New books – South African nursing and a Canadian perspective

This week two new OHS books came across my desk unbidden.  Both are very good but have very different contexts and both were published by Baywood Publishing Company Inc.

“Who Is Nursing Them? It is Us.” “Neoliberalism, HIV/AIDS, and the Occupational Health and Safety of South African Public Sector Nurses” by Jennifer R Zelnick

Northern Exposure – A Canadian Perspective on Occupational Health and Environment by David Bennett

South Africa is an exotic foreign land to me.  I am aware of the basic political issues of the country for the last 30 years but, in terms of OHS, I know there have been some major mining incidents and that HIV/AIDS is a major occupational and social challenge.  Zelnick’s book illustrates clearly the difficulty of tackling a workplace risk that is also a hot, contentious public health and political issue.

The analysis of the impact of neo-liberal policies is less directly relevant to hazard management of HIV/Aids risks to nurses from needlestick injuries.  For any health sector workers outside of South Africa, the level of resources and the attitudes to needlesticks is confronting.  Any stigma relating to HIV/AIDs in non-African countries is doubly problematic in South Africa.  Interviews with hospital managers and nurses show a lack of confidentiality and

“Health care providers are scared to discuss  HIV/AIDS because they are scared that they cannot handle the emotions and all the complications….” (page 120)

Gender issues in health care is a crucial element in this book, a perspective that was new to this (male) reviewer.  These issues are complicated by the social and political context of South Africa.  For instance, and again on page 120, public health practitioners are directly acknowledging

“the intractable difficulties in changing sexual behaviour and traditional relationships…” and

“If true, the acknowledgement that all African women are living in fear of being infected, in the context of occupational exposure and reporting requirements, means that most nurses have a legitimate fear of reporting injuries and agreeing to VCT [Voluntary Counselling and Testing]”.

Several chapters in this book include a Chapter Summary and Chapter Conclusion which are very useful as there is so much information and discussion that, occasionally, one must be reminded of the major chapter points.

What was also quite powerful and a feature that would be good in other books is a chapter of excerpts from first-person interviews.  Too often academic titles summarize interview responses into comparative percentages and, although this indicates significant statistics, it also dulls the voices.  In the chapter “Nurses Speak” Zelnick writes

“Overall, nurses’ views corroborated managers’ descriptions of how denial, stigma, women’s position, and government failures led to problems with implementing OHS measures.” (page 146)

Much of the content of this book contrasts remarkably with the OHS issues faced in other countries.  Manual handling risks pale when reading about the lot of nurses in South Africa.

Canadian Perspectives

Bennett’s book is more comfortable to this reviewer as the ideological/Commonwealth environment is more familiar as there is greater overlap with general safety management.  However, this book includes a balanced approach to environment as well as OHS, a combination rarely include in the one book but it works.  There is a similar level of activism and regulatory response to these two areas of law and that overlap, that convergence, is reflected in the increase of integrated HSE professionals.

Bennett devotes one chapter to “Occupational Health: A Discipline Out of Focus”.  In that chapter he writes  about us living in a “scientific culture” which reflects some of the push for evidence-based decision-making.  On page 52 he writes:

“There ought to be a clear distinction between the facts or the objective truths of science on one hand and, on the other, the prescriptions, policies, and strategies which are, in some way, related to them ….

But, I contend, this is not so, since de facto, the science which is appealed to, embodies both moral values and the strategies which will be used in the approach to industrial disease.  These prescriptive issues ought to be for (democratic) policy-makers to decide.  If I am correct, the strategies have, in effect, already been decided before the policy process takes place-to the detriment of truly effective policies to promote and protect workers’ health.”

As with the previous book, there is a new approach to content where Bennett revisits several important books or articles about cancer – “Cancer-Gate: How to Win the Losing Cancer War” and “The Politics of Cancer Revisited” both by Samuel S Epstein and “The Secret History of the War on Cancer” by Devra Davis.  The enjoyment of these short sections is that they are not just book reviews.  Bennett looks at the reception the Davis book received and also places these texts in more familiar literary territory by collecting them with other books that

“…include a focus on the part played by work and workers, both as those on the receiving end of current policies and as instruments of change.”

– books such as Natural Capitalism, Disaster Capitalism and Fast Food Nation.

Bennett takes a similar approach with Sustainability – “Materials Matter – Towards a Sustainable Materials Policy” By Kenneth Geiser, “Natural Capitalism: Creating the Next Industrial Revolution” by Hawken, Lovins and Lovins.

The chapter that had most “punch” was when Bennett critiqued the role of the International Organization for Standardization (ISO).  It provided a fresh approach to the potential “substitute for tangible national regulations” that is presented by a raft of international  standards including a health and safety management standard.  On page 159, Bennett writes:

“The chief danger for labor, however, is that an ISO Health and Safety Management Standard would come to be used as an empty surrogate for the health and safety regimes which have been built up over a century of carnage and campaigning and which were implemented in detail from roughly the early 1970s onwards.  Health and safety as merely a management function would cut workers out of the action completely and produce workplace conditions and procedures entirely alien to the regimes of the last quarter century.”

Bennett concludes the last chapter by speaking positively of the role of the ILO Guidelines on Safety and Health Management Systems but only after having considered the advantages and disadvantages of various national health and safety management systems, including Britain’s and Australia’s.  Bennett’s is a refreshing and thought-provoking perspective.

Both the above books, provided by Baywood for review, will appeal to safety professionals and policy makers but the Canadian safety and environment book clearly has a broader appeal but Zelnick’s book on South Africa is almost required reading for those who work in the health care sector and are active in OHS.

Kevin Jones

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