Some innovative local organisations are using film to empower people to make better decisions about their health. 

Dr Susan Levine is a medical and visual anthropologist based in Cape Town. In 2002 Levine partnered with an organisation called Steps for the Future (Steps) as a researcher. Steps is a non-profit organisation that uses film to educate, intervene and advocate for healthcare and social justice issues in impacted communities around Southern Africa.

Spotlight spoke to Levine on the side-lines of the AfroSurg Conference in Bellville following her presentation on community engagement and patient care. The conference explored the barriers to surgical care in South Africa and the rest of the Southern Africa region. Levine’s work with Steps has helped people in rural and underprivileged communities access healthcare including surgery.

“Over the past 20 years I’ve been finding ways to bring my passions in medical anthropology and the arts together, mostly documentary film, photography, theatre and dance,” Levine told Spotlight. “Leading up to 2002, I was already a visual anthropologist but I never thought I’d find that [both fields] could speak to one another. So, it was really amazing.”

Fear as barrier

Steps originally began as a way to interrupt the lack of government focus on South Africa’s HIV/Aids crisis through documentaries and mobile cinema.

“The [Steps] films are normalising the fear, and it’s also normalising the fact that fear is bound up with love and caring,” said Levine. “As a healthcare intervention, the idea behind the films is to say that these are really complex, painful stories.”

Levine explained that the films try to be gentle when dealing with something that may be seen as “wrong” or “bad”, such as defaulting on medication or seeking treatment late. The films also refrain from judgement.

The work with Steps has changed Levine’s research trajectory after seeing the effects the films had on communities. 

“Sometimes on the escarpment of Lesotho there’s just two young boys watching a film in a mobile cinema unit, [and] sometimes whole villages in Xai-Xai, Mozambique, would come to see films about malaria and HIV,” she recalled.

Educational tools

After the film screenings, Steps facilitates discussions with audience members, allowing them to ask questions about the film to experts and medical practitioners on a pre-selected panel. 

“The panellists there are people who can comment on the films, and the conversations are often really robust,” said Levine.

“[The audience members are] people who thought that maybe it was fiction, that Aids didn’t exist, or who were afraid of condoms or of dying,” she added. 

While the screenings can work as political, social and healthcare catalysts for community development, they also serve as educational tools for health and social justice. 

“I think the idea around using mobile cinema to spur action to anything is quite an old idea,” said Levine, “but the ways that it’s come together in terms of the research component, the community building component, the production – those things have come together in a very particular way.”

Using film to shine a light

Steps is not the only organisation using film to create change. Another organisation, Sunshine Cinema, is converting “solar power to social impact”. The South African based organisation brings thought provoking African films to audiences across the continent using solar-powered mobile cinemas. 

“What’s interesting about Sunshine Cinema is that while they have a large health focus, it’s not exclusively health,” said Levine. “They bring documentaries that deal with gender-based violence, sexuality, and social justice issues. They also just show really wonderful local content and African feature films if they can get the filmmaker to release the films.”

Like Steps, Sunshine Cinema also hosts a panel to respond to audience questions following each screening. 

During AfroSurg, Levine showed one of the Steps films titled Ngiyakibona or I see you. The short film follows the journeys of the families of two children who need cataract surgery in rural KwaZulu-Natal. The film was produced in partnership with Orbis Africa as a way to promote eye care.

Levine said the work with Orbis allowed her to travel to hospitals in KwaZulu-Natal as well as Zambia to investigate the causes of delay in eye surgeries and treatment. Through her research including interviews and observation, Steps was able to create life stories and pathways to care, which could eventually be made into film. 

A scary process

“Today at the conference I’ve had surgeons come up to me and say that was an amazing film. They didn’t know about those stories of how long it takes people to get surgery because of their fear of surgery – or even the relief that somebody’s child has woken up and to see that on the film, is really meaningful,” said Levine. 

As part of AfroSurg, surgeons from around the Southern African Development Community (SADC) discussed the barriers to accessing surgical care in their countries and the region. In South Africa, these barriers are categorised as factors that prevent people from seeking surgical care, that prevent them from reaching surgical care services and receiving the surgical care they need as well as factors preventing them to remain in care.

For many people, having surgery is a scary process that comes with many big questions. Prospective patients often don’t know where to go, who to speak to, what the surgery entails and how long it will take to recover. As a result of these uncertainties, people often fail to get the care they need. 

In a conference workshop, community and practitioner participants stated that this type of fear, a lack of support, information and communication along with delays in the referral system were among the top reasons people were unable to access care. Other reasons included challenges with transport, staff training and a lack of equipment at healthcare facilities. 

Coming soon

Meanwhile an ongoing clinical trial in the Western Cape is testing whether exposure to a series of films are impacting exclusive breastfeeding (EBF) rates. The so-called Philani MOVIE intervention is an entertainment-education initiative that works to promote EBF through a series of 13 short films. Community members and local stakeholders in child and maternal health help to create films that are shown by mentor mothers during home visits, as well as distributed over WhatsApp. 

The films address a variety of issues concerning EBF including the benefits and challenges of breastfeeding, stunting, unsafe infant feeding procedures and breastfeeding with HIV. The trial is set to be completed by July. 

*Dr Susan Levine is an Associate Professor of Anthropology in the School of African and Gender Studies, Anthropology and Linguistics at the University of Cape Town. Levine teaches a free, open access 6 week online course titled “Medicine and the Arts: Humanising Healthcare”. Interested readers can click here for more information and enrolment. 

* This article was produced by Spotlight – health journalism in the public interest.

^{Image credit: iStock}

Kathryn Cleary

The quality of water supply at the Kgapane Hospital in Ga-Kgapane in the Bolobedu region outside Tzaneen has allegedly been affecting the level of service and care offered at the hospital.

The causes for the water shortages range from inadequate infrastructure and water restrictions to illegal connections to the hospital’s water supply made by the community.

Low dam levels

The Mopani District Municipality announced that three boreholes would be drilled at the hospital, in a bid to alleviate the water shortages due to low dam levels and water restrictions in the area.

Municipality spokesperson, Odas Ngobeni, noted that the low dam levels pose a challenge to water supply at Kgapane Hospital, as the water restrictions mean that water isn’t readily available for use. 

“However, the municipality will be drilling at least three boreholes and installing storage tanks at the hospital. This is work that must start now; hence we are sending people to do the survey today. We will also ensure that a water tanker is available to supply the hospital as we continue to work,” Ngobeni said.

In contrast to the municipality, the Limpopo Department of Health spokesperson Neil Shikwambana, said in a statement that the department is unable to immediately address infrastructure challenges at Kgapane and other facilities due to financial constraints.

Community members took to social media to express their frustration about the lack of water and poor conditions for patients at Kgapane Hospital, however, the department refutes claims made by users of the hospital.

‘Rusty’ infrastructure

In a Facebook post, Fanie Ngobeni highlighted the hospital’s poor service, and voiced concerns about ill-treatment of patients, poor infrastructure and hygiene standards at the hospital and more.

“When I raised these issues, I was attacked, but that didn’t move me at all. A few months later, the situation is even worse. I think the governing party deployed useless cadres and incompetent individuals. They have no interest in safeguarding the lives of poor black people because their family members are taken to private hospital,” Ngobeni wrote.

The post further stated that nurses are neglectful towards patients and that the infrastructure of the hospital is “rusty” and dilapidated. Ngobeni also noted that the hospital has a record number of deaths in the region and province, which was due to nurses and hospital staff not valuing the lives of their patients. However, according to Health Systems Trust District Health Barometer 2017/2018, the Mopani District ranks higher than the Capricorn District in inpatient crude death rates.

Mmatlala Silowa from Ga-Kuranta, in Bolobedu, reports that her brother encountered horrendous service at the hospital. He sought malaria treatment after being brought to the hospital via ambulance from the local clinic, but his condition deteriorated as they queued for hours.

“My younger brother was brought into the hospital by ambulance at around 1pm. He was accompanied by our mother, who is 78-years-old, and they were told to wait for the doctor. His situation got worse before he was finally assisted at around 8pm – after my mother threatened to report them,” Silowa said.

Illegal water connections

Shikwambana addressed the popular post on social media via statement, saying it was “sensationalised”.

“The article falsely claims, among other things, that patients are requested by hospital authorities to bring their own blankets and 5-litre of water to hospital in order for them to bath and drink,” the statement reads.

“Although there has been a massive reduction on the quantity of water supply to the hospital in the recent past, it has not gotten to a point where patients have to bring water to the hospital. Nor have they ever been requested to bring blankets,” the statement continued.

Shikwambana went on to say that the department does not expect the community of Kgapane to blame the department on the shortages of water at the hospital, “because it is the very same community members who have illegally connected water on the mainline to the hospital”.

“The hospital has tried on several occasions to disconnect illegal connections, and even opened a case with the police but community members continue to connect water illegally, putting the operations of the hospital at risk. The department believes that the energy that is used to broadcast lies about the state of the hospital on social media should be correctly channelled towards partnering with the department and the local authorities to resolve the issue of illegal water connections by community members,” Shikwambana continued.

– Health-e News

^{Image credit: iStock}

Mogale Mojela

A fast acting ketamine-like anti-depressant spray is rejected by health watchdog NICE.

Its long-term safety and success remains untested – but some women have already paid at least £6,000.

To further shrink electronic devices and to lower energy consumption, the semiconductor industry is interested in using 2D materials, but manufacturers need a quick and accurate method for detecting defects in these materials to determine if the material is suitable for device manufacture. Now a team of researchers has developed a technique to quickly and sensitively characterize defects in 2D materials.

Since the 1900s, neuroscientists have known that the peripheral nervous systems of tetrapods (four-footed animals) vary greatly, but how these differences affect the way that animals walk, run, or move has not been well understood. Now, a study published in the Journal of Experimental Biology on January 27, authored by a New York Institute of Technology anatomy professor, suggests that neuromuscular adaptations in mammals and birds may have allowed them to become more nimble than reptiles and amphibians.

Duchenne type muscular dystrophy (DMD) is the most common hereditary muscular disease among children, leaving them wheelchair-bound before the age of twelve and reducing life expectancy. Researchers at Technical University of Munich (TUM), Ludwig Maximilian University of Munich (LMU) and the German Research Center for Environmental Health (Helmholtz Zentrum München) have developed a gene therapy that may provide permanent relief for those suffering from DMD.

Vaping has been deemed hazardous for your health by public officials across America, but you wouldn’t know it by scrolling through Instagram.

Instead, researchers discovered that Instagram posts that promote use of the devices outnumber anti-vaping content by a shocking ratio of 10 000 to one.

Vaping called an epidemic

Nearly one-third of US teens use e-cigarettes. In 2018, the US Food and Drug Administration launched a campaign to discourage vaping among youth, according to authors of the study published in the journal Frontiers in Communication.

“US public health officials have been calling vaping among youth an epidemic and have been putting a lot of effort into trying to stop this epidemic by introducing #TheRealCost anti-vaping campaign,” said researcher Julia Vassey, from the University of California, Berkeley.

“But this stark imbalance in the volume of posts has caused the FDA message to be overwhelmed by marketing from the vaping brands,” she said in a journal news release.

Vassey and her colleagues analysed nearly 246 000 Instagram posts from before and after the #TheRealCost campaign launch, and interviewed five vaping influencers and eight college-age social media users.

“We focused on Instagram because the vaping influencers we interviewed for this study identified Instagram as their most important social media marketing platform,” Vassey said.

Direction for anti-vaping campaigns

“Based on the results, the FDA anti-vaping campaign is not very popular and we saw Instagram user comments disputing the FDA claims of damaging health effects from nicotine and calling the campaign propaganda,” she said.

Vaping posts received nearly three times more “likes” after the launch of the FDA campaign launch, and there were six times as many vaping posts that had more than 100 likes.

The vaping influencers and social media users told the researchers that the FDA’s anti-vaping campaign promoted scare tactics rather than offering guidance on how to quit vaping.

“We’re hoping the findings will inform public health regulators about the most popular channels used by vaping influencers to promote vaping content among underage population in order to help counter e-cigarette marketing and slow vaping proliferation among youth,” Vassey said.

“This study could also contribute to providing direction for future federal and local public health anti-vaping intervention campaigns,” she said.

^{Image credit: iStock}