MY EPILEPSY STORY
Epilepsy South Africa: Turning obstacles into true potential *Naiemah Williams, *Wendy M. Nefdt, and †Jo M. Wilmshurst Epilepsia, 56(2):184–187, 2015 doi: 10.1111/epi.12641
Epilepsy South Africa Western Cape Branch (ESAWCB) is based in Cape Town, South Africa, and provides developmental services to children and adults with epilepsy and other disabilities. The organization promotes equal opportunities and protects and promotes the rights of people with disabilities.
Organizational Background Epilepsy South Africa, is the national epilepsy organization, which has branches in various provinces in the country (www.epilepsy.org.za). It was formally known as the South African National Epilepsy League (SANEL). In April 2002, the name and logo of the organization changed to Epilepsy South Africa (Fig. 1). The mission of the organization is to provide equitable services to people with epilepsy and other disabilities, which include psychotherapeutic intervention, public education, and economic empowerment programs, as well as research and advocacy. These services are provided at health facilities, educational institutions, corporate companies, social institutions, and welfare organizations. Figure 2 illustrates the message of hope that the organization aims to relay.
Epilepsy within an African Context When a child is diagnosed with epilepsy, the caregiver is faced with many challenges. These may include medical and social issues as well as limited access to resources. Challenges also include the management and the acceptance of the child’s condition and the disruption of the family infrastructure.1 Accepted March 20, 2014; Early View publication July 3, 2014. *Epilepsy South Africa Western Cape Branch, Cape Town, South Africa; and †Department of Pediatric Neurology, Red Cross War Memorial Children’s Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa Address correspondence to Naiemah Williams, PO Box 24573, Lansdowne, 7999 Cape Town, South Africa. E-mails: socdev4.wc@epilepsy. org.za, [email protected] Non-Profit Organisation Registration 003-941; PBO Registration 930006731; Vat Number 4190144230. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy
Figure 1. The current name and logo of the organization Epilepsy South Africa. Epilepsia ILAE
Medical Across many regions in South Africa, epilepsy treatment is affected by the lack of resources in the health care system.2 This includes lack of health care workers who are trained to recognize and to manage epilepsy and poor access to, as well as inconsistent supply of antiepileptic medication.3 This lack of resources adversely affects the caregiver’s ability to manage a child with epilepsy. Further challenges include traveling long distances to reach the medical facility, communication barriers due to language, cultural differences, and unemployment in the family, which further limit financial capacity to maintain treatment plans. Some parents believe that traditional healing and herbal medicines could help the child.4 Across Africa traditional healers are more accessible and routinely present in most communities; they are frequently approached as the more preferred service provider.5 Social Stigmatization of epilepsy is often exacerbated by misconceptions and misunderstandings of the condition. In certain cultures and communities in Africa, it is believed that epilepsy is a spiritual condition. Other beliefs are that children and adults with epilepsy are sexually deviant, antisocial, aggressive, and mentally ill.6 As a result of these beliefs, people with epilepsy are often discriminated against, resulting in social isolation, exclusion, and lack of support from communities. The fear that epilepsy may be contagious has resulted in children being excluded from communities and expelled from schools. Caregivers are the primary health care providers for most children with epilepsy. Often this has led to psychological problems such as stress, depression, and anxiety because of their inability to cope with the challenges they face on a daily basis.
184
185 Turning Obstacles into True Potential
Figure 2. The message of hope that the organization Epilepsy South Africa aims to relay. The image is of a child playing on a wasteland. He resides in the low income housing, which is seen in the background, and appears willing to face and cope with adversity. Epilepsia ILAE
In our setting we have found that caregivers may be afraid of disclosing to their family, friends, and associates that their child has epilepsy because they feel shame, rejection, or self-blame.6 This causes them to withdraw from their relatives and friends and leaves them further isolated. Resources The provision of appropriate special needs education and day care centers remains inadequate to meet the needs of children with epilepsy in South Africa. These children experience challenges with their epilepsy management due to the lack of facilities to treat them, as well as the limited treatments available to them.3 The cost of traveling and the long waiting hours at the health facilities affect the attendance of hospital appointments.5 The health facilities are often far from the family’s community, or the facility does not provide the medication that the child requires for epilepsy management. Often the services required by the children are limited to the few tertiary hospitals in the country, which usually require traveling considerable distances. This is further compounded by lack of knowledge about available resources. The result is that a proportion of children, which is suspected to be high, remain at home in the long-term isolated care of their caregivers who as a result cannot work. In turn this affects the household income and places a financial burden on the families. Because of this situation some children are sent away to the rural areas for extended family members to be the main caregivers; these are often elderly relatives. These rural settings have even fewer facilities and children potentially receive minimal medication and education. If the child’s health deteriorates, the family has little choice beyond putting them on a bus and returning them to the city; these children arrive in extremis with rarely any medical information to document
the prior events or interventions, requiring management of these children to be initiated “blind.” The arriving child may have been having seizures for the entire journey (often hours). Policy and legislation Capacity constraints, limited conceptual understanding, and inappropriate institutional arrangements result in ineffective policy implementation.7 According to the author (NW), although policies do exist for the protection and assistance for children with epilepsy, they are not effective in ensuring the adequate social support required. In South Africa, the Children’s Act No 38 of 20058 makes provision for the protection of children with disabilities, the implementation of the regulations of the Act is impeded as a result of a lack of capacity and infrastructural arrangements.
Red Cross War Memorial Children’s Hospital (RCWMCH): Services Rendered by Epilepsy South Africa Western Cape Branch (ESA-WCB) Red Cross War Memorial Children’s Hospital (RCWMCH) is a specialized tertiary Hospital. It has a specialized epilepsy clinic, and the patients are referred from various primary and secondary health care facilities in South Africa as well as other African countries. Up to 40 children are seen each week in a dedicated epilepsy clinic for children with established epilepsy; newly presenting patients undergo initial clinical assessment in other neurology clinics. The service has more than 2,000 clinic visits from children with epilepsy every year. Although most Epilepsia, 56(2):184–187, 2015 doi: 10.1111/epi.12641
186 N. Williams et al. attendees are from the city of Cape Town and immediate surrounding areas, a diverse range of locations are also responsible for clinic load with patients managed from farther afield. There are currently three patients from Burundi, Zimbabwe, and Congo who have received psychosocial intervention from ESA-WCB. The table below includes examples of the referrals that are received by RCWMCH Epilepsy Clinic: This service is supported by the input of a social worker, from ESA-WCB, who has had training in epilepsy education. Carers can refer themselves directly for counseling and support, or can be recommended through the medical staff from the clinic. The diverse but repetitive challenges faced by these families are illustrated by some of the examples of the referral concerns reported in Table 1. South Africa is a prime example of a setting where multiple layers of complexity compound optimal care for affected children and their families; these include poverty, poor education, additional diseases affecting the child or carer (such as tuberculosis and human immunodeficiency syndrome), substance abuse, and crime. A holistic approach to addressing the needs of a child with epilepsy and their family in a South African context has
been developed by ESA-WCB in collaboration with RCWMCH. Figure 3 illustrates the process of intervention: Key strengths of this approach include: 1. A multidisciplinary approach: This includes pediatric neurologists, social workers, other organizations, and caregivers. 2. Services provided are part of an ongoing process: This ensures that there is access to support within the hospital and outside through the relevant organization. 3. Linkages with community-based resources: This ensures that the care of the child is cascaded into the community. 4. Participation in RCWMCH Support Group: Caregivers are provided with a platform to share experiences.
A Mother’s Perspective Mrs. Smiths reported that she had to overcome several obstacles to ensure that her daughter with epilepsy enjoys optimal well-being:
Table 1. Examples of referrals received from RCWMCH epilepsy clinic The caregiver is unable to cope with the care and management of the child with epilepsy as he/she is overwhelmed with the multiple responsibilities in the family home The caregiver may have HIV/AIDS and is too ill to care for the child with epilepsy. Other family members or carers assist with the child’s epilepsy treatment; however, due to a lack of understanding, they do not comply with administering the antiepileptic drugs The child with epilepsy does not receive their antiepileptic drug treatment because of several factors such as Moving to a rural area where there is a lack of medical resources, Failure to attend the hospital regularly, and The inability to afford transport to the medical facilities. The caregiver is abusing substances and is unable to provide appropriate care to their child with epilepsy The child with epilepsy displays uncontrolled behavior and the caregiver is unable to cope. The child runs away from home and becomes vulnerable to social ills in the community The family lives in extreme poverty and relies on the care dependency grant of the child with epilepsy. The caregiver often exaggerates the amount of seizures that the child experiences to keep receiving the grant
Figure 3. Process of intervention provided by Epilepsy South Africa Western Cape Branch Epilepsia ILAE
Epilepsia, 56(2):184–187, 2015 doi: 10.1111/epi.12641
187 Turning Obstacles into True Potential My 14-year-old daughter experienced her first seizure at 9 months old. She was admitted to RCWMCH, and she was eventually diagnosed with epilepsy. At the age of 5 years, her seizures stopped completely. During the 4 years that my daughter was seizure-free, she experienced behavioral problems and bedwetting, and she was seen by a clinical psychologist. Her behavior was attributed to family stressors that affected her negatively. Her seizures returned when she started menstruating at the age of 11. Two years ago her father and I separated. This traumatic time has affected my daughter severely. Her seizures increased at an alarming rate. This resulted in her being bullied at school and therefore she refused to attend school. I approached ESA-WCB, where I was assigned to an amazing social worker. She helped me with my daughters schooling, social grant application, and other services. Through this, my daughter is now attending a school of her choice. She received an accolade for excellent progress. Although my daughter still experiences seizures, she is happier now than she has been in a long time. My life with my children does not seem so dark and bleak. Thanks to ESAWCB and RCWMCH who helped me to overcome my obstacles. This personal story is an example of the interventions received at RCWMCH. The holistic approach utilized by ESA-WCB is unique to the South African context, as it encompasses all spheres of the child’s life. The approach addresses the obstacles experienced by the caregiver, thereby nurturing the true potential of the child.
Acknowledgments Epilepsy South Africa Western Cape Branch Social Development Department. Professor Jo Wilmshurst (Head of Department of Pediatric Neurology, Red Cross War Memorial Children’s Hospital). Red Cross War Memorial Children’s Hospital Outpatient Epilepsy Clinic. Author of the
personal story (names changed and permission attained from the patient’s mother).
Disclosure The authors have no conflicts of interest to disclose. We confirm that we have read the journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
Disclaimer Editor’s Note: Epilepsia’s Epilepsy Stories is a venue for nonprofit organizations to educate our professional readership about their mission for people with epilepsy from around the world. Many organizations raise awareness about epilepsy including ILAE’s sister organization, the IBE and its chapters. Epilepsia does not endorse one organization over another. If you would like your nonprofit organization recognized, please contact us at [email protected].
References 1. Ellis N, Upton D, Thompson P. Epilepsy and the family: a review of current literature. Seizure 2000;9:22–30. 2. Eastman R. Epilepsy in South Africa. Acta Neurol Scand Suppl 2005;181:8–11. 3. Wilmshurst JM, Badoe E, Wammanda RD, et al. Child neurology services in Africa. J Child Neurol 2011;26:1555–1563. 4. Lupondo Y. Understanding epilepsy within historically black schools in the Western Cape. Stellenbosch: University of Stellenbosch; 2010. 5. Wilmshurst JM, Cross JH, Newton C, et al. Children with epilepsy in Africa: recommendations from the international child neurology association/african child neurology association workshop. J Child Neurol 2013;28:633–644. 6. Spangenberg J, Lalkhen N. Children with epilepsy and their families: psychosocial issues. S Afr Fam Pract 2006;48:60–63. 7. Dube A. The role and effectiveness of disability legislation in South Africa disability knowledge and research. 2005. Available at:http://r4d. dfid.gov.uk/PDF/Outputs/Disability/PolicyProject_legislation_sa.pdf. Accessed February 22, 2014. 8. Government Gazette REPUBLIC OF SOUTH AFRICA. No. 38 of 2005: Children’s Act, 2005; Vol. 4. 92 Cape Town 19 June 2006 No. 28944; Available at:http://www.saflii.org/za/legis/num_act/ca2005104. txt. Accessed February 22, 2014.
Epilepsia, 56(2):184–187, 2015 doi: 10.1111/epi.12641
This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.
Epilepsy South Africa: Turning obstacles into true potential *Naiemah Williams, *Wendy M. Nefdt, and †Jo M. Wilmshurst Epilepsia, 56(2):184–187, 2015 doi: 10.1111/epi.12641
Epilepsy South Africa Western Cape Branch (ESAWCB) is based in Cape Town, South Africa, and provides developmental services to children and adults with epilepsy and other disabilities. The organization promotes equal opportunities and protects and promotes the rights of people with disabilities.
Organizational Background Epilepsy South Africa, is the national epilepsy organization, which has branches in various provinces in the country (www.epilepsy.org.za). It was formally known as the South African National Epilepsy League (SANEL). In April 2002, the name and logo of the organization changed to Epilepsy South Africa (Fig. 1). The mission of the organization is to provide equitable services to people with epilepsy and other disabilities, which include psychotherapeutic intervention, public education, and economic empowerment programs, as well as research and advocacy. These services are provided at health facilities, educational institutions, corporate companies, social institutions, and welfare organizations. Figure 2 illustrates the message of hope that the organization aims to relay.
Epilepsy within an African Context When a child is diagnosed with epilepsy, the caregiver is faced with many challenges. These may include medical and social issues as well as limited access to resources. Challenges also include the management and the acceptance of the child’s condition and the disruption of the family infrastructure.1 Accepted March 20, 2014; Early View publication July 3, 2014. *Epilepsy South Africa Western Cape Branch, Cape Town, South Africa; and †Department of Pediatric Neurology, Red Cross War Memorial Children’s Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa Address correspondence to Naiemah Williams, PO Box 24573, Lansdowne, 7999 Cape Town, South Africa. E-mails: socdev4.wc@epilepsy. org.za, [email protected] Non-Profit Organisation Registration 003-941; PBO Registration 930006731; Vat Number 4190144230. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy
Figure 1. The current name and logo of the organization Epilepsy South Africa. Epilepsia ILAE
Medical Across many regions in South Africa, epilepsy treatment is affected by the lack of resources in the health care system.2 This includes lack of health care workers who are trained to recognize and to manage epilepsy and poor access to, as well as inconsistent supply of antiepileptic medication.3 This lack of resources adversely affects the caregiver’s ability to manage a child with epilepsy. Further challenges include traveling long distances to reach the medical facility, communication barriers due to language, cultural differences, and unemployment in the family, which further limit financial capacity to maintain treatment plans. Some parents believe that traditional healing and herbal medicines could help the child.4 Across Africa traditional healers are more accessible and routinely present in most communities; they are frequently approached as the more preferred service provider.5 Social Stigmatization of epilepsy is often exacerbated by misconceptions and misunderstandings of the condition. In certain cultures and communities in Africa, it is believed that epilepsy is a spiritual condition. Other beliefs are that children and adults with epilepsy are sexually deviant, antisocial, aggressive, and mentally ill.6 As a result of these beliefs, people with epilepsy are often discriminated against, resulting in social isolation, exclusion, and lack of support from communities. The fear that epilepsy may be contagious has resulted in children being excluded from communities and expelled from schools. Caregivers are the primary health care providers for most children with epilepsy. Often this has led to psychological problems such as stress, depression, and anxiety because of their inability to cope with the challenges they face on a daily basis.
184
185 Turning Obstacles into True Potential
Figure 2. The message of hope that the organization Epilepsy South Africa aims to relay. The image is of a child playing on a wasteland. He resides in the low income housing, which is seen in the background, and appears willing to face and cope with adversity. Epilepsia ILAE
In our setting we have found that caregivers may be afraid of disclosing to their family, friends, and associates that their child has epilepsy because they feel shame, rejection, or self-blame.6 This causes them to withdraw from their relatives and friends and leaves them further isolated. Resources The provision of appropriate special needs education and day care centers remains inadequate to meet the needs of children with epilepsy in South Africa. These children experience challenges with their epilepsy management due to the lack of facilities to treat them, as well as the limited treatments available to them.3 The cost of traveling and the long waiting hours at the health facilities affect the attendance of hospital appointments.5 The health facilities are often far from the family’s community, or the facility does not provide the medication that the child requires for epilepsy management. Often the services required by the children are limited to the few tertiary hospitals in the country, which usually require traveling considerable distances. This is further compounded by lack of knowledge about available resources. The result is that a proportion of children, which is suspected to be high, remain at home in the long-term isolated care of their caregivers who as a result cannot work. In turn this affects the household income and places a financial burden on the families. Because of this situation some children are sent away to the rural areas for extended family members to be the main caregivers; these are often elderly relatives. These rural settings have even fewer facilities and children potentially receive minimal medication and education. If the child’s health deteriorates, the family has little choice beyond putting them on a bus and returning them to the city; these children arrive in extremis with rarely any medical information to document
the prior events or interventions, requiring management of these children to be initiated “blind.” The arriving child may have been having seizures for the entire journey (often hours). Policy and legislation Capacity constraints, limited conceptual understanding, and inappropriate institutional arrangements result in ineffective policy implementation.7 According to the author (NW), although policies do exist for the protection and assistance for children with epilepsy, they are not effective in ensuring the adequate social support required. In South Africa, the Children’s Act No 38 of 20058 makes provision for the protection of children with disabilities, the implementation of the regulations of the Act is impeded as a result of a lack of capacity and infrastructural arrangements.
Red Cross War Memorial Children’s Hospital (RCWMCH): Services Rendered by Epilepsy South Africa Western Cape Branch (ESA-WCB) Red Cross War Memorial Children’s Hospital (RCWMCH) is a specialized tertiary Hospital. It has a specialized epilepsy clinic, and the patients are referred from various primary and secondary health care facilities in South Africa as well as other African countries. Up to 40 children are seen each week in a dedicated epilepsy clinic for children with established epilepsy; newly presenting patients undergo initial clinical assessment in other neurology clinics. The service has more than 2,000 clinic visits from children with epilepsy every year. Although most Epilepsia, 56(2):184–187, 2015 doi: 10.1111/epi.12641
186 N. Williams et al. attendees are from the city of Cape Town and immediate surrounding areas, a diverse range of locations are also responsible for clinic load with patients managed from farther afield. There are currently three patients from Burundi, Zimbabwe, and Congo who have received psychosocial intervention from ESA-WCB. The table below includes examples of the referrals that are received by RCWMCH Epilepsy Clinic: This service is supported by the input of a social worker, from ESA-WCB, who has had training in epilepsy education. Carers can refer themselves directly for counseling and support, or can be recommended through the medical staff from the clinic. The diverse but repetitive challenges faced by these families are illustrated by some of the examples of the referral concerns reported in Table 1. South Africa is a prime example of a setting where multiple layers of complexity compound optimal care for affected children and their families; these include poverty, poor education, additional diseases affecting the child or carer (such as tuberculosis and human immunodeficiency syndrome), substance abuse, and crime. A holistic approach to addressing the needs of a child with epilepsy and their family in a South African context has
been developed by ESA-WCB in collaboration with RCWMCH. Figure 3 illustrates the process of intervention: Key strengths of this approach include: 1. A multidisciplinary approach: This includes pediatric neurologists, social workers, other organizations, and caregivers. 2. Services provided are part of an ongoing process: This ensures that there is access to support within the hospital and outside through the relevant organization. 3. Linkages with community-based resources: This ensures that the care of the child is cascaded into the community. 4. Participation in RCWMCH Support Group: Caregivers are provided with a platform to share experiences.
A Mother’s Perspective Mrs. Smiths reported that she had to overcome several obstacles to ensure that her daughter with epilepsy enjoys optimal well-being:
Table 1. Examples of referrals received from RCWMCH epilepsy clinic The caregiver is unable to cope with the care and management of the child with epilepsy as he/she is overwhelmed with the multiple responsibilities in the family home The caregiver may have HIV/AIDS and is too ill to care for the child with epilepsy. Other family members or carers assist with the child’s epilepsy treatment; however, due to a lack of understanding, they do not comply with administering the antiepileptic drugs The child with epilepsy does not receive their antiepileptic drug treatment because of several factors such as Moving to a rural area where there is a lack of medical resources, Failure to attend the hospital regularly, and The inability to afford transport to the medical facilities. The caregiver is abusing substances and is unable to provide appropriate care to their child with epilepsy The child with epilepsy displays uncontrolled behavior and the caregiver is unable to cope. The child runs away from home and becomes vulnerable to social ills in the community The family lives in extreme poverty and relies on the care dependency grant of the child with epilepsy. The caregiver often exaggerates the amount of seizures that the child experiences to keep receiving the grant
Figure 3. Process of intervention provided by Epilepsy South Africa Western Cape Branch Epilepsia ILAE
Epilepsia, 56(2):184–187, 2015 doi: 10.1111/epi.12641
187 Turning Obstacles into True Potential My 14-year-old daughter experienced her first seizure at 9 months old. She was admitted to RCWMCH, and she was eventually diagnosed with epilepsy. At the age of 5 years, her seizures stopped completely. During the 4 years that my daughter was seizure-free, she experienced behavioral problems and bedwetting, and she was seen by a clinical psychologist. Her behavior was attributed to family stressors that affected her negatively. Her seizures returned when she started menstruating at the age of 11. Two years ago her father and I separated. This traumatic time has affected my daughter severely. Her seizures increased at an alarming rate. This resulted in her being bullied at school and therefore she refused to attend school. I approached ESA-WCB, where I was assigned to an amazing social worker. She helped me with my daughters schooling, social grant application, and other services. Through this, my daughter is now attending a school of her choice. She received an accolade for excellent progress. Although my daughter still experiences seizures, she is happier now than she has been in a long time. My life with my children does not seem so dark and bleak. Thanks to ESAWCB and RCWMCH who helped me to overcome my obstacles. This personal story is an example of the interventions received at RCWMCH. The holistic approach utilized by ESA-WCB is unique to the South African context, as it encompasses all spheres of the child’s life. The approach addresses the obstacles experienced by the caregiver, thereby nurturing the true potential of the child.
Acknowledgments Epilepsy South Africa Western Cape Branch Social Development Department. Professor Jo Wilmshurst (Head of Department of Pediatric Neurology, Red Cross War Memorial Children’s Hospital). Red Cross War Memorial Children’s Hospital Outpatient Epilepsy Clinic. Author of the
personal story (names changed and permission attained from the patient’s mother).
Disclosure The authors have no conflicts of interest to disclose. We confirm that we have read the journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
Disclaimer Editor’s Note: Epilepsia’s Epilepsy Stories is a venue for nonprofit organizations to educate our professional readership about their mission for people with epilepsy from around the world. Many organizations raise awareness about epilepsy including ILAE’s sister organization, the IBE and its chapters. Epilepsia does not endorse one organization over another. If you would like your nonprofit organization recognized, please contact us at [email protected].
References 1. Ellis N, Upton D, Thompson P. Epilepsy and the family: a review of current literature. Seizure 2000;9:22–30. 2. Eastman R. Epilepsy in South Africa. Acta Neurol Scand Suppl 2005;181:8–11. 3. Wilmshurst JM, Badoe E, Wammanda RD, et al. Child neurology services in Africa. J Child Neurol 2011;26:1555–1563. 4. Lupondo Y. Understanding epilepsy within historically black schools in the Western Cape. Stellenbosch: University of Stellenbosch; 2010. 5. Wilmshurst JM, Cross JH, Newton C, et al. Children with epilepsy in Africa: recommendations from the international child neurology association/african child neurology association workshop. J Child Neurol 2013;28:633–644. 6. Spangenberg J, Lalkhen N. Children with epilepsy and their families: psychosocial issues. S Afr Fam Pract 2006;48:60–63. 7. Dube A. The role and effectiveness of disability legislation in South Africa disability knowledge and research. 2005. Available at:http://r4d. dfid.gov.uk/PDF/Outputs/Disability/PolicyProject_legislation_sa.pdf. Accessed February 22, 2014. 8. Government Gazette REPUBLIC OF SOUTH AFRICA. No. 38 of 2005: Children’s Act, 2005; Vol. 4. 92 Cape Town 19 June 2006 No. 28944; Available at:http://www.saflii.org/za/legis/num_act/ca2005104. txt. Accessed February 22, 2014.
Epilepsia, 56(2):184–187, 2015 doi: 10.1111/epi.12641
This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.
