Informal care for people with chronic psychotic symptoms: four case studies in a San community in South Africa

Abstract

Despite the internationally recognised importance of informal care, especially in settings with limited services, few studies focus on the informal care for people with mental health problems in low- and middle-income countries. Making informal care visible is important for understanding the challenges and identifying the needs to be addressed. This ethnographic case study explored the dynamics of informal care for people with chronic psychotic symptoms in a group of San living in poor socioeconomic circumstances in a township near Kimberley, Northern Cape, South Africa. Data were collected in 2013 and 2014 and included semi-structured interviews, informal conversations and observations. Using local terminology, four individuals with chronic psychotic symptoms were identified and selected during the research process. A total of 33 semi-structured interviews took place with their caregivers. Data were analysed using descriptive, interpretive and pattern coding to identify core themes and interrelations across the four cases. Results indicate that informal care is characterised by shared and fragmented care structures. Care was shared among family members from various households and unrelated community members. This allowed for an adaptive process that responded to local dynamics and the care recipients' needs. However, informal care was fragmented as it was generally uncoordinated, which increased the recipients' vulnerability as caregivers could redirect care-giving responsibility and withdraw care. Specific challenges for providing care were related to poverty and care resistance. To improve the living conditions of people suffering from psychosis-related mental health problems, community-based mental healthcare should broaden its scope and incorporate local strengths and challenges.

Treatments for people living with schizophrenia in Sub‐Saharan Africa: an adapted realist review

“…(), de Wet et al. () and den Hertog & Gilmoor () found that traditional and faith healers were often sought in the first instance. Similarly, studies in Uganda (Abbo et al.…”

“…() that explored the effectiveness of a community‐based rehabilitation intervention found that educating the community about mental illness reduced stigma. In examining the way informal care was structured for people with schizophrenia in South Africa, den Hertog & Gilmoor () found that the nuclear family retained the main responsibilities of caring for a relative living with schizophrenia. Although caring responsibilities were shared among the relatives, poverty limited the amount of care provided, often forcing patients to resort to begging to supplement the family's income.…”

Knowledge and risk perception of sexually transmitted infections and relevant health care services among high school students in the Platfontein San community, Northern Cape Province, South Africa

“… 7 Poverty is a structural problem as 97% of the Khwe and !Xun live on less than one dollar/day and have an unemployment rate of 95%. 19 All learners were from either the !Xun or the Khwe San community. Each community practices a different home language, but all teaching is done in Afrikaans.…”

“… 16 , 17 Risk factors for STIs such as unemployment, alcoholism, domestic violence and HIV reported previously on marginalized communities in South Africa 18 were also entrenched among the Khwe and !Xun in Platfontein. 19 , 20 The San Baseline study conducted by the AIDS Foundation of South Africa revealed that 73% of the Platfontein San respondents were not using condoms, had multiple sex partners, and they had low knowledge of HIV and AIDS. 17…”

Socio-economic challenges faced by traditional healers in Limpopo province of South Africa: conversations from below

“…Finally, drawing on this investigative process of the proposed study, a hypothesis was developed on how poverty and social and economic processes apply to traditional healers and, specifically, how it can affect traditional healing. Research conducted on healing strategies in southern Africa explain how financial constraints limit access to traditional healing, as there are costs associated with visiting traditional healers (Den Hertog & Gilmoor, 2017). Identifying this gap assisted the researchers to formulate the broad objective of this research: To investigate how social and economic capital affect the process of healing by traditional healers.…”