A model for incorporating “indigenous” postnatal care practices into the midwifery healthcare system in Mopani district, Limpopo Province, South Africa

Abstract

English: Model development for incorporating “indigenous” postnatal care into a midwifery healthcare system is of utmost importance in ensuring the provision of culturally congruent care. There has been only limited evidence of the availability of a model which addresses “indigenous” postnatal care practices in midwifery health care systems. As a result, the nurses operate from a modern healthcare point of view only, rather than combining the two worldviews. The main aim of the study was to develop a model for incorporating “indigenous” postnatal care practices into the midwifery health care system in Mopani District, Limpopo Province of South Africa. The study was conducted in three phases. During the first phase the meaning of the concept “incorporation” was analysed. The results guided the researcher during data collection in the second phase, consisting of in-depth individual and focus group interviews to explore the experiences and perceptions of postnatal patients, family members, traditional birth attendants, registered midwives, Midwifery lecturers and the maternal and child healthcare coordinators. The findings confirmed that currently the “indigenous” postnatal care practices are not incorporated in the Midwifery curriculum, books or guidelines for maternity care. As a result there is lack of knowledge amongst midwives regarding the “indigenous” postnatal care practices and it is difficult for them to provide culturally congruent care. Due to inadequate knowledge midwives are displaying negative attitudes towards the family members, traditional birth attendants and patients from diverse cultures. The participants confirmed that there is no teamwork between the registered midwives and the traditional birth attendants (family members). The study findings also confirmed that currently there are no follow-up visits by the midwives for patients during the postnatal period. The midwives are imposing their health beliefs an practices onto the patients on discharge after delivery, without the involvement of the family members or the traditional birth attendants, resulting in sub-standard postnatal care, leading to postnatal complications and an increasing maternal mortality rate. Based on the findings of phases one and two, a model for incorporating “indigenous” postnatal care practices into a midwifery healthcare system was developed and described. The implications for further studies suggested the evaluation and implementation of the model in the healthcare institutions, nursing colleges, clinics and hospitals as an initial step to assist the Department of Health in Limpopo Province in incorporating “indigenous” practices into healthcare systems.

Sepedi: Tlhamo ya mokgwa ya go akaretša tlhokomelo ya ka morago ga pelego ya "setlogo" ka gare ga tshepedišo ya tlhokomelo ya maphelo ya babelegiši e bohlokwa kudu go netefatša kabo ya tlhokomelo ye e dumelelanago le setšo. Go bile le bohlatse bjo bonnyane fela bja go hwetšagala ga mohlala wo o lebanego le mekgwa ya tlhokomelo ya ka morago ga pelego ya "setlogo" ka ditshepedišong tša tlhokomelo ya maphelo ya babelegiši. Ka lebaka leo, baoki ba šoma go ya ka pono ya sebjalebjale ya tlhokomelo ya maphelo fela, go e na le go kopanya dipono tše pedi tša lefase. Maikemišetšo a magolo a nyakišišo ye e be e le go hlama mohlala wa go tsenya mekgwa ya tlhokomelo ya ka morago ga pelego ya "setlogo" ka gare ga tshepedišo ya tlhokomelo ya maphelo ya babelegiši ka Seleteng sa Mopani, Profenseng ya Limpopo ya Afrika Borwa. Dinyakišišo tše di dirilwe ka dikgato tše tharo. Nakong ya kgato ya mathomo go ile gwa sekasekwa tlhalošo ya kgopolo ya "go tsenywa". Dipoelo di hlahlile monyakišiši nakong ya kgoboketšo ya datha mo kgatong ya bobedi, yeo e bopilwego ka dipoledišano tše di tseneletšego tša motho ka o tee ka o tee le tša sehlopha sa nepo go hlahloba maitemogelo le ditemogo tša balwetši ba ka morago ga pelego, maloko a lapa, bahlokomedi ba pelego ba setšo, babelegiši bao ba ngwadišitšwego, bafahloši ba Babelegiši le balomaganyi ba tlhokomelo ya maphelo ya bomme le bana. Dikutollo di tiišeditše gore ga bjale mekgwa ya tlhokomelo ya ka morago ga pelego ya "setlogo" ga e tsenywe ka gare ga kharikhulamo ya Babelegiši, dipukung goba ditlhahli tša tlhokomelo ya pelego. Ka lebaka leo go na le tlhaelelo ya tsebo gare ga babelegiši mabapi le mekgwa ya tlhokomelo ya ka morago ga pelego ya "setlogo" gomme go thata gore ba neelane ka tlhokomelo yeo e dumelelanago le setšo. Ka lebaka la tsebo ye e sa lekanego babelegiši ba bontšha maikutlo a mabe ka maloko a lapa, bahlokomedi ba pelego ba setšo le balwetši go tšwa ditšong tše di fapanego. Bakgathatema ba tiišeditše gore ga go na mošomo wa sehlopha magareng ga babelegiši bao ba ngwadišitšwego le bahlokomedi ba pelego ba setšo (maloko a lapa). Diphihlelelo tša dinyakišišo di tiišeditše gape gore gabjale ga go na diketelo tša go latišiša ke babelegiši bakeng sa balwetši nakong ya ka morago ga pelego. Babelegiši ba gapeletša ditumelo tša bona tša maphelo le mekgwa go balwetši ge ba lokollwa ka morago ga pelego, ntle le go akaretšwa ga maloko a lapa goba bahlokomedi ba pelego ba setšo, go feleletša ka tlhokomelo ya ka morago ga pelego ya maemo a ka fase ga pelego, yeo e lebišago go mathata a ka morago ga pelego le tekanyo ye e oketšegago ya mahu a bomma. Go ya ka diphihlelelo tša kgato ya pele le ya bobedi, mokgwa ya tlhokomelo ya ka morago ga pelego ya "setlogo" ka gare ga tshepedišo ya tlhokomelo ya maphelo ya babelegiši o ile wa hlangwa le go hlalošwa. Ditlamorago tša dinyakišišo tše dingwe di šišinya kelo le phethagatšo ya mohlala wo ka dihlongwa tša tlhokomelo ya maphelo, dikholetšheng tša booki, dikliniki le dipetlele bjalo ka kgato ya mathomo ya go thuša Kgoro ya Maphelo ka Profenseng ya Limpopo go tsenya ditiro tša "setlogo" ka ditshepedišong tša tlhokomelo ya maphelo.

Afrikaans: Die ontwikkeling van ’n model vir die inkorporering van "inheemse" postnatale sorg in 'n vroedvrou-gesondheidsorgstelsel is van uiterste belang om die verskaffing van kultureel kongruente sorg te verseker. Daar was slegs beperkte bewyse van die beskikbaarheid van 'n model wat "inheemse" postnatalesorgpraktyke in vroedvrou-gesondheidsorgstelsels in ag neem. As gevolg hiervan werk die verpleegkundiges slegs vanuit die oogpunt van moderne gesondheidsorg, eerder as om die twee wêreldbeskouings te kombineer. Die hoofdoel van die studie was om 'n model te ontwikkel vir die inkorporering van "inheemse" postnatalesorgpraktyke in die vroedvrou-gesondheidsorgstelsel in die Mopani-distrik, Limpopo, Suid-Afrika. Die studie is in drie fases uitgevoer. Tydens die eerste fase is die betekenis van die konsep "inkorporering" ontleed. Die resultate het die navorser gelei tydens data-insameling in die tweede fase, bestaande uit indringende individuele en fokusgroeponderhoude om die ervarings en persepsies van postnatale pasiënte, familielede, tradisionelegeboorte-begeleiers, geregistreerde vroedvroue, dosente in verloskunde, en die moeder- en kindergesondheidsorgkoördineerders te ondersoek. Die bevindinge het bevestig dat die "inheemse" postnatalesorgpraktyke tans nie in die verloskundeleerplan, -boeke, of riglyne vir kraamsorg opgeneem is nie. Dit veroorsaak 'n gebrek aan kennis onder vroedvroue oor die "inheemse" postnatalesorgpraktyke, en maak dit vir hulle moeilik om kultureel kongruente sorg te verskaf. Vanweë onvoldoende kennis openbaar vroedvroue 'n negatiewe ingesteldheid teenoor familielede, tradisionelegeboorte-begeleiers, en pasiënte van verskillende kulture. Die deelnemers het bevestig dat daar geen spanwerk is tussen die geregistreerde vroedvroue en die tradisionelegeboorte-begeleiers (familielede) nie. Die studiebevindinge het ook bevestig vroedvroue tans geen opvolgbesoeke aan pasiënte bring gedurende die postnatale periode is nie. Die vroedvroue dwing hul gesondheidsoortuigings en -praktyke op die pasiënte af met ontslag na die geboorte, sonder om familielede of die tradisionelegeboorte-begeleiers te betrek, wat substandaard postnatale sorg tot gevolg het en tot postnatale komplikasies en 'n stygende moedersterftesyfer lei. Gegrond op die bevindinge van fases een en twee is 'n model vir die inkorporering van "inheemse" postnatalesorgpraktyke in 'n vroedvrou-gesondheidsorgstelsel ontwikkel en beskryf. Voorstelle vir verdere studiemoontlikhede is die evaluering en implementering van dié model in gesondheidsorginstellings, verpleegkolleges, klinieke en hospitale as 'n eerste stap om die Departement van Gesondheid in Limpopo te help om "inheemse" praktyke in gesondheidsorgstelsels in te sluit.

IsiZulu: Ukuthuthukiswa kwesibonelo sokuhlanganisa ukunakekelwa "kwabomdabu" ngemva kokubeletha ohlelweni lwezempilo lokubeletha kubaluleke kakhulu ekuqinisekiseni ukunakekelwa okuhambisana namasiko. Kube nobufakazi obulinganiselwe kuphela bokutholakala kwemodeli ekhuluma ngezindlela zokunakekela "zomdabu" ngemva kokubeletha ezinhlelweni zokunakekela kwezempilo ngokuphathelene nokubeletha. Ngenxa yalokho, abahlengikazi basebenza ngokombono wokunakekelwa kwezempilo wesimanje kuphela, kunokuba bahlanganise imibono yomhlaba emibili. Inhloso emqoka yocwaningo ukuthukisa imodeli yokufaka izinqubo zokunakekelwa kwangemva kokubeletha “kwabomdabu” ohlelweni lwezempilo lwababelethisi Esifundeni saseMopani, esifundazweni saseLimpopo, eNingizimu Afrika Ucwaningo lwenziwe ezigabeni ezintathu. Phakathi nesigaba sokuqala kwahlaziywa incazelo yomqondo othi "ukufakwa". Imiphumela yaqondisa umcwaningi ngesikhathi sokuqoqwa kwedatha esigabeni sesibili, equkethe izingxoxo ezijulile zomuntu ngamunye kanye neqembu eligxile ekuhloleni okuhlangenwe nakho kanye nemibono yeziguli ezingemva kokubeletha, amalungu omndeni, izikhonzi zokuzalwa zendabuko, ababelethisi ababhalisile, abafundisi bokubeletha kanye nabaxhumanisi bokunakekela kwezempilo komama nezingane. Okutholakele kuqinisekisile ukuthi okwamanje izinqubo "zabomdabu" zokunakekelwa kwangemva kokubeletha azihlanganisiwe ohlelweni lwezifundo, ezincwadini noma eziqondisweni zokunakekelwa ngokuphathelene nokubeletha. Ngenxa yalokho kunokuntuleka kolwazi phakathi kwababelethisi mayelana nemikhuba "yomdabu" yokunakekelwa kwangemva kokubeletha futhi kunzima ngabo ukunikeza ukunakekelwa okuvumelana namasiko. Ngenxa yolwazi olunganele ababelethisi babonisa isimo sengqondo esibi ngamalungu omndeni, abahlanganyela ngokwendabuko ngokuphathelene nokubeletha kanye neziguli ezivela emasikweni ahlukahlukene. Ababambiqhaza baqinisekisile ukuthi akukho ukubambisana kweqembu phakathi kwababelethisi ababhalisiwe kanye nababelethisi bendabuko (amalungu omndeni). Imiphumela yocwaningo iphinde yaqinisekisa ukuthi okwamanje akukho ukuvakasha kokulandelela kwababelethisi ezigulini ngesikhathi sangemva kokubeletha. Ababelethisi baphoqelela izinkolelo zabo zempilo imikhuba ezigulini ekukhululweni ngemva kokubeletha, ngaphandle kokubandakanyeka kwamalungu omndeni noma abakhulekeli bendabuko bokuzalwa, okuholela ekunakekelweni kwangemva kokubeletha okujwayelekile, okuholela ezinkingeni zangemva kokubeletha kanye nokwanda kwezinga lokushona komama. Ngokusekelwe kokutholakele ezigabeni zokuqala nezimbili, kwasungulwa futhi kwachazwa imodeli yokufaka izindlela zokunakekela "zomdabu" ngemva kokubeletha ohlelweni lwezempilo lwababelethisi. Imiphumela yocwaningo olwengeziwe iphakamise ukuhlolwa nokusetshenziswa kwemodeli ezikhungweni zezempilo, emakolishi abahlengikazi, emitholampilo nasezibhedlela njengesinyathelo sokuqala sokusiza uMnyango Wezempilo esifundazweni sase-Limpopo ekuhlanganiseni izinqubo "zomdabu" ezinhlelweni zezempilo.