Eye care in South Sudan Kenneth Lado Lino Sube

 
RESEARCH ARTICLES

• Prevalence of glaucoma among patients attending Buluk Eye Centre, Juba, South Sudan: a one-year study Kenneth Lado Sube et al
• Social demographic determinants of male participation in antenatal care in Nyamagana District, Tanzania Sarah M. Chamos, Alen Kinyina, and Harrieth Mtae
• Prevalence of HIV among pregnant mothers receiving antenatal care at Kator Primary Health Care Centre, Juba, South Sudan Kon Paul Alier et al
• A survey of tonsillectomy care patterns in Tanzania Daudi Ntunaguzi et al
• Musculoskeletal disorders among patients during a one-day outreach at Juba Military Hospital Mapuor M.M. Areu et al

 
MAIN ARTICLE

• How to use experience to improve teaching practice Rich Bregazzi

 
CASE REPORT

• Lower back musculoskeletal hydatid cyst: a rare presentation in a South Sudanese patient Lodu Swokiri N Kuju et al

SHORT COMMUNICATIONS

• “How-to” Teaching Videos–inspired by work in South Sudan Deborah Van Dyke
• Role of the community pharmacy in the control of pandemics in South Sudan Oliver Batista Ugoro
• Profile of the Department of Paediatrics and Child Health, Al-Sabbah Children’s Hospital, Juba, South Sudan Amanda Billy Berto Madison

OBITUARY: Dr Frederick Khamis Tawad
BACK COVER: WHO: Recovering from Monkeypox at home
 

The SSMJ team
Email: southsudanmedicaljournal@gmail.com
Website: http://www.southsudanmedicaljournal.com
Follow us on Twitter@SSMedJournal and Facebook

August 2022 - Journal of Health Care for the Poor and Underserved

To JHCPU readers,

 

The August 2022 issue of the Journal of Health Care for the Poor and Underserved (JHCPU) has been released:

https://muse.jhu.edu/issue/48370

The Note from the Editor appears below. Following the link will bring you to the full table of contents.

With best wishes for the new academic year,

Ginny Brennan

 

Note from the Editor

Public Health and Politics

Positioned at the nexus of social science and health, the Journal's work is necessarily political. One of the many concerns in the U.S. as we approach the Fall of 2022 is the U.S. Supreme Court's June decision in Dobbs v. Jackson Women's Health Organization to overturn Roe v. Wade and with it the Constitutional guarantee of the right to abortion, abrogating women's moral autonomy over their reproductive health. In this issue, Frohwirth and colleagues consider another contested site in the reproductive health care landscape—contraception affected by abortion policy—as they assess the impact on women in Iowa of a 2017 reduction in Medicaid coverage of contraceptive care. Due to the new law, patients enrolled in the state family planning program could no longer access subsidized care at publicly funded clinics affiliated with abortion provision, and over 15,000 patients had to find to find a new family planning provider. The researchers learned in their qualitative study that high fees for visits and contraceptive methods, restrictive or inadequate insurance coverage, and access barriers such as long appointment wait times were the most common barriers to preferred contraceptive care, and these barriers compounded one another. Furthermore, barriers grew once the more restrictive Iowa Medicaid policy was in place. The authors conclude that policy changes supportive of contraceptive care would decrease vulnerability and increase reproductive autonomy.

Several papers in this issue bear on the construction of datasets or use datasets in new and sophisticated ways. We publish them aware of the fact that database construction is central to many highly political debates. Qato and colleagues introduce an intermediate-level variable—the nursing home—into an analysis of the distribution of COVID19 vaccination among nursing home residents. Looking at over 12,000 nursing homes in terms of the racial heterogeneity of the residents, the authors find that residents of the quantile of homes that were more predominantly non-Hispanic White were significantly more likely to be vaccinated (mean vaccinated 85.65%) than residents of the quantile that was least predominantly non-Hispanic White (mean vaccinated 72.74%). The authors of this short article conclude, "A higher proportion of White residents per facility was associated with higher resident COVID-19 vaccination rates reflecting continued disparities in quality of care during the pandemic."

While it is not construed formally as a variable, the construct of neighborhood in the paper by DiFiore and colleagues reveals significant patterns in the distribution of food insecurity. They assess food insecurity in relationship to perceived neighborhood safety, social cohesion, informal social control, and crime, adjusted for demographics, socioeconomic status, and neighborhood characteristics. The participants in the study were 300 mothers and female caregivers of Medicaid-enrolled two- to four-year old children in Philadelphia. Greater food security was associated with higher perceived neighborhood safety and social cohesion, and lower police-recorded violent crime rates. The evidence of this research suggests that the structural condition of living in a supportive neighborhood social environment may protect against food insecurity.

Kong and colleagues conducted COVID19/food security research, using longitudinal data to assess the interrelationships among food insecurity, mental health, and the COVID19 pandemic. They found that food insecurity was associated with stress, depression, and anxiety. They also found that these conditions improved over time during the pandemic among food-secure participants but worsened among food-insecure participants. The pandemic appears to worsen the already vicious cycle connecting food insecurity and mental health.

Two papers based on the Youth Risk Behavior Survey (YRBS) argue for enriched variables for coding race and ethnicity. Jones and Satter analyze mental health outcomes based on race and ethnicity and, in doing so, they observe that over 80% of respondents to the YRBS who self-identified as American Indian/Alaska Native also self-identified as Hispanic. American Indians/Alaska Natives are often multi-racial and of Hispanic/Latino ethnicity, and therefore outcomes differ widely depending on whether one examines American Indian/Alaska Native alone or in combination with other racial/ethnic variables. Also using the YRBSS, Braun and colleagues assessed tobacco and alcohol use and adolescent sexual practices among Black, bi/multi-racial, and White adolescents. They find that results differed across all three groups, leading them to conclude that nuanced racial categories are called for.

It is our hope that these and the many other papers in this quarter's issue—through their attention to social, scientific, and political decisions affecting health and health care—will serve to advance health justice, either through or in spite of the political process.

Virginia M. Brennan, PhD, MA

Editor, JHCPU

Associate Professor, Meharry Medical College

My source:
Spiritof1848 Listserv WWW.SPIRITOF1848.ORG #Spiritof1848

Book review ii "Human Landscapes: Contributions to a pragmatist anthropology"

When I have a book to review I need a hard copy - too much screen already - and while I hope the review is worth the author's and publisher's kind engagement my purpose includes gathering insights and evidence to support the project here.

Back in July I lost this book (OK I fessed up). I've searched ... and must have left it somewhere! This is a great loss.*

Human Landscapes

Thankfully, Roberta forwarded an early pdf, and I'm enjoying an informed and challenging read:

The author's task:

"... only a few scholars have sought to outline a philosophical anthropology through a pragmatist lens." p.8.

Distracted, as ever, I'm making progress and can see an author who is:

- embodied, embedded, enacted, and extended (p.7) - in this subject matter.

I'm going backwards from post i, but I commented on this:

"Even if Michael Quante’s proposal is not grounded in Pragmatism, I agree with his claim that, in order to be pragmatistic, a philosophical anthropology should assume that each concept or theory requires questions like: “How is this related to human action? What place does it have in the context of our
actions? (2018, 22)." p.15.

In the context here, this is precisely the role of Hodges' model, at the conceptual level - placement in the care domains, and in theory, care approach (context), philosophy. I like Dreon's focus on evaluation too, and the fact that an example is the impact of COVID on education and the resort and reliance of online learning.

Dreon concentrates on the organism and the environment (a key debate) from across the literature, and discusses concepts that are notoriously problematic, terms like, sensibility, and human nature.

"The situation is particularly complex because, evidently, this is not a merely
theoretical issue; rather, it has serious existential implications, both moral
and political." p.17.

Reading, I instantly thought of the social determinants of health [SDoH], moving away from reductive explanations. But the SDoH are precarious in the extent to which they will affect policy, and give rise to specific metrics - similarly to the sustainable development goals [SDGs]. These have a pragmatic and clearly anthropocentric quality about them. As Dreon notes the oppositions and dichotomies (very quickly as per post i) these policies 'light up' the humanistic domains. As health professionals and educators we can shout, warm, warmer, colder ... to the policy makers (and currently the 'purse' holders).

A 'good' book reassures you about what you've read - Whorf, time, Hopi; but also points to what you might like to read:

"In his entry for the Encyclopaedia, Dewey claims that isolating
the allegedly native and original constitution of human nature is possible
only through the assumption of a static point of view on it, for example,
by privileging features at birth over traits characterizing the intrauterine
past or the organism’s future development and adulthood." p.19.

Bubbles: Spheres I by Peter Sloterdijk, Wieland Hoban (Translator) - my emphasis above.

My .pdf copy is littered with comments where I (inevitably) read evidence in support of h2cm. I don't want to dilute Dreon's purpose, which is comprehensive (for me) in referencing and critical analysis of the latest thought. But if Roberta and Suny Press will (please) forgive me for losing the hard-copy hopefully they can see why I draw attention to the following:

"Grene was very careful to avoid reducing the relationship between biological factors and culture to causal dependence: she preferred to speak of a widespread dependence of sociocultural life on biophysical reality and to consider the relation as an “anthropological circle” (Peterson 2010)." p.24.

 INDIVIDUAL

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 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

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GROUP

sustainable mindset (volunteered - incentivised)	"biophysical reality"
"sociocultural life"	circular economy

There are many circles, not just at work, but circles that need to work.

More to follow - as I pick up speed ...

Dreon R. (2022) Human landscapes. Contributions to a pragmatist anthropology. Suny Press, Albany.

https://sunypress.edu/Books/H/Human-Landscapes

*Looking at the photo, the table looks like a Booths cafe? I have phoned them and elsewhere - no joy. :-(

The paradox of Service Vs Person-Centred Care

Looking at Hodges' model and its basic structure of axes and care (knowledge) domains, I wrote a note to the effect that:

- the INTERPERSONAL (INTRA-) and SCIENCES domains are fundamental to individual care. 

This follows, of course, from the vertical axis.

Then I added, that the SOCIOLOGICAL and POLITICAL domains are fundamental to person-centred care.

 

Person-centredness is vested, is realised in and by the care domains that involve concepts mediated and related by the group, the collective.

 

There seems a (strong?) recognition of social justice and justice at work.

INDIVIDUAL

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 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

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GROUP

individualised	individualised
person-centred	person-centred

Perhaps this is the implicit origin of the call to new learners and professionals alike to 'Make a Difference', 'Be the Difference'?

Then I thought of the perennial duality of service-centred and person-centred care.

 

Accepting the idealised nature of these thoughts, when 'presented' with a case, health services - through their practitioners, focus on the individual. The individual may express personal choices, hopes, but the extent to which these garner a response, are acted upon, also depends on the SOCIOLOGICAL and POLITICAL domains. 

In terms of the ideals (that apply, and what I will call upon) there are two extremes - I have mentioned previously, consider:

In the triage situation, apart from establishing consciousness - communication and interpersonal are collapsed into seconds, and response to stimuli / pain, communication is not key. Task orientation, practice, procedure, events, rehearsal, stock and equipment checks are to the fore.

 

Alternately, there is the level of interpersonal skills that are exercised to communication with the patient, to learn of, recognise, and respond to their personal choices.

 

All of a sudden things seem to be reversed.

 

Short of being plain wrong (?) -

THIS seems powerful, essential and required medicine for the 21st century.

service	SERVICE
person	PERSON

It is even more nuanced, however, and I'm not trying to clever (mathematics and logic are definitely not my subject), but making the above easier to describe:

s	S
p	P

Above, I'm trying to suggest and represent:

1. A lack of regard and relative neglect of the humanistic domains [ s AND p ];
2. This is then reflected in the ongoing issues of parity of esteem for mental health, illness and psychological interventions [ s OR S ].

In #1, we can add the UK decade long, debacle of funding for social care and the status and recognition of the workforce; the legacy (lessons) of medical sociology and the potential of attention to the social determinants of health and the sustainable development goals (paper to follow mapping the SDGs to h2cm).

The [ S AND P] in the SCIENCES and POLITICAL domains - might (also) be indicative of the continuously espoused benefits of technology as part of health care delivery. While accessibility and improvements in this are emphasized, often Politically people are isolated due to lack of technology, or funds. There remains a SOCIO-technical divide.

The years to follow, will no doubt see the microscope from the SCIENCES placed in the humanistic domains and technology's impact - benefits examined there. Who knows: maybe a new instrument, simultaneously (transdisciplinary) qualified will be found?

Conclusion that might be drawn:

The bio-psycho-social model is insufficient for person-centred care (having an opportunity, then yes - I would say this).

The overall aim and objective of Hodges' model when applied, is not to tick boxes but to diffuse the disciplinary boundaries, to assure, and integrate.

More to follow... (a paradox?)

Memo: Understanding the difference between 'self-care' and 'SELF-CARE'

As we learn in infancy, run into physical structures and it hurts. The presence of structure in this case clearly has impact - not just literally - but globally.

While for me, the model is a constant, I'm constantly surprised by the 'work' that its structure, the two axes - can do from the initial - blank - template (empty set):

 

UK does deal with Nepal to bring in nurses to plug holes in staffing - despite Nepal being on a global red list for recruitment because of its own nurse shortages https://t.co/jSPTQmodLr

— Shaun Lintern (@ShaunLintern) August 23, 2022

 

 INDIVIDUAL

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 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

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GROUP

self-care 'understanding'	self-care (emphasis [again] on task-oriented care?)
SELF-CARE Social Care	SELF-CARE Code of Practice for International Recruitment 'Red List' NHS Workforce Planning, Recruitment and Retention, Pay, Terms and Conditions Local, National, Global 'jobs' market 'Memorandum of understanding ...' 'Selflessness' [here?]

WHO Global Code of Practice on the International Recruitment of Health Personnel: Fourth round of reporting:
https://www.who.int/news/item/02-06-2022-who-global-code-of-practice-on-the-international-recruitment-of-health-personnel--fourth-round-of-reporting

Code of practice for the international recruitment of health and social care personnel in England
Updated 22 August 2022:
https://www.gov.uk/government/publications/code-of-practice-for-the-international-recruitment-of-health-and-social-care-personnel/code-of-practice-for-the-international-recruitment-of-health-and-social-care-personnel-in-england

Memorandum of understanding between the UK and Nepal on the recruitment of healthcare workers:
https://www.gov.uk/government/publications/memorandum-of-understanding-between-the-uk-and-nepal-on-the-recruitment-of-healthcare-workers

Ten-fold increase in nurse recruitment from "red list" countries, RCN:
https://www.rcn.org.uk/news-and-events/Press-Releases/ten-fold-increase-in-nurse-recruitment-from-red-list-countries

c/o HSJ @ShaunLintern

Agile Visualization with Pharo: Normalizers

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 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

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GROUP

shapes?	normalization SHAPES
shapes? normalization	shapes?

Agile Visualization
with Pharo

"Normalizers: Shapes may be shaped and colored in a meaningful way to represent attributes and properties of the objects represented by the shapes." p.49.

Bergel, A. (2022). Overview of Roassal. In: Agile Visualization with Pharo. Apress, Berkeley, CA. https://doi.org/10.1007/978-1-4842-7161-2_5

ii The Jubilee Centre Framework for Character Education in Schools - 3rd edition

Some thoughts on the previous post ...

Regards, "Character is fundamental: it is the basis for human and societal flourishing;" and "Character is sought freely to pursue a better life;" p.7.

While education is rivalrous - character education is - should be non-rivalrous?

Philosophers have and continue to debate the meaning of 'success', 'good', and related concepts. At a time when students will be acutely aware of the socio-economic transformations needed to accept environmental limits and re-shape the global economy; the provision of tools for reflection, critical thinking, problem solving and 'Being well' should not be a constraint.

There is - must be - a place for a tool that invites, facilitates and rewards conceptual exploration, vocabulary development and the personal and social development that can follow.

Caught, Taught and Sought - are memes still a 'thing'? 

Hodges' model clearly has a hold here. 

Perhaps, you can embrace it too?

It is encouraging to see how character education draws in PSHE, Citizenship, general studies and more. We should not just acknowledge the role of the humanities in a well-rounded education, but as we turn-the-stones let's be aware of the corners too.

Here in the UK students study for O-Levels, A-Levels, T-Levels, BTEC and more. The government's policy to level up - demands that in education we run the gamut of the alphabet and much more. 

Given the global scope of education (usually*), with Hodges' model a product of Manchester Polytechnic now Manchester Metropolitan University, there are strong links between the healthcare sector, education and research - hence the sciences. The question now concerns the nature of these links. I feel they are bound to be strengthened. Even within healthcare, medicine, nursing and the allied health professions - on-the-ground it appears there is a need to do more to effect positive change through the sustainable development goals and not just draw attention to the social determinants of health, but to determine how we can act on them.

*https://theirworld.org/

University of Birmingham 2013, 2017, 2022
ISBN: 9780704429789
https://www.jubileecentre.ac.uk/527/character-education/framework

Cover image:

https://www.researchgate.net/publication/362745797_The_Jubilee_Centre_Framework_for_Character_Education_in_Schools_3rd_revised_version 

Schoolboy's guilt after controversial goal 50 years ago in Wirral football game finally put right:

ITV hub - https://www.itv.com/news/granada/2022-08-27/50-years-of-extra-time-for-schoolboy-football-match

 

 

The Jubilee Centre Framework for Character Education in Schools - 3rd edition

'The aim of our studies is not to know
what virtue is, but to become good.'
                                              
                                                 Aristotle

"WHAT CHARACTER EDUCATION IS

Character is a set of personal traits or dispositions
that produce specific moral emotions,
inform motivation, and guide conduct.

Character education includes all explicit and
implicit educational activities that help
young people to develop positive personal
strengths called virtues." p.7.


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GROUP

CHARACTER VIRTUES: Intellectual; Moral; Civic, and Performance Caring for and respecting others, as well as caring for and respecting oneself Positive psychology, mental health VIRTUE Literacy i-iii: ‘Perception’; (ii) Virtue ‘Knowledge and Understanding’; and (iii) Virtue ‘Reasoning’. - emotional literacy, judgement Improved attainment, better behaviour Direct teaching of character provides the rationale, language and tools to use in developing character elsewhere in and out of school. p.7. EMOTIONAL

Character is sought freely to pursue a better life. 'Success' in each domain ... Build - virtue literacy Character is educable: it is not fixed and the virtues can be developed. Its progress can be measured holistically, not only through self-reports but also more objective research methods. p.7. Character can be - Caught... ...through a positive school community, formational relationships, and a clear ethos. Taught... ...through the curriculum using teaching and learning strategies, activities, and resources. Sought... ...through chosen experiences that occur within and outside of the formal curriculum. p.12.

CONTAGION Belonging to, participating in - a school community Common good Role-modelling Flourishing societies [Address: Social Determinants of Health]* partnership with parents, families caring for and respecting others, as well as caring for and respecting oneself

Civic Citizens Committed leadership Increased employability, empowering, and liberating partnership teachers, employers, and other community organisations Each child has a right to character education

"Practical Wisdom (phronesis) is the integrative virtue,
developed through experience and critical reflection, which
enables us to perceive, know, desire and act with good sense.
This includes discerning, deliberative action in situations
where virtues collide." p.9.

University of Birmingham 2013, 2017, 2022
ISBN: 9780704429789
https://www.jubileecentre.ac.uk/527/character-education/framework

*Some thoughts to follow, to include on SDoH, and SDG.

Africa Re-Imagined

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GROUP

Dipo Faloyin Africa Is Not A Country Breaking Stereotypes of Modern Africa	Astrid Madimba, Chinny Ukata IT’S A CONTINENT
Socio-Economic and Cultural progress ...	Olúfẹ́mi Táíwò Against Decolonisation Taking African Agency Seriously

Owolade, T. (2022) Africa reimagined, FT Weekend, Books Life&Arts, 23-24 July, p.8.

Image 'IT'S A CONTINENT'

https://www.waterstones.com/book/its-a-continent/astrid-madimba/chinny-ukata/9781529376784

The dimensions and directions of self-care

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SOCIOLOGY  :   POLITICAL 

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GROUP

Mental capacity Personal autonomy My choice Subjective (lived-) experience Quality of (my) life Mood - mental state (assessment) Psychic pain - trauma Expectations - 'desired outcome' Can't keep a job "If it's all in my head - that's what one of the doctors said - I said, if it's an imaginary pain, how is the swelling there?" Nick	Physical pain - cause not identified Injury - trauma: history - playing football Goalpost collision - snapped - posterior cruciate ligament 28 years ago On feet leg swells Leg amputation 'best' option Twelve operations to date - Still in constant pain Clinical experience specialists, advice Guidance Evidence base Aggregated outcomes
Brown Housebound for days Feels guilty - holding family back Living pain-free ... would be a "New lease of life" Experience & expectations of family, friends .. Holiday, spoke to a veteran four years ago ..	Fundraising Mental Capacity Act Medical accountability Professional opinion - general outcomes NHS - "no" - 'Cosmetic'? Pain management (clinics)? Private operation £18,000 'desired outcome'

Chappell, P. Injured man fundraises for own leg amputation, The Times, August 10, 2022, p.19.

https://thetimes.pressreader.com/article/282080575609624

Liminal spaces I & II c/o Nan Mulder

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'A Liminal Space II' 21×48 cm mezzotint 2022	'A Liminal Space I' 21.5×48 cm mezzotint 2022

Learning, starting a course of study at whatever stage in life is often likened to a 'journey'. The term liminality is applied to this experience, with its spiritual and transformative connotations, an education rite-of-passage; also specifically in reference to threshold concepts:

https://www.ee.ucl.ac.uk/~mflanaga/popupLiminality.html

Images with thanks to Nan Mulder:

https://www.nanmulder.com/

See also: 'periplus'.

My source: Printmaking Today Summer 2022, 31:122, p.7.
https://www.cellopress.co.uk/page/printmaking-today

(Thanks also to Cello Press - looking f/w to 2023 issues.) 

 

Shining a light on Dark Patterns

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GROUP

PERSONAL DATA^	PERSONAL DATA DATA, DESIGN BIOMETRICS^ PERSONAL DATA  DARK   PATTERNS
PERSONAL DATA*	CONTROL TECH GIANTS TRANSPARENCY LAW CONSUMER PROTECTION ...

*And the data of family members.
^Data that is specific to an individual, organic, can include fingerprint, facial images, DNA, behaviours (including keyboard use, online).

Prompt: Mention of 'dark patterns' on BBC World Service promoting their tech coverage.

Previously: 'interface(s)'

"Suffering in Silence" c/o David Robertson

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Suffering in Silence, 2018. Woodcut, each 2000 x 910 mm. Installation: 2400 x 5500 x 5500 mm

"David Robertson’s immersive print installation explores the stigma around mental health and the difficulties men have in reaching out for help. Consisting of 25 life-sized men, the figure is a self-portrait but is representative of any man. Formed of tally marks, each mark representing an individual." ...
[my emphasis].

The Holburne Museum:
https://www.holburne.org/events/holburne-open-david-robertson/

Image: With thanks to David Robertson

David Robertson
www.davidrobertsonprintmaker.com
QEST Scholar
Instagram.com/multiple_of_one 

My source: Printmaking Today Summer 2022, 31:122, p.7.
https://www.cellopress.co.uk/page/printmaking-today

True (group) therapy for the masses ...

Draft thoughts ...

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GROUP

 

 SPIRITUAL

MENTAL MAPS PSYCHO-THERAPIES	MAPS PHYSICAL-THERAPIES
SOCIAL THERAPY?	POLITICAL THERAPY?

SITUATED - META-COGNITION

'Social therapy' is very much a thing - an invaluable therapy and intervention for patients / clients and  option for the multidisciplinary team. In form it may differ from the social therapy, industrial therapy encountered in 1977, with occupational therapy. Today, can I suggest that it has been diminished? Even as (in the UK) we have social prescribing, and very welcome it is too.

I still wonder if social therapy has been tainted politically, by its proximity to community?

Back in the 80s ... 90s ... I remember the mini-bus arriving with day care patients, people who had attended for years. Dependency was often a fact of life, for them, their family, or the choices were stark. and I've seen hints of dependency again. Psychological therapies were not offered as readily back then, and lack of engagement would have been the gate-keeper then and for many patients now. Day care is much diminished now, if provided at all. As a response to dependency, stasis this may not be a 'bad' thing, but what replaced it? How and where did people move on to?

Community, the original home and origin of the forum, the market place, and town crier has been left by successive governments to market forces. Now the High Street footfall is a sepia-coloured snapshot. Passers-by now, can read 'for sale' signs, 'units to let', see shutters, litter, pigeons on their break from 'being' online. The Ubers and e-food delivery enterprises now clog the roads, previously trodden by the clogs themselves (I've been told you could here them outside).

I realise there is a continuum at work here (and as 'group' in h2cm suggests - it does its work). A crossroads, hamlet, village, town, community, neighbourhood - with the exact position of some terms - 'community'  (on the IND-GRP axis) for example, subject to debate. 

The post back in May, concerning an individual therapy - New book: "Talking with a Map"

- has me thinking about the GROUP related domains of SOCIOLOGY and POLITICAL. 

About therapy not individually, but a need to address the idea of therapy at the community level. You might call this a 'root and branch' review, and yes, this is the sentiment. 

It is clearly more than 'levelling up'.

Stepping outside of the boxes (outside of #h2cm - the clinical context ...); this isn't a person with an illness. Neither is it an effort to instantaneously medicalise society (that's another post). The community (UK*) is also not best placed to self-care, to prosper - which would be quite a feat if it were possible.

Back in June, I saw tweet about WHO and the need to strengthen primary care; and the global role for primary care was highlighted in the previous post. I can't find the tweet now, but I think it was a global health call, as so many nations are still developing, even creating primary care.

Here in the UK (USA?) - like the longevity stats - we appear to be going backwards. Therapy here is not going to improve access to primary care, or correct the dental desertification the UK NHS is experiencing.

If I am true to the model - #h2cm - here as displayed above, then there must be group therapy equivalents. Not group therapy in the usual - psychological / psychotherapy - sense, but a real transition from the individual to the group as found in social and political terms. Perhaps, this can be summed up as the need to revisit and re-negotiate the social contract - if it were ever agreed? This is were healthcare and time must coalesce: the past, present and future. Our health systems need to change.

I need to work on this muddle!

*If I may be so bold.

The model is encompassed within situated cognition - meta-cognition and the spiritual.

What does the health workforce need to improve vaccine delivery? c/o Nursing Now

Great question from David Bryden, @FHWCoalition at today's #ImmunisationAdvocacyChampions webinar: What would be your message to your MoH about what the health workforce needs to improve vaccine delivery?#VaccinEquity #COVID19 #Nurses2022 #Midwives2022 @sabinvaccine

— Nursing Now Challenge (@NursingNow2020) August 9, 2022

I have responded to this tweet with its question below - and added the event video:

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

a generic conceptual framework pandemic preparedness and response individual acceptance individual health literacy beliefs unexpressed/non-shared anxiety active listening knowledge & expertise unique stories (person-alised) individual spiritual psychological access	routine immunisation all diseases, pathogens ... pandemic preparedness and response prevention logistics geography - terrain - distance vehicles technology - storage,energy,drones physical access impact of COVID-19 changes - data monitoring
pandemic preparedness and response family, community acceptance story-telling - narrative role models 'community temp' - what will others think, what will they say? More than posters & social media collective spiritual community engagement social access	informs - policy Health Services Nurses, Community Health Workers inequity, equality pandemic preparedness and response activism/advocacy by MoH and workforce funding - economics development counter / awareness of dis- misinformation political access ('real'* choice)

Hodges' model can assist in reflection and critical thinking about interfaces, campaigns, messages and much more.

*not just rhetoric.

Back to basics ...

The "Health Career - Care Domains - Model" created by Brian Hodges' provides:

• a 'springboard' for reflection and critical thinking;
  
• a generic conceptual framework for researchers;
• a model of care for clinicians;
• a generic model / conceptual framework for your local / global research initiative;
  
• and an individual & collective aide-mémoire.
  

Please see lower sidebar for a bibliography. 

peter.jones AT h2cm.info

Progress in Transdisciplinary Times

For about a decade I think ... hold on please! ...

Since October 2011 in fact, and an issue of -

Journal of Evaluation in Clinical Practice, Volume 17, Issue 5

Special Issue: Philosophy of Evidence Based Medicine

- I've carried the concept of 'progress' in my head. I think I picked up this issue somewhere and still have some of its key papers. 

 

Progress is always there in the media, in its obvious forms, technical, education, scientific, social, political, economic, medical; whether or not we agree on the pace, realisation, ethics, extent and contribution to overall well-being. Now, we can also add Earth as the foundational element.

Simon Kuper's 'Opening Shot' in the FT Magazine, 11-12 December 2021 wrote about 'progress' and Thomas Midgley Jr; "often described as the most disastrous peaceable human who ever lived." Responsible for the progressive, at the time, innovations of lead in petrol (to reduce "knocking" in petrol engines), and chlorofluorocarbons - you'll understand that one I think. Kuper notes how:

"Midgley's story illustrates the damage that one brilliant, ambitious, out-of-the-box thinker can do."

Since the early 20th century, we have nuclear fission, biolabs, genetic technology, artificial intelligence, climate change and other 'inventions'. The 'progress' of climate change is catching up with us. Ironic, how the question, after all those millennia remains - can I/We outrun this threat? The problems we face now, we are told, call for transdisciplinary solutions - adding yet more complexity.

Clearly, we need to equip people with the cognitive, conceptual tools to work alternately, in-and-out of the boxes. And, whatever our belief system consider progress in spiritual terms too.

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

progress	progress
progress	PROGRESS

Another thing to return to!

Simon Kuper, Opening Shot, When too much progress is a bad thing. FT Weekend, Magazine, December 11-12, 2021, p.8.

Previously on W2tQ: progress

Back to the Wires

Next week I'm heading back to Warrington (Cheshire, NW England) to work in the community.

A circle of sorts will be closed, as this is where I started in 1977. Heading south on the A49 peddling a 5-speed bike, then motorbike, to my first car [early years framed by modes of transport yet again]. I got booked - a caution (?) for speeding on that bike, one Sunday morning on a 0700 start. Passing the church in Newton-Le-Willows there's a downhill ... you see ...

As a nursing assistant and then from October that year, a student nurse [RMN back then] I heard of the areas, and villages where patients lived, listening and writing the details umpteen times on admission documents. As a 'county asylum' patients were also from a very wide area. Returning as a Deputy Charge Nurse, I witnessed the initial shifts for patients to be resettled, moving closer to their original 'home' as community services expanded and the closure of Winwick was also being planned and subject to debate:

https://edm.parliament.uk/early-day-motion/1935/closure-of-winwick-and-newchurch-hospitals

'Community care' remains an ongoing project.

Being hospital-based I went out on placement with the community psychiatric nurses, but that's a blur of course.

Now for a return visit. Whilst always braced, I'm really looking forward too.

Winwick Hospital:

https://en.wikipedia.org/wiki/Winwick_Hospital

Wire in Warrington: 

https://wmag.culturewarrington.org/local-history/the-wireworks/warringtons-wire-timeline/

Previously: 

https://hodges-model.blogspot.com/search?q=Winwick

"Your metacognitive fingerprint"

 INDIVIDUAL

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 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

"Why are some people more self-aware than others? Studies show that metacognition is a relatively stable trait, so if you tested your metacognition today, it is likely to be similar if you do the same test again tomorrow. Strikingly, it also seems that metacognition is independent of IQ and general cognitive ability: your metacognition can still be in good form as long as you recognise you are performing badly at a task. We still don't understand the origins of these individual differences, but one promising idea is that "explicit" metacognition is something we learn, based on feedback from our parents, teachers and social group. A genetic "starter kit" may establish forms of self-monitoring early in life and then our parents and teachers finish the job. But even in adulthood, these things aren't totally fixed (see main story), so this is one kind of fingerprint you can change." p.38.

finger p r i n t

- with my emphasis.

Fleming, Stephen. The power of self-reflection, New Scientist, 250,3333, 36-40. 8 May. 2021.
https://www.sciencedirect.com/science/article/abs/pii/S0262407921007946

I heard Stephen Fleming on the radio when the associated book was released last year - must buy a copy.

Still reading and enjoying 'Human Landscapes' with posts to follow.

See also: meta- meta- meta- +!

[The CINet] Individual-Level Solutions Have Led Policy Astray

"So, what do you think?

In their journal paper "The I-Frame and the S-Frame: How Focusing on the Individual-Level Solutions Has Led Behavioral Public Policy Astray" (summary here with links to abstract and full paper), two previously self-described members of the behavioural science academic community change their view.

'An influential line of thinking in behavioral science, to which the two authors have long subscribed, is that many of society’s most pressing problems can be addressed cheaply and effectively at the level of the individual, without modifying the system in which individuals operate. Along with, we suspect, many colleagues in both academic and policy communities, we now believe this was a mistake..'

The reasons for this about-face are based around the following:

'Results from [i-frame: individual-focused] interventions have been disappointingly modest.'

'The fact that corporations have spent billions of dollars promoting i-frame interventions in the belief that such interventions will fail should make behavioral scientists uneasy.'"

...

https://www.comminit.com/global/content/cinet-individual-level-solutions-have-led-policy-astray 

 

I don't want this to sound like "Told you so!" but I'm not surprised, even as the literature and media often wax lyrical about 'synergy', constantly about 'integration' and more recently 'population health'.

I appreciate too that having a (cognitive) model is just the beginning. I really admire the practitioners in The Communication Initiative Network and other groups who grapple with funding, policy, recruitment, communication, change and outcomes around the globe.

As efforts continue across health, social care and education ... never under-estimate the relevance of conceptual tools, especially the power of not just one lever - but at least two:

Hodges' Health Career - Care Domains - Model

See also: I-dentity: How the Individual-Group runs...

The Phillips Ives Review

Call to action:  please share widely across your networks.  If you would like our comms pack to promote the review in your organisations in health and social care, please let me know.  

The Phillips Ives Review has launched and will provide evidence and inform strategy; ensuring that nurses and midwives are given access to the knowledge, skills and education required for safe, effective digitally-enabled practice.

We’d like to invite anyone working in nursing or midwifery practice, or interested in this area to share your ideas, case studies and experiences on our engagement platform until 21 August. 

"The Phillips Ives Review was launched virtually on 26 May 2022 by its Chair, Dr Natasha Phillips, Chief Nursing Information Officer (CNIO), NHS England and International Vice-Chair Dr Jeanette Ives Erickson (USA).

This year long in-depth study will identify what is required to enable the meeting of the CNIO NHS England's aims for Nurses & Midwives:

• To ensure nurses and midwives are empowered to practice and lead in a digitally-enabled health and social care system, now and in the future.
  
  
• To ensure nursing and midwifery practice is fully supported by the use of digital technology and data science.

The Review will bring together national and international experts with expertise in nursing and midwifery and beyond, to investigate, critically appraise and make recommendations to ensure the breadth of ambition and scope of future practice of the pre and post registration nursing and midwifery workforce is captured."

My source: FutureNHS - https://future.nhs.uk//home/grouphome

Call for Papers - Basic Needs: Normative Perspectives

Call for papers*

for a special issue on

Basic Needs: Normative Perspectives

(Editors: Lukas Meyer – Daniel Petz – Alessandro Pinzani)

Lessico di Etica Pubblica

http://www.eticapubblica.it/

 

In recent years the debate on basic needs and their place in normative theories of ethics and politics has been rekindled. This controversial concept has finally been openly adopted by authors who adopt different approaches to discuss issues of social justice. There are good reasons for this.

As a currency of justice, needs have several advantages. First, in contrast to preferences, desires, and some other currencies, basic needs are fully objective, i.e., whether a person has a basic need for a certain thing is independent of her own or anybody else’s mental attitudes towards that thing. A second important reason for preferring basic needs as the currency of justice is that they are also universal, although their definition might be culturally influenced. Thirdly, basic needs are intrinsically morally demanding: that P has a basic need for O by itself entails that P ought to be able to have, be, realize, etc. O. Finally, basic needs also have an important advantage in the particular context of sufficientarianism. One of the main objections against sufficientarianism is that it is unable to provide a plausible substantive specification of its threshold of sufficiency. The concept of basic needs, in contrast, essentially entails the idea of a qualitative difference. Being able to fulfill such needs takes precedence over being able to fulfill non-basic needs and desires. Moreover, it distinguishes a life that has a certain minimum quality from a life that lacks this quality.

We invite authors to explore these and other aspects of the concept of basic needs and its use for normative theories of social justice, including intergenerational justice.

Contributions can be in English, Italian, German, and French. The deadline is September 30, 2022

For inquiries please contact: Alessandro Pinzani <alepinzani AT gmail.com>

 

*currently.