Hope in the Most Unlikely Spaces: Thawra and the Contemporary Arabic Novel

In the early to mid-twentieth century, many novelists in the Arab world championed Arab nationalism in their literary reflections on the social and political struggles of their countries, depicting these struggles primarily in terms of spatial binaries that pitted the Arab world against the West, even as they imported Western literary models of progress and modernity into their own work. The intense experience of national awakening that infused their writing often placed these authors at a literary disadvantage, for in their literature, all too often the depth and diversity of Arabic cultures and the complexity of socio-political struggles across the Arab world were undermined by restrictive spatial discourses that tended to focus only on particular versions of Arab history and on a seemingly unifying national predicament. Between the Arab defeat of 1967 and the present day, however, an increasing number of Arab authors have turned to less restrictive forms of spatial discourse in search of a language that might offer alternative narratives of hope beyond the predictable, and seemingly thwarted, trajectories of nationalism. This study traces the ways in which contemporary Arab authors from Egypt and the Sudan have endeavoured to re-think and re-define the Arab identity in ever-changing spaces where elements of the local and the global, the traditional and the modern, interact both competitively and harmoniously. I examine the spatial language and the tropes used in three Arabic novels, viewing them through the lens of thawra (revolution) in both its socio-political and artistic manifestations. Linking the manifestations of thawra in each text to different scenes of revolution in the Arab world today, in Chapter Two, I consider how, at a stage when the Sudan of the sixties was both still dealing with colonial withdrawal and struggling to establish itself as a nation-state, the geographical and textual landscapes of Tayeb Salih‟s Season of Migration to the North depict the ongoing dilemma of the Sudanese identity. In Chapter Three, I examine Alaa iii al-Aswany‟s The Yacoubian Building in the context of a socially diseased and politically corrupt Egypt of the nineties: social, political, modern, historical, local, and global elements intertwine in a dizzyingly complex spatial network of associations that sheds light on the complicated reasons behind today‟s Egyptian thawra. In Chapter Four, the final chapter, Gamal al-Ghitani‟s approach to his Egypt in Pyramid Texts drifts far away from Salih‟s anguished Sudan and al-Aswany‟s chaotic Cairo to a realm where thawra manifests itself artistically in a sophisticated spatial language that challenges all forms of spatial hegemony and, consequently, old and new forms of social, political, and cultural oppression in the Arab world.

HOME-BASED REHABILITATION AND ITS IMPACT ON HOSPITAL UTILIZATION

There is compelling evidence for the effectiveness of home-based occupational therapy and physiotherapy rehabilitation for community dwelling elderly who may struggle with basic activities and the functions of daily living and mobility. Nonetheless, an estimated 2% of home care’s elderly clients receive these therapies. Ontario’s home care data indicates that 78% of clients that could benefit from these specific therapies are not receiving them. The study examined a subset of elderly clients receiving home care following a hospital discharge during 2009-2010. The aim of this study was to: understand the difference between those home care clients who received occupational therapy or physiotherapy and those who did not; and determine if receiving these therapies impacted the utilization of hospital emergency departments and inpatient admissions. A retrospective cohort design and multivariate and survival analysis of hospital and home care administrative data structured the study. Results suggest that home-based rehabilitation is offered to a minority of the home care population. Distinct client characteristics and process variables significantly associated with the increased likelihood of receiving home-based occupational and physical therapies included: clients who were older, females, admitted to home care from hospital inpatient units, assessed as non-acute for clinical and service needs and required more home making support and assistance with activities of daily living. Almost one quarter of the total sample returned to hospital. Visits to emergency departments accounted for the greater part of hospital utilization and primarily for sub-acute general symptoms and signs, post-procedural complications, infections or acute episodes from chronic obstructive pulmonary disease and renal failure. Slightly over half of the clients returning to hospital did not receive home-based rehabilitation. Clients who received occupational therapy returned to the hospital sooner following their home care admission whereas clients receiving physiotherapy spent the longest time before rehospitalizing. The majority of the clients receiving occupational therapy were admitted to home care having just resolved sub-acute conditions or symptoms, many of which are known to influence functional and physical decline. Moreover, analysis of process variables indicated that the wait time for a referral to occupational therapy was two times longer compared to physiotherapy. These same clients also waited, on average, over one month before an occupational therapist’s first visit. The need to discriminate who receives home-based rehabilitation is essential to understanding how specific therapies contribute to improving systems outcomes. This study is the first examination that focuses specifically on home-based occupational therapy and physiotherapy rehabilitation and the client characteristics and process variables associated with receiving/not receiving these therapies and the impact these factors have on the time-to-rehospitalization.