FAMH1004A - The Science and Art of Health and Learning
DIEP technique task: Reflective writing activity
The waiting room
I can still feel the thick air of that waiting room, a tension I couldn't quite name then, but now I recognize as fear. It was the day we waited for Grandma's test results, a day that shifted something fundamental within me. She was usually vibrant, her laughter filling any room, but that day, she was subdued and her hands clasped tightly. I remember the faded health posters, the squeak of the plastic chairs, the distant beeping of some medical machine – all details I focused on trying to distract myself from the heavy silence. Rereading it now, I realize I was trying to avoid the truth: health isn't a given. It's fragile, a delicate balance that can be disrupted in an instant.
That experience, the long, agonizing wait, taught me more about health than any textbook ever could. Before, it was just something I took for granted, like the air I breathed. But watching Grandma, seeing her vulnerability, it hit me: illness isn't just a physical ailment; it's an emotional earthquake, shaking the foundations of your world. I interpret that day as a lesson in the uncertainty that healthcare brings. Waiting for answers, feeling powerless in the face of the unknown – it's a terrifying experience. I realize now that I was too passive. I should have sought more information, offered more comfort. I was overwhelmed by my own fear that I failed to fully support Grandma.
Evaluating that experience, I see my own shortcomings. I was a bystander, not an active participant. I understand now the importance of being an advocate, not just for myself, but for those I love. I also see the need for greater compassion within the healthcare system. The nature of the waiting room, the hurried consultations, the lack of clear communication – it all contributes to the anxiety and fear that patients and their families experience. Moving forward, I want to develop my empathy, to truly listen to the unspoken fears and anxieties of others. I want to remember that behind every patient file, every medical diagnosis, is a human being with their own story, their own hopes and fears. I want to carry that understanding with me, always, and to contribute in whatever small way I can to creating a more compassionate healthcare environment. It's not just about treating the illness; it's about caring for the person.
Reading an academic paper
Mkhwanazi, N., 2016. Medical anthropology in Africa: the trouble with a single story. Medical Anthropology, 35(2), pp.193-202
Applying the SQ3R method to Nolwazi Mkhwanazi's article revealed a powerful and clearly structured argument about representation in medical anthropology. The core thesis, evident in both the introduction and conclusion, is that a dominant "single story" pervades medical anthropological literature on sub-Saharan Africa, focusing narrowly on state failure, suspicion/distrust, and creative local agency. Mkhwanazi argues that while this narrative contains truth, its dominance obscures other important realities and risks perpetuating stereotypes. She urges anthropologists to resist using this narrative as scaffolding and actively seek out alternative accounts.
Mkhwanazi substantiates her critique by dissecting the 'single story' into three distinct claims, each supported by evidence. First, the foundational claim is that the narrative consistently depicts state failure or inadequacy in healthcare provision. This storyline traces a trajectory from post-independence investment through Structural Adjustment Program-induced cuts, leading to privatization, under-resourced services, brain drain, and heavy reliance on external interventions (especially for HIV). Vinay Kamat's work on childhood malaria in Tanzania exemplifies this, showing how therapy-seeking occurs within constraints shaped by neoliberal policies and historical inequalities. This narrative is presented as common across sub-Saharan Africa, including South Africa's initial refusal to provide ARVs. Second, Mkhwanazi identifies the pervasive theme of suspicion and distrust, manifesting in three key ways: towards outsiders/former colonizers, e.g., Senegalese migrants distrusting French doctors, Muslims in Nigeria suspicious of PEPFAR/Global Fund motives for free ARTs; towards the state itself, e.g., Nigeriens rejecting free polio vaccines due to distrust of the corrupt "shadow state"; and amongst Africans, e.g., Kuria communities in Kenya preferring public HIV testing due to fears secrecy enabled deliberate infection, or competition within therapeutic communities in West Africa. Third, the narrative consistently highlights the creative fashioning of local knowledge, meaning, and action as a response to the challenges outlined in the first two parts, often framed as "African solutions to African problems." Examples like Movasapile, the Tanzanian HIV "miracle healer" whose popularity reflected disenchantment with biomedical care, and Zionist Christian Church (ZCC) followers in South Africa integrating biological, witchcraft, and pollution concepts to understand AIDS while navigating conflicting identities, serve as evidence for this claim. The story of Dios, the ZCC member and university health promoter living openly with HIV, exemplifies navigating these contradictory worlds.
Elisabeth Hsu's work on Chinese doctors in Kenya challenges the trope of the selfless humanitarian medic, revealing them instead as economic migrants viewing Kenya as a stepping stone. Similarly, Babette Müller-Rockstroh's "technography" of ultrasound in Tanzania moves beyond predictable questions of utility or suspicion to ask profound ethical and political questions about what constitutes a "good" technology and whose criteria matter. The detailed case study of the failed "Soka Uncobe" medical male circumcision campaign in Swaziland serves as a potent illustration. While easily interpretable through the lenses of state inadequacy, local suspicion, or creative resistance, Mkhwanazi uses it to reveal an alternative, more disturbing story: Swaziland as a "living laboratory," where men were expected to passively comply for the "greater good".
This paper builds a clear, evidence-based critique. The thesis is unambiguous and reiterated. The supporting claims are logically structured, and each is backed by specific, relevant evidence from anthropological literature. Mkhwanazi does not just deconstruct the dominant narrative, but she offers counterexamples as well. Her structure of writing is directly applicable to my own academic writing, especially for reflective assignments and long essays. It demonstrates how to move beyond simply describing a problem to constructing a persuasive argument for change, using disciplinary sources effectively. It underscores the critical importance of seeking multiple perspectives and avoiding reductive narratives when discussing complex topics like universal health.
W9 S2 Race-based inequality and health
Journal reflection on my experience with racialization
Reflecting on my own experience of racialization, I acknowledge that this is deeply rooted with South Africa's complex and painful history. My family’s history of racialization is a story of navigating the structures imposed during Apartheid which was a system designed to separate and control people based on race, as explained in Price's 1986 article on health care as an instrument of Apartheid. For many families like mine, this meant limited access to crucial resources, including healthcare, education, and political power. These experiences were not just personal hardships but also part of a broader systemic effort to maintain inequalities and White supremacy.
Growing up, I saw how racialization affected the way my family was treated in different spaces, such as schools, neighbourhoods, even health facilities. These experiences, shaped by both explicit and subtle forms of discrimination, showed me that racial identity was not just about how one sees oneself but also about how society perceives and responds to that identity. For example, in predominantly black communities, there was a strong sense of shared identity and solidarity. But in mixed or predominantly White spaces, perceptions often shifted, sometimes resulting in feelings of exclusion or being othered.
These experiences have evolved over time. While overt segregation has officially ended, the legacies of Apartheid persist in uneven access to healthcare and economic opportunities as discussed in the lecture today. Racism today is often more subtle but no less real: systemic racism still affects opportunities and outcomes, particularly in health care. Studies show that Black South Africans still face disparities in medical treatment, including being less likely to receive pain medication or accurately diagnosed, reflecting ongoing systemic challenges.
My own health journey has been shaped by these realities in ways that sometimes felt invisible. For instance, accessing quality healthcare was often linked to where I lived or which health facilities were available to my community. This connects to ideas from Price’s article about how health services were and still are unequally distributed which is a legacy of Apartheid’s aim to control and limit the Black population's access while privileging Whites.
Looking forward, my vision for South Africa is one where the divisions of our past no longer dictate our futures. I hope for a society where health care is truly equitable, reflecting the needs and dignity of all people regardless of race. This means dismantling not only the formal structures of Apartheid but also the systemic and institutional racism that still shapes health outcomes today. Education, awareness, and participation in shaping policies that prioritize justice and equality are key.
For myself, this reflection deepens my commitment to understanding how racialization affects health and well-being. It encourages me to advocate for a more inclusive and fair healthcare system and social environment, where all South Africans can thrive without fear of discrimination.
Reflection: Would the Negotiators behind John Rawls’ “Veil of Ignorance” support a system of universal healthcare in which all citizens have free access to a reasonable range of healthcare services?
John Rawls’ “Veil of Ignorance” is a thought experiment where individuals design principles of justice without knowing their own identity, social status, race, wealth, or natural talents. This ignorance ensures fairness by preventing bias toward any particular position because anyone behind the veil must consider the possibility of being in any position in society
Yes, it is very likely that the hypothetical negotiators behind Rawls’ Veil of Ignorance would support a system of universal healthcare that guarantees free access to a reasonable range of healthcare services for all citizens.
This is because behind the Veil of Ignorance, no one knows if they will be born healthy or with costly medical conditions, wealthy or poor. Rational decision-makers would want to protect themselves if they end up in a disadvantaged health position, so they would favor universal access to healthcare to ensure basic well-being. Rawls’ two principles of justice include the liberty principle (maximizing equal basic liberties) and the difference principle (social and economic inequalities are only justified if they benefit the least advantaged). Universal healthcare directly serves the difference principle by improving the welfare of the worst off in society, who often face health disparities. A just society must guarantee everyone access to primary goods necessary for a good quality of life, which includes health. Universal healthcare fulfills the requirement of ensuring conditions necessary for self-respect and equal opportunity.
Rawlsian theory strongly aligns with the ethical imperative behind universal healthcare: that society should be structured to protect and uplift its most vulnerable members, knowing that anyone could be born into such a position. This approach counters social and economic uncertainties in health and access by pooling risk collectively and ensuring fairness. However, concretely implementing this system requires thoughtful design to balance costs, quality, and equitable distribution.
In conclusion, behind the veil, rational individuals would prioritize access to healthcare to safeguard their well-being regardless of their eventual social status, making universal healthcare an expected choice from a Rawlsian justice standpoint.
W15.S3a - Self-guided Reading: Naude (2022)
Critically reflect on ways in which this study and the study, and other research that it cites, reveal the concept of identity to be "multifaceted, multi-dimensional, and consisting of various domains" (Crocetti et al. 2013, as cited in Naude, 2022, p.2184).
The study by Luzelle Naude (2022), together with the research it cites like Crocetti et al. (2013), deeply illustrates that identity is far from a fixed or singular construct. Instead, it is revealed to be multifaceted and multi-dimensional, encompassing various domains that come together to form an individual’s sense of self. This complexity is apparent both in the content individuals use to describe themselves and in the dynamic contexts in which identity develops.
Naude's research highlights how adolescents and emerging adults articulate identity across a range of domains including social qualities (like being friendly or altruistic), intellectual traits, values such as respect and work ethic, physical traits, and group memberships. These different spheres do not exist in isolation but interact and fluctuate in salience depending on personal, social, and developmental contexts. For example, younger adolescents might focus more on physical traits, while emerging adults emphasize interactive social qualities, showing developmental dimension of identity.
Moreover, the research underscores the relational nature of identity, positioned on a continuum of independent (unique attributes and personal goals) to interdependent (group membership and social harmony), demonstrating that identity includes both self-focused and socially embedded elements. This continuum is influenced by culture, gender, age, and societal expectations, indicating that identity is shaped by and responds to diverse ecological factors.
Crocetti et al. (2013) support this understanding by emphasizing that identity consists of numerous interconnected domains, such as ideological, interpersonal, and existential, and that these domains can shift in importance at different times and for different individuals. They argue that the process of exploring and committing to elements within these domains is central in adolescent and young adult identity development, reinforcing the idea that identity is an active, evolving construction rather than a static state.
The multifaceted and multi-dimensional nature of identity invites researchers and practitioners to move beyond simplistic models and appreciate the richness and nuance with which individuals experience and express their selves. It also stresses the importance of culturally sensitive and contextually informed approaches to studying identity, as the prominence of specific identity domains can vary widely across cultural and social landscapes.
This perspective allows for a more holistic appreciation of the individual and challenges reductive views of identity that focus narrowly on single attributes or stages. It opens pathways for inclusive and nuanced understandings, vital for supporting the diverse developmental trajectories of adolescents and emerging adults in varied contexts, such as post-apartheid South Africa in Naude’s study.
References:
Crocetti, E., Schwartz, S. J., Fermani, A., Klimstra, T., & Meeus, W. (2013). Identity styles, dimensions, statuses, and functions: Making connections among identity conceptualizations. European Review of Applied Psychology, 63(1), 113-121. https://doi.org/10.1016/j.erap.2012.09.001
Naudé, L. (2022). Being me: Content and context in South African adolescents’ identity development. Current Psychology, 41, 2184–2193. https://doi.org/10.1007/s12144-022-03478-7
Erikson, E. H. (1968). Identity: Youth and Crisis. W. W. Norton & Company.
Marcia, J. E. (1966). Development and validation of ego-identity status. Journal of Personality and Social Psychology, 3(5), 551-558.
McLean, K. C. (2016). The role of narrative identity in adolescence. In D. Cicchetti (Ed.), Developmental Psychopathology (3rd ed., Vol. 1, pp. 346-392). Wiley.
W15.S5 - Getting Old
'Reflections on Erikson'
Erik Erikson’s psychosocial theory offers a profound understanding of human development by emphasizing the interplay of biological, psychological, and social factors across the lifespan. What stands out is how Erikson’s own multicultural and historically turbulent life influenced his conceptualization of identity as fluid, evolving, and deeply linked to social context. His stages reflect real-life challenges shaped not only by individual maturation but also by cultural expectations, historical events, and interpersonal relationships.
The video highlighted Erikson’s commitment to integrating ethics and social responsibility into developmental psychology, pushing beyond the limitations of purely biological or psychological frameworks. This integration laid the foundation for the biopsychosocial model, which remains highly relevant today, especially in clinical and educational contexts.
While some critiques argue that Erikson’s stages are too rigid or culturally biased, the video clarified his openness to variability and lifelong revisiting of psychosocial conflicts. This flexibility suggests that his model serves better as a framework for dialogue about identity challenges rather than a strict sequence of milestones. Moreover, the model’s focus on conflict and resolution captures the tensions inherent in development, including how individuals creatively integrate contradictions in their lives.
In conclusion, Erikson’s theory uniquely bridges individual experience with societal structures, providing valuable insights into the continuous process of identity formation and adaptation in diverse contexts. It encourages a holistic view of development, one that appreciates the complexity and ethical dimensions of human growth.
Davidson Films (Producer). (2019). Erik Erikson: A Life’s Work [Video]. YouTube. https://youtu.be/32J9BNMWynM
Erikson, E. H. (1968). Identity: Youth and Crisis. New York: W.W. Norton & Company.
McLeod, S. (2020). Erik Erikson's theory of psychosocial development. Simply Psychology. https://www.simplypsychology.org/erik-erikson.html
Sokol, J. T. (2009). Identity development throughout the lifetime: An examination of Eriksonian theory. Graduate Journal of Counseling Psychology, 1(2), 139-148. https://epublications.marquette.edu/gjcp/vol1/iss2/6
W17. S3 - The "Responsibilization of Illness" and its Shadow on South African Healthcare
Reading Jeffery Yen’s (2016) article, "Psychology and health after Apartheid," provides a clarifying framework. It articulates a tension I’ve often felt but struggled to name: the disconnect between a Western, individual-focused model of health and the complex, structural reality of a country like South Africa. The concept that stuck with me most powerfully, and the one that seems to hold profound significance for healthcare practitioners and systems here, is what Yen identifies as the "responsibilization of illness."
At its core, "responsibilization" is the process of shifting the blame and the burden of health from the state and society onto the shoulders of the individual. As Yen explains, this logic, central to mainstream health psychology and neoliberal discourse, frames health as a product of personal choice, a matter of individual behaviours, risk management, and lifestyle decisions. It’s the idea that if you just eat right, exercise, and think positively, you can avoid illness. Conversely, if you get sick, it is, to some degree, your own fault for making poor choices.
In the context of the Global North, where this ideology was forged, this is already a problematic and politically loaded stance. But when this logic is uncritically transplanted into the South African context, its implications become not just problematic, but potentially devastating and, frankly, a form of epistemic violence.
Yen’s historical narrative makes it starkly clear why this is the case. South Africa’s health profile is not a random collection of individual bad choices; it is the direct, tangible legacy of apartheid. The "four colliding epidemics" he describes, diseases of poverty, HIV/AIDS and TB, violence and injury, and chronic illnesses, are not the result of a population that failed to take personal responsibility. They are the logical outcomes of decades of state-engineered poverty, a migrant labour system that fractured families and fuelled the spread of disease, rampant inequality in access to resources, and the psychological trauma of systemic violence. To look at a patient suffering from tuberculosis in an overcrowded, under-resourced township and imply that their health is primarily their responsibility feels not just naïve, but cruel. It medicalizes poverty and politicizes sickness.
For healthcare practitioners, embracing this "responsibilization" logic creates an ethical and practical bind. It sets them up to fail. How can a nurse effectively promote a "healthy diet" to a family with no access to affordable, nutritious food, living in a food desert? How can a doctor lecture a patient on "stress management" when that stress is rooted in the inescapable daily threat of violence or the grinding anxiety of unemployment? This approach pathologizes people for their social conditions and turns healthcare into a moralizing lecture, eroding the very trust that is fundamental to the therapeutic relationship. It forces practitioners to become agents of a system that blames the victim, all while their hands are tied by the same structural constraints that make their patients sick.
For the healthcare system as a whole, the "responsibilization" agenda is a dangerous diversion. It lets the state off the hook. If the public discourse is focused on getting individuals to make better choices, there is less pressure on the government to address the foundational, structural determinants of health: building decent housing, ensuring a living wage, creating safe public spaces, and equitably funding a robust public health service. The ambitious, progressive vision of the post-apartheid National Health Plan, which understood health as integral to social justice, is gradually hollowed out and replaced by a market-driven model where health becomes a commodity for those who can afford it, and a personal failing for those who cannot.
This is precisely why Yen argues that the absence of a formal, U.S.-style health psychology in South Africa is a good thing. The more critical, eclectic, and politically-aware approaches that have emerged, in public health, community psychology, and violence prevention, have inherently resisted this logic of personal blame. They have, instead, insisted on locating health within its social, historical, and material context.
In conclusion, the "responsibilization of illness" is not a neutral clinical concept; it is a political ideology disguised as science. For South Africa, a nation still grappling with the profound wounds of its past, its adoption would represent a profound betrayal of the very principles of justice and equity that the struggle for democracy was fought for. The real task for healthcare practitioners and systems here is not to make individuals responsible for illnesses born from structural sin, but to continue the difficult, critical work of holding society and the state responsible for creating the conditions in which health is even possible. The weight of history is heavy enough; we should not ask patients to carry the blame for it, too.
Reference:
Yen, J. (2016). Psychology and health after Apartheid. Or, Why There Is No Health Psychology in South Africa. History of Psychology, 19(2), 77-92.
W20.S2 - Journal Entry
The embodiment framework
Before this lecture, my understanding of chronic illness was largely clinical. I saw it through a biomedical lens, that is a list of symptoms to be managed and a treatment plan to be followed. The upcoming task of analyzing a patient's narrative feels like it will challenge that perspective.
The lecture and readings on the embodiment framework, particularly Scheper-Hughes and Lock's "Three Bodies," have introduced a new way of thinking. I am starting to see that illness is not just a biological event but an experience that rewrites a person's entire relationship with their own body, their social world, and the healthcare system. I expect that exploring my patient's story will make these theoretical concepts real, showing me how a diagnosis like Autoimmune Hepatitis disrupts not just liver function, but a person's identity, daily life, and future. I anticipate that this will push me to move beyond seeing a patient as a "case" and instead understand them as a whole person navigating a profoundly altered existence.
W27.S1 - Culture & Healthcare
Reflection on Health Practices and Cultural Rights in South Africa
Looking at how South Africa manages its different health practitioners shows a country still trying to find the right balance. On one hand, you have doctors and nurses whose work is strictly controlled by official bodies. On the other, you have traditional healers, who are now recognised by law but are not yet fully part of the main health system. While the government has made a good effort to include traditional healing, the two worlds of medicine mostly operate separately. At the same time, a whole industry of wellness products and alternative therapies exists with very little oversight, which can be confusing and unsafe for people seeking help.
This situation makes me wonder if we are truly respecting the different health beliefs of all South Africans. I believe the answer is no, not yet. The law says that our culture and traditions must be respected, and our right to health must be fulfilled. However, in reality, the public health system is still built almost entirely around Western medicine. For many people, this creates a difficult choice: do they follow their cultural beliefs and see a traditional healer, or do they go to a clinic where their beliefs might not be understood or respected? When people have to make this choice, it means their right to health is not being fully met in a way that honours who they are.
So, what more can be done? I think we need to move beyond just allowing different systems to exist and start building connections between them. We could create projects where doctors and traditional healers can work together safely, especially for long-term illnesses. The government could also support research to understand which traditional medicines are safe and how they work. Most importantly, we need to educate the public on how to navigate these different options without risking their health.
Finally, individual health workers have a role to play too. Doctors and nurses could make a big difference by simply asking patients, "What do you believe is causing your illness?" or "Are you using any other treatments?" This shows respect for the patient's worldview and builds trust. For their part, traditional healers could also be open to dialogue with local clinics. True healthcare in South Africa should not be a choice between science and culture, but a system that respectfully includes both for the good of the patient.