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[lethiwebhengu]

Lessons From The Kenville Community

In the image above, my journey is illustrated through a series of trees, symbolizing the evolution of my knowledge from the beginning to the end of this block. When I first arrived, I brought with me the foundational theories from past experiences. Over time, however, my intellectual landscape has expanded and flourished with new ideas. While the trees in the picture showcase considerable growth, they remain in the process of maturing, reflecting my ongoing eagerness and commitment to continued learning and development.

Community occupational therapy (OT) has been a real eye-opener, offering profound insights into the complexities of societal issues. One of the most striking revelations has been the pervasive nature of poverty within the black community, where a significant number of individuals endure harsh living conditions. Statistics reveal that approximately 55.5% of South Africans live in poverty, with black South Africans being disproportionately affected (Statistics South Africa, 2017). However, poverty transcends its economic implications; it evolves into a mindset, almost a cultural norm, where the belief in enduring hardship overshadows the pursuit of progress. This notion of perseverance, though admirable, can sometimes be a double-edged sword, leading individuals to forgo opportunities for improvement due to the ingrained belief that they must endure their current circumstances (Nyasani, 2020).

This mindset often manifests in subtle resistance or reluctance towards interventions, particularly those that could potentially enhance their quality of life. As OTs, we encounter this resistance not merely as a barrier to treatment but as an indicator of a deeper psychological issue—an underlying sense of hopelessness or resignation to the belief that life may never change. This psychological component is often overlooked, yet it is crucial to address it. It underscores the importance of a holistic approach in OT, where we must be attuned to the psychological undercurrents in every case we handle. Even when a client’s diagnosis is not overtly related to psychological issues, there is always an underlying stress or mental health aspect that needs to be considered. This necessitates a gentle, client-centered approach, where we remain vigilant for signs of psychological distress and respond appropriately.

An additional theory that has emerged from my experiences in Kenville relates to health-seeking behaviour. Through discussions and observations, I have noted a concerning trend where individuals are hesitant or outright resistant to seeking medical help, even when it is necessary. Studies have shown that factors such as cultural beliefs, fear of stigmatization, and mistrust in the healthcare system contribute to this reluctance (Abel & Stiefel, 2014). In Kenville, this issue is particularly pronounced, and traditional strategies like advocacy and education have had limited success in changing this behaviour.

A bold solution that came to mind, inspired by a tutorial discussion, is the idea of making health-seeking behaviour a compulsory policy. While this is a broad and ambitious proposition, it reflects the urgency of the issue. The government could implement a policy mandating that every household accesses health services through mobile clinics. While this would undoubtedly stretch the budget, it is a necessary step if the government is serious about improving public health outcomes. This approach acknowledges that sometimes, drastic measures are needed to ensure that essential services reach those who need them most.

Another insight from community OT is the realization that just because someone appears healthy or lacks obvious medical issues, it does not mean they should be excluded from receiving care. Preventive services and general wellness initiatives are crucial in ensuring that even those who seem healthy remain so. This proactive approach to healthcare is essential in community settings, where access to services is often limited, and the focus tends to be on reactive rather than preventive care.

Finally, an interesting application of the feminist theory in OT has emerged from these experiences.  The link: https://books.google.co.za/books?hl=en&lr=&id=xRG7fDwewQIC&oi=fnd&pg=PR9&dq=feminist+inquiry&ots=f5WRm6n8WX&sig=0751VdyiOj5GdBG8r5MF0A3gwBI#v=onepage&q=feminist%20inquiry&f=false further explains this theory for extra reading. Feminist theory, which advocates for equality and addresses the systemic inequalities faced by women, can be adapted to challenge the societal norms that contribute to the marginalization of certain groups. In the context of community OT, this theory can be used to advocate for more equitable access to healthcare services, recognizing that social determinants like gender, race, and economic status significantly impact health outcomes. By applying a feminist lens, we can better understand and address the intersectional issues that affect our clients, leading to more effective and inclusive interventions (Hawkesworth, 2019).

In conclusion, my experience in community occupational therapy has illuminated the intricate web of societal issues that influence health and well-being. Poverty, particularly within the black community, is not just an economic condition but a deeply ingrained mindset that perpetuates cycles of hardship. This realization underscores the need for a holistic approach in occupational therapy, where psychological and social factors are as crucial as the physical aspects of care. The reluctance to seek healthcare, often rooted in cultural beliefs and systemic mistrust, further complicates efforts to improve community health. This highlights the potential need for more assertive public health policies, such as making health-seeking behaviour a compulsory practice, to ensure that essential services reach those who need them most. Additionally, the application of feminist theory in this context provides a powerful framework for addressing the intersecting inequalities that affect our clients, advocating for more equitable and inclusive healthcare solutions. Ultimately, these insights have deepened my understanding of the role of occupational therapy in addressing the broader societal issues that impact our clients' lives, reinforcing the importance of a comprehensive, client-centered approach in all aspects of care.

References

Abel, T., & Stiefel, M. C. (2014). The relative importance of social determinants of health: A conceptual model. Journal of Public Health, 22(2), 133-144. Retrieved from https://link.springer.com/article/10.1007/s10389-014-0613-1

Hawkesworth, M. (2019). Feminist inquiry: From political conviction to methodological innovation. Rutgers University Press. Retrieved from https://books.google.co.za/books?hl=en&lr=&id=xRG7fDwewQIC&oi=fnd&pg=PR9&dq=feminist+inquiry&ots=f5WRm6n8WX&sig=0751VdyiOj5GdBG8r5MF0A3gwBI#v=onepage&q=feminist%20inquiry&f=false

Nyasani, F. M. (2020). Cultural perspectives on poverty and their implications for social work practice. Social Work & Society, 18(1), 45-60.

Muhhamed Zulfan. (2020). Shuttershock. GrowingSprout Tree Royalty-free images. Retrieved from: https://www.shutterstock.com/image-vector/continuous-line-drawing-step-tree-growth-1867765423https://www.shutterstock.com/image-vector/continuous-line-drawing-step-tree-growth-1867765423

Statistics South Africa. (2017). Poverty trends in South Africa: An examination of absolute poverty between 2006 and 2015. Statistics South Africa.

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Occupational Therapy as a Catalyst for Sustainable Development in Kenville

In the vibrant yet challenging community of Kenville, Durban, where informal settlements and more stable housing coexist, many residents find themselves in a precarious situation—moving in for a job but ending up staying far longer than intended. Some use this as a temporary place after being promised by the government RDP houses. The patchwork nature of housing and the transient lifestyle have left a mark, creating a landscape where basic needs often fall short. As a healthcare professional, I've seen firsthand the cracks in early childhood education and healthcare, sparking a drive in me to make a difference. The link: https://www.youtube.com/watch?v=K0hwMUoJeI8&t=27s shares amazing ideas students at Stellenbosch have done to work towards bettering a community about a decade ago. Those are lovely ideas of which, I think of implementing but would take more than just 6 weeks to be done. This blog dives into my projects aimed at addressing these gaps, aligning with the Sustainable Developmental Goals. From ensuring quality education and combating hunger to improving health and gender equality, my initiatives aim to turn the tide in Kenville and contribute to a brighter, more stable future.

In our community(Kenville), there is a significant lack of resources for early childhood education, particularly in teaching basic numerical concepts. I observed a stark contrast between two creches: one with many children who knew their basic concepts well and another with only four, four-year children who could not count to ten. This discrepancy highlighted the urgent need for resources and effective teaching methods. The realization that smaller groups did not necessarily equate to better learning outcomes led me to understand the critical role of resources and teacher training in early education.

In our community, where resources for early childhood education are scarce, I encountered a learner in fifth grade struggling with basics like the alphabet and letter recognition, revealing a gap in fundamental skills that was eye-opening. This experience ignited a deep sense of purpose within me, highlighting the need for targeted educational interventions. I'm committed to implementing practical tools such as visual charts to aid children in mastering basic numerical concepts and training educators and caregivers to use these resources effectively. My goal is to increase the number of children who can count to ten and enhance teachers' abilities to deliver impactful lessons. By improving early numeracy skills, we can set a solid foundation for better educational outcomes, directly addressing the Sustainable Development Goal of quality education and making a significant difference in the lives of these young learners.

 To address these challenges, I aim to implement educational tools (such as charts), develop training sessions for educators, and encourage parental and community involvement. These measures will increase the number of children who can count to ten and enhance teachers' ability to deliver effective lessons, thereby improving numeracy skills among young children and leading to better educational outcomes as they progress to higher grades.

At our local clinic (Sea Cow Lake clinic), we frequently book appointments for children with developmental delays, but many parents do not return for follow-up visits. This has forced us to adapt by providing immediate, on-the-spot interventions whenever possible. This approach has taught me the importance of collaboration within my group and the necessity of home programs to ensure continuous care. Not only that, but I also have an amazing group of ladies for my active aging project and their love for exercising is quite evident.  Therefore, I would like to work towards that as well to improve their physical fitness and shake off their tired bodies. There are also other aspects as well of cooking and gardening I would like to make a therapy from with these lovely women.

 By developing comprehensive treatment plans that can be administered during the initial visit, creating detailed home programs for parents, and engaging elderly women in physical activities and gardening, we aim to improve the overall health and well-being of community members, reducing the burden on healthcare services. These initiatives align with SDG 3 (Good Health and Well-being), emphasizing the importance of health education and community participation.

Growing up in a female-headed household with a strong matriarch, I have not experienced much patriarchy personally. However, in Kenville, many women face verbal abuse and control by men, hindering their ability to pursue entrepreneurial opportunities and better their lives.  Acker, J. (1989) Goes into deep detail about the problem with patriarchy on the link: https://doi.org/10.1177/0038038589023002005 . Addressing this issue requires a multifaceted approach, including counselling and empowerment through skill development. Providing counselling services for women and men, establishing vocational training programs, and organizing workshops to educate the community about gender equality and respectful relationships are crucial steps in this process. These women can contact Saartjie Baartman Centre for Women and Children in the Contact: +27 21 633 5287 (Cape Town office, for local referral) and Email: info@womenscentre.co.za as they Offers comprehensive support services, including counselling and safe accommodation for abused women and their children. But this can be done once these women are ready. These initiatives will empower women to pursue entrepreneurial opportunities, reduce the incidence of verbal and emotional abuse, and promote greater gender equality, thereby enhancing opportunities and outcomes for girls and women thus also achieving Decent Work and Economic Growth (SDG 8).

Additionally, the women in my active aging group have expressed interest in gardening, specifically planting spinach. Given the limited gardening space, planting spinach in pot plants is a viable option. Spinach grows well in pots and can be harvested in about eight weeks, providing a steady supply of nutritious greens. I know my grandma is currently in her 80s and still has all her teeth and is strong as an axe. This is because of her gardening, not only does it calm her mind or give her purpose, it’s like a physical exercise to her. This link: https://www.youtube.com/watch?v=t3osRE2ccrM discusses further the benefits of gardening more especially for geriatrics. This initiative not only supports SDG 2 (Zero Hunger) by promoting food security and improved nutrition but also encourages sustainable agriculture practices within the community. It also promotes SDG 12 (responsible consumption and production) as growing your own spinach reduces the need for store-bought produce, which often involves packaging and transportation, thereby contributing to more sustainable consumption patterns.

With three weeks remaining in Kenville, I'm thinking about starting a stokvel for my active aging project. While it might not be an immediate focus, this idea would help manage financial resources among the elderly, with the plan for it to be run by them.

The community of Kenville faces numerous challenges, but by focusing on quality education, good health and well-being, and gender equality, we can make significant strides towards sustainable development. Through educational initiatives, healthcare improvements, and gender empowerment, we can create a better future for all residents. Collaboration, community involvement, and continuous adaptation are key to achieving these goals. By working together, we can transform Kenville into a thriving, resilient community.

References:

1. United Nations. (n.d.). Sustainable Development Goals. Retrieved from [https://www.un.org/sustainabledevelopment/](https://www.un.org/sustainabledevelopment/)

7. FAO. (n.d.). Agroecology Knowledge Hub. Retrieved from  [http://www.fao.org/agroecology/en/](http://www.fao.org/agroecology/en/)

Acker, J. (1989). The Problem with Patriarchy. Sociology, 23(2), 235-240. https://doi.org/10.1177/0038038589023002005

Baylor College of Medicine. (2019).Gardening Provides Health Benefits At Any Age [Video]. retrieved from: https://www.youtube.com/watch?v=t3osRE2ccrM

CNBC Africa. (2013). Africa’s Informal Settlements Increase. [video]. Retrieved from: https://www.youtube.com/watch?v=K0hwMUoJeI8&t=27s

[lethiwebhengu]

Encouraging Independence in Occupational Therapy Education Instead of Spoon-Feeding

Isn’t this question supposed to be posed at the experts of OT (Occupational therapy)? I feel like people who have already had experience will know what is best for the people new at the PHC level. This question posed at students will only allow them to create more ways to be coddled rather than encouraging them to develop resilience. This is a question; I will try answer from a perspective of what will work to prepare students at PHC level rather than make it easier for them. Working in the community is far from a joyride; it demands real-time decision-making and adaptability. Although I lack extensive experience at the PHC level, starting therapy in such settings has been a profound, eye-opening experience. It has shaped my perspective, fostering a deeper understanding and empathy for clients who often struggle to access essential OT (Occupational therapist) services. Engaging in community OT in the fourth year, in particular, hones one's ability to think on their feet and innovate with limited resources. This is a crucial skill, developed and refined during this stage of training.

OTs at the PHC level need a robust skill set. This includes strong assessment and intervention capabilities for both physical and mental health conditions, proficiency in community-based rehabilitation, and the knack for working collaboratively within interdisciplinary teams (World Health Organization, 2017). Engaging in community OT in the fourth year is particularly transformative. It's where you learn to think on your feet and make lemonade out of lemons, refining the ability to innovate with limited resources. This skill, honed during this phase, is crucial for future practice. The curriculum typically addresses these areas, focusing on assessment skills at the second-year level, which is essential for community OT where assessment and treatment often occur simultaneously. However, paediatric and community-specific skills are usually emphasized more in the fourth year. This reinforces my strong belief in fostering independent learners rather than spoon-feeding students. It introduces an element of navigating challenges on your own and emphasizes the importance of teamwork, as students must collaborate with one another and seek clearer guidance from those who have completed the previous block.

Solomon (2004) explains how convincing and charming clients is a necessary skill that, while partly innate, also requires cultivation and further explains that convincing and charming clients is a necessary skill to deliver effective services. While it can be daunting, the experience is less intimidating when working in groups rather than alone. I had discovered a site during the winter vacation that does training, provides courses and resources on effective communication, building self-confidence, and influencing others. Their programs are designed to enhance personal and professional skills. The website:Dale Carnegie takes you to the site while 8 Tips for Effective Communication in the Workplace | Dale Carnegie Blog gives tips on effective communication, although it is mainly directed to business people, it helps a lot especially with health promotion.

Furthermore, health promotion and prevention strategies are essential for supporting public health initiatives (Davy et al., 2016). Unfortunately, the curriculum often gives minimal attention to health promotion, despite its critical importance at the primary health care level. This oversight becomes glaringly evident when we, as students, realize our inability to succinctly define occupational therapy (OT). This challenge, however, is also an opportunity. It prompts us to reflect, question, and explore the essence of OT.  By simplifying and clarifying the role of OT, we not only strengthen our own understanding but also enhance our ability to advocate for the profession and its broad impact on health and well-being.

In community OT, working with those new to therapy or unable to afford it is a key challenge. While students learn to create assistive devices with machines and equipment that cannot be provided at PHC level., the lack of available equipment at the PHC level often leaves them high and dry. The Sweethearts Foundation with the link: The Sweethearts Foundation | Tops and tags for wheelchairs  is a non-profit organization that provides wheelchairs to those in need by recycling plastic bottle tops and bread tags. The Sweethearts Foundation collects plastic bottle tops and bread tags from various sources. These seemingly small items are then recycled. The funds generated from recycling these plastic tops and tags are used to craft wheelchairs for people who require mobility assistance.

The assistive devices taught as well are redundant as they cannot be useable in our clients’ homes such as clients who live in informal settlements. Why prescribe a wheelchair when it would not fit in any of the paths to their homes? Why talk about grab rails in that context? In such a state I would recommend portable ramps that can be made out of recyclable materials and try different techniques to squeeze the wheelchair in tight spaces. That special component and aspect is missing in the curriculum. The curriculum promotes a holistic approach to patient care, considering physical, emotional, and social factors but the curriculum's brief nod to SDGs and social determinants of health is like scratching the surface, missing the heart of the matter. This shallow dive leaves students feeling like fish out of water when facing real-world issues, highlighting a need for a deeper, more practical approach. Khulisa is a NPO focuses on broader social issues, they are involved in projects that support people with disabilities, including the distribution of assistive devices in informal settlements in various provinces. To access them there is Contact Number: +27 11 833 6464 and Email: info@khulisa.org.za.

Statistics from universities in South Africa show that reduced supervision has significantly impacted OT students' independence. A study by Steyn and Cilliers (2016) revealed that OT students who experienced less supervision reported a 30% increase in confidence and independence in clinical decision-making. Another survey conducted at the University of the Witwatersrand indicated that 75% of OT students felt more prepared to handle real-world challenges after participating in less supervised, community-based practicums (Mabunda & Mulwafu, 2018). These findings underscore the value of reduced supervision in fostering independence and practical problem-solving skills among OT students. Extensive supervision during training can lead students to doubt their own judgment, as they become accustomed to seeking constant confirmation. In the community, they must learn to trust their knowledge and be assertive with clients who may hold different views.

Introducing PHC-level OT to first-year students through community and home visits is a beneficial preparation step, as it helps integrate this exposure into their case presentations and studies. However, this practice is not always consistent. While second-year students, for instance, may not have the same opportunities for community exposure, which can leave them confused about their role and the objectives of community prac,  students engage in hands-on practice through internships and placements from second year, allowing them to apply theoretical knowledge in real-world settings.

Nonetheless, these gaps in training force students into challenging situations where they must learn to adapt and develop problem-solving skills on the fly. This trial-by-fire approach ultimately strengthens their ability to navigate real-world scenarios and deliver effective OT services under pressure.

References:

Davy, C., Bleasel, J., Liu, H., Tchan, M., Ponniah, S., & Brown, A. (2016). Effectiveness of chronic care models: Opportunities for improving healthcare practice and health outcomes: A systematic review. BMC Health Services Research, 16, 194.

Mabunda, D., & Mulwafu, M. (2018). Evaluating the impact of reduced supervision on the preparedness of occupational therapy students at the University of the Witwatersrand. South African Journal of Occupational Therapy, 48 (2), 22-29.

Steyn, M., & Cilliers, C. (2016). The influence of supervision on the professional confidence and independence of occupational therapy students in South Africa. Occupational Therapy International, 23 (3), 245-252.

World Health Organization. (2017). Rehabilitation in health systems.

Solomon, P. (2004). Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal, 27(4), 392-401.

[lethiwebhengu]

The Quality of Maternal Health Reveals Societal Problems, Societal Problems Reveal the Quality of Maternal Health

The state of our country is quite troubling. Both our economy and our social status are in poor condition (South African Institute of Race Relations, 2021). This situation arises from a combination of factors, some within our control and others beyond it. While apartheid played a significant role in shaping our current reality, it has been decades since its end, meaning we must also take responsibility for the present state of our nation. And “we” means everyone in South Africa. One particular area where we hold responsibility is maternal and child health.

Healthy mothers are more likely to give birth to and raise healthy children, reducing the risk of complications during childbirth and ensuring better early childhood development (World Health Organization (WHO. 2015). Good maternal health helps prevent conditions that can hinder a child's growth and cognitive development, which are essential for their future education and productivity (Smith, 2019).

Occupational therapists (OTs) typically address the underlying issues that affect a client’s function. In contrast, community OTs seek to identify deeper issues impacting the entire community, regardless of how little the number of people affected within that community are.

From a public health perspective, the well-being of mothers and children is a strong indicator of the overall health of a society (WHO, 2015). In the community of Kenville, I had observed and encountered (although not many) mothers facing financial constraints, particularly those unable to afford necessities or facing unemployment, encounter significant challenges that impact both their own health, babies that are to come after birth and their children who are already present. Poor involvement of fathers, especially prevalent in Black communities, adds to the psychological strain on these mothers. This situation contributes to health difficulties for both the mother and child.

 Financial limitations often force employed mothers to take shorter maternity leaves, further exacerbating their stress. For unemployed mothers, the realities are even more severe, perpetuating a cycle of poverty. These circumstances negatively affect maternal mental health and hinder access to nutritious foods, crucial for both prenatal care and child development. As a result, these children may experience compromised growth and psychological well-being, impacting their overall functioning. This made me understand that when it comes to understanding our community's core issues, maternal health often serves as the canary in the coal mine. It can be used as one of the indicators of not only the overall health of a society but can also indicate whether the social issues within communities are addressed or not. It was just my first week of community fieldwork and the reality of how people live changed my whole perspective about OT. I often thought that OT is all about referrals and doing all we can that our clients can afford but it’s that and more. Community OT is about doing all in your power to try and help our clients’ problems. It’s an act of ‘ubuntu.’ When these clients approach us, they want solutions from us, not “sorry, I can’t help you.” Although, I could not think of solutions for some of them on the spot but when I look back, I should have recruited them for job skills group, looked at the streams of income they have and try work with that. I should have focused on what they have to try reach what they don’t. My heart breaks when I think of solutions when the person has already left. And the funny part is that it does not break because of pity but mainly because as a profession we are taken for granted and people do not really understand what we do therefore they think OT is a luxury profession, like we don’t matter, and I do not like feeling like I don’t matter.

The article “Social factors determining maternal and neonatal mortality in South Africa” is about a study that aimed at identifying social determinants of maternal and neonatal mortality in South Africa. The findings revealed that poverty was an underlying factor to the vulnerability to illness and death of the mothers and their neonates. Other determinants were found to be the nutritional inadequacies, neglect and abuse by male partners, HIV or AIDS, inattention to reproductive health and violation of reproductive rights, and powerlessness of women and health system issues such as poor quality and incompetent health care ( Mmusi-Phetoe. M. 2016). This also emphasizes that poor maternal health leads to other social issues and worsens the state of the present social issues, highlighting the importance of maternal health.

Maternal and child health issues often stem from broader socio-economic factors. OT interventions also include community education about the importance of nutrition and avoiding substance abuse, which impacts both the mother and the unborn child. Reinforcing these messages can significantly benefit community health. However, lack of education is not the sole issue. Poverty plays a substantial role in maternal and child health.

OTs can address poverty's impact on maternal and child health by empowering communities through education and skill-building, advocating for social policies that support economic stability, and fostering cultural sensitivity to effectively engage with diverse populations and their unique challenges. This holistic approach helps OTs to collaboratively tackle systemic barriers and promote sustainable health outcomes.

By tackling both individual and community-level factors, OTs can create comprehensive interventions that support mental health and reduce environmental risks, leading to a safer and economically secure society.

In public healthcare, resource limitations can lead to complications, increasing the risk of disabilities such as cerebral palsy (Perinatal Problem Identification Program, 2014). In public healthcare, resource limitations can lead to complications, increasing the risk of disabilities such as cerebral palsy. Often, due to these constraints, it is student doctors who assist with childbirth in public hospitals, which can affect the quality of care provided (Perinatal Problem Identification Program, 2014).

Another aspect OTs work on to address is how we can work to prevent disabilities. With a lower number of disabled people, we make a society that has more functional people thus improving the health of our society. Quality of care during childbirth also affects maternal and child health. There are various factors that contribute to disabilities, impacting function across different areas of occupation and ultimately affecting our society and economy. Ensuring good maternal and child health is the foundation for improving the overall well-being of our nation.

In conclusion, while OTs play a crucial role in advocating and providing support, achieving optimal maternal health requires collective effort. Poor maternal health not only affects individual well-being but also generates broader social issues, which in turn perpetuate cycles of health disparities. By fostering a society where everyone contributes to supporting maternal health through policies, healthcare access, education, and community initiatives, we can mitigate these challenges. Addressing maternal health comprehensively not only improves individual outcomes but also promotes social equity and strengthens our communities.

References

Mmusi-Phetoe.M. (2016). Social Factors Determining Maternal and Neonatal Mortality in South Africa. Sabinet, Vol.39,No.1

Perinatal Problem Identification Program. (2014). Saving Babies 2012-2013: Ninth report on perinatal care in South Africa. Pretoria: Tshepesa Press. Retrieved from: https://www.up.ac.za/media/shared/717/PPIP/Saving%20Babies%20Reports/report-9-saving-babies-2012-2013.zp194901.pdf

Smith, L. (2019). The psychosocial impacts of single motherhood. Journal of Family Psychology, 33(1), 45-59.

VectorStock. (2024). Pregnant woman feeling stressed and overwhelmed vector image. Retrieved from: https://www.vectorstock.com/royalty-free-vector/pregnant-woman-feeling-stressed-and-overwhelmed-vector-41837276

World Health Organization. (2015). Nutrition: Key to development. Retrieved from https://www.who.int/nutrition/publications/nutrition_key_development/en/

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blog 5

The signs are always there. Sometimes we just need more training to see them.

As a young woman who grew up in a township where I saw the two extremes of poor average and rich families and citizens. The contributing factor is people have inner conflicts that require therapy. SA is known for a high rate of GBV and drug use.

A school factor would be that a learner that is struggling academically and has symptoms of mental disorders such as intellectual disability or learning disability that may be mild is pushed through to higher grades by the policy of not allowing the learners to repeat a phase twice. This leads to feelings of low confidence, self-worth and thus affects the length of their dreams, their dreams and ambitions start to be limited and they feel inadequate and less than average.

These feelings mixed with the wrong crowd of people who are also dealing with a lot of things leads to drug use. It makes sense. If you do not have good constructive use of time and constantly feel down and unworthy, you would get easily influenced into trying something that makes you feel better.

There are two dilemmas presented here for these learners. Since they feel like they have no future and have given up on life, it’s either they get therapy, or they get a quick ‘fix’. Therapy is said to be costly but there are hotlines and public clinic available that people do not know about.

This is how I got to see the importance of health promotion. Its about creating awareness and showing people that they can get help with what is available. The first time I found out that health promotion existed was when I was in Marianridge and even though some clients there acted like they weren’t interested their eyes gave me hint that this is something they needed. Of course, everyone is shy and can’t  speak on their personal issues in public, the fact that they asked for pamphlets and would give constant contact when we were educating them made me feel like health promotion does make a difference. It was my first time doing it, so it was flawed a lot but it’s these experiences that show us the importance of things.

I have a very close family member that is a grade 1 teacher, and she is very old so with her experience she knows how to quickly spot children with mental disorders and reports them to be sent to special schools. Unfortunately for some learners that do not show symptoms loudly and happen to have a teacher that isn’t as experienced these signs may be missed which leads to the social issue I explained above.

The main issue that has created a dilemma in SA is lack of emphasis and training for teachers of lower grades to quickly spot these difficulties and the policy of the children not being allowed to repeat a phase twice. Because if they do not do well the second time in that grade that should be a red flag. This problem is further taken as the child in question would be pushed through to other grades and once the parent starts to notice and wants to send their child to a special school, it is almost impossible because the child is now in a higher grade and sending it now would tarnish the school’s reputation as these symptoms should have been spotted in the foundation phase. No principal wants a low pass rate and certainly not a reputation of “diagnosing” the little carefree people. But pushing them further has further has evidently shown that it would set them up for failure.

Yes. Prognoses play a huge factor when it comes to this and sometimes it happens that the learner’s diagnosis had a gradual onset. But what if now most of the leaners have a gradual onset? Now what? How we that look for the school” for the principal there and most importantly the teachers working on the ground? Won’t it make them look like they are “lazy”?

There is a lot to lose for them. This is a dilemma in SA because we have an already “weakened” curriculum for basic education, dropouts due to ignored or passed symptoms of mental disorders.

This was a topic that was  further made interesting by a workshop we attended at marainhill presented by the fourth years where EAs in schools and some parents of children with mental disorders were there partaking in this rich discussion trying to integrate a solution to such problems.

Yes, drug use, environmental factors and social factors play a role in high school dropouts but do is it all entirely due to that. We will keep having more dropouts, more unemployment rates and high drug abuse rate because we are so in denial as a society that it is possible to make it in this country without using education as the key. What about entrepreneurship, protective workshops, and talent?

[lethiwebhengu]

BLOG 5

How All The Bright Places enriched my growth as a 3rd year OT student.

All The Bright Places is a romantic movie that highlights the importance of IPRs, engaging in meaningful leisure activities and the importance of ensuring independence in our clients.

Voilet is a character in this movie that just suffered the death of sister who is 2 years younger than her. She died in a car accident while crossing one of Indiana’s bridges. She was Voilet’s best friend, sister and her book of secrets. After her death, she was diagnosed with depression.  She wasn’t the same again. Her actions demonstrated that she met the DSM- TR criteria for depression. She was always late for class because she couldn.t wake up and her parents would try to motivate her and be firm with her. She didn’t talk AT ALL, she stopped hanging out with her friends, wasn’t interested in schoolwork, neglected her online business, she was always sleeping and kept her room untidy. Violet was in a “cry for help” state but no one noticed. Her parents knew she was not copying with the loss of her sister, but they did not know the disrupt it had done towards her occupational roles, habits and areas of occupation.

In the lens of an OT, I would conclude that she had time management as she sleeps a lot, a poor constructive use of time, poor IPRS, poor volition, poor social skills, poor rest and sleep, affected occupations of education and work. Intervention on her would be based on sessions  of drawing up timetable with her, engaging her in her favourite leisure activities regularly, group therapy to show her that she isn’t alone and that she can get through it while improving IPRS and social kills. I would also improve her engagement in education and work. AOTA (2020) states that one of the core values in OT is Altruism which indicates a demonstration of unselfish concern for the welfare of others. Occupational therapy personnel reflect this concept in actions and attitudes of commitment, caring, dedication, responsiveness, and understanding. Therefore, group and individual session with Voilet would be centred around Yalom’s therapeutic factors called catharsis to help Voilet not only be independent but get a sense of relief after speaking out her feelings and know that she isn’t alone. AOTA explains other important core values of being an OT which can be retrieved from: https://research.aota.org/ajot/article/74/Supplement_3/7413410005p1/6691/AOTA-2020-Occupational-Therapy-Code-of-Ethics

However, as an OT student, this taught me that OT may occur without the presence of an OT. A depressed person requires something new, something intriguing, something they will enjoy. And that something was Theodore, a person who was Voilet's secret admirer, who arrived just when she needed him. She would implore her to take down the enormous walls she had built around herself to keep people out.

Voilet stood on the edge of the bridge where her sister died, ready to die and be reunited with her sister. Theodore appeared to save the day. He interrupted her suicidal thoughts by simply stating, "Oh wow, it's pretty high up here, this road can get quite busy hey." He rescued her. Although he did an excellent job of saving her, he could have phoned a suicide hotline thereafter or as soon as he realized she was attempting suicide when he was still a long distance away from her. In South Africa, dial 0800 567 567 for a free call to the Suicide Crisis Line, and 1-800-273-8255 for the National Depression Hotline.

From there, he gradually began to heal her and restore her volition. He was adamant about her doing her studies with him (they were in the same class), taking her to forests, listening to her, and often engaging in her favourite leisure activity of long-distance cycling. Theodore's pals gradually became her friends. She was slowly regaining consciousness. They fell madly in love with one another. Theodore helped improve her volition most importantly, her time management, leisure engagement, her occupation of education, social skills and prevented her suicidal ideation from being a reality.

This taught me that as a society, we all have the ability to aid and heal one another. OT is simply a way to tap into untapped potential.  It is my obligation to ensure that, even as I enhance independence in my clients, I do so without making them believe they can't accomplish it by themselves or among themselves. A lesson I learned was Theodore, who assumed the position of an OT and became a fantastic "OT" in Voilet's life, was "intervening" Voilet's symptoms. Voilet couldn't fathom her life with Voilet couldn't fathom life without him, which should be common in romantic relationships, but it wasn't. After only 8 months of their amazing romance, Theodore died. This proves my idea that OT should not make our clients feel as if they require our services.

This brings us to a new ethical topic. It is critical to maintain a professional relationship with your clients at all times. Voilet's "therapist" was everything to her, and her depression remission led to severe depression following Theodore's death.

A document by HPCSA explain different ethical values and standards for healthcare professionals and can be retrieved from: https://www.hpcsa.co.za/Uploads/professional_practice/ethics/Booklet_1_Guidelines_for_Good_Practice_vDec_2021.pdf. Ethics taught in lectures also use this source as a reference show how we should obey them if we do not want to have troubles with the law, but this movie created a deeper meaning about for me. It made me think that as Ots if we get more high functional clients, we will strive to discover small problems and magnify them, especially in cases of developing children if we do not know the problem is or in private practice, because more "client factors to fix equals more money."  We make our clients feel as if they need us in order for them to feel the need for OT even if it isn't that severe. The more we try to give more assistance in unnecessary presentations of clients the more they feel dependant to us. This hinders their Improvement for our clients but benefits the department of OT. This leads to more unnecessary problems.

I remember I had a client with a wrist drop last semester and he had very long, and dirty nails and I did a nail cutting activity, I was clipping it for him as he was cutting using his affected upper limb, but I realised when my supervisor said I was more of a distraction than an assistance to the client. Therapy and providing assistance doesn’t mean they need you. She said, I should ensure that my sessions are more of the client doing things on their own then with my assistance and that stuck with ever since.

My final take-home message is that we should promote independence and not dependence just because it may benefit us.

[lethiwebhengu]

BLOG 3 PSYCHOSOCIAL BLOCK

 Therapeutic Use of Self Experiences During Fieldwork

"If it's meant to be, it will be." My roommate recently made a comment on how well I fit into the career I'm seeking. In general, I am a lively person who sympathizes with others and is good at maintaining discussions. The therapeutic use of self is defined as "a therapist's planned use of his or her personality and perceptions as a part of the therapeutic process" (Punwar & Peloquin, 2000). Because I am skilled at maintaining conversation, initiating conversations, and getting to know clients better, this allows me to establish a solid connection with the client, learn more about their personal history, and begin treatment planning with them. Taylor (2008) introduced the Intentional Relationship model, which classifies the six therapeutic modalities (or types).

According to the Intentional Relationship Model, six therapeutic modes characterize client–therapist interactions in occupational therapy: advocating, collaborating, empathizing, encouraging, instructing, and problem solving.

According to UCA (2023), "the role of advocacy for occupational therapists is to share the distinct value of occupational therapy, speak out to achieve reform in healthcare policies, and assist patients in receiving needed services when obstacles arise." I recall having a cervical spinal cord injury client whom I had to push for in order to get pillows for him since he was experiencing neck pains and stiffness. As there were a limited number of pillows available at the hospital, I had to use my charm to persuade the nurses to make a decision for him. According to Barclay. L (2015), enabling participation in meaningful community activities must be at the forefront of occupational therapy intervention, both at an individual client level and through advocacy and policy involvement, to improve the quality of life of people with SCI living in the community. It was my obligation as an OT to "open more doors" in order to improve the client's function. As he was in the mechanical engineering field, I should have contacted his work supervisors to arrange for another job task for him to complete. I could have also added leisure exploration (yes, in physical) to help him deal with his depression. The client could only move his neck from side to side and would look at the roof all day, making intervention sessions difficult to complete. We were gradually losing him to depression. A referral to a psychologist might also be beneficial.

 Collaborating is what I normally do with clients who have intellectual insight on their conditions. It is an act of helping the client meet their own goals. This my favorite mode, although I haven't had much opportunity to utilize it in this psychosocial block. The therapist sticks to client’s principles & involves them in all decisions (client-centred practice) (Nicholar. B, 2016). This once off matriculant client I had who had a stroke and became hemiplegic would always say that her one wish is to return to school. Together we would work together and draft a plan of how we would train and prepare her for a school environment. Unfortunately, a few days before my block ended, she passed away although she was recovering quite well.

I am currently working with an elderly woman who suffers from tangentiality. She says everything that comes to mind. She had gotten into a verbal altercation with one of her friends at the institution a few weeks ago, which made her quite upset. Whenever I spoke with her, she would return to this subject, even after I had addressed it. It irritated her. I sympathized with her and assured her that it was only a minor disagreement and that she and her friend would be good friends again. The therapist makes every attempt to completely comprehend the client's experience. (Nicholar.B.2016)

Using high 5s has been one way to encourage the client to continue with their task and to lift up their self-esteem. It is a trick my midterms client taught me. She loves high 5s. it’s a polite way of saying “good job, well done”. It was one way I use my encouraging mode during sessions while still keeping things professional. It also helps to maintain rapport with the clients as it is a friendly act.

Overall, that is how I have learnt to use my modes, while problem solving and instructing remains the main modes for my sessions.

Therapeutic use of self is a strength once you discover the beauty of your personality.

References

Barclay. L (2015). Facilitators and barriers to social and community participation following spinal cord injury.

UCA (2023). Advocating for Occupational Therapy.

Punwar& Peloquin. (2000). Occupational Therapy: principles and practice

Taylor. (2008) The intentional relationship

Nicholar B. (2016) Therapeutic use of self.

[lethiwebhengu]

Blog 2 psych block

If Mental Health Is Cinderella, South Africans Are Still Finding Our Prince Charming.

"An apple a day keeps the doctor away." A popular English-language adage from the nineteenth century that indicates "if one eats healthy foods, one will remain in good health and will not need to see the doctor often."

South Africa has around 55.5 percent of the population (30.3 million people) living in poverty at the official upper poverty threshold. World Bank (2020)

If half of the country is impoverished, it means they do not have the money to eat nutritious food. Feeding is no more about having excellent nutrition and being healthy, but rather about quieting their bodies' hunger pangs. This means that half of the country can no longer afford the "apple" and would need to see the doctor often.

However, there is more to this social problem. Assume you're given this scenario and asked to devise a treatment plan for these people. Of course, your first response to their poor health would be to cure kwashiorkor, Marasmus, anemia, vitamin deficiencies, and acute malnutrition and find ways to execute it. That is not incorrect, but there is another issue at work here.

A famous folk tale my grade 4 teacher used to read for our class when doing a listening skills assessment can provide a clearer picture of the issue I am trying to paint.

In this story, our people who are suffering from poverty represent the shoe, the evil stepmother and sisters are the poverty-caused diagnoses, the prince charming is your psychologists, OTs, and other health professionals that work in mental health, the late father are people who create awareness about mental health. Lastly, Cinderella is the stigmatized mental health.

Hugo, C.J., Boshoff, D.E.L., Traut, A. et al. (2003) explains how communities have stigmatising and judgemental attitudes towards people with mental health issues who cry for help. Just like Cinderella, mental health is constantly ridiculed, and stigmatised and society labels these people as weak and laughed at. The poverty-causing diagnoses just like the evil stepmother and the sisters are constantly outshining mental health, making them appear more important than mental health. Health practitioners are fooled by the bold statements these diagnoses make when in need of medical attention. Mental health is often silenced and therefore is forgotten. Why is this mot made a priority? What is the point of treating someone with malnutrition if they have suicidal ideation? Wouldn’t it affect their compliance? How do you start treating marasmus on someone with bipolar manic episodes? Why do we focus on physical conditions first when our patients’ mental health is not remediated or rehabilitated? Why don’t we start by increasing independence to improve their cooperation in their treatment plan?

The story had started by explaining the character of her late father who loved her and treated her well. P. John (2016) concluded that mental health awareness programmes in improved the stigmatised perception on mental health and number of help-seeking people in schools.  I was doing health promotion on Depression at Marianridge Clinic for the first time and although I was scared and thought it was pointless at first, in my heart I feel that I have made a difference. I had scanned the community and had already thought I would be wasting these people’s time as mental health is disregarded and derided. While actually people listened to me and asked for the pamphlets that were given out. This taught me that sometimes all people need is a sign to reach out and ask for help. And just like Cinderella’s late father, these people don’t stick around for long, or they come and go like how I am no longer there at Marianridge to spread the awareness again.

When it comes to the Prince Charming, as usual, the sisters and the mother are trying to outshine Cinderella and take him for one of the sisters but that can never happen because he is not meant to be with either of the sisters. The Prince Charming represents the health practitioners that give health services to people with mental health disorders. These people are psychologists, counselors, psychiatrists, occupational therapists, and social workers. 

The shoe represents the people with poverty but Cinderella who represents mental health is the only person that fits on it.

Poverty is only a small part of the puzzle when it comes to the causes of mental illnesses. Mental health is a significant obstacle, if not the primary one, although it is sometimes underestimated. As health practitioners, we can educate the community, raise awareness, and assist people in reaching out, but we cannot change South African attitudes around mental health. It takes decades to change a cultural norm.

The only difference between mental health and Cinderella is that Cinderella found her prince charming while in reality mental health in our people does not find our health practitioners working with mental disorders. Thus, creating a happy ending for Cinderella and a tragedy in our country.

References

World Bank (2020). Poverty & Equity Brief South Africa Sub-Saharan Africa. Retrieved from: https://databankfiles.worldbank.org/public/ddpext_download/poverty/33EF03BB-9722-4AE2-ABC7-AA2972D68AFE/Global_POVEQ_ZAF.pdf

Hugo, J.C .Dorothy E. L. Boshoff. Traut. et al (2003) Community attitudes toward and knowledge of mental illness in South Africa. Retrieved from: file:///C:/Users/Student/Downloads/s00127-003-0695-3.pdf

John. P(2016) Effectiveness of Universal School-Based Mental Health Awareness Programs Among Youth in the United States: A Systematic Review. Retrieved from: https://onlinelibrary.wiley.com/doi/full/10.1111/josh.12461

[lethiwebhengu]

BLOG 1 psych

Experiences That Left Letty with Questions.

“Letty, I can’t really see properly here but I think you passed. You are going to do your fourth year!” these are the words I always imagine my mother would say in the middle of December this year. It’s been tough, rough, “scratchy” and heavy this year, but they say growth happens through pain (and a few questions for me).

First of all, fieldwork for OT3 is scary so what helped me cope is ASMR which helps with anxiety. one of my favorites is (https://www.youtube.com/watch?v=-SYwOAe6V_4&ab_channel=CoromoSara.ASMR  ). I am not sure if it’s appropriate to use for patients with anxiety. It is amazing how I stepped into fieldwork not knowing much about physical treatment but ended up knowing a thing or two. During my physical block, I had a client who did not really see the point of OT since there is physiotherapy. This was hard for me because as a Zulu girl, adults are superior and nothing they say can ever be wrong to you. With the help of my supervisor, I had to brush up on my handling skills because they were challenged. I had to come up with more of a “if you do not co-operate during my sessions, you are likely to get worse” than trying to convince him that OT is beneficial and important. This taught me how handling is different and has to be altered for EACH and every patient because we are not the same people.

(Fleisje. A. 2023) explains that ethically it is great to have that person’s consent but as a health care professional, sometimes you have to work on contract the patients who refuse to cooperative rather than care to build rapport. In other words, consent is important, but you must always find ways to persuade the client if you know the therapy will benefit them. This was highlighted a lot by my current client who I have had for the past two days. She is the kind of client that needs gentle and soft handling most of the time. It is important for us as students to get a range of personalities of clients just to avoid ending up with assault cases because we are not trained enough to calmly find a way to get cooperation from the client.

I remember my first time on fieldwork. My first ever patient was an old man who had just been admitted to a psychiatric ward and very high functional. He was cooperative but I could tell he could not understand the meaning of the assessments I was doing (neither do I, because he was perfectly fine according to me!). on some days he would disappear for our sessions because he would do well for his assessments. So, he was non-compliant. He was an old man so every time we met after his disappearances, I would not address them because my approach was now a “as long as I get all the information from him and get out of here" approach. I didn’t try to persuade him or tell him about the importance for therapy and it looked like the third years at that time also did not care. Which is a problem now because it’s better that he was not be assessed but he was not getting therapy treatment.

why do we come with the “you need me, and if you don’t that’s none of my business” approach and not the “you have to let me help you” approach.” Why do we, occupational therapists (and students) and even other healthcare practitioners, not reinforce handling during training if our aim is to restore or maintain function? How will we do this if we let our clients be when they refuse to cooperate? If we let this be then that means our purpose as OTs is biased to only “easy” clients?

HOW DO YOU DEAL WITH A DIFFICULT PATIENT?

OR

With all the statistics rising for paralysis, comorbidities, unemployment, substance abuse, crime, and mortality in this country and the rest of the world. It seems we do not know that we are also part of the problem.

References

Fleisje. A. (2023). Paternalistic persuasion: are doctors paternalistic when persuading patients, and how does persuasion differ from convincing and recommending? Retrieved from: file:///C:/Users/Student/Downloads/s11019-023-10142-2.pdf

[lethiwebhengu]

BLOG 5

In the medical context, cultural humility may be defined as a process of being aware of how people's culture can impact their health behaviors and in turn using this awareness to cultivate sensitive approaches in treating patients. Prasad SJ, Nair P, Gadhvi K, Barai I, Danish HS, Philip A (.2016 .Feb).

My patient comes from the Xhosa culture which is quite similar to the isizulu culture. Bhat R.T (April. 2014) reports that “the medicinal plants are mainly used in making infusions and decoctions or poulties to be taken orally or applied externally. Some lants are used as a source of scepters for healing ceremonies and driving away bad spirits”.  This is just like the Zulu culture. The patient had lost his new-born baby in 2014 and had a wrist drop due to car accident in 2019 and now a TBI in 2019.

According to this culture this would be explained as that the patient had not performed certain rituals when the baby was born and when the baby passed. Therefore, it will haunt him until these rituals are done. The patient could go a traditional healer “nqhwele” to consult which rituals he is to do but knowing my patient does not believe in IsiXhosa traditional

ways of healing and believes in medical and western ways, the therapeutic implications for his treatment would be to not take the patient’s use of traditional medicines into account when planning treatment.

It has been a busy week and final week for blogging. Overall, it was an amazing week for me because I got to know more about myself, how I’ve grown and how I have changed since entering UKZN Westville Campus.

Monday’s day. I really do not like Mondays, I won’t use the word hate because it’s really not that deep. Mondays are full days and normally the patient that sees you later in the afternoon gets the exhausted and very hungry version of you (lunch is never enough). Last week Thursday, I was assigned a TBI patient who also presents with a wrist drop. All has been going okay ever since, I met him. To me he is one of those patient’s I will never forget. H has been quite a big eye opener in terms of my overall progress and clinical performance when I’m working with patients.

I am a panicker by nature by I think that has been working for me as now I am receiving assistance from various people with different perspectives and clinical reasonings. On Monday, I had planned to do a sandwich making activity using his left affected hand. My supervisor is not crazy about this choice of activity, but I had hoped it would work considering the feedback she had gave me when I had done it the first time which was that it does not bring many demands to the patient but wrist movements and gravity at play. I had also considered the fact that wrist extension is the functional position so I was positive it would work. And guess what? It didn’t quite work.

Well mainly because yes, the activity requires wrist movements, but does it really require wrist extension.NO. It is so embarrassing when your session doesn’t turn out to be what you had hoped for but rather become a total flop.

The main feedback that stuck on my mind was using activity analysis. I didn’t really prioritise this in my mind given the amount of time I have to do my session write up as I get to res late and had gotten away with it quite a number of times and really did not think it was that important.

It wasn’t until that my mentor read my write up on Wednesday and said the same thing. She broke things down for me, slowly and I got the importance of it. I had a visit from our academic leader to check on my progress which was quite intimidating considering his position but was effective as I am in desperate need for help. He also said the same thing. Do you know that thing that happens when different sangomas from totally different areas you don’t know of randomly bump into you and start telling you the same thing and it starts to force you to believe them and start making what they are saying a priority. Yes, that is exactly what happened to me. My supervisor, the academic leader and my mentor all saying the same thing just in different languages.

Another thing our academic leader picked up on was my lack of confidence. This is sad actually because I am not one to act like Miss-Know-It-All and I’m the youngest at home. I am the person you tell what to do not the other way around. But that has to change because it is going to be problem to my career overall.

 REFERENCES

Prasad SJ, Nair P, Gadhvi K, Barai I, Danish HS, Philip AB. Cultural humility: treating the patient, not the illness. Med Educ Online. 2016 Feb 3;21:30908. doi: 10.3402/meo.v21.30908. PMID: 26847853; PMCID: PMC4742464.

Bhat R.T (2014, April). Medicinal Plants and Traditional Practices of Xhosa people in the Transkei Region of Eastern Cape, South Africa. Indian Journal of Traditional Knowledge. Vol.13 (2), April 2014, (pp.292-298)

[lethiwebhengu]

FIELDWORK BLOG 3

The occupational therapy profession is a profession’s main goal is to enable people in activities of everyday life. In order to achieve this outcome OTs, have the responsibility to use EBP.( Occupational therapy Australia, 2018).

But what is EBP? EBP stands for Evidence -based practice. Evidence-based practice (EBP) is the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions .This means OTs will integrate information from their clinical experience, research evidence, knowledge about client values and circumstances, and the practice context as part of their clinical reasoning when making practice decisions. (Tilter.M.G, 2008) An article by occupational therapy Australia gets into deep detail about how to use evidence-based practice and its importance. (Link will be found on the references)

There are 5 steps of evidence-based practice. These steps were well explained in detail in an article by NThealthlibrary services(link below). The image below briefly states the steps used in this practice.

 Using these steps, I will explain how I have used these steps as a guide to my intervention this week.

The first being “ask a question?”. In this step I was required ask a question, find the need to get information relating to your client. So today is a Thursday and I was given a new patient to treat for my finals. The use of this step started immediately when I received the patient’s diagnosis and general information. My patient was diagnosed with a Traumatic Brain Injury and the first thing that came to mind was which AFR was I going to use? what is a typical clinical picture of a TBI patient? what approaches will I use? These questions would lead to the 2nd step of evidence-based practice which is finding information and evidence to answer my questions. I remembered during the lecture about TBI, our lecturer said to us, the minute we see TBI, it means NDT. So, I’m sorted for the AFR that will guide my intervention. I always keep a printed copy of the lecture slides we do in class about different diagnoses just to always have something to refer back to. I quickly browse through to get a clinical picture of TBI, what assessments I should prioritise and what my focus of intervention. I quickly look at whereabout in the brain is my patient affected and it talks about the parietal lobe. Okay, I quickly go on google and search what is affected if the parietal lobe is affected. I already know sensation will be affected but I’m dealing with someone’s life here, I have to be sure.

At this point, I move on to step 3. Critically appraising information. This just got interesting. After doing this mini research, I’m expecting sensation deficits, muscle tone, muscle strength, aphasia, apraxia, perceptual issues but the information I have on the diagnosis has to match where he is affected. The patient is affected in the parietal lobe so a sensation and a perception assessment is very important but step 4 says I must intergrate this information with my own clinical expertise which is that I must do all the assessments including cognition assessments as this is a nuero patient not just sensation.

When I get to the patient, I start with a little interview which probably lasted about 15 minutes just to assess any memory, reality orientation deficits. The rest of the information, I will get during the following sessions, there is no time to waste. The patient tells me that he does not know how he got to the hospital , all he remembers is that there were 2 guys that attacked him. Shame, he even lost his teeth. But is this a memory problem? Amnesia? Maybe? I would have to do a little bit of research about him to know what this is but already there is a memory problem.  Episodic memory loss.  he remembers today’s date, who he and where he is and why so reality orientation is good.

I dive into the physical assessments. I start with sensation, and I find out that he can feel light touch, deep touch and he is able to describe and localise the pain. What? I do stereognosis and he gets all the items right. I move on to muscle tone, I do not feel any “catches” in his arm and legs. I proceed to do his range of motion informally and I still do not see much that is wrong, just the range of motion of the fingers. I decide to not do it I am not confident enough to do it. I will wait for my mentor to teach me first. I decide to do bed mobility, posture and balance. The patient turned perfectly fine on the bed without any holding on to the grab rails. I did the trunk impairment scale to assess his seating balance and posture. As I am doing the test with him, he just stands in the middle of the session to fix his pants. That’s it! Test done. I did not have the berg balance with me, so I quickly assess his gait. I wonder where the TBI mainly affected him. The muscle strength assessment showed me that I have been grading it all wrong. I had only known that grading is supposed to be influenced by the amount of ROM he has and amount of resistance. At this point I do not know anything, it seems, and I only mainly printed out the physical assessments and not all of them. Money is very tight at the moment. Come Monday, I need to get all my psych assessments printed out. By now I had noticed the wrist drop on his left upper limb but isn’t that caused by damage to the radial nerve. At this point, I am freaking out. What is mainly wrong with him, just his left upper limb? And maybe some a psych part to him that I haven’t assessed. Whatever it is, my assessment findings will definitely not be right.

The patient had told me that he has had his wrist drop since 2019 and has been wearing his splints inconsistently over the years. Hard to believe hey? I also didn’t until he asked if it will ever get better and if he can get a grant for it. I didn’t even want to guess the answer I know I would probably be wrong, so I told him to ask his doctor I’m just a mere student.         This practice as guided me to plan my patient’s following sessions. I plan to continue assessments, assess and treat areas of occupations but prioritising ADLs first.

It is important to use the evidence-based practice as it guides how your you treat your patient. Not using it would lead to treating something that is not related to patients, treating something that doesn’t need treatment or worse causing more complications.

REFERENCES

NT Health Library Services. (2022). Evidence-Based Practice: 5 steps of Evidence-Based Practice – Overview. https://library.health.nt.gov.au/EBP/overview

Occupational Therapy Australia. (2022) Evidence- based position statement. https://otaus.com.au/publicassets/90977488-f433-e911-a2c2-b75c2fd918c5/ebppositionstatement.pdf

Wilson M, Austria. M.Feb (2021). What is evidence based practice? Retrieved from https://accelerate.uofuhealth.utah.edu/improvement/what-is-evidence-based-practice

Titler MG. The Evidence for Evidence-Based Practice Implementation. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 7. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2659/

[lethiwebhengu]

OT FIELDWORK BLOG 3

Strikes on Monday only made us go to prac at Albert Luthuli on Wednesday and Thursday. It’s been a rough road academically for this week and it’s a pity it will only get worse next week. I decided to do my demo on Wednesday as my patient changes his dressings on Monday and Thursdays. For my demo, a lot went wrong. Knowing myself to be a quiet and introverted person has cost me my handling skills with my patient. I had imagined the session and how it would go. Critical planned over the weekend and made it meet my aims.

 The activity I did was a dressing activity, and it would have met my aims, only if my aims were correct and matched my assessment findings and presentation of my patient. The assessment findings of my patient showed that he had a contracture on his RUL of 45 degrees of shoulder abduction and 90 degrees flexion of the elbow joint. How could I possibly think the patient would be able to be extend his limb to his back or his chest to wear the shirt and button the buttons? Logically it does not make any sense, but I did not think of it. It was not a realistic aim for my patient. Activity analysis is important but it wont help if you do not implement assessment findings to your treatment session. I am able to link aims to a session but I’m just not linking aims that are relevant to my patient. I have learnt how to integrate my assessment findings critically and include them in planning my treatment session.

I also learnt the importance of assessing and treating an area of occupation. There is not much time to assess these, but it is important to not only focus on improving client factors but to improve the skills of areas of occupation. That is the meaning of OT, to focus on independence of areas of occupation and not just client factors that affect them. It is not sufficient to only assess client factors and link them to areas of occupation and assume how the patient would struggle only to be surprised when assessing it that they struggle with something else. These areas of occupations can be assessed in one session and even during treatment sessions because there is no time on prac.

For my demo, there was no mirror, no introduction to my supervisors. My poor handling skills had also affected my structuring. Principles do affect each other as well. I was not firm enough to the patient to do the activity where curtains are closed to allow for privacy as the activity itself is very intimate. I had also had the TV on and the other patient distracting and watching the session. He was standing by the window, and he had asked to do the activity there as it was next to couch. I allowed him to do so as I thought it was an element of client centeredness, but it wasn’t. The scene was distracting for a session. I need more self-confidence and assertive skills. The sign at the door. I had completely forgot about that! I also had to inform the nurses that there was a session in place but that’s how we learn, through mistakes.

Multidisciplinary teamwork refers to working as a team with other healthcare practitioners to benefit our patients. Every practitioner playing their role. Which I think is the whole point of having hospitals and clinics and other healthcare facilities. I did have a couple of encounters of working as a team with the nurses, physio and doctors. The doctor gave me as an OT a diagnosis of Burns (which we have to check are accurate according to the merk manual if they are fitting) and let me play my role to bringing about independence in patient and putting a splint on him. The nurses are there to supervise and monitor the patient and physiotherapist help with doing exercises and massages to hep heal scars and work on his ROM and muscle strength. This is how we all got to play our part as health practitioners on treating our burns patient.

Multidisciplinary teamwork can also take place at the same time on the patient not separately like I explained above. I experienced this a couple of times first hand with the nurses and physiotherapists. I had experienced when my time with patient and the physiotherapist’s time was the same time. She was very welcoming and allowed me to also do therapy during her session. She had taught me different ways to scar massage a patient, I had never done it on a person but only watched videos so that was the first time doing on someone. I learnt about going up and down and doing “J” patterns. I had only known doing side to side and circular motions. I had also known the importance of pressure, but she taught me that it was important to also be aggressive during these massages in order to get to the muscles and structures underneath. So that was interesting.

 My main interactions with the nurses in terms of teamwork is asking them to give me different materials for my sessions, like aqueous creams, bowels, shirts and pants. They have been very helpful. My patient had also told me that the ROM exercises are much better when the bandages are off, unfortunately by the time I get to the hospital and have a session with him, his dressing is done already. I had spoken to 2 of the nurses to allow the patient to do these exercises when his dressing his off, to make him do it himself as I had educated him to. The patient did report that the nurses do allow him to do so when they are still waiting for the doctor to assess his progress of the burns. The other teamwork I’ve had with the patient is when the nurses give the patient their medication or meals to take.

About Thursday. During my demo, the patient said that he would go for skin grafting on Thursday and there won’t be much to do as he was going to change his dressing. I planned to do assessments again with him regardless, hoping that with the strikes happening, his skin grafting would be postponed. Fortunately for me, he was told he would go next week. I managed to do my ROM assessments to check his improvement but unfortunately there wasn’t. My therapy must not have been working. This was sad. But maybe he was going to improve gradually. I hope. I went to my second patient with flap cover. His stitch seemed to be closing onto the skin well but still no progress with his hand function. The progress would obviously be there after his surgery that is due next week. I also forgot about the precautions of his condition when deciding on which activity I was going to do with him. The main precaution was to not strain the flap cover too much. The activity was face washing and brushing teeth.

Research on a condition is important to know which assessments to prioritise but precautions are even more imperative. As OTs we are there to promote independence not cause complications that take them away! The diagnosis of this patient is quite long and foreign to me. This was a chance for me to gain more experience and learn about it.

The research of the diagnosis: right forearm debridement and para-umbilical perforator based truncal wall flap cover (this is just half of the diagnosis) showed me an interesting article on the diagnosis that mainly mentioned that the paraumbilical perforator flap has reliable blood supply, good texture, sufficient area, and is convenient to transfer. It's an ideal choice for the repair of the deep soft tissue defect in the hand and forearm. Wang. J, Wang. M, Xu.Y, GAO. Y, Cul. L, Wang.J, Hong. Z & Yaun. S. 2017). Some of the precautions I had researched some of them after discovering the importance of them are: If possible, try to elevate the wound so it is above your heart. This helps reduce swelling. Avoid any movement that might stretch or injure the flap or graft. Avoid hitting or bumping the area. avoid strenuous exercise for several days. Ask your provider (doctor) for how long. The site may become itchy as it heals. Do not scratch the wound or pick at it. (Hoss. E, 2022)

I had met with my mentor Wednesday afternoon, where she was explaining how to write a write up and she also emphasized on the importance of precautions for different diagnoses. She explained her experience on how she realised how important they are when she was on prac and given a spinal cord patient. She was going to first do assessments and sit the patient up. Luckily the doctor walked in right in time to tell her to not sit the patient up as they had been lying down for a long time and they could have Orthostatic hypotension and they had not yet done the spinal fusion, so it was very important to keep the patient immobile in order to keep the spinal cord immobile. So that also emphasized that not all precautions can be found online immediately, therefore before touching a patient it is important to ask the nurses and doctors if they are around to move, speak or touch the patient to prevent any further complications. 

 I only focused on making sure his upper limb is not abducted to much which could result in it coming off and getting as much bilateral hand function as possible. Little did I know that I could have caused a complication.

A lot went wrong this week, but this is a learning curve, no one is perfect, and I will get right someday but I’m glad I made mistakes because now I will carry these experiences as constant reminders of what to do and what not to do. One thing I have learned ever since going to prac is how to take criticism as it is and use it to improve in order to not repeat the same mistakes.

Wang. J, Wang. M, Xu.Y, GAO. Y, Cul. L, Wang.J, Hong. Z & Yaun. S. 2017. Paraumbilical Perforator Flap: A Good Choice for Repair of The Deep Soft Tissue Defects in the Hand and Forearm. Retrieved from Journal Of General Practice (https://www.hilarispublisher.com/open-access/paraumbilical-perforator-flap-a-good-choice-for-the-repair-of-the-deepsoft-tissue-defects-in-the-hand-and-forearm-2327-4972-1000334.pdf )

 (Hoss. E, 2022. Skin Flaps and Skin Grafts. Retrieved from MedlinePlus https://medlineplus.gov/ency/patientinstructions/000743.htm )

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FIELDWORK BLOG 2

Fieldwork is a learning journey. One where student therapist must become more practical, realistic and most importantly more eager to learn. For my sessions on Monday, I had planned to do a session with each of my patients but unfortunately fieldwork got cancelled due to strikes. Wednesday came and I was to run a burns group.

A group? I’ve never done this before. Maybe once but I’m certainly not good at running them. How should it go? I went online to watch a few videos about running a group therapy session. I watched 2 videos (link below), but I didn’t finish watching the first link.

I had spent most of my weekend trying to find an appropriate activity for all the patients in the group. It must be an ADL activity, it must be a functional activity, it must include an aspect of education about burns and all the patients must feel comfortable doing it. I spent the whole of Friday evening trying to figure out which one would be suitable. That’s it! Dressing! It’s an ADL activity, it's functional and I can include an educational aspect during warmups and some exercises which I’m sure all the patients would feel comfortable with. I started writing my write-up, planned everything, and updated Sithembile and the rest of the group members on their role. Everything was going to go smoothly.

It wasn’t until Tuesday afternoon when I was practicing on my roommate (she is always up for acting as my patient) on how the session will go that I realised it is actually inappropriate. Dressing is intimate, private and too personal for a group setting. One thing the sandwich-making activity taught me is to always practise the activity and don’t just imagine it only, just to be sure. So, I did so and started to ask myself questions. What if I get patients with burns on their lower limbs and they had to dress their lower limbs and their private areas start showing? I already knew we are getting both genders so this activity would be a no go. What would have happened if Sithembile’s patient(female) starts dressing her upper limbs and her chest shows in front of the other patients. BAD. Very BAD idea. I had to change it. So, I thought of playing cards. But it is not an ADL activity! It was a good choice because it met my aim but the subprogramme of it was off. You have to lose some to win some. But at least it is much more dignified than a group dressing activity.

During the burns group, I had planned RM exercises and education on their importance as warm up. Which are to: Prevents stiffness from developing into contractures (explain what a contracture is- A permanent tightening of the muscles, tendons, skin, and nearby tissues that causes the joints to shorten and become very stiff.)

It is good for your lymphatic system which gets rid of all the bad stuff that leads to diseases/ disorders.

There is expected pain when doing these exercises therefore before we start with our exercises and activity, that is why we did this session after the patients have taken their pain alleviating meds. (Porter, C. Hardee, J, D. Herndon, D. Sunman, O. 2015)

Scar massage. I love the sound of it. Well, I had included it as part of my closure but didn’t implement it because my supervisor had warned me that not all patients would be a part of it since not all of them have healed wounds (scars) which made sense because the therapy was for the whole group and leaving some people out was not the intention. However, I did get to do it as a “think on the spot small session” which was not really idea as it does not look at the functional aspect pf the patient necessarily. I think its more of an extra. It is to be added after a session but not as the main issue of a patient (especially mine).

Patient 2 with the thoracic myelopathy diagnosis. I had planned to use the activity of brushing teeth and washing his face to treat his poor static and dynamic sitting balance. I had planned to work on his bed mobility before the session and ensure good posture for his warm-up. Unfortunately, he wasn’t there. He went for an MRI scan. I hope there is improvement in his affected spinal cord, and I hope to see him on Thursday. I will do what I planned for Wednesday with him.

Thursday. The day client centeredness would be implemented. During my scar massage session with my burn’s patient. Client centeredness. To me this means putting the clients needs first. Including their opinion on the treatment plan, after all it is their treatment. I got to really feel client centeredness when my burns patient said to me his armpits smell really bad but that is because he can not apply roll on to his left armpit because he has limited ROM in his RUL and he is bandaged on his right. This got me thinking that I must include sessions of treatment where the aims and plans don’t just come from assessment findings and the problem list but also the patient.

There wasn’t much that happened this week, but it is amazing how much you can learn in a half day prac. I need to look up energy conservation. I will explain in more detail in my next blog. Oh! And today I got to see a skin graft for the first time, and it was exciting to see!

References:

Porter, C. Hardee, J, D. Herndon, Sunman, O. (2015). The Role of Exercise In The Rehabilitation Of Patients With Severe Burns. Retrieved from National Library Of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272612/

LINK: https://www.youtube.com/watch?v=IpS6LxLP8NM&ab_channel=TheBingeEatingTherapist

Link: https://www.youtube.com/watch?v=cLJVEEeiXVU&ab_channel=MedBridge

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Overall, my first fieldwork week was quite busy and overwhelming. I will start the first day, Monday. A full day. We had orientation and a brief introduction to the Inkosi Albert Luthuli Central Hospital. The Chief OT there, emphasised to us that there is a high turnover. The first day went fine. We were assigned two patients each because of the high turnover. I had first gone to do a few assessments on my first patient which was a burns patient. I had never had a burns patient before, so it was going to be a learning experience.

He was 41-year-old male with TBSA 35% burns-bilateral upper neck, posterior neck, right post head, and ULs. He had had debridement on the burns last week and now waiting to be ready for skin grafting. but I met him when he was in a lot of pain, and I got scared and mistaken him for having an attitude. He had just changed his dressing that morning and in a lot of EXCRUTIATING pain. I didn’t do any muscle strength and ROM assessments, I settled for an interview and balance assessments (trunk impairment and bergs balance scale). I managed to get a little bit of background information on the patient although he had a high frustration tolerance that day, he was a bit co-operative. He is a brother to his sister; he lives with her and his 1 niece and 2 nephews in KwaMashu. The patient is single and has no children but regards his sisters as his own. His education level is grade 12 and he is currently unemployed but earns the employment relief fund of R350. His previous occupation was working in retail stores packing and assisting customers. He jogs inconsistently. The balance assessments showed he had good balance. The balance session took us about 25 minutes, and he was complaining and moaning about his pain throughout the session and took a break after 13 minutes, I concluded that he has poor muscle endurance.

Later that day, I went to visit my second patient or back up patient if you will. I was able to get background information, assessed bed mobility and left. There wasn’t much time left to be with him. He is a 33-year-old male diagnosed with thoracic myelopathy from T3. I had to go research a little bit on his diagnosis because I have never heard of it before. It is a nervous system disorder that affects the spinal cord in the muddle of the spine (thoracic) which is caused by a disease, compression or tumours in the spinal cord. The symptoms are having pain in the back or neck, abnormality walking, muscle weakness, problems with coordination, rhythmic muscle spasm, stiff muscles, loss of muscle, muscle quiver, or overactive reflexes. For Sensory function, the patient may experience pins and needles, reduced sensation of touch, or uncomfortable tingling and burning. Urinary: leaking of urine or urinary retention Also common: balance disorder. (Ventak. S.R 2018) The patient’s level of education was grade 12 and he works at DSW and picks up dirt from households. The patient has a stable partner (girlfriend) and toddler children that live in Ixopo. He currently stays at Sydenham for work. The patient can not turn on the bed independently, but his upper limbs work very well. I prioritised the muscle tone, muscle strength, sensation, ROM, oedema, and balance assessments for the following day.

For my backup patient I did the sensation assessment on Wednesday using fingers to poke the patient (deep touch), cotton wool (soft touch) and a paper towel covered safety pin (pain). The Asia scale pin prick and light touch score was 46/56. The patient could feel in all dermatomes of the body but could partially feel in anterior proximal part of his LLs and plantar area of his feet. The muscle tone assessment showed that he had a score of 1 for his lower limb muscle groups but they were inconsistent and would be 0. The patient has muscle spasms. The muscle groups for upper limb scores are 0. This means they are good. The patient can do 50% of AROM in his lower limbs and his muscle strength grade for them was 3-. The muscle strength assessment was done on Thursday after the activity with the first patient.

For my first patient the assessment of sensation showed that the patient’s bandaged areas (RUL, proximal part LUL, Head) were deep touched and the patient had his eyes closed to describe what he felt. The patient was able to feel the touch on his posterior part of the proximal RUL and forearm as well as hi whole LUL. The patient could not feel in his head (which may be due to very thick bandaging). Range of motion was very limited. Range of Motion for the left upper limb was tested through stretches (shoulder-reaching for ceiling and moving it back, elbow- flexing and extending, hand-making a fist, wrist- moving it in circular motion)  and was noted to not have any limited ROM. The same stretches were done for the RUL and limitation was observed. Therefore ROM was measured with the goniometers. I learned a lot of treatment methods that my supervisor taught about burns. She had taught me about using warm water to make the muscles tender so that they allow for more ROM, and she told me about scar massage. I watched YouTube videos (My favourite link below) to teach myself-ways to how I could do it. I plan to include these as warm up in my following sessions.

Thursday came (half day as well). I had organised a meal prep activity of sandwich making which did not challenge the patient at all. This activity was really bad, and my supervisor explained this to me. If I were to get a chance to redo it, I would have done a face washing activity and grooming using his affected RUL to allow for more ROM IN HIS RUL. The patient’s session would have been a little longer and since he has good standing balance, the activity would be done in standing.

Although this week was overwhelming, but I learnt to be more client centered in terms of client factors as well and not just context wise. The next intervention sessions for my second patient would start with balance as this is his biggest problem. My first patient’s would focus on ADLs that the patient is struggling to do, doing exercises on the RUL to prepare for activities and educate the patient more about the importance of educating the patient about doing exercises and massages to help heal the wounds faster. I plan to sit and analyse how I will adapt the activities, make him use his affected limb for his occupations which will be a bit tricky as the Barthel index shows that he is independent using his LUL.

LinK: Venkat,S.R. (October 2018). What Is Meopathy? Retrieved from  What To Know About Melopathy? https://www.webmd.com/brain/what-to-know-myelopathy

Link: https://www.youtube.com/watch?v=oKszhYKy-9w&ab_channel=Asociaci%C3%B3nPro-Ni%C3%B1osQuemadosdeNicaragua