Contrary Voices: Heine, Holderlin, and Goethe in the music of Hanns Eisler

Contrary Voices examines composer Hanns Eisler’s settings of nineteenth-century poetry under changing political pressures from 1925 to 1962. The poets’ ideologically fraught reception histories, both under Nazism and in East Germany, led Eisler to intervene in this reception and voice dissent by radically fragmenting the texts. His musical settings both absorb and disturb the charisma of nineteenth-century sound materials, through formal parody, dissonance, and interruption. Eisler’s montage-like work foregrounds the difficult position of a modernist artist speaking both to and against political demands placed on art. Often the very charisma the composer seeks to expose for its power to sway the body politic exerts a force of its own. At the same time, his text-settings resist ideological rigidity in their polyphonic play. A dialogic approach to musical adaptation shows that, as Eisler seeks to resignify Heine’s problematic status in the Weimar Republic, Hölderlin’s appropriation under Nazism, and Goethe’s status as a nationalist symbol in the nascent German Democratic Republic, his music invests these poetic voices with surprising fragility and multivalence. It also destabilizes received gender tropes, in the masculine vulnerability of Eisler’s Heine choruses from 1925 and in the androgynous voices of his 1940s Hölderlin exile songs and later Goethe settings. Cross-reading the texts after hearing such musical treatment illuminates faultlines and complexities less obvious in text-only analysis. Ultimately Eisler’s music translates canonical material into a form as paradoxically faithful as it is violently fragmented.

The Barriers to the Integration of the Uterine Balloon Tamponade into South Africa and Ghana's Health Systems for the Management of Postpartum Hemorrhage

Background

Postpartum hemorrhage is the most significant contributor to maternal mortality globally, claiming 140,000 lives annually. Postpartum hemorrhage is a leading cause of maternal death in South Africa, with the literature indicating that 80 percent of the postpartum hemorrhage deaths in South Africa are avoidable. Ghana, as of 2010, witnesses 2700 maternal deaths annually, primarily because of poor quality of care in health facilities and services being difficult to access. As per WHO recommendations, uterotonics are integral to treating postpartum hemorrhage as soon as it is diagnosed. In case of persistent bleeding or limited availability of uterotonics, the uterine balloon tamponade (UBT) can be used as a second line of defense. If both these measures are unable to counter the bleeding, providers must perform surgical interventions. Literature on the UBT, as one tool in the protocol to address postpartum hemorrhage, has shown it to have success rates ranging from 60 to 100 percent. Despite the potential to lower the number of postpartum hemorrhage deaths in South Africa and Ghana, the UBT has not been incorporated widely in South Africa and Ghana. The aim of this study is to describe the barriers involved with integrating the UBT into South Africa and Ghana’s health systems to address postpartum hemorrhage.

Methods

The study took place in multiple sites in South Africa (Cape Town, Johannesburg, Durban and Mpumalanga) and in Accra, Ghana. South Africa and Ghana were selected because postpartum hemorrhage contributes greatly to their maternal mortality numbers and there is potential in both countries to lower those rates through greater use of the UBT. A total of 25 participants were interviewed through purposive sampling, snowball sampling and participant referrals, and included various categories of stakeholders integral to the integration process of a medical device. Individual in-depth interviews were used for data collection, with interview questions being tailored to each stakeholder category. The focus of the interviews was on the protocol used to counter postpartum hemorrhage, the frequency with which the UBT is used as part of the protocol, and the process of integrating it into the South Africa and Ghana’s health systems. The data collected were coded using NVivo and analyzed using content analysis.

Results

The barriers to integration of the uterine balloon tamponade to address postpartum hemorrhage in South Africa and Ghana were evident on the political, economic and health delivery levels. The results indicated that the barriers to integration in South Africa included the low recognition of postpartum hemorrhage as a problem, the lack of clarity surrounding the role of the Medicines Control Council as a regulatory body for medical devices, and low awareness of the UBT as an intervention to control postpartum hemorrhage. The barriers in Ghana were the cash constraints experienced by the Ghana Health Services to fund medical devices, a heavy reliance on donors for funding, and the lack of consistent knowledge on processes involving clinical trials for new medical devices in Ghana.

Conclusion

Existing literature on methods to counter postpartum hemorrhage to reduce maternal mortality has focused on and emphasized the efficacy of the UBT. Despite overwhelming evidence supporting the use of the UBT, many health systems across the world, particularly low-income countries, do not have access to the device owing to numerous barriers in integrating the device into obstetric care. This study illustrates the need to focus on incorporating the UBT into health systems for greater availability to health workers and its use as standard of care. Ultimately, this study can be used as a stepping-stone for more research on this subject, providing evidence to influence policymakers to integrate the UBT into their protocols for postpartum hemorrhage response.

Embodied Prayer: the practice of prayer as Christian theology

This dissertation attempts to retrieve the integration of prayer and theology in the life of the church. Prayer is a spiritual and bodily theological activity that forms Christian identity and virtuous character. The bodily dimension of Christian prayer plays an essential role in theological understanding and moral formation. However, the embodiment of prayer has been mostly neglected in modern academic theology. This study highlights the significance of the body at prayer in theological studies and spiritual formation.

Chapter 1 presents Karl Barth’s theology of prayer as a model of the integration of prayer, theology, and Christian life (lex orandi, lex credendi, lex agendi). However, Barth’s attempt to overcome the dichotomy between theory and practice in theology did not pay much attention to embodiment of prayer. Through ritual studies and phenomenology (Marcel Mauss, Maurice Merleau-Ponty, and Pierre Bourdieu), chapter 2 shows why the bodily dimension of the practice of prayer should be recovered in theology and ministry; then it explains how Christians in the early and medieval church actually prayed with the body, how their bodily actions were understood in their theological paradigms, and how their actions contributed to the formation of Christian character. Chapter 3 narrows the focus to the formation of the heart in the making of Christian character. The practice of prayer has been emphasized not only as an expression of the inner heart of pray-ers but also as a channel of grace that shapes their affections as enduring dispositions of the heart. Furthermore, historically the bodily practice of prayer gave theological authority to the devout Christians who were marginalized in academic theology or ecclesiastical hierarchy, and Chapter 4 presents the lex orandi of praying women who gained their theological knowledge, wisdom, and authority through their exemplary practices of prayer (Catherine of Siena, Mechthild of Magdeburg, Julian of Norwich, Margery Kempe, and Teresa of Avila). These historical examples reveal how Christian communities appreciated and celebrated the theological voices from the margins, which developed from theological embodiments in prayer.

This dissertation concludes that academic theology needs to heed these diverse theological voices, which are nurtured through everyday practice, as an integral part of theological studies. Therefore, it calls for a new paradigm for understanding the relationship between theory and practice in theological education. The integration between theory and bodily practice is necessary for both academic theology and spiritual formation. A more holistic understanding of Christian practices will not only enhance the training of scholars and clergy but also give the laity their own theological voices that will enrich academic theology.