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COMMUNITY SERVICE , AT THE EDGE OF CLOSING THE CHAPTER

Cato Manor is a settlement about 7 kilometres from Durban's city centre. The area has primary schools, a clinic, a market, and a multi-purpose centre. Cato Manor has faced significant challenges, including struggles over housing and service delivery, which have led to tensions and a high number of assassinations of activists and political figures, high rates of substance use and unemployment. It comprises many black South Africans, with the majority speaking Isizulu and some people from foreign nationals.

 Community fieldwork is going to these communities as occupational therapy student to learn and get exposure to their context, issues, and the broader community to get training for practice in community settings. They may learn how to enter the communities, be part of them, assess their context and needs and intervene under the scope of healthcare and occupational therapy. Community practice in occupational therapy book states that practising in a community setting provides occupational therapists/students with a realistic view of the client ‘s life and promotes better treatment outcomes as therapy occurs in a context; it shifts the student from intervening as per the textbook but as per client needs and that of their environment. As part of that training, I am placed in the Cato Manor community, as required by the community module in Ukzn. I want to take a train of thought with this blog, go back and relook at how the community block has been and how my view of occupational therapy practice in the community has influenced my approach to interventions. It will highlight the influence and impact of personal factors and how theoretical information has influenced intervention in this community.

As an occupational therapy student entering the community, my initial understanding of the therapist’s role was limited. I believe it involved learning about clients’ contexts, identifying barriers to occupation, and implementing interventions. However, this perspective was akin to putting cabbage in a water bottle, constrained and incomplete.

 According to Brownson (1998), community occupational therapy transcends individual client treatment. It extends to working with systems that impact individual and group abilities to engage in occupations and set goals. This aligns precisely with the Occupational Therapy Practice Framework (OTPF), which emphasises the interconnectedness of individuals within their communities (AOTA, 2008). I only gained a similar understanding while in the community from reading the papers written by grade 9 learners as they shared their challenges; in our attempt to solve these challenges, it was clear that they were rooted in the system of the community, and for intervention, one must start from the system of the community. being almost at the edge of the community block, I have gained a holistic understanding of the role of occupational therapy in fieldwork that effective intervention is when it goes outside of the walls of the clinic or hospital but intervenes with even the social, environmental aspects of the person, treating the community. one may ask how is the community treated? This question is as broad as the role of OT in the community. However, to name just a few that were relevant to Cato Manor Clinic or specify, it through health promotion, promoting health and well-being of the community, teaching and raising awareness to issues that impact or hinder healthcare accessibility and occupations, such as mental health, stigma, and inequality. This was done by programmes run in the community such as Phila Mntwana, maternal mental health, and reproduction health. The viewpoint discussed above is held by occupational therapists today, who understand that participation in occupations and activities at home, school, work, and community supports and maintains health. Developing and putting into practice occupational-based strategies that aim to include and participate a population in occupations that promote community health, occupational therapy actively engages in programs and services to support the health of communities and people (Estrany-Munar et al., 2021).

Reflecting on my time in Cato Manor, I’ve realised how important it is to embrace the full scope of occupational therapy, especially in community settings. Focusing on the whole person and their environment, taking a holistic approach and practising cultural humility is essential. I’ve learned that effective therapy goes beyond just helping individuals; it also involves tackling broader community issues and being mindful of how culture and religion influence interventions. In this community, we relied heavily on the Person-Environment-Occupation (PEO) model, which first examines how people interact with their surroundings and how social factors impact their lives. This model guided my approach and helped me plan specific, relevant, practical interventions. It became clear that effective interventions must address both personal and community challenges.

On a personal level, this experience has strengthened my commitment to fairness and supporting those in need, regardless of their socioeconomic status or cultural background. when working with children in a daycare centre that lacked toys, I had to be sensitive to their circumstances. Instead of bringing in store-bought toys, I focused on interventions that encouraged using materials they could easily access and create themselves. This experience emphasised the importance of cultural sensitivity and resourcefulness in community practice, ensuring that interventions are effective, sustainable, and respectful of the community’s way of life.

Cato Manor is an alive community with a rich cultural diversity, but it also faces significant challenges, such as the stated and a strained healthcare system.

As part of handing over and closing this chapter, the following community students need to immerse themselves in the community’s context and acknowledge the profound influence of culture, religion, socioeconomic factors, and nationality on the lives of the people in this community. The work was rooted in understanding this diversity, and I recommend that the next group take the time to build their awareness and relationships within the community,we relied on the Person-Environment-Occupation (PEO) model to guide our interventions. This model helped us see how the environment and social factors intersect with individual challenges, leading to more effective implementation of interventions. The next group must continue using this model, as it solidifies the understanding of the community’s needs holistically. it' was a lens through which to view the interconnectedness of the people and their surroundings in Cato Manor community.

References

Estrany-Munar, M. F., Talavera-Valverde, M. N., Souto-Gómez, A. I., Márquez-Álvarez, L. J., & Moruno-Miralles, P. (2021). The Effectiveness of Community Occupational Therapy Interventions: A Scoping Review. International Journal of Environmental Research and Public Health, 18(6), 3142. https://doi.org/10.3390/ijerph18063142

Jones, A. B. P. (n.d.). Community Practice in Occupational Therapy: What Is It? In Jones and Bartlett Publishers. http://samples.jbpub.com/9780763760656/60656_ch01_doll.pdf

Brownson, R. C., Fielding, J. E., & Maylahn, C. M. (2009). Evidence-Based Public Health: A Fundamental Concept for Public Health Practice. Annual Review of Public Health, 30(1), 175–201. https://doi.org/10.1146/annurev.publhealth.031308.100134

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Implementing sustainable goals at Cator Manor/crest community.

In September 2015, 193 UN member countries, including South Africa, committed to a 2030 Agenda for sustainable development in September 2015(Common Country Analysis, 2020). This commitment was to ensure effective and sustainable development in South African communities through set goals and targets the country must meet before the set 15 years. Sustainable development goals can be described as an action call to eliminate poverty and protect the environment and climate to ensure that people everywhere can have peace and prosperity. It can be described as a blueprint to achieve a better and more sustainable future for all.

Of the 17 sustainable development goals, some are health-specific and require health practitioners also to be agents of action towards implementing them; however, holistic health practitioners do not only focus on health-related SDGs but, in their practice, consider the whole person and their environment striving to implement SDG’S that promote overall advancement and wellbeing of an individual. Chotchoungchatchai et al. (2020) support this notion in their study, stating that delivering high-quality primary healthcare services is inadequate to meet the health-related SDGs, and some health concerns are environment-related. This means that to ensure the health-related SDGs are achieved, it is necessary to implement them that are not health-related but do impact health. As an occupational therapist working in the community setting, I aim to contribute to making a blueprint to achieve a more sustainable future for the community I am placed in. This will be through implementing and working towards these goals in the community, which will be discussed in this blog. It will state the sustainable goals I intend to work toward and how to achieve them.

Good health and well-being: This sustainable development goal ensures everyone has access to high-quality medical care, regardless of income. As highlighted in an ICLEI Briefing Sheet (2015), physical and mental health significantly impact various aspects of life, making it challenging to address sustainable development without considering them. This solidifies a key point made earlier in this blog: even health-related SDGs rely on implementing other non-health-related goals that contribute to overall well-being.

As an occupational therapist working in the Cato Crest community, I am committed to advancing this goal by focusing on specific targets within the health and well-being SDG. After three weeks of working in this community, we have observed a troubling pattern of substance abuse, with people, including high school students, frequently drinking or smoking in public. Some students have even admitted in our groups to using cannabis. For this community, the target of strengthening the prevention and treatment of substance abuse is crucial. We plan to address this through empowerment groups at the secondary school, where we will continue to educate students on the causes, effects, and strategies for overcoming substance use.

Furthermore, we will focus on promoting sexual and reproductive health by empowering students in secondary schools to prevent unwanted pregnancies. This will also be implemented in programs like Philamntwana, which aim to enhance community reproductive health awareness and services.

Quality Education: According to the Global Goals (2024), this SDG aims to ensure inclusive and quality education and provide learning opportunities for a lifetime. This means working towards a community that does not deprive individuals of education due to discrimination and more. The study by Loeb et al. (2008), cited in the previous blog, found some disabled young people deprived of education in the Eastern Cape and Western Cape, and Gauteng Graham et al. (2013 ) in the Western Cape is an example of what this goal aims to achieve. However, in the community of Cator Crest, the target of community occupational therapy would be to ensure that girls and boys from poor backgrounds enrolled in daycare, even when their age necessitates that they are in preparatory school, get some level of preparatory education. At the same time, in the daycare, this will be done by visiting the daycare centres, treating delayed children and stimulating all children so that their preparatory education milestones are met, such as basic concepts, fine motor, and visual tracking that will assist in school. secondly, this SDG is working towards ensuring that the community's youth have access to tertiary education by implementing the ongoing project that assists grade 12 with providing application information and assisting in tertiary applications and lastly, assisting the primary school to identify children with limitations in learning, treating and providing recommendations to improve their learning.

Reduced Inequalities: The SDG aims to reduce inequality in wealth, sex, age, disability, sexual orientation, colour, class, ethnicity, religion, opportunity, and other forms in the community. According to Martin (2023), there are still differences worldwide. Long-term social and economic progress is threatened by inequality, which also sabotages efforts to meet other SDGs, such as reducing poverty. It is in the role of an OT to contribute and be an agent of action in SDG; this is done through addressing health disparities and promoting equal access to healthcare services. In the community of Cato Manor, this goal will be implemented by ensuring that people who access OT interventions are treated equally regardless of who they are. This will reduce inequality and improve access to healthcare. This community also has a population of immigrants; clients will not be discriminated against based on their nationality or state of citizenship but will be given a holistic intervention as deserved.

Decent work and economic growth: Providing efficient treatment and intervention to enable people injured in the past to return to work and support the local economy is a key component of this sustainable development goal, which is being implemented at Cato Crest Clinic. This reminds me of a woman who was about to lose her job as a domestic worker due to a distal radial fracture. A community service occupational therapist had begun working with her and had referred her to us to treat her and to determine whether she could return to work. After that, we wrote a letter to her employer confirming that she could return to work. That's the part I can play in achieving this aim as an OT, ensuring that patients receive quality care and standing up for those who are eligible to return but are sent away.

Gender equality: To reduce gender equality in the community, as an OT at Cator Crest, I would run inclusive groups at the secondary school when addressing issues like sexual health and reproduction health, including males in programmes like Philamntwana. They are also involved in the growth of the children.

As an occupational therapist working at the Cato Crest community, I would contribute to the community achieving sustainable goals through focused interventions, including drug abuse prevention, education about sexual and relationship health, and professional and educational assistance. The work being done would align with the Sustainable Development Goals since it addresses health-related concerns and long-term social and economic advancement.

References

1.             Goal 4: Quality education - The Global Goals. (2024, January 23). The Global Goals. https://www.globalgoals.org/goals/4-quality-education/

2.             Alvaredo, F. (2018). Sustainable Development Goal 10 – Reduced Inequalities: Progress and Prospects. https://thedocs.worldbank.org/en/doc/925671552682607792-0090022019/original/SDG10EGM2019conceptnote.pdf

3.             Chotchoungchatchai, S., Marshall, A. I., Witthayapipopsakul, W., Panichkriangkrai, W., Patcharanarumol, W., & Tangcharoensathien, V. (2020). Primary health care and sustainable development goals. Bulletin of the World Health Organization, 98(11), 792–800. https://doi.org/10.2471/blt.19.245613

4.             COMMON COUNTRY ANALYSIS. (2020). In United Nations South Africa. https://southafrica.un.org/sites/default/files/2022-02/UN%20South%20Africa%20-%20ABRIDGED%20FINAL%20CCA%202019-2020%20%281%29.pdf#:~:text=South%20Africa%20is%20one%20of,but%20inequality%20remains%20a%20challenge.

5.             ICLEI BRIEFING SHEET - Urban Issues, No. 04 - The importance of all SDGs for cities. (2015). In ICLEI BRIEFING SHEET - Urban Issues. https://www.local2030.org/library/234/ICLEI-SDGs-Briefing-Sheets-04-The-importance-of-all-Sustainable-Development-Goals-SDGs-for-cities-and-communities.pdf

6.             Martin. (2023, October 20). Reduce inequality within and among countries - United Nations Sustainable Development. United Nations Sustainable Development. https://www.un.org/sustainabledevelopment/inequality

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OT curriculum in ukzn

One of the blog posts I   wrote in 2023 during the last block was titled "At the Edge of a Fate Deciding Journey," and it examined how the final block of that year was going to decide where my heart would lay in the OT domains. Once again, this term has grown increasingly bizarre since it now appears in a new context. As we approach the conclusion of the second to last block, we are approaching the end of the year, the finish of our training to become occupational therapists, and the beginning of our community service obligations. However, am I ready for community service? Are we, the class of 2024, prepared for this? is our level of readiness influenced by the level of training received and the level of knowledge acquired, or are we a bundle of nerves because of our challenges? As I began community block, these are some questions that have been flooding my mind; this blog will attempt to provide answers to these questions by taking a trip back to reflect on the Occupational therapy curriculum, highlighting the pros and cons of preparing students for community practice, primary health care.

The World Federation of Occupational Therapy (WFOT), the Occupational Therapy Association of South Africa (OTASA), the Health Professions Council of South Africa (HPCSA), and the South Africa Qualifications Authority (SAQA), which recognises the institutional formal qualification, are the four organisations that have influenced occupational therapy practice education or training (Naidoo et al., 2017). The University of KwaZulu Natal's occupational therapy curriculum is founded and based on principles from the organisations as mentioned above; this includes fieldwork practice as required by the OTASA. The students at the University of KwaZulu Natal, as per minimum requirements by HPSCA, need to have a 1000 hours of practical in training (OTASA, 2019) and the university ensures this by taking them to clinical sites for practice, where they are required to put their theory (taught in class )  into practice. During fieldwork, students are expected to develop a foundational understanding of occupational therapy through foundation classes and OT theory and to put newly acquired skills into practice during fieldwork components.

Students do theoretical work in courses where they participate in lectures. In the first year, they learn the basics; in the second, they integrate the fundamentals with practice-related theory; and in the third year, they go on to treatment, which is the application of theory into practice. This lecturer used to say, "Every student has a shelf in their brain where all information is stored, It is a matter of constantly revisiting the shelf to open and take content from it, but if one does not often visit the shelf to open and access it that is when problems arise"  the inability to access content makes these stages challenging to get through and conquer. These stages require one to take all the essential fundamental information throughout the years and apply it as their understanding enhances. However, in other cases, one may find that the shelf is there being accessed, knows the theory but is hindered by fear and doubt, and lack of confidence in the application as they need to trust their knowledge. these are some of the issues students faces: the inability to access, remember and recall theory content needed for application and loss of confidence to apply. Additional research has revealed that transitioning from a student's position to that of a certified practitioner can be challenging. However, they need to change to meet the changing health needs. (Morley, 2006).

From the information discussed above and some additional resources, it can be found that the pros are that since it is ensured that students have adequate practical experience with the requirement of 1000 hours of training (OTASA, 2019), students will have the necessary hours need to gain knowledge that they can use in community service working in primary health care. The blocks are different, assisting the students in having experience in various domains of occupational therapy, namely physical, psychosocial, paediatrics, and community block.

 The Community block is beneficial as it introduces students to real-world situations where they may handle issues comparable to those they would encounter in community service. It also exposes them to many OT facets. After completing a psychosocial block, paediatrics, and going to the physical block, this block allows me to perform physically as a fourth-year student until I feel confident enough to practice in the next block, which is the last and near to community service. The next pro is that the University of KwaZulu Natal curriculum is structured and planned in a way that the content of the profession (courses)program gradually increases knowledge, starting from the first year to the third year, where they are required to treat.

The curriculum's greater emphasis on theory has the disadvantage of sometimes leaving a gap during application—students can access the shelf. Still, they are unable to retrieve and apply information. This, in turn, contributes to the second disadvantage: students' low confidence, doubt, and fear when it comes to putting theory into practice—leaving them as community service primary health care practitioners who are uncertain and afraid. An additional disadvantage of this curriculum is that students are typically placed lacking patients or with a restricted spectrum of diagnoses, which limits their exposure to various kinds of illnesses and thus affects their practice, confidence, and knowledge.

From the discussion above, it is evident that both the training or curriculum offered and personal factors of students play a role in their lack of certainty in thriving in community service, and therefore, I have learnt to also relook at my own factors, revisit the shelf to decrease community service anxieties, and gain the confidence needed.

References

Naidoo, D., Van Wyk, J., & Waggie, F. (2017). Occupational therapy graduates’ reflections on their ability to cope with primary healthcare and rural practice during community service. South African Journal of Occupational Therapy, 47(3). https://doi.org/10.17159/2310-3833/2017/v47n3a7

Naidoo, D., Van Wyk, J., & Joubert, R. (2014). Are final year occupational therapy students adequately prepared for clinical practice? A case study in KwaZulu-Natal. In South African Journal of Occupational Therapy (Vol. 44, Issue 3, p. 25). https://www.scielo.org.za/pdf/sajot/v44n3/07.pdf

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The Importance of Maternal Mental Health in Society and its Implications for Occupational Therapy Practice

Maternal mental health is an important issue that is often overlooked in the field of public health. One may ask, but what is maternal mental health? and how it differs from mental health. well, Maternal mental health is the emotional, psychological, and social well-being of women during and after they have given birth. According to the World Health Organization (WHO), maternal mental health is defined as a state of well-being in which a mother realizes her abilities, can cope with the normal stress of life, can work productively and fruitfully, and can contribute to her family and community. Despite its significance, maternal mental health is often underemphasized even in our societies and treated as a secondary concern when, in fact, it is in society and is fundamental not only to mothers but the entire families that make up a society. This blog will unpack some of the importance of maternal health and child health in society, using research done maternal mental health, child health, and the community.

Research indicates that approximately 15% of pregnant women experience mental health issues, with this number rising to 19.8% in developing countries, including South Africa (WHO, 2017). These statistics outline the nature and seriousness of maternal mental health and its impact on both mothers and their children.

Illustration of some statistics on maternal mental health

Maternal mental health and child health

Poor maternal mental health can negatively affect children's growth and development, emphasizing the interconnectedness of maternal and child health. Research shows that poor maternal mental health during pregnancy can have lifelong impact / consequence on a child’s development. Some studies have shown that prenatal depression and anxiety can increase the risk of emotional and behavioural problems in early childhood (Julie A. et al., 2013). This proves a link between a mental health of women before , during, after birth and the health of their child ,therefore if maternal mental health is swept under the rug among other stigmatised societal issues this could have a adverse impact not only to the women ,children but the society as whole. Children are the society , they are next generation that is currently being shaped. A study by Julie A. et al., (2013), demonstrated associations between prenatal depression, anxiety and increased risk of emotional and behavioural problems in early childhood. These findings further highlights the effect of maternal mental health that extend beyond the mother influencing the development journey of the child therefore influencing the kind of child they will be, the kind of society member they will become .

The health of children and women (not limited to ) in a society are a reflection of the society . To expand on this here's example , Just like how high unemployment rates in a community like Cato Manor are a collective issue, poor maternal mental health and its consequences is an issue of the of the society . That is why maternal mental health and child health is important for the society, that society prioritizes maternal mental health, shifting from ignoring women who suffer in silence to providing support. The lack of knowledge of what is maternal mental health, it Importance and how it affect the society has hindered some women from seeking, getting and accept intervention even when it comes to them. As a community Occupational therapist student working in a community clinic where we serve and interact with women and children mostly, some are hesitant to speak about maternal mental health . This might be as result of lack of knowledge about it which affect the process of receiving intervention . This may be because it is a silent issue in the community and therfore may intervention processes are affected including that of Occupational Therapy. Occupational therapists a among other professions such as psychologists and psychiatrists positioned and trained to address the complex needs of mothers experiencing mental health issues they themselves face problems in proving intervention as required to needing individuals. It is an occupational therapist role to do health promotion of conditions affecting the community in community gathering sites like clinics , when fulfilling this role they encounter problems such as the community not receiving the knowledge they bring , when people are hesitant to speak out if they have symptoms due to stigmatised .Other issues may include women not coming to intervention because they do not understand their diagnoses and therefore leading to services not being rendered. Maternal mental health is an important factor of health and of the society , even though it is commonly underemphasized and overlooked , society should be aware well informed, so as to prevent the prevalence of poor maternal mental health and negative impact on child health and growth .OT profession play a role in the community in informing and intervene on enhancing maternal mental health however it is very important that the society also pulls it weight and decrease the implications of lack of knowledge within society to OT intervention and receive intervention and information provided to them by means of health promotions

In conclusion, maternal mental health is a vital aspect of public health that demands attention and action. Its impact on child health and community well-being cannot be overemphasized. By understanding the link between maternal mental health and broader societal health, we can develop targeted interventions that support mothers and their families, fostering healthier communities for generations to come.

Reference list • Julie A. et al. (2013). Prenatal depression and anxiety and its effects on early childhood development. Journal of Child Psychology and Psychiatry, 54(3), 352-361. • World Health Organization. (2017). Maternal mental health. Retrieved from https://www.who.int/news-room/fact-sheets/detail/maternal-mental-health • Author, A. (2015, August 17). Maternal mental health. Life with Ivy. https://lifewithivy.com/2015/08/17/maternal-mental-health/ • Ivy. (2015, August 17). Maternal mental health. Life with Ivy. https://lifewithivy.com/2015/08/17/maternal-mental-health/

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Silent pandemic in SA

There are quite a few mental health topics and issues that have recently flooded South Africa, more than any place in the digital world; some of the topics that have hit the internet by storm are anxiety, substance abuse, schizophrenia, bipolar, and depression, which were the most common. According to estimates, 1 in 5 persons in South Africa may experience depression at some point, making it one of the countries with the highest incidence of the illness worldwide. Since depression may have a terrible effect on people, families, and communities, this is a serious public health issue. Various variables, such as poverty, violence, trauma, and limited access to mental health, cause the high rates of depression in South Africa.

We all have mental health, just as we all have physical health, I even at one point in life experienced depression due to academic  due to stigma of being portrayed weak I had to go through it alone.  Thankful to the student support system that helped me to through it ,however family support would’ve made the process of intervention better. Many South Africans suffer in silence due to fear of being stigmatized this affects their choice of seeking for help, some never do. In South Africa, the stigma around mental illness is still strong. While some people are stepping up to support those struggling with depression, others still view it as a sign of weakness. In this blog, we’ll explore stigma towards depression toin South even after it hit the internet by storm, with people speaking about it since 2020, and how we can move towards a more open and supportive society for those suffering.

 The Depression and Anxiety Group highlighted during World Mental Health Day that the number of calls they receive per day has increased by more than 400 %. The increased number of calls to The Depression and Anxiety Group on World Mental Health Day is an encouraging sign that more and more people are reaching out for help. It demonstrates the impact of increased awareness about mental health issues and the need for support. However, it also highlights the need for more resources to be allocated to mental health services to ensure that everyone who reaches out receives the support they need. This increase is a positive sign, but it’s just the beginning – we must continue working towards a society where no one must suffer in silence.

-spread silentbreakingawareness-

Statistics show that people in the 25-34 age group in South Africa are most likely to seek help for depression, followed by the 35-44 age group. It’s interesting to note that while younger generations may be more aware of mental health issues and more likely to seek help mostly due to their exposure to trending new social media, where most people create awareness for depression and mental health., older generations may face more barriers to accessing support. In South Africa, cultural stigma around mental health issues may prevent older people from seeking help, as they may fear being ashamed for admitting they need support. In addition, access to mental health services may be limited in rural areas, where older people may be more likely to live. These factors can compound the effects of depression, making it more difficult for older people to recover.

 As much as their knowledge and exposure to social  media has helped them to understand depression in that they now seek intervention, it is not done for them,  it a societal duty of young ones to help create awareness of mental health on adults, provide them with platforms suitable for them that will create awareness. The Younger generations can play a key role in breaking down the stigma around mental health and encouraging people of all ages to seek help. They can do this by starting conversations about mental health, sharing information about resources and services, and leading by example in seeking support when needed. Younger people can also be advocates for change, pushing for increased funding and resources for mental health services, and working to make these services more accessible to all. In this way, the younger generation can help shape a new society where everyone has access to the support they need.

One possible avenue for further discussion could be the role of technology in shaping the younger generation’s attitudes towards mental health. Technology has made it easier than ever to access information and support, and platforms like social media have created new spaces for people to discuss mental health openly. However, there is also concern that the constant connectivity of technology can have negative effects on mental health, leading to increased feelings of isolation and anxiety.

It is our duty as occupational therapist to bring about awareness of depression and do away with stigma .The awareness and  de stigmatization efforts of occupational therapists can inform individual interventions in various ways. Just to name the few, by understanding the signs and symptom of depression, occupational therapists can better tailor their interventions to meet the specific needs of the person they are working with as my former supervisor once said ‘ an effective intervention speaks to every aspect of the client’. Second, by reducing stigma, occupational therapists can help individuals feel more comfortable talking about their experiences and seeking support. Finally, by promoting mental health education, occupational therapists can help individuals understand how to take care of their own mental health. This knowledge can be empowering and lead to positive changes in individuals’ lives, which is the reason I, even though fieldwork is over will start using social media platforms to create awareness and make my contributions towards Mental health

the above graph shows how social media increased wellbeing of certain respondents, 61% of respondents say it enhanced their wellbeing, proving there might be more good than mad in social media.

In conclusion, All mental health is an important issue that affects people of all ages and backgrounds. The younger generation is shaping a new society in which mental health is more openly discussed and supported. Technology has played a role in this change, but it can also have negative effects on mental health. Personal stories can be a powerful way to encourage others to seek help, but it's important to consider the potential consequences of sharing these stories. Overall, there is a need for more awareness, support, and resources for mental health, and the younger generation is leading the way in this movement.

References

Sachin/SABC. (2023, October 10). Distress calls increased by 400% post COVID-19: SADAG. SABC. https://www.sabcnews.com/sabcnews/distress-calls-increased-by-400-post-covid-19-sadag/#:~:text=The%20South%20African%20Depression%20and,on%20World%20Mental%20Health%20Da

Craig, A. et al. ( 2022) The prevalence of probable depression and probable anxiety, and associations with adverse childhood experiences and socio-demographics: A national survey in South Africa, Frontiers. Available at: https://www.frontiersin.org/articles/10.3389/fpubh.2022.986531/full (Accessed: 16 October 2023).

M, T. et al.( 9 september 2020). International Journal of Creative thoughts: Impacts of Social Media on Mental Health, volume 8, 2320-2882

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"I Am Sam" is a movie that explores the challenges faced by people with mental illness, The movie tells the story of Sam, a man with an intellectual disability a  mental illness that involves problems with general mental abilities that affect Intellectual functioning which includes  learning, problem solving, judgement and Adaptive functioning that includes activities of daily life such as communication and independent living (American Psychiatrist Associations 2023). This blog entry will reflect on this movie, reviewing the events from the perspective of an OT. 

Sam  functions at the age of a 7 year old and manages to raise his daughter Lucy to the age of  7 , when she turns 8 and her intellectual ability grows to be higher than  his ,He is shown in this film as  struggling to be a good father to his daughter, Sam faces many barriers to performing his role as a father due to his mental illness. His problems increase when social services get involved and he wants to take Lucy away from Sam to foster care as they believe he does not have the capacity to take care of his daughter Lucy. This leads to Sam fighting for her daughter in the court of law with the help of a lawyer, Rita.

  

Sam was presented to be struggling to engage in some occupations as well such as his occupation as an employee, he had difficulty with tasks such as organizing the shelves, operating the cash register, and interacting with customers and co-workers. He also had difficulty participating in community activities, such as going to the library or attending events. These challenges are due to his difficulty with executive functioning, social interaction, and emotional regulation, all of which are impacted by his mental illness. These difficulties are some of the reasons why it was presented in court that he does not have the ability to take care of 8-year-old and therefore lost custody of his daughter. These difficulties deprived him of his meaningful role, that of a father. 

 Not only does this movie reveal occupational an engagement difficulties of people living with mental ill but also reveal of how mental illness is often overlooked and under-resourced in the healthcare system. For example, Sam's mental health issues are not taken seriously by his social worker, who sees his difficulties as merely a result of his low IQ. Furthermore, Sam is not given access to the same resources and support that other people with disabilities receive, such as vocational rehabilitation or support groups that could have helped him to be better resourced and equipped to take care of his daughter.

The movie highlights the stigma and discrimination that people with mental illness often face, both from the healthcare system and society at large, according to an article by health direct , stigma can cause people with mental illness to withdraw from society, after having denied custody of her daughter Sam withdraws from society and locks him self in his room, in a corner closed with paper origami, he could not deal with the emotions of dealing with the society that took his daughter away and believed to have no value in it.

 Occupational therapists could have intervened in several ways in this movie, First, they could have provided Sam with more support in the workplace, such as coaching and training on how to perform his tasks. This would have helped him be more successful at work and reduced the likelihood of termination. Second, occupational therapists could have helped Sam develop coping skills and strategies to manage his emotions, as well as strategies for navigating social situations. This would have helped him better interact with his co-workers and customers and reduced the likelihood of conflict or misunderstanding and thus helped him to keep custody of his daughter as a report from the Occupational therapist stating his capability and training would have saved his role as a father. 

Also, we see the law is portrayed as a barrier rather than a tool for supporting individuals with mental illness. Sam's case in court highlights how the law can be used to discriminate against people with mental illness, rather than protect their rights. Sam is denied custody of his daughter not because he is unable to care for her, but because of the stigma associated with his mental illness. This illustrates how the law can perpetuate stigma and discrimination, rather than promote inclusion and equality. The judge, who made decisions based on stereotypes and preconceived notions about people with mental illness, rather than on the evidence presented in court. 

 The movie "I Am Sam" offers several valuable lessons for occupational therapy supervisors. First, it shows the importance of taking everyone's situation into account and not making assumptions based on stereotypes or preconceived notions. Sam was not a typical client, and he required a unique approach that took into account his specific needs and abilities. Second, the movie demonstrates the power of collaboration and teamwork in achieving positive outcomes, that was demonstrated through some characters that supported him. Sam's friends and co-workers offered him support and encouragement, both at work and in his personal life. Sam's lawyer, who advocated for him in court and helped him present evidence of his capacity to parent his daughter. Lucy, Sam's daughter, who remained close to him and benefited from his love and care, despite the challenges of his mental illness. These characters helped Sam to engage in his roles as a friend, co-worker, and father, despite the barriers he faced. They demonstrated that support and understanding can make a big difference in the lives of people with mental illness.  

Finally, the movie emphasizes the value of compassion and understanding in helping clients to reach their goals, The importance of occupational therapy in helping people with mental illness overcome barriers to occupational engagement and fulfill their meaningful roles. 

References

Mahoney, W.J. et al. (2015) Occupational engagement and adults with intellectual disabilities, American Occupational Therapy Association. Available at: https://research.aota.org/ajot/article/70/1/7001350030p1/6123/Occupational-Engagement-and-Adults-With (Accessed: 30 September 2023).

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Therapeutic use of self

Therapist use of self refers to the idea that a therapist or practitioner uses their own self as a tool in intervention. Thomas(n.d) Describes therapeutic use of self a deliberate and conscious use of therapeutic relationship as an agent of change. The therapist provides intervention through themselves. In psychosocial practice, therapeutic use of self can be used to make difference by helping them understand and resolve their problems. Another concept of understanding therapeutic use of self is by thinking of a hammer and nail concept. The intervention in the concept being a nail, the hammer being the therapist and the hammered objects the client. During any work the hammer hit the nail to cause some impact on object , so is in therapeutic use of self ,the therapist uses themselves (hammer ) to do intervention ( hitting the nail ) to cause impact in in the client.

This blog will be exploring the use of therapeutic use of self in fieldwork ,focusing on my reflection on my experiences and past interventions given ,to unpack and critique previous interventions.

As aspiring Occupational student ,still fresh and a new to the profession, we tend to think too much on things ,analyse techniques as complex and later finding out they are no so complex and I have been using the skills and techniques from the start no knowing. In honest truth this is how we get to learn. When I take a step back and reflect on my intervention,  therapeutic use of self has always been there and in play but never noticed. Lao Tzu once said  "The highest form of skill is to be without any. That is, the highest form of skill is to execute something without being conscious of having skill in it, and I fully understand what this writer means. When one has full conscious of their skill they focus more on executing that skill to perfection rather than doing what is beneficial for the client that particular time . I believe that my therapeutic use of self while I didn't know anything about it was much more effective and beneficial to the client than now that I have that skill.

Before learning about therapeutic use of self , in my sessions I would use myself as form of upgrade, downgrade or handling skill to intervene in the client’s situation or adapt sessions, this would be spontaneous, unplanned but effective as it would be specific to the client's need at that particular time.

Now that I have learnt about therapeutic use of self, aware of it ,when planning my session I plan for it which sometimes is not intervening to the client's present need.

  Therapeutic use of self should be a skill used mostly on the "Here and now". The here and now approach emphasizes focusing on the present moment and what is happening right now, rather than dwelling on the past or future. It's about being fully present and engaged in the moment, both for the therapist and the client, in this approach the therapist can identify the need in the here and now and use themselves to intervene in those emerging problem areas.

Therapist use of self refers to the idea that a therapist or practitioner uses their own self as a tool in intervention.Carrington(2006) describes therapeutic use of self a deliberate and conscious use of therapeutic relationship as an agent of change. The therapist provides intervention through themselves. In psychosocial practice, therapeutic use of self can be used to make difference by helping them understand and resolve their problems. Another concept of understanding therapeutic use of self is by thinking of a hammer and nail concept. The intervention in the concept being a nail, the hammer being the therapist and the hammered objects the client. During any work the hammer hit the nail to cause some impact on object , so is in therapeutic use of self ,the therapist uses themselves (hammer ) to do intervention ( hitting the nail ) to cause impact in in the client.

This blog will be exploring the use of therapeutic use of self in fieldwork ,focusing on my reflection on my experiences and past interventions given ,to unpack and critique previous interventions.

As aspiring Occupational student ,still fresh and a new to the profession, we tend to think too much on things ,analyse techniques as complex and later finding out they are no so complex and I have been using the skills and techniques from the start no knowing. In honest truth this is how we get to learn. When I take a step back and reflect on my intervention,  therapeutic use of self has always been there and in play but never noticed. Lao Tzu once said  “The highest form of skill is to be without any. That is, the highest form of skill is to execute something without being conscious of having skill in it, and I fully understand what this writer means. When one has full conscious of their skill they focus more on executing that skill to perfection rather than doing what is beneficial for the client that particular time . I believe that my therapeutic use of self while I didn’t know anything about it was much more effective and beneficial to the client than now that I have that skill.

Before learning about therapeutic use of self , in my sessions I would use myself as form of upgrade, downgrade or handling skill to intervene in the client’s situation or adapt sessions, this would be spontaneous, unplanned but effective as it would be specific to the client’s need at that particular time. Now that I have learnt about therapeutic use of self-aware of it ,when planning my session I plan for it which sometimes is not intervening to the client’s present need.

 Therapeutic use of self should be a skill used mostly on the “Here and now”. The here and now approach emphasizes focusing on the present moment and what is happening right now, rather than dwelling on the past or future . It’s about being fully present and engaged in the moment, both for the therapist and the client, in this approach the therapist can identify the need in the here and now and use themselves to intervene in those emerging problem areas.

Therapeutic use of self should be a skill used mostly on the “Here and now”. The here and now approach emphasizes focusing on the present moment and what is happening right now, rather than dwelling on the past or future(Perlz, 1940) . It’s about being fully present and engaged in the moment, both for the therapist and the client, in this approach the therapist can identify the need in the here and now and use themselves to intervene in those emerging problem areas. Therapeutic use of self is an important skill to master occupational therapy , not only does it handle here and now situations, but it guides client centeredness

One baseball legend Yogi Berra once said , In theory there is no difference between theory and practice. In practice sometimes we can know all about something in theory, but it’s only when we put that knowledge into practice that we truly learn and understand.

Analyzing this topic has been only tuaght me theory information on therapeutic use of self but I’ve nit learnt anything until I practice it which is why this hear and now therapeutic use of self concept outlined above will inform my intervention session from now onwards to practice the above mentioned skills of applying principles hear and now

The 'Here and Now' in Occupational Therapy" would be:Twist, M., & Carrington, R. (2006). Living in the Now: The 'Here and Now' in Occupational Therapy. American Journal of Occupational Therapy, 60(5), 603-609.

Wilcock, P. (2009). Gestalt Therapy: A Model for Occupational Therapy. British Journal of Occupational Therapy, 72(11), 528-534.

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Happily ever after.

Cinderella is a fictional character by Walt Disney created in 1950; she is an abused and neglected girl who escaped the clutches of her evil stepfamily by marrying the prince and had a happily ever after. According to WHO (2022[1]), mental health is a condition of mental wellness that enables people to manage life's stressors, develop their potential, learn, work effectively, and give back to their communities. It is said that mental illness is the Cinderella of healthcare. As an aspiring healthcare practitioner, it is in my best interest to uncover the truth behind this statement. In this blog entry, look closely into this statement and what it means and break it down to who is considered the evil stepmother, stepsisters, Fairy Godmother, and the prince. This will solidify my knowledge and understanding of mental health and health care, which is crucial if I focus on psychosocial and essential in my everyday practice. I need to understand why certain things in mental health are as they are; furthermore, as I unpack this statement, it will open the doors to using my observation skills to understand some of the reasons behind mental institutions' operation.

As I read articles on this statement, it was clear that the department of Health Government is an evil stepmother in this whole story. According to the South African Society of Psychiatrists, mental health is only allocated 5%   of the public health care budget even though South Africa was found to be leading with the highest number of people struggling with mental health with 36 %[2]. The rise in standard and treatable mental health conditions has become the leading cause of medical disability claims in South Africa. This proves its neglect of mental health and people living with mental health.

This was evidenced in the Life Esidimeni tragedy when the government terminated its contract with a private facility that provided care to public mental health patients. Patients were taken to cheaper places, where some were unlicensed, and others were not equipped to provide proper care and interventions, and as a result, some patients died[3]. Mental health care must receive the funding it deserves for it to function without any bearers., Withholding funds is only making it worse as patients will not be effectively treated, which will cause them to be later readmitted, using state resources again. In the attempt to save and cut down, the matter is only being made worse and only increases the stats of people with mental health; that was an evil stepmother's move, neglecting the human rights of people to save.

Evil stepmother depriving Cinderella.

The evil stepsisters can be said to be the society. The Ignorance of the department towards taking good care of mental health has led to a community that is ignorant of mental health; it has shaped the stigma within the community to neglect mental health. It was said that to understand the present, one must goback to the beginning; the past shaped this kind of society that overlooks and stigmatises mental health, where mental health was seen as a punishment from God /Ancestor. The healthcare system still has traits of that belief; this is seen by how health institutions are constructed. several of them are made like prisons, even though people who are admitted are considered the most vulnerable. Still, their vulnerability is seen as a threat because of the society that has shaped us.  

The sad part is that the healthcare practitioners who are trained to rehabilitate, protect and intervene in healthcare grow up in a society that does not understand, and due to lack of understanding and installed fear of mental health and people living with mental health, some hold on to that stigma and play a part in neglecting and abusing mentally vulnerable now those are evil stepsisters. I can only hope that as an aspiring OT, training and going to placement with mental health, I get exposed to them, understand them and use knowledge taught to me by the fieldwork supervisors to advocate for mental health and not play a part in being one of the evil stepsisters but be the prince.

The fairy Godmother in mental health can advocate mental health, including those who speak out for mental health, promote awareness, and speak against injustices towards mental health  such as the  South African Federation for Mental Health which fight for people with mental health problem such as psychosocial and intellectual disabilities[4].

The Cinderella story ends with a happy ending; it is not certain if this fairytale of mental health will have the same luxury, however, I believe that every healthcare professional that has a role of intervening in mental health has a role and potential to be the prince to mental health by providing proper intervention, advocate for mental health as it is said  a squeaky wheel that gets the oil. If only healthcare professionals may strife to be the prince and not evil stepsisters, and raise their voices on behalf of mental health, only then can this be a happily ever after story.

Being vulnerable does not mean being weak!, it courage

[1] World Health Organization. (2022, June 17). Mental health. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

[2] Writer, S. (2023, March 3). Mental health in SA in dire need of better funding: SASOP. Home. https://www.axesshealth.org/blog/mental-health-in-sa-in-dire-need-of-better-funding-sasop

[3] Wikimedia Foundation. (2023, June 12). Life ESIDIMENI scandal. Wikipedia. https://en.wikipedia.org/wiki/Life_Esidimeni_scandal

[4] About US - Mental Health Wellness Advocacy & Promoters - SAFMH. SA Federation for Mental Health. (2020, October 26). https://www.safmh.org/introduction-to-safmh/

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on the edge of a Fate-deciding journey

When looking at different definitions of what being on the edge really means, I found that according to the Merriam-webster dictionary, it means very close to something, and the Cambridge dictionary describes on the edge as a feeling of nervousness or being worried. This is one phrase, defined in two different ways that are not even similar. The irony of this phrase and its definitions is that even though these definitions differ they somehow describe the phase I have been in lately, what I have been feeling as I embarked on this fate-deciding journey. One may question my choice of the words “fate-deciding”, well this block is fate-deciding to me because after this block I will be able to decide if psychosocial is really what I am passionate about, so this block is the eleventh hour. In this entry, I would like to invite you to buckle up with me on this train of ruminating as I reflect and try to unpack my first week of this fate-deciding block after it had been a year and six months after being in such a setting(psych).

The reality of how much I am at the edge only surfaced on the morning of practical preparation, but at this time the reality that struck was that I’m on the edge meaning close to finishing my third year, in my eyes three months were as good as three days. I was mostly excited about psych block, which I would now get to treat in psych as this was my favorite block in the second year when we were assessing. A few days down the line our first day on psych block came. At the Crack of dawn, I woke up to get ready for practical, and right then it all came crashing down, the uncertainty of what I would find on the block made me anxious and nervous.

 My confidence level went down as my stress levels went up; I was not sure if I had enough knowledge to be able to cope. This kind of feeling is common among health science students according to research cited in (Perkins,2021) more than half of healthcare students experience stress at the beginning of their clinical practicals. This is because when they go to practical, they are to demonstrate their theory knowledge (Perkins, 2020) in a more practical way which may be new to them, and therefore this leads to a decrease in confidence in what they are capable of doing. My stress and worry were rooted in my lack of confidence in demonstrating appropriate skills and theory when treating and assessing of which this feeling is common among Ukzn OT students, in a ukzn research by Naidoo (2013) fourth-year students also noted that the level of confidence is one of the factors that affect the preparedness for clinical.

Reassurance from my supervisor that we don't have to know everything and that we are still learning decreased my worry, I started to see my future in psychosocial as I engaged with the clients. The second day was not as calming as the first, I came in calm and confident. As I engaged with clients I was gradually being pushed towards the edge as I found it hard to handle some clients, however with constructive feedback I received my confidence in psych being my passion came back as the supervisor used the shortcoming as a way to teach and for me a learning time.

Yes, I am on the edge, close to reaching a place of decision-making where all cards pertaining to psychosocial (all experience) will be laid on the table and a fate-deciding decision will have to be made. Whether or not psychosocial will be my passion only time will tell, but at this time in moment it is not about what is at the end of this fate-deciding journey but acquiring as much experience and knowledge as possible while on the journey.

useful links

for ways on which health science can cope going on clinicals visit

UKZN Research on preparedness of student for practicals ( by Deshni Naidoo)

definitions of on the edge

Merriam-Webster. (n.d.). On the edge of. In Merriam-Webster.com dictionary. Retrieved August 18, 2023, from https://www.merriam-webster.com/dictionary/on%20the%20edge%20of

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cultural humility in health care

Since it is the last 2 laps of one of the miles in this journey of a thousand miles, the last two weeks of hospital Practical I would like to reflect on how culture and cultural humility played a role in my planning and implementing interventions on this block.

Students working in the hospital/ health care communities, such as medical students and all health science students, must learn and understand different cultures as they engage and work with different cultures. Culture, according to Boston University (n.d), can be defined as “all the ways of life including arts, beliefs, and institutions of a population that is passed down from generation to generation. Culture has been called "the way of life for an entire society".  When health students in the hospital or healthcare community become aware of how people's culture can impact their health behaviours and, in turn, use this awareness to cultivate sensitive approaches to treating patients, they show cultural humility.

Being born and raised in a multiracial town and being in KwaZulu- Natal, one would think cultural humility will not be a factor that will need consideration in the Hospital placement as I have been exposed to most KZN cultures.

 We knew we would be placed in a central hospital that takes patients from all over KwaZulu Natal and nearby provinces such as the eastern cape. When I got into the hospital, one of my clients was from another province; in planning my session, I had to be considerate of, most importantly, her language since she did not understand some ZULU words. in planning and writing in write up, I had to picture client, rewrite Zulu words to English which I thought will understand better. I had to put myself in her shoes in every intervention plan to be able to discover some barrier to the language. The client was Xhosa; I had to research the differences between Zulu and Xhosa cultures to understand the client more.

In the implementation of the sessions and continuing with working with the clients, I understood that it is not only a matter of language, but the belief of people also play a role in intervention, as Boston University further stated that understanding of culture requires an understanding not only of language differences, but also differences in knowledge, perceptions, beliefs, attitudes, and behaviours.

 When implementing intervention with my last client, I found that her beliefs, language, perception, and some of her knowledge shaped by her religion related to what I personally believed in; one would say that the intervention processes would be easy on me as a therapist and beneficial to the client, as they will be treated by someone who understands and relates to their culture. That was not the case; I discovered that even though some cultures may be similar in belief, attitudes, knowledge, and behaviour, how we interpret those cultural aspects and practices would be different and would need a therapist to be considerate and shape their intervention for the benefit of the client regardless of their culture.

I learned that cultural humility is not only about the therapist understanding language differently but rather a collaboration between therapist and patient in intervention planning, being considerate of one’s cultures and finding common ground where both parties are accepting and considerate.   

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evidence based practice in OCCUPATIONAL THERAPY

Dr. David Sackett describes evidence base practice as integrating individual clinical expertise with the best available external clinical evidence from systematic research. It is about combining the therapist's expertise, skills, and experience with the client’s situation, values, and context to make informed decisions about their care.  In my intervention planning for the midterm, the client was characterized by those mentioned above. According to Sackett et el (2011), evidence base practice follows a 5 A’s cycle; in my intervention planning and implementation, evidence-based approach steps were followed.

 During the assessment of the client, I asked questions in trying to understand the client; during the interview, I asked questions that would give the client the platform to explain her situation in her own words, as they are the ones who best know their body and needs, from what they said their values were apparent. She explained her context. The client's needs were formulated from the situation laid out by the client and the information given in the file (Ask ).

In continuation with intervention planning and preparation, the client was assessed using formal assessment to get sound evidence of the situations laid by them and past clinicians. The areas that the client had said were limiting occupational engagement (acquire).

To validate assessment findings, research was done about diagnoses, reassessments and comparisons to normal. This way, the assessment findings were checked to see if they were valid and relevant to the client. The conclusion and clinical picture of the client were made, along with their limitation to occupation performance.

In implementing the intervention, this is the (applying stage ). after assessment, the patient's context, situation, and values were taken to collaborate with the therapist's skills, research and training.

To provide the client with a context-relevant intervention that addresses different engagement limitations. The setting of the sessions was so that it was relevant to the client. Research done on the client's condition was used, and the client received an intervention that is appropriate client centred and seeks to benefit the client.

After intervention and receiving feedback from the supervisor on the session, I reflected on the assessment to reporting, which assessments were good but lacked reporting. A reassessment was done on some formal assessment findings to track k for progress and to validate findings. ( audit )

The client is made the important part of the intervention by applying evidence-based assessment in intervention.

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*The reign of the client*

client-centered therapy

Client-centred therapy is a non-directive therapy approach where the client assumes an active role and therapists support them (based on Carl Rogers). Client-centred is about allowing the client to take reign and be king of their intervention as they best know themselves and their needs. It is with great disappointment that my clients were dethroned and stripped of that crown.

In my past sessions, not only did I have ulterior motives (of conducting perfect sessions and pleasing the supervisor or feeling a sense of accomplishment), but clients were also deprived of the opportunity to take reign of their intervention. But by not including patients in the I intervention, I unintentionally stripped them of their power. My understanding of the client-centred approach was enlightened only after the group session. Feedback about allowing the client to do things themselves was given to us as a group of therapists, my mind replayed all the treatment sessions I had done, and mistakes that suppressed the client from directing the intervention depriving them of their reign were apparent.

Knowing theory without practice is of little value, whereas practice is proof of the theory; my treatment session may have shown an understanding of the client and the client’s needs. But by reflecting, they did not show a non-directive approach of the therapist but instead directive. After the feedback and understanding I have acquired by looking closely at the client-centred approach, it is in my heart to correct the lack of this approach in sessions by implementing it.

Once again, you do not walk by only following the rules; as I continue with fieldwork, it is up to me to follow through with all the feedback I have received by doing as corrected by my supervisor.

At the end of it, you are what you do and not what you say you will do; I can conclude by saying that only actions will tell as time goes on.

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Theory to Practical

You do not learn to walk by following the rules. You learn by doing and falling over. My experience transitioning from theory-based intervention planning in the past year has not prepared me for what is yet to come. The wise once said a thousand-mile journey starts with a single step. Monday morning dressed all green and black, the sun is out but my beating drum echoing through my bones, can’t keep my eyes open due to the anticipation of what lies ahead. The lingering thought of doing just the assessment on the first day calmed me down due to the familiarity and what to expect. The tools I prepped for were not implemented due to the uncertainty of the hospital routine. Being versatile allowed me an educational opportunity to work in collaboration with the physiotherapist. Amid it all, I was unprepared to provide intervention due to the impression of doing just an assessment. This allowed me to build the skill of adapting to situations rather than being therapy directed. That granted me a confidence boost in how to approach treatment. A room of disappointment was closed leading to the presumption of fieldwork taking a sudden shift. The second day was filled with disappointment and unpredictability. It showed the importance of activity analysis and grading principles. Furthermore, allowing me to learn from single-directed treatment to developing SMART aims that include all areas of limitations to provide the client-specific session. To further comprehend the importance of problem-solving and time management within the session. Being able to apply principles of treatment per the occupational performance of the client is crucial. The prior knowledge and constructive criticism were stepping stones in my educational journey of becoming a confident 3rd-year occupational student. Cooley states I am who you think I am, as I approach the second week of fieldwork my support system lies in the peer learning among the students and the supervision of the clinical supervisor to guide my educational journey as they serve as the mirror of the thousand-mile journey.