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REFLECTIONS ON MY COMMUNITY BLOCK: A 4TH YEAR OCCUPATIONAL THERAPY STUDENT PERSPECTIVE

As I write what I believe is my last blog of the year, possibly and hopefully the last blog I will ever write as a student, I reflect on my journey in my community block. For the past 5 weeks, I have had the pleasure and the privilege to serve the Cator Manor Community and the people at the Denis Hurley Center. I have to say, I am filled with gratitude to have been exposed to such a community. Not only has it helped shape me as a student, but it has also helped teach me invaluable lessons that I believe will be useful to me as a future health practitioner.

Serving the Cator Manor community, an under-resourced community with most of the people falling in the lower socio-economic status, I encountered and worked with people with various health challenges including, but not limited to hand injuries, strokes, people in need of wheelchairs, and children with ASD. While working in this community, I came to realize that contrary to my preconceived assumptions about community practice, even though the people come from the same community and share similar cultural backgrounds, each of them has their own story. By understanding that, I believe I was then able to fulfill our roles of promoting health and well-being (AOTA,2020), and ensuring people can participate in occupations meaningful to them. Through collaboration with other healthcare practitioners in the clinic, which included, but was not limited to, having joint sessions with physiotherapists, we did our part in fulfilling the aim of holistic care through the Multidisciplinary approach, which optimized outcomes for our clients (Bonder & Dal Santo, 2018). 

Personally, throughout this blog, my favorite task was running group sessions. With the occasional assistance from my colleague, I ran the Women's Support Group, to create a haven for women to share their struggles while creating a community that fosters a sense of universality, and empowerment (Change, 2023). In the Substance Abuse group, I witnessed the power of community support as group members actively supported each other in their recovery journey (Baker, 2024). I learned to utilize the group members who are further along in their recovery road to encourage others by sharing their stories and coping strategies. These 2 projects, I hold dear and am passionate about, as I have personally witnessed a lot of people in need of such groups in my own community, which includes family members of my own.  In a local high school, my colleagues and I ran groups that allowed us to target the youth through mental health promotions, education, and addressing underlying issues at an early age.

However, my journey was not without challenges. At some point during my community block, a colleague and I had a traumatic experience where we were mugged of our personal belongings. It was very hard as we had to go back to that same community. Matters did not get any better when I ran into the of my victimizers in the community at some point, which triggered me as I felt unsafe, frustrated, and frankly, quite vengeful. This led to feelings of PTSD, as I felt unsafe when serving the individuals in the DHC, as I was constantly on edge and in a defensive mode as if someone were to attack me at any time. After realizing how this was impacting how I was serving the community, I started to reconsider the idea of seeking therapy. So, I digest…

Anyway, I am proud to report that throughout this block and academic year, I discovered my ability to be resilient, and to rise above adversity.  As I come a step closer to concluding my training as a student, I plan to take these lessons and acquire the tools I learned along the way to continue to strive to carry the values of Occupational therapy to communities I have yet to serve.

REFERENCES

American Occupational Therapy Association (AOTA). (2020). Occupational therapy practice framework: Domain and process (4th ed.). AOTA Press.

Baker, S. (2024, March 1). The Importance of Building a Community in Addiction Recovery. Iron Bridge Recovery Center. https://ironbridgerecovery.com/articles/the-importance-of-building-a-community-in-addiction-recovery/

Bonder, B. R., & Dal Santo, J. (2018). Occupational therapy in community-based practice settings. Jones & Bartlett Learning

Change, A. of. (2023, October 16). Empowerment in Social Work: Techniques and Importance. Agents of Change Social Work Test Prep. https://agentsofchangeprep.com/blog/empowerment-in-social-work-techniques-and-importance/

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Addressing Sustainable Goals in Occupational Therapy.

In a country like South Africa, there is a huge need for development implementation. People from all walks of life, and professions must work together towards achieving the goal of getting the country more developed. This includes the occupational therapy profession. This blog will explore how I, an occupational therapy student, have been, and plan to continue addressing some of the Sustainable Development Goals in a community like Cator Manor, a community facing a lot of socio-economic challenges such as unemployment, poverty, crime, substance use, and poor infrastructures.

 

 As an occupational therapy student currently in the community blog, my colleagues and I have been doing our part in the movement of implementing some of the Sustainable Developmental Goals in the community we are currently serving. For the sake of this blog, I am only going to mention 5 of the SDGs, namely; No poverty, Zero Hunger, Quality Education, Good Health and Well-being, and Gender Equality United Nations (2023).

For the past 3 weeks, I have had the pleasure and the privilege of serving the community through services I provide in the community clinic, local creches, the primary, and secondary school. Through these services, as minuscule as they may seem, I would personally like to believe that I have been doing my part in bringing positive change in the community, promoting occupational engagement to some of the community members, and somehow enhancing life in the community as a whole.

According to the United Nations (2003), the Sustainable Development Goal of No Poverty aims to alleviate Poverty in all shapes and forms.  As an occupational therapist, I have a duty that includes encouraging and enabling community members to develop job skills, rehabilitate the injured, and prepare them for job integration, and encourage the community to consider exploring sustainable incomes through self-employment, such as starting vegetable gardens, all in the name of trying to improve economic independence (Durocher et al.,2016).

The idea of the vegetable garden can ultimately work on another Sustainable Goal, which is Zero Hunger. And in the interest of the sustainable goal, of Zere Hunger, we, as Occupational Therapy students have had the pleasure of helping in the community feeding scheme that serves food outside the community hall.

In a community facing socio-economic challenges, quality education is of significant importance for all willing to receive it. This would ultimately offer the community more opportunities such as getting more people into higher education and bettering their chances of getting more jobs. In a community like Cator Manor, schoolers were reported to be abusing and selling drugs, having behavioral issues, and also facing hardships in their school and personal lives. We, as occupational therapists, have an important role in helping teachers and social workers address the needs of students with learning disabilities to enhance engagement in education (Durocher et al.,2016). We also run groups and individual interventions for psychosocial challenges such as peer pressure and substance use.

While working in the Clinic, I also have the opportunity to address the Sustainable Development Goal of Good Health and Well-Being. My colleagues and I have been doing health promotions almost every day, aimed at informing the public about services Occupational Therapy and other medical professionals in the clinic offer. We worked on raising awareness on Mental Health (anxiety and depression, substance abuse, traumas), and addressing the often-overlooked Maternal Mental Health (Wednesdays at the Philamntwana Clinic). We also looked at barriers the community members face that prevent them from engaging in meaningful occupations, all to promote Good health and Well-being.

In a school with social workers, there were a lot of reports of scholars witnessing and experiencing Gender-based Violence, at home and the school, I had the pleasure of doing a group session that included promoting Gender equality. This was aimed to address social and cultural norms that are unfair to women and provide psychosocial assistance to those experiencing these inequalities.

As many of our academics say, as occupational therapists, we are agents of change in communities. Through advocation and promotion, we can address Sustainable Developmental Goals. As much as we cannot address these with every single individual in the community, I believe through engaging with some of the members, we can create a ripple effect that benefits the community. Still, until then, we are going to do what we can, one step at a time.

REFERENCES

Durocher, E., Gibson, B. E., & Rappolt, S. (2016). Occupational justice: A conceptual review. Journal of Occupational Science, 21(4), 418–430.  https://doi.org/10.1080/14427591.2013.775692

United Nations. (2023). Sustainable Development Goals. https://sdgs.un.org/goals

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UKZN OT Curriculum, preparing students for Community Practise

According to a quick internet search, there are 7 different Universities in South Africa that offer the Bachelor of Occupational Therapy Degree, with the University of KwaZulu Natal being the only one situated in KZN.  Like most Health Sciences degrees, the Occupational Therapy Degree period of study is 4 years, with the students graduating with an Honors Degree. Occupational Therapy students are fortunate enough to be allocated to places to do Community Service for the year after completing their degree. That certainly takes a load off

A few weeks ago, I, a 4th-year occupational therapy student, also found myself having to apply for various possible placements for CommServe 2025, in case I pass of course. And yes, it could go either way. I suffer from a lot of things as a student, but ‘Dilulu’ isn’t one of them. I am not going to pretend like it's been a walk in the park and that I have this in the bag. It has been quite a struggle with honestly, more downs than ups. I have shed more tears for this degree than I have ever shed for anything, and probably acquired lifetime traumas along the way…. Sorry, my subconscious self took over there for a minute. What were we even talking about? Oh yeah, the Occupational Therapy Curriculum.

Okay, before we delve into the curriculum, can I just say just how much respect I have for this profession and the discipline? According to multiple conversations I have had with students (both within the Occupational Therapy Discipline and in other Disciplines), a lot report that they feel that the Occupational Therapy discipline is arguably one of the most hard-working disciplines in the UKZN Westville Campus. Inkosi impela baqinisile uma bethi “le Degree akuyona eyolamthumthu ripped arm emoji”(it is not for the weak or faint-hearted.

From the very first step in the first year, being introduced to 4 Anatomy modules, after not having gone any further than human reproduction in the 12th grade, that is quite a leap. But before I go any further, I have to be honest.

In the topic of the UKZN OT curriculum preparing students for practice, I don’t think I'm part of the best generation to comment accurately on that topic. As part of the COVID-19 student generation, we probably did not experience the OT curriculum at its very best. As the pandemic was relatively new in 2021, everyone was still integrating into online learning. Almost every lecture and class was held online, including Anatomy spotters and ironically, Community Studies lectures. Get it? Community Studies lectures online, with students not able to visit the community they are training to serve rolling eyes emoji. So that’s how we began our journey, with online classes and online tests, robbing us of a true university experience.

Fast forward to the 2nd semester of the second year, where we were integrated back into normal university life. A huge transition, from barely ever attending contact lectures to attending full-time. With no time to ease into it, we were thrown into the deep end.

I recently took a look at a research study by Thavanesi Gurayah (2022), which aimed “to explore facilitators and barriers to completing an occupational therapy degree at the University of KwaZulu-Natal” by interviewing 7 graduates from the Class of 2015. According to said study, the graduates interviewed found the OT curriculum “academically challenging”. However, the study concluded by saying that the participants reported that the experience gave them the “opportunity for personal growth.”  

I am afraid to report, that I do not share the sentiment. Personal growth, at what time? Under the UKZN OT curriculum, the students are overworked, with barely any chance to recover from one block to another. As for preparing students for working in the community level, it is hard to say given that we were not exposed to working in/with actual communities until the very last year, and for a 6-week block, like that’s supposed to be enough?

I have to be honest, I envy the Class of 2015. From the study, they seem like they have positive remarks to make about The UKZN OT curriculum. I wish I could also say despite all the rollercoasters, I found a way, an opportunity for “personal growth”. I wish I could talk about anything other than the traumas, self-doubt, and emotional scars I have acquired under this discipline. I don’t know. Maybe someday I might look back and find great things to say about the experience here. Maybe someday, but that day is not today.

REFERENCES

Thavanesi Gurayah. (2022). An Exploration of the Facilitating Factors in Completing an Undergraduate Occupational Therapy Degree at the University of KwaZulu-Natal, South Africa. Africa Education Review, 19(3), 1–18. https://doi.org/10.1080/18146627.2023.2278050

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Maternal and Child health in rural South frica.

“Hold on, what do you mean you have no idea what that even means?”  

“It’s 2024 and women and children are still overlooked. Why am I even surprised?  I mean, nothing new there!”

This was my response when I tried to engage one of my friends in a conversation about Maternal and child health. I must admit, I was quite shocked and disappointed, considering this friend of mine is a new father. I thought we would be a lot further than this at this point in life. This goes to say, “We are not yet Uhuru”.

I’ll say, that although I am not much of a blogger, this topic is one I feel quite passionate about. South Africa’s health is an ongoing crisis with detrimental implications for individuals, families, and communities. Although efforts have been made to address maternal and child health, with it being part of arguably one of the most important of the MDGs (Koblinsky, M., Anwar, I., Mridha, M. K., Chowdhury, M. E., & Botlero, R. (2008)), it is still a huge health concern. I am not going to bore you with the stats, as I am sure countless others have.

Having grown up in a rural area and now being exposed to and working with less privileged communities as an occupational therapy student, I have seen a lot done to address to enhance child health. From the free health care, including check-ups at the clinic before and after birth, to the promotion and provision of free vaccinations (Wagstaff et al., 2004), which coincidentally, I saw being done 2 days ago (measle vaccination) in a clinic where I was doing health promotion on maternal health, promoting physical and mental health and overall well-being mothers.

However, the focus on maternal health usually ends after giving birth. Important factors such as postnatal depression (Almalik, 2017), postnatal anxiety, and burnout are often overlooked. What people fail to understand is just how linked maternal health and child health are, as a tired, burned-out mother cannot fully take care of a child. See the dilemma there?

One of the things I have observed is that in communities, maternal health is often ignored, focusing only on the child's health and well-being. As an occupational therapy student, I tasked myself with doing the best I could to address this imbalance. I am currently providing education and raising awareness about maternal health during the women's support groups that will also provide education to even those who are not yet mothers. I also plan to address matters during the fatherhood groups I plan on establishing in the community, to ensure the women get the support they need at home.

The crisis of overlooked maternal and child health needs to be tackled by the whole community to get better outcomes. As an occupational therapy student, I know I cannot do it alone, but I am committed to doing my part. After all, children are our future, and women are the pillars of our society. Let us take care of them to ensure a healthier society and future.

Almalik, M. M. (2017). Understanding maternal postpartum needs: A descriptive survey of current maternal health services. Journal of Clinical Nursing, 26(23-24), 4654–4663. https://doi.org/10.1111/jocn.13812

Koblinsky, M., Anwar, I., Mridha, M. K., Chowdhury, M. E., & Botlero, R. (2008). Reducing Maternal Mortality and Improving Maternal Health: Bangladesh and MDG 5. Journal of Health, Population, and Nutrition, 26(3), 280–294. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740701/

Van den Broek, N. R., & Falconer, A. D. (2011). Maternal mortality and millennium development goal 5. British medical bulletin, 99(1), 25-38.  chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.researchgate.net/profile/Nynke-Broek/publication/51619843_Maternal_mortality_and_Millennium_Development_Goal_5/links/564c9d5508ae635cef2a75b5/Maternal-mortality-and-Millennium-Development-Goal-5.pdf

Wagstaff, A., Bustreo, F., Bryce, J., & Claeson, M. (2004). Child Health: Reaching the Poor. American Journal of Public Health, 94(5), 726–736. https://doi.org/10.2105/ajph.94.5.726

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A Mental Health Factor That Has Created a Dilemma in South Africa 

There is a storm silently brewing. A storm so complex and multifaceted, with significant consequences for individuals, families, and communities: ALCOHOLISM, a mental health factor that continues to wreak havoc in South Africa. 

Alcohol has engrained and deep-rooted itself into the South African society. Having transcended age, gender, and socioeconomic status, with widespread availability and cultural acceptance of alcohol that has normalized excessive drinking, South Africa arguably has the highest rates of alcohol consumption in Africa (Filby, 2023). 

Alcoholism as a mental health factor. 

Alcoholism significantly impacts individuals’ psychological well-being. Common mental disorders such as depression, anxiety, stress, and increased risks of suicide can be risk factors of alcoholism (Obeid et al., 2020), as people often turn to alcohol as a coping mechanism. 

Mental health services in South Africa are often under-resourced and underprioritized even worse with the stigma surrounding mental health and addiction, people with alcohol use disorders suffer in silence due to the fear of being judged and discriminated against. Individuals do not get the help they need further deepening the dilemma. 

The consequences of alcoholism do not just affect the people abusing alcohol. It affects those around them, including families and communities. It contributes to the high and rising levels of domestic violence, child neglect, and GBV. It has been recognized that children who grow up in homes exposed to alcohol abuse are at a higher risk of developing mental health issues such as depression, anxiety, and stress, which further continues the circle. 

Alcohol abuse often plays a huge role in crimes and violent behaviors such as domestic violence, public disturbances, and road accidents. These incidents take a toll and have a negative effect on law enforcement and healthcare-care system, which turn into a health and safety dilemma. It also has an economic burden as these resources could have been used to address other issues in our society. 

In recent years, South Africa has been taking steps to address the issue of substance abuse. This includes increased awareness campaigns, support for community-based treatment, and a growing recognition of the importance of mental health services.

Alcoholism as a mental health factor has created a profound dilemma in South Africa.  To address this dilemma, there’s a need for increased access to mental health services, and a shift in societal attitudes toward addiction and mental health. Only by recognizing and addressing the mental health aspect of alcoholism can South Africa hope to navigate the storm and emerge into a brighter future. 

REFERENCES 

Filby, S. (2023, May 29). Drink up, it’s closing time: South African study calculates that limiting opening hours will save lives. The Conversation. https://theconversation.com/drink-up-its-closing-time-south-african-study-calculates-that-limiting-opening-hours-will-save-lives-205700#:~:text=South%20Africans%20are%20among%20the 

Obeid, S., Akel, M., Haddad, C., Fares, K., Sacre, H., Salameh, P., & Hallit, S. (2020). Factors associated with alcohol use disorder: the role of depression, anxiety, stress, alexithymia and work fatigue- a population study in Lebanon. BMC Public Health, 20. https://doi.org/10.1186/s12889-020-8345-1 

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Occupational Therapy Perspective on Sam Cahill's Mental Health Struggles in the movie "Brothers". 

I watched the movie ‘Brothers’, starring Toby Maguire (as Sam Cahill: Marine Corps Captain), Jake Gyllenhaal (as Tommy Cahill: Sam’s Younger brother, ex-convict released a few days before Sam’s deployment), and Natalie Portman (as Grace: Sam’s wife and mother of his 2 daughters and high school sweetheart) 

In the movie, Sam Cahill, a Marine Corps Captain survives an ambush that took the life of most of his platoon. He survives with one of his men. They are then captured and held as prisoners of war in Afghanistan. After months in captivity, Sam is forced to choose between his life and the other Marines. The Taliban forced Sam to brutally beat other marines with a steel rod to death.  

 Back home and to the US Military, Sam and his entire platoon are presumed dead. His family mourns him, and his ex-convict brother (Tommy), steps up and takes care of his wife and children by doing necessary renovations around Sam’s house and takes the kids out to play and inadvertently takes on a fatherly role to his nieces as they grow attached to him. One night, Tommy and Grace happened to kiss, they both regretting it right after.  

 Sam is rescued by the US army. Upon his return home, he experiences intrusive memories, nightmares, and emotional numbness, which according to (Symptoms of PTSD, 2021), these are classical signs of PTSD.  

These symptoms affected his ability to engage in social participation. Sam's relationship with his wife is strained and he is unable to connect with his daughters as he is emotional numb. He first shows when his daughter makes a joke, and he questions it and vocalizes it's not funny. He also screams at his daughter. Sam ends up avoiding social activities and avoids his wife and kids due to his emotional distress. 

Sam suffers from survivor's guilt (TN & States 877-467-3123, 2023) when he sees the widow and toddler of the Marine he was forced to kill. When the widow asked how her husband died, he lied and said he was not there when he died.  

Sam experiences paranoia. According to the article ‘Paranoia and PTSD: Are They Linked? | BetterHelp (2019)’ paranoia may not be directly related to PTSD but can follow a traumatic experience. Sam shows paranoia when he is in his kitchen at night, and he hears dogs barking. He immediately pulls out his pistol and is ready for combat. He also accuses his wife and brother of adultery. He wrecks their kitchen in a rage, screaming and yelling. He pulls his gun on his family and the cops are called. He considers killing himself by suicide by cops. Failing that, he puts a gun to his head Fortunately, his brother talks him down. He was committed to a mental institution, where he received the help he needed, and by the time he came out, he was a changed better man. 

While watching this movie, I appealed to the therapist in me. It certainly opened my eyes a lot because I was able to identify a few ways an OT could intervene. Cognitive behavioral Intervention could have helped Sam manage his intrusive thoughts and reduce anxiety and emotional distress (Cognitive Behavioral Therapy for Veterans - Heroes’ Mile of DeLand, FL, 2020).  

 Social Reintegration could have helped Sam rebuild his social skills. By using group therapy and social skills, he could eventually overcome his social isolation. Family therapy could also help improve communication and understanding to promote healthier interactions. 

REFERENCES 

Symptoms of PTSD. (2021, January). Www.mind.org.uk. https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd-and-complex-ptsd/symptoms/ 

TN, & States 877-467-3123, 37228 U. (2023, October 23). Understanding & Learning How to Deal with Survivor’s Guilt. Centerstone. https://centerstone.org/our-resources/health-wellness/understanding-survivors-guilt/#:~:text=Understanding%20survivor 

Paranoia and PTSD: Are They Linked? | BetterHelp. (2019). Betterhelp.com. https://www.betterhelp.com/advice/ptsd/are-ptsd-paranoia-linked/ 

Cognitive Behavioral Therapy for Veterans - Heroes’ Mile of DeLand, FL. (2020, July 20). https://www.heroesmile.com/cognitive-behavioral-therapy-for-veterans/ 

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Therapeutic Use of Self

As an occupational therapist, the goal is to help clients be as independent as possible. It has been said that therapeutic use of self can have a significant difference in therapeutic outcomes. 

According to (Mosby’s Medical Dictionary, 2009), therapeutic use of self is the thoughtful and deliberate use of the health care provider’s personality, opinions, and judgments as a component of the therapeutic process. 

Therapeutic use of self can be the difference between a successful treatment and a disconnected treatment. It allows the therapist to build a good rapport with the client which could improve client engagement, collaboration, and the overall treatment experience for both parties involved. 

According to a blog titled 3 Ways Therapeutic Use of Self Can Improve Patient Outcomes, (2023), therapeutic use of self can be as easy as being empathetic, being genuine, and being vulnerable/open. By being empathetic, one can try to understand the clients' experiences and emotions by putting themselves in the clients' shoes. This could help in understanding the clients’ perspective so that the treatment planned could be meaningful. Therapists could also create a safe and supportive environment for the client to be comfortable sharing that without the fear of being judged. The client can show vulnerability within the professional context to connect with the client on a human level, thus creating a deeper level of trust and empathy.  

Over the course of my student career, I have been using therapeutic use of self. Believe it or not, I started using it even before I knew of such a concept. Somehow, it felt right to do things this way. With each given client, I would always try to put myself in their shoes to try and see things from their perspective for better engagement moving forward. The important thing to remember when doing this was to never lose sight of the actual case. I might try to relate but at the end of the day, I'm not the one going through whatever they are going through, so what they say matters more than what I think. 

I have always tried my best to create a safe environment for clients so that they are comfortable enough to share. I would try to treat them as I would like to be treated if the roles were reversed. However, it is always important to remember that people are not the same and some would not take to such an environment and be able to share, and it would not be by any fault of mine.  

Being open means the therapist would share a little about their vulnerable side. When it comes to this, I try to share as little as I possibly can about myself to keep each session in the present. 

There is a very thin line between building good rapport and oversharing to a point of no return that might change the relationship dynamic to a point of no return. So, the concept of therapeutic use of self should be used properly to get good therapeutic outcomes. 

REFERENCES 

Therapeutic use of self. (n.d.) Medical Dictionary. (2009). Retrieved September 14, 2023, from https://medical-dictionary.thefreedictionary.com/therapeutic+use+of+self 

3 Ways Therapeutic Use of Self Can Improve Patient Outcomes. (2023, May 2). MedBridge Blog. https://www.medbridge.com/blog/2023/05/3-ways-therapeutic-use-of-self-can-improve-patient-outcomes/#:~:text=Incorporating%20empathy%2C%20authenticity%2C%20and%20vulnerability%20into%20your%20therapeutic%20use%20of 

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Mental Health Is Known as The Cinderella of Health Care.

‘Mental health being the Cinderella of health care.' I honestly can’t say I’ve ever heard anyone say it better. Like Cinderella’s glass slipper, this fits perfectly.

(Redirect Notice, 2023)

Now, why is Mental health known as the Cinderella of Health Care? To understand that, you would have to be familiar with the story of Cinderella. Don’t worry, I don’t know it either, shhhhh 🤫! According to a quick internet search and the tens of memes I have come across relating to the ‘Cinderella’ story, it is about a young girl who loses her father at a young age, leaving her under the care of her abusive stepmother and two stepsisters. Cinderella is neglected and overlooked in her household.

(Redirect Notice, 2015)

Now, here why this topic is so fitting. A lot of people can agree that when compared to physical health, mental health is the rather neglected and not given nearly as enough attention it deserves. According to the Mental Health and Integration: Cinderella or the Ugly Sisters? (n.d.), “The phrase ‘Cinderella service’ is often applied to mental health in the UK in respect of the lack of funding that it receives in comparison to physical health treatment services.” Most of the funding goes to countering and dealing with and treating physical disabilities than mental health.

According to an article posted by The State of Mental Health in South Africa | EAPA-SA, n.d.), South Africa ranks as one of the worst countries in the world regarding mental health. According to this article, South Africa spends about 5% of its total health budget on mental health. Poor South Africans have the worst end, as there is a lack of accessibility to mental health care in the public sector. In black communities, it is said they often do not seek mental health care due to the stigma where their families call them weak or dramatic, so they end up just suffering in silence.

There is not much awareness raised about mental health compared to physical health. Even as a student, I can tell in venues in which I have been placed that the focus is on physical health. For the elderly, the active aging programs mainly focus on the physical components. Retirement homes and assisted living facilities do not do enough to address the mental health issues people suffer from. They easily call a schizophrenic person crazy or dramatic when they could be learning about mental health issues so they understand the people suffering from them better.

Personally, I feel mental health is as equally important as physical health. We need to stop neglecting mental health as they both go hand and hand. We need to learn about mental health, so we don’t judge those that suffer, but instead support them.

REFERENCES

Mental Health and integration: Cinderella or the Ugly Sisters? (n.d.). The Strategy Unit. Retrieved September 1, 2023, from https://www.strategyunitwm.nhs.uk/news/mental-health-and-integration-cinderella-or-ugly-sisters#:~:text=The%20phrase%20

Redirect Notice. (2015). Google.com. https://www.google.com/url?sa=i&url=http%3A%2F%2Fkiddylane.blogspot.com%2F2015%2F05%2Fcinderella-midnight-princess-fairytale.html&psig=AOvVaw1tiaRAo_DQwv8sCFZdxtwe&ust=1693681758117000&source=images&cd=vfe&opi=89978449&ved=0CA4QjRxqFwoTCIjtyN6OioEDFQAAAAAdAAAAABAE

Redirect Notice. (2023). Google.com. https://www.google.com/url?sa=i&url=https%3A%2F%2Ftenor.com%2Fview%2Fshoes-slipper-glass-cinderella-gif-5557408&psig=AOvVaw3HM_e-ROXx3bZ904sEWT4t&ust=1693683619913000&source=images&cd=vfe&opi=89978449&ved=0CA4QjRxqFwoTCNDoyLaWioEDFQAAAAAdAAAAABAE

The State of Mental Health in South Africa | EAPA-SA. (n.d.). Www.eapasa.co.za. https://www.eapasa.co.za/the-state-of-mental-health-in-south-africa/#:~:text=According%20to%20the%20second%20Annual

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Standing on the edge of being an OT. 

Just the other day we were ‘awkward pimple-faced teens’, fresh out of high school, struggling to access our emails and modules on Learn. When did we get here? Where did the time go? 

 I still remember those days like it was just yesterday. What an emotional roller-coaster this journey has been. From the first email stating that I was accepted to do OT, to having virtual orientation week and doing Anatomy TUTs and spotters online.  We definitely got here at a very awkward and complicated time. The COVID-19 pandemic definitely robbed us of a real authentic university. 

Redirect Notice. (2023) 

Redirect Notice. (2020)

For over a year and a half, we had online lectures, most of which we attended from the comfort of our own beds. Sounds fun right? Wrong!!! The transition from attending 9 hours of school, with the occasional evening classes, to not even having to leave bed to attend lectures was a terrible way to start our college experience. I know I speak for many of us when I say, that ruined us. We didn’t see it at the time but now that we are transitioning back to full contact classes, with the return of actual exams instead of continuous assessments, we feel it. We didn’t even get our chance to make friends at the beginning and now we’re just strangers just trying to get to 4th year and move on with life because we feel it’s too late to make friends at this point. 

This journey has definitely not been an easy one. But now we are here looking out to the horizon, standing on the edge of becoming an OT🤔? And I gotta say, this definitely feels anticlimactic. I mean, I should be excited, right😏? My classmates definitely are. Most of them are already discussing graduation attire, and some are already thinking about cars and checking out contract phones, meanwhile, I can't even think about where I want to do my comserve.….... I don't know why but I am not looking forward to any of this, and it is very disconcerting😥. 

I've been pondering this question for the better part of my life. Why? I mean, I’ve worked my butt off my entire life to get to this point. The countless sleepless nights, the blood, sweat, and tears. The hardships I've endured and the obstacles I have had to overcome. Not to mention the countless calls I made to my mother crying when things were not going my way. My family and I invested a lot of time, money, and effort to get me to this point. All this has made me understand why people cry at graduation ceremonies yet somehow, despite all this, I still don’t feel even a tiny bit excited. WHY? 

I have never been able to celebrate my achievements. Getting to this point after such a long journey is worth celebrating but I can't get excited about it. But maybe someday this will change, and I will finally give myself the grace I deserve and celebrate as I should. Until then, it's been one hell of a ride, and its not even over yet. To whatever that is yet to be thrown at us, I say bring it!

REFERENCES 

Redirect Notice. (2023). Google.com. https://www.google.com/url?sa=i&url=https%3A%2F%2Fvc.ukzn.ac.za%2F&psig=AOvVaw1IUsb2z2z0nD__o1Ab_WCe&ust=1692437374102000&source=images&cd=vfe&opi=89978449&ved=0CA4QjRxqFwoTCIDPxtXy5YADFQAAAAAdAAAAABAq 

Redirect Notice. (2020). Google.com. https://www.google.com/url?sa=i&url=https%3A%2F%2Fxaviernewswire.com%2F2020%2F08%2F24%2Fthe-good-and-the-bad-of-zoom-classes%2F&psig=AOvVaw3LYw68_aKupKXZs3Gx5BH_&ust=1692439794916000&source=images&cd=vfe&opi=89978449&ved=0CA4QjRxqFwoTCIDXitv75YADFQAAAAAdAAAAABAD 

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Reflect on collaborative practice -multidisciplinary team and teamwork and reflect on how you have been a health advocate. 

A multidisciplinary team is a group of healthcare workers who from different disciplines provide health services to patients. The members may independently treat various patient issues, but focus on the matters in which they specialize, (Multi-Disciplinary Team, n.d.).  

According to the World Health Organization (2010), “collaborative practice in healthcare occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers, and communities to deliver the highest quality of care across settings. Practice includes clinical and non-clinical health-related work, such as diagnosis, treatment, surveillance, health communications, management, and sanitation engineering.” Collaborative practice and teamwork can improve healthcare quality if well executed well, (Peduzzi & Agreli, 2018). 

I was exposed to an environment with health workers from different disciplines for the past few weeks. Although it was not my first time in such an environment, I knew that working relationships in institutions are not always the same and healthy.  According to (NSW Health, 2014), “To ensure optimum functioning of the team and effective patient outcomes, the roles of the multidisciplinary team members in care planning and delivery must be clearly negotiated and defined”, but as I was not part of the actual staff at the institution, I did not attend any of the MDT meetings. As much as I was not a part of the MDT of the institution, I feel I worked pretty well with the health workers at the hospital. I worked well with members of my discipline, including my colleagues, my academic supervisor, my clinical supervisor, and her colleagues. I was also able to work with the nurses in the wards when I needed collateral information on the client, as they know more about them. Most of them were very forthcoming in helping with all I needed. Some even offered help even before it was asked. The nurses were able to help me with transferring the clients in and out of their beds. 

Unfortunately, I learned first hand that not everyone shared the same enthusiasm for teamwork and collaborative practice. After it was suggested by someone from the OT department team, I approached one of the physiotherapists on site with the intent to borrow an assistive device I needed. It was then when I was met with a hostile attitude where he raised his voice at me and demanded I tell him the name of my supervisor, as he wanted me reprimanded for attempting to use an assistive device that was not yet issued to the client as he had not greenlit its use appropriate. Luckily, over the course of my life, I developed a thick skin about such behaviors.  

It was there and then where I truly understood the concept of ‘chain of command’, and that I had not followed it properly. Had I done that, the whole experience could have probably been avoided. To stay out of trouble, as I felt I was already walking on thin ice with my superior, I tried to de-escalate and diffuse the situation myself at the spot before it made it to my department. I did learn my lesson, but aside from that experience, I feel I played my role well as a health advocate. I prioritized my clients, utilized all the help and assistance available to me, and managed to treat everyone in the equation with respect, and never, not even once, did I break character. I don’t know about you, but I feel like that’s a W in my book. 

REFERENCES. 

Multi-disciplinary team. (n.d.). HSE.ie. https://www.hse.ie/eng/services/list/4/mental-health-services/dsc/communityservices/multidisciplinaryteam.html#:~:text=A%20multidisciplinary%20team%20is%20a 

World Health Organization. (2010). Framework for action on interprofessional education & collaborative practice. Www.who.int. https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice 

Peduzzi, M., & Agreli, H. F. (2018). Trabalho em equipe e prática colaborativa na Atenção Primária à Saúde. Interface - Comunicação, Saúde, Educação, 22(suppl 2), 1525–1534. https://doi.org/10.1590/1807-57622017.0827 

NSW Health. (2014). Multidisciplinary Team Care. Nsw.gov.au. https://www.health.nsw.gov.au/healthone/Pages/multidisciplinary-team-care.aspx 

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Evidence-Based Practise

Sackett et al (1996) defined the evidence-based practice as a clinical decision-making framework that encourages clinicians to integrate high-quality quantitative and qualitative research information with the clinician's clinical expertise and the client's background, preferences, and values when making decisions. It involves critical appraisal of information to answer clinical questions during the treatment process.

It seems like a long process, and often people just make use of their clinical expertise in all their decision-making during the treatment planning and implementation. They refuse to consider and implement evidence-based practice because their methods worked at the time. As much as their methods have worked for them in the past, who is to say other methods wouldn’t work better.

If everyone had that backward mentality, we would still be striking rocks or rubbing two sticks together to make fire.  

According to OTseeker (2013), there are steps to implementing the evidence-based practice, which includes; identifying relevant clinical questions, doing research on the clinical questions, critically appraising research findings to see how valid it is and if you can use them, determining how your findings from your research can be used in your case, and then evaluating the whole process. Research is just one of the things to consider before making clinical decisions. One also has to consider the client’s background, values, context, and preferences. To do so, one must do an interview with the client. While doing research and interviewing the client, one must rely on their clinical expertise as well, as past experiences can better influence their critical thinking and their clinical reasoning in treatment.  

To be honest, the concept of evidence-based practice is relatively new to me. But after doing a bit of research on it, I realized I had been using it without even realizing it. Isn’t that just amazing?

Upon initial contact with each client, I would do interviews to determine their values, background, needs, and preferences. This would determine the outcomes expected by the clients and develop the clinical question of how I can implement the most effective intervention. I would then do research on their diagnosis and ask colleagues their clinical thoughts so I can determine the approaches for treatment. From all the information I find on the interview, research, and colleagues, I can determine which is useful and what seems appropriate in my case and client, regarding his background, values, and preferences. Throughout this whole process, I would make use of my clinical expertise and past experiences while also ensuring they do not negatively affect my clinical decision-making. It has been working quite well for me, and honestly, I think it is one of the best things out there.

Nothing is without flaws. In evidence-based practice, practitioners like myself often lack the skill to seek and critically appraise the research finding in relation to the client's needs and context, so they end up using the evidence practice approach wrong. So it is important to thoroughly understand the fundamental principles of the concept before implementing it.

REFERENCES 

Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312(7023), 71–72. https://doi.org/10.1136/bmj.312.7023.71 

‌ What is Evidence Based Practice? (n.d.). https://www.cmto.com/assets/What-is-Evidence-Based-Practice.pdf 

‌ OTseeker. (2013). Otseeker.com. http://www.otseeker.com/resources/WhatIsEvidenceBasedPractice.aspx 

‌ CEBMa. (2019). Limitations of Evidence-Based Practice – Center for Evidence Based Management. CEBMa. https://cebma.org/faq/limitations-evidence-based-practice/ 

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What Client Centred Means To Me.

Law et al (1995) defined client centred  as ‘an approach to providing occupational therapy which embraces a philosophy of respect for and partnership with people receiving services’, Townsend (1998) called it ‘working collaboratively with clients, rather than doing things for clients’. According to the Canadian Association of Occupational Therapists (1997), this approach allows to show respect for clients and involves them in decision making in meeting their needs. How considerate 😏 

 Personally speaking, I have not always agreed with this. Concepts like these are why I do not go to a therapist. The concept of paying R600-R2000 rates per session just for someone to ask for my opinion, what I think would be the solution to my problem is ridiculous. Like ‘Hello!!!’🙄 

Like...why would I come to u if I already had the answers?

I will admit, this was a misguided conception on my part, or maybe that was just me trying to find an excuse to disguise the fact that I am cheap. Over the years, my view of client-centered therapy has changed. Growing up in a public health system, a client-centered concept is not something I experienced or even knew existed. Health practitioners were never fans of suggestions. They did not include their patients in decision-making, or is that why Occupational therapy uses the term ‘client’ rather than ‘patient’ to identify service recipients? 

I had never seen the client-centered concept in action until I learned about it in Occupational therapy. Suddenly, it made some sense to me. And I agree with it now. It would be very ignorant of practitioners not to acknowledge the client’s perspectives in treatment planning. This approach is centered around partnership, respect, choice, and client involvement. When the client-centred approach is used, the client can feel more comfortable and confident in your service. It also builds mutual respect, which is important in the client-therapist relationship. 

This way in the therapeutic process, you will meet their emotional, social, and practical needs, thus ensuring they maintain a high quality of life. In my books, that’s therapy at its best. 

It costs nothing to be a decent human being.

I have been using the client-centered approach in all my interactions with my clients and it has been working out well, or at least I hope. I love how they light it when they see me coming from across the room. It makes me feel like I'm doing something right. After all, according to (Corring and Cook 1999) when the approach is applied well, from the client’s perspective, it could emphasize that they are valued human beings.  

REFERENCES 

Law, M., Baptiste, S., & Mills, J. (1995). Client-Centred Practice: What does it Mean and Does it Make a Difference? Canadian Journal of Occupational Therapy, 62(5), 250–257. https://doi.org/10.1177/000841749506200504 

Sumsion, T. (2000). A Revised Occupational Therapy Definition of Client-Centred Practice. British Journal of Occupational Therapy, 63(7), 304–309. https://doi.org/10.1177/030802260006300702 

Burton-Hughes, L. (2018, February 23). Person-Centred Care Guidance. The Hub | High Speed Training. https://www.highspeedtraining.co.uk/hub/what-is-person-centred-care/#:~:text=Person%2Dcentred%20care%20is%20important%20for%20patients%20because%3A&text=The%20patient%20will%20trust%20you 

Corring, D., & Cook, J. (1999). Client-Centred Care Means that I am a Valued Human Being. Canadian Journal of Occupational Therapy, 66(2), 71–82. https://doi.org/10.1177/000841749906600203 

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[mukelaniot]

CULTURAL HUMILITY

Cultural humility is defined as ‘a process of openness, self-awareness, being egoless and incorporating self-reflection and critique after willingly interacting with diverse individuals’. It has been an increasingly important concept in healthcare delivery, as there’s often power imbalances between clients and healthcare providers, especially in cross-cultural interactions. Cultural humility is promoted across health disciplines as it facilitates better and effective engagement between health care providers and clients and reduces power imbalances, resulting in better health outcomes.

While there have been many studies conducted on cultural humility in cross-cultural interactions, not much research has been done on cultural humility on people from the same ethnic group. Some people do not realize that there can be an imbalanced power dynamic between people of the same ethnicity. It could be because of gender difference, a large age gap, or that people are from diverse backgrounds and or generation, meaning their beliefs may not be the same. Or it could be from the perceived hierarchy that having less education means one is inferior to the other.

During these first 2 weeks of prac, without even realizing, I put this concept was put action. I was given a client with the same race, same ethnicity, and the same religion as me, but we have quite a big age difference, as he is old enough to be my grandfather. Upon initial contact, I had to eliminate the potential power imbalance, as it is known in our culture that in any context, the adult is always right and is superior to the young. Luckily, the client did not seem to consider himself superior and did not give me any problems. There was mutual respect between the both of us.

I informed the client about autonomy (the right of patients to make decisions about their medical care without experiencing undue influence from their health care providers), and client-centeredness, about how he has the final say in in decision making during the therapeutic intervention process, to remove the possible perceived hierarchy that patients should always do as told and question nothing.

While I may feel we both behaved appropriately towards one another and the therapeutic experience went well, there is a chance he does not feel the same way, and that is okay. There is still time to do better because if this week taught me anything, it is that despite all I have learnt so far, I still have a lot to learn.

REFERENCES

Singh, H., Sangrar, R., Wijekoon, S., Nekolaichuk, E., Kokorelias, K. M., Nelson, M. L. A., Mirzazada, S., Nguyen, T., Assaf, H., & Colquhoun, H. (2022). Applying “cultural humility” to occupational therapy practice: a scoping review protocol. BMJ Open, 12(7), e063655. https://doi.org/10.1136/bmjopen-2022-063655

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

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OT3 Fieldwork First Week.

The First Week of Fieldwork.

The past few months felt like an academic turning point for me. I have been putting in more and more hours to my studies in preparation for fieldwork. It felt like those training montage scenes in movies where the song ‘Eye of the Tiger’ comes on. Boy, oh boy was I wrong. This is what it must it felt like to be Jon Snow.

….i know less than Jon Snow, and he knew nothing at all.

It turns out that college students are not always as well-prepared as they think they are in their own minds (Scott Jaschik, 2015). This week, I experienced this first hand. It did not take long to realise I was not as prepared as I thought I was. The theoretical cases I had used preparing for fieldwork treatment are definitely not the same as dealing with an actual case. I know that now. I struck me as a surprise how overwhelmed and underprepared I was, as it would unfold.

In my first week, I got a CVA client, I had had multiple CVA patients in my previous placements, and while preparing, the cases I used were mostly stroke-related, so I figured it would be easier. I was wrong. My patient is a 68-year-old Zulu male with a left CVA. The right side of his body is affected, and he also lost the ability to speak. I can’t imagine what it is like to lose the ability to speak as an adult. As I needed to conduct an interview upon initial contact, I watched as my client tried to speak and failed, I felt the pain almost like it was me on that chair.

To be able to do client-centred treatment, I should be able to get the client’s needs and preferences from him, and not have to only assume from cultural perspective. The communication barrier made it harder to get information, so it made it harder to do proper client-centred therapy.

So, to improve my treatment approach, I need to know what my client’s interests are and his needs. What occupations he used to engage in that he cannot post stroke. I will be able to do that after I call his next of kin and ask the questions he could answer himself.

The first week was nothing like I expected it to be, but I take some comfort in knowing it could’ve been way worse, and I still have time to do better. So this weekend, I will take a significant amount of time to prepare and do research…

…I will return a stronger man.

REFERENCES

Jaschik, S. (2015). Well-prepared in their own eyes. Inside Higher Ed, 20, 1-13. https://q20.me/Are%20Students%20Prepared.pdf