Flourishing with chronic illness(es) and everyday stress: Experiences from Soweto, South Africa.

The pursuit of flourishing, or living a good life, is a common human endeavor with different meanings across individuals and contexts. What is needed is a further exploration of the relationship between flourishing and health, particularly chronic illness, which affects individuals across the life course and is affected by experiences of stress derived from social and structural vulnerability. Drawing on data from the Soweto Syndemics study, including a locally derived stress scale and in-depth interviews, we explore the connections between flourishing and health for those living with multiple chronic illnesses in Soweto, South Africa within a syndemic of communicable and non-communicable disease. Rather than drawing on Western-centric notions of flourishing (which place emphasis on an individual's capabilities or capacities to thrive), we draw on previous ethnographic work on flourishing in Soweto, South Africa, which described how ukuphumelela, or "becoming victorious," as a social or communal affair. This conceptualization reflects local values and priorities for people's lives and the ways in which their lives are deeply intertwined with each other. We contribute to a more robust understanding of flourishing in context, of how chronic illness is experienced, and of how the role of a patient is transcended in spaces where individuals are part of a social or faith community. As people living with chronic illness(es) actively pursue the good life, health care systems must consider these pursuits as valid parts of the human experience that also challenge narrow definitions of health.

Coping mechanisms during the COVID-19 pandemic and lockdown in metropolitan Johannesburg, South Africa: A qualitative study.

BACKGROUND: The COVID-19 pandemic has caused prolonged stress on numerous fronts. While the acute health impacts of psychosocial stress due to the pandemic are well-documented, less is known about the resources and mechanisms utilized to cope in response to stresses during the pandemic and lockdown. OBJECTIVE: The aim of this study was to identify and describe the coping mechanisms adults utilized in response to the stressors of the COVID-19 pandemic during the 2020 South African lockdown. METHODS: This study included adults (n = 47: 32 female; 14 male; 1 non-binary) from the greater Johannesburg region in South Africa. Interviews with both closed and open-ended questions were administered to query topics regarding the COVID-19 pandemic. Data were coded and thematically analyzed to identify coping mechanisms and experiences. RESULTS: Adults engaged in a variety of strategies to cope with the pandemic and the ensued lockdown. The ability to access or engage in multiple coping mechanisms were either enhanced or constrained by financial and familial situations. Participants engaged in seven major coping mechanisms: interactions with family and friends, prayer and religion, staying active, financial resources, mindset reframing, natural remedies, and following COVID-19 prevention protocols. CONCLUSIONS: Despite the multiple stressors faced during the pandemic and lockdown, participants relied on multiple coping strategies which helped preserve their well-being and overcome pandemic-related adversity. The strategies participants engaged in were impacted by access to financial resources and family support. Further research is needed to examine the potential impacts these strategies may have on people's health.

God, Church water and spirituality: Perspectives on health and healing in Soweto, South Africa.

Faith, belief, and religion can powerfully shape how people live with and heal from illness. Engaging in religious practices, from gathering for services to reading the holy texts and engaging in private prayer, can serve as a critical way of coping or building resilience amidst everyday social, moral, and medical challenges. In this article, we investigate why, what, and how people living with chronic illness in an urban South African township prioritise healing practices of the Church over the Clinic. We conducted 88 in-depth qualitative interviews to understand how people think about health, chronic illness, and healing. Most people described complex socio-spiritual beliefs and practices that many prioritised or practiced apart from biomedical care. This included religious practices, such as prayer and drinking church water, as well as one's spirituality, which was an essential way in which people found healing. Recognising how socio-spiritual practice fosters healing and wellness is critical for thinking about health and healing for Soweto residents.

A mixed-methods, population-based study of a syndemic in Soweto, South Africa.

A syndemic has been theorized as a cluster of epidemics driven by harmful social and structural conditions wherein the interactions between the constitutive epidemics drive excess morbidity and mortality. We conducted a mixed-methods study to investigate a syndemic in Soweto, South Africa, consisting of a population-based quantitative survey (N = 783) and in-depth, qualitative interviews (N = 88). We used ethnographic methods to design a locally relevant measure of stress. Here we show that multimorbidity and stress interacted with each other to reduce quality of life. The paired qualitative analysis further explored how the quality-of-life impacts of multimorbidity were conditioned by study participants' illness experiences. Together, these findings underscore the importance of recognizing the social and structural drivers of stress and how they affect the experience of chronic illness and well-being.