husnaot

[husnaot]

Last thoughts: will enough ever be achieved?

It feels like just yesterday that I was reunited with my practical partners from my physical and paediatric blocks, with an additional member, to start our last block of our final year. Now, four weeks in, I can safely say that this last block was filled with fun, laughter, surprise and both hopes and worries for the future. The question I always ask myself when going into the community everyday is: am I doing enough?

At its core, community occupational therapy is rooted in a philosophical framework that emphasises the internal value of human connection and the ethical duty to enhance the well-being of others. In the current community that we are working in, MR, one which is vibrant and unique in its cultural norms, the interactions I have had with diverse groups highlighted principles of social justice and equity. Each interaction reminded me that the well-being of individuals cannot be separated from the socio-economic and cultural contexts in which they live. It spoke to what we have been taught since our first year in this degree: Occupational Therapy treats the Holistic Self. I am glad that I had the opportunity to witness and implement this in person. (“Position Statement: Community-Based Rehabilitation (CBR),” 2009)

As I collaborated with the local creches and the primary school, I encountered children whose lives were shaped by various challenges, from socio-economic constraints to limited access to healthcare and educational resources. Some of the children were coming to school and having their only meal for the day which is a service organized by the community centre in the community. It was heartsore to witness, and these experiences prompted a deep reflection on the ethical responsibilities of healthcare practitioners such as ourselves. We need to advocate not only for individual clients but also for the systemic changes that foster healthier communities. This holistic understanding became a guiding principle in my practice and an essential lesson in my journey toward becoming a competent occupational therapist.

The projects we undertook were instrumental in improving my professional skills. Working with children in early childhood development provided me with a unique opportunity to apply theoretical knowledge in real-world settings, building a bridge between theoretical learning and practical implementation. Designing and implementing therapeutic interventions for young learners required creativity and adaptability, as I navigated cultural sensitivities and diverse learning needs. While some children liked table-top activities, others needed a gross motor component to rid themselves of their excess energy and be able to focus. Navigating these different types was a challenge that I loved. These experiences cultivated a sense of empathy and reinforced the importance of client-centered care—a pillar of occupational therapy. (Kugel et al., 2017)

The development of a relapse prevention package for substance use disorder was another significant project that enhanced my understanding of the complexities surrounding the condition. Collaborating with community members, we aimed to create a culturally relevant program that addressed the specific needs of individuals affected by substance abuse. The idea for this project was thought of once we spoke to the community leader and heard of the people who have given up substances and are worried about relapsing. She reported that they needed assistance since the community shunned them for any acts they had committed while using substances and they feared that they would relapse if not occupied. This initiative taught me the value of participatory approaches in health promotion, where community input is essential for effective intervention design. Without the input from the community leader in terms of common conditions and contextual factors, we would not have thought of this project that is both client-centred and relevant to the community. (Lauckner et al., 2011)

While my professional development was indescribable, the personal lessons I gained throughout this experience were equally transformative. Engaging with the community on a personal level challenged me to confront my assumptions and biases. It illuminated the stark disparities in access to resources and highlighted the resilience of individuals facing adversity. Witnessing the strength and determination of the people I served ignited a sense of humility within me. It became clear that while I entered MR with the intention to help and assist as best as I can, I was equally enriched by the stories and experiences shared with me. (Foronda et al., 2016)

My interactions during home visits were particularly impactful. Meeting clients in their own environments revealed the intricacies of their lives and the challenges they faced daily. I learned to listen deeply and to recognize that the solutions I proposed needed to resonate with their lived experiences or else they would not see the value in my intervention. This realization reinforced the importance of building trust and rapport, which are essential for effective therapeutic relationships. Each visit was a reminder of the profound impact that understanding, and compassion can have on an individual’s journey toward health and well-being. (Hammell, 2017)

One of the home visits that impacted me greatly was a stroke client. Inside the home, the walls were covered with mold and the bathtub was full of tiny pieces of cracked cement from the ceiling in their bathroom. They were using a bowl as a washbasin as this was the only way to bath. They were hesitant to, however, they reported that they do struggle to make ends meet with basic groceries and maintaining the utilities bill. Despite these socioeconomic challenges that they were facing, every time I visited I was greeted with a warm smile and a wiped chair. They offered me their food if I came as the mother was cooking and thanked me excessively each time I left the session. It made me realise that there is a beauty in humanity and that the core of every person is to share with compassion and to share in culture.

This links to a lesson I find valuable which is that the importance of cultural competence cannot be overstated. As occupational therapists, we must be attuned to the cultural narratives that shape our clients’ identities and experiences. Embracing cultural humility—acknowledging the limitations of our knowledge and remaining open to learning from those we serve—will be pivotal in my ongoing professional and personal development. (Crawley, 2022)

Moreover, the experience highlighted the significance of collaboration and partnership in practice. No single individual or organization can affect meaningful change in isolation. The successful implementation of our projects relied heavily on the involvement of local stakeholders, healthcare providers, educators, and community members. This collaborative approach will inform my future endeavors, reminding me that collective efforts can amplify impact and foster sustainable change. (McKinnon et al., 2024)

As I transition from an academic setting into the professional world, my commitment to community service remains unwavering. The lessons learned in MR will continue to shape my practice and influence my engagement with diverse populations. I aspire to integrate a community-oriented perspective into my occupational therapy practice, advocating for equitable access to care and resources while providing holistic, culturally relevant intervention for my clients.

In a broader context, I recognise the responsibility to engage in ongoing advocacy efforts that address social determinants of health. This involves not only providing direct services but also participating in initiatives aimed at policy change, community development, and education.

In reflecting on my experiences as an occupational therapy student in MR, I recognise the profound impact of community service on both my professional and personal growth. The lessons learned—from the importance of cultural competence to the value of collaboration—will serve as guiding principles as I navigate my community service next year, as well as my career in the future. With two weeks remaining of the block, I know I will continue to learn from the people around me and to have an impact on others but also recognise their impact on me.

My university’s OT department has been in MR for 12 years now. Year after year, students enter the community hoping to make a change, whether it is for marks or for the good of the world, who knows? But what I can say is that the answer to my question will forever be unknown until we have an ideal society. Until then, we have a lot of work to do.

References:

Crawley, R. (2022). Cultural competence in occupational therapy to reduce health disparities: a systematic literature review. International Journal of Therapy and Rehabilitation, 29(10), 1–14. https://doi.org/10.12968/ijtr.2021.0011

Foronda, C., Baptiste, D.-L., Reinholdt, M. M., & Ousman, K. (2016). Cultural humility: A concept analysis. Journal of Transcultural Nursing, 27(3), 210–217. https://doi.org/10.1177/1043659615592677

Hammell, K. W. (2017). Opportunities for well-being: The right to occupational engagement. Canadian Journal of Occupational Therapy, 84(4-5), 209–222. https://doi.org/10.1177/0008417417734831

Kugel, J. D., Javherian-Dysinger, H., & Hewitt, L. (2017). The Role of Occupational Therapy in Community-Based Programming: Addressing Childhood Health Promotion. The Open Journal of Occupational Therapy, 5(1). https://doi.org/10.15453/2168-6408.1259

Lauckner, H. M., Krupa, T. M., & Paterson, M. L. (2011). Conceptualizing Community Development: Occupational Therapy Practice at the Intersection of Health Services and Community. Canadian Journal of Occupational Therapy, 78(4), 260–268. https://doi.org/10.2182/cjot.2011.78.4.8

McKinnon, S., Petrone, N., & Tarbet, A. (2024). The Role of an Occupational Therapy Practitioner in Professional Advocacy: a Scoping Review. Translational Science in Occupation, 1(2). https://doi.org/10.32873/unmc.dc.tso.1.2.02

Position Statement: Community-based rehabilitation (CBR). (2009). World Federation of Occupational Therapists Bulletin, 59(1), 6–7. https://doi.org/10.1179/otb.2009.59.1.003

Picture References:

370+ Muslim Nurse Illustrations, Royalty-Free Vector Graphics & Clip Art - iStock. (n.d.). Www.istockphoto.com. https://www.istockphoto.com/illustrations/muslim-nurse

Artgro. (2020, February 17). Different Types of Mold Found in Homes: How it Grows, Thrives and Spreads - Mold Inspection Houston. Mold Inspection Houston. https://moldinspectionhouston.com/2020/02/17/different-types-of-mold-found-in-homes-how-it-grows-thrives-and-spreads/

Hibrida13. (2017, February 22). Community concept with people silhouettes. Dreamstime. https://www.dreamstime.com/stock-illustration-community-concept-people-silhouettes-holding-letters-word-image86572397

Premium Vector | Kid opposites loud and quiet. (n.d.). Freepik. https://www.freepik.com/premium-vector/kid-opposites-loud-quiet_4808217.htm

[husnaot]

5/17 SDGs, who is looking after the other 12?

The above quote by Grace Lee Boggs elicits a feeling of contentment within me as she manages to take the feeling of working in community and put it into words. Yes, it is spiritual practice, because completing my third week in community has made me realise that there is another level of effort that needs to be put in in order to create change. One of the ways that we can do this is through looking at the Sustainable Development Goals (SDGs) and how we have contributed to them thus far.

Occupational therapy (OT) plays a crucial role in enhancing the quality of life for individuals and communities by promoting participation in meaningful activities. Using the Sustainable Development Goals (SDGs) created by the United Nations (UN), we can address critical challenges within our community. We will focus on five specific SDGs that I find I have contributed to in the current community: Quality Education, Good Health and Well-Being, Reduced Inequalities, Zero Hunger, and Partnerships for the Goals. Each of these goals provides a framework through which occupational therapy can encourage growth and improvement.

1. Quality Education

Quality Education (SDG 4) is essential for personal and community development. In our community, we recognize that education is not limited to traditional classrooms. It includes lifelong learning and skill development. There have been reports from the supervisor at the Community Centre that the primary and high school are overpopulated. What should be a school for around 800 students is currently populated with 1200. Classrooms are flooded, academic work is difficult, teachers are overwhelmed, and students are not receiving the attention that they deserve. Our OT team has implemented a project on student red flags. This is a simple to understand checklist that teachers will be able to use to identify on-the-go whether their student needs OT. It will include symptoms related to abnormal behaviour in class, learning difficulties and attention deficits. The aim is to improve the children’s experience in education and assist the teachers with identifying and providing one-on-one attention to children that require it. As it stands, we also provide primary school groups with the grade R classes and provide reports to show their progress. By collaborating with schools, we can support students with diverse learning needs. Our goal is to lessen the pressure on the teachers and provide them with the tools they need to help their students thrive academically and socially, fostering a culture of inclusivity and support.

2. Good Health and Well-Being

Good Health and Well-Being (SDG 3) is a foundation in the practice of occupational therapy. We aim to promote holistic health by addressing physical, mental, and emotional well-being. Our community programs will focus on preventive health measures, such as physical activity sessions with the elderly (Active Aging Groups), as well as health promotion done in the Clinic. So far, two health promotion pamphlets have been created in collaboration with the first years. In the previous two weeks, we had identified two health conditions that were prevalent to the community: Postpartum Depression and Substance Use Disorder. The pamphlets created were in both English and isiZulu as those are the two languages most spoken in the community and these were handed to the Community Centre Supervisor, as well as the Community Health Worker at the Clinic. They covered topics regarding what the condition is, what symptoms are associated with the condition, how occupational therapy can assist with management of it and relevant numbers of support groups or contacts to assist if the person needs help. These pamphlets were brightly coloured and truly grabbed the readers attention. We also completed health promotion in the clinic regarding Postpartum Depression and received feedback from clients saying that it was a relevant topic since there are many new mothers who attend the clinic.

This is one of many topics that we cover in the community. Along with health promotion, we also focus on rehabilitation through home visits with clients. These clients, if needed, are referred to local healthcare providers for screenings and early interventions when identified. For example, one of the clients was referred to speech therapy while another was referred to physiotherapy. This shows a good collaboration and usage of the multidisciplinary team. By fostering a supportive environment that prioritizes health education and wellness, we can help individuals develop healthier lifestyles and improve their overall quality of life.

3. Reduced Inequalities

Reduced Inequalities (SDG 10) is a critical goal that OT can address through inclusive practices. We recognise that marginalised groups often face barriers to accessing health services and participating in community life. Our approach involves advocating for equitable access to resources and services for all individuals, regardless of socioeconomic status, ethnicity, or ability. One of the marginalized groups that we have identified is the clients who have a history with substance use. This group of people, although they may have stopped using substances years ago, are stigmatized by their community due to what they used to do when they were actively using. They are now left isolated, abandoned, not being included in community activities and not willing to engage in these activities for fear of being judged. They have asked the Community Centre Supervisor for assistance with this issue as they feel that the more they are left alone with unconstructive use of leisure time, the more likely they will relapse, looking for substances as a way to escape.

The OT team has decided that our project for the block will focus on creating Relapse Prevention Packs. These packs will include information packages on what substance use disorder is, what they can do to manage their symptoms, different ideas for activities that they can do during the day using the resources from the cupboard built by the previous team and a list of numbers and support groups to contact should they struggle in the future. The aim is to prevent the relapse from happening and to prove to members of the community that these previous users have now healed and are invested in their journey to healing. By providing client-centred support, we aim to help individuals overcome obstacles and achieve their goals.

4. Zero Hunger

Zero Hunger (SDG 2) is intimately linked to health and well-being, making it a significant area of focus for our community work. Poor nutrition can hinder an individuals' ability to engage in daily activities, impacting their overall health. As occupational therapists, we can lead initiatives that promote food security and healthy eating habits. This may involve health promotion on nutrition education which is aimed at teaching individuals how to prepare nutritious meals, individual intervention sessions of preparing a grocery list using a budget (identifying specials and which store has sources of nutrients for a cheaper price and alternatives) and community gardens.

My home visit client in the MR community has only one source of income for the household, this being his wife’s disability grant which is soon to expire. Although he has applied for a grant for himself due to his condition, the appointment date for his evaluation is in a month’s time and they may go a month without money for food. The Community Centre does provide food for the Primary School which his daughter attends, however, the household will not be able to eat well for those weeks without the grant. My job as an OT is to advocate for my client and find out what the correct process is to continue with the application. I could also start a fund, with their permission, and gain donations of essential groceries of a month supply to prevent their hunger until the grant is given.

By fostering a greater understanding of food choices and doing whatever is in our power to assist others with putting a meal on the table, we can empower community members to make informed decisions that support their well-being and encourage a belief in faith and dedication to intervention from our clients.

5. Partnerships for the Goals

Partnerships for the Goals (SDG 17) highlights the importance of collaboration in achieving sustainable development. As OTs, we recognize that we cannot work in isolation. Our impact is greater through collaboration with various stakeholders, including local organizations, schools, healthcare providers, and government agencies. We will actively seek partnerships to share resources, knowledge, and expertise. By creating a network of support, we can address the complex challenges that the community faces more effectively. Together, we can design and implement programs that align with the SDGs, ensuring a comprehensive approach to community well-being.

One of the ways in which we have already started aligning ourselves with this goal is through collaboration with the Community Centre team in creating the relapse prevention packages. They have given us vital information on those packages, advice on the health promotion topics and information on home visit clients. Without them, the process to implement ourselves into the community would have been a struggle and a half. We are ever grateful for their openness in communication, their support and their dedication to the community.

By integrating the Sustainable Development Goals into our occupational therapy practice, we can address pressing community needs while promoting social and health equity. Focusing on the above SDGs allows us to create a more inclusive and resilient community. Through targeted initiatives and collaborative efforts, we can empower individuals, enhance their participation in meaningful activities, and ultimately contribute to a healthier and more sustainable future. The role of occupational therapy extends beyond individual care; it encompasses the collective effort to uplift and transform our community for the better.

This leaves me with the question that runs through my mind. If it takes a team of four students to create this much improvement in 5/17 SDGs in one community in a tiny province in our southern country, what is stopping big corporations from contributing even a fraction of their time and effort to making a difference? Does giving back to the community always require something in return?

References:

SDG Impact Assessment Tool. (n.d.). Sdgimpactassessmenttool.org. https://sdgimpactassessmenttool.org/en-gb/articles/about

UNESCO. (2023). Education for Sustainable Development Goals: learning objectives. Unesco.org. https://www.unesco.org/en/articles/education-sustainable-development-goals-learning-objectives

United Nations. (2015). The 17 Sustainable Development Goals. United Nations. https://sdgs.un.org/goals

(2023). Aota.org. https://www.aota.org/practice/practice-settings/community-based-services

Picture References:

370+ Muslim Nurse Illustrations, Royalty-Free Vector Graphics & Clip Art - iStock. (n.d.). Www.istockphoto.com. https://www.istockphoto.com/illustrations/muslim-nurse

Chalkboard. (2018). Emaze Presentations. https://app.emaze.com/@AOORCTCCL#/1

Grace Lee Boggs Quote: “Building community is to the collective as spiritual practice is to the individual.” (2024). Quotefancy.com. https://quotefancy.com/quote/1572629/Grace-Lee-Boggs-Building-community-is-to-the-collective-as-spiritual-practice-is-to-the

says, B. (n.d.). Opinion: Why The UN Sustainable Development Goals Really Are A Very Big Deal. Ecosystem Marketplace. https://www.ecosystemmarketplace.com/articles/opinion-why-we-should-all-be-paying-close-attention-to-the-un-sustainable-development-goals/

[husnaot]

A Course of Bricks, Ticks and Info that will Stick (hopefully) 🧳

The last four years I spent carrying around my eye suitcases (they've upgraded from being eyebags) trying to keep up with the curriculum better be worth whatever is to come in the future.

The University of KwaZulu-Natal (UKZN) is an institution that prides itself on offering a diverse range of courses to complete, good facilities to offer practical experience and great opportunities to network with others through the various events that take place. What it does not account for is the potential burnout that students may be experiencing, as well as the threat of failure that hangs over their heads.

The UKZN OT degree is a four-year degree that includes an Honors year. What the three undergraduate years consist of is various practical blocks focusing on engaging the learner in interventions regarding physical conditions and psychological conditions. While the exposure to these conditions is helpful and good for experiential learning, the environment in which we learn is often quite restricted and limited. (Undergraduate Programmes - Discipline of Occupational Therapy, 2019)

Do I, personally, feel like UKZN OT degree has prepared me for working at a community and primary healthcare level?

No, not at all, and this is my evaluation of it.

Pros:

Comprehensive Understanding of Community Health, at least, in theory:

The curriculum includes modules that focus on community-based questions and practical experience, as well as, primary healthcare. This module is the clinical studies done in first year, along with the OT fundamentals module being incorporated this year. This creates a good theoretical fundation in order to understand the community in terms of the social determinants of health, their assessments and heath promotion stategies. By using tools like the CBR matrix or PESTLE analysis taught in class, my practical group will be able to provide good analysis of the community. (Lysack et al., 1995)

Inter-professional Education and Collaboration (IPE):

IPE is emphasized in every lesson by the lecturers, citing that collaboration between different parts of the health science field will benefit us in the future and will provide a more holistic, conclusive report about the client’s presentation. This prepares OT students to work effectively in multidisciplinary teams (MDTs). (MacQueen et al., 2001)

This was evident on our first Wednesday in the community. Upon reaching the clinic, we had a short meeting with the Community Health Workers (CHWs) about the area and had a short orientation to the area. What we learned was that substance use is a common condition amongst the youth in the community and gained referrals for adult clients as well.

Focus on Advocacy and Policy:

OT education at UKZN includes components that educate students about advocacy for social justice and healthcare policy. This empowers us as the future to the health science field to advocate for improved healthcare services and policies that benefit underserved communities. In this way, UKZN teaches us that we are capable of creating a ripple on the surface of a system that has been running since before we were born, but also that we need to respect the space that the community has given to us.

One of the most important lessons that I have learned is that it is best to communicate with the people you are trying to help instead of making the project independently as it is best to receive some feedback on the activities that will be included in order to make it more client-centred.

Cons:

Limited Exposure to Rural Health Challenges:

 The curriculum often incorporates clinical placements in semi-urban and urban areas. This hands-on experience allows students to apply theoretical knowledge in real-world contexts, develop essential clinical skills, and understand the challenges and dynamics of working in community settings. Despite efforts, there may be limited exposure to the unique challenges faced by rural and remote communities in South Africa. More emphasis on rural health issues and specific strategies for overcoming geographical barriers could better prepare us for practice in these settings. (Harper et al., 2022)

For example, my first psychosocial block was in a private facility. Had I not been placed in a semi-urban area for my second block, the shock of coming to the community for the first time in fourth year would have affected my treatment for the first week as I would still need to become familiar with certain ideas.

In conclusion, the UKZN curriculum for OT provides an idea of what working in the community and in primary healthcare is like and provides essential theoretical information about skills that are needed in community. Due to a lack of experience in different types of areas in the clinical environment in previous blocks and a poor control of who goes to which placement during the three undergraduate years, not everyone is able to have the same exposure to different areas and have never experienced a different sense of community.

There are no words to describe what being part of the community feels like, even if it just for six weeks, therefore, my suggestion is to continue with the exposure to community that the first and third years are currently experiencing as it gives them an idea of how the block will be completed instead of being thrown in the deep end with a heavy suitcase filled with theoretical information that is hard to process, let alone implement in a completely new environment.

But what happens if I let the suitcase fly open?

This is Husna, signing OuT!

References:

Harper, K. J., McAuliffe, K., & Parsons, D. N. (2022). Barriers and facilitating factors influencing implementation of occupational therapy home assessment recommendations: A mixed methods systematic review. Australian occupational therapy journal, 69(5), 599–624. https://doi.org/10.1111/1440-1630.12823

Lysack, C., Stadnyk, R., Paterson, M., McLeod, K., & Krefting, L. (1995). Professional Expertise of Occupational Therapists in Community Practice: Results of an Ontario Survey. Canadian Journal of Occupational Therapy, 62(3), 138–147. https://doi.org/10.1177/000841749506200305

MacQueen, K. M., McLellan, E., Metzger, D. S., Kegeles, S., Strauss, R. P., Scotti, R., Blanchard, L., & Trotter, R. T. (2001). What Is Community? An Evidence-Based Definition for Participatory Public Health. American Journal of Public Health, 91(12), 1929–1938. https://doi.org/10.2105/ajph.91.12.1929

Undergraduate Programmes - Discipline of Occupational Therapy. (2019, July 18). Ot.ukzn.ac.za. https://ot.ukzn.ac.za/undergraduate-programmes/

Picture References:

370+ Muslim Nurse Illustrations, Royalty-Free Vector Graphics & Clip Art - iStock. (n.d.). Www.istockphoto.com. https://www.istockphoto.com/illustrations/muslim-nurse

Andy Milne. (2022, June 6). Teaching Health Advocacy. #Slowchathealth. https://slowchathealth.com/2022/06/06/teaching-health-advocacy/

Interprofessional teamwork: Nursing - Osmosis Video Library. (2022). In osmosis.org. https://www.osmosis.org/learn/Interprofessional_teamwork:_Nursing

The Integrated Urban Development Framework (IUDF) – Cooperative Governance and Traditional Affairs. (2016). Cogta.gov.za. https://www.cogta.gov.za/index.php/the-integrated-urban-development-framework-iudf/

[husnaot]

The Apple Does Not Fall Far From The Tree 🍎

Maternal and child health is a priority to the well-being of society. It is foundational in influencing the health outcomes of the community from a public health perspective. Mothers that are healthy have a better ability to care for their children. These healthy children become productive adults which contribute positively to the social and economic state of the community. Maternal and child health is, therefore, crucial to the overall development of society and an individual’s well-being.

Studies have shown that a focus in maternal and child health provides society with substantial returns in terms of reduced healthcare costs and improved quality of life. The World Health Organisation (WHO) reported that effective maternal and child interventions in terms of health can reduce infant mortality rates and improve maternal outcomes. This leads to improved economic productivity and social stability. It emphasises that early interventions in a mother’s health can prevent complications which may lead to long-term health issues for both the mother and her child. (World Health Organization: WHO, 2019)

Concerning Occupational Therapy (OT), the effects of maternal and child health are significant. Occupational therapists play a role in supporting the development of both the mothers and children holistically. (Dagvadorj et al., 2018) This means that we focus on offering support in their physical, emotional, as well as cognitive development. At a community level, however, OT also includes working with families to address issues that they are facing. These issues could be postnatal depression, children with developmental delays and the barriers to access healthcare services. (Minkovitz et al., 2002)

For example, an OT working with a new mother may develop coping mechanisms and strategies for managing the physical and emotional difficulties of postnatal recovery. This may entail helping the mother establish a customized schedule that will support her child's care as well as her own self-care (ADLs, or activities of daily living). Thus, this will encourage leading a more balanced and healthful lifestyle. In terms of developmental delay, the OT can work with the mother to improve her skills in nurturing her child’s development through client-centred intervention such as intervention focused on play, as well as making environmental modifications in their home to assist with development. (Sepulveda, 2019)

Furthermore, at a community level, OTs will collaborate with other professionals and stakeholders concerning the systemic issues which affect maternal and child health. This will include working on community health interventions which focus on enhancing access to resources. These interventions could be offering nutritional support and parenting education programs focused on educating parents about how best to care for their child, as well as themselves. Through these community-based programs, OTs will help to foster a supportive environment for mothers and their children which will result in better health outcomes.

In my current community that I have been placed in, for example, occupational therapy has been a service provided by the university for years. The locals are familiar with the students entering the community and trying to make a change wherever possible. Although I have only been there for one week, it is clear that the community faces high rates of socioeconomic challenges, as well as poor awareness of mental health with regards to mothers. Intervention for OT will focus on providing support for mothers who struggle with mental health and addressing the social factors that impact the maternal and child health. OT will also focus on creating awareness into postnatal depression by doing health promotion at the clinic through the help of the first-year students who will be working with us.

In conclusion, maternal and child health is integral to the well-being of society, influencing both individual and community health outcomes. OTs play a crucial role in offering support by addressing their needs at a systemic level in the community. Through client-centred interventions and collaboration with the multi-disciplinary team, OTs will contribute to a healthier, more resilient community resulting in the improvement of maternal and child health in order to benefit society.

The apple does not fall far from the tree, but it sure thrives in the tree’s shade. We need to assure the improvement of society by creating strong roots in the tree in order for the apple to grow.

References:

Dagvadorj, A., Ganbaatar, D., O. Balogun, O., Yonemoto, N., Bavuusuren, B., Takehara, K., Mori, R., & Akahira-Azuma, M. (2018). Maternal socio-demographic and psychological predictors for risk of developmental delays among young children in Mongolia. BMC Pediatrics, 18(1). https://doi.org/10.1186/s12887-018-1017-y

Minkovitz, C. S., O’Campo, P. J., Chen, Y.-H., & Grason, H. A. (2002). Associations Between Maternal and Child Health Status and Patterns of Medical Care Use. Ambulatory Pediatrics, 2(2), 85–92. https://doi.org/10.1367/1539-4409(2002)002%3C0085:abmach%3E2.0.co;2

Sepulveda, A. (Apple). (2019). A Call to Action: Addressing Maternal Mental Health in Pediatric Occupational Therapy Practice. Annals of International Occupational Therapy, 2(4). https://doi.org/10.3928/24761222-20190813-02

World Health Organization: WHO. (2019, September 23). Maternal health. Who.int; World Health Organization: WHO. https://www.who.int/health-topics/maternal-health#tab=tab_3

[husnaot]

South Africa's Emotional Landscape: Navigating the Shadows of Depression and Anxiety with Resilience

Depression and anxiety are prevalent mental health conditions with significant global impact, South Africa being no exception to this. Our country faces unique challenges and opportunities in addressing these conditions, which manifest both dilemmas and positivity. In this blog, we will explore the prevalence of depression and anxiety in South Africa, the dilemmas they pose, and the positive efforts being made to address these issues. (Craig et al., 2022)

Depression and anxiety are major public health concerns in South Africa. The high prevalence of these disorders is driven by the following factors:

Socioeconomic Inequality: South Africa is marked by stark socioeconomic disparities. A legacy of apartheid has resulted in persistent inequalities, affecting the majority of the population. These inequalities can lead to chronic stress, increasing the risk of depression and anxiety.

Historical Trauma: Apartheid's brutal history has left deep emotional scars. The collective trauma experienced by many South Africans can contribute to depression and anxiety, as the effects of historical oppression continue to impact generations.

Contemporary Stressors: South Africa faces contemporary challenges, such as high levels of crime, unemployment, and political instability. These stressors can worsen mental health issues, contributing to the high prevalence of depression and anxiety.

Addressing depression and anxiety in South Africa presents several dilemmas. These being:

Stigma: Stigma surrounding mental health is prevalent in our society, as it is in many other countries. Individuals experiencing depression and anxiety often face discrimination and social isolation, making it difficult to seek help.

Access to Care: A major dilemma is the limited access to mental health care. South Africa's healthcare system faces significant resource constraints, leading to an inadequate number of mental health professionals and facilities. This results in long waiting lists and insufficient support for those in need.

Inequality in Access: The distribution of mental health services is uneven, with urban areas having better access than rural regions. This heightens existing social and economic inequalities, as those in marginalised communities are less likely to receive good, timely care.

Cultural and Language Barriers: our country is a culturally diverse nation with many different languages and belief systems. These differences can create barriers to accessing mental health care, as individuals may be reluctant to seek help from professionals who do not understand their cultural context. (Wits University, 2022)

Economic Factors: Many South Africans lack financial resources to afford private mental health services. The public healthcare system, while intended to be accessible to all, often struggles to meet the demand for mental health care due to financial constraints. (Elwell-Sutton et al., 2017)

Despite these dilemmas, there have been positive efforts to address depression and anxiety in South Africa. These being the following:

National Mental Health Policy Framework: In 2013, South Africa adopted a National Mental Health Policy Framework and Strategic Plan. This comprehensive document speaks about a strategy to promote mental health, improve mental health services, and reduce the stigma associated with mental health conditions.

Mental Health Awareness Campaigns: Various organisations and government agencies have launched awareness campaigns to reduce the stigma surrounding mental health. These initiatives aim to encourage individuals to seek help and engage in open conversations about their mental well-being therefore creating awareness. 

Community-Based Services: Recognising the challenges of delivering care to remote and underserved populations, community-based mental health services have been established. These programs focus on prevention, early intervention, and support for individuals with depression and anxiety.

Task-Shifting and Lay Health Workers: South Africa has employed task-shifting strategies to address the shortage of mental health professionals. Lay health workers are being trained to provide basic mental health services, expanding access to care in under-resourced areas. (Schneider & Lehmann, 2010)

Support for Trauma Survivors: South Africa acknowledges the profound impact of historical trauma on its citizens. Specialised programs and initiatives provide counselling and support to survivors of violence, discrimination, and other traumatic experiences, which can have a positive impact on their mental well-being.

In conclusion, depression and anxiety are pressing mental health concerns in South Africa, driven by a complex intersection of historical trauma, socioeconomic inequalities, and contemporary stressors. The dilemmas include stigma, limited access to care, unequal distribution of services, and cultural and economic barriers. Positive efforts, however, are being made through policy development, awareness campaigns, community-based services, task-shifting, and support for trauma survivors. These initiatives represent a step forward in addressing the challenges and promoting mental well-being in a diverse and complex society. Reducing stigma and improving the mental healthcare infrastructure remain essential for advancing the mental health of South Africans. I hope we, as future healthcare workers, will be able to take this initiative by storm. 

References:

Craig, A., Rochat, T., Naicker, S. N., Mapanga, W., Mtintsilana, A., Dlamini, S. N., Ware, L. J., Du Toit, J., Draper, C. E., Richter, L., & Norris, S. A. (2022). The prevalence of probable depression and probable anxiety, and associations with adverse childhood experiences and socio-demographics: A national survey in south africa. Frontiers in Public Health, 10(1). https://doi.org/10.3389/fpubh.2022.986531

Elwell-Sutton, T., Folb, N., Clark, A., Fairall, L. R., Lund, C., & Bachmann, M. O. (2017). Socioeconomic position and depression in South African adults with long-term health conditions: a longitudinal study of causal pathways. Epidemiology and Psychiatric Sciences, 28(2), 199–209. https://doi.org/10.1017/s2045796017000427

Schneider, H., & Lehmann, U. (2010). Lay health workers and HIV programmes: implications for health systems. AIDS Care, 22(sup1), 60–67. https://doi.org/10.1080/09540120903483042

Wits University. (2022, November 14). 2022-11 - Mental health in SA is at shocking levels but people are not seeking help - Wits University. Www.wits.ac.za. https://www.wits.ac.za/news/latest-news/research-news/2022/2022-11/mental-health-in-sa-is-at-shocking-levels-but-people-are-not-seeking-help-.html‌

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"A Beautiful Mind": A Cinematic Experience into the Complexity of Mental Health

In the world of the film industry, certain movies transcend entertainment and become explorations of the human condition. "A Beautiful Mind," directed by Ron Howard and starring Russell Crowe, is a prime example of one. This movie delves into the life of the brilliant mathematician, John Nash, serving as an enlightening view into the world of mental health. In this blog post, I will be talking about the impact of this film and its storytelling, lessons I have learned from it and what I can take into practice. 

Released in 2001, "A Beautiful Mind" is loosely based on the life of John Forbes Nash Jr., a Nobel winner in Economics, whose career was halted by his struggle with schizophrenia. The film takes us from Nash's early academic excellence to the challenges posed by his mental illness. What it focuses on is the great impact of schizophrenia on an individual's life, relationships, and pursuit of happiness.

What makes the film immersive in its nature is the cinematic techniques used to assist the audience with understanding his schizophrenia and how it disorients him. With the help of visual effects, the audience is engaged into Nash’s distorted perception of reality. This aids in enhancing our understanding of his condition and serves as a reminder that mental illness can distort one’s perception of the world. Through Nash’s eyes, we see what a terrifying experience it can be. 

As it is set in the 1950s and 1960s, the film provides a look at the societal attitudes towards mental health at the time. Nash’s experiences with institutionalisation and electroconvulsive therapy reflect the limited understanding and harmful treatments that were common during that era. It is, therefore, reminder of the progress we've made in mental health care but it also highlights the ongoing need to combat the stigma surrounding mental illness even today. 

One of the most heartwarming parts of the film is the support provided by Nash's wife, Alicia, portrayed by Jennifer Connelly. Alicia's character is a pillar of strength and understanding in Nash's life. Her commitment to her husband's well-being highlights the power of love and support in mental illness. It reinforces the idea that building a strong support system is crucial for individuals battling mental health challenges.

In addition to Alicia, Nash's relationships with his colleagues and friends play an important role in his journey. Ed Harris, who portrays Nash's close friend and fellow mathematician, embodies unwavering loyalty to his friend. These relationships show the therapeutic value of meaningful connections. They emphasise that we are all stronger when we lean on each other during our darkest moments.

As I reflect on "A Beautiful Mind" and its portrayal of mental health, there are valuable lessons that I’ve learned along the way:

Humanising Mental Illness: The film humanises the experience of living with a mental health condition, reminding us that those who suffer are not defined by their disorders. As an OT, I will need to consider the person as a holistic individual, taking into consideration their contexts and what makes them who they are. 

Empathy and Understanding: It encourages empathy and understanding for individuals facing mental health challenges. By engaging us in Nash's world, we gain a deeper appreciation for the struggles people with mental illnesses face. 

The Importance of Support: The film highlights the importance of support systems and the role they play in mental health recovery. Alicia's unwavering love and support demonstrate how powerful these relationships can be. 

Combatting Stigma: It highlights the need to combat the stigma surrounding mental illness, both in the past and in the present. By shedding light on the harmful treatments of the past, the film encourages us to advocate for better mental health care and understanding today. 

In conclusion, "A Beautiful Mind" is more than just a movie; it's an exploration of the complexities of mental health. As an OT currently in her psychosocial block, this film truly touched my heart. Not enough value is given to mental health in the health care world, people focusing more on the challenges that physical disorders provide and leaving mental health to waste. This film has taught me that more light needs to be shed on mental health issues and that it is my job as an OT to advocate for it. Mental illness is not a diagnosis that should be swept under the rug so it is our job as the next generation of health care workers to stress its importance and heighten its value. 

[husnaot]

Therapeutic Use of Self: What is it?

Occupational therapy is a holistic approach to rehabilitation and healthcare that focuses on helping individuals achieve independence and improve their quality of life. One of the unique and powerful tools within the OT’s toolbox of techniques is the therapeutic use of self. It honestly took me a long time to grasp what this meant and how to use it in practice. After many learning experiences and guidance from my supervisor, I think I have a decent understanding of what it means. So for this blog post, I will explore what the therapeutic use of self in OT is, its importance and how it can elevate your treatment. 

The therapeutic use of self is a fundamental feature of occupational therapy practice. It refers to the deliberate and purposeful use of one's own personality, emotions, and experiences to create a therapeutic relationship with clients. We use our empathy, compassion, and genuine interest in our clients' well-being to establish trust and rapport. This connection forms the foundation upon which the therapeutic process is built.

Why is the therapeutic use of self so important? 

It helps to establish trust. Trust is essential in any therapeutic relationship. Clients are often vulnerable, facing physical or emotional challenges, and need to feel safe and supported. By using themselves therapeutically, OTs can create a secure space where clients feel comfortable sharing their concerns and working towards their goals. 

It assists with client-centred intervention. Every client is unique, with their own set of needs and goals. The therapeutic use of self allows OTs to adapt their approach to each individual, making interventions more effective. By understanding the client's background, preferences, and motivations, therapists can create customized treatment plans that resonate with the client's personal experiences. 

It promotes independence. Occupational therapy is all about helping clients regain independence in their daily lives. Through the therapeutic use of self, therapists can empower clients to take charge of their own recovery. By fostering a sense of autonomy and self-determination, OTs enable clients to make informed decisions and work towards their goals with confidence.

It brings out effective communication. This is vital in occupational therapy. The therapist's ability to listen actively, provide constructive feedback, and offer emotional support is greatly facilitated by the therapeutic use of self. This open and honest dialogue encourages clients to express their thoughts and feelings, leading to more productive therapy sessions.

How do we use it in practice:

One of the most important aspects of the therapeutic use of self is active listening. OTs must not only hear what their clients are saying but also understand the underlying emotions and concerns. By actively listening, OTs can respond empathetically, validating the client's experiences and emotions.

OTs must also demonstrate genuine empathy and compassion for their clients. This means acknowledging their struggles and celebrating their successes. By showing empathy, we can create a sense of understanding and connection that motivates clients to engage actively in therapy.

We must engage in ongoing self-reflection to understand their biases, emotions, and reactions. This introspection allows them to maintain professionalism and avoid projecting our own beliefs onto clients. It also helps OTs to stay emotionally resilient, as the work can be emotionally demanding.

We should also try to build a strong therapeutic alliance is key to successful outcomes in occupational therapy. OTs can use their personalities and interpersonal skills to build rapport with clients. This rapport fosters a sense of trust and collaboration, making it easier for clients to work towards their goals.

At the facility I currently am in, I struggled with grasping this concept. Because despite listening to the client, gaining her trust, and giving her the most client-centred treatment I could offer, it goes beyond that. I struggle to use myself as a therapist properly during sessions due to worry of pushing the client’s boundaries, but, most of the time, it needs to be pushed to create the best intervention. 

In conclusion, the therapeutic use of self is a powerful and integral aspect of occupational therapy. By harnessing their personality, emotions, and interpersonal skills, OTs can create a nurturing and supportive environment for their clients. This approach fosters trust, empowers clients, and enhances communication, ultimately promoting independence and improving the quality of life for those in need. In the world of occupational therapy, our ability to use ourselves therapeutically is a bridge to recovery, helping clients navigate the path towards a brighter future.

References:

Abson, D. (2019, March 3). Therapeutic Use of Self. The OT Hub. https://www.theothub.com/article/therapeutic-use-of-self

Ch, M., & OTR/L, ler. (2018, April 18). Therapeutic Use of Self: What Does That Even Mean for OTs? Myotspot.com. https://www.myotspot.com/therapeutic-use-of-self/#:~:text=The%20most%20widely%20cited%20contemporary

MOTR/L, M. C. (2023, April 27). How To Use Therapeutic Use Of Self In Occupational Therapy | OT Flourish. Otflourish.com. https://otflourish.com/therapeutic-use-of-self-occupational-therapy/‌

[husnaot]

Mental Health is the Cinderella of Healthcare, yes or no?

Growing up, I used to binge Disney movies. Every day after preschool I used to alternate between watching Barney episodes and choosing a Disney princess to watch. I learned all the songs off by heart and still know them to this day and I valued the lessons taught by each princess and the adventure she has to go on. 

Now in 2023, the media reduces princesses like Cinderella to just “needing to be saved by the prince”. I disagree with that statement and I’d like to expand on that with regards to this topic. 

Ella, her birth name, was a girl given a rough life. Her mother died when she was young and her father remarried a terrible, cruel woman who came with two equally cruel, naive daughters. They would go on to treat her as a servant and inferior to them when her father passes away. She is often thrown to the side, left for the dust and given the scraps of every meal rather than getting her own dish. 

Despite receiving this cruel treatment, she persists in making the best of her life. Although she is thrown to the side, she makes friends with the animals that live in her garden. She shares her food with them, an act of selflessness that indicates her good character. She is kicked out of her room, yet she throws no fuss and gains warmth sleeping next to the fire. Every scrap she gets as a meal she shares with her little friends. Her only relief comes through one person (the fairy godmother) who gives her a chance of a lifetime by letting everyone see her true value. 

Mental health is similar. There is not enough emphasis put on mental health as healthcare workers but also by the government as well. Like Cinderella, there are not enough healthcare workers who focus on mental health, leaving this whole aspect of treatment to be left to rot in the dark. Often times, we treat the physical body with such care and focus, yet leave the client’s mental state to feed on the scraps of treatment, for example writing their feelings in a little notebook. How can we expect our clients to abide by treatment if their mind is not well? (2018)

And what about the scrap leftovers? The Government does not budget enough money into the improvement of mental health facilities through the country. While physical treatment receives funding for equipment, materials and tools, as well as having fun days, mental health is left to receive the scrap of the budget. (Worrell, 2020)

One can argue that people are now growing more aware of mental health, even putting an emphasis on it as times grow tougher in society, but it is an uphill climb that is taking too much time and not happening fast enough. (Cohen, 2023)

We need to recognise that Cinderella did not need to be “saved by the prince”. It was her good character, her patience, strength and courage to be kind that led the fairy godmother to recognising a beautiful soul trapped in a bad situation.

In conclusion, yes, I do agree with the statement and I feel that it is our responsibility to become the fairy godmothers of healthcare. Occupational therapists should grab their wands and bibbity bobbity boo their clients to recognise the true value of their mental health. We need to be holistic in our treatment of clients and value both their mind and body so that they can reach their Prince Charming (goals of treatment). 

References:

Cohen, G. M. and S. (2023, April 7). Cinderella no more: Mental health matters. Social Europe. https://www.socialeurope.eu/cinderella-no-more-mental-health-matters 

Splisbury, P. (2018, July 4). Mental Health and integration: Cinderella or the Ugly Sisters?. NHS choices. https://www.strategyunitwm.nhs.uk/news/mental-health-and-integration-cinderella-or-ugly-sisters 

Worrell, C. (2020, July 23). Mental health funding: A Cinderella story. Medium. https://medium.com/inspire-the-mind/mental-health-funding-a-cinderella-story-19ce6a21eb2c 

’mental health the Cinderella of health care’- president of the South African Federation for Mental Health. The Centre for the Study of Violence and Reconciliation. (2018, February 20). https://traumaclinicblog.wordpress.com/2018/02/20/mental-health-the-cinderella-of-health-care-president-of-the-south-african-federation-for-mental-health/ 

[husnaot]

Week 1: Standing on the edge of becoming an OT - my rocky but loved path

I have said this before and I will say it again: occupational therapy was not on my list of career choices in grade eleven. In fact, my seventeen year old mind was stuck on becoming a successful businesswoman who would bathe in green. Little did I know that a wonderful forest green would be my future scrub colour. 

Like many of my life-changing decisions, the journey to becoming an OT started with my mother’s advice. She knew that I have a knack for teaching and a passion for people, therefore working behind a desk was not going to be an option for me. Occupational therapy, she figured, would provide a place for growth and development as a person throughout my career. 

My mother was proven right as I have never encountered a programme that constantly goes beyond my expectations. However big I dream, OT calls that dream simple-minded and presents me with a much greater one. 

A prime example would be that I did not know what occupational therapy was about. A speech therapist I had spoken to before making my decision had told me that it was an easy job. She said, and I quote, “you just have to through a ball with a child”. (2020, UKZN)

After two and a half years of studying, I can clearly see that it is a lot more than that!

In fact, occupational therapy is so diverse. It is one of the things I love most about the field. Whether it is physical, psychosocial, paediatrics or community, there is always room for further exploration and advancement. It is like an everlasting game with constant adventured to go on. Yes, there are obstacles along the way, but you will surely get through it! (2020, UKZN)

For example, my first ever psychosocial client was a struggle to get through to. This client was elderly and institutionalised. She refused to change her routine at all, even refusing to attend my midterm demo. 

Though I cannot blame her for her refusal to participate, it did hurt to be rejected by someone I wished to help. 

When it came to my finals demo, I managed to set up boundaries with my client. Rather than being my usual more friendly and bubbly self, I put on a more professional attitude and conducted myself as such. As a result, my demo, case presentation and case study went well and my results on paper proved it too. 

Going forward, I try to remember to set boundaries with my client. How else are they supposed to take my contribution to their wellness seriously if they do not see the value in my position? 

Along with that, I do try to keep an open mind and try not to be surprised or overwhelmed by the challenges that come with being an OT. Yes, I may see something that makes me want to hurl, but at the end of the day, between dropping out and continuing for the next year and a half, there is clearly a better option. 

Besides, I have come this far, I’m rather excited to see what awaits!

References:

Why reflecting on your past will be reflected in your future (no date) Evergreen Journals. https://www.evergreenjournals.com/blogs/guides/why-reflecting-on-your-past-will-become-reflected-in-your future#:~:text=Reflection%20gives%20our%20brain%20an,we%20don%27t%20understand%20them

Home - discipline of occupational therapy. (2020). https://ot.ukzn.ac.za/ 

Home - discipline of speech language pathology. (2020). https://speechlp.ukzn.ac.za/

[husnaot]

Week 5: Cultural humility aka self-identity and tolerance

All my life I have been grown up with the idea of a "rainbow nation". As a child, I wondered where in the rainbow was there skin colour, but now I realise the beautiful metaphor that it truly is.

That answer is: we're all different but to shine and be appreciated, we must co-exist and be accepting of each other's difference. If one is missing, the others don't shine as brightly.

It's something I've learned being an OT.

The beauty of human beings lies within their identity. It lies with their religion, their morals, values, their context... but the most important factor that OTs look at and delve into is the person's culture.

Where does the person come from? What kind of place is it? Are their any traditions that are done and what physical and psychological requirements does it need to participate in it?

And, most importantly, is it important to the client?

Because we are all different, we have to exercise cultural humility.

To quote the University of Oregon, cultural humility is: "A personal lifelong commitment to self-evaluation and self-critique whereby the individual not only learns about another's culture, but one starts with an examination of her/his own beliefs and cultural identities."

This means that not only am I having a willingness to learn about other people's culture and how they participate in it, but I am also constantly examining my own culture and background and how it has influenced me.

I'll use an example to explain this.

This week I was given a rough week at the hospital. I had just started fasting again after a whole week off and life was about to get harder. Not only was I dealing with dehydration and a major craving for salted apples, but I was also having to deal with broken elevators and a slow operating system. On top of all this, my patient was discharged and my demo had to be done on someone completely new.

Fortunately I had a day to find out information with her and change my original demo to be client-centred to this client in particular.

My demo was to be grooming and personal hygiene. One of my biggest consideration was whether my client had running water in her home. The answer was, unfortunately, no. This meant that my client would not be used to washing her face at the sink and therefore would need a basin to make it familiar.

Since a basin is difficult to carry to the hospital, I adapted my structuring to have the client use one basin sized bowl and a smaller sized bowl that can be used to pour the water. These were both propped on the cardiac desk at the hospital which was lowered to act as a table.

The reason for this structuring was due to the fact that my client's grooming routine at home was very similar. Her basin was also propped on a desk and she too was used to standing and washing herself with a cloth instead.

I used the concept of cultural humility in this as it is clear in my actions and though process when deciding on the activity.

I am fortunate enough to have taps which running water comes out of, both hot and cold. Because of this, I could have assumed that everyone else in the world also had running water from a tap. Had I not looked within myself and realised the ignorance that I have, I could have structured the activity differently and cause more harm than good.

Instead of leaving my client with a smile on her face, I could have offended her or made her do something that was not familiar to her. I am grateful that I exercised that knowledge that I have.

I will continue to use cultural humility within my therapy with clients. It clearly helps build rapport with the client and make them appreciate you more. (Campbell, 2022)

[husnaot]

Week 4: Evidence-based practise aka Sackett's rule for a holistic session

As in previous blog posts, I’ve mentioned that OT focuses on treating the client holistically. What this includes is a working through evidence-based practise. Here’s what the experts say:

David Sackett, a Canadian physician, states:

““EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values. The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology”. 

Clearly, he deserves his title of a pioneer in evidence-based practise. 

From the quotation above, we can conclude that evidence-based practise includes clinical expertise (in this case the OT’s own experience in their field, their knowledge and education as well as their skills that they’ve learned), the patient’s own values (things that they find important to them, such as family, their religion or their friends) and the findings that influence the decisions made for giving the patient the best treatment. 

I’m going to be talking about one of my favourite clients that I’ve had so far and we’ll be calling her Miss A. 

Miss A is a strong-minded woman who valued her family the most. She presented with a diagnosis that led to her having a weak cardiovascular endurance. She was still able to walk around but fatigued faster than she used to prior to her diagnosis and struggled to do her tasks and activities at home so much that her sister had to step in to help her. This led to her becoming disappointed in herself as she could not complete the task that she put all her love into, that is cooking. 

Through evidence based research I came to the following findings:

Patient values: my patient values her family and loved ones the most. She also values her place in her household which she sees as the domestic housewife. She feels that her most valuable trait would be her ability to take care of others therefore her cooking every meal for her spouse and children is her way of showing her love for them. 

Research evidence: my patient has been physically assessed and presents as having weak cardiovascular endurance. Although she can still walk, she takes a longer time and grows tired easily. Her condition, although more medical, also requires her to rest, especially after standing for so long. 

Clinical expertise: I know from my work in previous blocks that my choice in activity to do with my client needs to be client-centred in that the client must like it and it must be valuable to the client’s treatment. Should I lose focus on the former or the latter, my session will not go as well as I planned and not only will my rapport with the client be damaged, but so will my marks. 

From this research I concluded: 

My client should perform an IADL (instrumental activities of daily living) activity focusing on meal preparation and clean-up. My client clearly values her children and domestic duties therefore this will be interesting to her. The standing up at the kitchen counter while participating will be good to test her endurance and see what her current limit is. This will also provide a way to educate her on the importance of resting after long sessions of standing. This activity is client centred in its value to the client and her treatment! 

Therefore, in terms of evidence based research, it’s looking good!

After I implemented the activity and received feedback from my supervisor, I realised that I had mistakenly consistently referred to her cardiovascular endurance as physical instead. That was my mistake and I should have researched further into the difference between the two. 

I realised that I missed quite a few therapeutic opportunities during the session such as forgetting to tell the client to rest when her breathing picked up and telling her that it was fine to remove her mask to breathe clearly. 

There were, however, positive things that went well during the session. 

My client, for example, thoroughly enjoyed the session. She had missed making a meal and, although it wasn’t going to be given to anyone else to enjoy, she expressed that the satisfaction of making something again and being in a kitchen environment after so long made her more than happy. 

I think my shortfalls during the session comes with not thinking clearly for my write-ups. Although I practiced the evidence based practise in theory, my implementation only came through about 60% of the way. This is clearly in how I made a mistake in my referral of her endurance and how I missed the opportunity to talk to her about resting. 

It’s clear that I need to strategise better and almost picture my session and how it is supposed to go in my head before implementing it, that is, taking my evidence based research and playing it out. Turn theory into practise. 

We’ll see how finals week goes!

[husnaot]

Week 3: The Multidisciplinary Approach aka Teamwork makes the Dream Work !

The great thing about working in healthcare is that there's so many aspects to it that people don't know about. There's a simple example which I've always found difficult to explain.

What is the difference between a physiotherapist and an occupational therapist?

Before starting practicals and having to actually work with patients, I truly did not understand it myself. Now though, it's really simple.

While physiotherapists focus on the injury/impairment itself, occupational therapists look at the patients different areas of life and see how these will be affected.

Despite these differences, we perform best when we work together!

Just this week I was assigned a new client. It looked like a difficult case, one I had never encountered before but which was theoretically quite appealing. I knew this was my chance to explore the physical side of OT deeper and gain a better understanding.

On my arrival, I met with the speech therapist who had been assigned to my patient. From just a five minute talk, I learned so much about my patient before I had even spoken or seen him. I learned about his condition and how it affects his speech and why the referral to the speech therapist was necessary.

Later, I was lucky to have met the physiotherapist assigned to him. She was a lovely lady and I even helped her with her intervention session. Her aim was to get the client to sit on the side of the bed and, with my amateur help, we achieved it together! Although he was not independent in his sitting in the slightest, I, once again, learned so much from this physiotherapist and was able to conclude quite a few assessment findings within 15 minutes.

These were just two of the disciplines that I met with within an hour and they helped to understand my client's condition so much. I realised that it is important to use these workers and form connections with each other in order to progress your client's state even more.

Ironically, it was in the OT's notes in my client's file that I was confused by their findings as they were, to myself at least, unbelievable compared to what my eyes were seeing in front of me. Of course, after a consult with the OT who wrote those notes, I vaguely understood what they meant. It is, however, important to note that the best findings to trust is your own.

My intervention session that I did with my previous session was one focusing on meal preparation and clean up, an IADL. In my week 2 blog post, I remember speaking about the idea I thought of with the help of my supervisor. I decided to go with a salad making activity before my client's lunch time.

The activity went well! My client was happy with the food, was happy to engage and was happy because she was doing what she loved. Food is her happy place as she uses it to take care of her family and children.

In terms of the technical aspects of my session, I realised that I don't really link my principles and my secondary aims together properly. They almost seem like two disconnected concepts that have a vague, threadbare, link to each other. It's disappointing because the activity I planned was successful in terms of the client's happiness but on paper it looked like a mess.

There's so much more I can think about in terms of my activity and this was proven by my supervisor's feedback. Although she liked my activity, the critiques received made me realise how superficial I was being with my activity analysis. It really made me understand how much more there is to just finding the perfect activity the client will enjoy.

For my next intervention session with my new client, I'm going to take one of two routes: using Neuro-developmental techniques with my client in order to get him to start functioning independently and facilitate his movement OR start with alternative augmented communication by using a keyboard or making my own.

These are both client-centred and use a multidisciplinary approach to OT!

Come back next week to see how things go :)

[husnaot]

Week 2: Client-centred? aka the approach to success in intervention ;)

When I was applying to study OT, I truly had no idea what it actually was. I was told by a speech therapist that it was easy and just "throwing a ball with a child" and that it's a good profession to get into.

Looking back on it now, only the last point remains valid.

OT, I've realised, truly encompasses a holistic way of life. Not only do we look at the client from their diagnostic point of view, but also their ways and means of life. Client-centred is looking at your client and planning their treatment based on what their interests, means of volition and daily occupations are. This builds rapport with the client as they are more eager to participate when an activity interests them.

This week I missed a shot but also scored a decent goal.

We, unfortunately, missed our full, 8-hour day of practical for the week, yet again. I recognise that it is not something that we can change, merely another external factor that dictates our life process. It's not our plan and therefore it is trivial to be disappointed in myself over what I cannot control.

Because of this missing day, I was unsure of whether my client would still be at the hospital when I returned on Wednesday, therefore, my ideas for treatment were at an all-time low.

Should I continue with treating my client psychologically? Should I rather prepare an ADL activity? No, she is independent in them all, so what is the point? I was unsure of what to do and, for fear of disappointing, I did nothing and prayed for her to at least be there.

When Wednesday arrived, I had a major lightbulb moment. The client is a mother! She loves to take care of people! She has a good appetite and loves food! What better activity than a meal preparation and cleanup?!

With the electricity still running, I asked my supervisor for advice on a and it was, fortunately, well received. The bulb grew brighter with every piece of advice inputted and I left the hospital running on the remaining energy to plan for my session the next day.

The process of completing the write up for the session was surprisingly easy because I now had an activity that was meant for the client. Implementing it went pretty fantastic in my opinion. My client was happy to engage in the activity and I could tell that she enjoyed it on a surface level, at least.

In hindsight, based off of the feedback I received, I realised that I need to look more into my aims to understand what I am looking for in the activity. It is not enough that the client enjoys the activity, but that I, as an OT, also treat during it.

I learned that I need to look deeper into my secondary aims in order to gauge each step that the activity should take. I feel like I'm still stuck in the assessment mindset and so I'm looking to test the client instead of trying to improve aspects of their performance.

Although my supervisor said that it was a good activity choice, the consequence feedback I received offered even more guidance and understanding of the OT process. I'm grateful for the chance that mid-terms offers so that I myself can improve for finals.

Next week, I will try to implement client-centredness into, not only my activity choice, but also the aims that the client and I need to achieve.

There's a lot to learn while on practicals, and I am glad I have the open mindset to absorb the information. The next step is working on perfect implementation!

Let's go through with Finals!!!!

[husnaot]

Week 1: Theory to practice? more like knowledge to OvErWheLmiNG StrEsS

No five weeks of theory classes could have prepared me for what was to come. The hospital.

I had never been placed in a hospital before, therefore going for fieldwork in my current facility was overwhelming. Everyone is professional and there's an integration and collaboration that I never experienced in a nursing home. Fortunately, I was placed with one of my closest friends to help me along.

Implementing theory into practice seemed difficult at first. Were all the notes actually in my head correctly? Was I doing things perfectly? Am I making my client uncomfortable by reading through their file? Will my client still be here tomorrow? These were all worries that plagued my mind. Luckily enough, I got used to the rush of the hospital and the fast-track movements of everyone there.

Assessment, due to last year's thorough work, went smoothly. Physical assessment and screening was easy with both my clients as they were willing to engage in sessions with me. Both were pleasant and friendly, therefore rapport was built easily with them and ideas for their treatment session came easy too.

Although I found taking the applied frames of references notes difficult to understand and apply, due to the tutorial that took place this morning by my supervisor, it makes it far easier to comprehend as the answers were right in our faces for us to apply.

With that in mind, I was excited to implement my treatment and assessment sessions with my two clients.

Monday came and brought my whole mood down. Strikes occurred and unfortunately we were not able to go to the hospital for fieldwork, but there was still hope as we were to go to the facility on Wednesday!

Wednesday came and both my clients had been discharged. All that time spent preparing my two session, printing out my KAWA model (rocks, river and driftwood pieces), learning how to implement it and downloading songs for my chair aerobics assessment session, went down the drain.

I was given two new clients this morning with only half a day to assess. Luckily, I was able to physically assess my first client quickly and continue with the interview session, however, my second client I have yet to see. Tomorrow is a new day and I will try my best!

One lesson (among many) that I have learned: you can learn all the theory notes, research and read all the articles, and absorb knowledge like a sponge, but nothing prepares you for the disappointed of a client being discharged and your expectations for the day blowing up in your face.