In 1997, a new clinic was established at the Central Middlesex Hospital to serve the needs of a mainly Somali population who had suffered genital mutilation in childhood. Between June 1997 and January 2005, 4,125 clinic attendances were recorded. A total of 215 reversals of circumcision were carried out (FGM 3), all on a day-care basis. In the majority of cases, an intact and undamaged clitoris was found under the scar tissue. The clinic staff were able to draw attention to cultural and religious issues which proved important in the medical management of these women. The experience of this clinic has shown that where there is a large immigrant population of women from the Horn of Africa, clinics such as this are efficient and cost-effective and encourage women to attend with a variety of health concerns. The clinic also encourages these women to take their health concerns seriously.
People with profound intellectual and multiple disabilities may not always be well supported to engage meaningfully in activity at home, an injustice impacting on well‐being and quality of life. Research sought better understanding of how occupational therapists work to improve the quality of this support, in particular, how they encourage support workers and managers to adopt recommendations. A single, purposively selected, case of supporting engagement in activity at home was investigated using a critical ethnographic case study methodology from an interpretivist and social constructionist stance. An occupational therapist worked with five people with severe and profound learning disabilities and their support workers over one year. Data were collected using ethnographic methods (participant observation, interviews and document analysis) and analyzed using an emergent systematic strategy (formal coding and categorization, alongside intuitive and affective analysis) and NVivo qualitative data analysis software. The case's story (illustrated by an ethnographic vignette constructed from the data) highlights challenges encouraging others to follow recommendations as intended. It has two overarching themes: the impact of shifting support and leadership cultures; and characteristics of occupational therapy, seeking in particular to create and sustain cultural change by working with support workers in a collaborative and empowering way. To overcome the impacts of organizational culture on how support is given (thereby improving the quality of lives of people with profound intellectual disabilities) professionals need to collaborate with support workers. Occupational injustices they arguably may face, in particular risk of burnout where their roles are conflicting or ambiguous, may also need to be addressed. Implications are suggested for health and social care professionals working indirectly through support workers of people with profound intellectual disabilities (and others with high support needs) and for the education and training of these professionals.
This study combined quantitative and qualitative data in order to understand more fully the Somalian perspective of family planning services. Quantitative data alone were insufficient to provide a plausible explanation for the poor uptake of contraceptive services and methods for spacing pregnancies among Somalian women attending the African Well Women Clinic at the Central Middlesex Hospital. The qualitative data elicited deeper issues, provided insights and explained the causal factor of low uptake of family planning services. Religious teaching, status of men and women and an oral tradition were identified as fundamental to Somalian conceptualisation of family planning services. This study suggests that there is a need to provide not only family planning, but health-care services as a whole within a broader social and cultural dimension that meets the need of this clientele. This would entail viewing care within their social and religious context.
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