Community Block Blogging

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The OT role in Primary Health Care and the use of media as a tool for health promotion and prevention

Primary health care can be defined as “Essential health care made accessible at a cost that a country can afford, with methods that are practical, scientifically sound and socially acceptable. Everyone should have access to it and be involved in it, as should other sectors of society” (White, 2015).

Due to South Africa consisting of many rural communities, primary health care has become one of the key principles behind health service provision in South Africa. This is primarily due to its underpinning theory of universal access to all as it aims to reach several individuals who are in desperate need of health care services. It involves overcoming various demographic and socioeconomic circumstances that were previously disadvantageous to one receiving quality health care.

In terms of OT intervention, a study in 2016 had identified many OT’s to adopt an approach to PHC that was more rehabilitation focused and lacked the necessary health promotive or health preventative components (Naidoo, Van Wyk & Joubert, 2016). OT’s play an integral role in the health promotional aspect of PHC through management of chronic conditions, injury prevention techniques and caregiver education ("Occupational Therapy and Primary Health Care", n.d.).

While working at 2 clinics within this community block, the importance of health promotive activities was recognised by us as OT students. For example, many mothers were educated on topics such as early childhood development and maternal health. This equipped the mums to be able to identify the early warning signs in either themselves or their child, so that the necessary intervention could be accessed sooner. Another example would be the community health worker training (CHW) training program, which focused on improving the CHW’s knowledge and insight into specific conditions and their management. CHW’s work extremely closely with the community and therefore any training with them is likely to positively influence the care of several community members.

While the above-mentioned anecdotes have indicated the importance of OT in PHC, further awareness needs to be highlighted to create additional understanding on its significance. One of the keyways in which this awareness can be raised is through health promotion on various media platforms. This could include newspaper or magazine articles, radio interviews, podcasts, YouTube videos, TV shows and so on. Another commonly used platform by the youth is social media platforms such as Instagram, Facebook, Snapchat etc. For example, health promotion on the global coronavirus pandemic can be conducted with respect to safe social distancing, the correct use of a mask, the symptoms of the virus, what should you if you suspect you have the virus and so on. By using these various platforms, health promotion on various imperative topics, such as Covid-19, can be discussed. This will enable OT to empower the community through knowledge and encourage them to take charge of their own health and well-being.

In conclusion, an OT’s role in PHC is of paramount importance as we contribute largely toward health promotive and health preventative interventions. We have the ability to nip health concerns in the bud and prevent it from developing into major issues or hurdles. Therefore, more OT’s need to acknowledge the importance of such interventions and greater strides need to be made in ensuring that these interventions are of a high quality.

References

All you need to know: Community-based primary healthcare. (2017). Retrieved 13 November 2020, from https://www.youtube.com/watch?v=kcN3ezZdQ1Q

Naidoo, Deshini, Van Wyk, Jacqueline, & Joubert, Robin W. E.. (2016). Exploring the occupational therapist's role in primary health care: Listening to voices of stakeholders. African Journal of Primary Health Care & Family Medicine , 8(1), 1-9. https://dx.doi.org/10.4102/phcfm.v8i1.1139

Occupational Therapy and Primary Health Care. Retrieved 13 November 2020, from https://www.caot.ca/document/4068/Primary%20Health%20Care%20-%20Fact%20Sheet.pdf

White F. (2015). Primary health care and public health: foundations of universal health systems. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 24(2), 103–116. https://doi.org/10.1159/000370197

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SDG’s and the role of a Community OT

 ("Why should you care about the sustainable development goals?", 2020)

The Sustainable Development Goals were originally drawn up by the United Nations in 2015. They are also commonly referred to as the global goals which focuses on improving the economic, social and environmental standing of countries ("Sustainable Development Goals | UNDP", 2020). The sustainable development goals consists of 17 objectives as indicated in the above image.

As community occupational therapists, we often work on the ground with our patients and the society; and hence are more aware of their contexts and backgrounds. This is advantageous with respect to us being able to easily identify areas in which a community is struggling.

One of the sustainable development goals namely, SDG 4 which speaks to quality education, was identified as a component that could be worked on within community M. While children have access to Grade R, primary school and high school; there remains a gap in the early identification and intervention for children who are struggling. These children often become lost in the system with them either performing poorly during high school or dropping out. Drop out rates have been further associated with an increase in future unemployment rates ("Learner dropout increases unemployment rate", 2020). This leads the ongoing cycle of poverty within the community. As community OT’s we have a role to play in early childhood development which can help in terms of working towards SDG 4. The occupational therapy students can screen children whom they see in clinic, in the creches and in the primary school. These children can be screened with the purpose of identifying any developmental delays or schooling difficulties. The early identification of these issues will benefit the child, as he/she will receive prompt treatment and will be better equipped to meet the demands of school. OT should also educate the parents on the available support structures within the community which they can access should they identify their child struggling. Lastly, the OT should also encourage parent and teacher involvement in a child’s education as they are major stakeholders in ensuring a child’s successful education.

The SDG 2 which is centred around the concept of “zero hunger” is another area in which occupational therapy could assist. OT’s could begin food schemes where fellow campus students are asked to donate any extra food items they may have. This includes anything from canned beans, pasta packs and so on. The food items collected through this project can be shared with the families who are in need within the community, hence reducing the amount of community members who experience hunger.

The next SDG to be considered is number 5 which looks at the promotion of gender equality. Within many communities, there is often a patriarchal system of thinking (Sathiparsad, Taylor & Dlamini, 2008). This is evident by the men usually being the ones who work while the women are expected to fulfil the domestic roles of being a stay-at-home mother who relies on her significant other for financial stability. One of the projects that has already been implemented over the years by occupational therapy students is a women’s empowerment project. This project aims to provide unemployed women with the opportunity to earn their own income through the sale of second-hand clothing items donated by university students. Although this project has been on a temporary standstill, newly recruited women will benefit by being able to earn a small income while being engaged in occupations outside their domestic role. This project therefore aims to promote gender equality.

As health care professionals in training who play an integral role in terms of SDG 3 which speaks to good health and well-being. OT students should always engage in health promotional clinic talks and screening to identify both adults and children who require and will benefit from OT intervention. This includes both mental and physical related conditions as well as paediatric care. The health of these patients will undoubtedly be improved by them having access to these essential health services.

Lastly, SDG 17 relays the need for forming partnerships to assist toward achieving these goals. Community OT’s should continue to link up with vital stakeholders of the community to assist in bringing about an improvement in these social, economic and educational domains. This could be in the form of seeking donations from community businesses, collaborating with extracurricular schooling programs and so on. Forming a network allows for these goals to be met a lot faster than attempting to work toward them alone.

In conclusion, OT has a significant role in contributing toward the attainment of these sustainable developmental goals. This is due to them being one of the few health professional disciplines who work closely with the community on a primary health care level. While these goals cannot be achieved overnight, small strides can indeed make a significant difference.

References

Learner dropout increases unemployment rate. (2020). Retrieved 6 November 2020, from https://www.skillsportal.co.za/content/learner-dropout-increases-unemployment-rate

Sathiparsad, R., Taylor, M., & Dlamini, S. (2008). Patriarchy and Family Life: Alternative Views of Male Youth in Rural South Africa. Agenda: Empowering Women for Gender Equity, (76), 4-16. Retrieved November 6, 2020, from http://www.jstor.org/stable/27739392

Sustainable Development Goals | UNDP. (2020). Retrieved 6 November 2020, from https://www.undp.org/content/undp/en/home/sustainable-development-goals.html

Why should you care about the sustainable development goals?. (2020). Retrieved 6 November 2020, from https://www.un.org/sustainabledevelopment/blog/2015/09/why-should-you-care-about-the-sustainable-development-goals/

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“Positionality- the social and political context that creates your identity in terms of race, class, gender, sexuality, and ability status”

 ("Writing Strategies: What’s Your Positionality?", 2017)

The development of one’s positionality is dependent on several influential factors. The above image indicates some of these factors that help to build our positionality namely, ethnicity, religion, socio-economic status and so on. South Africa is known for its wide range of cultures which further impacts on the diversity of our positionalities.

The most significant factor that has contributed toward my positionality is my religion. My religion of Hinduism strongly reiterates the importance of viewing everyone in the same light. One of the core principles stated within the Bhagavad Gita (i.e. holy scriptures) is to “Identity, Recognize and Accept Equality in Life” ("11 Lessons from Bhagavad Gita Which Teaches The Very Roots Of Our Life - MetroSaga", 2020) . This principle speaks to the importance of equality amongst people, and guards against one developing discriminative behaviours/thoughts. This has resulted in me always having an open mind and treating individuals from various backgrounds or contexts fairly.

With respect to my ethnicity, equality was always encouraged within my Indian community and at home. However, I have noticed some disparities or gaps especially with the older generation. Many of them who have underwent the Apartheid regime have developed a sense of bitterness and retained some of the discriminative thinking. This was further reiterated by Puttick (2012), who found many South African citizens presenting with racist thinking post-Apartheid. This was also observed by some members of the Indian community who saw and treated each race group differently or inferiorly. Therefore, while factors such as ethnicity have been found to contribute toward one’s positionality; I do not believe it to be the all-important element in us determining our positionality. I believe that our positionality can be influenced by these external factors but ultimately should be determined by the individuals own thinking and choices.

Other demographic and socio-economic factors that contribute to my positionality would be the presence of a safe suburban home, easy access to basic amenities such as water/electricity and the opportunity to study at a tertiary institution.

It is important for us as health science students, to acknowledge and understand our positionalities. Especially as we enter communities, it will allow for us to have a sense of humbleness and open-mindedness. It helps us to bear in mind and comprehend the various contexts from which our clients come. As occupational therapists, we often analyse the daily activities of a client to identify possible ways in which we can improve their performance in the respective task. For example, when going on a home visit in the past week- Mrs N who presented with early onset arthritis complained of pain in her joints and fatigue when having to wash her clothes. If I did not acknowledge the client’s socio-economic status which contributes to her positionality, I could have simply recommended that the client purchase a washing machine to relieve the joint pain. However, by bearing her positionality in mind; alternative, more client-centred intervention can be suggested such as washing smaller loads of clothes or recommending she places washing higher up on a chair next to her, to prevent back pain and fatigue. This correlates with the need to view patients as individuals and to develop a shared understanding, resulting in better quality of care (Kennedy et al, 2018). Likewise, when creating projects for the communities, the positionality of the community members should be acknowledged. This will ensure that projects are specific to the community’s needs and is holistic.

In conclusion, acknowledging one’s positionality as well as understanding the positionality of the client, is extremely important especially for effective intervention to occur. One should always bear this mind and inquire further to ensure further comprehension.

 References

11 Lessons from Bhagavad Gita Which Teaches The Very Roots Of Our Life - MetroSaga. (2020). Retrieved 30 October 2020, from https://metrosaga.com/lessons-from-bhagavad-gita/

Kennedy, B. M., Rehman, M., Johnson, W. D., Magee, M. B., Leonard, R., & Katzmarzyk, P. T. (2017). Healthcare Providers versus Patients' Understanding of Health Beliefs and Values. Patient experience journal, 4(3), 29–37.

Puttick, K. (2012). Retrieved 30 October 2020, from http://hdl.handle.net/10539/11275

Writing Strategies: What’s Your Positionality?. (2017). Retrieved 30 October 2020, from https://weingartenlrc.wordpress.com/2017/01/09/research-writing-whats-your-positionality/

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Why is maternal and child health important to society? The implications for Occupational Therapy, and life within the context I am working in.

“The health of a mother and child is a more telling measure of a nation’s state that economic indicators”- Harjit Gill (Chief executive officer of ASEAN and Pacfic, Royal Philips).

The above is a powerful quote that strongly reiterates the importance of maintaining the health of mothers and their children. The maintenance of maternal and child health is a significant issue in health care; that requires a global initiative for improvement to occur (Mabaso, Ndaba, Mkhize-Kwitshana, 2014). This was emphasized by it being included under the fourth and fifth Millennial developmental goals namely, to reduce child mortality (MGD 4) and to improve maternal health and gain universal access to reproductive health (MDG 5).

Being a healthcare student within the South African clinical context, has also indicated the value of maternal and childcare on a community level. Based on my own experience at Mariannridge Clinic, one can clearly identify several reasons as to why maternal and child health is so fundamental in a South African setting.

Extensive clinic queues and clinic waiting rooms, tend to primarily consist of pregnant women or young mothers with babies. Teenage pregnancy in South Africa has become the norm, with mothers being as young as 13 years old. While teenage pregnancy is attributed to various reasons such as the non-use of contraceptives, having parents who were divorced etc. (Ayanaw Habitu, Yalew, Azale Bisetegn, 2018); it cannot be disputed that these young mums or mums-to-be lack the sufficient knowledge to take care of both themselves and their baby. This relays to the need for health promotion on maternal and childcare, to ensure both the mum and baby are healthy. Failure of primary health care to provide such services is likely to result in increased maternal mortality rates. Infants with neurological or developmental delays have a greater chance of being lost in the system or identified at a substantially late stage when intervention will not be as effective.

Within the Mariannridge community, substance abuse is also a prevalent issue amongst community members. This includes the frequent consumption of alcohol, the excessive smoking of cigarettes and the use of drugs such as cannabis. The youth tends to be the most influenced by these substances. Teenagers who are pregnant may fail to acknowledge or disregard the dire consequences of engaging in substance use during their pregnancy. This can result in a greater number of infants being born with foetal alcohol syndromes. This was emphasized by statistics which revealed that South Africa has the highest reported foetal alcohol syndromes, with a prevalence of 28% in some communities ("Foetal alcohol syndrome awareness programme", 2020).

Recent research on maternal and child health, have revealed that while it has significantly improved over the years, there continues to be a gap (Goga et al., 2019). As final year occupational therapy students, it is important to recognize our role in helping to close this gap. We need to familiarize ourselves with our role of being advocates for maternal and childcare. As we approach the threshold of entering the public health sector, we as occupational therapists, need to acknowledge our part in health promotion on both maternal well-being and the importance of meeting developmental milestones. As OT’s we also play an integral role in the screening process and in the assessment of the above-mentioned areas. Problem areas that are identified earlier can result in a greater prognosis. In conclusion, I feel that maternal and child health is capable of being more successful in South Africa through early intervention.

References

Ayanaw Habitu, Y., Yalew, A., & Azale Bisetegn, T. (2018). Prevalence and Factors Associated with Teenage Pregnancy, Northeast Ethiopia, 2017: A Cross-Sectional Study. Journal of pregnancy, 2018, 1714527. https://doi.org/10.1155/2018/1714527

Foetal alcohol syndrome awareness programme. (2020). Retrieved 23 October 2020, from https://www.westerncape.gov.za/general-publication/foetal-alcohol-syndrome-awareness-programme#:~:text=South%20Africa%20has%20the%20highest,for%20this%20irreversible%20lifelong%20condition.

Goga, A., Feucht, U., Zar, H., Vanker, A., Wiysonge, C., McKerrow, N., Wright, C., Loveday, M., Odendaal, W., Ramokolo, V., Ramraj, T., Bamford, L., Green, R., Pillay, Y., & Nannan, N. (2019). Neonatal, infant and child health in South Africa: Reflecting on the past towards a better future. South African Medical Journal, 109(11b), 83-88. doi:10.7196/SAMJ.2019.v109i11b.14301

Mabaso, M. H., Ndaba, T., & Mkhize-Kwitshana, Z. L. (2014). Overview of Maternal, Neonatal and Child Deaths in South Africa: Challenges, Opportunities, Progress and Future Prospects. International journal of MCH and AIDS, 2(2), 182–189.