Patient-centred care: The patients' perspective ­ a mixed-methods pilot study

Background: Patient centredness is a broad concept, a moral philosophy. Patient-centred care can be viewed as the actions of patient-centredness. One of the most pertinent actions that a healthcare practitioner can utilise to deliver patient-centred care is empathic communication. Whilst many medical programmes include empathetic communication skills as part of their curricula, the recipients of this care are not asked about the relevance of this teaching. Aim: We attempted to determine whether the Western constructs of empathy were relevant in our context and also establish whether there were any parts of the medical interview which participants felt were especially important to be communicated to in their home language. Setting: Two urban communities within the City of Cape Town, Western Cape Province, South Africa. Methods: This was a mixed-methods pilot study using an explanatory sequential design. Participants who would typically make use of public health care facilities and whose first language was Afrikaans or isiXhosa were conveniently sampled. A subgroup of participants was invited to take part in a follow-up focus group discussion to add clarity to the survey responses. Results and Conclusion: Western constructs for empathy appeared to be relevant within our multicultural context. Patients wanted to communicate with their doctors and understand the cause of their problems as well as the management plan. Finally, whilst the numbers in this pilot study were too small to be generalisable, it was evident that patient-centred care was not perceived to be implemented in some public healthcare facilities attended by the participants, which resulted in them feeling unseen and disrespected

Circumcision Weeks: Making Circumcision Part of Routine Training and Service Delivery at District-Level Hospitals in South Africa

"Background: Medically safe; elective male circumcision supports traditional and cultural rites of passage by reducing the risk of adverse events and death among men undergoing initiation. It is a way of preventing penile conditions that arise from being uncircumcised. It also protects against various sexually transmitted infections; playing a particularly important role in human immunodeficiency virus (HIV) prevention; as it protects against HIV infection in men by up to 60. It also helps reduce herpes simplex virus type 2; a key biological co-factor thought to account for some human susceptibility to HIV infection and human papillomavirus. To address these needs and to meet the World Health Organization's call to upscale male circumcision to 80in HIV/AIDS epidemic-gripped sub-Saharan Africa; there is a need to provide male circumcision as standard care in district health. Method: A retrospective review of three years of circumcision services; using the sleeve method; and not the high-volume; forceps-guided method; and training at a Level 1 district hospital in South Africa. Results: Two hundred and twenty-one medical circumcisions were performed; increasing significantly in each successive year. Mostly; they were carried out under local anaesthetic; and there were only four complications; all of which were successfully resolved. The average age of the patients was 20; and generally; they elected to have medical circumcision carried out for cultural reasons. Some 60 students and clinicians were trained in safe medical male circumcision. Conclusion: To meet the growing demand for male medical circumcision; especially among teenagers and young adult men at district-level hospitals; there is a need to significantly expand the surgical competency of clinicians in this field. ""Circumcision weeks"" are one way of routinely upscaling surgical skill levels; while simultaneously responding to increased patient demand for safe medical circumcision."