izwakele

[izwakele]

A Cator Manor Experience

Overall reflection: Closure, handover with lessons (both professional and personal) learnt and way forward into community service. Remember this is a philosophical, conceptual and axiological essay.

My last few days of community in Cator Manor, I found my self with feelings of fulfilment, reflective spirit and nostalgia from the realization of the growth I have obtained from the block and the closing of this years. This block offered so many character developments and forced so much social transformations – it is changed the way we think and perceive our environment especially the social aspect of it. This journey facilitated gradual growth with each stage necessary for the growth from the next stage. It was beautiful to see all the spheres of holistic interventions come to play when with clients and where the golden thread end from the intervention from the hospital to home context. This block was necessary in creating strong clinical reason with cultural appropriate and realistic programmes for carry over to home context as we looked at theory on the other end.

Looking a Cator Manor now compared to the when I first got in the community, I can now see the beauty of the community – the vibrancy of the streets, the culture of the people, with each step into community practice led to a much deeper meaning, the life filled with unspoken and unexplored challenges. This was the same with Denis Hurley in the street of busy Durban – the beauty of the centre did not lie in the building it is situated in but the people in line outside, the consistency in offering their services and the hope in the eyes of the homeless – they knew that even if everyone did not show up in their lives DHC was going to be there with a warm plate of home made food, hot shower and family of many brothers and sister each committed to the course. It was in those streets that I learned that community practice is not just about offering occupational therapy services but on how we constantly moulded by the people we interact it. In a nutshell, occupational therapy became a tree of solace and sanctuary its roots so deep in empathy, cultural humility and professionalism.

I witnessed a beauty of theory into practice. A green scrubbed OT with a pink bucket full of theory, eager to apply structured intervention yet the community was so bending and unstructured nothing went according to plan. In every day we are forced to reflect, evaluate and develop to ne able to meet the needs of the community. I think I learned too fast that the community did not dance to the music of academia, that it was the other way around – academia danced to the rhythm of the community. I did not read articles to master and understand community practice then experience it but had to experience community practice then read articles to understand it. I personally saw and experienced social determinants in a way that no lecture would’ve been able to explain it, I saw the type of therapist I wanted and called to be emerging in this block. That the love for OT bloomed from undressing the social determinants from the community practice model not medical model emphasising on prevention not rehabilitation to improve the health outcomes. This block helped me find my voice and standing in society – it taught me that I’m the owner of my views and opinions no matter how absurd or philosophical they are, but they were mine and I needed nothing more than my won voice to master community practice. I met clients who taught me more about the social determinants of health than any textbook and search engine could—where poverty was not just a concept but a daily negotiation for survival.

The practice in this community extended beyond the professional understanding. I learned the actual meaning of cultural humility—not as a theoretical concept, but as a practice based on genuine curiosity and a willingness to learn from others' lived experiences. Hook et al. (2013) defines cultural humility as a constant circle of self-reflection and self-criticism in which the emphasis moves from attaining competency in a culture to being modest and receptive to learning from the community. Engaging with clients and understanding how cultural identity influences health-seeking habits was critical to offering relevant and meaningful interventions.

In the DHC, I also learned the unwavering spirit of humans despite hardships, social ills but they continue looking for opportunities to better their futures and that of their families. The product of therapy in different situations that are not limited to a mere diagnosis – this block allowed me to treat the Mona Lisa not the graffiti. That occupational therapy was more than clinical representations but was about helping people find identity, practice their culture and that hobbies/ occupations were not limited to the affording. This growth allowed me to change a perspective in my approach and how holistic intervention was the true recipe to better health outcomes.

The other lesson was on the personal level, but I recognise the importance of being constant. The importance of being present and nit focusing on solving or fixing but understanding, the community know what they want, and it is within your scope to find it out and implement. Professionally, DHC encouraged me to be flexible, adapt and be a critical thinker when providing interventions. That being human was the vital part of therapy. As I move to community service year I’m thrilled and ready to apply all lessons I took from this block to practice. And that in my future endeavours I will always know that I do not know it all but I’m both a giver and receiver in the community. Community is not to test your knowledge of community practice but to groom your humanity – there are scary things out there and community has no secrets.

References

Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., Jr., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60(3), 353–366. https://doi.org/10.1037/a0032595

Vermeulen, N., Bell, T., Amod, A., Cloete, A., Johannes, T., & Williams, K. (2015). Students’ fieldwork experiences of using community entry skills within community development. South African Journal of Occupational Therapy, 45(2), 51–55. https://doi.org/10.17159/2310-3833/2015/v45n2a8   

Janse van Rensburg, E., & Du Toit, S. H. J. (2016). The value of a rural service learning experience for final year undergraduate occupational therapy students. South African Journal of Occupational Therapy, 46(1). https://doi.org/10.17159/2310-3833/2016/v46n1a4

[izwakele]

Green Scrubbed Energy As A Fuel And Stepping Stone To Meeting Our Sustainable Goals – Building Our Nation One Discipline At A Time

What if the solution to meeting our goals as a nation include the use of activities as the way to sustain our communities? What if the stepping stone to better future is community engagement in occupations like sports, active aging, psychosocial support, ensuring better mental health and basic task like reading and writing? These are the questions fuelling our approach of using occupations to address the social determinants like poverty, inequality, illiteracy, unemployment and poor health access -pushing us towards meeting our united nations’ sustainable developmental goals (SDGs). This blog will emphasise on how we can move from abstract goals to action and change in places like Cator Manor and Mayville. This is where the work of a green scrubbed OT in community practice become one of the stepping stones to sustainability and development of our communities.  

As occupational therapist in community practice we pride ourselves in facilitating change and looking at human as occupational brings through lens of occupational science to understand the human potential to sustain oneself. By our understanding of how occupations bring meaning or purpose in people lives, we better understand how different occupations impact health this propel us into applying creative thinking in addressing the SDGs. This blog will dig deeper on how me as an aspiring community occupational therapists approaching finishing line turtle different social ills, focusing on good health and well-being, quality education, reduced inequalities, gender equality, and peace, justice, and strong institutions.

1. Good Health and Well-being – OT in promoting better health outcomes

The 3rd SDG s namely good health and wellbeing, emphasise on promoting and facilitating better health outcomes for all. In my community, occupational therapy intervention to meet this goal range from maternal mental health to physical and mental health promotion and everything in between. Maternal mental health is the foundation of our communities as we talked in my pervious blog. As a community occupational therapist focusing on support groups, counselling, and activities that build resilience or empower mothers does not only improve the health outcome of the mother but contribute to the child development. This one of the projects that are currently active in my community which include screening for mental illness in mother during clinic dates and outreach to community. Children screening for developmental milestones is one of the ways to promote health and wellbeing as early identification of developmental milestones can lead to early intervention improving overall health outcome e of the child as we utilise therapy like sensory stimulation, caregiver training, assistive device and different frame of reference to address different delays. In communities the first access to rehabilitation through an occupational therapist as most of the time the mothers do not know where to look for assistance leading to late identification and poor health outcomes.  Health promotion of different programmes available in the community clinic and community like active aging and support group during outreach ensure parting of information to the targeted population ensuring access to primary health care. Therapist access the schools leading to access to youth and children and through use of interdisciplinary approach different learning /motor difficulties can be easily identifies. Implementation of programmes like after school sport programmes which foster physical health, social skills and emotional development – these programmes cater for children with different disabilities.

2. Quality Education: Bridging Gaps in literacy Through OT

SDG 4 aims at ensuring better educational opportunities in providing inclusive and quality education for all especially in under resourced and disadvantage communities. In Cator manor and Mayville, the are a lot of barriers affecting education including crime, substance use, teenage pregnancy, poor parental guidance, learning difficulties and lack of volition among the pupils. In the secondary schools, screening and intervention for the learning difficulties such as pupils with dyscalculia, visual perception, ADHD and cognitive impairments. The early detention and interventions to improve their ability to obtain quality education. Research shows that early intervention can improve academic outcomes by up to 30% (National Education Evaluation and Development Unit, 2022). One of the programmes include psychosocial support for students including groups for students with emotional and social challenges affecting their learning – these had been seen individually in the school as poor attendance of pupils. These groups aim to assist the students with copping strategies, mental health, stress management, leisure pursuits, reading clubs and career connect groups.

3. Peace, Justice, and Strong Institutions

SDG 16 promote peaceful, inclusive communities to ensure justice for all. Occupational therapists play a role in this by advocating for marginalised individuals and collaborating with different stakeholders in the community to influence policies and legal frameworks at play in the community to ensure inclusivity and justice for all. By using CBR matrix, OT can work in addressing the barriers for people with disability through identifying limiting factors in the community, what is available and what their need are. By collaborating with interdisciplinary members existing in the community, occupational therapists can advocate for structural changes and inclusive policies. By working alongside social workers, psychologists, can help identify and address the root causes of social ills like gender-based violence or lack of access to health care. This collaborative effort can provide a holistic approach to community care, ensuring stronger striving community that promote peace and justice.

4. Reduced Inequalities: promoting inclusion through occupations

SDG 16 focus on reducing the social inequalities in communities. In community like Cator Manor and Dalton where access to primary health, education, financial stability and housing is lacking, OT attempt to address these through education, outreach – health promotion and advocacy. Using CBR approach to integrate marginalised and disabled individuals into their communities and occupations. In the community programmes that improve access to education, skills development and social participation for everyone. This SDG can be addressed by the other programmes in the other gaols already mentioned as there is a link and carryover of programmes addressing more than one goal.

5. Gender Equality: addressing the societal perceptions – turning shame to power

SDG 5 aims to improve the gender quality focusing more on empowering and building a safe community for women and girls. In my community this talks into challenging the gender-based oppression and patriarchal views that cause occupational depravation and alienation in women. This can be addressed through providing intervention for men mental health as an approach to cerate safer community and homes for women and girls. These groups will focus on addressing stigma against men’s mental health, challenge toxic masculinity which contribute to poor health outcome for families and women. In my community we utilised groups like fatherhood, substance use group which incorporate men mental health and incorporating information on support available for men in health promotion. One of the approaches that I was thinking for the secondary school to is the psychosocial groups for teenage mothers by providing support, mental health screening and address the unique challenges faced by these girls. In one of the interventions to the school was incorporation of sexual health for women, contraceptives for young girls and encouraging safety in relationships – imparting information on the available support structures in the community including the school social worker, organisation in the school and local clinic. The recently started project was the women support group in Dalton community which is populated by informal settlements and rough sleeping individuals – this group was to promote maternal mental health, empower women through coping strategies and knowledge on support structures available for them in their area which include DHC and clinic in the area.

in conclusion, the community occupational therapist plays a vital role in achieving the Sustainable developmental Goals. From health promotion, support groups and sustainable programmes that are occupational based to reduce inequalities, facilitate occupational justice – OT touches every aspect of the community through utilization of CBR matrix as a frame of reference and foundation of therapy. In community like Cator Manor and Mayville infested with social ills, I got a chance to facilitate change and better health outcomes. As much we ensure sustainability of our programmes, we are still not sure of the long-term impact of these programmes. What else can a green scrubbed OT do to apply occupational science to achieve the sustainable development goals? It is questions like these that create the backbone of our profession, driving us to be critical thinkers and facilitators of social transformation as the way to build sustainable thriving communities.

[izwakele]

“Reflect on UKZN’s OT curriculum, the pros and cons in terms of preparation for practice at a community/PHC level”

The road to becoming a healthcare professional, especially in a field like occupational therapy requires more than a high caffeine intake and breathing exercises but a combination theory and practice. At the University of KwaZulu-Natal (UKZN), the Occupational Therapy program is designed to do this, equipping students with the foundations of critical thinking and work experience. But how effective is this curriculum in preparing students for the challenges they will face in real-world with under resourced environments? Does the program's focus on theory in the early years prepare students for the community practice, or does it leave a gap in their preparation?

The pros of this module is the carryover of content from one module to another ensuring triangulation during practice. University of KwaZulu Natal provide a 4-year programme with modules building on each other as the years goes which aid in ensuring their students learn critical thinking, improve ability to triangulate content from one module to another and ability to integrate theory into practice (University of KwaZulu Natal, 2019).  The first-year programme focuses on creating foundation for learning capturing components that will be essential for the students to grasp the content as the years pass (University of KwaZulu Natal, 2018). During the 2 years we focused on assessment on the theoretical level through being taught each client factor individually – this prepared me to be able to assess client factors comprehensively and as years went by, I was learned to prioritize and assess on the spot essential for community practice as we do have the luxury of time. The 3rd year focus on treatment for each diagnosis triangulate theory from assessments, fundamentals and use of therapeutic media to treat (University of KwaZulu Natal, 2018).

In my first year, I got exposed to community through use of primary health model – I was taught on types of communities and learned ability to identify the needs of the community which then is carried over to when we got to fieldwork and do clinical practice as they now able to consider context when assessing and treating throughout the years this programme incorporate service modules offered by other departments namely anatomy, clinical science, health and illness behaviour and research in honours level which also create a good foundation for integration to community practice (University of KwaZulu Natal, 2019). In this blog we will delve into how the way this programme is structured prepare the 4rth year students to practice at community level/ PHC looking at different components offered. Focusing on the pros and cons in preparing students for community practice.   

Pros for this curriculum is teaching the reality of our health care system – scarcity. To me scarcity is a promotive factor as it encourages critical thinking, flexible mind and speaks to our core values which is providing primary health care and meeting our sustainable goals irrespective of social determinants. What would stop a green scrubbed OT with a pink basket full of ideas, inspirations, therapeutic mindset. This fighting spirit allows us to provide therapy for all irrespective of lack of resources.  This programme is structured to be able to focus on the challenges of delivering OT services in under-resourced settings ensuring ability for students to work with client from different backgrounds. I’m in placed in a centre offering services to rough sleepers and address social illness – it does not have an occupational therapy department or working space – treatment tools, but I utilise what is available to offer holistic interventions to deserving marginalised clients. Most of the community placements do not have occupational based departments and students utilise the resources given by the university to ensure therapy for all.

The module highlights the importance of working within an interdisciplinary team to maximise therapy while distributing workload for proper use of resources available. This essential in the community as we are required to contact different community leaders and NGOs forming part of the community in addressing different social ills. The ability to negotiate and advocacy is made easier if we understand how to utilise the interdisciplinary team. I have interacted with different partners in the communities namely teachers, mothers, shop owners, municipality workers and members of the community encouraging shared goal – this approach ensured that the was contact communication with the stake holders and that the community was the primary beneficiary.

One of the things the fieldwork module stress on is multidisciplinary approach especially in clinical placements. I have seen long queues – people wanting to access primary health care and they end up spending more money and whole day in accessing health. MDT ensure that we can give clients value for their money and time by maximising therapy in less period of time. I have been utilising this approach in the community clinic I’m placed in through proving intervention for CVAs with physiotherapy and intervention for ASD/ADHD with speech therapy to ensure the client don’t spend long time in cues. In the placements (centre) I had collaborated with the social worker and psychologist in starting the women support group as there is high number of people requiring primary health care in on of the sites I attend to and requiring different services offered by these disciplines. The programme ensure that the student learn about services provided by different professionals.

Cons in this curriculum is the clash between clinical practice and the theoretical foundation. The curriculum in the 3 years focus more on providing students with theoretical foundation for practice which helps the students to be critical and transformative in community practice, enhancing clinical competence, professional confidence and ethical integrity. But in the first few years in this programme, I had been subjected to online learning limiting clinical practice this had made me feel underprepared and not confident in community practice – my treatment had been more theoretical based other than contextual due to spending more time using simulated client and seeing community in videos with no direct contact.  One of the modules talking to community practice is community studies in first year which was the most hated module among the students, but its contribution had made its impact now that we are in community block. The curriculum was adapted in 2021 to fit the online teaching method which limited us in going to different communities learning about community entry and understand the different structures that exist in the community. The need for practical aspect in this module talks to the incident that I had encountered on practice – the whole group had thought they have achieved community entry and only to be placed in an unsafe and life-threatening situation by members of the community. Although we could see that some of the members of the community understood contribution to their wellbeing not all of them had seen its benefits – this could’ve been something we picked when we were ambulating in the community. This could be because we were not integrated well into the community – as the students are forced into the shoes of the previous blocks not understanding that the community might not welcome us the same way. As much as they see the green scrub and its contribution, they also consider us as individuals and how we present themselves. This talks to the encounter where one of the community members expressed his hatred and prejudice for Indians as our group have one person from that ethnicity – this is clear indication that they consider our personal features. It could be nice that the students rotate in communities over the years as the community start to be entitled to certain things and reinforce their beliefs on therapists.

While community engagement is introduced early, more experiences and interpretation of what is seen in the community can be utilised to better prepare students for the challenges they face in community practice. During 3rd year we were placed in different placement to be orientated to how the community worked, and it looked simply because the 4th years students during that block had achieved entry and were riding on their reputation, we had made in the community thinking this was the reality for most communities – being accepted and welcomed. these incidents highlight the clash between theory and practice which the curriculum could not address due to the covid 19 lockdown levels, and the teaching methods used back then.

The UKZN curriculum, while provide theoretical knowledge but it also presents both opportunities and challenges in shaping students for community practice. The program’s emphasis on interdisciplinary, MDT approach, critical thinking and ability to practice in under resourced environments equips students with the tools necessary for holistic intervention. However, the clash between theory and practical experience, exacerbated by online learning lack of early exposure and poor community integration has left some students feeling underprepared for community practice. As I reflect on these experiences, it’s clear that while the curriculum has laid a good foundation which encourage evidence-based practice, there remains a need for a stronger emphasis on early clinical exposure in community practice. The question we should as ourselves is how this programme can change to better suit the needs of students in preparation for community practice.

References

Naidoo, D., van Wyk, J., & Joubert, R. (2015). Are final year occupational therapy students prepared for clinical practice? A case study in KwaZulu-Natal. South African Journal of Occupational Therapy, 44(3), 24–28. Retrieved from SAJOT.

University of KwaZulu Natal. (2018). Hands-On Opportunities - Discipline of Occupational Therapy. Discipline of Occupational Therapy. https://ot.ukzn.ac.za/hands-onopportunities/

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

Vermeulen, N., Bell, T., Amod, A., Cloete, A., Johannes, T., & Williams, K. (2015). Students’ fieldwork experiences of using community entry skills within community development. South African Journal of Occupational Therapy, 45(2), 51–55. https://doi.org/10.17159/2310-3833/2015/v45n2a8

Janse van Rensburg, E., & Du Toit, S. H. J. (2016). The value of a rural service learning experience for final year undergraduate occupational therapy students. South African Journal of Occupational Therapy, 46(1). https://doi.org/10.17159/2310-3833/2016/v46n1a4

[izwakele]

why maternal and child health is important to society. The analysis on how this has implications for Occupational Therapy practice, particularly at a community level, and life within community I work in

Maternal and child health is the key elements contributing to the survival of our communities. Due to increasing number of homes led by single mothers and women. According to stat SA, in total of 18 million households in South Africa more than two- fifths (42%) were headed by women with staggering 47% of women leading families in rural areas (StatSA, 2022). This is clear indication of the importance of equipping women in our communities with better health for the survival of our societies.

But for decades the government has been fighting the battle against psychosocial and economic barriers that hinder and contribute to death of women and children. Although the mortality rate of children dying under five years old is decreasing there are still concerning figures as of 2022, 4.9 million children died that is 13 400 children dying every day and according to the World Health Organization (WHO), approximately 810 women die daily due to complications related to pregnancy and childbirth (WHO, 2021). These numbers really set a different tone in the services delivered in ensuring the health of mother and child – these figures go beyond survival rates.

The psychosocial barriers mentioned in vast number of articles include pregnancy related complications and preexisting maternal diseases. In one of the studies done in South Africa the results highlighted the cause of poor health outcome for women. Those causes were poor facilities, lack of primary health care, poor referral system form clinics to hospitals, no antenatal care, lack of awareness, lack of appropriate trained staff, poor assessment and recognition of these diagnosis (Mabaso et al., 2014). All these could have been avoided and contained within the health system.

The importance of maternal health in our society exceeds survival for all. What the society fail to understand is that a healthy mother can be able to provide the health environment for a child leading to proper development (Phua et al., 2020). One of clients seen in psychosocial block was admitted for acute psychosis said the reason she was failing to fulfil her roles - poor ability to take care of her 2-year-old child leading to malnutrition of the child was due to lack of support from her family (her immediate society) – her words were “I can’t pour from an empty cup”. Poor maternal mental health can have a negative impact on children health, hindering their development and contributing to cycle of poor health outcome further disabling our societies. In essence good maternal and child health create a good society as children can grow and contribute to the betterment of our communities

The poor maternal health in South Africa is the leading cause to poverty in homes as the mothers are too weak or too sick to work. Thus, further increasing the unemployment rate, burden in tax, dependency on men contributing to abuse of women and children. All these create cracks in our already bleeding society. One of the things I had noticed in the community in informal settlements when mothers brought their children to the ECD was the lack of life, poor health and poverty. One of the mothers was walking slow and poorly kept – this made me think about how she was managing the home, how she also needed taking care of. Most of the mothers when they bring their children, they go to the clinic in the property to get their medications and food – they are facing issues like abuse, poverty, poor housing, stigma and poor mental health.

Occupational therapy has a crucial role in addressing the psychosocial barriers that hinders maternal and child health especially in community level as this profession take pride in providing primary health care accessible to all and tailored for the needs of the people. In the community levels services like health promotion and outreach programmes are utilised in addressing stigma and raising awareness in services available for women in occupational therapy (Lassi et al., 2016).  The occupational therapist utilises tools like advocacy for women and equipping them with skills/opportunities to advocate for themselves. Occupational therapist also plays a role in prevention through use of education about postnatal care, child development and maternal mental health. One of the OT interventions is providing therapy in primary health care like screening developmental delays, support groups tailored for the needs of the community, psychosocial support, and intervention for physical limitations (Lassi et al., 2016).

Occupational therapist in the community needed to utilise observations and black consciousness when working in the community as most of the things can not obtained from files or interview with patient as the community as a whole is recognise as a patient. Therapist should reflect and questions their intervention at all times as the community is forever changing. I had noted that most of our projects in the community are only effective for a certain period of time irrespective of sustainability measures in place as the communities’ changes, it could be either new barriers are emerging or there is improvement in health outcomes- which is why it essential for community OT to be flexible and adapt to the changes in people’s lives

The intervention for physical limitations focusses on management of illnesses – this requires OT to be equipped with principles of rehabilitation and remediation when working with clients. This had been on of the difficulties I faced in community as I was now used to treating clients in acute phase. I had struggles with identifying the correct intervention for the client with CV from 2 years ago, when I found out she had learned independence in herb ADL, social participation and IADLS – I had found myself confused on what to do next. It Is essential that when community OT are in acute wards to think further on to what the management strategy for this client will be if she was seen in the community level.

In conclusion, maternal and child health should the priority especially in primary health care as it is the future of our communities. As we pride ourselves in evidence-based practise, occupational therapist in community level should utilise research in understanding what is required by different communities and be critical thinkers that see the community for what it is.

References

StatSA. (2022, October 19). Economic, social and political empowerment are critical for achieving gender equality in SA | Statistics South Africa. STATS SA. https://www.statssa.gov.za/?p=15833

Mabaso, M. H. L., Ndaba, T., & Mkhize-Kwitshana, Z. L. (2014). Overview of Maternal, Neonatal and Child Deaths in South Africa: Challenges, Opportunities, Progress and Future Prospects. International Journal of MCH and AIDS, 2(2), 182–189. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948143/

Phua, D. Y., Kee, M. Z. L., & Meaney, M. J. (2020). Positive Maternal Mental Health, Parenting, and Child Development. Biological Psychiatry, 87(4), 328–337. https://doi.org/10.1016/j.biopsych.2019.09.028

Lassi, Z. S., Kumar, R., & Bhutta, Z. A. (2016). Community-Based Care to Improve Maternal, Newborn, and Child Health (R. E. Black, R. Laxminarayan, M. Temmerman, & N. Walker, Eds.). PubMed; The International Bank for Reconstruction and Development / The World Bank. https://www.ncbi.nlm.nih.gov/books/NBK361898/#:~:text=Results%20from%20a%20systematic%20review

[izwakele]

WHAT CLIENT CENTRED MEAN TO ME ?

[gets on a stage – crowd goes wild] Hey everyone!! it’s been a minute …welcome to MY OT space I’m sure you all look forward to hearing about this week” [takes a sit}

My understand of client centeredness is deep rooted in models and frame of reference we use in OT. like with MOHO client centredness is divided into 3 subheading namely occupational performance, occupational identity, and occupational competence – when understanding a person, I need to understand all these concepts which will talk to my intervention planning the whole process gives birth to client centeredness. Client centredness is a process of holistically viewing a person and understanding the therapeutic implications of context, past experiences, culture, religion, values, belief and then work timelessly in coming up with intervention that is in line with all these. Client-centeredness was part of Carl Roger’s work – a clinical psychologist that came up with client centeredness therapy – his theory was circulating around these concepts -congruence, acceptance, and empathy. You can watch a video of interview with carl where he explains client centred approach - https://youtu.be/QyJ3mvQousc

Having said all that I ensured client centredness in my interventions by investing time into screening and interviews where the client shares everything about them and things that I can take an assessment form and assess – these things will help me with coming up with intervention sessions that my client will enjoy and that will also be therapeutic. My therapy emphasis on a client's autonomy and right to choose goals and interventions based on his or her identified needs and wants. After conducting interviews, reading client’s file and screening I go back to OT theory and analyse what all these mean for my client – I consult with Models, Applied frame of reference and programmes that will mostly offer my client maximum therapy. The use of different literature in OT books namely – Merck Manual (https://www.merckmanuals.com/professional) and Occupational Therapy for Physical Dysfunction.

I also ensured client centred in my intervention by understand the importance of roles with the interaction with client – understanding that the client is an important partner in everything. During session I followed ethical conducts like autonomy, beneficence, non-maleficent, and accountability. In understanding all these I was allowing my client to be the one to drive therapy.

During implementation of intervention, I allocated time for feedback so that we can evaluate the session with the client and note the changes for next session to ensure that the intervention is always in line with the client and that the session is within the client’s interest and needs. Evaluation is part of continuous OT process – this was to allow for flexibility in therapy and to ensure client satisfaction at the end of therapy.

I spent almost 30 minute after my sessions to evaluate and make proper deductions from my observations and findings – this was to ensure that during evaluation with supervise I get to go over everything and get feedback on everything – a therapist can see and observe the session but still miss some of the deductions in this case evaluating with supervisor gives opportunities to go over things you may have missed and to come up with principles for next session on things you might have mistakenly deducted.

Besides evaluation from supervisor, I also get evaluation from my peers – after firework we get to talk about our session and experience at large this is the time where we go over everything and ask questions about things we did not understand. Our supervisor sometimes mask feedback but peer evaluation gives details and deeper understand. They helped understand some of the things that happened during session that I may have missed when I was evaluation with my supervisor.

Read about client centeredness' here - https://marcr.net/marcr-for-career-professionals/career-theory/career-theories-and-theorists/client-centred-theory-rogers/

it always a pleasure sharing my experience with other people … 😊😊

[izwakele]

“…From theory into practice: MY FIRST WEEK OF FIELDWORK …how does treating make me feel…”

🤞❤Welcome - I'm Izwakele ..Hi I hope you're enjoying your evening

I'll just get into it don't wanna make it awkward😂...the first day of fieldwork I was conflicted by many things – having a new supervisor, will my clients like me … am I prepared … is my preparation enough – the last thing you need for fieldwork is your preparation to be not in line with your day. My first thought meeting the King Edward stuff was that they know their work and it will be tragic for me to not know mine. Another fear that cripples me during the first day is the diagnosis you will come across with cause they speak to the treatment principles and planning you have to provide and my previous supervisor always gave me neuro case and in one of the lectures Deshini mentioned that it will be misfortune for me if I don’t become a  Neuro OT one day seeing the love and excitement in my face for a human brain  – it is exciting but scary at the same time  

Me being strong willed and unshaken I could take on any case I told myself over and over gain sitting on red chair in a 4 walled room filled with new aspiring therapist like myself and a wishful supervisor … until a small paper written “gastritis “was placed in front of me … and the life changing question from me to my supervisor was “what is my job “cause at that point to me a clinical picture was painted in my mind and there was no enough clinical reasoning to convince me a mere stomach ache is my scene as a therapist.

My first time treating - my first time seeing gastritis client I went to the wards unshaken , determined and confident in what I know cause no one was gonna give me the validation I needed – there she was [smiled in pride and joy at the good memory] 73 years old Gogo - her face lighted up when she saw me and I knew we were going to get along like house on fire – and we sure did.  A good rapport between therapist and client is the foundation of a good intervention and a satisfied client. Clients sometimes reveal secrets, worries, and fears to therapist which are essential for client-based interventions, but they can only disclose to someone they trust and that someone must be you as an OT – work towards that and prioritise it. Them placing trust in you as a Therapist and your services helps them to maintain a healthy confidence toward their health or look forward to gaining from you and lastly to comply to therapy for sake of well-being and that strong need to engage in meaningful occupations. This unique relationship encompasses 4 key elements: mutual knowledge, trust, loyalty, and regard – and I believe with all my clients that I have seen so far, I have managed to keep these components as a foundation of my intervention.

I have always allowed my self to take criticism and feedback with positivity and spirit to go out there and fix those issues as soon as possible -  in these 2 weeks I’ve looked forward to feedback and evaluation from my supervisor cause I wouldn’t know where to improve and what to work on – another thing that always stayed with me and leaves a bad taste is me seeing students prioritising passing over experience and reflection – ‘’my supervisor hates me – I’m failing “… “I’m over this .. OT is not for me “… they fail to understand that it all comes to you and what you have done to improve – I have improved a lot and there was a lot of learning and research I needed to do to reach the stage I think I’m in and it all comes back to you and your perspective of everything around fieldwork.

Treating is way different from assessment and all those sessions we planned in 2nd year or 1st year notes we studied – in here you are working towards a bigger goal – them going home with enough tools for them to engage in meaningful occupations. In this placement I’m in – in most cases there are no opportunities to work toward that “bigger goal” due to high client turnover – now one need a skill to think on the sport and prioritize treatment. I think I have established a new way to work around that - “know your prognosis and client value” then prioritize that – prioritize your assessment… prioritize research and evidence “you are a evidence based OT – understand that” said my lecture Dineo in one of her lectures  … adapt on the spot and always be aware of your shortcomings those are the things you need to always work on … don’t leave things for last minute. Those are the tools I equipped my self within this work of a solder – the sooner you understand you are in war with time the better.  Treatment gave me sense of belonging in the OT world – it gives me hope and that urge for excellency and creativity is fed during treatment when you get to drive therapy – where it all come to you –when it is all about a client but also about you [give yourself credit when it is due]. “it’s all come to you” I tell myself this each day when I put my scrub on.

Another things to touch on is my improvement in writing skills – the OT wording and jargon is finally kicking in – all that time I spent reading articles from google scholar and that never ending browsing of  Pinterest – my favourite is the Pinterest community called ‘MY OT Spot - https://www.myotspot.com/ ” – they always have new approach to treatment from all over the world and we get to share experience with every OT out there.

in conclusion it’s been a joy ride for the past 2 weeks as much as I survive on 2 to 3 hours of sleep every day🤣🤦‍♀️, I still prioritize my experience and growth over everything and that’s all that matters – EXPERIENCE AND MEMORIES!!

[drops microphone and leaves stage, audience goes wild - they've never seen someone so passionate about life] 😂😂😂hope you enjoyed my Blog