I sat across from my younger self, a strong-willed yet uncertain student, sipping coffee that was just a little too bitter. She looked at me, eyes filled with the same curiosity I once carried about the future, about the path ahead.
“You’re an occupational therapist,” I told her. “And not just any therapist—you’ve worked with clients whose stories weigh heavily, yet you help them carry that weight. You’ve seen how mental illness, trauma, and disability shape lives, and you’ve learned to meet people where they are, to offer a bridge when they feel lost.”
My younger self fidgeted, unsure. “Do I make a difference?” she eagerly asked. I smiled. “More than you think. You’ve sat with clients as they built safe places from cardboard, as they found words for emotions they never named before. You’ve guided them through grief, disorientation, stigmatization, fear. You’ve watched them take small steps toward connection, toward understanding themselves. And you—well, you’ve learned too about BECOMING. About compassion, systematic barriers, cultural influences and stagnating perceptions and oppressive experiences in a overwhelmed community. You learned about yourself.” she nodded slowly, stirring her black coffee. “What about me? Right now?” I hesitated, then reached across the table. “You’re doing just fine. Every exam you stress over, every patient that challenges you, every case study you pick apart—it’s all shaping you. Trust the process. You won’t always have the answers, but you’ll learn to ask the right questions.”
The coffee had grown cold, but we sat there a while longer. And as my younger self walked away, I knew she’d be okay. Because I was.
THE END OF A CHAPTER BUT A NEW BEGINNING OF AN OT JOURNEY:
“Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure.” (Mandela, 1994)
I ask myself, What are the terms that measure my adequacy? How can I serve, be present, and be critical in my performance to impart change in someone else? What are the tools set to ignite life back into the voiceless, marginalized individuals when existing oppressive belief systems and structures are set to perpetuate inequalities?
Our country's diversity and rich history—looking at the beauty and darkness—tells a story of how our differences can be scars, but they are also a call for humanity. I started to recognize that the most significant change begins with me as an aspiring health professional. One of the “Ahaa moments” in my experience was realising how my own internalized beliefs engraved in me in my childhood were how I viewed marriage at a young age as something unusual and, to some degree, wrong. It originated from the cultural perception that dating young is terrible, which clouded my thoughts about the therapy and its impact on the client’s life. How it was easier to accept the grievances, ready to dismantle the broken and abusive relationship, not realizing the value it served for my client. How culture has influenced and moulded her identity solely on being a wife and a follower in society and her home. It indicated how we as students are eager to call for cultural competence when we do not understand or agree with the social patterns and principles that have changed over time, proving to disempower women, causing stagnation, if not progression of gender inequalities.
The unemployment rate in South Africa declined to 28.4 percent in 2023.
My biggest lesson was the importance of critical analysis. You can deduce connections, patterns, gaps, realities, and scars behind the clouded story through analysis. There is a need for iterative approaches in therapy to allow for an understanding of the lived experiences and the acting influences, good or bad, in everyday life. It shows how our enriched history isn’t just a landmark representing where we came from, our identity, and the trail to destined current issues, social patterns, inherited behaviours, and cultural practices. What I mean is the impact of apartheid on health and educational disparities, looking at the social and economic consequences. We see the rising unemployment rate and poverty in the communities, which indicate the looming mental health crisis looking at depression, low self-esteem, hopelessness, and maladaptive coping behaviours that feed into crime, substance use, broken interpersonal relationships and burden of care. You start to wonder how can an overburdened healthcare system cater for the needs of the community, depicting the need for support systems within marginalized communities to deal with the trauma, the pain and the barriers within their context. To prioritize the community needs, motivating the importance of OT in community practice. Doing more from the resource deficiency inaccessibility, finding the tressure in the trenches, and making a difference.
"South Africa has the third highest suicide rate on the continent, with more men than women committing suicide."
(Mbele,2020)
The growth calls for not just seeing the injustices but being critical in reflecting on the cycles and trends we see in the community, how we hardly see males, young or old, seeking health services. It later turned out that the health promotion talk was about maternal mental health, forgetting the other drivers of the community being the men. I learned to see beyond what is presented, asking why and how to gain an understanding of how societal norms and cultural influences have given men power as patriarchs but also chained them in terms of the expectations in an environment that does not sustain or support their societal role figures of being providers and decision-makers. This feeds into gender-based violence due to the mental health issues that are swept under the rag, bottled up, hoping to disappear, only to burst open and hurt the people who had no hand in the pain caused. You start to wonder about the implication of the barriers to the health and wellness of men when they express the solution being solely on economic liberation in a country far from reaching economic transformation. What it means for OT is how we can achieve and be in base to serve as a bridge in promoting good health-seeking behaviours overcoming the crippling stigma and toxic masculinity that perpetuate health disparities. A goal is to have partners, fathers, brothers, and sons actively engaging in the community effectively and harmoniously, removing the layers of barriers hindering cohesiveness within a community and belonging.
Learning and collaborating with the community structures shifted my experience in therapy as I learnt the importance of recognizing the roles of these structures and their impact on the client’s well-being. How can a CCG change the therapy process to add value to the client’s life by ensuring progression and treatment goals? They serve as catalysts for the sustainability of treatment and alleviate the barriers and burden of care by supporting clients and health professionals.
Retrieved from: (Scott, 2022)
"As we are liberated from fear, our presence automatically liberates others." I began this block with fear of not knowing; the anxiety of reaching my fullest potential was holding me hostage from exploring the possibilities and experiences beyond the safe borders that have comforted me for the past three years. Community practice knocked with urgency to open my eyes and see the beauty beyond the layers and layers of pain, inequality, patriarchy, culture and social determinants of health. Knowing the person to understand how to assist holistically and give it my all is essential within the first session, even when I'm too scared, with an understanding that it may be the last time I see them, be impactful and therapeutic. Fear holds us back from the future we envision.
My takeaway message for this week is the importance of looking beyond the issues and seeing the beauty of the individual, which requires doing more. Doing more in therapy means understanding that before the client starts to feel a sense of belonging, they need to unbecome, stripping off the influences of culture, patriarchy, poverty, and socio-political issues and redefining their values to become. Ultimately, we strive for community collaboration, growth, cohesiveness, and health to ensure self-reliance.
OT enthusiasts, the green scrub won't be hanged as I take my final bow. Thank you for walking this journey with me. See you in my next chapter.
References
Mandela, N. (1994). 1994 Inauguration speech of Nelson Mandela. University of Houston. https://uh.edu/~hwagan/pnl/mandela.pdf
Scott, M. (2021, February 3). Overcoming Fear | University of Central Florida News. University of Central Florida News | UCF Today. https://www.ucf.edu/news/overcoming-fear/
Wilson, F. (1996). Challenges for the Post-Apartheid Economy. The American Economic Review, 86(2), 322–325. https://www.jstor.org/stable/2118145
Wits University. (2022, November 14). 2022-11 - Mental health in SA is at shocking levels but people are not seeking help - Wits University. Www.wits.ac.za. https://www.wits.ac.za/news/latest-news/research-news/2022/2022-11/mental-health-in-sa-is-at-shocking-levels-but-people-are-not-seeking-help-.html
What is hope? Is hope the illusion that keeps us in faith, fingers crossed, breath-held, waiting for change to knock at our door?
Take this journey with me through the OT student lens in community practice, digesting the lived realities of communities versus sustainable development goals (SDGs). In 2015, the United Nations established the seventeen global goals with an understanding of the interrelatedness of the social, economic, and environmental factors that affect everyday life and aim to alleviate inequalities, poverty, climate change, and ecological unsustainability by the year 2030. The goals were adopted from the Millennium Development Goals, hoping to overcome the gap in what was not accomplished in 2015. When poverty is considered, it is vital to include the interconnected links to the vicious cycle of hunger, crime, disease, inequalities, and a harsh standard of living. The person's understanding in exercising their human rights to accessibility, equality, fairness and opportunities.
Picture retrieved from:(The Global Goals, 2022)
One of the key projects we are running at Kenville is the KITE project. It incorporates vocational rehabilitation and gender inequalities eradication. It aims to upskill women in entrepreneurial skills while providing financial support. Consequently, it promotes the value and voice of a woman in a household, with the ability to provide for herself and her children. It eliminates the patriarchal influence and power dynamics of a male figure being the sole provider. It challenges the projection of the societal norms of gender roles. The project's success over the years has enriched the seller's lives, proving its effectiveness and the goals of eradicating gender inequality among women, children, and hunger. Sustainable development goals two and five strive for gender equality, no hunger, and nutrition and food security. Hence, this project aimed to tackle the social barriers in the social determinants of health to promote social equality and ensure inclusion, a positive support system, and a source of income. Additionally, the provision of affordable clothes assists in meeting the community's needs and fundamental human rights to dignity and self-image through the eyes of the community. The implication into practice is to be transformative as therapists, highlighting the need to be intentional in acquiring the challenges and barriers the community faces. Consequently, relevant projects must be established to meet the needs and multifactorial influences consisting of cultural and personal factors to ensure sustainability. Below are numbers of grant-dependent homes in South Africa, retrieved from (Statistics South Africa, 2023)
Goal two is significantly impacted by the climate conditions South Africa is subjected to. The aftermath of the floods in KwaZulu Natal left the vulnerable communities in crisis regarding food prices and housing. Therefore, it magnifies the issues perpetuating poverty and poor living conditions in communities. For example, in Kenville, one of the creches is being closed due to health hazards, instability, and the high possibility of the informal settlement falling over. Therefore, it has detrimental effects on the livelihood of the owner, parents, and children, with the owner losing a source of income, which is an obstacle for the parents in the support system in raising the child. At the same time, they work, and a lack of stability for the child to explore, learn, and grow within the environment. Our role in working towards the sustainable development goal is to bring services to the children, providing opportunities for growth and learning, diversifying their skills development, and shaping their behaviour and livelihood.
SDG 3 ensures healthy lives and well-being by promoting accessible and quality healthcare services. This incorporates universal health coverage, including essential services that include health promotion, disease prevention, rehabilitation, and palliative care. Hence, it encompasses the goals and principles of the National Health Insurance Plan. The lack of immunization and resources in clinics depicts the regression toward reaching this goal by 2030. Therefore, vulnerability to preventable diseases and infections for both mother and child contributes to the high maternal mortality rates of 86 deaths per 100,000 live births in 2018.
We, as OTs, contribute to this goal through comprehensive primary healthcare services that encourage community participation, economic building, and poverty eradication. In community practice, we conduct daily health promotion talks with the clinic crowd to raise awareness of our services and role in the clinic and the community. The elaboration of the projects to support the needs of the community. The individual sessions contribute to providing healthcare services by ensuring mental and physical health and well-being. Furthermore, reducing the stigmatization and non-compliance of HIV and AIDS reduces the epidemic through education and psychosocial support. The goal further includes the prevention and treatment of substance use. I encountered three gentlemen who appeared to be under the influence. At that moment, the theory left me underprepared for the realities of communities with high drug usage and normalized. Education and insight-building seemed to impact treatment like water off a duck’s back. Therefore, alarmed by my unpreparedness and lack of ideas for bridging the gap.
Sustainable Development Goal four aims for equality in education, which, through the primary school project, can address the factors that limit equal opportunities in acquiring knowledge and learning. To support individual students in building academic tools to strive academically, targeting the learning difficulties and barriers that hinder effective participation in school-related activities and social environments. Furthermore, the target is to eliminate gender disparities in education to promote a non-violent and inclusive environment, including PLWD. We encountered a case of a mother reporting gender inequality and mistreatment that led to her child not attending school, which violated their constitutional rights to education. Therefore, highlights the setbacks in the transformation of our country and the lack of structures to protect the rights at a community level. Unfortunately, a follow-up session was not conducted, leaving us with “what ifs”. A learning opportunity to understand the importance of treating the person as if it were their last session at a community level.
Combined with goals sixteen and five, they encompass gender equality and inclusivity in the community, fostering fundamental human rights and peace. George (2020) states that “Patriarchal culture and the historical precedent of inequality have exacerbated the inequality that exists between men and women in South African society.” An everyday tale in the context of our communities, women being stripped of their values and rights. Jewkes (2002) proposes the ideology that the driver of gender inequalities and gender-based violence is driven by cultural and societal norms that regard male superiority and reinforce gender roles and the hierarchy, with women being oppressed to low social value and power as expected. Therefore, the sustainable goal of equality for women and children is disputed. As observed in the community of Kenville, women object to the gender roles of carers and nurturers of life yet are incapable of making informed decisions. For example, a mother and child were screened, and upon assessment of the child, developmental delays were observed. Hence, occupational therapy services are needed to support the child's development. The mother and child are foreign nationals, so the mother detains vital information, including their names. Furthermore, the mother was hesitant and required permission from the spouse regarding a follow-up session but ultimately refused to share her number to make a follow-up session. Consequently, the encounter made me think about what I could have done more. We babbled about advocacy, but at that moment, I failed to advocate for the rights of that mother and child. The take-home was, where do I start when I have provided the education and risks? What now? How can I convince this mother about the need for occupational therapy to ensure positive health outcomes? Find out more about the staggering information on GBV in the link below:
The female homicide rate in South Africa is roughly 24.6 per 100,000 population—nearly six times the global average.
Regarding personal growth, researching sustainable development goals has enlightened me to think about how a national problem can cause a huge ripple effect in vulnerable and marginalized communities with limited resources and a high burden of poverty. The experience has encompassed critical perspectives on the importance of comprehensive primary healthcare. Transitioning from only formulation solutions on paper to becoming the agents of change requires advocacy and internally driven principles in ensuring quality and holistic healthcare services. The experience is dotting but an eye-opener of the diverse hats we wear as Ots.
In conclusion, sustainable development goals are indicators of an evolving and transforming process overcoming historical inequalities and barriers to achieving liberation inequality in services and resources, aligning with human rights, and encouraging the participation of individuals in social, economic, and political structures. We, as OT, teach and equip communities to identify the socio-political and socio-economic factors that hinder the fullness of human beings, causing occupational injustices, and to understand the multifactorial influences of people’s context at play. Give them the tools to start their own gardens of knowledge and awareness to reap the fruits of choice and optimum well-being.
share your thoughts:
Do you believe we will reach the targets of the SGDs 2 and 5 in a society that keeps oppressing and abuses women and children?
yes
no
Voting ended onMar 23, 2024
George, L. (2020, July). Gender-Based Violence against women in South Africa. Ballard Brief. https://ballardbrief.byu.edu/issue-briefs/gender-based-violence-against-women-in-south-africa
Jewkes, R. (2002). Intimate partner violence: causes and prevention. The Lancet, 359(9315), 1423–1429. https://doi.org/10.1016/s0140-6736(02)08357-5
Maluleke, R. (2019). Inequalities trends in South Africa: a multidimensional diagnostic of inequality. https://www.statssa.gov.za/publications/Report-03-10-19/Report-03-10-192017.pdf
Statistics South Africa. (2023). Sustainable Development Goals: Country Report 2023. https://www.statssa.gov.za/MDG/SDG_Country_report.pdf
The Global Goals. (2022). The 17 Goals. The Global Goals; Project Everyone. https://www.globalgoals.org/goals/
Through the eyes and voice of an OT student analysing the theory and preparedness for practice at the community level.
The global north ideology runs the ship of occupational therapy's theoretical structures, models, and practices. The need for African contextual theories and frameworks contradicts the essence of our role in healthcare. Karen Whalley (2018) further highlights how assessments lack the inclusivity of cultural and contextual factors that are norms to the global south communities. Therefore, students and professionals must apply critical reflections and reasons behind the chosen activities and the appropriateness of the assessment. However, based on experience, occupational therapy's knowledge and academic structures are transformative and kinaesthetic, allowing for altering treatment to suit individual needs. To find more about the Western influences on the practices of occupational therapy, refer to the link below:
Ask yourself why we care so much about the mark we get yet forget about the impact we make in community practice. Naidoo and Van Wyk (2016) elaborate on how, as students, we are focused and anxious about our marks, and the fear of failure is the internal driver of our learning. This further has detrimental effects on confidence in practice, causing a gap in the connection between trust and positive rapport between the therapist and the client. The fourth year allows a sense of independent practice due to the minimized supervision and specific expectations as guidelines during fieldwork. Hence, how can you awaken and integrate the social, political, and economic factors in maintaining the PHC principles? Community practice forces you to analyze and understand the interconnected factors that influence an individual's overall function and quality of life. It exposes us to the harsh realities of most of our country, highlighting the importance of the treatment you give, which may be the first and only during the allocated time. Hence, the mark pressure becomes a maladaptive personal chase, forgetting the oath taken at the beginning of the block. Disregarding the primary principles of client-centredness.
To those asking what primary health care is, Alma Ata defines it as “the community being active participants and is essential based care that relies on the practical, scientific sound and socially acceptable methods and technology made universally accessible to all individuals at a cost the community can afford. That is a lot to take in, but in simpler terms, primary health care is the bridge that serves communities to access the public health system. It incorporates the different structures that are important in a community. Look at the link above explaining primary health care(PHC).
The academic structures emphasize the importance of evidence-based practices, utilizing science to treat holistically and consider the communities and the social, political, interpersonal, and economic factors at play. In 2021, my first encounter with what community is, I was bombarded with loosely used information terms, not understanding the meaning and relevance of the social determinants of health, sustainable developmental goals, and community structures and our role. COVID-19 left us vulnerable, minimizing the initial community experience and preparation for the fourth year. Proceeding to 2023. Here I am, doing projects but lacking the foundation of knowledge and the “why” regarding the needs or gaps in the community. The poor exposure during both years proved the need to re-centre my focus and think beyond the four lines of what I see or is presented, resisting the urge to be oblivious. For example, the mother's word-of-mouth responses are challenged. This is due to possible internalized stigma when the child is delayed in terms of milestones, has difficulty accepting, or is in a state of shame or guilt. Therefore, understanding the role of OT in PHC in addressing social determinants of health, alleviating health disparities in the community, and looking at the policies, social and interpersonal factors to ensure quality of care equips students to strive in community practice. It is crucial to consider the individual as a person in a community with various essential components at play that affect the quality of life and functioning. For example, when treating a parent, adult, or child, it is crucial to ask for valuable information that may evoke feelings of embarrassment, requiring communication skills to prompt the client.
The cons of the OT curriculum are the challenges of the student’s lack of understanding of lived experiences and the integration of diversity in the context of the client’s impact on treatment outcomes and effective therapy (Naidoo & Van Wyk, 2016). Therefore, based on the community block experience, the questions asked, along with handling and presentation skills, are vital in collecting information about social and interpersonal issues. The lack of a primary language skills package limits the engagement between clients and therapists, causing a loss of meaning and understanding. The loss of communication causes detrimental effects on treatment compliance and health outcomes. However, problem-solving skills as an OT are vital to making in-action changes to facilitate understanding through physical demonstration, use of the translator, breaking down words and use of laymen's terms. Read more on the article below:
Clinical reasoning develops with experience, highlighting the importance of the role of the supervisor and lecturers (Thavanesi Gurayah, 2022). A knowledgeable and conscious lecturer—we will call her Mrs Joe—planted seeds in us years before the final year of study, and she kept watering the plant with anecdotes that are starting to sprout now. Emerging and evolving perceptions as an OT: how to see an individual as a person, not a diagnosis. How to align our practice with the PHC principles. We, as Ots, need to continuously evolve, displaying flexibility with the needs of a community. Collaboration between clinical and academic supervisors is required to equip students with professional skills to ensure that treatment is valuable, purposeful, and appropriate for better health outcomes. To enhance the validity of the qualification.
In conclusion, the University of KwaZulu Natal has equipped its students with the fundamental skills to assist in the beginning stages of community-based practice. However, it will require individuals to shift their thinking patterns, broadening their views on livelihood and realities within the global South communities. To understand our role in providing prevention, promotion, and education regarding PHC principles. The ability to emerge in critically identifying the gaps and how to problem-solve. We may lack the resources, but we are exposed to the lived experiences of most South Africans, justifying the preparedness of students to strive in the community.
LET US TAKE A POLL:
WHO WOULD YOU PREFER TO TREAT YOU?
A therapist that cares about their mark and personal atrributes
A therapist who's holistic, considers the clients as a whole looking at context.
Voting ended onMar 22, 2024
References
Dennill, K., King, L., & Swanepoel, T. (1999). Aspects of Primary Health Care (2nd ed., pp. 19–35). International Thomson Publishing (Southern Africa) (Pty) Ltd. (Original work published 1995)
Naidoo, D., & Van Wyk, J. (2016). Fieldwork practice for learning: Lessons from occupational therapy students and their supervisors. African Journal of Health Professions Education, 8(1), 37. https://doi.org/10.7196/ajhpe.2016.v8i1.536
Think Business Event. (2019). WFOT 2018 Final Day Plenary - Karen Whalley-Hammell. Www.youtube.com. https://youtu.be/9WipUPXx_Kk
Thavanesi Gurayah. (2022). An exploration of the facilitating factors in completing an undergraduate Occupational Therapy degree at the University of KwaZulu-Natal, South Africa. Africa Education Review, 19(3), 1–18. https://doi.org/10.1080/18146627.2023.2278050
World Health Organization. (2019). Primary health care throughout our life. YouTube. https://youtu.be/QX7Q0a8GxaA
Women's hands held out holding A Falling, Unstable House.
'The death of a child and mother is a violation of human rights.'~Dr Julitta Onabanjo, Director of the Technical Division at the United Nations Population Fund (UNFPA)
A child and a woman die in every seven-second cycle, according to the World Health Organization (2023), meaning it is equivalent to 12 343 deaths a day and 86 400 deaths in a week, based on the United Nations report for 2023. As it substantiates the staggering mother and child deaths of 4,5 million every year. The fundamental causes are the preventable factors that occur to women and children during childbirth, pregnancy, and a few weeks post-childbirth (World Health Organization, 2023). Therefore, it serves as a lens magnifying the prominent death-causing factors consisting of HIV/AIDS, tuberculosis, hypertension complications, a lack of health care infrastructure to serve mother and child, poor antenatal care, and delayed medical attention. It takes one rock to cause havoc in still water, and the same applies to the negligence of health workers, viewing the individual without considering the context, issues, and barriers that violate their human rights, which perpetuates the poor level of care for mother and child.
The Mandala of Health model explains the individual being the centre having the mind. body and spirit and focus on the interrelations of individual ecosystems. Furthermore, includes the role of the community in healthcare, looking at the environment, family dynamics, stressors, and barriers (Hancock, 1985). The interactions of the person, community and cultural influences. Hence, society is the fundamental structure of a person; it shapes their identity, choices, and way of living. The role of society in healthcare is vital as it draws from the social determinants of health, communal needs, and politics. In my first week in community practice, I observed the injustices and issues around women's health. The economic vulnerability they are subjected to, poverty, poor education level and poor psychosocial support cause adverse health outcomes. They are expected to be present mothers in an environment that does not sustain nor support them. It was an epiphany, realizing the urgent need to expand the multidisciplinary healthcare service at the primary healthcare levels, which is not feasible in the economic state of our country and the fractured healthcare system. You start to ask yourself how you can bridge the gap.
The Department of Statistics (2022) argues that as a country, there is a progressive decline in maternal and child mortality rates about the maternal mortality facility ratio (MMFR), indicating a 16,9% decline in deaths from 105,9% to 88% per 100000 live births in 2019 and 2020, respectfully. Based on the graph above, KwaZulu Natal was third with the lowest MMFR in 2020. However, there is a gap between the community and healthcare as the high unemployment rate, food insecurity, poverty, education, and grant-dependent homes are the realities we see in the community. Women and grandmothers are the cornerstones in the sustainability of homes and providers with poor to no support provided. There is a prevalence in the drug use community in terms of selling an unsanctioned occupation, using due to being normalised within the community or easily accessible.
The barriers within the community include unequal power relations due to cultural norms and a patriarchal way of life. Additionally, jeopardises the well-being and health of the women and children, including the violation of their fundamental human rights and safety crises for both children and women. Based on the experience in the community, you start to recognize a pattern of HIV cases and exposed children, which raises internal conflict in the principles that guide the practice. I found myself in discomfort due to my poor confidence and firmness in asking about the HIV status, which enforced one-word misleading responses. Consequently, jeopardizes the essence of OT practice and Batho Pele's principle of openness and transparency. Understanding how transference is a lack of confidence in being okay in the uncomfortable created obstacles in therapy, soon becoming a hindrance in destigmatizing HIV/AIDS and sex talk.
Transformative occupational therapy is vital in the community because it requires the therapist to question and integrate the knowledge and principles of occupational therapy to be solution-focused in minimizing the barriers and hindering factors that are socially and politically inclined in the clients' lives. Furthermore, it requires critical and comprehensive reflexivity to understand the contributing factors to advocate for the lives of women and children's health. It also requires a collaborative approach to instilling relevant, sustainable projects regarding resource availability and accessibility. flexibility in adapting to the community for community entry and as a tool in treatment. to read more on transformative through occupations, find the link below:
In terms of community-level practice, prioritizing sustainable developmental goals and utilizing the constitution to support and advocate for the needs of the community, particularly children and women, decreases the adverse outcomes. Expanding MDT in community-based practice will benefit the National Development Plan, which aims to reduce poverty and inequalities for better health outcomes.
TAKE A QUICK POLL:
Do you think by the end of 2030 will we be able to reach the Sustainable goal considering the level of healthcare services"ending preventable deaths of newborns and children under five years of age, with all countries aiming
to reduce neonatal mortality to at least as low as 12 per 1000?"
YES
NO
Voting ended onMar 15, 2024
In conclusion, policy transformation to advocate for women and children will minimize the staggering GBV statistics, poverty, inequalities and mortality rates. It highlights the importance of our practice to consider the individual holistically, focusing on the individual in the community. the take-home message for this week is how important the questions we ask as healthcare practitioners, how it can influence your therapy and goals.
References
Department of Health (2021). South African MATERNAL, PERINATAL, and NEONATAL. https://knowledgehub.health.gov.za/system/files/elibdownloads/2021-06/SA%20MPNH%20Policy%2023-6-2021%20signed%20Web%20View%20v2.pdf
Duncan, M., & Watson, R. (2004). Transformation through occupation: Towards a prototype. Transformation Through Occupation. London: Whurr Publishers, 301-318.
Hancock, T. (1985). The mandala of health: a model of the human ecosystem. Family & Community Health, 8(3), 1–10. https://doi.org/10.1097/00003727-198511000-00002
Statistics South Africa. (2022, March 28). Maternal mortality rate on the decline in SA | Statistics South Africa. Stats.sa. https://www.statssa.gov.za/?p=15321
Watson, R., & Swartz, L. (2015). Transformation through occupation. In repository.hsrc.ac.za. Whurr Publishers. https://repository.hsrc.ac.za/handle/20.500.11910/7666
World Health Organization (2023, May 9). Global progress in tackling maternal and newborn deaths stalls since 2015: UN. Www.who.int. https://www.who.int/news/item/09-05-2023-global-progress-in-tackling-maternal-and-newborn-deaths-stalls-since-2015--un
Change is inevitable. Change is uncomfortable. Our solution-oriented reaction would be to fix it. However, we forget that we need to learn to be okay with the uncomfortable. We have fought, kicked, cried, and screamed just to release the discomfort. Maybe before we start trying to change the world, start with the first person you see in the mirror.
The core essence of a community is the formation of societal cohesion beyond the conventional healthcare system. In celebration of the World’s Mental Health Day, the eThekwini community, NGOs (a community of mental health activists), and the KwaZulu-Natal Mental Health Advocacy Group took the initiative to take to the streets for the advocacy walk, raising awareness about mental health issues and destigmatizing concepts roaming in our communities, cultural influences, and shame (Nair, 2023).
Building social solidarity outside the formal healthcare system is the heartbeat of community activism, said clinical psychologist and resea
In April 2023, the first nationwide collaborative meeting involving government and mental health professionals was conducted. The introduction of the National Mental Health Policy and Strategic Framework 2013-2020 was on the agenda for the day. It's a document that lays forth a comprehensive and cohesive national mental health policy. The ultimate objective is to promote mental health and wellness while reducing the burden of mental illness on service users, families, and communities.
The framework's main goal is to promote mental health, prevent mental illness, and provide effective treatment and care to people who have mental illnesses. The framework recognizes that mental illness is a significant public health issue and that there is an imperative need to enhance mental health services and support.
The Framework presents a multitude of policies aimed at enhancing access to mental health services, decreasing stigma and prejudice, and increasing mental health awareness and education. The framework also emphasizes the significance of incorporating mental health services into primary care and enhancing community-based mental health services.
The framework's implementation is supported by various initiatives and programs at the national, provincial, and municipal levels. These include creating mental health laws, establishing mental health review boards, and implementing community-based mental health services. To read more about the meetings follow the link below:
Presentations Plenary Sessions Opening plenary session Charlene Sunkel What does policy mean in realityProf Olive Shisana – Opening Presenta
The implementation phase is critical since the previous framework was impotent to address the issue of providing accessible, adequate care to children and adolescents. To provide care to the people, one delegate proposed flattening the intervention pyramid and deploying all the specialists in the community.
The greatest driftwood slowing the river flow is stigma, societal labelling, and discrimination. Therefore, mental health promotion involves raising awareness and promoting mental health literacy, as well as improving attitudes towards mental illness and people with mental illness. To ensure the success of the framework, it is essential to improve access to mental health services, develop and implement mental health policies and guidelines, and increase the capacity of mental health professionals to prevent an overburdening system (Morar et al., 2023).
Is mental health in South Africa moving forward?
As OT students, we consider ourselves to be agents of change, attempting to achieve client-centeredness. It talks about the role we play and the importance of adequate community health services. We must consider cultural influences, resources, and accessibility. How can we achieve equity in healthcare? The aim is to close the gap between people and healthcare services.
I have seen growth both professionally and personally. Learning to accept the moving wheel means understanding that we need people, destinations, and landmarks in our journey through life to gravitate toward success and move away from our comfort zones, allowing failures to be testimonies.
Who would have thought ten weeks ago I would be here? No white flags were raised, just badges as a token of the journey.
See you on the next adventure!
Love the Green Scrubs Chronicles.
REFERENCES
Morar, T., Breedt, J. E., Mdaka, N., Maaroganye, K., & Robertson, L. (2023). Is mental health in South Africa moving forward? BJPsych International, 1–3. https://doi.org/10.1192/bji.2023.32
National Department of Health, & Government of South Africa. (2013, January 1). WHO Mindbank - National Mental Health Policy Framework and Strategic Plan 2013-2020. Extranet.who.int. https://extranet.who.int/mindbank/item/4018
Nair, N. (2023, October 10). Hundreds step up for “South Africa’s biggest mental health advocacy walk.” TimesLIVE. https://www.timeslive.co.za/news/south-africa/2023-10-10-hundreds-step-up-for-south-africas-biggest-mental-health-advocacy-walk/
Presentations - Mental health conference. (2023, June 1). https://mentalhealthconference.co.za/presentations/
South African Government. (2023, October 10). World Mental Health Day 2023 | South African Government. Www.gov.za. https://www.gov.za/WorldMentalHealthDay2023#
We live in a world of atrocities, gender, colour, betrayal, and estrangement, all of which are in question. Mirror on the wall, I see women screaming in silence: Am I next? I saw the reflection of a stranger I once knew displaying similar features, but I am unable to recall who I am. They say you wear your scars on your sleeves; as the seven women of colour, abandonment is their home, unhappiness being their mantra intertwining personal crisis, heartbreak, shame, and secrecy.
The film is based on Ntozake Shange's play For Coloured Girls Who Have Considered Suicide/When the Rainbow Is Enuf, which consists of a jumbled canvas with seven individuals, each recognized by colour, in seven different locations with seven different varieties of difficulties. Each colour represents a distinct battle for equality and recognition, drawing attention to the interconnections of race, gender, and culture. An emphasis on systemic oppression and discrimination with the goal of diminishing their worth, prominence, and voice.
The movie entails the lives of nine women living around the same block who experience trauma, abuse, unrequited love, suffering, societal wrongs, and resilience as African-American women. It gravitates toward the concept of not being alone and the perceived persona burying the scars that lie behind the crooked smile. We observe the beautiful Yalom curative factor of universality among the nine women.
The people in focus of the movie include a woman named Crystal who is involved in an abusive relationship with the father of her two kids while working for Jo. The husband is a war veteran and a victim of post-traumatic stress disorder that drove him to drop his children out the window under substance influence obsession and paranoia over Crystal leaving. See the movie scene below:
Jo was oblivious to the internal chaos and physical scars Crystal carried to work. Jo, the renowned magazine editor, faces a cheating husband living a double life, causing her to contract HIV. Then comes the relationship counsellor Juanita, whose love became daggers piercing through her heart as she had to love someone who did not belong to her. Read further on the characters below:
Some plays resist filming. They exist as stage fantasies that can't survive the greater realism of cinema. When a stage character performs a
In relation to the South African context, a human rights violation compromises gender inequality, gender-based abuse, and cultural influences on the abuse and rights of women.
We live in one of the most dangerous places for women and children. South Africa is the rape capital, and the number of women being violated is five times higher than the global average, with 10 818 rape cases reported in the first quarter of 2022 (Govender, 2023). Gender-based violence is the driver of homicide, violence, and women's brutality. According to the World Population Review (2023), 36.40 per 100,000 people commit homicide in South Africa, with under 50% of women reporting having ever experienced emotional or economic abuse at the hands of their intimate partners in their lifetime. Therefore, it causes the GBV victim to develop PSTD if untreated depression, suicidality, and substance abuse are common.
The overburdening health system faces a crisis due to the increased risk of unwanted pregnancy, HIV, and other sexually transmitted infections, including domestic injuries in need of orthopaedic and emergency care.
To get those eyes off me, get them rods out of me, this hurts, this hurts me, and nobody came... I was pregnant and ashamed of myself. One of the famous soliloquies expressed by Nyla relates to her experience with abortion. It speaks to the societal influences and negative support system perpetuating shame and guilt. The lack of seeking adequate care for both mother and child due to the stigma and perceived image of her. Bringing back to South Africa, we resonate with her words as ours, as many lose trust in the health systems rather than seeking refuge at backstreet abortion services.
The trauma suddenly devolved into shackles and a cage, devaluing the significance, and meaning of individual lives. Occupational injustices (deprivation, alienation, and imbalance) arise, and social isolation. Losing one's sense of self, values, and belonging is like snow in the summer sun.
A mind-altering experience seeing the need for occupational therapy and advocacy emphasises the importance of seeing the Mona Lisa behind the graffiti. To reflect on the past and present in treatment planning for the goal-directed outcomes, considering economic, cultural, and personal factors.
Reference
Ebert, R. (2010, November 3). For Coloured Girls movie review (2010) | Roger Ebert. Https://Www.rogerebert.com/. https://www.rogerebert.com/reviews/for-colored-girls-2010
Govender, I. (2023). Gender-based Violence – an Increasing Epidemic in South Africa. South African Family Practice, 65(1). https://doi.org/10.4102/safp.v65i1.5729
IvyPanda. (2020, March 20). The Film "For Coloured Girls" by Tyler Perry. https://ivypanda.com/essays/the-film-for-colored-girls-by-tyler-perry/
Saba, A., & Smit, S. (2020, August 27). Real action on gender-based violence a pipe dream as women die every day. The Mail & Guardian. https://mg.co.za/news/2020-08-27-real-action-on-gender-based-violence-a-pipe-dream-as-women-die-every-day/
Saferplaces. (n.d.). Gender-based violence in South Africa. SaferSpaces. https://www.saferspaces.org.za/understand/entry/gender-based-violence-in-south-africa#:~:text=Just%20under%2050%25%20of%20women
World Population Review. (2023). Murder Rate By Country 2023. Worldpopulationreview.com. https://worldpopulationreview.com/country-rankings/murder-rate-by-country
Empathy is seeing with the eyes of another, listening with the ears of another and feeling with the heart of another. – Alfred Adler
When you see a person cry, the instinctual reaction would be to comfort, sympathize, or mewl with them, but the end goal is to reassure them. A few months ago, I was tasked with being a translator during electives. I was torn between being who I am and what I’m required to do to become what I envisioned myself to be. A light bulb moment occurred as I acknowledged the crucial component of empathy in healthcare, which means finding the equilibrium between being sympathetic and apathetic, where you reach a point of understanding the subjective experience of the client to gain a perspective in return for finding the way to provide intervention that is client-specific and therapeutic to bring meaning to the sessions and engagement. However, some face an internal war as past traumatic triggers close the walls to feeling or being averse to the situation, serving as adherence in achieving trust, heed, and therapeutic value in the interactions with the client.
During the initial contact, you gather background information, including interests, values, home context, and medical history, in exchange for personal and similar information, to build trust and a relationship with the client. Therefore, considering the cultural values and principles to find the balance between the activity and the person involving the client in the decision-making process and keeping them informed.
An AHA moment occurred when my supervisors advised me to be a log during the sessions, meaning that therapeutic use of self is not only based on emotions and words but also on your senses, body, and attitude within a session.
The empathizing mode of Taylor’s six therapeutic modes is based on undertaking significant efforts to comprehend the client's subjective perspective, which compromises being able to observe and deduce from the shared information to take it into consideration during treatment planning to achieve meaningful participation and compliance. The intertwining of the collaborating and empathizing modes works in unison to attain client-centeredness. Specifically, conducting an interview and assessments to identify issues and establish prioritized problem statements to plan and implement treatment. Read more on the modes below:
Therapeutic use of self is a concept that encapsulates the need and urgency for the provision of a safe and attentive space that allows the therapist to be present, to listen, and to consider the subjective needs and experiences of the client to achieve cohesion and facilitation of personal growth and healing. An essential aspect of a session that strives for optimum function through exploration of thoughts, feelings, and barriers. As students, we commonly become superfluous by utilizing the statement "I will be a tool to facilitate" in planning to reach the set goals of treatment. Furthermore, we subconsciously apply the modes of encouragement, problem-solving, and advocacy to bring therapeutic value and meaning to the activities during treatment and after. Hence, as we grow in theory and practice, we will be able to find the links and rationale, rather than it being a subconscious process. I believe Taylor’s modes form the foundation of the handling principles we implement in the session, as we will encourage and affirm a client with low self-esteem striving to attain confidence and volition to participate in tasks and not be trampled by fear.
Like in every professional practice, we are bound by terms that govern our behaviour. In this instance, we have the unconditional positive regard by Carl Rogers in the balance theory, which focuses on the key component of effective engagement between therapist and client regardless of disparities: preserving a safe and supportive environment to promote reflection without judgement or conditions. The therapist is to be conscious of their personal perception of worldview and how it contrasts with the client's. The concept can be utilized as a technique within a session with low self-esteem, detached, introverted, and asocial clients to build positive self-concepts, assertiveness, and social skills that promote effective participation.
The take-home message this week is to consider that everyone wants to be heard, and an inclusive environment is crucial in any setting. The therapeutic use of self aims to alleviate the barriers in order to view the clients as they are and explore past and possible experiences. According to Malcolm Forbes, the art of conversation lies in listening, and when combined with the most significant skill in our toolbox, observation, a powerful element is formed to optimize function in occupations and bring meaning.
You ask yourself, "Does my feelings, experiences, and prejudices cause a transference in sessions?"
References
Cho, M. (2018). Intentional Relationship Model (IRM) | OT Theory. Ottheory.com. https://ottheory.com/therapy-model/intentional-relationship-model-irm
Elliot, Prof. R. (2010, March 19). What does unconditional positive regard mean? Www.youtube.com. https://youtu.be/9gbziXBIppQ
England, A. (2023, July 19). Asocial vs. antisocial: What’s the difference? Verywell Mind. https://www.verywellmind.com/asocial-vs-antisocial-differences-7555163
otandmee. (2022, May). The power of you (therapeutic use of self) | the OT process. Www.youtube.com. https://youtu.be/uNZDTPiY140
The neglected, dusty glass slipper loses its colour and form; will there be a perfect fit for Cinderella?
OT enthusiasts, our first tourist stop is the mental health museum. We dive into the injustices and mauling within the societal and cultural domains that serve as chambers entrapping the sounds for help and chains embedded with stigmatization, loneliness, and hopelessness seeking answers in spaces lacking stimulation.
The World Health Organization (2022) defines mental health as a mental state that allows individuals to cope with life's challenges, realize their strengths, learn, and work productively, and contribute to their community. It is an essential component of health and well-being that underlies our individual and communal capacity to make decisions, form connections, and influence the environment. Read more below:
WHO fact sheet on mental health providing key facts and information on determinants, strategies and interventions, WHO response.
Mental health should be a priority, as it is the fundamental principle of our roles in societal and community practices, needs, functions and interests. When lacking the adequate support system and love that Cinderella yearned for, dysfunction occurs, creating an environment of disaster due to internal conflicts, an inability to express, and a need to seek intervention that becomes a prison lacking stimulation and accessibility due to negligence in financial constraints and prioritization.
"Mental health is widely stigmatized, misunderstood, or underappreciated for its intrinsic or instrumental worth, which contributes significantly to its lack of prioritization and present neglect," argues Freeman (2022). I was raised in a culturally-centred home where we have encountered grief, trauma, and solace. In my years of existence, I have not seen my father cry, as he was driven by the decrepit motto "men don’t cry," fuelling toxic masculinity and stigma, which led him to be a parasuicide due to the attitude barricade of a lack of perceived urgency or need for help. His actions became his loudest cry, mental distress, unresolved trauma, and a need to re-establish the line of support and communication. According to SADAG, in 2016, there were 6,476 suicides, with 79.34% being male, supporting the claim that mental distress is undervalued and misunderstood within society, indicating a gap in the mental health promotion, integration of services in primary health care level and accessibility of the available services and knowledge.
The WHO Health Report on Mental Health 2001, which outlines the barriers to enhancing mental health care, was one of the mental health milestones. The most significant issues confronting the South African health system are restricted access to mental health care and shortages of health professionals, mainly in rural areas. Slow integration and collaboration of mental health into general health assure comprehensive and holistic care. The most critical challenges are stigma and prejudice, which impede access to support and care and induce social marginalization, rendering people reluctant to seek intervention. the over-reliance on institutional care, which deprives individuals of their rights and autonomy.
Individuals' well-being is threatened by the inadequate community mental health system, which includes community mental health centres and teams, psychosocial rehabilitation, peer support services, and assisted living services. As a result, health professionals subjected to work burdens have negative consequences on the lifestyle and function of other occupations or roles, such as high absenteeism, low productivity, and negative perceptions of themselves and others. Sapiens Labs' World State of the World Report 2021, due out in March 2022, agrees that our mental health treatment is among the worst in the world.
According to the WHO report, 13,774 suicides were reported in South Africa in 2019. Of these deaths, 10 861 were men, while 2 913 were women. Therefore, this translates to a chasm in the prioritization of mental illness as cases of gender-based violence, COVID-19, academic or job demands, and the role and societal pressures are catalysts of mental distress. Additionally, it indicates heightened prevalence in school-going individuals due to the lack of support, learned helplessness, and stressful environments, which call for mental health crises. A 19-year-old pupil in Limpopo, Khutso Mabiletsa, committed suicide due to bullying, as did a 19-year-old falsely alleged student in Mpumalanga, Ricky Rick, and Patrick Shai.
My take-home message is a pending practising professional, considers the presented facts on the poor status of mental health services and how stigma and a lack of need for care, support, and awareness limit prevention during the acute phases of mental distress. As a result of the disdain for social or cultural values, infrastructure, and misrecognition, it creates a gap between clients and their needs, producing a disruption in accessibility and attaining holistic treatment. The absence of understanding presents a barrier to discovering the linkages to address the individual's demands while preserving cultural values and mental illness.
The evil stepmother locked the gates of collaboration to attain adequate service to improve treatment outcomes and livelihoods.
References:
Freeman, M. (2022). The World Mental Health Report: Transforming mental health for all. World Psychiatry, 21(3), 391–392. https://doi.org/10.1002/wps.21018
Newson, J., & Thiagarajan, T. (2021). The State of Mental Health in South Africa | EAPA-SA. Www.eapasa.co.za. https://www.eapasa.co.za/the-state-of-mental-health-in-south-africa/#:~:text=According%20to%20the%20second%20Annual
SADAG.org. (n.d.). In https://www.sadag.org/images/brochures/Depression-Infographics-2017.pdf.
South African Society of Psychiatrists. (n.d.). Suidice among men. Sasop. https://www.sasop.co.za/mens-health
van der Merwe, P. (2019, September 10). South African Depression and Anxiety Group. Www.sadag.org. https://www.sadag.org/index.php?option=com_content&view=article&id=3048:sa-men-four-times-more-likely-to-commit-suicide-than-women-who-report-finds&catid=92&Itemid=154
World Health Organization. (2022, June 17). Mental health. World Health Organization; World Health Organization. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response
I have conquered mountain by mountain to reach the edge. I’m not Nirmal Purja, the world's greatest mountaineer, but I have conquered the edge that accompanies professional growth as an OT, evoking a personal shift that gravitates toward the urge to consume more knowledge, skill, and experience. I close my eyes as I feel my legs start to tremble, giving in to the extensity of mental and physical demands of the degree, to the burning chest with little air to breathe, and my sight failing on me as I see the end so near but yet far.
All aboard! OT enthusiasts, the train is in motion; let the journey take you where you long to be, free your thoughts of the world you once knew, and as destiny unfolds, rising above the heavy storms, flooding derails the route to the top of the mountain.
The edge is calling as I jump into the uncertainties of a young and perplexed student the chaos shouts and fights for its existence. When I started in occupational therapy, I was introduced to the framework of being, belonging, and doing. I have seen the wilderness soon become my home, identifying the commonalities and the installation of hope as I mature and learn in the journey of OT. Why did I jump? Well, the darkness engulfed me whole, fear developing into confidence. Still, through the supervision of my lecturers, and academic advisors, they became my lighthouse, guiding me as I found myself in what OT means to me and the first building block of a future practising professional. The link below to read more on the framework:
Raising the white flag was not in my rucksack as I embarked on the hike toward becoming the therapist I envision becoming. Hesitancy and self-doubt took over, which was implicated in how I carried myself in a session and later progressed to a chasm in treatment planning. Therefore, limiting the therapeutic opportunities to learn and teach the client to achieve treatment outcomes. When I encountered a difficult, culturally centred, unwilling, and egocentric client, I saw the anxiety and poor self-esteem protruding through the façade displaying my personal shortfalls became a great wall in achieving therapeutic goals. Moreover, poor cultural humility due to the lack of knowledge of the core principles in Nazareth Baptist Church contributed to the noncompliance and poor initiation, and cooperation.
The demands of OT motivate professional development and highlight the importance of cultural aspects of what we do and how they affect the quality of care, treatment outcomes and planning. We reside in a culturally rich country that enforces continuous learning, ensuring client-centeredness and a stepping stone to achieving cultural humility without our prejudices clouding our decisions, clinical judgment, and duty.
Belonging entails the prospect of self-actualization, which is comprised of three components: becoming, being competent, and becoming a social being. To effectively participate in active occupational roles, positive interpersonal relationships, and sustainability, you must indulge in introspection and reflection on your own performance, advocate for change, or redefine values. My greatest shortfall was the detachment process becoming a bumpy uphill switchback ride permeated by the power imbalances creating seas of high tides engaging at initial contact. When faced with adversity in an attempt to build a positive rapport I began to redefine the core values and detach from my moral compass to comprehend my client’s choices by not only hearing but listening to respect their right of choice to refuse therapy, and not equating it to my inadequacies.
To connect the dots and comprehend what we do, we developed the understanding of being evidence-based practitioners, rooting out what makes us therapeutic through clinical reasoning. It is the blueprint for what makes us person-centred. My take-home message is to allow myself to not be driven by fear of the unknown, as failure opens doors for growth. Growth can be attained through exploring the knowledge of those before us in literature to take a page that will shape the therapist I will soon be. Read more on evidence-based practice:
I believe as students we have evolved and inherited the default accountability syndrome, easily shifting the blame on circumstance rather than ourselves. They say Rome was not built in a day; some fell and gave in to the demand, but Rome still stands to this day, indicating you may fall, but dust yourself off and try again.
How would you see the beauty of this world if you were not fighting to reach the top?
As I take the final bow, fieldwork has been a journey of a thousand steps through a valley of a thousand hills. One may argue that the pressure equates to growth and forces you to gravitate out of your comfort zone. I agree because the young, scared girl in green scrubs that walked the gates of this tour has emerged as a confident and capable being. Growth means not just seeing progress but also considering my shortfalls.
Allow me to take you to our final stop in the OT Chronicles. It is sad, but everything comes to an end. Did I take the learning opportunities placed in front of me to be the therapist I have to be in less than 18 months, but who is counting?
If you ask me what cultural humility is, the sensible definition I will give is to break the words into two: culture is what guides our morals, principles, and basically who we are, and humility is how we present ourselves and treat the people around us. The University of Oregano defines cultural humility as a practice of self-reflection on how one’s background and the background of others impact teaching, learning, research, engagement, choice, and leadership. They further mention the components that embody the concept of culture, such as the analysis of our cultural practices and beliefs and how they impact choice and perception. It consists of having the ability to acknowledge the power imbalances and the willingness to learn to dissemble the stigmatization and stereotypes we carry as individuals.
The blurred lines between cultural humility and cultural competency due to the perceived idea of learning about one’s culture and adapting behaviour and communication style to uphold the cultural principles of another do not necessarily equate to cultural humility because it leads to being general about certain cultural values and overlooking the uniqueness within the individualistic cultural principles. For example, with a client that is a black Zulu man who is a Nazarene, I walked into a treatment session with perceived biases about what I should expect. That diverted from seeing him as an individual, causing a negative impact on his occupational profile when looking at his roles and general behaviour. For instance, I would refrain from doing meal preparation activities because of the cultural setting within a black Zulu household of a man not being in the kitchen. My biases may be proven to align with the client's overall being, as he did not perform house duties that he perceived as feminine, which I perceive as normal. This may contradict my perceptions pertaining to household chores, but exposure, it broadened my viewpoint and gave me a generalized idea of what to expect. This leads to reflecting and understanding that it is a choice of "a person" but not a group, and to being aware of qualities that may overlap among different groups of people but do not bind them into a single cultural belief.
Cultural humility addresses the negative power imbalances in therapist-client interactions. It goes to the initial contact with the client as you build rapport based on how you present yourself and the appropriate use of social skills. We unconsciously do and behave a certain way, shaped by our own cultural principles and ethical behaviour, to portray and uphold ourselves in a professional way. When I interact with people, I exhibit an enthusiastic and friendly manner which some may perceive as appropriate to interact only with peers and seem like a lack of respect for an older. This may be due to their own beliefs and background on how one should behave. For instance, I adapted my presentation skills based on the client’s values in a way where I had to refrain from maintaining eye contact with a client and minimize the vocal flexibility and projections to maintain a controlled dialogue. To me, it was abnormal due to my own experiences and the absolute freedom to express myself while maintaining respect within my home, friends, and community. However, it was a learning opportunity to comprehend further the Shembe religion and core values.
The power we exert as professionals within practice causes an imbalance, subconsciously disagree with clients when they consider traditional medicine due to their knowledge and personal beliefs. When I look back to my interaction with my CVA client, she expressed that her stroke was due to a white bird sent by a witchcraft-practising neighbour. I cracked my head trying to comprehend the intricacies of the cause outside of the constructs of Western medicine. Based on research, I learned more about the cultural beliefs about diseases and their pathology. My perception of witchcraft clouded the possibility of the validity of the reason, but to uphold cultural competency, I adapted and accepted the client’s beliefs, but that caused me to perceive it as a goal rather than acquiring more to reach a mutual place to provide a collaborative approach, as I was unable to cater to the needs of the client due to internalized biases. According to Singh et al. (2022), occupational therapists may identify and rectify power relations over time, improve cross-cultural therapeutic interactions, hold systems responsible in client-centred practice, and eventually eliminate health disparities by improving their practices to encourage cultural humility. Read more below on cultural humility in occupational therapy:
Introduction Cultural humility is becoming increasingly important in healthcare delivery. Recognition of power imbalances between clients an
I was stunned dumbfounded for a few seconds, "All I need is prayer, and Christ will hear my cry." Occupational therapy preaches about giving clients hope, but how can I validate her belief that she will be healed by employing prayer? Hope is a notable notion, but the absence of dedication to Christ renders it challenging to provide assurance and empathy for her cries. Given my beliefs in prayer caused by grief and my psychological state, which impacted the encounter with the client, all I could provide was medical knowledge to reassure her. I lacked holistically in contemplating her spiritual expression, although acknowledging and controlling my prejudices, produced a stumbling block in reaching a higher plane in developing a positive rapport. In the session, I learned how religion moulds our behaviour, choices, and lives. The ability to comprehend the role we play as health professionals in the dynamic interaction of religion, the power element, and the influence on clients' care. It goes back to how the client interacts; the level of participation and motivation to engage are guided by culture. Therefore, cultural humility promotes the complexity of our identities and helps us understand the uniqueness of individualism. I agree that it will be an ongoing learning experience due to how diverse our country is, as we are a rainbow nation displaying uniqueness within our commonalities in religion and cultural groups, further broadening the diversity.
Tell me and I forget. Teach me and I remember. Involve me and I learn. -Benjamin Franklin, It has not been an easy journey, but through supervision, it was a lighthouse in an unsettling stormy sea. What I learned from my supervisor was the importance of consistency and a willingness to learn. To avail yourself and absorb the information to improve critical thinking, employing thinking beyond what is superficial and finding links. To not work in the process of elimination and categorization but be able to observe and use yourself as a tool through the guidance of therapeutic frameworks to adapt and perform sessions with clients. The supervisor included me in my learning experience, which was profound as I could compare and contrast my performance without prompting. At first, I perceived it as a formal setting between teacher and student, but I shifted my view and differentiated the key components, which were support, assurance, collaboration, and a conducive environment to learn.
OT enthusiasts, my take-home message this week is that we are better together because together we can achieve great things. Together, we must be able to acknowledge the sameness in our culture but also understand its individualistic uniqueness. To open ourselves to actively learning about our differences and reflecting on our own prejudices, as our differences should unite us rather than separate us. We have 11 official languages, each of which contains diversity to explore, research to humanize our interactions, and our own stories as tools to assure, heal, and validate.
We have closed the chapter of this story, but the book is not finished yet. This is not a goodbye, but “a see you soon”.
Wait, cue the music, anchor the ship, we are back! What a journey it has been! Welcome to the evidence-based practice island of occupation.
When I looked down memory lane, I realised that the little choices processed through value and its intricacies laid the foundation of who I am today. A wise man once said, “May your choices reflect your hopes, not your fears.” That is exactly what we are all about today: decisions. Decisions are driven by factual evidence and collaborative and dynamic interaction with diverse sources of information. A decision can be defined as an internal, adventurous process of considering the facts laid out in front of you. My question to you is: if we are the decision-makers, what kind of life do we perceive our clients to live?
You may ask, "What is evidence-based practice?" It is characterized as fundamentally a clinical decision-making framework that motivates clinicians to integrate information from elevated quantitative and qualitative research with the clinician's clinical expertise and the client's history, preferences, and values. It is the complexity of incorporating the value, experience, and educational use one gain over time as a health practitioner. Furthermore, the compromise of viewing the client holistically, including their context and values, promotes a client-centred approach and proficiency in clinical reasoning. For more information read on:
It's about integrating individual clinical expertise and the best external evidence
Evidence based medicine, whose philosophical origins ex
The OT process consists of evaluation to build an occupational profile. We can enquire about relevant information through deliberate discourse with the client, clinical presentations, textbooks, or scholarly research to address the client's needs through prioritized assessments and interventions to promote the effectiveness of therapy through evidence-based practice. The principles of what we do and why we do it are facilitated by evidence-based practice. This week, I seized the ability to experience hand therapy. I was assisting two young men identified as X and K who both had the same diagnoses. I researched the pathology to apply broad therapy concepts, but what distinguished my approach from the two men was their diverse contextual backgrounds. The inefficiency of implementing the city-based home program for Mr K due to his peri-urban lifestyle of different religious and societal constructs will be meaningless. Evidence-based practice acts as a liaison between pathology and client-specific therapeutic needs.
Occupational therapists thrive on finding the "fit" between person, context, and environment. The evidence-based practice provides the opportunity to dive deeper through research to fit the different puzzle pieces together to do the puzzle through a collaborative approach to attain a shared goal. For instance, Mr K needed orthopaedic care to drain the abscess from his hand, nurses to dress his wound, and occupational therapy to return hand function so he could engage in his everyday activities and reintegrate with ease back home and work. This can be achieved through will of exposure and learning from our interactions.
According to Bennett and Bennett (2000), evidence-based practice is a framework and a process based on clinical considerations that must be made at all phases of the occupational therapy treatment process. Clinical questions that represent the information required to make clinical judgments and consider the specific client or group of clients being treated and the context in which therapy occurs are identified.
I know that is an amalgamation of information one is bombarded with, but I am the solution. Do not fear, OT enthusiasts; different reliable sources are available for an OT to refer to and learn from through the hierarchy of research Sackett's method of ranking evidence, such as the AOTA, AOTF, NIH, and SciElo. Please take a look below to read more about available resources.
This resource on evidence based practice in occupational therapy includes places to obtain evidence for therapy interventions.
We move to the “how,” which incorporates first asking questions related to assessment, treatment planning, and context. to be in search of evidence using a variety of sources to locate data relevant to the client. Then follows the appraisal of evidence to implement evidence-based data into practice in intervention planning.
This guide includes links to key sources of health evidence, and guides users through systematic searching strategies.
We may not follow the same process of reviewing evidence, but when I saw the TB spine client, I entered the therapy session with a presumption of how he would present and began asking questions to better understand the pathology and establish his hypothesized prognosis. I consulted with the hospital OTs to attain a better understanding and learn from their experiences as practising OTs. I consolidated the information through online articles to guide my intervention planning. I would have followed up with the evidence presented to clinical reason out the therapeutic aims and goals I have for the client, which I would then implement into practice. This process may not work for the next person or client, but we change and adapt to use ourselves as therapeutic tools within and outside of therapy.
This guide includes links to key sources of health evidence, and guides users through systematic searching strategies.
As we approach the final stops of our OT journey, when I look into the mirror, I fall in love with the person I see. The four-week-ago version of myself would have been proud of my tenacity, determination, and willingness to always learn, even in situations when I was on the verge of tears. How I managed my client's horrific experience of a situation we had no control over shifted my perception of myself and the importance of collaborative care. The continuous support from my supervisor allowed space for tranquillity and being okay with shortcomings, but also the importance of accountability, being equally yoked with my group, and wearing the shoe on the other foot. Sometimes we need to jump the fence and learn from those who have walked the path further than we have. Albert Einstein emphasized not to stop learning; allow yourself to explore and learn to be the therapist that is client-centred through EBP.
OT enthusiasts, if you ask me how my week was, no words can describe the physical and mental strain I was under. The academic pressure closed in on me, but through the guidance of my supervisor, "still I rise." She sharpened my observational skills during my session and explained their importance. What I learned was to be thorough and not superficial in going back to EBP to consider and apply the available resources to ensure intervention planning is evolving and therapeutic. She planted the purpose of precision and evidentiality from initial contact to treatment to guide and reason your session to attain therapeutic objectives through research, articles, observing experiences from seniors, and consolidating through interactive learning such as the NDT techniques tutorial.
My take-home message is that we as students forget the power element we instil within the sessions with the clients, and the role we play within the multidisciplinary team requires knowledge in order to clinically reason our therapeutic process. Remember, a decision is not a choice because “a good decision is based on knowledge and not on numbers.” – Plato
Welcome to the collaborative practice of the MDT museum!
The way to achieve your own success is to be willing to help somebody else get it first- Iyanla Vanzant
Well, friends, it is that time of the week again. What is a multidisciplinary team? Is anyone on deck? It was a remarkable construct designed to assist and service clients. Do I agree with the existing service standard? No, but it is perceived as a collaborative practice done individually and lacks the "work together aspect," We are the people liable for ensuring MDT is not just what we do but who we are.
Collaborative practice is defined as a group of health and care workers from various disciplines and professions who collaborate to make treatment choices for individual patients and service users (NHS England, 2022). It involves the integration of care in which professionals and practitioners work together around the needs of the client, family, and community. Focus on the video below to further explain collaborative care:
Collaborative practice is a tool to attain client-centred care. Collaborative practice prioritizes the client's needs and treats them holistically. For instance, having a CVA grandmother in the ward. The level of care she receives reflects on her prognosis. We need the nurse to provide the first line of care, the doctor to diagnose and prescribe medication, the physiotherapist to improve lower limb strength and mobility, the speech therapist to help with swallowing difficulties and aphasia, and the noble OT to attain function to engage in activities. The amalgamations of care serve a common goal, with no service above the other but prioritizing the therapeutic goals and health of the grandmother. That is what client-centeredness is all about through teamwork and goal-directed intervention planning.
Our stereotyped perception of the roles of other health professionals limits our interprofessional teamwork as it challenges social interaction, behaviour, and power element. The poor cohesion between students and staff deprives them of opportunities to attain positive teamwork to service clients, causing individual care to not be prioritized and specific to the client. My encounter left a bitter taste, as the beautiful concept, in theory, was not up to par with the practice aspect. The inability to openly discuss and learn from the personnel tasked with the well-being of my client created a dilemma: is my client ready for discharge after not meeting therapeutic goals to find an empty bed the following day? Therefore, the lack of positive teamwork created a shortfall in services, disadvantaging the client's needs and integration back home and into the community.
One of the prejudices is my default attitude and perceptions that hinder my confidence in seeking collaborative interaction and goal setting, causing me to conform and lack advocacy for the profession itself and my clients. We are all fallible. Our differences in practice and imperfections should be what unify us, as the beauty of service lies in the diversity of professionals.
Take a careful look at the green pastures that entail the grass is greener on the other side, as one may assume that collaborative practice exists in private health care due to accessibility to resources, health specialists, and the basic standard of care, therefore achieving prioritized intervention. OT enthusiasts, I have to disagree; the grass is greener on the side you water. Regardless of the kind of service you receive, collaborative practice is what drives all professions, as we aim to attain success in client-focused services by improving and meeting the needs of the client.
Collaborative practice allows room for interprofessional education, especially in a hospital with practitioners who do not understand the importance of occupational therapy. Ainsworth (2021) argues that interprofessional education is a crucial step forward in the evolution of health professional education and enhances the quality of patient care by allowing future physicians and other healthcare professionals to work successfully together in an increasingly complex and specialized healthcare system. A crucial educational component in breaking down the obstacles that inhibit efficient workplace cooperation and communication. Sometimes I wonder if the green scrubs are not bright enough to be seen shouting, "I'm here and I’m important," as the professor of occupation, Mr. Dee, says it.
The one mistake we make as students is that we box the MDT team as rehab, and I am guilty as charged your honour. I know, being an OT enthusiast is not one of my greatest moments. We fail to see beyond rehabilitation. The collaborative practice focuses on not just health professionals but other sectors that affect your client specifically, like a cerebral palsy client. The MDT team will include an educator, a speech therapist, an OT and a physiotherapist working together to reach the needs of the client.
The supervisor gave me the honour of seeing my shortfalls and the importance of confidence in my thoughts and knowledge. It was a tongue-tied moment, as I perceived myself as shy and scared. It was eye-opening to realize that sometimes anxiety is not the cause but my performance. The ability to link my performance and interaction with the MDT. Do I represent the client the best way I should? Am I able to express myself and communicate without falling on deaf ears? As I try to gather the courage to affirm my plan and knowledge of theory to provide the best care I can and to advocate for the services of the green scrub. The wind is howling like a swirling storm inside me as contradicting thoughts arise: "Your thoughts matter. Speak your mind," she says. The doubts and ambivalence originate from the perceived predicament in which I am not confident in the consolidation of knowledge and aptitude, fear of inflicting harm, and self-disappointment.
The collaborative practice consists of teamwork, which I have observed within my group. The positive reliance within and outside of fieldwork provides the fundamentals of skill development with a support system that serves all people within the group equally. To facilitate positive peer learning and personal development in terms of accountability, cohesiveness, and productivity. Some claim there is no I in the word team, but there is no us either. However, what I have seen over the past few weeks depicts the importance and effectiveness of teamwork. The opportunity to observe and actively assist my fellow teammates with their clients allows for space for professional growth and exposure to learn and sharpen skills. Whereas one would perceive it as a support system and an affinity for adapting to a new environment.
Along the OT cruise, I saw growth in the constructive feedback from the supervisor, as I learned to offer continuous input throughout the session, allowing the client to actively engage, comprehend, and adhere to the therapeutic process. I observed attributes in myself of which I was previously unaware. It felt like fish battling for breath as they emerged from the sea. However, my supervisor's favourable traits about my performance transformed my viewpoint, allowing me to look beyond my green scrubs as a student and over the horizon as a professional.
My take-home message this week, ladies, and gentlemen, is that we need to occasionally compromise our objectives and ambitions to allow others to succeed in accomplishing the shared goal. Allow yourself to walk a mile in the footsteps of someone else to gain the principles and respect required to foster understanding and cohesiveness and utilize our disparities as tools rather than weapons to divide us. Let us hear from the experts: If I have seen further, it is by standing on the shoulders of giants, Isaac Newton asserts, implying that collaboration is essential in efficiently serving the people, including both students and seniors, promoting interprofessional learning, not forgetting that your client is part of the multidisciplinary team.
Collaborative practice is fundamental to client-centred care, and we OTs serve and uphold the principles of holistic care and collaboration. It improves productivity by ensuring clients receive care but is also cost-effective, which positively influences the current shift in the implementation of NIH. Therefore, we necessitate converging and surpassing subtle disagreements and antagonisms to create a sustainable healthcare system.
NHS Transformation Directorate - transformation to improve health and care for everyone
See you next week on our next tourist stop OT enthusiasts.
I can't change the direction of the wind, but I can adjust my sails to always reach my destination -Jimmy Dean
My deepest fear is the inadequacies that water the seeds of doubt that roam through my head as I walk into the hospital gates. As I announce myself as an occupational therapy student, the beauty of confidence emerges, contradicting my inner struggle with myself, my chest beats like a drum and salt droplets drenched my hands. Subsequently, my session and handling of the session when Mr Z was poorly engaged did not serve therapeutic goals for both Mr Z and me. Kahlil Gibran elaborates on the anxiety-inducing experience triggered by a lack of control and uncertainty. Do I have adequate knowledge to offer and satisfy the expectations placed on me?
The AOTA (2020), describes occupational intervention as a three-phased process that includes the intervention plan, intervention implementation, and intervention review respectively. They further explain that occupational therapists provide intervention to facilitate participation in activities in everyday life. I needed to have acquired the skill of assessment in the application of the three-phased process. The intervention planning for the first time was thought to prove and promotes self-efficacy in self within therapy and in consideration of the client and their environment. This allowed me to be a client-centred occupational therapist in consideration of the client holistically.
Upon the initial session with the client, I had the basic knowledge of tuberculosis, its clinical picture and how it will impact function. This provided an opportunity to anticipate the general performance, and functional level and to conduct prioritized assessments. The sessions taught me the value of ensuring constructive use of time and planning to be client specific. The supervisor shifted my thoughts and concept on how to conduct assessments to be activity-based and key tools we use as OT's clinical observations. I recognized that in a meaningful activity, I can influence the session flow and accurately assess cardiovascular endurance at Mr Z's functional level. When the supervisor verbally assisted me during the session with redirecting and how-to advice granted me an opportunity to provide optimal care and be meaningful.
Disseminated tuberculosis is an infestation of two or more non-contiguous sites caused by Mycobacterium tuberculosis hematogenous dissemination, which is possible as an outcome of progressive initial infection, reactivation of a latent focus with subsequent spread, or, in rare cases, through the iatrogenic origin (Khan, 2019).
The intervention was effectively implemented but could not ensure the treatment was sustainably implemented post-session with Mr Z and at home after discharge. This acted as a challenge as I presented myself and the department to ensure that health and optimal function were promoted. Mr Z portrayed a thick and tall brick wall that negatively affected our fundamental relationships as therapist and client, delaying future sessions in establishing treatment goals collaboratively. It was an informative but stressful experience because I learned how to be flexible and adjust to new situations in treatment, uncertainty, and guilt about my own performance as a therapist arose. The encounter did not grant me the opportunity to learn and explore the role of OT with TB clients from theory into practice, as he was my first client.
The inability to provide activity-based treatment and have continuous sessions placed me at a disadvantage being unable to track the progress or regression of the client or make out-action changes based on the functional level against therapeutic goals. Mr Z's refusal of therapy and lack of engagement made me consider alternatives to influence his choice but disregard the patient autonomy ethical code that states as a healthcare practitioner shall respect the patient's decisions. My supervisor's support educated and evolved my perspectives and techniques with beneficial future implications to address human rights and patient healthcare acts throughout my sessions.
My performance attributes to the client’s refusal of therapy could be my presentation skills and confidence was not accurately portrayed which resulted in a lack of education about my role as an OT and how it is pitched to him was an average functioning level.
The take-home message includes the importance of holistic care concerning ethical codes to guide me as the therapist is important. There is no greater agony than bearing an untold story inside of you Maya Angelou speaks about the importance of a collaborative approach and seeking assistance as the next individual may be going through the same struggles as you.
In conclusion, theory in practice is an intertwining tree as theory is important in the application for a person to understand and learn. The theory is the fundamental base for integrating knowledge through practice which permits trial and error in order to attain an understanding for optimal learning and bear the fruits of the tree through soil nourishment (constructive criticism).
references:
American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 74(4). https://doi.org/10.5014/ajot.2020.74s2001
Biographbook. (2018, January 21). Maya Angelou’s Biography | No Greater Agony Than An Untold Story | Biograph 2020. Biograph. https://www.biographbook.com/maya-angelous-no-greater-agony-untold-story/
Khan, F. Y. (2019). Review of literature on disseminated tuberculosis with emphasis on the focused diagnostic workup. Journal of Family & Community Medicine, 26(2), 83–91. https://doi.org/10.4103/jfcm.JFCM_106_18
Olejarczyk, J. P., & Young, M. (2023). Patient Rights And Ethics. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538279/#:~:text=more%20informed%20decision.
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