ObjectivesFirst objective was to strengthen the national maternal death review, by addressing local challenges with each step of the review cycle. Second objective was to describe review findings... Show moreObjectivesFirst objective was to strengthen the national maternal death review, by addressing local challenges with each step of the review cycle. Second objective was to describe review findings and compare these with available findings of previous reviews.MethodsConfidential Enquiry into Maternal Deaths methodology was used to review maternal deaths. To improve reporting, the national committee focussed on addressing fear of blame among healthcare providers. Second focus was on dissemination of findings and acting on recommendations forthcoming the review. Reviewed were reported maternal deaths, that occurred between 1 April 2018 and 31 March 2019.ResultsSeventy maternal deaths were reported; for 69 (98.6%) medical records were available, compared to 80/119 (67.2%) in 2012-2015. Reported maternal mortality ratio increased with 48% (92/100,000 live births compared to 62/100,000 in 2012-2015). Obstetric haemorrhage was leading cause of death in the past three reviews. The "no name, no blame" policy, aiming to identify health system failures, rather than mistakes of individuals, was repeatedly explained to healthcare providers during facility visits. Recommendations based on findings of the review, such as retaining experienced staff, continuous in-service training and guidance, were shared with decision makers at regional and national levels. Healthcare providers received training based on review findings, which resulted in improved management of similar cases.Conclusions for PracticeEnhanced implementation of Confidential Enquiry into Maternal Deaths was possible after addressing local challenges. Focussing on obtaining trust of healthcare providers and feeding back findings, resulted in better reporting and prevention of potential maternal deaths.What is already known on this subject? To analyse and improve quality of care, a national maternal death review is recommended. In Namibia successful implementation was hampered by a blame culture. Around the world, healthcare providers are frequently blamed by decision makers when a woman dies. Limited literature is available on how this issue could be addressed.What this study adds? It was possible to improve implementation by focussing on increasing trust of healthcare providers in the review process. This was achieved by addressing fear of being blamed, dissemination of findings and acting on the recommendations forthcoming from the review. Show less
Over the past decades increasing efforts have aimed to improve the health of pregnant women around the world. Namibia has made limited progress in reducing severe maternal outcomes. Aims of this... Show moreOver the past decades increasing efforts have aimed to improve the health of pregnant women around the world. Namibia has made limited progress in reducing severe maternal outcomes. Aims of this thesis were to enhance implementation of a national obstetric surveillance system and assess requirements to improve maternal health in Namibia. The findings of chapters 2-7 provided insight into several important drivers of severe maternal outcome. The most important contributor of the high-incidence of severe maternal outcome in Namibia was poor quality of facility-based care and particularly vulnerable women appeared to be at higher risk of severe maternal outcome. Obstetric surveillance played a crucial role in obtaining these insights. Based on these, targeted recommendations could be formulated. The maternity care system needs to be strengthened, to enable health workers to provide universal coverage of good health care to all women in Namibia. It is therefore crucial the next step will follow, which is to act on the proposed recommendations. The insights obtained through obstetric surveillance will contribute to such action, as for any intervention, it is key it addresses a local need in a context-specific manner. Show less
The call to decolonize African Studies has a profound influence on the field, with varying degrees of success. This article addresses this topic in relation to the author’s personal experiences in... Show moreThe call to decolonize African Studies has a profound influence on the field, with varying degrees of success. This article addresses this topic in relation to the author’s personal experiences in the publishing industry in Namibia. By describing the attempt to publish a historical book about Namibian beer with a well-known German–Namibian publishing house, the lingering power of German–Namibian settler colonialism becomes clear. This article renders visible the power structures within the Namibian book market that perpetuates a whitewashed version of Namibian history and argues that decolonizing knowledge cannot succeed without paying attention to the (private) publishing industry. Show less
Since Namibian independence in 1990, historians have increasingly made use of Namibian archives to explore the history of the German and South African occupation. Researching the recent past is,... Show moreSince Namibian independence in 1990, historians have increasingly made use of Namibian archives to explore the history of the German and South African occupation. Researching the recent past is, however, much more difficult, considering the absence of a SWAPO archive and an embargo on governmental files of thirty years. But now, thirty years after independence, the files from the postcolonial administrations are set to gradually open up. In anticipation of this new chapter of Namibian history, this article examines the state of various archives in Namibia and offers a number of observations that may be of use to scholars who are interested in consulting them.Résumé: Depuis l’indépendance de la Namibie en 1990, les historiens ont de plus en plus utilisé les archives namibiennes pour explorer l’histoire de l’occupation allemande et sud-africaine. La recherche du passé récent est cependant beaucoup plus difficile, compte tenu de l’absence d’archives de la SWAPO et l’embargo fait sur les archives gouvernementales de moins de trente ans. Mais aujourd’hui, trente ans après l’indépendance, les dossiers des administrations postcoloniales sont amenés à s’ouvrir progressivement. En prévision de ce nouveau chapitre de l’histoire namibienne, cet article examine l’état de diverses archives en Namibie et offre un certain nombre d’observations pouvant être utiles aux chercheurs intéressés à les consulter. Show less
Namibia was one of the final African states to gain independence, a political transformation which was the outcome of a decades-long liberation struggle. The global dimension of the struggle has... Show moreNamibia was one of the final African states to gain independence, a political transformation which was the outcome of a decades-long liberation struggle. The global dimension of the struggle has been duly recognised by generations of historians. As a result, archival materials related to this era - as well as the colonial ones preceding it – are to be found all over the world. Through a discussion of relevant archival collections pertaining to Namibian history - though located outside the boundaries of the Republic of Namibia – this article considers the global archival paper trail of Namibian colonisation and decolonisation. We shed light on the origins of various collections located in South Africa, Europe, North America, and beyond in order to reveal the ways in which the utilisation of such global archivalia can shape our understanding of Namibian decolonisation. This applies to government archives, private collections, institutional solidarity collections, as well as those of international organisations. We then delve into some of the promises and pitfalls of the digitisation of archival records, noting issues of ethics and methodology. Ultimately, we hold that historians must balance both internal and external Namibiana archivalia in crafting our arguments about the past, and we must balance both the merits and demerits of the digital turn in historical research. Show less
Heemelaar, S.; Hangula, A.L.; Chipeio, M.L.; Josef, M.; Stekelenburg, J.; Akker, T.H. van den; ... ; Mackenzie, S.B.P. 2021
Background & Aims Namibia has been suffering from an outbreak of hepatitis E genotype 2 since 2017. As nearly half of hepatitis E-related deaths were among pregnant and postpartum women, we... Show moreBackground & Aims Namibia has been suffering from an outbreak of hepatitis E genotype 2 since 2017. As nearly half of hepatitis E-related deaths were among pregnant and postpartum women, we analysed maternal and fetal outcomes of pregnancies complicated by acute hepatitis E and assessed whether HIV-status impacted on outcome. Methods A retrospective cross-sectional study was performed at Windhoek Hospital Complex. Pregnant and postpartum women, admitted between 13 October 2017 and 31 May 2019 with reactive IgM for Hepatitis E, were included. Outcomes were acute liver failure (ALF), maternal death, miscarriage, intra-uterine fetal death and neonatal death. Odds ratios (OR) and 95% confidence interval (CI) were calculated. Results Seventy women were included. ALF occurred in 28 (40.0%) of whom 13 died amounting to a case fatality rate of 18.6%. Sixteen women (22.9%) were HIV infected, compared to 16.8% among the general pregnant population (OR 1.47, 95% CI 0.84-2.57, P = .17). ALF occurred in 4/5 (80%) HIV infected women not adherent to antiretroviral therapy compared to 1/8 (12.5%) women adherent to antiretroviral therapy (OR 28.0, 95% CI 1.4-580.6). There were 10 miscarriages (14.3%), five intra-uterine fetal deaths (7.1%) and four neonatal deaths (5.7%). Conclusions One in five pregnant women with Hepatitis E genotype 2 died, which is comparable to genotype 1 outbreaks. Despite small numbers, HIV infected women receiving antiretroviral therapy appear to be less likely to develop ALF in contrast with HIV infected women not on treatment. As there is currently no curative treatment, this phenomenon needs to be assessed in larger cohorts. Show less
An earlier version of this African Postal Heritage Paper was published as African Studies Centre Leiden Working Paper 118 / 2015: "A postal history of the First World War in Africa and its... Show moreAn earlier version of this African Postal Heritage Paper was published as African Studies Centre Leiden Working Paper 118 / 2015: "A postal history of the First World War in Africa and its aftermath - German colonies; III Deutsch Südwestafrika", written by Ton Dietz. Show less
Following Ingold's dwelling perspective, the world comes into being because an organism/person is continuously interacting with his/her environment through bodily activity. Ingold contrasts... Show moreFollowing Ingold's dwelling perspective, the world comes into being because an organism/person is continuously interacting with his/her environment through bodily activity. Ingold contrasts dwelling with building; in the latter, people construct the world cognitively before they can live in it. In this paper, we add the concept of 'lodging' to refer to a situation in which people live in an environment that contains increasing dominating powers. Under the influence of conservation and the implementation of a Community Based Natural Resource Management (CBNRM) programme, with a strong focus on tourism, the environment of the Ju/'hoansi Bushmen of the Nyae Nyae Conservancy in Namibia has changed dramatically. In this paper, we use various examples to show how the environment has become more dominant, often in very subtle ways. We argue that the Ju/'hoansi do not dwell as they used to, but lodge instead in an environment that is increasingly influenced by CBNRM and tourism activities. Some of the Ju/'hoansi's agency has become limited to acquiescing; they passively adapt to and cope with the changes in their environment, while others have shown a more active adaptation strategy. Show less
An earlier version of this African Postal Heritage Paper was published as African Studies Centre Leiden Working Paper 118 / 2015: "A postal history of the First World War in Africa and its... Show moreAn earlier version of this African Postal Heritage Paper was published as African Studies Centre Leiden Working Paper 118 / 2015: "A postal history of the First World War in Africa and its aftermath - German colonies; III Deutsch Südwestafrika", written by Ton Dietz. Show less
An earlier version of this African Postal Heritage Paper was published as African Studies Centre Leiden Working Paper 118 / 2015: "A postal history of the First World War in Africa and its... Show moreAn earlier version of this African Postal Heritage Paper was published as African Studies Centre Leiden Working Paper 118 / 2015: "A postal history of the First World War in Africa and its aftermath - German colonies; III Deutsch Südwestafrika", written by Ton Dietz. Show less
An earlier version of this African Postal Heritage Paper was published as African Studies Centre Leiden Working Paper 118 / 2015: "A postal history of the First World War in Africa and its... Show moreAn earlier version of this African Postal Heritage Paper was published as African Studies Centre Leiden Working Paper 118 / 2015: "A postal history of the First World War in Africa and its aftermath - German colonies; III Deutsch Südwestafrika", written by Ton Dietz. Show less
The Namibian Khwe Bushmen live in the Bwabwata National Park, where they are highly affected by the park's history and conservation activities. Following Ingold's dwelling perspective, the world... Show moreThe Namibian Khwe Bushmen live in the Bwabwata National Park, where they are highly affected by the park's history and conservation activities. Following Ingold's dwelling perspective, the world comes into being because a person is continuously interacting with his/her environment. This contrasted with building, in which (wo)man constructs the world cognitively before (s)he can live in it. We apply a third notion, lodging, to refer to a situation in which people live in an essentially foreign environment. In this, many changes in the environment of the Khwe are triggered beyond their control, instead of through their interaction with their environment. Show less
Crucial challenges for multiparty mediation processes include the achievement of adequate cooperation among the mediators and consequent coordination of their activities in the mediation process.... Show moreCrucial challenges for multiparty mediation processes include the achievement of adequate cooperation among the mediators and consequent coordination of their activities in the mediation process. Existing literature goes only as far as to make it clear that successful mediation requires necessary cooperation and coordination between mediators, as if these features were exogenous to the process. Available research does not consider whether these features might change over time and if such change could have an impact on the overall mediation process. Experience shows that it is not rare for mediators who were initially willing to pool their resources and act in concert with one another to decide at a later point to stop cooperating. Using a game theoretical model (developed for the purposes of this research) and an analysis of five cases of multiparty mediation, this research illustrates the importance of maintaining necessary levels of cooperation and coordination to achieve successful outcomes and provides insights on how to achieve them in case the mediating coalition is faced with internal conflict of interests. Show less
The central tenets of this paper are that genocide and crimes against humanity are learnt practice, and that the seeds of the genocides that occurred in Namibia between 1904 and 1908 were sown in... Show moreThe central tenets of this paper are that genocide and crimes against humanity are learnt practice, and that the seeds of the genocides that occurred in Namibia between 1904 and 1908 were sown in the Congo in the late 19th century. The paper argues that the violence perpetrated by German officers in the service of the Belgian King Leopold in the Congo Free State was formative for the manner in which German colonial forces came to wage war in Tanzania, Namibia and China. In addition it argues that this violence was qualitatively different there where it could be and was checked by the intervention of civil society. [Book abstract, edited] Show less
Am 12. Januar 1904 brach in Namibia ein Krieg zwischen der deutschen Kolonialverwaltung und grossen Teilen der lokalen Bevölkerung aus - ein Krieg, der später als Herero-Krieg in die Annalen der... Show moreAm 12. Januar 1904 brach in Namibia ein Krieg zwischen der deutschen Kolonialverwaltung und grossen Teilen der lokalen Bevölkerung aus - ein Krieg, der später als Herero-Krieg in die Annalen der Kolonialgeschichte eingehen sollte. Dieses Kapitel versucht in dichter Beschreibung der Ereignisse unmittelbar vor und nach Ausbruch des Krieges sowie durch die konsequente Durchleuchtung individueller Handlungsrationalität das Augenmerk weg von strukturellen Ursachen des Krieges hin zu unmittelbaren Auslösern der Gewalt zu lenken. Es wird gezeigt, dass der Krieg nicht das Resultat eines länger geplanten Aufstandes der Herero gegen die deutsche Kolonialherrschaft war. Der Krieg war eine unmittelbare Folge der Siedlerparanoia in Verbindung mit der Inkompetenz und Panik eines deutschen Offiziers (Zürn). Fussnoten. [Zusammenfassung ASC Leiden] Show less
Following a brief description of the Herero genocide of 1904/1907, this chapter provides a chronological overview of the way in which the Herero have sought to draw the world's attention to the... Show moreFollowing a brief description of the Herero genocide of 1904/1907, this chapter provides a chronological overview of the way in which the Herero have sought to draw the world's attention to the crimes committed by imperial Germany in Namibia. Calls for recompensation revolve in the end around the issue of German government responsibility. That is, to what extent were the Herero genocide and related atrocities the product of German policy? To what extent were the criminal acts not merely the actions of individuals? Material presented in this chapter shows that the Herero genocide and associated atrocities were indeed officially sanctioned. During the Herero-German war, the German settlers and soldiers carried out a shoot-to-kill policy, conducted extrajudicial killings, established concentration camps, employed forced labour, and in at least two cases, established death camps. After the war, the loss of Herero liberty, land and stock was officially sanctioned in legislation. At no stage after 1904 were any German settlers or soldiers brought to justice for genocidal acts committed in Namibia between 1904 and 1908. Bibliogr., notes [ASC Leiden abstract] Show less
The colonial conquest of Namibia was extremely brutal. Repressive controls continued in the decades that followed as exemplified by the South African colonial administration's regulation of the... Show moreThe colonial conquest of Namibia was extremely brutal. Repressive controls continued in the decades that followed as exemplified by the South African colonial administration's regulation of the production and consumption of alcohol by the territory's black African inhabitants. Nonetheless, the colonial State's policies were inconsistent and vigorously opposed at every turn by differing sections of the black population. In this chapter, the unlikely alliance of two of the territory's Herero urban groups, the 'Otruppe', illiterate Herero men, and the female 'khari' beer brewers, is examined. During the 1920s and 1930s, they faced the colonial State's attempts to undercut and ultimately eradicate the illicit production of alcohol through the establishment of a Location Advisory Board. In so doing, they were pitted against the colonial State and a newly emerging Herero political elite. The 'angry young men' of the 'Otruppe' and the Herero women brewers proved to be an invincible alliance that managed to evade colonial regulations on alcohol. Bibliogr., notes, ref. [ASC Leiden abstract] Show less
This article explores the social impact of the motorcar on the relationship between the colonial State, the mission, and the Herero in Namibia in the period before 1940. It looks at how... Show moreThis article explores the social impact of the motorcar on the relationship between the colonial State, the mission, and the Herero in Namibia in the period before 1940. It looks at how perceptions of space and reality changed, how information regarding these factors and society changed, and how both Herero and European missionaries were affected by, and dealt with, the introduction of the motorcar into their midst. The article disusses the introduction of the motorcar in 1904, the car and South African colonial rule, new legislation regarding the occupation of land and Herero mobility, cars and status, the disadvantages of motor vehicles, cars and farms, the disadvantages of waggons and the use of cars by missionaries. It shows that motor vehicles became an indispensable attribute of colonial rule in Namibia. The introduction of the motorcar led to the development of new hierarchies of power and status. It brought greater mobility and, consequently, contact among people, yet at the same time it led to the loss of contact between the missionaries and large sections of the Namibian population. Includes notes and bibliographical references. [ASC Leiden abstract] Show less
