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[ohtea3]

Penny for my thoughts?

Welcome Back to Blog 4, Week 4, and unfortunately, my last blog for this block…

Today's topic - ''my overall reflections''- a strangely timed blog, considering we still have 2 weeks left! It was just last week that my peers and I checked in to see how each of our projects were going and how we could re-strategize for the time we had left. But nonetheless, here is what I’ve learned working at the Kenville Community...

The one thing about community is that it is different from working in a hospital setting; you have to be open-minded, creative, and able to think on the spot due to resource and time constraints. We also work in a variety of places (i.e. clinics, schools and fields) and run multiple projects. The clients themselves rarely have a single issue, often times we are treating the people within the clients context and their environment as well. As health science students we are trained using a medical model to focus on pathology, as OTs, we've been trained on MOCA and MOHO, and yes, all these models are important. But still, it either has a narrow focus, is individualistic, or does not consider the broader picture of the client and context.

Thus, it's important to immerse yourself in the community and do a community needs assessment, such as the ABCD, PESTLE, CBR MATRIX, or SWOT Analysis, so you can have a holistic picture of the strengths and issues of the community and how it impacts its people. This picture summarizes the community entry process; the article it’s from identifies 3 principles for effective community engagement: LOOK, LISTEN, AND LEARN, you can read more about that here (Vermeulen et al. 2015).

In Kenville and many of the informal settlements, socioeconomic issues such as financial insecurity, homelessness, lack of service delivery and high levels of substance abuse, GBV, xenophobia, and teenage pregnancy are common. It's important for OTs to be aware of this as it informs us on what intervention is required in terms of promotion and prevention, to tackle key issues within the community. These social injustices can also lead to existential weariness- aka Occupational Ennui as my supervisor, Christopher, defined it-, which makes people feel stuck in this state of exhaustion or hopelessness and not wanting anything better for themselves. At Kenville, we've noticed this culture of poor participation and willingness to attend coming from the community. Too often, I have had a patient promise to come for an appointment but have not shown up despite previously benefitting or needing OT services. Initially, this was confusing, then it became disheartening as I spent hours preparing and waiting for them to come, and now it's worrisome... Even in our group projects, attendance is low, i.e. despite the high unemployment rate, our job skills group still has no members. Do we need to understand the community better? Do they not accept us? Are other external factors that deter engagement– such as stigma, lack of time, no transport perhaps?

This reminds me of Kraus's article I read earlier this year, who had a similar experience of the community not accepting him. The strategies he wrote to mitigate this involves self-emancipation-to liberate yourself from both internal and external constraints (i.e., bias, stereotypes, or cultural norms) by developing self-awareness-; cultural sensitivity; and a rich understanding of the community by: engaging with leaders first; seeking guidance from ‘cultural interpreters’; spending time engaging in task-orientated community activities; allow community member to take lead in projects (i.e., allow them in the decision-making process), and working collaboratively with community members. This picture summarizes key points and you can read more about this experience here as well:

Another aspect when working with Kenville, is feeling overwhelmed by the number of injustices I see and the various projects that can or should be done. It sometimes feels hopeless, and you're left questioning whether your actions will make a huge difference (Richards & Galvaan, 2018). This apparently is a common feeling by community-based OTs as mentioned by my peers and even literature such as the one below:

It's reassuring to know that it's not only me who feels like this sometimes. It then creates an opportunity for us to use our collective knowledge and experiences, to try and find ways to tackle these issues within the OT scope. This is why I sometimes enjoy Wednesday tuts, as I enjoy hearing different perspectives and focusing on the HOW, like how can we as OTs bring about systematic change, can we? I guess, the reassurance and comfort we get then, is pretty nice too. It gets you through the block and sometimes gives you the motivation, to try and be more innovative. In our tuts we spoke on, trying not to do it all - yes advocacy and education will always be our role to try to bring on systematic change. But it's just as important to focus on individual clients - if you change the life of one kid, that’s one future family you have changed, and that’s what also brings about systematic change. Also, knowing that there are other stakeholders that we can contact, to collaborate with to bring about a larger change.

Now that we've addressed my experience during the community block and what I've learned, how will these thoughts translate to keeping my penny next year, aka passing community service? This link is about an OT community service experience and is quite an interesting read if you are a student:

https://www.theothub.com/article/occupational-therapist-rural-south-africa

From this block alone, I've gained much experience on how a community operates, of course, bearing in mind that each community has different issues, which also depend on the type of community, i.e., rural vs. urban vs. informal settlement… The idea is basically cultural humility and accepting that I will never truly know everything about a community, but I should try my best to do research and collaborate with the community to better understand them and get them to engage in therapy based on their needs. It’s also important to expect some resistance and see so many injustices, which can be emotionally taxing; nonetheless, you keep showing up and trying your best. It’s important to rely on a support system to prevent burnout and emotional exhaustion, after facing all these issues and listening to clients trauma. Having a good relationship with supervisors and feeling satisfied with your job can also help with this (Struwig, 2020).

To summarize my reflections, I can truly say that this block was not as bad as I thought it was going to be. In the process, I've learned a lot about the community and myself. Community reminded me of why I chose OT in the first place; it's this hands-on/working directly with clients who need it, which is what drew me into health science in the first place. Dare I say, it made me feel immense gratitude and some happiness? I would be lying if I didn’t mention the struggles as well; from the increased workload, projects all over the place, patients not pitching up for sessions, and feeling as if I'm not doing enough; all do play negatively on my mind and cause me stress. But hey, I'm an optimist, so I'll give this block the benefit of the doubt!

And yes, please, a penny for all these thoughts would be GREAT for funding our projects- aka another worry...

Until next time- maybe not, hmm we will see..

Peace✌️

[ohtea3]

Midterm Reflections: SDG guide to make an impact in the community

It's 2015, and the United Nations has just called a universal call to action to end poverty and inequality, protect the planet, and ensure all people enjoy health, justice, and peace. Who will respond to this call? (WHO)

WELCOME BACK TO BLOG 3, WEEK 3

Can you believe it's already midterms? That means we're halfway through the block, and by now, I have begun to understand the multi-dimensional layer it takes to be a community OT. As I grow fonder of the community, I keep asking myself how can I make a significant impact with the little time I have left. The task sometimes seems almost impossible and overwhelming, as there’s so much to do and so much more that can be done… This blog will highlight the work I intend to do in the community using the Sustainable Developmental Goals (SDG) as a guide.

Before I begin, let me briefly inform you about the SDG- In 2015, the United Nations came together to create a plan for a better future called the Sustainable Development Goals (SDGs). It comprises of 17 goals to make the world fairer, safer, and more prosperous by 2030 (UN). The SDGs build on the progress made by the Millennium Development Goals (MDGs), launched in 2000. The MDGs made a big difference in reducing poverty, improving healthcare, and promoting education globally, with the exception of developing sub-Saharan Africa, leaving millions of people still lagging behind. This is why an urgent global call to action was required…

The SDGs are a call upon governments, businesses, and individuals to work together to ensure quality education and healthcare and promote peace and justice, among many other goals, as explained in the link below:

This one is related to South Africa and is more relevant to us.

So, what are we, as community OTs, doing to work towards these goals?

In my last blog, I mentioned how my mornings occur at the New Clinic where we do health promotion. Here, we inform the patients about OT, screen for possible clients, and educate and rehabilitate those in need. We see a variety of cases from psychological, physical, and pediatrics, such as mums with postpartum depression, workers with low back pain, elderly people with arthritis, and kids with developmental delays. This aligns with SDG 3, “Good Health and Wellbeing’’, in which we aim to promote physical and mental health and well-being for all ages. This goal concerns maternal and child health; you can read more about that in my first blog! We also run an active aging group for elderly ladies to promote healthy aging, prevent age-related diseases, and encourage social participation.

The next goal we intend to work towards is SDG 4: “Quality Education.” This goal aims to ensure all learners have access to ECD centers such as creches (4.2) to prepare them for primary school. In Kenville, there are many creches, but the kids are often under-stimulated and do nothing all day. As OTs at the creches, our role is to stimulate and bridge that gap to prepare the kids for primary school. We do this by using play, building cost-effective and stimulating toys, and upskilling teachers to support the learners better. The goal also aims to improve youth literacy and numeracy skills (4,6). At the Kenville primary school, we see many learners unable to read, write, and count. As OTs, we can use alternative and fun learning methods to help learners meet their grade requirements and write legibly.

Moreover, we try to promote SDG8, “Decent Work and Economic Growth.” With our individual clients, we provide vocational rehab for those who are struggling to work due to an illness or injury such as pain, edema, or a hand injury. At the New Clinic, we run a project called KITE, which employs a local community member to work to sell donated clothes to earn an income. We have also been trying to run a job skills program to upskill community members and teach them financial literacy skills. We also aim to tackle youth unemployment by running a study skills group and career guidance for high school learners to educate them about careers and colleges, to improve their marks, and to be able to meet university requirements.

Another goal we intend to work towards is SDG10: “reduced inequalities.” At Kenville, we see income and social inequalities such as poverty, gender-based violence, xenophobia, and the effects of patriarchy on women. This perpetuates a cycle of poverty and marginalization. As OTs, we try to reduce inequalities by focusing on advocacy, education, and social inclusion. At the high school, we discuss pressing issues such as bullying, substance abuse, and teenage pregnancy to help combat these issues. We also run expressive groups for the youth to provide a safe space for the kids and to promote self-esteem and a sense of equality within the community. This links with the last goal as well…

Lastly, we aim to work towards SDG11, “Sustainable Cities and Communities”. This goal aims to make cities and human settlements inclusive, safe, resilient, and sustainable. Kenville has a lot of litter and pollution; we can try to start community clean-up initiatives and environmental education programs; this can be done with the youth soccer kids as they are the ones playing on the fields. We can collaborate with local organizations and businesses to make community resources more sustainable and safer. Our goal for this block is to get a shipping container to work from and improve the youth soccer field (i.e., build goals and clean space). We also need to ensure our programs implemented are sustainable and continue even without us present through caregiver/ teacher/social worker education or, better yet, advocate for an OT post within the community. As OTs, we can also make and provide assistive devices and adapt the home environment to make it more inclusive and safe for people with disabilities.

As you can see, OTs have an active role within communities in helping meet sustainable developmental goals. For the last 3 weeks, we have ''unconsciously'' been working hard, in accordance with the SDG, to help create communal change, promote health, reduce inequalities, provide quality education and work opportunities, and achieve a sustainable and safe community.  By focusing on these five SDGs, we aim to create a ripple effect of positive change within our community. It's important to note that each goal has many sub-goals; we, as OTs, work within our capacity to meet these goals as much as possible, despite the various barriers - such as corruption, poor service delivery, discrimination and occupational ennui of clients- yet our impact is still significant. Considering we have 5 years until our goals should be met, there is so much to do, indicating the need for more/permanent OT services at the community level. Seeing the importance of the SDG to promote health, justice, and peace, as well as the link between the SDG and our OT role, I ask you, have you responded to the UN's call as a future or graduate OT?

Until the next blog

Peace ✌️

[ohtea3]

Curriculum vs. Community

‘’I feel like I know so much but so little at the same time.’’

Welcome Back to Blog 2, Week 2…  

As you know, I have been working at the Kenville Community for the last 2 weeks, and I think I'm finally getting the hang of things. So, let me walk you through my mornings: At the new clinic, we start the day with Health Promotion sessions, where we stand before the queue, sharing insights about Occupational Therapy (OT) and its role in promoting health. But our work goes beyond just talking. Through individual screenings, we assess various health needs, spanning from prevention to rehabilitation. Whether it's advising mothers on child development, assisting the elderly with pain management, or treating injuries, each interaction contributes to our overarching goal of providing comprehensive primary healthcare (PHC). But what exactly is PHC?

The WHO defines Primary Health Care as ‘’ a whole-of-society approach to effectively organize and strengthen national health systems to bring services for health and wellbeing closer to communities.’’ It is made up of 3 components: Providing integrated health services to meet people's needs throughout their lifespan, tackling underlying factors affecting health through multisectoral action and policy, and encouraging individuals and communities to actively manage their health and well-being.

You can read more about it here:

Kenville Community Clinic, with our OT role, falls under PHC, as it is the first level of contact for individuals and communities to access comprehensive healthcare services for promoting health and well-being, preventing disabilities, and facilitating rehabilitation within the community. We also look at the client's context and try to address determinants of health such as the social (low educational or employment level), economic (low income), and environmental (lack of infrastructure) factors - but more on this next week… Moreover, through education, skill building, and advocacy, we try to promote self-management strategies so the client can manage their own health. These components within the PHC aims for universal health care.

Now you might be thinking, this all sounds great on digital paper, but does my education and training prepare me to work at a community or PHC level?  It's important to note that when talking about my education or the curriculum, we are not only talking about the content of the courses but also the learning opportunities and the execution of this teaching (Oxford Dictionary).

In terms of modules, we only have one community module, in our fourth year, in which we gain practical, hands on experience working at the community level. However, throughout the last 3 years, we have done several lectures related to community-based practice. I -vaguely- remember lectures about the PHC, SDOH, SDGs, cultural sensitivity, and so on, and not only from OT modules but even community-based modules way back in the first year. But to be honest, community, unlike the physical, paediatric, or psychosocial modules, does not only focus on one component of OT. It deals with all 3 aspects in one go; this is due to the diversity of clients and the multiple factors of each case. Thus, an integration of all these modules is required to work at a PHC level; the question then is, was this adequate?

An article by our very own Professor Naidoo highlighted that overall, UZKN final-year students only felt partially prepared to practice OT, that means there is room for improvement within our curriculum. Lets highlight some of the pros and cons here, so we can compare how good or poorly run aspects of our curriculum are, which could possibly be changed to better prepare students to practice at a community or PHC level.

The students preparedness was linked to their perceived ability to adequately apply the OT process and their confidence in applying their newly developed professional skills. Students felt that they had the ability to implement basic therapy; however, their increased confidence and skill were linked to having exposure to previous fieldwork and which experiences they preferred or were positive. Positive and constructive feedback as well as autonomy, promoted a positive experience, while negative feedback had the opposite effect (pro/con). Furthermore, the students were able to adequately assess clients and write down a problem list but struggled with more complex cases. At UKZN, in 2nd year is when OT students learn and practice assessments only; this gives students sufficient time and focus to grasp the first part and most crucial part of the intervention process, which is why students were good at this (pro). However, since physical and psych blocks were taught separately, students typically view them in isolation. This is not good as clients; especially at a community level where clients aren't separated by wards; experiences both physical and psychological problems and need a holistic treatment approach (con).

Due to limited time being observed by supervisors, due to their own caseloads, students found that they did not get adequate supervision and feedback, which is why we sometimes see 4th-year students unable to do basic assessments properly such as using a goniometer, as they were not corrected initially (con). Moreover, students struggle to use theory to guide intervention planning and subsequently to grade sessions/activities. This can be due to many reasons, such as a lack of information or gaps in the teaching curriculum of theoretical work OR students are not taking enough initiative in their learning by either missing lectures, not paying attention in class, not asking questions, or not doing readings (con). UZKN had a culture of racial segregation, which impairs information sharing and peer learning (con)

UZKN uses an interactive educational teaching method that makes use of demonstration, peer learning and discussion, which assist students to integrate theory with practical work (pro). The screening of clients and health promotion projects teaches students to have good handling skills and interpersonal relationships with others (pro). (Naidoo, 2014). This article highlighted that students are able to manage OT practice using the current curriculum, however, improvements can be made such as better training for supervisors to support students effectively, the use of diverse teaching methods to enhance learning, and the promotion of intercultural and interracial interaction among students to foster tolerance and mutual learning, ultimately benefiting their clinical practice.

Another article by Professor Naidoo, highlighted more cons of our curriculum at UKZN related to PHC: The curriculum has a remedial and hospital-based approach, rather than PHC. It also has a medical model focus, as it does not prioritize health promotion, disease prevention and there has also been limited emphasis on MDT collaboration, which deviates from a comprehensive PHC approach (Naidoo, 2016). Additionally, the curriculum does not have adequate training on inter-professional education, and students struggle to find their place in the workplace amongst the other MDTs (such as working with physiotherapists). The curriculum does not prepare you for the administrative tasks required of you, nor does it teach you the procedures of other government departments, new health care policies, or how the DOH operates to secure resources.  Lastly, communication barriers were seen to be a major issue in service delivery; this goes back to first-year Zulu not adequately equipping health science students with the right vocabulary required in practice. The pros within the curriculum included good ethical grounding for practice, which can be used at the community/PHC level (Naidoo, 2017). Furthermore, the article highlighted again that the community block was most beneficial in learning about PHC and increased skills in research, as you had to find solutions to problems seen within the community, which was valued by students.

These findings emphasize the importance of enhancing curriculum content and teaching to better equip occupational therapy graduates for effective practice at PHC and community levels, addressing the identified gaps in preparation and skills needed for diverse practice settings. Whilst the UKZN curriculum has taught us so much about the PHC and community, it can never be enough. I believe that you can never be too prepared, and that you only learn through experience and continuous up-to-date reading, especially in our ever-changing society. 6 weeks in Kenville, is good experience but every community is different. In 2 weeks alone, I feel like alot has changed for me- mainly good things-. Its important to remind ourselves, that although the last few years we have learnt so much, to the point it has changed how we see everyday activities as being more- or is that just me, no?- Being a student comes with that uncertainty, lack of experience and lack of confidence, which is why its okay to feel like you don't know enough sometimes, as long as your open to learning. As my lecturers -loosely- say, ''its impossible to teach you everything within 4 years, being a health science student is being a lifelong learner, there are always more articles, courses, research to do and things to learn!''

Until the next blog

Peace ✌️

[ohtea3]

Maternal and Child Health, an OT students perspective

WELCOME BACK TO WEEKLY BLOGS!!!

You will be happy to know that I’ve made it to 4th year, and I’m currently in my community block based in Kenville. For my first blog, let me set the scene of the New Clinic: Imagine an outdoor plot of land shaped like an open book. Half the space is sandy with patches of grass, and the other half is concrete—three white shipping containers arranged in the shape of an L. In the middle, rows of chairs are filled with people waiting for a consult, medication or an injection. Many of these people are waiting for maternal and child health (MCH) services, but what does that mean?

When I think of maternal and child health (MCH), I think of a new mother and her baby, but MCH is much more than that. It extends long before and after a baby is born. Maternal health is a woman's health during pregnancy, childbirth, and the postnatal period, while child health is a child's health from birth through the adolescent years, primarily focusing on birth through five years of age (Perez, 2023). It also includes women's health issues such as abortion, contraception, HIV and STDs, infertility, and domestic violence, as well as child health issues such as developmental delays, malnutrition, adverse childhood experiences, and infectious diseases. -this is what community does, it wants you to think broader-

MCH is essential in reducing the maternal, neonatal, and under-five mortality rates in many Sub-Saharan African countries (WHO, 2015). In South Africa, a significant portion of these deaths are preventable, with up to 54% attributed to healthcare system failures. Modifiable factors like inadequate antenatal care and delayed treatment-seeking behaviors contribute to a large proportion of these deaths (Lancet, 2008). Moreover, there are substantial disparities in MCH service coverage in the public health system. Individuals from poor families face increased health risks due to difficulties accessing timely and high-quality care. Challenges such as underutilization of healthcare facilities, transportation barriers, and substandard care provision further exacerbate these disparities (Mayosi, 2012)

This article speaks more about our governments policy regarding MCH, an informative read...

A healthy pregnancy is essential for the healthy growth and development of the fetus, which reduces the risk of neonatal morbidity and mortality. Prenatal and antenatal care also reduces the risk of complications during childbirth, such as hemorrhage, infection, and obstructed labor, which can be life-threatening for the mother.

In addition to the health benefits, ensuring maternal health can have economic benefits such as contribution to the workforce, support of families, poverty reduction and promotion of gender equality (Leung, 2023).

Furthermore, maternal health is important to ensure the health, safety, love, and well-being of the child, as in our communities, it is often the mother who raises the children. They teach their children fundamental skills such as communication, forming relationships, and the use of objects so that the child can meet developmental milestones and later integrate well in school, socializing, and work.  A mother who then experiences postpartum depression or health issues that prevent them from meeting their child's needs will result in children with psychological issues. Child health also aims to ensure the health and typical development of a child; failure of this will result in future burdens of dependence that come from an unhealthy and unskilled workforce and dysfunctional families (National Research Council, 2004).

This article gives insight into MHC in South African context specifically...

By now, I’m sure you can begin to see the importance of Maternal and Child Health and how a lack of intervention here can lead to ill health. These all have implications for OT practice; as OTS, our job is to address the physical, emotional, and developmental needs of mothers, infants, and children, to ensure engagement in their respective roles. For children, we ensure they are meeting developmental milestones and address any delays or disabilities. This intervention looks at using play to improve gross motor skills (such as jumping, running, and catching) and fine motor skills (such as handwriting and self-feeding), independence in self-care (dressing and feeding), as well as to enhance attention, visual perceptual and sensory processing abilities. For new mothers, we can provide post-partum support to manage anxieties and depression and adjust to life with a newborn; we can teach relaxation techniques, proper body mechanics, and energy conservation strategies to manage the physical demands of pregnancy and postpartum recovery, as well as help them adjust to the return to work. We can also educate and train new mums on typical child development, stimulation of children, and home/toy/tool adaptations if need be.

This article gives you more insight into OTs role in maternal health care:

In the Kenville community, we see a lot of new mums bring their kids vaccine shots; it's here that we can screen for and provide support for mums who might have postpartum depression or general anxiety about having a newborn. We also address issues such as HIV and domestic violence to ensure Mum is getting the treatment and support she needs, as well as trying to normalize and remove the stigma surrounding these topics, as it is a harsh reality many women in South Africa face. We screen for kids who might have a developmental disorder, such as ADHD, autism, or a learning disability so that they can get early intervention and be placed in a special needs school if need be. We also see kids with conditions such as Cerebral palsy, malnutrition and HIV. With all the kids, we asses to see if they're meeting their milestones from rolling to running. We use NDT techniques and teach mums how to facilitate typical movement and encourage the mum to practice these at home. We also provide cost-effective ways to make toys to stimulate kids, such as a rattle using a bottle with rocks inside, due to this being a community that struggles with poverty or low incomes. With school-going kids, we assess to see if they are coping with grade and age requirements in terms of handwriting, understanding of basic concepts, and regulating their emotions.

As you can see, the OT scope is vast; however, in communities such as Kenville, it requires a context-specific approach so that intervention is relevant to the mum and child. Personally, for me, coming from a psych block, this was a major adjustment as we now have to assess and treat patients in one session as the chances of them coming back are unlikely. We are also their first access to an allied health care worker who can potentially screen for more significant psychological and physical impairments and subsequently provide early intervention to prevent later difficulties or possible death as a result of these conditions. We also work with fewer resources- in Kenville, we work under a gazebo, with a blanket on a trestle table- yet that does not diminish the importance or effectiveness of the work we do, as for most patients, it’s the only extra assistance they will receive. From my blog I hope you can see how OT, especially in this context, plays a vital role in maternal and child health... What's your perspective?

Until the next blog...

Peace ✌️

[ohtea3]

13.10.23

Welcome back to my 5th and final blog of this year…

Today's topic is a serious one, and one so fitting for October since it is Mental Health Awareness Month. It is about mental health dilemmas in SA, and wow we have a lot! I think the main two being the stigma surrounding mental health which is preventing people from accessing care and -like everything in this country- the lack of funds that are being given to mental health and mental facilities.

Here is my source, so you know this information is fact checked:

Let me summarize them for you, before Covid-19 it was estimated that 30% of South Africans would suffer from a mental disorder over the course of their lifetime; 25.7% are probably depressed with only ¼ receiving help; and only 15% of South Africans with mental illness receive treatment. This is largely due to the public stigma surrounding mental illness, adverse childhood experiences (aka ACEs such as neglect, caregiver mental illness, emotional abuse, and violence); and the lack of capacity, accessibility, and resources in the public health sector for mental health care, which is what majority of the population (74%) utilizes as they can’t afford private treatment. Even in the private sector, medical aid companies don’t provide adequate options to cover mental illness treatment. Moreover, South Africa only spends 5% of its total health budget on mental health, which means less than 1 in 10 people receive treatment. This doesn’t consider the money ‘’lost’’ due to corruption.

This article also highlighted the fact that in rural areas and African communities especially, there is shame put on people with mental illness; who often fear prejudice, discrimination, and isolation, they will experience should their community know of their mental illness. I have seen it with many of my patients in my physical block, who had mental disorders as well. The client and even their family refuse to accept they have a problem, so compliance with medication and therapy isn’t too great, which just results in more problems and increased hospitalization, which is a burden in our system with no capacity for this aka 'revolving door theory'. It was even worse to see, that the health professionals themselves choose to treat physical conditions only as well, perhaps we to share in the stigma regarding mental health, maybe we are burnt out we can’t help, maybe we don’t have either the knowledge or resources to do anything? I’m not really sure, but this problem works on all levels, so who then is looking out for people with mental illness?

Even in this psych block, I’ve heard concerning stories, of people with mental illness being exploited, in so-called ‘protected’ workshops. They are being worked without pay, and in these hostels being denied necessities such as nutritious food and hygiene products. Where is the money going to? Who is looking out for these people? It’s not the government for sure and us... Idk we feel helpless too, what do we do? Can we change this broken system? I don’t know, maybe we are part of the problem... -not me spiraling-

As you can see mental health is a HUGE issue in South Africa, so what is the way forward? Firstly, if you or anyone you know has a suspected mental health issue, please get help, either speak to a trusted person, go to the hospital/clinic, or contact a mental health organization such as SADAG.

We then as a population need to EDUCATE ourselves about mental health, or SPEAK UP about our own struggles and ADVOCATE about it and the importance of getting help, so we can start to change the narrative and remove the stigma around mental health. The government also needs to play its part, they need to allocate more budget for prevention, treatment, and support strategies and ensure the right people are receiving it. They also need to implement better mental healthcare plans and provide more skilled mental health professionals and resources at ALL levels of care.

Here are some other tips on advocacy, please check it out, we need to act now!!!

https://www.pathwayscounselingsvcs.com/how-to-become-a-mental-health-advocate/

Here you can find out what mental health advocate is:

Here is how you can advocate for your own struggles:

I leave you with these tips, I hope next year there will be more noise and movement surrounding mental health, maybe this is wishful thinking idk, but trust I will play my part, I hope you do to ...

Until next year, PEACE ✌️

[ohtea3]

29.09.2023

GREETINGS TO ALL!!! It's finally midterm break, well not much of a break if I'm doing this work... But it's okay, today's blog required us to watch a movie and reflect on how this influenced me. The watching part was kind of fun, but this just reminds me of high school me writing a book report- which yes went about the same way, I watched the movie instead of reading the book, don't tell my teachers, I'm not much of a reader. Moving on ...

If you don't recognize this scene, you've clearly not watched ''All the Bright Places.'' If you don't want any spoilers, I suggest you stop reading but if you do, here's a quick summary of what it's about...

This link gives some lessons from the movie...

This movie follows two teenagers who are both struggling with mental illness and trying to find support and purpose from each other. Much like every YA movie it's filled with romance, comedy, mystery, and drama, so you could possibly guess what happens. What was intriguing was trying to figure out what Finch was struggling with. Lucky for me I attended my lectures this semester, so I knew that the symptoms of impulsiveness, reckless behavior, and outbursts, followed by a depressed mood meant one thing - SPOILER- Bipolar Disorder.

Okay well, that's just my clinical diagnosis, it wasn't really confirmed in the movie, which was a bit concerning?! Why didn't he go to a psychiatrist? He clearly needed help?? But also, it makes sense, mental health is the Cinderella of health care- iykyk. If he got help, he would’ve been diagnosed, which would give him some peace of mind, as he didn't have to wonder what was wrong with him. He would have gotten treatment- medication, psych, and OT intervention- to manage his symptoms. With a psychoeducational program for him and his loved ones, they too would understand and know how they could help him and not feel so helpless or hurt by his behaviour. Ofc this goes back to the medical model and the stigma surrounding mental health, in which he felt a diagnosis would put another ‘label’ on him.

Whoops, I'm a bit off-topic, so what did I learn and how has this movie influenced me as an OT student?  

This movie showed me the importance of strong, meaningful relationships, and how these can add happiness, hope, and meaning into your life and guide you out of a dark place. As an OT, we need to build rapport and trust with our clients, so we can provide a safe place for them. We can also learn something from Finch – ASK questions, even if they’re messy, be good listeners, and offer kind words. It also shows us the importance of social skills training (SST) for people with mental illness, as just having 1 person to be there, can pull you down from off a ledge. Here some info about SST to get you started:

Another important lesson is the therapeutic value of leisure exploration and participation, as OTs and well society at large, we don’t see the value of doing fun things, leisure is not only something to pass the time or keep you occupied but it's more than that – it boosts self-esteem, mood and volition. You can read up on more benefits here:

This movie made me look at leisure in a new light, it's kind of amazing that this is a main occupation OTs focus on. It also showed me the importance of how doing little daily activities like flipping pancakes, eating, sleeping, reading, or writing, can benefit a person.

I also got to see/pick up some treatment principles, as people with mental illness, often don't like engaging in tasks. The principles Finch used included breaking down a task into small steps, using the by-the-way approach, and providing verbal encouragement and motivation.

The movie also highlighted the importance of understanding the effect of critical life events such as the death of a sister, a car accident, or abuse from a father and how these have lasting effects on someone. This emphasizes the need for a psychodynamic formulation and the use of psychodrama, as well as taking small steps to overcome fears and deal with PTSD. It also highlighted the therapeutic nature of talk therapy, the use of journals (gratitude and experience-based), and support groups, to deal with this.

Overall, I think this was a good movie about mental health, I found myself laughing and crying -inside-, whilst watching it. In viewing it from the lens of an OT student, I definitely learned a lot and it kind of inspired me and made me more grateful, as I could see my value or purpose in both the client's life, as a future OT. -SPOILER- maybe if Finch had an OT, his life wouldn't have ended so soon, as he would've had someone to see the capacity in him and give him the tools and support required to deal with his mental illness.

Until next time, PEACE ✌️

[ohtea3]

15.09.2023  

Welcome Back to Blog 3, life update, we are halfway through this semester!! -cue applause-

Today’s a bit of a informative topic, surrounding the ‘Therapeutic Use of Self’. But what is it?

‘’It is a term used to encapsulate the therapist’s role in working consciously with the interpersonal side of the therapeutic relationship to facilitate an optimal experience and outcome for the client. It is the planned use of the therapist's personality, insights, perceptions, and judgments as part of the therapeutic process. ‘’

From my understanding this is when an OT uses themselves as a therapy tool, like an audiologist would use an otoscope, or an optometrist uses an ophthalmoscope, OTs don’t really have a specific apparatus needed to treat patients, -ofc we do use equipment such as a dynamometer, wheelchairs and assistive devices- but we are the MAIN apparatus.

Us, in our interaction with clients, is supposed to be beneficial. It involves being aware of our behaviors, words, and interpersonal skills; to build a good rapport with your client, so that they want to engage fully with therapy. Oftentimes, we need to adapt these to suit our client, this technique is called attunement, an example from my practice: I came into a session energetic, loud, and excited for my client to engage in the activity I had planned, unfortunately, she was having a bad day and was really sad, so I had to adjust my tone of voice, to be softer, comforting and empathizing; I also had to hold of my activity and allow her to express her feelings instead, which is what she needed, as it made her feel better. Another example was when a client did something a bit inappropriate, I made sure my facial reactions and body language did not show my frustration, to not make him feel bad, but rather educated him instead. Another technique is unconditional positive regard, this is to make a client genuinely feel respected, understood, and valued without any strings attached. This links with being aware of power imbalance, by reassuring the client that therapy is a collaborative experience, and their opinions are equal, encouraged, and valid. This is what it means to be client-centered, we do this by first having an in-depth, holistic interview with our client, where we listen attentively, and we then use this knowledge to select therapeutic activities they enjoy, need, or want to engage in. Another technique I used is self-disclosure, this is when the therapist shares some information about themselves, so the client feels comfortable to share as well.  

To read up more about these techniques look here:

Additionally, we can use the interpersonal relationship model to explain the therapeutic use of self this includes:  

Read up more about it here:

You can be therapeutic in many ways, but how my mind understands it is being able to anticipate and identify the needs of your clients and change course to get the best therapeutic outcome. When I think about it, my mind goes to how we grade our treatment principles of handling, presentation, structuring, and activity requirements, to best suit the client. Examples from my practice: My client was getting distracted, so I used handling principles to bring him back to task and reassure him (encouraging mode) that he needed to finish the task, I even downgraded the session by removing external stimuli and providing extra assistance (problem-solving mode). Another example is when my client was struggling to follow instructions, I used my presentation principles to incorporate the repetition of verbal instructions and physical demonstrations. (instructing mode)

For all my non health sci readers who are confused, you can read other easier examples here:

To conclude, I think therapeutic use of self is important in therapy, it is something, I feel, separates OTs from other health professionals. We go over and above by analyzing things that are often overlooked such as how we place ourselves or items in relation to the client, is meant to be therapeutic. I feel like this technique allows us to maximize therapy and really be of benefit to our clients.

Until next time, PEACE✌️

[ohtea3]

01.09.2023

Cinderella, who doesn’t know her- glass slipper, fairy godmother, midnight, prince, pumpkin carriage, mice … All sounds familiar, right? But what on earth has that got to do with mental health and health care?

BRB, I need to Google this one...

A'ight, we're back, so from my understanding, they're referring to Cinderella before the ‘’bibbidi bobbidi boo’’ when she was the neglected child, being forced to stay at home and scrub the floors whilst her stepsisters went for the balls and had fun. Likewise, mental health is often neglected compared to physical health, although they are both equally important and play a significant role in your health and well-being. All Cinderella needed was someone to see her for who she truly was and help her to reach her dreams even if it was just for a few hours, this small act made a huge transformation in her life, -spoiler alert- she got out of a toxic family situation and met the love of her life. Likewise, if we focus more on mental health, we can see major transformations in people’s lives, they can reach their goals and do so much more if they just have a little help. Also, despite the façade of the magic, deep down Cinderella was not doing too great. Similarly, mental health is often an internal struggle, no one sees, you can look like the happiest person but be struggling inside, waiting for an escape, waiting for someone such as a prince or fairy godmother to come rescue you...

But why is it like this? Why don’t people speak up about it more, why don’t healthcare workers do more?

I think the major reason, is that mental health has a negative stigma surrounding it. If you suffer from a mental illness, the common conception is that there's something wrong with you, that you are weak or less than other people and often you are made to feel ashamed. This is why people don’t seek help, it’s also these internalized negative stereotypes that make healthcare workers shy away from these topics. Here is a link about the stigma surrounding mental health.

There are also other reasons such as the lack of knowledge and awareness around mental health or where and how to get help; as well as the lack of funding, resources, and trained professionals available to deal with mental health issues. In the South African context, mental health is seen as a luxury, that a lot of people can't afford or even access, it's also seen as a 'taboo' thing in some cultures/communities, or healthcare professionals are not culturally competent enough to help out. You can read more about this here:

However, I personally feel like nowadays mental health is more openly talked about, although I wouldn’t have much to compare it with, 'back in my day' was just a few years ago… But I feel like more people are advocating about it, I mean it's all over my Tiktok fyp, by now I've diagnosed myself with like 100 things, I say it as a joke but also, concern??? Am I the only one worried about the unconscious impact social media and this bombardment of information has on you??? anyway, that's a topic for another day---

I've seen this with the older generations in my family, who because of social media have come to believe mental health is a real thing. Unfortunately, I'm a very small proportion of the population who got ‘’lucky’’ by their enlightenment, but the same is not true for ALOT of people. The stigma around mental health has deep roots in all of us, including me, so even this awareness doesn’t necessarily change much unless we confront our own perceptions surrounding it and actually start having open discussions on more platforms around it.

This article is really inspiring, check it out

It reminded me of this definition, one of many, that's engraved in my brain because of university,

"Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.'' - WHO

If you need to know anything about OT is that it is 'holistic', this quote kinda helped me understand that word. I wouldn't be a good OT, if I didn't try to change this narrative about mental health and health care. We as healthcare workers need to do our job in helping people with mental health issues, just as we would physical ailments. As we know 'miracles' take time and this is obviously not a struggle we can fix with a wave of a wand overnight, but if we keep advocating and trying, maybe this Cinderella of an issue can finally have a happily ever after...

And with that cringe of an analogy and this inspiring quote,

PEACE✌️

[ohtea3]

18.08.2023

WELCOME BACK to weekly blogs, It's Round 2, Let's gooo!!!

According to the Oxford Dictionary, ‘’Reflection is careful thought about something, sometimes over a long time.’’

What does Reflection mean to you?

To me reflection is looking back on something; analyzing your actions, thoughts, and behaviors; what you have learned from past experiences, and how would use this knowledge to do things differently in the future. This is something I do often, maybe because I’m a typical 20 year old, confused about life as an 'adult', trying to figure out who I am with all this newfound freedom, to me reflecting allows me to become more self-aware so that I can work towards a version of who I want to be. Here are some other reasons why reflection is important...

This one is inspiring...

This one is informative ...

If I’m being 100% honest, my thoughts about OT for the first two years of Uni was ‘’Did I choose the right degree?’’ I kept going back and forth thinking if Accounting or literally any other health science degree might be better for me. Now I’m in SECOND SEMESTER OF THRID YEAR, can you believe it??? It's way wayy wayyy too late to back down now. I feel like I’m on top of a mountain, walking toward the edge…

This is it? This is my future? This is what I’m going to be doing 5 times a week from 8-4. It will consume most of my time, it will be my life.

When you think about it like that, it's actually scary and a lot of pressure…

What if I don’t enjoy it? what if I choose wrong?

The journey so far, much like climbing to the top of a mountain has been hard, with its rocky and windy path – filled with much uncertainty and stress. This journey started off way back in 2020 during my matric year when Covid happened. Due to the lockdown, I didn’t get to do job shadowing, so I joined OT knowing absolutely nothing about it. Then throughout my 1st and 2nd years, we were on and off campus, either because of Covid or the usual UKZN strikes. I didn’t really get to have a normal university experience -which will forever be sucky- but hey these last 2 years will make up for that, right? Then ofc there were the occasional life stressors. But yeah the journey wasn’t always doom and gloom, there were a lot of days I enjoyed it. Contrary to popular belief, I actually enjoyed going to campus to see the cadavers in anatomy; I enjoyed making cool things in woodwork and sewing – although those machines really tested my frustration tolerance – I enjoyed eating at my new favorite VCITY -or so it was called back then-; I enjoyed meeting so many new people, bonding over our struggles at prac… Speaking about prac I actually didn’t hate it, I enjoyed learning more about OT, about people, about how our body and mind work; I enjoyed hearing different people's stories, and I enjoyed helping patients especially when I saw actual improvements or even just improving someone's mood with your company, it’s a pretty cool feeling ngl. During pracs I also discovered or became more of who I want to be - I found myself having much more patience, gratitude, empathy, perseverance, and strength than I thought I had.

As an optimist, this quote speaks to me. This is my way forward, through reflecting, I can remind myself of the good. When I think about how far I've come, how helping others make me feel, and how doing this taught me about myself, I can't think of anything else I could’ve possibly studied. So for now, I'll keep going with an open mind, learning from bad experiences so that I can improve myself, but focusing more on the good experiences and being grateful for everything I've gained so far.

Before I leave here are some tips on how to reflect, if you don't already... I suggest you give it a try

BONUS: to any students out there, here are other ideas to stay motivated and keep going forward, when the journey is seeming too daunting.

Until next week, Peace ✌️

[ohtea3]

WEEK 5: 22.05.2023

Greeting: السَّلاَمُ عَلَيْكُمْ وَرَحْمَةُ اللهِ وَبَرَكَاتُهُ ‘’May the peace, mercy, and blessings of God be with you

’’Response: -وَعَلَيْكُمُ ٱلسَّلَامُ وَرَحْمَةُ ٱللَّٰهِ وَبَرَكَات"And upon you be peace, as well as the mercy of God and his blessings."

 ‘Salaams’ –which means ‘Peace be upon’ you in Arabic & it is a greeting all Muslims, such as myself, say upon seeing someone. In week 3, I started with “Sawubona or should I say Sanibonani”… Backstory: In hopes of trying to be more confident with my Zulu pronunciation & be more culturally respectful, I was greeting all the staff using Sawubona, but I found most of them saying Sanibonani. I knew that was the plural form, but I didn’t understand why they were saying that when I was alone, so naturally I asked my peers; ‘’In Zulu culture, ancestors play an important role, so when you greet a person, you don’t only greet them but the ancestors that walk among them’’.

IDK why but that kinda stumped me. I thought it was such a simple yet significant & beautiful difference, it actually made me introspect, which made me feel so ashamed cuz I tend to greet my fellow Muslims with ‘Hello, Hey, Hi’ instead of the proper greeting. See, as Muslims, it’s not just a matter of greeting but when you greet properly, you’re praying for that person & wishing them nothing but goodness, setting a tone of friendship & peace, irrespective of your differences. And in return not only do they pray for you, but you get a lot of blessings. It’s something so small, so simple, so routine; but I took it for granted &, in the process, robbed myself and others of blessings. It's so weird how the smallest things can change so much for you, this 1-minute convo changed my perspective on culture and what we take for granted. It made me think about all the ‘’insignificant’’ things I could be doing that indirectly offends someone OR all the blessings I am missing from simply not being culturally sensitive.

During this fieldwork block, God was trying to show me something,🤣 cuz just this week another thing happened!! Storytime: I had this patient who had TBM (Tuberculosis meningitis) but presented like a CVA (cerebrovascular accident) – he was hemiplegic among other things- for my non-health science kiddos here’s a link about these fancy terms.

Basically, his left side were paralyzed, making him unable to do simple tasks like getting up in bed to eat, wipe himself, or apply lotion, which he really wanted to do cuz his skin was becoming dry and flaky & he was conscious about it. So naturally I upgraded my session to allow him to take care of this, but when I gave him the cream he STOPPED, and oohhh the CRINGE of that awkward silence was killing me. I was so confused, why was he doing this? Was it fatigue? did he not know how to do it? Was he embarrassed? Instead of letting my mind make assumptions OR die from the silence, I simply asked, to which he kindly said, ‘It’s a cultural thing’’. I managed to get passed my own awkwardness of feeling dumb for not knowing & enquiring more. He explained that he was praying on it, that he didn’t need me to do anything, and that he appreciated my asking and taking an interest in it. This helped me get a better picture of my client, & made my session more client-centered & enjoyable for my client. From this I learned that it’s okay to not know, it’s okay to ask questions about culture, it's not insensitive or it doesn’t make you rude for not knowing, you will never always know. So it's important to read up, to enquire, and to always be aware that simple acts or words that might be insignificant for you, could mean a lot more for someone else. This inquiry and constant awareness to me is cultural humility. Here is a link to read more about cultural humility.

OMW I just remembered another example from this week, storytime: it was my final case presentation & I had a Schizophrenic client whose sister could not come to terms with this diagnosis, which was hindering him from getting better as he was not compliant with treatment. The client had been diagnosed for over 10 years so I didn’t understand why the sister could not accept this. But Ms. S and my classmates pointed out that in Zulu culture, having a psychiatric illness could be a punishment from the ancestors, which is why the community members also didn’t like him. This was a light bulb moment for me because simply trying to educate the sister more about Schizophrenia would not get to the root of the issue or fix anything, I had to approach it from a cultural perspective for things to change. Yet again reminding me that Cultural humility and culture have a HUGE impact on a patient’s well-being thus is vital for it to be part of the intervention.

So you're probably asking why am I mentioning all these stories and not just giving an essay about cultural humility for the sake of getting marks. Lmao I’m asking myself the same thing, but to me, these ‘’stories’’ hold a lot of weight, it's stories or should I say indirect life lessons like these, I normally tend to remember. Moments when I was questioning myself, moments when my worldview was unexpectedly moved. To me, this is how I understand & will remember cultural humility. To me it begins with self-evaluation, it begins with ‘Salaam’ -to examine my own beliefs & accept that in some ways makes me unconsciously biased, which doesn’t make me a bad person, it just makes me human. And that’s okay, cuz now I’ve learned it's okay to not know, as long as you are curious and willing to learn about cultural differences in genuine hopes to be better. It's also good to be interested in others' experiences, often people appreciate this. Lastly, to realize that culture extends more than a label of religion or race or sexuality, it can have a genuine impact on your health, thus making it one of the most important things to consider regarding OT intervention. As in the above ‘story’ had I been more culturally conscious, I could’ve changed a person's life in terms of promoting better health compliance.

Sorrows, sorrows, and prayers to all my readers (as you can see, I binged Queen Charlette) Unfortunately for you all it's my last day of hospital prac, which means no more blogs inna while.  I hope today's blog, changed something in you as it did to me, I wish you all the best and for the last time, PEACE or should I say SALAAMS ✌️✌️✌️

[ohtea3]

15. 05 2023

Hallo almal – that’s Hello all in Afrikaans. Don’t ask me why I’m doing this language-greeting thing, idk, but I started something, and it can't be stopped, so I think it's my thing now?

Welcome back to blog 4, week 4… this week felt like the ‘Wednesday’ of fieldwork, it wasn’t too memorable, maybe because we were puzzling to find patients and for once we had a manageable amount of assignments. Hmm let's think, there were only 3  things worth mentioning that came out of this week:

Ms. S had a check-in session with us, which was nice, for the first time a supervisor cared about what we thought/felt, I also got to ask questions & learned a little about discharge planning, you can read up about it here

Ms. S had a ‘tut’ with us in which we revised bed mobility, I found that this was a very helpful reminder because for some reason there was an influx of CVA (stroke) patients that needed training in bed mobility … for all those who don’t know bed mobility (an ADL) refers to activities such as scooting in bed, rolling, side-lying, sitting with the legs straight out (long siting) & over the edge (short sitting). Here is a link about bed mobility, OTS teach patients how to do this, the video is very helpful too….

Ms. S joined me for a session with a TB meningitis patient who was bed bound and presented like a stroke patient (they had hemiplegia - 1 side paralysis) , so naturally I had to do bed mobility & passive stretches to prevent pressure sores and contractures (deformaties where the bone/skin is stuck in 1 position) Although it was stressful to have her watch me, it actually made me feel a bit more confident in myself knowing I was using the correct treatments & methods. I also got to learn a few things about NDT from her feedback such as how to do joint compression and that sometimes flaccid limbs could have a catch due to muscles atrophy… for all those confused, here’s a link about NDT. She also emphasized that when we do bed mobility we should also incorporate another activity based intervention such as personal hygiene, to make it more therapeutic and OT based, as we focus on OCCUPATIONS. I used this advice for my final demo

Okay, okay, now I sound like a suck-up cuz the only things worth mentioning were related to my supervisor or me learning something, but genuinely this week was not it, I barely had patients and the ones I did were discharged, so I didn’t REALLY have a patient,

But yeah isn’t it weird that what I found worthwhile or enjoyable was learning? I thought the only thing learning gave me was boredom & anxiety. Is it weird tho? Weird that I NEED to know what I'm doing is by the book or ‘evidence-based’ to feel competent. Okay well now that I phrased it like that, lol yes obviously everything you do has to have a clinical reason or backing behind it, we are studying 4 years after all, otherwise anyone can do anything and call it OT. 👀What I meant was, it's weird of me to base so much of my competency or worth on how much I know & that too not just knowing but being research based. The problem is I have no time to do as much research as I want especially when we have to quickly asses & treat patients on the spot..... That poses the question will I ever be certain in my capabilities? I feel like with more experience I'll just know more & feel more confident, I guess only time will tell... I love how on reading today's topic ‘’how OTs use evidence-based practice to guide intervention” I was really confused about what it was or how I would link it, but indirectly I have just learned something about myself – brb, time for me to overthink this…

Okay, now that I’m back… according to the AOTO evidence based is ‘’the integration of critically appraised research results with the clinical expertise, and the client’s preferences, beliefs and values.” It’s not only about reading research articles & applying techniques but the careful analysis & application of these assessment and treatment methods, to provide the best care for your patients on a daily basis. It has many benefits such as better cooperation from patients, more informed patients, more effective treatment sessions and it keeps your skills up to date. Here's a link to read more about it

OT is very much so evidence based, our entire scope of practice is  dictated by models, Applied frames of references (AFR) and approaches. Every session we do is guided by our AFRS, and it's principles of handling and presentation. Like evidence based practice, we as OTs value the patient’s unique concerns, preferences and expectations. We use their needs to guide our intervention that is based on both scientific research and our own clinical reasoning, something that is emphasized by our supervisor as well. Tbh when they thought us this section last year I barely understood it, so it was hard for me to incorporate it as I didn't really know what it is. 😭 But Ms S emphasized it's importance and even made us do a task about AFRs, this forced me to read into it and YES to me using evidence based practice filled up some gaps, it made it easier for me to plan intervention sessions as the AFRS give you guidelines and it made me feel as if my sessions where more effective and therapeutic. For all those interested here's a link about AFR and OT...

So basically the 1st thing I do when i see a referral, i read the the diagnosis and think which AFR would be more suitable eg. For hand injuries it would be Biomechanical as the body structure is affected and for a stroke it's NDT as the brain is affected. I had a stroke patients, so i was already thinking bobath approach, which basically dictates how to do mobility and it gives you techniques to activate the muscles and facilitate movements, so walking in i already knew what i was doing..... See it's that simple!! Thanks to ✨evidence based approach✨, okay but why did that sound like an advert 😂

Ps, read more about Bobath here

Anyways I hope that helped you understand OT & evidence based abit more... Now I'm going to bury my head in work cuz next week is FINALS, which means ALOT is due😭 & I need to get a head start on the week... Pray for me 🙏

Untill next time, peace ✌️

[ohtea3]

08.05.23

Sawubona or should I say Sanibonani? This means ‘Hello all’ in Isizulu – I’ll explain more about this in Week 5, so stay tuned😁👍

Welcome back to my blog 3, week 3, this was a short but HECTIC week. To start of let me debrief you about my week, I don’t think I've mentioned this but we only go to the hospital 3 times a week, Monday from 8 am to 4 pm (yes lol 8 LONG hours as a student, not tiring AT ALL), Wednesday and Thursday from 8 am to 12 am… Monday was a public holiday for most South Africans, except for us OT3 students😪 instead we were working on our MIDTERM Case Presentations and Case Study, which are basically suppppper long reports about a patient in terms of holistic overview, assessment, and treatment. Mahn were we in for a surprise when new deadlines started coming out from nowhere. At 4 pm the afternoon before the nerve wrecking presentations we found out that we were writing a very important test straight after presentations, a test I did not start studying for, RIP😭 I've NEVER known such stress, I had absolutely no time for both and for some reason I chose to prioritize my midterm case presentation, although it was 'worth no marks, weird innit! Long story short, I’m so glad that I did, it really helped me get a good-ish mark and it, with the feedback from my superviser helped me prepare for finals. To my fellow OTs, one thing I learned regarding Applied Frame of Reference is that cognitive and behavioral shouldn’t be used together as they kinda contradict each other, rather use a CBT if applicable, to all those confused here's a link to learn more about AFRs, they're basically like principles to guide intervention depending on how each patient presents.

JBTW I aced that test too, very relieved... anyways back to prac on Thursday for the 1st time that week... This was a sad-good day, sad because my patient was being discharged and i couldn't do my planned session but good, although his hand function was not 100% as yet, I made a huge difference and helped him regain a lot of his independence over the last 3 weeks. This was the first time I actually treated a patient where I saw his function improve this much, so that was pretty cool too ngl, I felt like I made a difference for the 1st time… Here's a link to tips you can use to improve hand function, ps. Don’t do these yourself, please see an OT if you have a hand injury

https://www.flintrehab.com/hand-therapy-exercises/

Now that you’ve been debriefed about my week, time to talk about this week's topic of discussion, that is: MDT, teamwork, and being a health advocate, if you don’t know what MDT or a health advocate is check this out…

This topic is such an important one most people including myself, only know about doctors, nurses, or physios, and very few people realize that there is a whole rehab team that specializes in different areas such as OTs, psychologists, speech therapists, audiologists, dieticians and so much more. What's even more wild is that most doctors I've spoken to at KEH don’t even know what OTs do, is that why we barely have referrals?? I’m kinda jealous of the dieticians, they get at least 5 new referrals everyday, whereas we have to screen for hours, is that a bad thing to say?!🤔 But tbh I don’t blame them, I didn’t even know OTs existed before this degree but like surely they should know by now? Most of them have been working for years, right?? At KEH, I feel like the 1st job of being an OT is advocating and educating patients, nurses and doctors about what it is we do and how we differ from other health practitioners. If I had R1 for every time someone asked me if we are the same as physiotherapy, I’d probably have a solid R30 rn, that's a 1 delicious wrap at West grill, iykyk😐 I'm not gonna lie, it's a bit annoying when it comes from the doctors because that means they aren’t referring patients to us, but when it comes from the patients, it kinda makes me feel proud to be an OT, idk, something about teaching others new thing and standing up for OT feels good. As OTs we don't only advocate for ourselves but also for our patients, our primary job is to teach and motivate them to look after themselves as independently as possible and to prevent secondary complications such as pressure sores, contractures or edema that limits function. We also educate them about their condition to improve insight and help them be compliant with treatment to improve or maintain function. We also advocate for independence by adapting the environment, task or equipment. This all falls under today's AOO that I'm teaching you all about - HEALTH MANAGEMENT - read up about it here

In terms of MDT, I would love to go on about how well we work together, especially the rehab team, but tbh I haven’t seen any other of the rehab team. Well, I've seen their notes in the files and I most likely saw them in passing but never working collaboratively, maybe that’s just me… To be fair, there are a lot of healthcare workers, and with the doctors not having a uniform color it's hard to tell who does what, and don’t get me started on their writing. - Not me complaining about doctors and further being a part of the stereotypes, whoops😬. – but shame I actually applaud them for their work, it's not easy hey… we getting of topic so carrying on.... I have collaborated with other MDT members, as seen in my interactions with the nurses, doctors, and social workers. I always like to ask them questions about the patients to gain a more holistic overview and to find out about medications and precautions. Fyi This collecting of information is known as collateral.... Also, I've worked collaboratively with my fellow OTs whether it be my supervisor observing and teaching me during my sessions; my peers helping me with Zulu and screenings; and the permanent staff who give me advice when needed.

Since barely anyone knows what an OT does at KEH, as part of a group project my OT3 peers and I decided to do an advocacy poster about an OTs role in neuro, ortho, pediatrics, and hand injury patients, specifically to KEH. We are also planning to do a pamphlet to educate patients about amputations and how OTs help, not only as an educational tool for amputees but to provide an example of our role in a diagnosis. This along with talking to and answering patients' questions about OT and their condition, will promote health advocacy. This can create awareness and help improve communication between MDT and OTs so we can get more referrals and treat patients better with our combined skills. As for teamwork, the OT department is a very supportive and a strong team, something I am grateful for as they help me learn new OT methods and help me make it through the days…

Overall I'd say the collaborative practice between MDT at KEH has room to improve, it's a good way to provide the clients with the best care..

Untill next week, Peace ✌️

[ohtea3]

01. 05.23

WEEK 2: Hold up, wait a minute, let's rewind for abit now that, I think, I know what a blog is?!🤔

Hi, hey, hello to anyone reading this, I hope you are all doing well…👋

A little about me, I am a third-year Occupational Therapy student and part of my training is to work at a hospital (KEH), naturally, we are guided by our supervisor (Ms. S), to teach and help us grow into good health practitioners. Part of our training is to write blogs about our experience and what we learn. So yeah, to anyone out there interested, stick around to learn more about me, OT and my journey navigating South African hospitals as a student…

Today's topic is about being ‘client-centred,’ sounds pretty self-explanatory right? Here is link to find out what it is...

To me being client-centred or ‘person-focused’ is putting your client first, asking them what THEIR needs or wants are, and treating them accordingly, with THEIR best interests at the front of your mind. It's about listening to them, letting them guide, and be equal partners in interventions. However, It doesn’t mean blindly listening to them if they're going to cause harm to themselves, in this way it's also about using your own clinical knowledge to do what's best for them.

Now you're probably thinking, isn’t that what all health practitioners are supposed to do? The answer is yes and no. Yes, all health practitioners are supposed to focus on the clients during intervention but unfortunately, it's not the case IRL. If these last 2 weeks at KEH have thought me anything that is far from reality, I've seen some doctors speak over the clients as if there are just some problems that needed to be solved, no client involvement, no empathy showed, and the clients where completely in the dark about what’s happening to them, it's actually kinda heart-breaking. Okay okay, I’m being a bit too harsh, shame there were actually a lot of nice doctors but just the 1 or 2 I saw were enough for it to be an eye-opening experience, that discomfort did not sit right with me… It made me appreciate OT more, to us being client-centred is a must, it's what separates us from other health practitioners cuz everything we do has some significance in the client's life, from the planning right down to implementation and discharge planning. Client-centred to me means taking my time with each client, speaking nicely in a way they can understand and feel heard, asking them how they feel, explaining what an OT is and how they would like me to help them, involving them and their family in their care, and taking into consideration their contexts. Side notes, Contexts or home/work environments is an important aspect of OT, so clients can function IRL, check out this link to find out more about context:

It also links with planning and implementation of interventions, as OTs we pick an activity and base our principles on what our client NEEDS... but what do you do when your client can't communicate their needs? Unfortunately, this was me, with my midterm demo (fyi this is basically when our supervisors watch and give us marks and feedback for doing a treatment session with our clients.) I had already done a lot of ADL sessions with this particular client which was successful, so naturally I had to move on to the next AOO, which was IADLS, specifically meal preparation (find out more about IADLs here

given that the client was an African male, one could assume this isn’t a '' normal''' occupation that he would engages in, not very client-centred or very feminists of me, right?! –-pleass don’t come at me for being stereotypical🥴, tbh the permanent OT possed this question to me as well, which actually furthered my doubts about it, but I decided to stick to this IADL because - - to me it was client-centred, as this session was more beneficial to the client as it worked to improve more client factors and it allowed me to educate the client about more matters than I would've in an ADL session, Ms. S agreed with me as well. 😁Even the client enjoyed the task - well more so the eating than anything- but a win is a win. I also got a whole load of encouraging and helpful feedback from Ms. S, which I appreciated, to my fellow OTs here are some out-of-context tips I received: if a client is struggling to follow verbal commands or sequencing of steps, break down the task into simple steps and use visual aids. Psychomotor activation often leads to fatigue which leads to distractibility, it's important to structure the environment to remove any external stimuli. You can easily challenge the client's attention and concentration by adding back stimuli such as noise using a radio, having other people in the room chatting, or opening doors/windows to allow outside noise in. Yes, assistive devices are a good way to downgrade an activity, but we can also try modelling behaviour or hands-on facilitation before we resort to that. Oh if u didn’t know here's what psychomotor agitation or assistive devices are here are some links

https://mn.gov/admin/at/getting-started/understanding-at/types

In conclusion, whilst it’s important to be client centred, it’s not always possible to do what the client wants as we might not know, it is then our job to incorporate this into our principles, this looks like doing what’s best for the client and treating them with genuineness, unconditional positive regard and empathy.

I think that’s enough ‘wisdom’ for this 2-day week, time to enjoy a well-deserved long weekend, until next week… peace✌️

[ohtea3]

24.04.23

Week 1 at KEH: anxious, unprepared, and constantly tired - is this how working as an OT is going to feel, or is this just student life? I guess these are normal feelings to have,  it makes sense when there's a lot of uncertainty and pressure surrounding it– I never really knew what I wanted to study, I didn’t even know what Occupational therapy was, well now I do…

‘’OTs allow people to engage in activities of everyday life, this includes things they want to, need to, or are expected to do, one way they can do this is by modifying the occupation or the environment to better support their occupational engagement (WFOT)’’

3 years in and it’s a little too late to be unsure, RIGHT??? That’s where the pressure and worry come in- what if I don’t enjoy it? what If it's not within my capabilities? –not to forget that it's for marks and a real person’s well-being is in my ‘learning hands’…

I'm trying to accept the anxiousness that comes with being a student, and that I need to give OT a chance, which I have, and honestly… I like it… treating for the 1st time and seeing patients get better or improve their mood even just for a little, makes it worth it (I know that sounds cliché but it's true, I love helping others). As for feeling inadequate in my capabilities, I try to have an open mind and not be too hard on myself, I am a student after all, and 90% is not my goal anymore – although that would be great… a reminder to myself that, my goal is to LEARN by getting in as much knowledge and experience from my supervisors, peers, patients as well as extra research; not being afraid to ask questions or accept and learn from my mistakes.

Looking back, I’m kinda grateful my 1st patient was a high-functioning, elder person…

“High functioning means that the patients function on a level of user-directed self-presentation. They have much better social and cognitive skills, as well as proper self-care. They also have a better ability to decide for themselves how to go about a task and can complete more complex tasks (Kruger)”

This allowed me to get used to quick screening, as one normally does in hospitals, compared to the excessive in-depth assessments we did last year; and to ease into treatment with a fun leisure activity. It also forced me to think outside of the box of ADLS (an OT’s 1st priority)

“Activity of daily living is a term used to collectively describe fundamental skills required to independently care for oneself, such as eating, bathing, and mobility. The term was first coined by Sidney Katz in 1950 (Edemekong)”

“Nonobligatory activity that is intrinsically motivated and engaged in during discretionary time, that is, time not committed to obligatory occupations such as work, self-care, or sleep (Chen)’’

This patient was in the early stages of Parkinson's and didn’t need OT intervention as yet, so I did a leisure activity as it meet my aims and was his primary occupation after ADLs - which he was already independent in. My supervisor recommended I do a health management pamphlet about Parkinson's, which I did and I must say, the patient really appreciated it, which helped me build rapport. However, it was kind of concerning that the doctors never tell the patient about his condition or prognosis… Is this what healthcare in SA looks like???  This made me appreciate choosing OT, whose focus is being holistic and client-centered, and putting the well-being of the patient first. It emphasized the importance and made me more conscious about involving the patients in care, using simple terminology, and making sure they understand why and what I'm doing – as any OT should do…

Links

Chen, S. W., & Chippendale, T. Leisure as an end, not just a means, in occupational therapy intervention. The American Journal of Occupational Therapy

Edemekong PF, Bomgaars DL, Sukumaran S, et al. Activities of Daily Living: https://www.ncbi.nlm.nih.gov

Krüger, C., & Van der Westhuizen, R: An audit of attendance at occupational therapy by long-term psychiatric in-patients at Weskoppies Hospital. South African Journal of Occupational Therapy

WFOT: https://wfot.org/about/occupational therapy