ZAH Family News October 2022

October 2022

The healing nature of our garden

By Elzaan de Villiers, Public Relations Officer and would imagine that patients trees and plants, an "outdoor"
may sit in. coffee shop, seating for groups and
Visiting a hospital is a stressful individuals, Gerard van Grinsven,
experience. Hospitals are Historical roots of gardens President and CEO of Henry Ford
associated with painful procedures, Hospital West Bloomfield, shared
high levels of discomfort, The restorative properties of nature their hospital's garden held the
uncertainty, monitors and alarms, could be found in the ancient history following benefits:
and unfamiliar people and routines. of mankind. A study in 2017
explained that Hippocrates extolled  It added to the delivery of
A hospital can offer a respite from the necessity of water, open spaces healthcare.
these stressors through friendly and air while early Roman texts
assuring staff and beautiful suggested that nature (countryside  It lead to engaged employees
surroundings and gardens. This is and outdoors) holds many benefits who relax in a tranquil
particularly true at Zuid-Afrikaans for mental and physical wellbeing environment who then take
Hospital, and the gardens are one (Franco, Shanahan and Fuller, better care of patients.
aspect that is often highlighted in 2017). As early as the 1200s,
patient survey reports. monasteries prescribed gardens  Increased recovery for patients.
"not only for food but also for
Arial views of other Pretoria recreation in the open air to aid the  Reduced stress and enhanced
hospitals proved that aside from recovery of the sick and to preserve coping for family members who
trees, most open spaces on health and improve those fatigued visit their family and loved ones.
hospital grounds were built up and by their spiritual studies," (Montford,
consisted of parking spaces. There 2004)  Reduced the perceived
were almost no obvious garden intimidation of a hospital setting
settings where one may find grass Sitting in an indoor atrium, filled with
 Education and increased
awareness of the role of nature in

the healing process. The duck pond in the ZAH Garden ZAH is also one of the few hospitals
in the country that has three
The history of the ZAH patients are found sitting outside, gardens and that makes use of the
Garden enjoying the sunlight and during gardens as part of the healing
visiting hours, one often sees process.
ZAH's foundational vision was to visitors and patients making use of
create an environment where the verandas. Several patient Senses
patients would feel at home. birthdays, wedding anniversaries or
other special days are celebrated The primary senses humans
In an article published in 1916 it is on the verandas or gardens. engage with are:
noted that Zuid-Afrikaans Hospital
valued the treatment of patients in a Although evidence of an intentional  Vision
setting that felt like home: “onze decision could not be found, the  Smell
patienten doen behandelen in een gardens have been integrated into  Touch
huiselijke omgeving” (have our the healing setting from the  Taste
patients treated in a home hospital's onset. Today, the garden  Hearing
environment) and further “Wij willen is an integral part of the vision of
trachten die afkeer te overwinnen ZAH stating that ZAH will "Sustain a A study conducted in Australia
door onze patienten in zuld een tranquil environment that promotes found that "the multi-sensory aspect
omgeving the plaatsen, dat zij holistic patient recovery". of nature experiences is crucial
zoveel mogelijk zullen gevoelen, because the monotony of
alsof zij in hun eigen huis worden Preservation of the gardens stimulation can be a source of
verpleegd.” (translate: remains a priority at the hospital as stress and multimodal sensory
Elize van der Walt, landscape input itself can drive positive mental
”.) architect explains: “ZAH is fortunate states such as tranquillity" (Franco,
to be situated in an extremely tree- Shanahan and Fuller, 2017). The
The gardens of old also served a rich area of town, with numerous study found that although vision is
perma/horticultural purpose as it is massive old trees. While doing the the predominant sense, the
told that the hospital had a layout for the new parking lot near combination of all our senses
vegetable and fruit garden. A grape the Doctors' Consulting Building, we impacts us physiologically and
arbour used to be situated in Ward tried to keep as many large old trees psychologically.
C's garden where the staff rest area as possible. With any further
is today - the white pillars were built developments, we will aim to do the A diary entry by a Belgian physician
to support the grape arbour. same to retain as much of the of the Belgica Arctic Expedition in
Stories have it that the matron and peaceful, shady atmosphere of the the late 1800s (Struster, 2000)
cook of the day reprimanded staff area as possible.”
who were found eating the grapes,
as it was served to patients.

According to a letter written by a
nurse in the early years, the garden
also hosted a duck pond and nurses
had to stuff the patient pillows with
freshly plucked feathers if they had
nothing to do. No mention is made
of infection control considerations
regarding feathers...

The hospital's architecture includes
large windows and double doors
leading onto verandas. To this day,

indicates that monotonous and Benefits of the garden for by a patient to describe the gardens
repetitive discontent started to ZAH patients andZAH staff was “personal” – the patient
occur when they saw their fellow indicated that without the gardens,
explorers for days and weeks on end What do our patients ZAH “would just be another
while living in the ship’s confined experience? impersonal hospital with four walls.”
spaces.
A study involving astronauts and Interviews were conducted with All the patients indicated that the
researchers found that limited several patients throughout the gardens made them feel at ease,
sensory stimulation lead to hospital whose average length of reduced their stress levels, and
increased stress levels among the stay was 4 days or more. Except for added to their interest during long
scientists and astronauts who had to one, all of the patients were also days. A US-based non-profit
find ways to counteract this through treated in other hospitals in the past, organisation started a prisoner
changed routines and exercise. which did not have gardens. gardening project called Insight
(Ridgeway, Otto and Leveton, 2012) Garden Project, in several prisons
Confinement or a confined space, Patients indicated that it was not across the US. They also affirmed
seeing the same people, in the same only the gardens that made an that gardens alleviated symptoms of
space, with little variation and impression but also the main depression and anxiety, and that it
natural environmental input to a reception area, fresh flowers at both enhanced their well-being.
person’s well-being, may reduce the entrances and particularly the (Herscowitz, 2021)
social connection and mental health architecture of the historical
of a person. buildings. A long-term patient said that she
Interviews with patients at ZAH enjoyed watching the plants grow –
indicated that when they visited or One patient indicated that you are it gave her a sense of hope and
were treated in hospitals without pleasantly surprised to find the large staff from Ward C also said that this
gardens, they experienced the open garden as there is no hint of particular patient was often found
hospitals as cold, impersonal, and such, as you enter the main building. sitting on a bench in the garden,
boring – they also felt more anxious, overlooking the roses. Research by
confined and claustrophobic and in All the patients Kelsey Timler, a PhD candidate for
ICU they had a confused sense of indicated that the British Columbia University also
day and night. gardens add to an confirmed this as prisoners involved
atmosphere of in permaculture gardening
Patient birthday during “home”. Descriptive described their experience as a
visiting hours words used by “sense of freedom, self-
patients included reflection or inner-garden”
friendly, peaceful, (Timler, 2019). The gardens
homely, relaxing, provided a “comfortable
food for the soul environment” to make peace with
and ambient. the circumstances in which you
found yourself.
One particular word

One particular patient said that the witnessed in patients who either had renewed energy. Unit managers
well-maintained buildings and in a view of or who visited the garden: who noticed that staff experienced
particular the gardens made them strain and burdens, would also
feel safe. This corresponds well to 1. Noticeable improvement in vital encourage their staff to take a break
the Broken Window Theory that sets signs in the garden as they knew that it
forth that any form of neglect, even would relieve their stress. During
wilting plants, sends a message 2. Improved mood with extended the height of the COVID-19
about the level of care that patients improvement in vital signs pandemic, it was noticeable to see
may experience in a healthcare staff sitting in the gardens during
setting. In a further study by Ellis 3. Decreased anxiety breaks.
(2020), the relationship between 4. Increased co-operation with staff
environmental design and the well- 5. Increased appetite Conclusion
being of staff was investigated and
the result indicated that Unit managers indicated that the There is overwhelming evidence,
environmental factors influenced difference between male and female that people have a positive
patient safety due to the impact on patients, was that women physiological and psychological
staff effectiveness and well-being. appreciated the flowers while men response toward nature. The
(Ellis et al., 2020) appreciated the smell of freshly cut benefits of connecting with nature,
grass. whether predominantly visual or
One would often see an ICU patient, otherwise, in a hospital setting are
who are well enough, taken onto the Unit managers also indicated that numerous.
veranda to experience the heat of when patients were transferred from
the sun, sounds of birds and the ICUs to normal wards, the first thing Although a sterile environment is
wind on their skin. One patient who patients wanted to do was to sit necessary to avert infections,
was hospitalised for nearly 6 outside, irrespective of the nature provides a therapeutic
months, first in ICU for 3 months and temperature. environment that enhances the
then an additional 3 months in a overall well-being of patients,
normal ward, was often seen on the Interestingly, a unit manager visitors and healthcare workers and
veranda when staff moved his bed indicated that there was a support staff. The benefit of a well-
outside. correlation between complaints and maintained garden is worth the
access to a natural environment - costs involved.
A male patient, who is a farmer by she indicated that the highest
vocation, said that he enjoyed number of complaints were from Old trees, special benches, and
listening to a bird in the Yellow Wood patients in multi-patient rooms with specific palm trees tell a story of
tree in the corner of the garden in little natural light, air and visibility of healing at this hospital.
Ward B. Another patient enjoyed the natural environment such as plants.
flurry and quarrel of birds especially The three beautiful ZAH gardens are
at sunset when the birds settle in for When asked about the impact it had a positive reminder of hope and life
the night and also witnessed night on staff, unit managers remarked and a place where nature nurtures
monkeys playing in the trees. that staff who enjoyed their lunch in
Patients indicated that this and other the garden were refreshed with
nature sounds, such as the wind,
gave them a sense of relaxation.
One patient noted that the ability to
open a window and listen to birds
assured her of life and a purpose
for her life.

What do our staff say?

Interviews with unit managers of
Wards A, B, C, M and CICU shared
the following benefits they

Global
Handwashing

Day

Orthopaedic & Spinal Awareness

Emma Malabuyo, Alamy.com

By Elzaan de Villiers, Public Relations Officer both equipped with clinically  Multi-procedural surgery
advanced technology. These
The month of October places a facilities enable our specialists to table will be installed in the new
renewed focus spinal, bone and deliver innovative and high-quality
joint health with Back Care medical care to patients with Spinal Theatre toward the end of
Awareness week from 4-8 October, orthopaedic and spinal-related
World Bone and Joint Week from 12 needs. the year. The company brochure
– 20 October and World Spine day
on 16 October. Construction to the current describes the design as: “to give
Thoracic and Spinal Theatre
In relation to orthopaedic and spinal complex will extend our hospital's surgeons better imaging access
health conditions ZAH Family news current spinal operating capacity to
reflected on the service offering at two dedicated spinal theatres. Sr to their patients during many
the hospital. As part of our core Adele Botes, Unit Manager of
business the hospital is committed Thoracic and Spinal Theatre noted types of procedures – including
to providing patient centred care that this will expand the total
while advancing towards clinical number of theatres in the Thoracic those requiring total access to
innovation. Patients are treated in a and Spinal Theatre complex to six –
tranquil environment that promotes two cathlabs, two thoracic theatres the spine. The surgical
healing, through our specialists, and two spinal theatres.
specialised theatre facilities and table offers a radiolucent,
advancements in technology. Zuid- Hospital management works
Afrikaans Hospital offers extensive closely with surgeons and staff to cantilevered frame equipped
treatment options and solutions and ensure that the facilities meet their
is in constant pursuit and evaluation needs to serve our patients. We with customizable positioning
of new treatment techniques and understand that our patients require
technologies to ensure the best advanced imaging, considerable pads and components for prone,
outcomes for our patients. theatre time and special post-
operative care. The upgraded supine and lateral procedures”. It
Theatre complexes theatre will incorporate the current
and new technologies: allows for unobstructed imaging
The hospital has two theatre
complexes: Multi-Theatre and the from imaging devices such as
Thoracic & Spinal Theatre complex,
the O-arm and C-arm

technologies.(Mizuho OSI, 2022)

 The Zeiss Kinevo 900
Microscope was a recent
addition to the Spinal Theatre
and is current used for back and
neck surgery. It provides high
magnification of structures at
detail level with two screens. The
product offers a unique Micro-
Inspection Tool and Surgeon-
Controlled Robotics to ease
precise positioning. The product
allows our surgeons to “focus
and move around a structure to

 ZAH also acquired Loop- procedures. Sr Vanessa
Duvenhage, Unit Manager of Multi-
X™ from Brainlab, an Theatre noted that two of the five
theatres are laminar flow theatres,
intraoperative imaging exclusively designed for
orthopaedic procedures. She said
system, designed for use that visiting surgeons often praise
ZAH's Multi-Theatre for its efficiency
in all spine procedures. in turnaround time. ZAH applies
international standards from the
“Loop-X robotic World Health Organisation and
Centre for Disease Control which is
architecture automates 8-10 minutes. During this time, the
theatre is cleaned, and particle rest
imaging workflow steps time is applied.

Photo credit: Carl Zeiss and robotically moves In the last five years, our
orthopaedic surgeons have seen
visualize the targeted anatomy – with the procedure and on exponential growth in technological
reducing any manual hassle. In command, in sync with robotic advances in instrumentation and
addition, PointLock enables you arms and the surgeon/staff. biological reconstructive materials
to do a KeyHole movement to Brainlab said the non-isocentric that push the boundaries of what is
observe a larger area inside a movement and collimation doable and beneficial to patients.
cavity – a particular benefit in capabilities allow for the imaging Apart from instrumentation and
areas with narrow access.” of structures that are much advanced prosthetics, our Multi-
(Zeiss, 2019) larger (e.g. in diameter) and Theatre offers the following
much smaller, reducing radiation supportive technologies:
 One of the spinal theatres is also exposure compared to typical
equipped with the Medtronic O- CT or 3D C-arms. The device  The Hana orthopaedic
Arm. The “O-arm™ is an provides 2D and 3D imaging in surgery table was designed for
intraoperative imaging system ultra-high resolution with extra- optimal patient positioning
that provides current patient low doses.” ZAH is the first during hip and fracture
data in the theatre. Provides hospital in the southern procedures. The bed is further

additional information in hemisphere to make use of this

challenging procedures, like technology. LoopX will be

heavier patients or patients with launched together with a robotic
unusual anatomy. On-demand arm in November 2022.
imaging eliminates the need to

send the patient to Radiology for

scanning. (Medtronic 2012) Multi-Theatre has five theatres

available for orthopaedic

LoopX by Brainlab

Multi-Procedural Surgery table addition of advanced telescopic and Dr Zanet Oschman, who specialises
imaging equipment. in Musculoskeletal (MSK)
constructed from radiolucent Ultrasound diagnostics and
carbon fibre and allows for ZAH is part of the Femoral Head treatment, recently transferred her
unobstructed intra-operative Recovery Programme from the practice to ZAH. Dr Oschman's
imaging. According to the Tshwane University of Technology service officering includes MSK
product brochure, "the table and Centre for Tissue Engineering. ultrasound for muscles, ligaments,
supports a number of Patients who receive hip tendons, extra-articular joints and
procedures including the replacements, can consent to peripheral nerves. She has an
anterior approach to total hip donate femoral heads to the Centre active interest in sports medicine
replacements (AATHA), hip for Tissue Engineering. Through and has extensive experience in
arthroscopy, hip fractures, and bone tissue engineering, bone ultrasound-guided precision
lower limb fractures in either the products are used in clinical infiltrations that enhances recovery
supine or lateral position. The leg applications of bone repair and time.
spars allow for hyperextension, regeneration. Since 2019, ZAH
abduction, adduction and patients have donated close to 500 Specialists
external rotation of the legs.” femoral heads of which 343 could
(Mizuho OSI, 2022) be used to help other patients. Our specialists are sought after for
their approach to treatment and
 Stryker Stack endoscopic Support imaging services excellence as well as the application
equipment will be upgraded of new innovative approaches to
later this year. The technology Diagnoses begin with high-quality surgery including minimally invasive
allows for enhanced resection imaging. Our Radiology procedures. Patients benefit from
abilities and consistent Department moved into its new the hospital and specialists'
visualization throughout upgraded facilities in September excellence in spinal and
arthroscopic cases. The 2021. ZAH Radiology replaced all orthopaedic surgical services, pre-
technology also allows the the equipment with more operative preparations, advanced
specialist to store the data and sophisticated imaging equipment clinical technology in theatre and
access the information post- such as a new MRI, a new screening early mobility (where applicable)
operatively for evaluation, machine for general X-rays and applied by allied healthcare
research or discussion with the general ultrasound equipment. The workers.
patient in follow-up visits. new MRI offers enhanced
musculoskeletal imaging and heart Our surgeons further rely on the
 Advanced instrumentation MRI to patients, which was not trained and experienced staff to
and drill systems used in joint possible in the past. care for and advance the treatment
and ligament surgery. and outcome of patients.

 The Multi-theatre is supported by New MRI Machine at Radiology
a C-Arm from our Radiology
Department which is used inter-
operatively.

Sr Vanessa indicated that future
upgrade planning for the Multi-
Theatre complex includes the

Our experienced specialists often specialised imaging technologies procedure.
treat complicated cases and for microscopic and endoscopic
remain updated with the latest spinal procedures. Sr Alida Viljoen, Unit Manager of
surgical techniques and MICU shared that pain medication
efficiencies as part of their Post-Operative Care may influence blood pressure and
armamentarium. In co-operation urine excretion. During this time,
with Operation Healing Hands our We believe that post-operative it is imperative to carefully monitor
surgeons have also made a care and rehabilitation forms an these patients' blood pressure,
significant impact in the lives of integral part of receiving breathing, and urine excretion to
patients who were treated pro- specialised orthopaedic or spinal maintain optimal health. The neck
bono. treatment. circumference of cervical spinal
patients is constantly measured to
Our resident orthopaedic Depending on the post-operative monitor for any neck swelling. This
surgeons consist of Dr Rian Steyn, orthopaedic or spinal procedure in conjunction with the other co-
Dr Charl Olivier and Dr Cobus needs, orthopaedic and certain morbidities of the patient, is taken
Wessels, while visiting spinal patients may be transferred into consideration during the care
orthopaedic surgeons include Prof to our specialised high care unit. of the patients.
Theo le Roux, Dr Claud Killian, Dr Depending on the nature of the
Shandukane, Dr Johan de Beer procedure, spinal patients can The goal of pain management and
and assisted by Dr Ola van der also expect treatment in the Multi- monitoring is to “stay ahead” of
Spuy. Intensive Care Unit before being the pain following a procedure. It
transferred to Ward B. is possible to manage patients'
The most common orthopaedic pain either by administering
procedures performed are Post-operatively, spinal patients epidural pain medication or by
arthroplasty, foot and ankle spend 1-2 days in the Multi- administering analgesics under
surgery, shoulder surgery as well Intensive Care Unit. Acute pain patient control, also known as
as fractures and arthroscopy. management for spinal patients PCA. Alternatives include
Several national sports stars are critical within the first 24-48 intravenous and oral
choose specialists at Zuid- hours following a spinal
Afrikaans Hospital for sports
orthopaedics.

Our sought-after resident High Care of Multi-ICU
neurosurgeons focus on spinal
surgery and include Dr Christo
Aldrich, Dr Louis Nel and Dr
Emmanuel Thobejane. They have
a wealth of experience and
according to Sr Adele Botes, Unit
Manager of Thoracic and Spinal
Theatre, the majority of spinal
procedures include discectomy,
laminectomy and spinal
decompression and fusion. She
noted that they use the most
appropriate and least invasive
techniques. In addition, our
patients are supported by
advanced instrumentation and

High Care of Ward B

administration. Wound assessment, and will assist in daily living ensures that our specialists have
drainage monitoring and activities. Rehabilitation and access to the best possible
management of side- effects are treatment plans are specific to technologies and facilities to
also part of the care regime. Nurses specific patient needs. It is our complement their clinical expertise,
assist spinal patients with basic experience that early intervention leading to the best outcomes for
hygiene, positioning and that and management accelerates our patients.
patients remain comfortable patient recovery, pain relief and
supported by proper care during ultimately functional independence. Reference list
their recovery.
Physiotherapy for orthopaedic or  Brainlab. (2022). Loop-X - Mobile Robotic
Patients who received knee or hip spinal patients will commence as Imaging - Brainlab. [online] Available at:
replacements are treated in the high soon as relevant to the specific https://www.brainlab. com /surgery-
acuity unit of ward B, also called procedure protocol. Patients are products/overview-platform-
COX. The treatment plan includes often seen exercising on the products/robotic-intraoperative-mobile-
monitoring for post-operative veranda with physiotherapists. cbct/ [Accessed 21 Sep. 2022].
complications such as thrombosis,
nausea, reducing swelling, wound Conclusion  Medtronic (2012). O-arm - Surgical Imaging
care, ensure proper fluid drainage Systems. [online] Medtronic.com. Available
and pain management. Caring for orthopaedic and spinal at: https://europe.medtronic.com/xd-
patients is a multidisciplinary en/healthcare-professionals/
Pain control is a key element in post- responsibility. Patient education, products/neurological/surgical-imaging-
operative care because pain control pre-operative preparation, systems/o-arm.html [Accessed 21 Sep.
allows therapy progress. Once specialist treatment, careful post- 2022].
patients are in a stable condition, operative care and rehabilitation are
they are transferred to the normal essential for the successful  Mizuho OSI. (2022). Hana Orthopedic
ward, Ward B, for further care and transition from hospital to Surgery Table | Mizuho OSI. [online] Available
rehabilitation. community for orthopaedic and at: https://www.mizuhosi.com/product/
spinal patients. hana/ [Accessed 3 Oct. 2022].
Rehabilitation
The hospital's dedication to the  Mizuho OSI. (2020). Insite Surgery Table |
Patients benefit from the multi- spinal and orthopaedic needs of our Mizuho OSI. [online] Available at:
disciplinary approach by supporting patients, ensure that we are able to https://www.mizuhosi.com/product/insite/
physiotherapists, orthotists, and provide the best possible outcomes [Accessed 3 Oct. 2022].
biokinetici which include early for patients. Further to this, our
mobility to enhance rehabilitation, commitment to clinical  Vetalice, J.A. (2019). Brainlab Introduces
optimal recovery, promote self-care advancement in technology Loop-X Mobile Intraoperative Imaging Robot
| ORTHOWORLD. [online] ORTHOWORLD.
Available at: https://www.orthoworld.
com/brainlab-introduces-loop-x-mobile-
intraoperative-imaging-robotbra/ [Accessed
21 Sep. 2022].

 Zeiss (2019). KINEVO 900 from ZEISS
Advancing Surgical Certainty. [Brochure]
Zeiss. Available at: www.zeiss.com/kinevo
[Accessed 21 Sep. 2022].

Vaccine Statistics Total vaccinated since the beginning of
2022 amounts to 3933 people of all
Total Monthly Vaccination categories - Pfizer & J&J

Vaccination per age category per month

VACCINE

100 Years of Pathology

PathCare celebrates their centenary in September 2022. Staff at
PathCare, Zuid-Afrikaans Hospital, celebrated the special event by
participating in their nationwide anniversary competition. They had to
select a word that describes them and most fitting, UBUNTU, was
selected. The PathCare team at ZAH is a “can-do” team whose service
and support to patients, specialists and the hospital is applauded.
ZAH congratulates PathCare Laboratories on this special anniversary.
May the future hold many more years of growth and innovation.
Founded in 1922, PathCare, private diagnostic pathology practices that
practices in clinical pathology, hematology, microbiology/virology,
veterinary services, environmental testing and more.

Patient Stories

Hip Hip Hooray!

On 27 September 2022, our patient received a
hip replacement in co-operation with Operation
Healing Hands. We thank each staff member,
the hospital as well as the anaesthetist, Dr T
Venter, orthopaedic surgeon, Dr Charl Olivier
and assistant Dr. Erasmus for their generous
time and expertise.

167 Days of Healing

We are very grateful with the Sykes family. Mrs Sykes was discharged
from hospital on 29 September 2022, after spending 167 days at
ZAH, as well as spending time in two other hospitals as well.
Staff from the hospital shared in her joy to go home and sang songs
of blessings and joy as the ambulance staff accompanied her during
her discharge. Her family’s emotions touched everyone’s heart.
She will be recovering at home. We wish her the very best of health
on her journey to healing.

Construction Update: The new main entrance
staircase was opened on
Spacious Stairs Monday 26 September 2022.
opened The sweeping stairs is spacious
and simplistically designed.
After a short speech delivered
by Robert Jordaan, Hospital
Manager, Priscilla Botha,
Nursing Manager cut the red
ribbon and declared it open.

Attending the ceremony with
HODs of the hospital, was the
architect, Jeanne Butler and
builder, Hilton Holder. A large
corner window overlooks the
garden creating a great sense
of space and light. This is
complimented with repeating
decor elements from the main
reception area. The stairs lead
up to the main corridor, with
three large windows that floods
light into the corridor,
overlooking the garden of Ward
A.

Construction Update:
Doctors Change Room, Theatre Staircase

& Day Ward

Day Ward, partitioning & floor with a view of the front door

New Thoracic and Spinal Theatre Change Rooms

The beautiful and spacious Thoracic
and Spinal Theatre Change Rooms
were opened on Monday, 26
September. The change rooms
contain shower facilities, ample
locker space for personal items and
storage facilities for freshly treated
theatre clothing. The facilities are
secured by a key pad for each change
room.

Construction Update: Two multi-rooms in the Paediatric Ward are
being changed into single rooms, divided by a
glass panel to allow for additional bed capacity

Paediatric Ward Update as well as infection control measures in the
unit. This will bring the total bed capcity to 12.

Caring for your back

As part of Back Care Awareness buttocks and down each leg. weakness of muscles and bowel
week from 4-8 October, caring for Sciatica is how common people and bladder disturbances.
your back in a demanding working refer to pain that travels down the
environment is very important. leg from the lower back, although 4. Osteoporosis:
your doctor may use the term Osteoporosis may also cause low
Lower back pain is one the most lumbar radiculopathy. back pain – this happens when the
common experiences of health bones become brittle and porous.
care workers and support staff. 3. Disc Degeneration: As the vertebra weakens,
Disc degeneration is a damaged compression fractures may occur
What are the most common disc that leads to discomfort. As when too much pressure is placed
causes of lowback pain? people age, the disc wears away on the vertebra. in severe cases, it
and shrinks – in some cases the may even break with everyday
Pace Hospital noted the following disc may collapse causes the facet activities or even completely
causes: joints to rub against one another – collapse.
this is also known as osteoarthritis.
1. Strains and sprains: This will result in pain and stiffness 5. Infections of the spine:
An injury to the muscles and and can get worse with movement. Spinal infections can cause back
ligaments that support the spine, As orteoarthritis develops, the pain while infections of the disc,
may cause back pain. This can body grows new bone in the facet (discitis) and bone infections
occur when lifting something heavy joint to support the loss of bone and (osteomyelitis) may cause severe
in an improper weigh, poor posture support the vertebrae. This growth lower back pain.
or being overweight. may narrow the spinal canal which
is called spinal stenosis. This may 6. Abnormal shape of the spine:
2. Herniated Discs: appen in both the upper (cervical) ConditionsPhostuo ccrhedit:aDsr. RsocchoellleioLeseis,
Herniated discs, bulging discs, and and lumbar spine, of which lumbar kyphosis or excessive lordosis will
slipped discs refer to discs that spinal stenosis is the more cause back pain.
bulge or slip out of place, resulting common form of spinal stenosis.
in pain, tingling, numbness, or 7. Inflammatory back pain:
weakness in the area supplied by 4. Spondylolisthesis: Inflammatory back pain is
the nerve root. It is a condition where your vertebra associated with multiple joint pains
can slide forward on the top of and stiffness. This could be
Sciatica is a type of pain caused by another. If too much slippage attributed to a rare arthritic
a pinched or irritated sciatic nerve. occurs, the bones begin to press condition called ankylosing
This nerve runs down your lower on the spinal nerves resulting in spondylitis, while rheumatoid
back through your hips and arthritis, psoriatic arthritis, are

included as part of these examples. If you use a rucksack, carry the following advice
item over both shoulders and
7. Sacroiliac joint pain: not just one shoulder.  Invest in the right shoes -
Your spine is connected to your One key factor in back support
pelvis on both the sides by the  Use a chair with a backrest. is wearing the right shoes. With
sacroiliac joints. Inflammation and Sit with your feet flat on the floor so many choices, here are
infections of the sacroiliac joints or on a footrest. Change how some things to consider:
produces back pain. you sit every few minutes.  Weight—Lighter shoes will
make it easier to walk
8. Posture related:  Quit smoking. It is thought that around; heavy and/or clunky
Poor posture is a common cause of smoking reduces the blood shoes can make it feel like
back pain, which includes forward supply to the discs between the you're dragging yourself
standing, slouching while sitting, vertebrae and this may lead to around during the day
and improper lifting of heavy degeneration of these discs.
objects.  Support and stability: Select
 Lose any excess weight. shoes that offer ankle and
How then should you care Additional pressure on your back support and factors
foryour back? spine, may cause inflammation such as heel height, shape,
and spinal stress. construction/design, and
Nursingtimes.net (2022) provided material.
the following advice regarding back  Choose a mattress suited to
care: your height, weight, age and  Slip resistance: ensure you
sleeping position. purchase a shoe that has
 Maintain a good posture. good traction and that will
Avoid slumping in your chair, In addition to this, Bayada Home prevent you from falling.
hunching over a desk or walking Healthcare (2022) suggested the
with your shoulders hunched.
Lift your chest bone and walk
with your shoulders pointed
back.

 Exercise your back
regularly. Walking, swimming
(especially backstroke) and
using exercise bikes are all
excellent ways to strengthen
your back muscles. Inactivity
has been listed as a possible
cause of back pain. Get active
and exercise your back.

 Lifting technique. Always
bend your knees and your
hips when lifting heavy
objects, not your back.

 Never twist and bend at the
same time.

 Always lift and carry objects
close to your body.

 Try to carry loads in a
rucksack and avoid sling bags.

 Personal needs: consider the Available at: https://drposture.com/  Pacehospital.com. (2022). PACE
shape of your feet and other education/ [Accessed 27 Sep. 2022]. Hospitals - Hitech City-Hyderabad.
conditions such as wide feet, [online] Available at:
bunions, flat feet or any other  Mayo Clinic. (2021). Simple ways to https://www.pacehospital.com/an-
support for your feet such as prevent back pain at work. [online]
the foot bridge. Available at: https://www.mayoclinic. overview-of-low-back-pain-causes-
org/healthy-lifestyle/adult-health/in- risk-factors-and-treatment
Applying heat and cold therapy depth/back-pain/art-20044526 [Accessed 23Sep. 2022].
Applying heat to your back can help [Accessed 28 Sep. 2022].
relax the lower back muscles and
provide relief.  NT Contributor (2012). Top 10 back
care tips | Nursing Times. [online]
You can also apply alternating heat Nursing Times. Available at:
and cold packs to provide relief https://www.nursingtimes.net/archive
from muscle spasms. Localized /top-10-back-care-tips-02-04-2012/
cooling shuts down capillaries and [Accessed 21 Sep. 2022].
reduces blood flow to the area,
which helps ease the swelling and
resulting pain.

Conclusion

Occupations in hospital
environments require healthcare
workers and support staff to be
constantly on our feet - bending
over patients, cleaning areas or
standing. It places a significant
demand on our back.

Be aware of aspects that influences
your own health and movement -
make an effort to understand what
causes back pain at work and what
you can do to prevent it.

There are simple ways to support
your spine and overall back health.
Prevention is better than cure.

If you experience back pain - don’t
wait, seek help early and limit the
damage.

References

 Bayada Home health Care (2016). 6
Nurse-approved Ways to Protect Your
Back on the Job. [online] Work-Life.
Available at: https://blog.bayada.
com/work-life/6-nurse-approved-ways-
to-protect-your-back-on-the-job
[Accessed 21 Sep. 2022].

 Dr David Shahar (2020). Education |
Avada Fitness. [online] Dr Posture®.



Surviving Trauma

By Sr Lize Beyl, Unit Manager, Emergency Trauma injuries are not only Stress does not only have an
Department responsible for physical disabilities emotional impact on your body but a
but also the mental impact in the physical impact and could delay the
World Trauma Day is celebrated on aftermath of dealing with trauma or process of recovery. Avoid factors
the 17th of October 2022. The the loss of a loved one. By focusing that increase stress and find a
commemoration of this day is to not only on the prevention of stress relief technique that helps
emphasize the prevention of trauma, this day is also to place you.
trauma, and disability, to save lives focus on coping in a crisis and
and to properly attend to dealing with trauma for the patient Be patient
emergency cases. By hosting world and relatives When dealing with a crisis or trauma
trauma day, the Zuid-Afrikaans there is an assumption that negative
Hospital Emergency Department Effective Trauma emotions are a sign of weakness or
would not only like to give thanks to Management not dealing well with trauma. After a
all stakeholders present in trauma traumatic event, it is natural to not
care but also educate the public on Here are some effective ways in feel like yourself and therefore you
safety and injury prevention. dealing with the aftermath of trauma must learn to be patient when
dealing with your emotions or even
Trauma injuries around the world are Pay attention to what is that of a loved one.
the leading cause of death under the important.
age of 45, with a 9% death rate that Focus on your resources and what is Focus on self-care
is related to traumatic injuries. important in your day. Sharing After a traumatic event, stress is
According to the World Health responsibility with friends and family placed not only on you but the
Organization (WHO) recent research could unburden your load. Stick to caregiver as well. Remind yourself
has shown that at least 50 % of road necessary commitments and that this is a phase in life that will
accidents leading to death could prioritize your tasks to conserve pass and that every challenging
have been preventable with physical and emotional energy. situation will have an outcome.
effective care and interference after Ensure you stay committed to Accept the imperfections,
trauma has occurred. This includes: rehabilitation and a healthy lifestyle. weaknesses and strengths as
recovery is not a one-day process.
 Appropriate and effective pre- Find support Focus on what makes you feel
hospital care Find positive support within your better.
family, friends, or a support group.
 Adequate training and This will help with staying focused Physical activity and exercise
knowledge regarding emergency and completing tasks and Focus on rehabilitation and exercise
care commitments. Having support is to improve the outcome of your
the first step to recovery injuries, by staying focused on the
 Adequate facilities and rehabilitation phase you will notice
equipment to provide emergency Avoid stressors an improvement in time.
care

Improvement might be slow but injuries or signs and symptoms of Conclusion
every step no matter how small is a possible infection or further injury
step to recovery and victory. please seek medical attention Trauma injuries and disability are
immediately. Follow-up care with diseases on their own, finding the
Seek medical attention medical professionals is of utmost necessary treatment and aftercare
In case of any deterioration in importance on the road to recovery. is the key to success. Prevention is
progress, concern regarding better than cure.

Basic Life Support Outreach Training

By Sr Ilze van Eeden,, Unit Manager, Training Department Nylstroom) all qualified as different health care
providers.
This year the logo for CPR is “Saving a life is in your
hands”. On Tuesday the 27th of September, ZAH and Among the groups were two care workers, three
Critical Care and Emergency Services (CCES) took this registered nurses and three clinical technologists. Four
message to Bela Bela where Sr Ilze van Eeden of the staff members will visit ZAH in October to attend
presented “Basic Life Support (BLS)” training to the the Advanced Cardiac Life Support (ACLS) course with
staff of NRC for the Bela-Bela and Nylstroom branches, CCES.
an outreach initiative.
This was the first outreach project that ZAH conducted
BLS is an internationally accredited course of the in partnership with CCES. It was a big success as all
American Heart Association which is valid for two years members passed the enjoyable course. We hope to see
and accepted worldwide. them again in two years for the renewal training.

Eight staff members (four from Bela Bela and four from

World Restart a Heart Day

Make sure it is safe to approach:
Check for any response from the victim
Tilt the head back, lift the chin and check breathing
If breathing is absent or not normal, CPR is needed

Call 112 or 10177 and follow their instructions.
If someone is there to help, ask them to call 112 or 10177 for you, and
let them fetch an AED
Cardiac compressions are most important for survival. Do not delay or
interrupt cardiac compressions

Place both hands in the centre of the chest
 Compress the chest 5 to 6 cm 100-120 times / min to the rhythm of

“Stayin´Alive”
 If you learned how to do it, provide 2 rescue breaths between every 30

compressions, otherwise pump the chest continuously
 Push hard and fast. Don't worry, you can't do any harm
 If an AED arrives, switch it on immediately and follow the instructions
 Once the emergency services arrive, continue until you are told to stop
 Well done! Doing something saves lives and is ALWAYS better than

doing nothing.

BLS Training for Security Guards

On 23 and 30 August, Sr Ilze van Eeden and Sr Kimre Meintjies, trained our special core of Security Guards in
Basic Life Support. Each of the 24 staff members who participated thoroughly enjoyed the training
opportunity. Apart from our safety, we can rest assure that they will also be able to perform basic CPR if
required.

BLS Training for Security Guards (cont.)

Wellness Days at ZAH

Zuid-Afrikaans Hospital hosted four health awareness of Discovery Health. The health awareness days were
days on 7 and 15 September, for staff who do not well accepted and staff made use of the opportunities
belong to a medical aid or staff who are not members that presented itself at the hospital.

The Discovery Health Wellness Days were
hosted over two days - 20 and 27
September.

Wellness screening included body mass
index, BMI, blood pressure testing,
glucose testing, cholestrol screening and
HIV testing.

One of the four nurses who assisted in the
screening noted that many people are not
aware of their health risks.

Anel Espach from the People Company
assisted staff to schedule and book
screening slots.

We sincerely thank the team from
Discovery Health, Anel Espach and Sr
Sonja Scholtz, OHS and Hugo Minnaar for
making the Wellness Days possible for our
staff.

Awareness of your health will aid in
changing and motivating our health
behaviour.

Linking Health Behaviour
to Lifestyle Diseases

By Nicolene Schoeman, Clinical Pharmacist

Health behaviours are defined as “overt
behavioural patterns, actions and habits that
relate to health maintenance, to health
restoration and to health improvement”.1

Health behaviours determine our health status,
and influence both the quality and length of our
lives. Health behaviours include smoking, alcohol
use, diet, physical activity, sexual behaviours,
physician visits, medication adherence,
screening, and vaccination.² Poor health
behaviours may lead to lifestyle diseases.³

Lifestyle disease (Non-Communicable
Diseases)

Lifestyle disease also referred to as Non-
Communicable Diseases (NCDs) occurs due to a
combination of our genes, daily environment, and
lifestyle health behaviours. A lifestyle disease
cannot spread from person to person and
typically becomes a chronic condition if no
changes are made.4

NCDs are of increasing global concern due to
their high mortality rates. NCDs are now the
leading cause of death worldwide, having
surpassed all communicable disease deaths
combined and this represents an emerging global
health threat.5

According to the World Health Organisation,
NCDs kill 41-million people each year, equivalent
to 74% of all deaths globally. Eighty percent
(80%) of all premature NCDs deaths are
attributable to cardiovascular disease, cancers,
chronic respiratory disease, and diabetes.

Cardiovascular diseases constitute for the

majority of NCDs related deaths NCDs Follow these preventative
accounting for 17.9 million deaths
annually, followed by cancers (9.3  Physically inactivity strategies to improve you lifestyle
million), chronic respiratory accounts for 83 000 behaviour.
diseases (4.1 million), and diabetes deaths annually
(2.0 million including kidney disease Conclusion
deaths caused by diabetes).4 Metabolic risk factors
Health behaviours determine our
Tobacco use, unhealthy diets, a lack Metabolic risk factors contribute to health status, influencing both the
of physical activity, and the harmful four key metabolic changes that quality and length of our lives. Poor
use of alcohol are known as increase the risk of NCDs4: health behaviours may lead to
modifiable behavioural risk factors  raised blood pressure NCDs. NCDs are a global health
that may increase our risk of dying.4  overweight/obesity concern as it has become the
These behaviours may show up in  high blood sugar levels leading cause of death worldwide.
people as what are known as  high cholesterol levels Both modifiable and metabolic risk
metabolic risk factors, namely, factors contribute to an increased
raised blood pressure, increased The leading metabolic risk factor risk of NCDs. The only effective
blood sugar levels, high cholesterol globally is elevated blood pressure, preventative strategy to reduce the
levels and obesity. accounting for 19% of global risk of all NCDs are lifestyle
deaths, followed by raised blood modifications and interventions.
Modifiable behavioural risk sugar levels and References - Continue on back page
factors overweight/obesity.4

Modifiable health behaviours, such Prevention is better than
as tobacco and alcohol use, cure
physical inactivity, an unhealthy diet
all increase the risk of NCDs4: Lifestyle changes and interventions
are the most effective preventative
 Tobacco accounts for strategy to reduce the risk of NCDs
more than 8 million and as such should be the focus
deaths every year area. This includes changes in diet,
(including from the physical activities, cessation of
effects of exposure to second- smoking, and the control of
hand smoke) metabolic disorders.2

 Excess salt/sodium The high consumption of processed
intake accounts for 1.8 meat and sugary beverages,
million annual deaths combined with an unhealthy
lifestyle, a high body mass index
 Alcohol use accounts for (BMI), physical inactivity, and
3 million deaths, of which smoking have a marked association
more than half are from with NCDs.2

By Zuretha Volschenk, Administration needs across time and providers. every day or every few days.
Manager: Case Management
One of the key roles of a case The case manager also arranges
A hospital case manager is usually a manager is to assess the patient's home visits from a visiting nurse
nurse or a medical experienced health insurance plan/medical aid after being discharged from the
individual who does both updates on and to work with the fund and hospital or to get authorisation for a
a patient as well as discharge multiple providers to ensure that the rehabilitation facility. The case
planning. Utilization review involves best care is delivered, with the least manager will help the patient pick a
making sure that a patient is getting financial burden to the patient. home care health company or step-
the care that is medically necessary down facility (sub-acute) that is
and getting it in the correct setting. For example, the case manager contracted with their funder, which
They also follow up with the treating makes sure a patient's medical aid will accept them as a patient, after
providers (specialists) on letters of understands what is happening hospitalization for management of
motivation for approval of certain during the patient's hospitalisation, further recovery, before sending
treatments in the hospital. from admission to discharge. them home. High-cost medication
for use at home is also pre-
Discharge planning is the process The case manager would also make authorised by the case manager
of predicting the patient's sure that the funder has all the with the Pharmacy for home-based
continuing medical needs after they information it needs to approve care.
leave the hospital and putting in payment for the hospitalization and
place a plan to meet those needs. works to prevent any co-payments Additionally, a case manager may
Hospital case managers are towards the patient. A case negotiate coverage benefits
masters at organizing complex care manager will typically communicate between a medical aid, specialist
with the medical aid fund manager

Meet our Case Managers

Mel Sandra Olivia Zuretha Elvera Almarie Monique
Galinos Barnard Hingley Heck Nel
Volschenk van der Vyver

and patient. their specific role. They serve as a manager will have the answer.
valuable resource for the patient,
The case manager may end up the hospital, and the patient's For the week of 9-15 October, it is
negotiating with the pharmacy, health plan. Case Management Week, so
home healthcare company, please remember to thank your
medical aid, and the patient. In In short, the hospital case manager hospital's case managers, for their
some cases, the patient may have is the link between the hospital, continued hard work and
to pay some out-of-pocket Doctor, Allied Services and dedication, to your hospital.
expenses, but it will be far less than Pharmacy on treatment in the
what it would cost to stay in the hospital. The case manager is Reference:
hospital. By negotiating with all often referred to, as the heart of the Davis RN, E. (2014). Duties and
parties, the case manager can help hospital, as to get the patient the Types of Case Managers. [online]
drive costs down. best possible care at the least cost Verywell Health. Available at:
to the patient's pocket. https://www.verywellhealth.com/
Hospital case managers are often what-does-a-case-manager-do-
referred to, as care coordinators or If you have any questions regarding 1738560 [Accessed 27 Sep.
patient advocates, depending on medical aid funds, your case 2022].

Breast Cancer
Awareness Month

What are the symptoms?

Early treatment starts with
early diagnoses. Don’t wait.
Examine your breast



Crawford College spoils
ZAH staff with flowers &

music

On 2 September, Crawford College
Music School spoiled ZAH staff by
sharing flowers and making music
in our corridors. Staff were
pleasantly surprised and truly
appreciated the special renditions
of old favourites and flowers.

ZAH Celebrates Spring! On 2 September 2022 ZAH celebrated
spring with tremendous style and a

competition. Wards went all out to welcome

the new season. Well done to everyone!!

First Prize - Circus by Thoracic Theatre You are all winners.

Second Prize - Ward B, Spring Angels

Third Prize - Pool Party, by Administration
GICU & MISO - Flowerland
CICU - Green Flower Power

Spring
Day
by
ED
Multicolour Sweets by MICU

Queen Bee by Ward M

Hello Spring by
Stores & Goods Receiving

Purple Power by Multi-theatre

Hello
Spring
by
Pharmacy

Sunshine Spring by
Ward C

Happy Spring by
Services Division

Pink Petals by Ward B

Spring Cooking by
Food Services

Shining Spring by Admissions

Butterfly Spring by Training Centre

Welcome to the new ZAH staff

We trust that our new staff members will feel at home soon. We are
really glad that you joined our family.

Renee Ferreira Deidre Colyn Natasha Bezuidenhout
CICU Pharmacist Assistant Management Secretary
Pharmacy

Victoria Khoza George Goddard Atang Chabana
Ward A Billing Supervisor Ward B
Administration

Reinhart Koekemoer, son of
Ronel Koekemoer in the
Thoracic Theatre, married his
beautiful bride, Kelly Mills on
10 September 2022.

Little Diandré,
grandson of Louise
Hansen from Billing
and Administration
turned one year old in
September 2022



Sources Floriade 2002. Texas: Center for Health Systems and
Design - Colleges of Architecture and Medicine, University
Healing Nature of Gardens - Reference list of Texas. Available at: [Accessed 13 Sep. 2022].

 Brooks, L. (2021). Why Hospitals Are Planting Gardens. Back Awareness - Reference list
Forbes. [online] 29 May. Available at: [Accessed 13 Sep.
2022].  Home, B. (2016). 6 Nurse-approved Ways to Protect Your
Back on the Job. [online] Work-Life. Available at:
 Cervinka, R., Roderer, K. and Hammerle, I. (2014). https://blog.bayada.com/work-life/6-nurse-approved-
Evaluation of hospital gardens and implications for ways-to-protect-your-back-on-the-job [Accessed 22 Sep.
design: benefits from environmental psychology for 2022].
architecture and landscape planning on JSTOR. [online]
Jstor.org. Available at: [Accessed 13 Sep. 2022].  Nabraska Spine Hospital (2017). Back Pain: A Health
Concern For Nurses - Nebraska Spine Hospital. [online]
 Children's Hospital of Philadephia (2017). The Positive Nebraska Spine Hospital. Available at:
Impact of Gardens on Patients and Families | Children's https://nebraskaspinehospital.com/nurses-back-pain/
Hospital of Philadelphia. [online] Chop.edu. Available at: [Accessed 22 Sep. 2022].
[Accessed 13 Sep. 2022].
 Pacehospital.com. (2022). PACE Hospitals - Hitech City-
 Ellis, L. (2015). Applying the 'Broken Windows' Theory to Hyderabad. [online] Available at:
Healthcare. [online] The Center for Health Design. https://www.pacehospital.com/an-overview-of-low-back-
Available at: [Accessed 16 Sep. 2022]. pain-causes-risk-factors-and-treatment [Accessed 22
Sep. 2022].
 Franco, L.S., Shanahan, D.F. and Fuller, R.A. (2017). A
Review of the Benefits of Nature Experiences: More Than  Unique Health - Nursing | Healthcare | Management.
Meets the Eye. International Journal of Environmental (2021). Back Awareness Week - Unique Health - Nursing |
Research and Public Health, [online] 14(8), p.864. doi:. Healthcare | Management. [online] Available at:
https://www.uniquehealth.co.za/back-awareness-week/
 Franklin, D. (2012). How Hospital Gardens Help Patients [Accessed 22 Sep. 2022].
Heal. Scientific American. [online] doi:",.
Health Behaviour - Reference list
 Jiang, S. (2014). Therapeutic landscapes and healing 1. Https://www.tandfonline.com/doi/full/10.1080/
gardens: A review of Chinese literature in relation to the
studies in western countries. Frontiers of Architectural 08870446.2017.1336240
Research, [online] 3(2), pp.141–153. doi:.
2. Https://www.frontiersin.org/articles/10.3389/
 Ridgeway, K., Otto, C. and Leveton, L. (2012). fpubh.2020.574111/full
Countermeasures to Mitigate the Negative Impact of
Sensory Deprivation and Social Isolation in Long-Duration 3. Https://www.ncbi.nlm.nih.gov/pmc/articles/
Space Flight. Core.ac.uk. [online] PMC45 11598/#:~:text=Health%20
doi:oai:casi.ntrs.nasa.gov:20120002722. Behaviors%20%E2%80%93%20Definitions%20a
nd%20Emerging%20Concepts&text=Actions%2
 Spence, C. (2020). Senses of place: architectural design 0that%20can%20be%20classified,adherence%2
for the multisensory mind. Cognitive Research: Principles 0to%20prescribed%20medical%20treatments.
and Implications, [online] 5(1). doi:.
4. WHO https://www.who.int/news-room/fact-
 Stuster JW (2022). Bold endeavors: behavioral lessons sheets/detail/noncommunicable-diseases)
from polar and space exploration. Gravitational and
space biology bulletin : publication of the American 5. Https://www.cdc.gov/globalhealth/
Society for Gravitational and Space Biology, [online] healthprotection/ncd/global-ncd-overview.html#:
13(2). Available at: [Accessed 15 Sep. 2022]. ~:text=Noncommunicable%20diseases%20(NC
Ds)%2C%20such,all%20communicable%20disea
 Timler, K. (2019). Growing connection beyond prison se%20deaths%20combined.
walls: How a prison garden fosters rehabilitation and
healing for incarcerated men. [online] Journal of Offender
Rehabilitation. Available at: [Accessed 20 Sep. 2022].

 Ulrich, R. (2002). Health Benefits of Gardens in Hospitals.
In: Plants for People. [online] International Exhibition

Unless otherwise indicated, the content of this newsletter was written, designed and compiled by
Elzaan de Villiers, Public Relations Officer, ZAH. Direct any enquiries to: [email protected]