tianipeters97

[tianipeters97]

A tough yet humbling journey in community practice

“we do not learn from experience. We learn from reflecting on experience” – John Dewey. Using the Gibbs reflective cycle I would like to take you on a journey of my experiences in community practice.

Something that wasn't obvious to me before this community block is that I need feminism and equality in our educational system and society because men and women are still unequal, and I need feminism because girls are sexually attacked and the first question people ask is what she was wearing. I need equality for all Because the residents of the Sea Cow Lake settlement are dehumanized, and because immigrants in that community must hide their identities to avoid xenophobic violence. And yes, I am aware of the state of our government and politics; in fact, I am no longer hesitant to question a system that has normalized the dehumanization of women and marginalized communities; I have come to the empowering awareness that I can push back against oppressive beliefs and structures.

in the first week of health promotion which involves informing the people in the clinic of the role of occupational therapy and how we can help them I was startled by how most people seemed indifferent to the services offered, there I was a student used to being handed clients in hospital settings, clients that may have never heard of occupational therapy but engaged due to being confined to the hospital. I was completely thrown off by this experience. In that very moment I thought to myself how will I get through an entire block in a community where no one seems interested in what I am saying, 4 weeks into this block and I can assure you all people need is a reason to seek your services, soon after I came to this realization my health promotion speech changed to include circumstances around me, I realized that no one wanted to hear about eating healthily for good overall health when those words are coming from someone who doesn’t even know if they have enough food in the first place. This is an example that I like to use because the more my health promotion seemed less rehearsed I started connecting with people in front of me by adapting to every age group that I was promoting services to. Linking this experience to equality what I would have done differently in the first few weeks of health promotional speeches would be taking into consideration that even in the words used in speaking to people in different communities the is always a need to meet the conditions of the people and certain words that I used were not relevant in those settings.

As discussed in my previous blog according to the united nations (2015) gender equality sustainable goal aims to provide equal opportunities for women and girls for work, leadership positions, education, reproductive rights and ending exploitation and abuse. Since my last blog I have come across a number of women of varying age groups, with one of these women in Mariannridge community expressed her dire situation of limited finances leading to malnutrition of her 4 months old baby, me and my colleague then used this opportunity to inform her about the women empowerment program which allows women to make a living by selling donated clothes. We expected the women to arrive first thing the next morning due to her circumstances however till this day not a single word was heard from her, when contacted her reasons for not coming to work included concerns such as who would look after the baby and what if she didn’t sell anything. Both of which may seem like reasonable excuses but we provided solutions to both problems without any financial strain to her but she still did not come to work. my first thoughts were that providing opportunities should be enough, I felt disappointed that this woman wasn’t taking the help she needed and this for me was a lack of urgency that I have come to be acquainted with, as frustrated as I was after having a debrief with my supervisor and colleagues I new perspective came to me that it was easy for me to apply my own positionality to the situation and thinking that if it were me I would have taken responsibility and grasped the opportunity to make a living to feed my child but looking at Social Inclusion according to Nelson & Prilleltensky (2010) one of the 3 levels I wish to discuss is the individual level which is concerned with giving people control over their lives. I realized that therapy needs to start at the individual level and for this women it would mean peeling back layers of oppression in order for her to realize the power of taking control of her life and as I look back I regret giving up on her.  

I cannot reiterate this enough, positionality is a key thing to be aware of own biases and privilege in the community block (tianipeters97, 2022). Being aware of my positionality allowed me realize the power dynamics between myself and my clients, I realized the power imbalance even in the clients own home settings where one would assume they would command more power. through one of my older clients in Kenville during a session where she didn’t understand the purpose of the activity however she continued with the activity until I asked if she had understood the reason why we were doing that particular activity, I always assume that clients will ask if they don’t understand but from this experience I realized the is little chance that our clients say no to sessions regardless if they find them meaningless due to the trust they place on us, they think we know what is best for them, which is completely not true. Furthermore, through interactions with this client I have abandoned this dogmatic thinking that any activity if relevant should bring meaningfulness to the client. I have come to realize that just because she wasn’t participating in certain activities doesn’t mean she wasn’t fulfilled partaking in her everyday occupations.

I am no longer afraid, I am not afraid of the discomfort that comes with discussions about social justice and social inclusion for all people in south Africa. I am not afraid to call myself a humanist and a feminist and no, being a feminist or a humanist doesn’t make me a man hater or a despiser of the privileged on the contrary I believe the fight for women equality and inclusion for the less privileged starts with all humanity. These experiences have brought me to this moment, I declare myself an activist for equality because social inclusion should not be limited by peoples identities, and I welcome the discomforts that come with knowing that I am doing what is right and ethical as both a human being and an occupational therapist in the making because my wellbeing and that of the communities that I serve is more important than any discomfort I may experience in seeking solutions.

    References

Nelson, G., & Prilleltensky, I. (Eds.). (2010). Community psychology: In pursuit of liberation and well-being. Macmillan International Higher Education.

United Nations charter, sustainable development goals 2015

Tianipeters97. (2022, March 25). Reconciling positionality in the life of a young modern therapist. https://tianipeters97.tumblr.com/post/679722779068743680/reconciling-positionality-in-the-life-of-a-young

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.twenty20.com%2Fphotos%2F0433b8b7-f748-4ad6-8538-eda68668cc7c&psig=AOvVaw1Mu4Nug3P9994Zb-P4KWiN&ust=1649533141465000&source=images&cd=vfe&ved=0CAoQjRxqFwoTCNDdk6aGhvcCFQAAAAAdAAAAABAD

https://www.google.com/imgres?imgurl=https%3A%2F%2Fs3-eu-west-1.amazonaws.com%2Faaimagestore%2Fessays%2F1278686.002.png&imgrefurl=https%3A%2F%2Fwww.ukessays.com%2Fessays%2Fhealth%2Foccupational-therapy-reflective-essay-4762.php&tbnid=Wtqa-cUP27DfnM&vet=12ahUKEwi9tJy4nIX3AhUOohoKHVeyA1YQMygNegUIARDSAQ..i&docid=0tlswTZwtFY9PM&w=443&h=187&q=occupational%20therapist%20pictures%20of%20reflections&ved=2ahUKEwi9tJy4nIX3AhUOohoKHVeyA1YQMygNegUIARDSAQ

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Sustainable developmental goals in community based occupational therapy practice

Sustainable development goals are a set of proposals aimed at acquiring a healthier and improved life for everyone over time (United Nations, 2015). In the past week several thefts against students have occurred in the communities where we practice in. but I remain resilient in providing intervention for the people that need it to bring about a better quality of life. I use these crimes as a way to emphasize the importance of achieving sustainable development goals because I believe that different positionalities maybe hard to comprehend but when I look at these communities this way my thoughts are if there was an improvement in their lives in terms of economic, social and environmental equalities this would greatly increase  social justice and inclusion, the crime rates wouldn’t be high as people’s lives would be improved. Therefore, my objective is to present good health and wellbeing, gender equality, reduced inequalities, peace, justice and strong institutions and partnerships for the goals as the 5 sustainable development goals I aim to work towards in Kenville and Mariann ridge communities because not only are they essential to the people living in these communities, they are interlinked and a lack in one affects the other goals resulting in poor quality of life.

Good health and wellbeing goal aims to focus on social and economic inequalities to improve quality of life through access to good healthcare services such as reproductive health, mental and maternal health, to encourage healthy lifestyles and  the prevention of epidemics such as HIV (United Nations, 2015). Substance abuse is rampant in the communities where I work, and inadequate health care services are related to under-resourced health care facilities, resulting in individuals getting secondary disabilities that could have been prevented. Furthermore, the promotion of good health and wellbeing is hindered by poor socio-economic status resulting in residents to being unable to access healthcare services, poor child development due to poor nutrition, a high birth rate among adolescents and poor maternal health seeking behavior. Through occupational therapy services I aim to improve health and wellbeing through the daily health promotion speeches as this allows awareness of occupational therapy services as well as normalizing speaking of HIV/AIDS to allow people to seek answers from us, the clients can ask questions about any health issue allowing me to refer or intervene if its within the scope of occupational therapy practice. Through follow ups on clients, I am able to establish a client handover that will allow the client to continue to get occupational therapy services in the future. Through screening of children, I’m able to pick up signs of malnutrition and from the conversation with the mother I can educate about maternal health, reproductive health and rights and mental health, home visits allow for access to occupational therapy to everyone including people that are unable to travel to the clinic. Currently Being in Contact with possible food donors allows for food security and improved nutrition leading to improved health and wellbeing in the community.

Gender equality is a goal that aims to eliminate discrimination against women and girls by giving equal opportunities for work, ensuring women's leadership, education, and reproductive rights, and ending exploitation and abuse (United nations, 2015) “Inherent conditions of living as a woman, within a township and further as a "Coloured" woman, has created specific material and socio-cultural conditions that are embodied within their everyday lives and occupations, and in their marginalized identities” (Christopher et al., 2021, p. 5) .the conditions within their daily lives indicating gender inequality is observed through Women taking on domestic duties and caring for the children while their husbands are at work, as well as differences in formal work opportunities, the inability of women to make informed decisions about their health and the health of their children, inability of mothers in high school to be afforded counselling and the ability to catch up on school when their children are sick, and acts of violence against women. As an occupational therapist, my goal is to help more women achieve gender equality by empowering them to participate in women empowerment programs that enable women to earn a living and so relieve stress by allowing them to financially support themselves. Furthermore, I aim to empower and educate girls on reproductive health and rights in order for them to be able to report acts of violence such as rape. I aim to practice therapeutic use of self to Ensure that my choice of activities for intervention are not solely based on my client’s gender in order for carry over of occupational consciousness. Furthermore, I aim start a job workshop for the women in Mariann ridge who are not educated to help them create curriculum vitae and provide a list of possible employers in order to create job security and reduced dependence on their male counterparts.

Reducing  inequalities is important as the large majority of the south African population is living in poverty linked to gender inequality where women earn less than men (Shikha, 2019). This goal aims to acquire equality for everyone  disregarding their demographic status immigrant status, ability status and any other status that define people in a country (United Nations, 2015). with numerous people living with disabilities in the low-income communities of Kenville and Mariann ridge, the acquisition of wheelchairs in a difficult process and when wheelchairs are acquired  the poor infrastructures such as narrow inclined uneven roads hinder community participation, during home visits I make recommendations of easy and affordable ways to adapt wheelchair pathways leading into clients’ homes in order to afford them the mobility they need to access the society. I aim to help disabled minorities of all age groups gain social inclusion in group interventions at the clinic. Through the women empowerment projects of selling clothes, I aim to help women gain skills that maybe useful in other job opportunities. Due to the communities experiencing poverty inequalities I aim to create a youth project that supports girls and boys in these communities to finish their education through improving stress management and substance abuse interventions. Furthermore, through educating people that come for interventions and through pamphlets I aim to decrease biases and stigma surrounding disabled people and seeking help for mental illness. Furthermore, due to Kenville community having immigrants from Malawi, Zimbabwe and other African countries, I aim to ensure inclusion in community participation.

Peace, justice, and strong institutions is a goal that aspires for more nonviolent and inclusive communities, as well as strong and dependable institutions, in order to achieve all of the Sustainable Development Goals (United Nations, 2015) I aim to work towards being a part of advocating for the marginalized communities I work in, by ensuring that as a health care professional I do not bring in biases in my intervention and to uphold ethics by treating all people equally. McDermot (2019) stated 'Violent behaviors could become liberating instruments, advancing democracy by empowering marginalized people.' My goal is to inspire people to speak up for their rights in the face of injustices in a way that does not damage others or destroy infrastructure.

partnerships for the goals intends to strengthen and revive the global partnership for sustainable development's implementation mechanisms (United Nations, 2015). as an occupational therapist working in poor communities, I aim to use resources such as the blaumeier atelier projects to inform me on different ways to incorporate tools that can assist in helping my clients express themselves therefore getting rid of barriers such as inequalities. furthermore, through reaching out to other institutions and making partnerships such as Addington hospital aiding in equipment for neurodevelopment disabilities allows the implementation of the goals discussed.

Finally, I encourage you, the reader, to reflect on yourself and be a part of the solution in achieving a fairer and more prosperous South Africa. You are part of the problem if you're reading this blog and thinking to yourself, "It's a Them problem."

Picture links if interested:

https://www.google.com/url?sa=i&url=http%3A%2F%2Fwww.picturequotes.com%2Fwellness-quotes&psig=AOvVaw1jRYjjmpSRw_p5nZRLkozs&ust=1648926919161000&source=images&cd=vfe&ved=0CAsQjRxqFwoTCJD6r_Oz9PYCFQAAAAAdAAAAABAD

 https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.inspiringquotes.us%2Ftopic%2F2138-gender-equality&psig=AOvVaw0Thd8avtFQf103mqZxEfAM&ust=1648927037835000&source=images&cd=vfe&ved=0CAsQjRxqFwoTCMCpz7W09PYCFQAAAAAdAAAAABAD

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.pinterest.com%2Fpin%2F361554676326746962%2F&psig=AOvVaw3GbPjg_8k69AF3H4NZL3K9&ust=1648927158746000&source=images&cd=vfe&ved=0CAsQjRxqFwoTCOC13eq09PYCFQAAAAAdAAAAABAD

References

Shikha, V. D. (2019). Gender equality for achieving sustainable development goal one (no poverty) in South African municipalities. International Journal of Social Sciences and Humanity Studies, 11(1), 84-98.

McDermott, Constance L., Acheampong, Emmanuel, Arora-Jonsson, Seema, Asare, Rebecca, de Jong, Wil, Hirons, Mark, Khatun, Kaysara, Menton, Mary, Nunan, Fiona, Poudyal, Mahesh and Setyowati, Abidah (2019) SDG 16: peace, justice and strong institutions – a political ecology perspective. In: Katila, Pia, Pierce Colfer, Carol J., de Jong, Wil, Galloway, Glenn, Pacheco, Pablo and Winkel, Georg, (eds.) Sustainable Development Goals: Their Impacts on Forests and People. Cambridge University Press,

Christopher, C., Joubert, R. W., & Pillay, M. (2021). " Walking with a Smile but Her Shoulders are Hanging Down" Exploring" Coloured" Women's Occupational Resistance in the Face of Personal, Historied and Societal Suffocation. South African Journal of Occupational Therapy, 51(4), 4-12.

United Nations charter, sustainable development goals 2015

[tianipeters97]

Reconciling positionality in the life of a young modern therapist

Is it too much to want to be humanized first?

The reason why we are required to check a small box in any application form that identifies us as female or male, south African or not, black, white, Indian or other, homosexual or heterosexual, employed or unemployed is a question many of us never ask ourselves and if we do, we rarely give it much thought. I imagine a world where being human is just enough. A world in which hatred, marginalization and social exclusion of a particular group of people was not embedded in our societies and political contexts. since we live in the real world where our social and political contexts form our identities. I hereby state my positionality as a black woman from a middle-class, religious family living in post-apartheid South Africa, and how this identity influenced the way I had always believed that as a woman I was obligated to a higher moral ground than men, acceptance of homosexual individuals, thinking that people living in abject poverty were just lazy, and stigma surrounding foreigners. Some of these prejudices changed as a result of a shift in positionality that is still gradually occurring.

During apartheid, religious propaganda was used to further divide people while also having a strong influence on masculinity to maintain men's superiority over women. This influence is still present in society today (Meyer, 2022). As a young black woman raised in a religious family, I had very little opportunity to express myself and explore my own understanding of whatever my family didn't believe in, in contrast to my brother, who was permitted to make his own decisions because he was a man. With this limited expression I formed a world view that was both limiting and perpetuated segregation among people of different belief systems. I had countless biases including seeing homosexuality as evil as at that time I couldn’t question what I didn’t resonate with in the bible less it be seen as acts of disrespect or blasphemy. As a result, I ascribed to gender roles where a woman’s value is based on chastity, her ability in household chores and her ability to be meek allowing a man to be the provider and the head of the household (Eisend, 2019). The importance of considering my positionality with regards to the influence of religion and my patriarchal family is that when assessing and working with communities It's critical to comprehend why some women share this belief system and why others don't. not to further divide the community, not to blame women who still have such identities, but to present an alternative way of thought to liberate and empower women in this society, to assist them examine why independence isn't granted to them and how this restricts their freedom and growth. Also, to push for equal work opportunities and occupational choices.

 The reality of living in a so called “post-apartheid, post-colonial south Africa” I say this in inverted comas due to the country currently still experiencing segregation and south African policies being of the neoliberal agenda, according to Chiweshe (2016), “south Africa has remained in late apartheid condition marked by a white strong grip on land and productive assets”. this south African context of institutional racial segregation and class have greatly influenced my view of what is regarded more of white occupations such as competing in swimming sports because for me majority of Caucasian people have access to swimming pools in their homes, so why bother right? furthermore my understanding of how to behave around Caucasian people to make them feel more comfortable or make them view black people as less barbaric and worthy of being equal in this democratic country stems from the history of apartheid. going to a mixed-race high school I was confronted with the reality of institutional racism with regards to the school policy of seeing black natural hair (Afro) as untidy and not being allowed at school. As a result, when my hair wasn’t braided, I had to use chemical relaxers or be forced to shave my hair off. Till date this experience formed an understanding of what good hair needs to look like. with this awareness of how apartheid and colonialism has shaped my identity, I got to explore the community practice with a view of how in some ways most of us are within the marginalized and socially excluded, some less than others. The realization of my positionality brings about power, the power of not only sympathizing but to assert my shifting positionality through actions in community practice.

As a construct of apartheid and colonialism being from a Middle-class family pursuing a tertiary education imbedded in a neoliberal agenda as a young black woman in opposition with inequality, patriarchy, racism, homophobia and xenophobia through Exposure to communities with foreigners and south African people living in abject poverty, one thing is clear to me. As liberated as I thought and imagined myself to be from all those factors that had previously formed a narrow narrative of the people living in south Africa some biases still held true. Yes, I have been a victim of racism, patriarchy and inequality but I have never lived through food insecurity or subjected to violence due to my nationality neither have I been subjected to poor sanitary conditions. as selfish as this was, I thought I cared for people experiencing hardship with identities that did not resonate with mine, such as being sympathetic with foreigners being burnt alive during the xenophobic attacks or with gay or lesbian people not being hired in jobs, kicked out of churches and violated due to their sexuality but in truth I only spoke up on what affected me directly.

The importance of being able to realize my positionality as a therapist in the community is to not only get rid of the stigma surrounding the marginalized but to be aware of my privileges, such as never encountering food insecurity, being able bodied or being educated. but also, to ensure that programs that are meant to empower people in a community challenge the mindset or positionality of  marginalized groups to build self esteem through programs that empower foreigners and south Africans living in poverty to fight for their independence against male superiority, financial dependence and to cultivate the essence of “ubuntu” an Isizulu term meaning humanity. To cultivate a stronger united community of people that view themselves worthy of good living conditions and respect, to advocate for humanization of this community, to acquire social justice for them.

With this stated, I acknowledge that I am a product of my social and political environment, but I refuse to remain ignorant to injustices any more. As a result, I show myself in visual form:

https://drive.google.com/file/d/1EJfYk5KElz2rUZvgtmb9uyysqUQ_3P_Z/view?usp=sharing

References

Meyer, J. (2022). Investigating the nature of and relation between masculinity and religiosity and/or spirituality in a postcolonial and post-apartheid South Africa. Retrieved 25 March 2022,

chisweshe, m. (2016). Social Positionality and Xenophobia: The Case of Rugby Player Tendai Mtawarira. Africology: The Journal of Pan African Studies, vol.9, no.7,.

Eisend, M. (2019). Gender Roles. Journal of Advertising, 48:1, 72-80,   DOI: 10.1080/00913367.2019.1566103

https://i.pinimg.com/originals/21/82/6a/21826a3b08c366ccaa8e8ebe30979bee.jpg

https://www.google.com/url?sa=i&url=https%3A%2F%2Fm.facebook.com%2Fnotinourtown%2Fphotos%2Fa.96509304578%2F10157165128254579%2F%3Ftype%3D3&psig=AOvVaw025Nb5G4RTJFKITb2o1eOB&ust=1648313387202000&source=images&cd=vfe&ved=0CAsQjRxqFwoTCNCf-K7G4vYCFQAAAAAdAAAAABAD

[tianipeters97]

a different take on maternal and child health: OT implications in a community setting.

Introduction when I thought of maternal child health my understanding put simply was, mothers taking multivitamins and adhering to checkup appointments to ensure their babies were growing well. It never occurred to me to look at the bigger depiction of what maternal and child health actually entails. Now that I have had a chance to practice occupational therapy in a community setting, I have come to the realization that while the physical health of women and children is emphasized, the mental aspects of their health are often ignored by maternal and child health programs (Atif, 2015). I hope that by writing this blog, I will be able to emphasize the importance of mother and child health by examining the repercussions of poor maternal health.

According to the world health organization (WHO) maternal mental health is a state in which a mother knows her own potential, can cope with regular challenges of life, has the ability to work productively and has the ability to contribute to her community. Maternal mental health should be integrated into primary maternal health programs, this has the ability to close the treatment gap by detecting, preventing, and treating maternal mental health issues like depression early on (Atif, 2015). Furthermore, Perinatal anxiety and depression are more common in mothers from low- and middle-income countries. in low- middle income women, a number of contributing variables to maternal depression have been found to be Poor socioeconomic situations, interpersonal issues, and traumatic life events can all be considered contributory factors. Women from low- and middle-income countries are more likely to face poverty, lack of a steady employment, low literacy, social isolation, and lack of empowerment (Rahman et al. 2013) The importance of maternal mental and child health is further supported by (Michelle Olivia Erasmus, 2020) Who states that Maternal depression during pregnancy raises the likelihood of obstetric difficulties like preterm birth, according to research, Children of moms who have depression or depressed symptoms are more likely to be underweight. Postnatal depression was linked to a delay in cognitive and motor development in children (Rahman et al. 2013). Other consequences of parental depression were more diarrheal episodes, early breastfeeding termination, poorer immunization rates, and increased children diseases. According to studies, such infants have a higher long-term risk of poor mental health, social impairment, and medical-related mortality (Atif, 2015).

Maternal and child health is limited not only by not focusing on the mental aspects that affect both the mother and child as mentioned above but also by the barriers that pregnant adolescents face in accessing maternal and child health, this barrier to maternal health is important for us as occupational therapists and other health professionals to understand as South Africa’s adolescent birth rate is high, with 49 per 1000 births (The World Bank 2015). During my practice in the community multiple pregnant adolescents have expressed not only feeling depressed about being mothers at such a young age and not coping with school but they also felt ashamed and fearful of others reaction in their families and in the community including being scolded by nurses or being afraid of the nurses in the community disclosing their pregnancy or HIV status to their parents or other members of the community if they sought after antenatal care. These factors then stand in the way of young pregnant people seeking the care they require as a result Early adolescent pregnancy is also associated with increased HIV incidence (Christof ides et al. 2014) and a slower uptake of antenatal antiretroviral (ART) and higher mother-to-child transmission of HIV (Fatti et al. 2014). Mothers in low and middle income countries are often employed in informal work, Informal workers generally do not enjoy minimum wages, maternity (or paternity) leave, job and wage security and predictability or occupational health and safety (Gautam Bhan et al. 2020)Thus, while informal work is testament to the productive capacities of workers, it also is vulnerable and risky, and lacks access to legal protection, formal training and official social security systems how then does informal work affect maternal and child health, for example mothers that are street vendors. Firstly, informal workers are much more likely to return to work soon after childbirth because of the absence of an employment contract and its associated entitlements or in this case fear of losing their street vending spot. As women resume work, workplace conditions (a sidewalk for street vendors) often hinder the proximity between mother and infant that is needed for breastfeeding. Secondly, multiple overlapping dimensions of income poverty, informal work and socioeconomic marginalization are likely to reinforce each other to adversely affect the health of mothers, their opportunity to care for their infants and the health and development of their children (Gautam Bhan et al. 2020)

In conclusion the implications of occupational therapy Integrating maternal mental health through policy makers, health care workers and larger community to advance maternal mental health (Michelle Olivia Erasmus, 2020). Strategies to improve maternal mental health have to be linked to broader development goals, including poverty reduction and gender empowerment. In the context that I am currently practicing in, this can be done by enabling conditions for working mothers to care for themselves and facilitate their children reaching their health and developmental potential through more women empowerment projects such as the selling of donated clothes. As occupational therapists we are aware of ethics as mandated by the HPCSA therefore it is our duty to report breach of confidentiality from any health care worker that exposes information about any patient including young pregnant people. Furthermore, it is imperative that we normalize conversations that attempts to offer alternatives to the punitive and moralistic language often applied to adolescent pregnancy and their sexual health during interventions with them or offer these programs in community settings in order for more young pregnant people to seek maternal and child health including mental health. As part of health promotion in the community settings (schools or clinics) occupational therapists need to emphasize on the timing and access to antenatal care to promote health seeking behavior to ensure that the lack of knowledge regarding maternal mental health is reduced. I might not have all the answers but this is a step in the right direction.

References Michellle Olivia Eerasmus, L. K. (2020). barriers to accsessing maternal health care amongst pregnnat adolescents in south africa. international journal of public health, 65:469-476. Rahman A, Surkan PJ, Cayetano CE, Rwagatare P, Dickson KE (2013) Grand Challenges: Integrating Maternal Mental Health into Maternal and Child Health Programmes. PLoS Med 10(5): e1001442. doi:10.1371/ journal. pmed.1001442. Christofides N, Jewkes R, Dunkle K, Nduna M, Shai N, Sterk C (2014) Early adolescent pregnancy increases risk of incident HIV infection in the Eastern Cape, South Africa: a longitudinal study. J Int AIDS Soc 17:18585 Atif, N. (2015). Maternal mental health: The missing "m" in the global maternal and child health agenda. manchester : Elsevier .

[tianipeters97]

Advice to my future self as a person and as an OT

Dear Tiyani in the future, remember me in 2021 in third year of occupational therapy? It’s you. you’ve made it as an occupational therapist I’m here to let you know that you should not doubt yourself, you’re an amazing person with a sweet heart and an amazing mind. Put all that effort you place in wondering and worrying about what others think of you into yourself, continue making a difference, the stars are the limit. Travel, love and study further in hand therapy like you’ve always wanted to and touch as many lives as you can. Relax more, engage in things that make you happy. Enjoy your profession and remember that you’re unique hence stop trying to fit in. occupational therapy is broad move to other countries and learn as much as you can about the profession and life itself. Keep in mind the reason for doing what you do and how it benefits the people around you. Say "I'll figure it out" instead of "I don't know." Develop a mindset that recognizes failures, limitations, and challenges as opportunities to learn, experiment, and grow. Do not keep yourself in a box, explore different traditions, cultures, food and music and appreciate every little thing. And always remember to keep a look out for a life long partner in your travels, its not set in stone that he has to reside in south Africa.

I could probably go on forever writing this letter to you. but most importantly do not try to wait to be happy or to give yourself a pat in the back. Be proud of all your achievements no matter how small they seem compared to your peers, walk your own journey. Studying OT hasn’t been the easiest achievement you feel tired and stressed yet you have gotten this far. Continue to grow as a person and in your profession. Volunteer more in old age homes and disability institutions, “I don’t have the means to travel to intuitions to volunteer”, shouldn’t be an excuse at this point, manage your time and money wisely. Make friends with people that bring value into your life and never think you deserve any less.

life can be much broader once I discover one simple fact and that is that everything around you that you call life was made up by people that were no smarter than you (Praks,2018). One day you will look back at this moment and wish you could tell your past self that it will be ok, well consider this a message from your future self. you will get through this and you will come out on top.

[tianipeters97]

occupational barriers experienced in mental health

Occupational barriers experienced in mental health is an idea that I’m familiar with and might have experienced myself, however like most people this is a subject less advocated for and spoken about. Gottfredson (1981) referred to occupational barriers as perceived accessibility as per a person’s judgements about the obstacles that he/she faces in the occupational domain. mental health includes emotional, psychological and social wellbeing. This affects how we think, feel and act. Therefore, when mental health is negatively impacted ones perceived judgements of occupational domains may change resulting in occupational barriers.

Occupational barriers are a result of limited knowledge, negative attitudes and external barriers in relation to mental health (Lautenberg, 2016). People with Mental health problems such as depression, anxiety and psychiatric disorders experience occupational barriers such as feeling misunderstood and unaccepted therefore not engaging in pre-existing or new occupations or roles. occupational barriers can be identified in different levels such as professional, organizational, social and the wider environment (Lautenberg, 2016). Mental health problems such as depression and anxiety, are among the leading causes of work disability worldwide, it is estimated that at any one moment 20% of the working age population is suffering from a mental disorder which negatively impacts work capacity and productivity (Beurden, 2016). Moreover students with mental health problems and anxiety may perform poorly in school or dropout of the school system as a result of not being able to cope with the mental demands required for work and social interactions.

With the above information it is imperative that an extensive research and education be provided to different individuals, organizations, communities and professional work settings to offer insight to people living with mental health problems on how to improve their occupational performance and to get rid of certain nuances that create occupational barriers. Furthermore, the insight will be provided to people living without mental health problems in the different levels of occupational barriers mentioned above this will improve awareness of the barriers in mental health and ensure advocacy to decrease occupational deprivation, this will be done to increase empathy among colleagues, students and families as they will better understand the limitations faced by individuals who experience mental health problems.

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Covid-19 -trick or treat -unpacking the good, bad and the ugly of the pandemic

“My fellow south African’s” the first words of the president, who would have thought these words would change our lives, as the rapid spread of covid-19 caught me of guard, the world started changing. A national lockdown was implemented whereby the whole country was shut down, schools, shops, gyms, and social gatherings, my anxiety rose as the cases of covid-19 rose in south Africa. Most of us expected the pandemic to just be fleeting. However, the cases just kept rising and the country remained in lockdown. The way of living changed drastically this impacted people’s general wellbeing and happiness.

The impacts of covid-19 were on the social wellbeing, emotional and mental health, and opportunities for all age groups globally. children and adolescents were deprived of social interactions that they require at this stage of development such as exploring the development of socially appropriate language, play and explorative means in the school and social environment. Their coping mechanisms changed drastically from having a structured schooling environment to an online platform managed by parents that were not intellectually equipped to operate it, this led to a major setback in their learning experiences.

In the lives of young adults, it affected their normal schooling, this caused major depression in the lives of many as they could not cope with the changes. Although most high school learners passed matric, they were deprived of the opportunity to experience their matric dance and close social interactions due to regulations such as keeping a social distance. Furthermore, they were deprived of chance to experience and explore university, their university experience is limited to the screen of a zoom meeting. Their social skills were severely impacted as they do not get the chance to interact with their peers as classes are online.

In adults and the elderly, the quality of life was heavily impacted as most people lost their jobs and were unable to support themselves and their families in the elderly this caused confusion as they had problems grasping the idea of covid-19. Their immune system was already weak due to old age and other co-morbidities this made them vulnerable to the covid-19 pandemic.

The good that the pandemic brought about was the ability of families to bond and have better relationships with their families, they were also able to balance their occupations and roles as they worked from home, they could be parents while working and engage in more leisure activities. Sales on online stores increased, people are now aware of ways to protect themselves from germs by sanitizing and washing hands regularly. Technology has improved people’s lives by means of communicating on different platforms and access to learning sources on the internet have increased. Covid-19 will not be here forever however we can make the best out of our current situation.

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standing on the edge of being an occupational therapist

Wondering if you have what it takes to be a great occupational therapist? Well, that makes both of us, being so close to being a qualified therapist should be less confusing right? But that’s not even close to being true. Just when I thought I had it all figured out turns out I still have a lot to learn. On my first day of psychosocial fieldwork my amazing supervisor (Helen Gatley’s) words were “occupational therapy is very broad, the is no such thing as being a perfect therapist” these words stuck with me. I have realized that sometimes the dots just don’t connect from all the knowledge from my first year till date things can still be confusing, but I’ve learned that doesn’t make you a bad therapist it’s just a learning curve.

I must first admit that I struggled to find a professional identity in occupational therapy, I was always concerned with trying to be the best therapist. I constantly worried about if I seemed professional enough in front of my clients and my colleagues, if I was saying the right things, if I shared the same opinions with them. well, I’m proud to tell you that although my identity as an occupational therapy is still evolving, I’ve evolved as a therapist in the past two and a half years of studying. I’ve become more confident from being exposed to real life clients and this has made me realise that the is still room for growth, I now work at providing the best therapy for my clients to the best of my ability. Fieldwork placements nurture the development of skills which supports the development of competence in occupational therapy (Adriana V. Haro et, al).

I recall a time I couldn’t wait for my treatment sessions with my clients to end, presently I can never have enough time with my clients. If you’re feeling a bit lost or starting your journey as an occupational therapist I would like you to know that the is never enough knowledge in occupational therapy, you learn something every day, I’ve learned that I don’t need to know everything, and chances are I might never know all the is to know about occupational therapy. I’ve learned that I need to know enough to have a positive impact in the lives of my clients no matter how little the impact is we all need to start somewhere, these are the words I wish I could have heard sooner.

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cultural humility

Cultural humility is a process of self-reflection to understand personal and systematic biases and to develop and maintain respectful processes and relationships based on mutual trust. Cultural humility involves humbly acknowledging oneself as a learner when it comes to understanding another’s experiences (Allison Naber, et. al 2020). Throughout fieldwork I have encountered clients with similar cultures to mine which made it easy to understand their culture as they were either more western or religion greatly impacts their culture however everyone practices their own culture differently and differs with every individual Furthermore this allowed me to gain insight into what culture is to someone else this challenged any biases’ I might have had of any culture.

Intervention was planned to focus on bridging the gap between the environment and the clients’ occupations, the client has reached maximal functional independence therefore the planning of intervention was focused on what the client wants to be able to do and how the environment being the hospital hinders or doesn’t encourage the occupation. The client expressed that he would like to have more leisure activities as he gets bored, and this makes him overthink impacting on his mood. As an occupational therapist we need to be holistic therefore intervention was also planned on finding therapeutic implications during observing the client perform his ADLs.

Intervention was implemented to reduce the time the client spent in the ward however I also planned intervention around what other ADs or education the client could benefit from to make the ADLs that they can perform independently much easier and what client factors might be improved through the participation of leisure activities to further promote function in other occupations. The feedback received from my supervisor was that the aims of the session need to be met in the session to render the intervention purposeful as well as ensuring that the aims of the session are realistic as well as have a reason for the aim.

This whole fieldwork block was an opportunity for me to learn how to do treatments as we had never done it before, it was not easy but I have learnt how to work in a Multidisciplinary team and this gave me a chance to see how different types of therapy are able to work towards a common goal of functionality in the client, I was anxious about doing new things with my clients but as we build good rapport it because easier to get them to engage in the sessions, the aims for the clients were to try to get them to participate more in their occupations and some had expressed that therapy was good for them and they had enjoyed it. There may have been therapeutic opportunities that I had missed, and this was because I am still new at treatment and it is hard to find fault in things you thought were good, hopefully my therapeutic eye will develop throughout the year and I will be able to provide better therapy for the clients.

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use of evidence based practice to guide intervention

Evidence based practice is applying or translating research findings in our daily patient care practices and clinical decision making (Barbra Wilson, 2020). This also involves integrating available evidence with clinical knowledge, while considering client centeredness to provide treatment techniques that work. When using evidence-based practice the therapist is responsible for doing extensive research so that the best results can be achieved. Applying evidence-based practice in intervention involves several processes that require research, evaluation and sharing the results with the multidisciplinary team you are working with (David L. Sacket, et. al. 1996).

I did some research on the diagnosis and tried to make my treatment as effective as possible while making it client centered as well as applying frames of references and approaches such as bobath by stabilizing joints during movements such as the shoulder joint as the client had suffered from a stroke and this technique was proven to prevent subluxation of the shoulder and strengthening rotator cuff muscles The intervention of the past weeks has been structured to meet the client’s needs, this would be getting them to do the functional activities that they would require daily. The intervention was client centred as the clients had expressed the occupations that they would like to be independent in, through this intervention the clients were doing activities that they would like to regain independence in and through evidence-based practice I as the therapist knew which techniques would work do gain the desired movements from the client. and from the research I knew the clients’ limitations due to the diagnosis.

I also made use of some assistive devices; this was going to help the clients with some occupations that would require assistance in the form of assistive devices. The clients were able to grasp the concept of them and through more sessions they will be able to use them independently therefore making them more independent in their ADL’s. Reading articles and other case studies helps when using evidence-based practice as this gives a more practical understanding of the condition and this is how intervention can be implemented. From the past weeks of treatment my supervisor has allows encouraged researching on the clients diagnoses in order know more of what the client requires such as the precautions I had apply that were specific to my client during treatment and she has always reviewed my choice of intervention chosen and the treatment principles applied by asking me the reason behind it and in future intervention I plan to have more rationale for my choices of treatment activities and principles and techniques.

 For my future intervention I will be focusing on maintaining the function the client already has and get clients to do activities that their function allows them to do. I plan on using more of NDT techniques specifically bobath to decrease tone and allow for better physical handling of client and for more dissociated movements on the affect side the intervention will still be client centered and it will work on improving their functional capabilities, through engaging in the sessions the clients will be more familiar in the tasks and hopefully they will have been able to decrease the assistance they require.  The use of evidence-based practice is not about validating existing information, rather it is about translating evidence and applying it to clinical practice and intervention to make the best decisions for your client (Julia lambert, 2017). Evidence based practice includes the expertise of the clinicians involved, the healthcare teams and the client preferences and values. Sometimes research is not enough and doing an activity once won’t make you master it at the same time, we go back, read, interpret, understand and practice so that we get the most out of it (St. Petersburg college, 2010)

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multidisciplinary team and teamwork

Multidisciplinary team in health care as defined by (world health organization 2011) as the coming together and coordinating health and care services to meet the needs of individuals with complex care needs by bringing together expertise and skills of different health care professionals to assess, plan and manage care jointly. Teamwork enabled me observe intervention and discuss with other healthcare providers which factors we would be focusing on and why during intervention to provide holistic and appropriate care for the client.

I planned my intervention according the clients physical capabilities and taking note of the clients limitations as observed during the clients treatment in physio, after a further discussion with the team I took into account the clients cognitive limitations to help plan for therapy this allowed me to set realistic goals that could be achieved and furthermore not causing distress to the client by planning intervention that was not only unrealistic but also rushing the client to engage in intervention that the client maybe able to participate in but had not been prepared for, for example I found out if the client was able to do toilet  transfers independently or with how much assistance from the OT and the physio before attempting to start toilet transfers. This allows the team to work towards a similar goal in order to treat the client effectively and without risk of any injuries. collaborating with the social worker who also provides counselling for the client allowed me to understand the clients current mental state and her support systems which is important in planning for intervention in order to ensure intervention will be effective upon discharge. The nurses provided collateral information which was significant in order to know when the best times to schedule interventions were in order not to disturb the clients daily schedule and also to gain insight to the medication the client was on and signs for side effects experienced from the medication to better plan intervention.

The implementing of intervention was the challenging part because even the best plan can fall apart due to unforeseen circumstances, my supervisors advice was to always plan intervention with contingency plans, we call these contingency plans downgrading the intervention meaning having a plan to ensure the aim of treatment is met by modifying the environment, context or equipment to best suit the clients need at that time however even plan B can fall apart but that doesn’t mean the intervention session needs to be cancelled I have learned from my supervisor and the OT staff at the hospital  that sometimes we health care professionals need to think outside the box furthermore feedback from my supervisor regarding taking note of how principles of treatment will be implemented and ensuring that the structuring of the sessions were specific to the clients limitations and context allowed me to further appreciate the multidisciplinary team as the information and comparing of notes with the team allows for the team to work better together allowing me to be in the know as to any progress in any cognitive or physical factors in order to properly structure my intervention and implement the correct principles during treatment.

In future intervention I plan to consult the multidisciplinary team more often because the clients physical or mental performance may change every day, and this will allow me to be better prepared for those days that intervention sessions do not go as planned. I plan to work closely with other health care providers to ensure more benefits such as improved health outcomes, efficient use of resources and the clients enhanced satisfaction (health NSW 2010).

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The aim of occupational therapy is to enable clients to participate in occupations that are meaningful to the clients and they enjoy doing personally or occupations that they are expected to perform socially or culturally (purdie, 2010). As well as occupations that help them regain function or a certain level of independence in their occupations. This is what I had tried to implement with my client’s sessions for this week. I had taken into consideration the occupations they had engaged in at the hospital in the past 3 years and occupations that the client wanted to engage in and what they had enjoyed doing and the premorbid occupations the client engaged in.

The few interventions I started with were interventions that were meaningful to the client however the client had engaged in interventions that were similar or the same, this made me realize that although the interventions were based on what the client wanted to do, it was meaningful but the client wasn’t receiving intervention for other performance skills and client factors therefore client centeredness for me is providing intervention that is holistic and will allow the client to engage fully in all occupations that they need to engage in, the feedback I got from my supervisor was that I need to have a rationale for the intervention I was providing other than the physical components she encouraged me to also look at the cognitive aspects in planning for intervention therefore I reassessed intervention plan and the client centeredness around it, this is how I had decided into doing the functional activities which resulted in more participation  and an improvement from the previous activity outcomes. The activities were activities that they normally performed when they were at home and they had a sense of familiarity to them, this also gave them a sense of control over the activity as they did not need a lot of verbal cues or instructions, these activities were teaching them new ways in which they can do these activities when they get discharged from the hospital.

The feedback that I received from my supervisor was that when planning for intervention I need to take in account specific handling and structuring principles as well as precautions specific to the diagnosis and the client. This was taken into consideration and it put me in the right track with what to look out for when doing client centered approaches.

In the future my intervention will include partnership between me and the clients and figuring out how to make the activities client focused and more enjoyable while functional for them. The implications of client centeredness for practice are that the clients and their families should be asked to identify their occupational performance needs (Casteleijn, 2017). This implies that the planning of the intervention should revolve around the client’s occupations and how they go about those occupations to identify the gap between the client’s actual performance and the desired performance therefore future intervention will be planned to fit the client’s needs.

Person centeredness is sometimes hard to measure its outcomes but can lead to positive results in a therapeutic relationship (R.J, 2014). The best outcome in intervention relies on involving client centeredness however other approaches can be taken into consideration when planning intervention, as person centeredness focuses on what the client enjoys doing personally or overreaching or under reaching their functional prognosis and it may miss some therapeutic opportunities for the client. I hope that through the next weeks I will be able to focus on functional activities while making it client centred.

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from theory to practice: first week of OT intervention

The first week of implementing theory into practice in occupational therapy which involves assessing and treating for the first time was very nerve wrecking for me I felt out of my depth but I believed I could do it, Treatment in occupational therapy is the ability of the therapist enabling the client to engage in their occupations so I was still a bit confused as I have used engagement in occupations before to assess so distinguishing between assessing and treatment was a bit overwhelming because I thought I might have the wrong idea of how intervention is applied. The first week was overwhelming however with the help of my therapist I felt more at ease and comfortable.

My supervisor wanted to know how I would be assessing and the functional activities I would be engaging my client in to further assess and treat, she then gave feedback that the formal assessments I had prepared were on the right track however she gave feedback that assessments also needed to be done through functional activities such as using a tea making activity. This allowed me to think of how I will be able to assess and treat at the same time in the future by engaging my clients in functional activities to improve their function and still be assessing at the same time.

The assessment’s I completed in my first week and the intervention I started implementing involved bed mobility and assistance required in activities of daily living, my supervisor commented that my intervention needs to be centered around what the client needs to be able to do and what they want to do meaning the interventions also need to be influenced by what the client wants to be able to do and in my clients case my supervisor pointed out that she wants to be able to apply makeup this helped me plan for future interventions as I know what the clients functional ability is from the assessments and what I could implement in the intervention to be to help the client engage in grooming as this is meaningful for her therefore, I look forward to making my intervention more self-centered in the future.

My supervisor pointed out that my client is in her late twenties and that her age should influence the type of interventions I need to focus on, this made me plan for my future interventions taking her age into consideration. Some of my assessments were done through observations when the client was in therapy with the physiotherapist from those observations, I began to make deductions about my client’s level of function, I received feedback from my supervisor that although I have observed her engaging in activities, I still need to assess myself therefore I will use this feedback in the future and ensure I still do the assessments myself.

In my intervention next week, I plan to use my time effectively and take all my supervisors’ feedback into consideration into my intervention, I am ready for the challenges and the knowledge I will gain from this experience, the journey of treating has only begun for me and I’m very excited and ready to see what is to come next.