Graft versus host disease in oncology nursing practice

INTRODUCTION: Gastrointestinal graft-versus-host disease (GI-GvHD) is extremely debilitating and is multifactorial in its causative factors, management and treatment. It is an exaggeration of normal physiological mechanisms wherein the donor immune system attempts to rid itself of the host. The inflammatory process that follows has the benefit of providing an anti-tumour effect for many diseases, but unfortunately in patients undergoing human stem-cell transplantation, the nature of the inflammation can result in disability, wasting and death. AIM: The aim of this article is to discuss the pathophysiology of this often misunderstood or misdiagnosed condition, as well as its signs and symptoms, management and considerations for nursing care. Considerations for nursing practice: While the medical management is aimed at minimising GvHD through the reduction of T-cell production and proliferation and gastrointestinal decolonisation, the nursing care is often focused on the signs and symptoms that can have the most prominent impact on patients. CONCLUSION: GI-GvHD has serious life-threatening complications, namely wasting syndrome, diarrhoea and dehydration. The basis of signs and symptomology is easily recognisable owing to the stages of progression through the human stem-cell transplantation process. Oncology nurses are in a prime position to identify these serious risks, initiate treatment immediately and collaborate effectively within the multidisciplinary team to minimise GvHD onset and provide expert support to patients, family and caregivers.

Epistemological lens : birth, death and ecology of documentary practices

This paper considers the epistemological life cycle of the camera lens in documentary practices. The 19th century industrial economies that manufactured and commercialised the camera lens have engendered political and economic contingencies on documentary practices to sustain a hegemonic and singular interpretive epistemology. Colonial documentary practices are considered from the viewpoint of manipulative hegemonic practices - all of which use the interpretive epistemology of the camera lens to capitalise a viewpoint which is singular and possesses the power to sustain its own status and economic privilege. I suggest that decolonising documentary practices can be nurtured in what Boaventura de Sousa Santos proposes as an 'ecology of knowledges' (Andreotti, Ahenakew, & Cooper 2011) - a way of including the epistemologies of cultures beyond the 'abyssal' (Santos), outside the limits of epistemological dominance. If an 'epistemicide' (Santos) of indigenous knowledges in the dominant limits has occurred then in an ecology of knowledges the limits become limitless and what were once invisible knowledges, come into their own ontological and epistemological being: as free agents and on their own terms. In an ecology of knowledges, ignorance and blindness may still exist but are not privileged. The decolonisation of documentary practices inevitably destabilises prevailing historicities and initiates ways for equal privilege to exist between multiple epistemologies.

Fictionalising Trauma : The Aesthetics of Marguerite Duras's India Cycle

Marguerite Duras (1914−1996) was one of the most original French writers and film directors, whose cycles are renowned for a transgeneric repetition variation of human suffering in the modern condition. Her fictionalisation of Asian colonialism, the India Cycle (1964−1976), consists of three novels, Le ravissement de Lol V. Stein (1964), Le Vice-consul (1966) and L'amour (1971), a theatre play, India Song (1973), and three films, La Femme du Gange (1973), India Song (1974) and Son nom de Venise dans Calcutta desért (1976). Duras’s cultural position as a colon in inter-war ‘Indochina’ was the backdrop for this “théâtre-text-film”, while its creation was provoked by the atrocities of World War II and post-war decolonisation. Fictionalising Trauma analyses the aesthetics of the India Cycle as Duras’s critical working-through of historical trauma. From an emotion-focused cognitive viewpoint, the study sheds light on trauma’s narrativisation using the renewed concept of traumatic memory developed by current social neuroscience. Duras is shown to integrate embodied memory and narrative memory into an emotionally progressing fiction. Thus the rhetoric of the India Cycle epitomises a creative symbolisation of the unsayable, which revises the concept of trauma from a semiotic failure into an imaginative metaphorical process. The India Cycle portrays the stagnated situation of a white society in Europe and British India during the thirties. The narratives of three European protagonists and one fictional Cambodian mendicant are organised as analogues mirroring the effects of rejection and loss on both sides of the colonial system. Using trauma as a conceptual prism, the study rearticulates this composition as three roles: those of witnessing writers, rejected survivors and colonial perpetrators. Three problems are analysed in turn by reading the non-verbal markers of the text: the white man as a witness, the subversive trope of the madwoman and the deadlock of the colonists’ destructive passion. The study reveals emotion and fantasy to be crucial elements in critical trauma fiction. Two devices intertwine throughout the cycle: affective images of trauma expressing the horror of life and death, and self-reflexive metafiction distancing the face-value of the melodramatic stories. This strategy dismantles racist and sexist discourses underpinning European life, thus demanding a renewal of cultural memory by an empathic listening to the ‘other’. And as solipsism and madness lead the lives of the white protagonists to tragic ends, the ‘real’ beggar in Calcutta lives in ecological harmony with Nature. This emphasises the failure of colonialism, as the Durasian phantasm ambiguously strives for a deconstruction of the exotic mythical fiction of French ‘Indochina’.

"We don't tell people what to do": An ethnography of health promotion with Indigenous Australians in South East Queensland

This thesis contributes to the decolonisation of health promotion by examining Indigenous-led health promotion practice in an urban setting. Using critical ethnography, the study revealed dialogical, identity-based approaches that centred relationship, community control and choice. Based on the findings, the thesis proposes four interrelated principles for decolonising health promotion and argues that Indigenous-led health promotion presents a way to bridge the rhetoric and practice of empowerment in Australian mainstream health promotion practice.

“We don’t tell people what to do”: Ethical practice and Indigenous health promotion

Health promotion aspires to work in empowering, participatory ways, with the goal of supporting people to increase control over their health. However, buried in this goal is an ethical tension: while increasing people’s autonomy, health promotion also imposes a particular, health promotion-sanctioned version of what is good. This tension positions practitioners precariously, where the ethos of empowerment risks increasing health promotion’s paternalistic control over people, rather than people’s control over their own health. Here in we argue that this ethical tension is amplified in Indigenous Australia, where colonial processes of control over Indigenous lands, lives and cultures are indistinguishable from contemporary health promotion ‘interventions’. Moreover, the potential stigmatisation produced in any paternalistic acts ‘done for their own good’ cannot be assumed to have evaporated within the self-proclaimed ‘empowering’ narratives of health promotion. This issue’s guest editor’s call for health promotion to engage ‘with politics and with philosophical ideas about the state and the citizen’ is particularly relevant in an Indigenous Australian context. Indigenous Australians continue to experience health promotion as a moral project of control through intervention, which contradicts health promotion’s central goal of empowerment. Therefore, Indigenous health promotion is an invaluable site for discussion and analysis of health promotion’s broader ethical tensions. Given the persistent and alarming Indigenous health inequalities, this paper calls for systematic ethical reflection in order to redress health promotion’s general failure to reduce health inequalities experienced by Indigenous Australians.

Editorial of "International Journal of Critical Indigenous Studies Volume 2, Number 2, 2009"

This edition of the International Critical Indigenous Studies Journal, our second for 2009 takes alternative understandings as its theme. All four articles in this edition attend to citizenship and Indigenous sovereignty though in different ways...

"My" i "oni", "swój" i "obcy". Bałkany XX wieku z perspektywy kolonialnej i postkolonialnej

W artykule został przeanalizowany dyskurs bałkański XX wieku z kolonialnego i postkolonialnego punktu widzenia. Pierwsza część przybliża geopolityczny stosunek do Bałkanów,The Balans in the Gaze of Western Travellers (2004) jako przykłady korygującego wobec istniejących dotychczas reprezentacji i wyobrażeń Bałkanów. skupia się jednak nie tylko na nazwie geograficznej Półwysep Bałkański, lecz przede wszystkim na figuratywnym i metaforycznym języku, bazującym na stereotypach i negatywnych „etykietkach” Bałkanów, takich jak: „beczka prochu”, obszar „zadawnionej nienawiści”, „zderzenie cywilizacji”, „strefa rozłamu”, europejskie „jądro ciemności”, „dzika Europa”, „jeszcze- nie” Europa. Ten stosunek opiera się na opozycji My-Oni z kolonialnego, punktu widzenia Zachodu. W drugiej części tekstu zostaje przeprowadzona analiza trzech utworów prozatorskich autorstwa wybitnych pisarzy z Bałkanów – chorwacki dyskurs literacki jest reprezentowany przez Miroslava Krležę w opowiadaniu W Dreźnie. Mister Wu San Pej interesuje się problemem serbsko-chorwackim (1924), serbski dyskurs przedstawia Ivo Andrić w opowiadaniu List z roku 1920 (1946), natomiast bośniacki – Nenad Veličković i jego powieść epistolarna Sahib. Impresje z depresji (2001). Te trzy dyskursy z różnych przełomowych dla Jugosławii okresów pokazują, że pisarze chętnie sięgali po figurę „Obcego”, by uwypuklić problemy związane z własną złożoną, często zwielokrotnioną tożsamością. Ostatnia część akcentuje nowe, postkolonialne podejście do problemu Bałkanów – uczestniczą w nim wybitni naukowcy pochodzący z tego regionu, którzy zrobili kariery w Europie Zachodniej i USA. W tej części zostają zaprezentowane trzy fundamentalne dla tego problemu książki – studium Marii Todorowej (Bułgarka) Imagining the Balkans (1997), monografia Vesny Bjelogrlić-Goldsworthy (Serbka) Inventing Ruritania: The Imperializm of the Imagination (1998) oraz antropologiczna książka Božidara Jezernika (Słoweniec) Wild Europe.

Varieties of resource nationalism in sub-Saharan Africa’s energy and minerals markets

This article examines resource nationalism in sub-Saharan Africa's energy and minerals markets. It does so by exploring economic and political developments in three cases: Nigeria as an example of a petro-state established by means of expropriation in the wake of decolonisation; South Africa, a mature mining industry shaped by its settler colonial history; and Mozambique, a new and therefore highly-dependent entrant into the league of significant natural gas producers. Extractive industries have played a controversial role in sub-Saharan Africa due in particular to the prevalence of the resource curse. Nevertheless, energy exports will continue to play an important role in fuelling economic growth and, potentially, also development as new deposits of natural gas and oil are discovered across the region. Resource nationalism has, moreover, increasingly constrained operations of the traditionally dominant Western energy companies, in particular as competition from state-owned energy companies in sub-Saharan Africa and from emerging powers such as China is increasing.

Hollywood and world cinema influences: tracing intertextuality in the works of two contemporary filmmakers from Francophone Africa; Mahamat Saleh Haroun and Abderrahmane Sissako

Don’t tell me the moon is shining; show me the glint of light on broken glass Anton Chekhov Representations of Africa in cinema are almost as old as cinema itself and date back to Hollywood’s silent era. Most early examples feature the continent as a mere exotic backdrop and include The Sheik (Melford 1921), soon followed, in 1926, by George Fitzmaurice’s Son of the Sheik starring Rudolph Valentino. The next decade brought Van Dyke’s Tarzan movies, Robert Stevenson’s King Solomon’s Mines (1937), and, on the European side, Duvivier’s Pépé le Moko (1936). For representations of Francophone Africa by Africans themselves, the viewing public more or less had to wait, however, until decolonisation in the 1960s (with, for example, Sembene Ousmane’s Borom Sarret and La Noire de…, both released in 1966 and, in 1968, Mandabi). Since then Francophone African cinema has come a long way and has diversified into various strands. Between Borom Sarret and Mahamat-Saleh Haroun’s 2006 Daratt, Saison sèche - or the same director’s Un homme qui crie, almost half a century has elapsed. Over this period, films inevitably have addressed a spectrum of visual, ideological and political tropes. They range from unadorned depictions of the newly independent states and their societies to highly aestheticised productions, not to mention surreal and poetic visions as displayed for instance in Djibril Diop Mambéty’s Touki Bouki (1973). Most of the early films send an overt socio-political message which is a clear and explicit denunciation of a corrupt state of affairs (Souleymane Cissé’s Baara, 1977). They aim to trigger strong emotional and political responses from the viewer, in unambiguous support for the film-maker’s stand. Sembene himself declared: “I consider cinema a means of political action” (Murphy 2000: 221). Similarly, the Mauritanian director Med Hondo wishes to “take up this technical medium and to make it a mouthpiece on behalf of [his] fellow Africans and Arabs” (Jeffries 2002: 11). All this echoes the claims of the Fédération Panafricaine des Cinéastes (FEPACI, founded in 1969), an organisation “dedicated to the liberation of Africa”. In sharp contrast to the incipient momentum given Francophonie by Bourguiba, the Nigerien Hamani Diori and the Senegalese Senghor, who invoked a worldwide communauté organique francophone, FEPACI called for “the creation of an aesthetics of disalienation… [using] didactic... forms to denounce the alienation of countries that were politically independent but culturally and economically dependent on the West” (Diawara 1996: 40). Sembene’s Xala (1974) became the blueprint for this, to this day the best-known vein of Francophone African cinema. Thus considered, this pedigree seems a million miles from mainstream global cinema with its overriding mission to entertain. A question therefore arises: to what extent can a cinema that sprang from such beginnings be seen to interface in any meaningful way with a global film industry that, overwhelmingly and for a century, has indeed entertained the world – with Hollywood at its centre?

Une approche interculturelle des relations entre les nations autochtones et non-autochtones au Canada : une porte ouverte sur le postcolonialisme?

La situation économique, sociale et politique des nations autochtones au Canada et leur relation avec les nations non-autochtones présentent des similarités avec les anciennes colonies européennes. Peut-on qualifier cette relation de « coloniale » ? Cette interrogation est primordiale, vu les aspects immoraux et illégaux que prit la colonisation. Nous parcourrons la pensée d’auteurs reliés au libéralisme, au nationalisme autochtone et à l’interculturalisme et nous choisirons ce dernier comme angle d’approche. Nous élaborerons ensuite le concept de colonisation interne et nous le confronterons au cas des autochtones. Puis, nous présenterons les motivations à la décolonisation ainsi que la composition d’un hypothétique État postcolonial canadien et de nations et communautés autochtones décolonisées. Finalement, nous analyserons la démarche judiciaire, la négociation d’ententes d’autonomie gouvernementale, la mobilisation des masses et l’approche des word warriors, l’objectif étant d’évaluer jusqu’à quel point ces moyens s’inscrivent dans un éventuel processus de décolonisation des nations autochtones.

Staking a truth claim : Constructing a document in two laws

The documentary 'Two Laws' constitutes a legal document in support of the Borroloola claim to their land and contributes to the decolonisation of the images of Aboriginal Australia, which have circulated within ethnographic cinema, television journalism and fiction film. The 'two laws' of the film's title refer to white law and 'the Law', the system which regulates Borroloola social interactions and relationships with the land.

Australia and East Timor : elitism, pragmatism and the national interest

For over two decades the issue of East Timor's right to self-determination has been a ‘prickly’ issue in Australian foreign policy. The invasion by Indonesian forces in 1975 was expected, as Australian policy-makers had been well informed of the events leading up to the punitive action being taken. Indeed, prior discussions involving the future of the territory were held between the Australian Prime Minister and the Indonesian President in 1974. In response to the events unfolding in the territory the Australian Labor Government at the time was presented with two policy options for dealing with the issue. The Department of Defence recommended the recognition of an independent East Timor; whereas the Department of Foreign Affairs proposed that Australia disengage itself as far as possible from the issue. The decision had ramifications for future policy considerations especially with changes in government. With the Department of Foreign Affairs option being the prevailing policy what were the essential ingredients that give explanation for the government's choice? It is important to note the existence of the continuity and cyclical nature of attitudes by Labor governments toward Indonesia before and after the invasion. To do so requires an analysis of the influence ‘Doc’ Evatt had in shaping any possible Labor tradition in foreign policy articulation. The support given by Evatt for the decolonisation of the Netherlands East Indies (Indonesia) gave rise to the development of a special relationship-so defined. Evidence of the effect Evatt had on future Labor governments may be found in the opinions of Gough Whitlam. In 1975 when he was Prime Minister, Whitlam felt the East Timor issue was merely the finalisation of Indonesia's decolonisation honouring Evatt's long held anti-colonialist tradition existing in the Australian Labor Party. The early predisposition toward Indonesia's cohesiveness surfaced again in the Hawke and Keating Labor governments of later years. It did not vary a great deal with changes in government The on-going commitment to preserving and strengthening the bilateral relationship meant Indonesia's territorial integrity became the focus of the Australian political elites’ regional foreign policy determinations. The actions taken by policy-makers served to promote the desire for a stable region ahead of independence claims of the East Timorese. From a realist perspective, the security dilemma for Australian policy-makers was how to best promote regional order and stability in the South East Asian region. The desire for regional cohesiveness and stability continues to drive Australian political elites to promote policies that gives a priority to the territorial integrity of regional states. Indonesia, in spite of its diversity, was only ever thought of as a cohesive unitary state and changes to its construct have rarely been countenanced. Australia's political elite justifications for this stance vacillate between strategic and economic considerations, ideological (anti-colonialism) to one of being a pragmatic response to international politics. The political elite argues the projection of power into the region is in Australia’s national interest. The policies from one government to the next necessarily see the national interest as being an apparent fixed feature of foreign policy. The persistent fear of invasion from the north traditionally motivated Australia's political elite to adopt a strategic realist policy that sought to ‘shore up’ the stability, strength and unity of Indonesia. The national interest was deemed to be at risk if support for East Timorese independence was given. The national interest though can involve more than just the security issue, and the political elite when dealing with East Timor assumed that they were acting in the common good. Questions that need to be addressed include determining what is the national interest in this context? What is the effect of a government invoking the national interest in debates over issues in foreign policy? And, who should participate in the debate? In an effort to answer these questions an analysis of how the ex-foreign affairs mandarin Richard Woolcott defines the national interest becomes crucial. Clearly, conflict in East Timor did have implications for the national interest. The invasion of East Timor by Indonesia had the potential to damage the relationship, but equally communist successes in 1975 in Indo-China raised Australia's regional security concerns. During the Cold War, the linking of communism to nationalism was driving the decision-making processes of the Australian policy-makers striving to come to grips with the strategic realities of a changing region. Because of this, did the constraints of world politics dominated by Cold War realities combined with domestic political disruption have anything to do with Australia's response? Certainly, Australia itself was experiencing a constitutional crisis in late 1975. The Senate had blocked supply and the Labor Government did not have the funds to govern. The Governor-General by dismissing the Labor Government finally resolved the impasse. What were the reactions of the two men charged with the responsibility of forming the caretaker government toward Indonesia's military action? And, could the crisis have prevented the Australian government from making a different response to the invasion? Importantly, and in terms of economic security, did the knowledge of oil and gas deposits thought to exist in the Timor Sea influence Australia's foreign policy? The search for oil and gas requires a stable political environment in which to operate. Therefore for exploration to continue in the Timor Sea Australia must have had a preferred political option and thoughts of with whom they preferred to negotiate. What was the extent of each government's cooperation and intervention in the oil and gas industry and could any involvement have influenced the Australian political elites’ attitude toward the prospect of an independent East Timor? Australia's subsequent de jure recognition that East Timor was part of Indonesia paved the way for the Timor Gap (Zone of Cooperation) Treaty signing in 1989. The signing underpinned Australia's acceptance of Indonesian sovereignty over East Timor. The outcome of the analysis of the issues that shaped Australia's foreign policy toward East Timor showed that the political elite became locked into an integration model, which was defended by successive governments. Moreover, they formed an almost reflexive defence of Indonesia both at the domestic and international level.

The case of children's literature : colonial or anti-colonial?

Since Jacqueline Rose published The Case of Peter Pan in 1984, scholars in the field of children’s literature have taken up a rhetorical stance which treats child readers as colonised, and children’s books as a colonising site. This article takes issue with Rose’s rhetoric of colonisation and its deployment by scholars, arguing that it is tainted by logical and ethical flaws. Rather, children’s literature can be a site of decolonisation which revisions the hierarchies of value promoted through colonisation and its aftermath by adopting what Bill Ashcroft refers to as tactics of interpolation. To illustrate how decolonising strategies work in children’s texts, the article considers several alphabet books by Indigenous author-illustrators from Canada and Australia, arguing that these texts for very young children interpolate colonial discourses by valorising minority languages and by attributing to English words meanings produced within Indigenous cultures.