Reckoning With Apartheid: The Conundrum of Working Through the Past, An Introduction

From April 26-29, 1994, South Africa held its first universal, democratic elections. Witnessed by the world, South Africans of all races waited patiently in line to cast their ballots, signaling the official and symbolic birth of the “new” South Africa. The subsequent years, marked initially with euphoric hopes for racial healing enabled by institutional processes such as the Truth and Reconciliation Commission (TRC), have instead, most recently, inspired deep concern about epidemic levels of HIV/AIDS, violent crime, state corruption, and unbridled market reforms directed at everything from property to bodies to babies. Now, seemingly beleaguered state officials deploy the mantra “TINA” (There Is No Alternative [to neoliberal development]) to fend off criticism of growing income and wealth disparities. To coincide, more or less, with the anniversary of 1994—less to commemorate than to signal something about the trajectory of the past twenty years—we are proposing an interdisciplinary, special theme section of Comparative Studies in South Asia, Africa, and the Middle East (CSSAAME) entitled “The Haunted Present: Reckoning After Apartheid” (tentative title). The special theme section is framed around questions of reckoning in the double sense of both a moral and practical accounting for historical injury alongside the challenges and failures of the no-longer “new” South Africa. Against accounts depicting the liberation era as non-violent and peaceable, more nuanced analysis we argue suggests not only that South Africa’s “revolution” was marked by both collective and individual violence—on the part of the state and the liberation movements—but that reckoning with the present demands of scholars, the media, and cultural commentators that they begin to grapple more fully with the dimensions and different figurations of South Africa’s violent colonial history. Indeed, violence and reckoning appear as two central forces in contemporary South African political, economic, and social life. In response, we are driven to pose the following questions: In the post-apartheid period, what forms of (individual, structural) violence have come to bear on South African life? How does this violence reckon with apartheid and its legacies? Does it in fact reckon with the past? How can we or should we think about violence as a response to the (failed?) reckoning of state initiatives like the TRC? What has enabled or enables aesthetic forms—literature, photography, plastic arts, and other modes of expressive culture—to respond to the difficulties of South Africa’s ongoing transition? What, in fact, would a practice or ethic of reckoning defined in the following way look like? ˈrekəniNG/ noun: • the action or process of calculating or estimating something: last year was not, by any reckoning, a particularly good one; the system of time reckoning in Babylon • a person’s view, opinion, or judgment: by ancient reckoning, bacteria are plants • archaic, a bill or account, or its settlement • the avenging or punishing of past mistakes or misdeeds: the fear of being brought to reckoning there will be a terrible reckoning (Oxford English Dictionary) Looking back on the period, just before 1994, is sobering indeed. At the time, many saw in the energies and courage of those fighting for liberation the possibilities of a post-racial, post-conflict society. Yet as much as the new was ushered in, old apartheid forms lingered. Recalling Nadine Gordimer’s invocation of Gramsci’s “morbid symptoms” more and more it seems “the old is dying and the new cannot be born” (Gramsci cited in Gordimer 1982). And even as the new began to emerge other forces—both internal and external to South Africa—redefined the conditions for transformation. The so-called “new” South Africa, as Jennifer Wenzel has argued, was really more than anything “the changing face of old oppressions” (Wenzel 2009:159). The implications for our special theme section of CSSAAME are many. We begin by exploring the gender, race, and class dimensions of contemporary South African life by way of its literatures, histories, and politics, its reversion to custom, the claims of ancestors on the living, in brief, the various cultural expressive modes in which contemporary South Africa reckons with its past and in so doing accounts, day by day, for the ways in which the present can be lived, pragmatically. This moves us some distance from the exercise in “truth and reconciliation” of the earlier post-transition years to consider more fully the nature of post-conflict, the suturing of old enmities in the present, and the ways of resolving those lingering suspicions both ordinary and the stuff of the dark night of the soul (Nelson 2009:xv).

Reckoning With Apartheid: The Conundrum of Working Through the Past

From April 26-29, 1994, South Africa held its first universal, democratic elections. Witnessed by the world, South Africans of all races waited patiently in line to cast their ballots, signaling the official and symbolic birth of the “new” South Africa. The subsequent years, marked initially with euphoric hopes for racial healing enabled by institutional processes such as the Truth and Reconciliation Commission (TRC), have instead, most recently, inspired deep concern about epidemic levels of HIV/AIDS, violent crime, state corruption, and unbridled market reforms directed at everything from property to bodies to babies. Now, seemingly beleaguered state officials deploy the mantra “TINA” (There Is No Alternative [to neoliberal development]) to fend off criticism of growing income and wealth disparities. To coincide, more or less, with the anniversary of 1994—less to commemorate than to signal something about the trajectory of the past twenty years—we are proposing an interdisciplinary, special theme section of Comparative Studies in South Asia, Africa, and the Middle East (CSSAAME) entitled “The Haunted Present: Reckoning After Apartheid” (tentative title). The special theme section is framed around questions of reckoning in the double sense of both a moral and practical accounting for historical injury alongside the challenges and failures of the no-longer “new” South Africa. Against accounts depicting the liberation era as non-violent and peaceable, more nuanced analysis we argue suggests not only that South Africa’s “revolution” was marked by both collective and individual violence—on the part of the state and the liberation movements—but that reckoning with the present demands of scholars, the media, and cultural commentators that they begin to grapple more fully with the dimensions and different figurations of South Africa’s violent colonial history. Indeed, violence and reckoning appear as two central forces in contemporary South African political, economic, and social life. In response, we are driven to pose the following questions: In the post-apartheid period, what forms of (individual, structural) violence have come to bear on South African life? How does this violence reckon with apartheid and its legacies? Does it in fact reckon with the past? How can we or should we think about violence as a response to the (failed?) reckoning of state initiatives like the TRC? What has enabled or enables aesthetic forms—literature, photography, plastic arts, and other modes of expressive culture—to respond to the difficulties of South Africa’s ongoing transition? What, in fact, would a practice or ethic of reckoning defined in the following way look like? ˈrekəniNG/ noun: • the action or process of calculating or estimating something: last year was not, by any reckoning, a particularly good one; the system of time reckoning in Babylon • a person’s view, opinion, or judgment: by ancient reckoning, bacteria are plants • archaic, a bill or account, or its settlement • the avenging or punishing of past mistakes or misdeeds: the fear of being brought to reckoning there will be a terrible reckoning (Oxford English Dictionary) Looking back on the period, just before 1994, is sobering indeed. At the time, many saw in the energies and courage of those fighting for liberation the possibilities of a post-racial, post-conflict society. Yet as much as the new was ushered in, old apartheid forms lingered. Recalling Nadine Gordimer’s invocation of Gramsci’s “morbid symptoms” more and more it seems “the old is dying and the new cannot be born” (Gramsci cited in Gordimer 1982). And even as the new began to emerge other forces—both internal and external to South Africa—redefined the conditions for transformation. The so-called “new” South Africa, as Jennifer Wenzel has argued, was really more than anything “the changing face of old oppressions” (Wenzel 2009:159). The implications for our special theme section of CSSAAME are many. We begin by exploring the gender, race, and class dimensions of contemporary South African life by way of its literatures, histories, and politics, its reversion to custom, the claims of ancestors on the living, in brief, the various cultural expressive modes in which contemporary South Africa reckons with its past and in so doing accounts, day by day, for the ways in which the present can be lived, pragmatically. This moves us some distance from the exercise in “truth and reconciliation” of the earlier post-transition years to consider more fully the nature of post-conflict, the suturing of old enmities in the present, and the ways of resolving those lingering suspicions both ordinary and the stuff of the dark night of the soul (Nelson 2009:xv).

Black Femininity through the White Speculum: The Implications of Medicosocialism and the Disproportionate Regulation of Black Women’s Reproductive Autonomy

At the crux of health disparities for women of color lies a history of maltreatment based on racial difference from their white counterparts. It is their non-whiteness that limits their access to the ideologies of “woman” and “femininity” within dominant culture. As the result of this difference, the impact of the birth control movement varied among women based on race. This project explores how the ideology attributed to the black female body limited black women’s access to “womanhood” within dominant culture, and analyzes the manners in which their reproductive autonomy was compromised as the result of changes to that ideology through time. This project operates under the hypothesis that black women’s access to certain aspects of femininity such as domesticity and motherhood reflected their roles in slave society, that black women’s reproductive value was based on the value of black children within slave culture, and that both of these factors dictated the manner in which their reproductive autonomy was managed by health professionals. Black people’s worth as a free labor force within dominant culture diminished when the Reconstruction Amendments were added to the constitution and slavery was deemed unconstitutional—resulting in the paradigmatic shift from the promotion of black fertility to its recession. America’s transition to the medicosocial regulation of black fertility through Eugenics, the role of the black elite in the movement, and the negative impact of this agenda on the reproductive autonomy of black women from low socioeconomic backgrounds are enlisted as support. The paper goes on to draw connections between post-slavery ideology of black femininity and modern-day medicosocial occurrences within clinical settings in order to advocate for increased bias training for medical professionals as a means of combating current health disparities. It concludes with the possibility that this improvement in medical training could persuade people of color to seek out medical intervention at earlier stages of illness and obtain regular check-ups by actively countering physicians’ past transgressions against them.

Role of patient factors, preferences, and distrust in health care and access to liver transplantation and organ donation.

Despite major improvements in access to liver transplantation (LT), disparities remain. Little is known about how distrust in medical care, patient preferences, and the origins shaping those preferences contribute to differences surrounding access. We performed a single-center, cross-sectional survey of adults with end-stage liver disease and compared responses between LT listed and nonlisted patients as well as by race. Questionnaires were administered to 109 patients (72 nonlisted; 37 listed) to assess demographics, health care system distrust (HCSD), religiosity, and factors influencing LT and organ donation (OD). We found that neither HCSD nor religiosity explained differences in access to LT in our population. Listed patients attained higher education levels and were more likely to be insured privately. This was also the case for white versus black patients. All patients reported wanting LT if recommended. However, nonlisted patients were significantly less likely to have discussed LT with their physician or to be referred to a transplant center. They were also much less likely to understand the process of LT. Fewer blacks were referred (44.4% versus 69.7%; P = 0.03) or went to the transplant center if referred (44.4% versus 71.1%; P = 0.02). Fewer black patients felt that minorities had as equal access to LT as whites (29.6% versus 57.3%; P < 0.001). For OD, there were more significant differences in preferences by race than listing status. More whites indicated OD status on their driver's license, and more blacks were likely to become an organ donor if approached by someone of the same cultural or ethnic background (P < 0.01). In conclusion, our analysis demonstrates persistent barriers to LT and OD. With improved patient and provider education and communication, many of these disparities could be successfully overcome. Liver Transplantation 22 895-905 2016 AASLD.

Hydrological Response of East China to the Variation of East Asian Summer Monsoon

Copyright © 2016 Fuxing Li et al.The sensitivity of hydrologic variables in East China, that is, runoff, precipitation, evapotranspiration, and soil moisture to the fluctuation of East Asian summer monsoon (EASM), is evaluated by the Mann-Kendall correlation analysis on a spatial resolution of 1/4° in the period of 1952-2012. The results indicate remarkable spatial disparities in the correlation between the hydrologic variables and EASM. The regions in East China susceptible to hydrological change due to EASM fluctuation are identified. When the standardized anomaly of intensity index of EASM (EASMI) is above 1.00, the runoff of Haihe basin has increased by 49% on average, especially in the suburb of Beijing and Hebei province where the runoff has increased up to 105%. In contrast, the runoff in the basins of Haihe and Yellow River has decreased by about 27% and 17%, respectively, when the standardized anomaly of EASMI is below -1.00, which has brought severe drought to the areas since mid-1970s. The study can be beneficial for national or watershed agencies developing adaptive water management strategies in the face of global climate change.

Food Swamps, Obesity & Health Zoning Restrictions on Fast Food Restaurants

Protecting public health is the most legitimate use of zoning, and yet there is minimal progress in applying it to the obesity problem. Zoning could potentially be used to address both unhealthy and healthy food retailers, but lack of evidence regarding the impact of zoning and public opinion on zoning changes are barriers to implementing zoning restrictions on fast food on a larger scale. My dissertation addresses these gaps in our understanding of health zoning as a policy option for altering built, food environments.

Chapter 1 examines the relationship between food swamps and obesity and whether spatial mapping might be useful in identifying priority geographic areas for zoning interventions. I employ an instrumental variables (IV) strategy to correct for the endogeneity problems associated with food environments, namely that individuals may self-select into certain neighborhoods and may consider food availability in their decision process. I utilize highway exits as a source of exogenous variation .Using secondary data from the USDA Food Environment Atlas, ordinary least squares (OLS) and IV regression models were employed to analyze cross-sectional associations between local food environments and the prevalence of obesity. I find even after controlling for food desert effects, food swamps have a positive, statistically significant effect on adult obesity rates.

Chapter 2 applies theories of message framing and prospect theory to the emerging discussion around health zoning policies targeting food environments and to explore public opinion toward a list of potential zoning restrictions on fast-food restaurants (beyond moratoriums on new establishments). In order to explore causality, I employ an online survey experiment manipulating exposure to vignettes with different message frames about health zoning restrictions with two national samples of adult Americans age 18 and over (N1=2,768 and N2=3,236). The second sample oversamples Black Americans (N=1,000) and individuals with high school as their highest level of education. Respondents were randomly assigned to one of six conditions where they were primed with different message frames about the benefits of zoning restrictions on fast food retailers. Participants were then asked to indicate their support for six zoning policies on a Likert scale. Subjects also answered questions about their food store access, eating behaviors, health status and perceptions of food stores by type.

I find that a message frame about Nutrition and increasing Equity in the food system was particularly effective at increasing support for health zoning policies targeting fast food outlets across policy categories (Conditional, Youth-related, Performance and Incentive) and across racial groups. This finding is consistent with an influential environmental justice scholar’s description of “injustice frames” as effective in mobilizing supporters around environmental issues (Taylor 2000). I extend this rationale to food environment obesity prevention efforts and identify Nutrition combined with Equity frames as an arguably universal campaign strategy for bolstering public support of zoning restrictions on fast food retailers.

Bridging my findings from both Chapters 1 and 2, using food swamps as a spatial metaphor may work to identify priority areas for policy intervention, but only if there is an equitable distribution of resources and mobilization efforts to improve consumer food environments. If the structural forces which ration access to land-use planning persist (arguably including the media as gatekeepers to information and producers of message frames) disparities in obesity are likely to widen.

Connecting Mentally Ill Detainees in Large Urban Jails with Community Care.

Large urban jails have become a collection point for many persons with severe mental illness. Connections between jail and community mental health services are needed to assure in-jail care and to promote successful community living following release. This paper addresses this issue for 2855 individuals with severe mental illness who received community mental health services prior to jail detention in King County (Seattle), Washington over a 5-year time period using a unique linked administrative data source. Logistic regression was used to determine the probability that a detainee with severe mental illness received mental health services while in jail as a function of demographic and clinical characteristics. Overall, 70 % of persons with severe mental illness did receive in-jail mental health treatment. Small, but statistically significant sex and race differences were observed in who received treatment in the jail psychiatric unit or from the jail infirmary. Findings confirm the jail's central role in mental health treatment and emphasize the need for greater information sharing and collaboration with community mental health agencies to minimize jail use and to facilitate successful community reentry for detainees with severe mental illness.

Examining the Crack Epidemic and Subsequent Drug Policy through Identifying Trends in Outpatient Substance Abuse Treatment for Crack Use/Abuse: 1995-2005

Disparities in the crack/cocaine discourse have changed drastically since its inception over 30 years ago. Since the late 1980s, research examining this particular abuse has become more complex as both nationally and globally crack use/abuse has been examined within various contexts. Crack use has often been framed as an African American problem in part resulting from the high volume of African Americans seeking treatment for illnesses associated with their crack-cocaine use, and more African Americans dying from crack-cocaine overdose. This logical fallacy persists despite evidence showing African Americans have lower substance use/abuse compared to Caucasians. Given the impact of the crack epidemic as well as its related drug policies on African American communities and their families, further examination of crack use/abuse is necessary. This study will discuss the crack epidemic historically and examine crack use among clients of a large sample of outpatient substance abuse treatment units over a decade period between 1995 and 2005.

Landscape and planning: strengthening discussions in the decision-making process

Since the emergence of the European Landscape Convention (ELC) in 2000, the important link between landscape and planning has greatly intensified. Now, more than ever, the fundamental role of the planning system in delivering the ELC’s requirements is recognised. This has been further substantiated within Ireland’s recently published National Landscape Strategy. However it has continually been suggested that decision-making processes need to adapt better to the holistic, valueladen and multidimensional approaches underpinning the ELC. In light of these milestones for the preservation, management and planning of landscape, this research sets out to establish synergies and disparities in the existing relationship between landscape and planning. It investigates detailed evidence of the presence and manifestations of landscape in key processes of day-to-day planning practice in Ireland, from individual planning appeals and ‘special’ cases, to the major strategic instruments that inform the making of landscape policies within development plans. This is set within wider theoretical and policy contexts where the compatibility of landscape and planning is subjected to critical scrutiny and then explored through these practical case studies. Driving this research is the intention to make a case for the planning domain to be an ideal ‘home’ for landscape – in all its deep, multidimensional meaning – and for enhancing landscape arguments and objectives in the face of conflict, competing values and power-plays in the real world. Emerging out of this research is a set of recommendations for how, at a national level, new approaches for decision making for and about landscape can be more effective and meaningful.

Diagnosing primary ciliary dyskinesia: an international patient perspective

Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by progressive sinopulmonary disease, with symptoms starting soon after birth. A European Respiratory Society (ERS) Task Force aims to address disparities in diagnostics across Europe by providing evidence-based clinical practice guidelines. We aimed to identify challenges faced by patients when referred for PCD diagnostic testing. A patient survey was developed by patient representatives and healthcare specialists to capture experience. Online versions of the survey were translated into nine languages and completed in 25 countries. Of the respondents (n=365), 74% were PCD-positive, 5% PCD-negative and 21% PCD-uncertain/inconclusive. We then interviewed 20 parents/patients. Transcripts were analysed thematically. 35% of respondents visited their doctor more than 40 times with PCD-related symptoms prior to diagnostic referral. Furthermore, the most prominent theme among interviewees was a lack of PCD awareness among medical practitioners and failure to take past history into account, leading to delayed diagnosis. Patients also highlighted the need for improved reporting of results and a solution to the “inconclusive” diagnostic status. These findings will be used to advise the ERS Task Force guidelines for diagnosing PCD, and should help stakeholders responsible for improving existing services and expanding provision for diagnosis of this rare disease.

Obesity, Cardiovascular Risk Factors, and Weight Loss in a Population of Adult Mexican Americans

The study of obesity has evolved into one of the most important public health issues in the United States (U.S.), particularly in Hispanic populations. Mexican Americans, the largest Hispanic ethnic subgroup in the U.S., have been significantly impacted by obesity and related cardiovascular diseases. Mexican Americans living in the Lower Rio Grande Valley (the Valley) in the Texas-Mexico border are one of the most disadvantaged and hard-to-reach minority groups. Demographic factors, socioeconomic status, acculturation, and physical activity behavior have been found to be important predictors of health, although research findings are mixed when establishing predictors of obesity in this population. Furthermore, while obesity has long been linked to cardiovascular disease (CVD) risk factors such as hypertension, type 2 diabetes, and dyslipidemia; information on the relationships between obesity and these CVD risk factors have been mostly from non-minority population groups. Overall, research has been mixed in establishing the association between obesity and related CVD risk factors in this population calling attention to the need for further research. Nevertheless, identifying predictors of success for weight loss in this population will be important if health disparities are to be addressed. The overall objective of the findings presented in this dissertation was to attain a more informed profile of obesity and CVD risk factors in this population. In particular, we examined predictors of obesity, measures of obesity and association with cardiovascular disease risk factors in a sample of 975 Mexican Americans participating in a health promotion program in the Valley region. Findings suggest acculturation factors to be one of the most important predictors of obesity in this population. Results also point to the need of identifying other possible risk factors for predicting CVD risk. Finally, initial body mass index is an important predictor of weight loss in this population group. Thus, indicating that this population is not only amenable to change, but that improvements in weight loss are feasible. This finding strengthens the relevance of prevention programs such as Beyond Sabor for Mexican populations at risk, in particular, food bank recipients.

The Career Development of Black Female Chief Nurse Executives

This qualitative study was designed to explore the career development of Black female chief nurse executives. Although a small proportion of Black female nurses have achieved positions at the nurse executive level, there remains a paucity of Black female nurse executives in this crucial position which raised the question of what factors contributed to this lack of advancement, but, more important, what factors have contributed to the success of the few who have achieved such level of success in healthcare organizations. The purpose of the study was to explore the career paths of Black female chief nurse executives with a view of understanding the factors which both facilitate and hinder the career development of these leaders in healthcare organizations. The guiding research question was, How do Black female nurse executives in this sample describe their career development? The participants in this study were Black female chief nurse executives located throughout the United States who, for the most part, were raised in segregation with a strong family foundation. To collect data, semistructured telephone interviews were conducted with 10 Black female chief nurse executives throughout the United States. The transcripts from the interviews were transcribed, coded, and analyzed. Using Super’s (1990, 1996), and Gottfredson’s (1981, 1996, 2002, 2005) career development theories and critical race theory (Crenshaw, 1995; Delgado, 2000) as the theoretical framework, the researcher found that the participants’ career development was influenced by (a) strong support system, (b) guidance, (c) influence of diversity, and (d) servant leadership. The findings help us understand the factors that have contributed to their successes as Black chief nurse executives. With the increasingly diverse population and concurrent increasing diversity in nursing and concerns about healthcare disparities, it is imperative that organizations attract, hire, develop, retain, and advance qualified Black nurses. Future studies addressing not only the career development of Black nurses but nurses in general might be informed by the present study’s findings. Recommendations are offered for nursing practice, education, and organizational policy.

The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

Migrant women’s employment in paid reproductive work through the crisis: the case of Italy (2007-2012)

Paid reproductive work, especially in the case of cleaning and home-care for elderly people, is an important sector for foreign women in Italy. For this reason, since the beginning of the current economic crisis, scholars have wondered about the impact of the recession on migrant domestic workers. They have looked particularly at possible competition with Italian women entering the sector for lack of better alternatives. Our paper takes this discussion a step further by assessing the overall changes affecting migrant women in the Italian labour market, 2007-2012. We will look at how their position has been transformed, by taking both an ethnic perspective, in relation to Italian women, and a gender perspective, in relation to migrant men. By way of a conclusion, the argument will be made that there is a substantial lack of competition between Italian and foreign women in the care and domestic sector due to differences in their earnings, hours of work and activities.

Perspectives on gender, migration and transnational work: joint work of social reproduction and care in Southern Europe

This paper presents the "state of the art" and some of the main issues discussed in relation to the topic of transnational migration and reproductive work in southern Europe. We start doing a genealogy of the complex theoretical development leading to the consolidation of the research program, linking consideration of gender with transnational migration and transformation of work and ways of survival, thus making the production aspects as reproductive, in a context of globalization. The analysis of the process of multiscale reconfiguration of social reproduction and care, with particular attention to its present global dimension is presented, pointing to the turning point of this line of research that would have taken place with the beginning of this century, with the rise notions such as "global care chains" (Hochschild, 2001), or "care drain" (Ehrenreich and Hochschild, 2013). Also, the role of this new agency, now composed in many cases women who migrate to other countries or continents, precisely to address these reproductive activities, is recognized. Finally, reference is made to some of the new conceptual and theoretical developments in this area.