VII. DISCUSSION

Major Findings
In addition to identifying the major trends as discussed above, the subjects explored in our study uncovered from specific findings that beg further inquiry:

Conceptions of Health

• Health is not a closed concept in Khayelitsha. Rather, it is thought of in terms of personal behaviors, external support, and environmental factors.

Health Status

• Further investigation of the emerging community stigma of TB is needed. Informants identified a loose community affiliation between TB and HIV, but more specific inquiry is necessary in order to enable targeted sensitization and education efforts.
• There is an identified need for diabetes education. A focused investigation of current community knowledge of diabetes is warranted. Knowledge about high blood pressure seemed to be better, and a comparison of current education and understanding of the two conditions could help to shape a more effective information campaign about diabetes.
• The prevalence of child diarrhea in Khayelitsha is rising. Further investigation to identify the specific cause of this rise is needed. Community perceptions of hygiene and living conditions as discussed in this study provide a good foundation for that investigation.

Health Information

• Multiple sources identified the language barrier as a major challenge in delivering efficient care at the Site B Day Hospital. One health educator estimated that she spends as much as 85% of her time translating. Further examination of this problem is needed in order to identify effective solutions.
• Although this study identified radio programming as a major source of health information, a closer look at the frequency and nature of the programming could help to further the potential an already-useful source of health education.
• A similar examination of health curricula in schools and churches could identify points for improvement and ultimately further community health awareness.
• Another notable pattern is that health education is generally disease-specific and given to patients after they are already sick. Thus, patients only have health information concerning health issues they are affected by.

Perceptions of Site B Day Hospital

• This study identified triage and waiting room organization as major problems in the current logistics of the day hospital. Closer observation of these problems could help to generate creative solutions.
• The hospital is currently undergoing a transition from shared provincial and city authority to being entirely controlled at the provincial level. The ramifications of this change need to be assessed and incorporated into the recommendations made in this study.
• Following the transition, an evaluation of staff placement and turnover might help to identify other windows for improvement in clinic functionality.

Prevention

• Site B Day Hospital was identified as the most common agent in preventing illness, but our research did not yield a clear picture of the hospital’s approach to preventative care. Further research is needed.
• Many community members struggle from the connection between unemployment and poor nutrition. Further thought needs to be given to ways to affordably provide a balanced diet to all community members, regardless of employment status.

Limitations of the Assessment
Due to the limited time period, language barrier, and other challenge, our study has many limitations. These limitations identify points of improvement for future studies and a better understanding of health in Site B.

• Too little too late? At their conclusion, studies often feel compromised by what there wasn’t time to accomplish. This inquiry was severely limited by the short timeline for its execution. However, we believe that it provides useful and previously nonexistent baseline for future research. Its worth is also confirmed by its locally actionable findings.

• A negative view of community health status? Our data seems to reveal an overwhelmingly negative view of the health status of Site B residents. This is not necessarily indicative of the community sentiment. Rather, it is a reflection of our failure to identify a question that would extract positive feelings or pride relating to health in the community. This inability, though, might in turn be a reflection of a lack of existing positivity or pride.
• Future study should include a deeper examination of this notion.

• Health in English or Health in isiXhosa?  The scope of our study was severely limited by the ratio of researchers and translators. Nuances in tone and word choice were lost in translation, and conceptually abstract ideas were compromised (both in posing questions and obtaining information. E.g., there is no English equivalent of “Xhosa wounds.”). Future studies should include an increased role for Xhosa speakers on the research time.

• What does a non-representative sample actually represent? The results of this study do not compose a representative sample. However, the trends and frustrations identified are no less legitimate, and they point to important opportunities for improved health regardless