Suchergebnisse

There is growing concern within the global mental health arena that interventions currently being executed to scale up mental health services in Africa will be ineffective unless simultaneous steps are taken to address people's help-seeking behaviour. Drawing upon two conceptual tools arising from science and technology studies (STS), those of a "classification system" and "the black box," this paper looks critically at discursive constructions of help-seeking in Africa within mental health research over the last decade. Research in this area can be divided into two dominant traditions: the knowledge-belief-practice survey and indigenous-knowledge-system approaches. Although the content and value-codes between these approaches differ, structurally they are very similar. Both are mediated by the same kind of system of classification, which demarcates the world into homogenous entities and binary oppositions. This system of ordering is one of the most stubborn and powerful forms of classification buried in the "black box" of the modernist/colonial knowledge archive and is fraught with many questionable Eurocentric epistemological assumptions. I consider whether there might be other ways of understanding help-seeking for mental illness in Africa and discuss two studies that illustrate such alternative approaches. In conclusion, I discuss some of the challenges this alternative kind of research faces in gaining more influence within contemporary global mental health discourse and practice.

In response to life's tribulations, sometimes we laugh so that we will not cry. Even the most trying circumstances (and perhaps particularly these) are shaded with a sense of the absurd; when we can focus on the ridiculous, we can often transcend the most confining problems. In postrevolutionary Cuba, where the literary aesthetic during the 1960s and 1970s demanded a socially and politically committed prose, humor was not the order of the day. On the contrary, writers attempted to depict the decadence of the former dictatorships and the glory of the revolution in a style that has been called Cuban socialist realism. However, in the 1980s one literary voice emerges that challenges the necessary division between serious ''revolutionary'' literature and humor. In a prose that recuperates the complicated choteo of the Cuban neobaroque, Mirta Yáñez imbues even the most serious and compelling literary moments with irreverent humor. Yáñez's ability to laugh at herself and at the inconsistencies of Cuban life has made her one of the most important contemporary writers on the island. This paper will discuss how Yáñez's use of irreverent humor is critical of systemic problems without being censored as politically subversive. Resumen Cuando la vida ''no es fácil,'' a veces es necesario reír para no llorar, ya que hasta los momentos más difíciles (y quizás muy particularmente en el caso de Cuba) están matizados con un sentido de lo absurdo. Cuando podemos enfocarnos en lo ridículo, muchas veces trascendemos los problemas más graves. En la Cuba posrevolucionaria, donde la estética literaria de los años 60 y 70 demandaba una prosa social y políticamente comprometida, el humor era algo fuera de contexto. Los escritores trataban de retratar la decadencia de las dictaduras de Machado y Batista y la gloria de la revolución en un estilo que llegó a llamarse el realismo socialista cubano. No obstante, en los años 70 surge una voz literaria que desafía la división establecida entre la literatura revolucionaria ''seria'' y el humor. Usando una prosa que recupera el complejo choteo del neobarroco, Mirta Yáñez utiliza un humor irreverente para describir hasta los momentos más serios. La capacidad que tiene Yáñez de reírse de sí misma y de develar lo cómico de las inconsistencias de la vida actual cubana la convierten en una de las escritoras contemporáneas más importantes de la isla. En este trabajo crítico, exploraré cómo es que el humor irreverente de Mirta Yáñez contribuye a una narrativa irreverentemente revolucionaria.

South Africa, like many low-and-middle-income countries, is integrating mental health services into routine Primary Health Care (PHC) through a task-shifting approach to reduce the gaps in treatment coverage. There is concern, however, that this approach will exacerbate nurses' abuse of patients currently common within PHC in the country. To address this concern, the Perinatal Mental Health Project developed its Secret History method, a critical pedagogical intervention for care-providers working within maternity settings. This article describes the method's theoretical underpinnings and practical application amongst nurses. Drawing on Augusto Boal's Theatre of the Oppressed and contrary to traditional nursing training in South Africa, the method creates a space for nurses to interrogate and reimagine nurse–patient relations. By introducing nurses to a counter ideology of empathic care, the method seeks to prepare the maternity environment for mental health task-shifting initiatives and ensure these initiatives are more democratic, responsive and humane.

Trade liberalisation has played a critical role in advancing peace and prosperity. Differences on agriculture have been the major impediment to a future multilateral trade round. The recent agreement on agriculture at the WTO meetings in Geneva may signal a breakthrough in that sector. This article analyses the benefits of recent trade agreements and examines the prospects for future ones. It also presents an alternative framework for advancing trade, the Global Free Trade Association.

Background There is increased international focus on improving the rigour of clinical practice guideline (CPG) development practices. However, few empirical studies on CPG development have been conducted in low- and middle-income countries. This paper explores national stakeholders' perceptions of processes informing CPG development for primary healthcare in South Africa, focusing on both their aspirations and views of what is actually occurring. Methods A qualitative study design was employed including individual interviews with 37 South African primary care CPG development role-players. Participants represented various disciplines, sectors and provinces. The data were analysed through thematic analysis and an interpretivist conceptual framework. Results Strongly reflecting current international standards, participants identified six 'aspirational' processes that they thought should inform South African CPG development, as follows: (1) evidence; (2) stakeholder consultation; (3) transparency; (4) management of interests; (5) communication/co-ordination between CPG development groups; and (6) fit-for-context. While perceptions of a transition towards more robust processes was common, CPG development was seen to face ongoing challenges with regards to all six aspirational processes. Many challenges were attributed to inadequate financial and human resources, which were perceived to hinder capacity to undertake the necessary methodological work, respond to stakeholders' feedback, and document and share decision-making processes. Challenges were also linked to a complex web of politics, power and interests. The CPG development arena was described as saturated with personal and financial interests, groups competing for authority over specific territories and unequal power dynamics which favour those with the time, resources and authority to make contributions. These were all perceived to affect efforts for transparency, collaboration and inclusivity in CPG development. Conclusion While there is strong commitment amongst national stakeholders to advance CPG development processes, a mix of values, politics, power and capacity constraints pose significant challenges. Contrasting perspectives regarding managing interests and how best to adapt to within-country contexts requires further exploration. Dedicated resources for CPG development, standardised systems for managing conflicting interests, and the development of a political environment that fosters collaboration and more equitable inclusion within and between CPG development groups are needed. These initiatives may enhance CPG quality and acceptability, with associated positive impact on patient care.

BACKGROUND: The Ugandan government recognizes mental health as a serious public health and development concern, and has of recent implemented a number of reforms aimed at strengthening the country's mental health system. The aim of this study was to provide a profile of the current mental health policy, legislation and services in Uganda. METHODS: A survey was conducted of public sector mental health policy and legislation, and service resources and utilisation in Uganda, in the year 2005, using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS) Version 2.2. RESULTS: Uganda's draft mental health policy encompasses many positive reforms, including decentralization and integration of mental health services into Primary Health Care (PHC). The mental health legislation is however outdated and offensive. Services are still significantly underfunded (with only 1% of the health expenditure going to mental health), and skewed towards urban areas. Per 100,000 population, there were 1.83 beds in mental hospitals, 1.4 beds in community based psychiatric inpatient units, and 0.42 beds in forensic facilities. The total personnel working in mental health facilities were 310 (1.13 per 100,000 population). Only 0.8% of the medical doctors and 4% of the nurses had specialized in psychiatry. CONCLUSION: Although there have been important developments in Uganda's mental health policy and services, there remains a number of shortcomings, especially in terms of resources and service delivery. There is an urgent need for more research on the current burden of mental disorders and the functioning of mental health programs and services in Uganda.