- Further reading and public health learning
- Useful organisations
- A holistic patient assessment and management using the ICF framework
Further reading and public health learning
Books and eBooks
Social Epidemiology. Berkman LF, Kawachi I, Glymour MM (Eds). OUP 2014. 2nd Ed. (This is a clear, although detailed and scholarly explanation for the links between social and economic disadvantage and health).
Epidemiology. A research manual for South Africa. Joubert G, Ehrlich R. OUP 2007. 2nd Ed. (Easy to read with reliable descriptions about how the links between risk factors and disease are investigated).
Management Sciences for Health. 2012. MDS-3: Managing Access to Medicines and Health Technologies. Arlington, VA: Management Sciences for Health. Available at: http://apps.who.int/medicinedocs/documents/s19630en/s19630en.pdf (This is a free e-book that provides useful detail about the supply chain for pharmaceuticals and medical technologies).
The Institute for Healthcare Improvement: The site includes many resources to guide quality improvement projects
The One Health Initiative: News and resources about the One Health approach.
Massive Open Online Courses
Some of the world’s top universities have online courses that can be taken usually for free, although it is possible to purchase a certificate or make a donation. The material is of high quality and learners can interact with other students around the world. The two best known learning platforms are EdX and Coursera.
Another website that lists course is classcentral.com.
The following online courses contributed important background and understanding to this book. All are highly recommended and we would like to thank the course presenters for making their content available for worldwide learning.
OECx:PH241x and PH242x. The biology of water and health, parts 1 and 2. J Griffiths and D Gute.
HarvardX: PH207x Health in Numbers: Quantitative Methods in Clinical and Pubic Health Research. M Pagano and EF Cook.
HarvardX: PH201x. Health and Society. I Kawachi, ML Wang.
HarvardX: PH556x Practical improvement science in healthcare: A roadmap for getting results. D Goldman, D Williams and D Berwick
HarvardX: PH555x. Improving global health: focussing on quality and safety. A Jha.
HarvardX: PH557x. Lessons from Ebola: preventing the next pandemic. A Jha
HarvardX: PH231x. Readings in global health. D Hunter.
HarvardX: SW25x. Global health cases studies from a biosocial perspective. A Kleinman, P Farmer, A Becker and S Keshavjee.
MITx: 14.73x. Challenges of Global Poverty. AV Banerjee, E Duflo.
MITx: JPAL101. Evaluating social programmes. R Glennerster, M Shotland and S Sarma.
HKUx: HKU01x Epidemics. G Leung.
Princeton X: MGWx. Making Government Work in Hard Places. J Widner.
UWashingtonX: ECFS311x. Becoming a resilient person: the science of stress management and promoting well-being. C Cook.
KIx: KIeHealthX. eHealth – opportunities and challenges. S Koch, M Hagglund, S Riggare.
The challenges of global health. D Boyd, Duke University.
Community change in public health. W Breiger, Johns Hopkins University.
Systems thinking in public health. D Bishai and L Paina, Johns Hopkins University.
Other learning platforms
Open2Study. Emergency management. J Mitchell, Massey University.
|Rural Health Advocacy Project (RHAP)
A safe and effective channel that assists, advises and refers rural health providers with a number of problems.
|Stop Stockouts Project (SSP)
Report shortages of essential medicines to them. They put all reported information together and take up the problem with relevant stakeholders. Anyone can send messages by email, online, by sms, or a “please call me”
You can report corruption issues in the health system.
|Treatment Action Campaign
They campaign on issues of access to and quality of care in the public health system.
|South African Medical Association (SAMA)||012 481 2000|
|The Junior Doctors’ Association of South Africa (JUDASA)||011 833 2902|
|Democratic Nursing Education Organisation of South Africa (DENOSA)||012 343 2315/6/7|
|Health and Other Services Personnel Trade Union of South Africa (HOSPERSA)||031 765 4625|
A summary of the Protected Disclosures Act can be found on the Department of Justice’s website.
A holistic patient assessment and management using the ICF framework
Diagnosis: 55 year old female – left above knee amputation (AKA) 1 month ago, lives in an informal settlement
|Body function impairment: any physical impairment or medical condition||Activity limitation: any impairment in ADL secondary to what is mentioned in column one||Participation restriction: limitations in the patient’s ability to part
take in life roles
|Left AKA due to diabetic peripheral vascular disease.
Peripheral neuropathy right leg = pain
No kidney, cerebral or cardiac changes
Vision disturbances – no glasses
Uncontrolled on meds (noncompliance vs incorrect meds?)
BMI 40 with poor cardio respiratory fitness
Hypertensive, but controlled on meds
|Unable to stand independently
Difficulty with transfers to and from bed, chair and toilet
Cannot walk with crutches due to AKA, short of breathe and pain in right foot
Too unfit to propel wheelchair distances of > 50m
|Cannot return to work at Shoprite due to transport
Cannot use local transport
Self-care limited: requires help
Cannot do shopping of household
Cannot attend church, social occasions unless pushed by someone
Cannot attend clinic independently to collect meds
|Environment Factors||Personal Factors|
|Barriers (-): negative aspects of the patient’s environment that influence her life and need to be addressed||Facilitators (+): positive environmental factors that are available for us to use as clinicians to benefit our patient||Negative ‘intrinsic’ personal factors that might affect
|Positive‘intrinsic’ personal factors that might affect
|Small house – not wheelchair accessible – steps
Uneven terrain around house
Taxi = only transport
Shops and clinic > 2km away
Community is far from Shoprite in town
Daughter in Matric
No other carer at home
Daughter’s boyfriend emotionally abusive to patient
4 year old grandchild at home in the evenings
Alcohol use (damaging? addict?)
Patient was main breadwinner
|Church close by
Pastor owns a car
Lives with 19 year old daughter – available to help in evenings
Church community support
Friends in area
Community care workers available for home visits and delivering medications
Was employed as packer as a packer (UIF)
Suitable wheelchair already issued
|Std 3 education
History of depression
Suicidal tendencies in the past
Aggressive when drunk
Disillusioned about chance of getting a prosthesis
Not empowered, will do whatever she is told by
Wants to reintegrate into the community
Trusts the doctors and compliant to their suggestions
|Team Management Plan|
|Whole team||Counsel on weight loss, exercise.
Motivational interview to reduce smoking and drinking.
|Doctor||Stabilise sugar levels – meds / counselling on compliance
Refer to optometrist
Arrange medication for longer periods to reduce number of clinic visits
Refer to community care workers to do bi-weekly home visits to test glucose and blood
Assess for depression and manage family consultation for health promotion
|Social Worker||Application for Unemployment Insurance Fund (UIF) or temporary disability grant with previous
Refer to Association for Physically Disabled for assistance with ramp at house
Contact pastor to negotiate for help with support, food, care for child and transport to hospital visits, assistance with abusive “son-in-
|Physio||Rehab, exercises, weight loss and exercise tolerance
Issue walking frame and assistance with transfers, home visits, wheelchair dexterity, stump bandaging and diabetic
foot care education with family
|OT||Assistance with self-care and activities of daily living
Long-term plan for return to work with negotiations with employer
|Human Nutritionist||Assistance with meal plan to aid sugar control and weight loss within budget|
|Nurse||Wound care, stump care and bandaging, education on diabetic foot care||Extra to the team||Community care workers
Pastor and church members
|Community issues to be addressed||Lack of local transport accessible to the disabled
Accessibility of medication for disabled