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Pictures from Google Images: an indication that lessons learned can be negative or positive.

TITLE:  Standing At the Edge of the Community Block!

4 weeks down the line, things are coming to an end. Knowledge and insight were gained throughout this new and eye-opening experience. Buckle up as I take you through my journey at Mariannridge Community and on the peak of my personal and professional growth.

My heart was pumping and beating out of my chest as a box of community fieldwork was opened. Anxious, as not knowing what to expect and how this period would be navigated consumed my thoughts. This has been a period of nothing but 4 weeks of a roller coaster. Working in communities like Mariannridge changes one perspective on how they view and deliver their treatment. In a hospital setting, treatment and recommendations are based on the picture of the context the client had painted. Being in the community, physically, instilled that your recommendations must be realistic and can be applied. Prompting questions and going as far as asking for pictures will give a clear picture you would have gotten when paying a visit. For example, in some areas within this community having rails is impossible so suggesting the build rails is no longer realistic, and due to their financial status, it won't permit them to have one. Community is a reminder that OT intervention must not be textbook treatment-centered but reality-based treatment.

This block teaches sympathy, that even when you go to other places as an Occupational Therapist you need to understand why other things happen, why other people will miss their doctor's appointments. 70% of individuals we have been seeing in this community- to attend their appointments, they need to hire private cars which is also expensive whilst they struggle with finances. Not only sympathy but client-centeredness, being in the client's shoes. So, this teaches one that you can’t send people because they were late for their appointment.

Collaboration with community workers or stakeholders is important. This is what makes the lives of individuals in the community better. Understanding the streams of communication with stakeholders is important, as we had an incident where we nearly approached sponsors without talking to specific members which might have caused a rift between them and us. Being able to make relationships with the community social workers, and caregivers made the carryover and intervention a success and holistic as they were also people willing to intervene. Collaboration with political members must be approached with caution as they can use Health Workers for their political benefits not the community, this was picked up during one of the Project Managers' meetings.

Being exposed to working with kids, which I never had a chance to do before, opened an opportunity to learn that you need to be able to adapt everything and be smart and not fall into their tricks. For example, they might say their hand is paining when they are supposed to write which is likely to be a lie. When this was happening in a section destructing them was the best idea and went back to the activity. Working with children from the community with low socio-income you need to be aware that their parents might be struggling also which then affects the child, especially with school. If they are willing, working with them would automatically benefit their children. This is unlikely to happen as sometimes it is hard for them to admit that their children need assistance. Discovering sites such as the OTToolbox came in handy in treatment planning https://www.theottoolbox.com/.

Finally working at SANCA (Alcohol and Drug Rehab, https://sancadbn.org.za/)  with high-functioning individuals with substance abuse, painted an image that they never woke up one day and decided to be addicts but events led them to that. We need not see them as addicts but as individuals with unmet needs.  The intervention provided in groups aimed at addressing areas that resulted in them being on drugs not forcing them to stop. There's also a trend noted that with these individuals, most must have lacked love. It is easy to fall into addiction and we may preach self-love but if we don’t get it from people, we value such as parents it causes shame and doubt. Loving and being caring can still bring hope to 1 individual who feels loved.  Can visit this page for assistance if affected by someone's use of substances: Al-Anon Family Groups South Africa, https://www.alanon.org.za/.

Not only do you have to put your theory into practice but integrate with the real situation in front of you. With all season lessons are learned, and so is with this block. These were lessons learned and are to be used not for a short period but for a lifetime, being sympathetic, understanding and kind, realistic, collaborative, and effectively communicating.

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Impacting Lives, Saving The Future!

Images from google images

All United Nations countries share a common goal which aims to ensure sustainable development that addresses economic, social, and environmental factors that impact the quality of life (United Nations Development, 2015).  There are 17 global goals, that are analyzed through open data and research, that also help achieve and measure progress on set goals(Gurin et al., 2015). In the Mariannridge community, the sustainability goals that will be working on are, no poverty, good health and well-being, quality education, zero hunger, and sustainable cities and communities.

Lacking basic human needs including shelter, food, clean water, social support, education, and also access to health are measures of poverty (Divine Word Missionaries, 2023).  Having the privilege of being placed and working in a low-income community forces one to look for strategies that can help sustain and result in access to basic needs. One can never eradicate all at the same time but seeing what the community needs the most and can be sustainable is important. In the Thornwood community under the Saint Marys’ Community Outreach Centre, we have been working with children from underprivileged homes who mostly depend on social grants and also meals provided by the After Care Centre that looks after them. We have started implementing a vegetable garden that will be used for their meals as they had mentioned that they struggle as a Centre with funds. This program will be sustainable as there are people with gardening skills within the center. This will also teach the children the skills of gardening that they can even use in the future since they will be active members in carrying out the project. This project serves as a reminder that even the little action we take, can lessen the burden and improve lives

According to GGI Insight (2024) living your life to the fullest while in a state of being healthy and fulfilled is considered good health. Being in a community setting means making an impact in people's lives, instilling hope providing and delivering health services. Chen (2023), mentioned that one can not access services such as hospitals or clinics due to reasons such as finances, being a community OT in the Marrianridge community means bringing interventions into their homes as they also have challenges with accessing health care services due to funds. Four times a week home visits are conducted to those whose health status is not in good standing. Going to their homes to provide care brings hope to them and also gives them the sense of being cared for which they always appreciate at the end of the sessions. More than 3 individuals encountered mentioned having missed their appointments not only once or twice due to lack of finances.  With these home visits from door to door, the number of people who do not get health attention decreases and some are equipped with knowledge as caregivers are also educated. Health Promotion in clinics and schools is conducted to promote health and share information that they may not need now but future.

According to World Health Organisation (2022) providing quality education to all is a global goal. It is aimed at ensuring equal access to education, encouraging lifetime opportunities and access to universal education while improving literacy rate and educational income. With the increased number of people accessing the quality of education decreases, for example, at Marrianridge Primary School there is a high number of student intake (access to education), but due to this number in each class, there's decreased individualized attention given to learners resulting in challenges in quality of education and literacy decreasing their chances of accessing higher education, increasing a number of people dropping out. Working with children who are having challenges in school such as writing, and reading has been motivating when improvement is noted due to individualized care. With a lack of access to tools that can be used to improve the quality of education, tools made out of recycled material will continue to be explored such as using cardboard boxes to improve directionality, this is to be implemented as this is something they struggle with the most. This also adds to the overall global goal of providing quality education. Seeing them having access but not benefiting makes one reflect on how they can assist in the few weeks spent with them. A Red Flag workshop will also be held with educators, sharing indicators for their learners who need attention so that their challenges may be addressed early.

Working on eradicating hunger is one of the aims we would like to achieve by the end of the block. Implementation of strategies that would be working on this is not in place as yet. Advocating for community members on the stakeholders will be considered. On observations at the Thornwood community, there's a community kitchen soup by the Councillor’s office every. Advocating for the same thing in Marianridge would assist in eradicating hunger. Improving access to quality education and access to basic needs by the programs implemented would also indirectly fight against hunger in the lives of community members. While improving one development goal mentioned before our Marianridge community would be sustained. Working hard as a community OT channeling, advocating, and implementing will surely help in achieving the goals.

Remember it takes one step

Remember it only takes one step to win the race, which we are ready to take on!

Total Number of Words: 899

References

Chen, J. (2023, July 12). What’s Poverty? Meaning, Causes, and How to Measure. Investopedia. https://www.investopedia.com/terms/p/poverty.asp#:~:text=The%20term%20poverty%20refers%20to

Divine Word Missionaries. (2023). Poverty Isn’t Just About Food — 3 Types of Poverty Around the Globe. Stories.svdmissions.org. https://stories.svdmissions.org/the-mission-post/poverty-isnt-just-about-food-3-types-of-poverty-around-the-globe

GGI Insight. (2024, May). Good Health and Well Being: What You Want to Know. Www.graygroupintl.com. https://www.graygroupintl.com/blog/good-health-and-well-being#:~:text=Good%20health%20allows%20us%20to

Gurin, J., Manley, L., & Aris, A. (2015, September). Sustainable Development Goals and Open Data. World Bank Blogs. https://blogs.worldbank.org/en/digital-development/sustainable-development-goals-and-open-data#:~:text=Open%20Data%20can%20help%20achieve

United Nations Development Programme. (2015). Sustainable development goals. Sustainable Development Goals; United Nations. https://www.undp.org/sustainable-development-goals

World Health Organization. (2022). Sustainable Development Goals. Www.who.int. https://www.who.int/europe/about-us/our-work/sustainable-development-goals

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An OT Curriculum Available In South Africa That Is On An International Level.

Images from google images.

Amongst all other health professions, occupational therapy is the only client-centered profession that focuses on promoting health and well-being through participation in meaningful activities. The primary goal is to enable participation by working with individuals, and communities to enhance their ability to engage in occupations they want to do, need to do, or are expected to do (World Federation of Occupational Therapists, 2024). For occupational therapists to be able to do so, occupational science or understanding is used to modify the occupation itself or the environment to support the client's needs or occupational engagement (Therapists, 2022). Higher educational training is needed to be a qualified OT, with one of the research-leading university, the University of KwaZulu Natal, offering the course. This then leads us to the big question: Are Occupational Therapists produced by this institution prepared for Community or Primary Health Care?

Primary Health Care (PHC) is the initial health care individuals need or seek. PHC is a whole-society approach that ensures that individuals receive quality, cost-effective, and effective health care that will enhance social well-being, mental well-being, and physical well-being (World Health Organisation,2022). Just like any other academic institution, the University of KwaZulu-Natal also has a set standard-based sequence of planned goals that is essential and facilitates learning amongst students, this is also known as a Curriculum (Great Schools Partnership, 2015). According to the Rhodes Department of Education, the curriculum specifies skills, content students need to learn and practice or achieve and be able to independently apply. This includes study materials, schedules, and instruments.  In today’s piece, we will be analyzing the OT curriculum at this prestigious University of KwaZulu Natal.

The UKZN OT practical aspect of the curriculum prepares students by demanding students to think out of the box and think on their toes, taking into consideration all the factors that affect access to health care such as socio-economic status. Going to their communities or homes aids in preventing social disparities in health care caused by one's socio-economic status. Knowing that you might never see the client again because of lack of access due to money or transport demands the therapist in charge (Student) to maximize time with the client and ensure that treatment is effective. With different placements in every block since the second year, your mind is broadened by the exposure to different clients' environments limiting us to just only recommend what the theory says that may collide with the client's real life situation.

With this exposure, you cannot suggest modifications that are based on what you think is the environment of the client but need to be in a real environment and make realistic programs and modifications. For example, just because the client says you they have stairs doesn’t mean you can suggest they build ramps, in communities like Mariannridge they might not do that, due to how their environment is like(living close together, the gradient of the stairs, and how the only houses they have are build and also socio-economic status). This makes one think of other individuals we have seen in clinics and suggested impossible things. But because we never understood and still learning, little grace and learning from these is important.

With every encounter with people accessing the service, you are always reminded that we need to have sympathy and treat each individual with care regardless of their socioeconomic status background, or reason for access.  We are taught to be advocates and work with stakeholders. This wasn’t an easy part because we were cautioned that we need to be able to articulate our words very well, which I am not so good in but improving. In this block, in Mariannridge we have recently advocated to the ward Councilor to donate wheelchairs to those who are in need,  as this assistive device does enable occupational engagement. We have collaborated and we are working hand in hand with other stakeholders with the minimum resources we have for treatment sessions, collaboration with individuals such as CCGs and learner support does make service delivery much better. We were prepared by the OT curriculum that you might not get all the fancy equipment in the place you are placed at, therefore you need to use available resources including human resources which brings hope that there will be a carryover of the sessions or treatment.

Not only as students we are practically prepared, with theory which is the basic and initial phase of the course we are prepared from the word go. How each module is set up for each year makes sense when you must integrate it in the Final, 4th year. Each module feeds on your holistic intervention from understanding Anatomy and physiology and integrating it with your Kinesiology when doing modifications. These modules selected are seen making forming a golden thread in 4th year and aiding in improving treatment delivery in primary health care. The presentations that take place aid in summarising and reporting about clients in writing or verbally.

There is a Zulu saying that says “akukho soka elingenasici” which translates to “there are always pros and cons in a situation. With the OT curriculum as students, we are Exposed late to practicing in the community even though it has changed for other levels. They are exposed to the community since the first year. We were unfortunate due to conditions such as COVID 19. With all this preparing us, it is worth it in the end even though it is physically, and mentally taxing. The workload makes it even harder especially during 4th year.,

Even so with the Dearth in Universities that thoroughly prepare students for Primary health care service delivery,  in the Discipline of  Occupational Therapy, The University of KwaZulu Natal curriculum is recommended. Their curriculum does not only equip them with assessment but intervention skills too, with the help of experienced supervisors and lecturers.

References

Great Schools Partnership. (2015, August 12). Curriculum Definition. The Glossary of Education Reform. https://www.edglossary.org/curriculum/

Therapists, W. F. of O. (2022, September 20). Statement on Occupational Therapy (Archived). WFOT. https://wfot.org/resources/statement-on-occupational-therapy

World Federation of Occupational Therapists. (2024). About Occupational Therapy. WFOT. https://wfot.org/about/about-occupational-therapy

World Health Organization. (2022). Primary Health Care. World Health Organization. https://www.who.int/health-topics/primary-health-care#tab=tab_1

World Health Organization. (2023). Declaration of Alma-Ata. World Health Organization. https://www.who.int/teams/social-determinants-of-health/declaration-of-alma-ata

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Another Pandemic Faced by Women in Low-income South African Communities.

Images from Google Photos.

Health issues concerning women cannot be separated from issues of social development and their right to improve health status (Walters, 2024). Maternal health and child health refers to the health of women and the child during pregnancy, childbirth, and postnatal period until adolescence, WHO (2019). According to the South Africa 2023 government health report, maternal mortality is a health issue that must be addressed. In this report, it was further stated that women residing in informal or low-income communities have the least access to health care and have a maternal mortality rate of 200 per 100000 compared to other communities' rate of 32. According to WHO (2024), facts sheet maternal deaths occurred almost every 2 minutes in 2020, summing to almost 800 women dying from causes related to pregnancy and childbirth that could have been avoided.

According to WHO (2024), over 40% of pregnancies in developing countries miscarriage, induced abortion, and other factors lead to illness, complications, or permanent disability for mother or child. During pregnancy, factors that may affect the mother and child's health are malnutrition, lack of income hindering access to health services (such as access to the clinic due to lack of transportation), and lack of education or adequate information on how to ensure a safe and healthy pregnancy.

With only one week at this site, where the student therapist has been placed for academic practice, during community assessment members mentioned that water outage is an everyday thing that affects engagement in occupations and affects them psychosocially (stress and anxiety) as they sometimes do not know when they will be back again. Water is an important source of living and an everyday need. Insufficient and inadequate clean water may impact the mother's health and child resulting in deficits in development and increased chances of the mother being anemic (Omer, 2024).  Advising the mothers to store water in bottles and buckets for days when they do not have water would decrease the chances of health problems, during health promotion workshops in the clinics as there have not been any treatment or assessment provided to pregnant and new mothers.

Due to nutritional problems and status mothers are more likely to be anemic as they do not receive enough nutrients, (buying what would sustain them for the whole month is also important) which increases the chances of delivering a low-birth-weight infant. Due to not the baby receiving enough nutrients- (which affects baby development in the uterus which may later result in poorer cognitive skills). Suggesting other ways of growing vegetables will seem unreasonable as they live close to each other and they don’t always have water. A high number of substances used in this community affects the mother and child's health, due to the decreased employment rate this is what most community members turn into.  As they continue with the substances during pregnancy, this may affect the mother and their children resulting in conditions such as withdrawal symptoms in the baby after birth, and cognitive and behavioral problems. This as an OT student must inform my preventative approach to the community adolescents on ways to cope with depression, and anxiety as it is also one of the risk factors for substance use. Sites such as SADAG can also be recommended to the youth of this community as they have access to cell phones.

During birth poor management during labor and delivery results in complications or disabilities, which may lead to conditions such as cerebral palsy.  Experiencing hunger, and diseases will cause negative consequences such as the inability to concentrate. With the knowledge and skills as an OT student that I have, promoting health awareness to young children in this community would be appropriate as the teenage pregnancy trend is noted, raising awareness on how incomplete development of the pelvis poses a risk of hypertensive disorder which results in maternal mortality.

Malnutrition and, disease expose children to poor mental & physical growth. Then poor mental & physical growth exposes children to poor performance at schoolwork which has been noted in most of the schools in this community. Learning difficulties amongst students in these schools, the Red Flag workshop was established by other OT student that aid in informing teachers about students that needs further assessments and referrals to special needs schools.  Raising awareness on this should be prioritized to be avoided where it could.Poor, large families further exposing to disease and malnutrition and the cycle continues to the next generation.

With the possibility of the mothers going back to substances after childbirth as a way of coping due to stress on how they could take care of their children, this often leads to child neglect which sometimes affects the psychodynamic formulation of the child. As the student therapist has never had a chance to work with mothers and children, this block is expected to be an eye-opener considering real-life situations. The treatment programs or interventions will aim to facilitate health and safety during pregnancy and after birth. And informing mothers on signs that may be indicators of the need for therapy intervention. Remember health is not the absence of disease but complete physical, mental, and social well-being, WHO (2024).

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References

Addisse, M. (2023, January). Maternal and Child Health Care. https://www.cartercenter.org/resources/pdfs/health/ephti/library/lecture_notes/health_science_students/LN_maternal_care_final.pdf

Caudill-Slosberg, M. A. (2024). Maternal and Child Health. The Human Journey. https://humanjourney.us/health/global-health/maternal-and-child-health/?gad_source

Omer, S. (2024, February 6). Global water crisis: Facts, FAQs, and how to help. World Vision. https://www.worldvision.org/clean-water-news-stories/global-water-crisis-facts#:~:text=Maternal%20and%20newborn%20health%3A%20The

Walters, V. (2004). The Social Context of Women’s Health. BMC Women’s Health, 4(Suppl 1), S2. https://doi.org/10.1186/1472-6874-4-s1-s2

WHO. (2024, April 26). Maternal mortality. Www.who.int. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality/?gad_source=1&gclid=Cj0KCQjw6PGxBhCVARIsAIumnWZ0Tm-8KHcVXeiQOcVhq63-bstxrekYj4QatRp51cXGZLM6ba4Mco4aAnhLEALw_wcB

World Bank. (2023). World Bank income groups. Our World in Data. https://ourworldindata.org/grapher/world-bank-income-groups#:~:text=Low%2Dincome%20countries%20are%20those

World Health Organisation. (2023). Health and Well-Being. Www.who.int; World Health Organisation. https://www.who.int/data/gho/data/major-themes/health-and-well-being

World Health Organization. (2019). Maternal health. Who.int; World Health Organization. https://www.who.int/health-topics/maternal-health#tab=tab_1

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“Stay home, stay safe!”

“The nationwide lockdown is necessary to save the lives of thousands, even tens of thousands, of our people”  the South African president said during his first speech during the outbreak of Coronavirus in South Africa. According to the World Health Organisation https://www.who.int/health-topics/coronavirus#tab=tab_1 ,  it is an infectious disease caused by the SARS-CoV-2 virus where one infected will experience mild to moderate respiratory illness, some recover and unfortunately,  some pass away. To minimize the spread of the disease social distancing, quarantining, sensitization, or frequent washing of hands is advisable. Early during the outbreak period in South Africa, this was said to save thousands of lives instead peoples’ lives were more in danger.  He emphasized everyone to stay home and be safe, unfortunately, those who were experiencing GBV and running away from their abusers were forced to be in the same environment or space with them. Many citizens were left unemployed, and still are, due to businesses shutting down resulting in high numbers of depressed individuals.

People were forced to adapt new ways of getting entertained or staying in touch with the outside world. Here comes TikTok and Instagram or Facebook.  According to Hum (2021) https://www.frontiersin.org/articles/10.3389/fhumd.2021.684137/full , there was a higher increase in engagement on social media during COVID-19 than in any other year in history. People were not only entertained but they also learned the importance of taking care of one's health, as a physical and spiritual being. This period was an eye-opening to society and the world at large. Learning how important it is to take care of your mental health and looking after those who are around you.

During this period people started sharing their struggles, some were academic struggles. Please visit my first blog to read more about my struggles at https://www.tumblr.com/mzeken/726054270181457920/i-may-not-be-there-yet-but-im-closer-than-i-was?source=share&ref=_tumblr. These social media platforms created awareness on cases such as depression, gender base violence, and anxiety. These platforms assisted with the destigmatization of mental illness.  As people started sharing what they were going through even those who didn’t know that they were depressed started seeking for help.  During covid 19. I was battling with depression as I felt shame, guilt, and a disappointment as I couldn’t pass all my modules. I knew then when my family started looking or taking serious mental health that I would have their support. Even though they didn’t know much about my case the way they viewed and sympathized with other people gave me hope that even if I share this with them, I will not be alone in overcoming this.

There is this famous quote that says there is a lesson in every storm. Even though we lost significant others, our lives changed forever, some in the same circumstances got to know about platforms that can assist us with mental health problems or mental illness such as  SADAG https://www.sadag.org/index.php?option=com_content&view=article&id=11&Itemid=114 and learned the importance of taking care of our mental health. I hope you take care of your health too before it is late. Unfortunately, we have come to an end of my writing to you. I hope you have enjoyed my blogs. If you missed some of my blogs, visit my page and enjoy my pieces online on Tumblr at https://www.tumblr.com/.

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“Split”.

According to the American Psychological Association, Personality refers to the characteristics and behavior that comprise a person's unique adjustment to life, including major traits, interests, drives, values, self-concept, abilities, and emotional patterns. The characteristics become of concern when they interfere with one's life in terms of occupations, including social life and work.

Split! In this thought-provoking, sensitive movie that keeps you glued to your screen and on the edge of your seat, we are introduced to three girls who were kidnapped after a birthday party by a man diagnosed with 23 distinct personalities. These 23 personalities have evidence from his trusted psychiatrist. As Kevin’s (a man with 23 personalities) therapist delves deeper into his mysterious disorder, the girls must find ways to escape before the new and sinister 24th personality itself.  This enlightened how important it is to have a great relationship with the MD, as you can be able to gain other information during assessment and work with it in planning treatment, in this movie the Psychiatrist is the one who knows a lot about Kevin.

In this movie, we are not only observing how fearful the girls are but also how confused they are. This emphasized how important it is to do psychoeducation with the people around persons with disabilities, which can be family or co-workers. According to Better Help (2023,  https://www.betterhelp.com/advice/therapy/what-is-psychoeducation-and-why-does-it-matter/  psychoeducation is when therapists teach people about their mental health conditions and disorders. People who receive a diagnosis of any kind want to learn about their condition, and mental disorders are no different, even so this can also be important for caregivers and people around the patient as it can then influence how they act towards the patient. The sudden change in personalities opened a new perspective of how people who live with people with different personalities can feel and as an OT a support group for them should be prioritized. If you are living with anyone with personality disorders and you need support you can contact SADAG as they offer support to people living with mental illness and those who are impacted, visit their page online at https://www.sadag.org/index.php?option=com_content&view=article&id=1897&Itemid=101.

 I am not one of the girls in the movie, but I was deeply moved. Not knowing how one will react in a situation can lead to depression and an increased level of anxiety. According to Mohammad (2013),  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791092/#:~:text=a%20separate%20window-,Emotional%20impact,every%20member%20of%20the%20family. these feelings can be due to feeling helpless and hopeless in situations. Kevin did not show any signs of occupational limitation as the report from his workplace was, that he is managing very well. However, due to his condition, he found himself engaging in life-threatening activities unconsciously as he was not aware that these personalities affected others as well.

Unfortunately, I am not a movie person, but this changed my perspective on movies, that they are not only used for entertainment but can also be educational, helping us to grow in certain fields of practice. I have never treated anyone with a personality disorder but with being glued to the screen I got to understand how important other MDT members are especially when dealing with mental illness and how people with personality disorders behave. To enjoy the same movie, you can download or watch it online on Goojara at: https://ww1.goojara.to/myP8PO. For more of my blogs about mental illness, you can visit my page on Tumblr at:  https://www.tumblr.com/mzeken.

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We might be in different positions, but we are all living in the same world.

Occupational Therapy is known to be the most diverse medical profession as it uses a holistic approach during assessments and interventions.  There are different frames of reference, models, and techniques used in occupational therapy to analyze and shape interventions. There is also one technique known as “therapeutic use of self”.  According to Finlay, (2022), the therapeutic use of self is the self-aware intertwining of both our professional self, the one that uses knowledge, skills, and techniques) and our personal self (which arises from our history, beliefs/values, personality, and embodied lived experience) https://www.lindafinlay.co.uk/therapeutic-use-of-self/. This is known to be a tool where one (therapist) uses themselves in a way that they become an effective tool in the evaluation and intervention process.

According to Cam (2022), therapeutic use of self is when practitioners leverage their own knowledge, personality, thoughts, feelings, or even their physical body to benefit their patients. During assessments, it can be used to build rapport with the client or social support by empathizing with the client, encouraging and giving them hope. In short, we use ourselves to advocate for patients to gain access to resources, collaborate with the client (autonomy), encourage the client by positive re-enforcement, educate the client about important issues to be considered and help problem-solve which will enable our clients to reach their ultimate occupational goals. For more details visit Cam’s YouTube page at https://www.youtube.com/watch?v=uNZDTPiY140.

Therapeutic use of self to me, means understanding my patients and treating them with an understanding that they are real human beings, not robots to be used for academic purposes. Even thou I have little patient which I am willing to work on, relating to my patients in terms of how they may be feeling is important for me. Having the role of being their therapist doesn’t make me superior to them hence “we might be in different positions, but we are all living in the same world”.  It is all about being a human being in relation to another human being. It's less about applying therapy techniques and more about finding a way to be with our clients, in patience, curiosity, compassion, caring, and challenge, while we go exploring together how we can make life meaningful again, Finlay (2022).

In my journey of being an OT, I have used my interests and lived experience during therapy, especially during assessments. In 2022 on my first Psycho-social block I had a patient who was not willing to engage in therapy. But I started sharing my love for football and how I have sustained injuries whilst playing. He then started mentioning his perspective on football which then led to having more conversations as this allowed him to warm up to the student therapist, he was seeing for the first time, and already asking questions. Therefore I used myself to elicit better outcomes during assessments (https://lifelonglearningwithot.wordpress.com/2016/04/20/therapeutic-use-of-self/#:~:text=Therapeutic%20use%20of%20self%20is,information%20you%20choose%20to%20share%E2%80%A6). We even utilize this technique unconsciously.

For intervention, this reminds me of the young male adult who was involved in a car accident rendering him T8/T9 dislocation. He had fluctuation of moods due to the sudden permanent changes in his life. Having to adapt the sessions, empathize with him, and physically do passive mobilization, and then educate him to minimize contractures was also a therapeutic use of self. This technique can also apply to physical aspects of life not only psychosocial such as sharing common depressing stories to help others pull out of their depression states or making them see that other people also go through what they are going through or relate.

This also reminds me that how we treat our patients really has an impact on when and how other clients can start seeking intervention. If the word of mouth is that Ots treat their patients like trash. No one even in their sickness would like to be treated as such. So, it is important for us to use ourselves in a good way. In closing this is advocating us to always practise the Golden Rule!

For more information on the therapeutic use of self, you can also visit the OT Practise framework online: American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), Article 7412410010. https://doi.org/10.5014/ajot.2020.74S...

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Images from google images.

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“To not have your suffering recognized, is an almost unbearable form of violence", Androl Lanitov

Psychologically, we all have something going on. It is either all of us are undergoing, pain or hardship if not it is either you have been here, or you are going to be here. According to the DSMV TR, this starts to be a problem when it affects one's occupations and roles. The 4th OTPF defines occupations as everyday personalized activities that people do as individuals, families, and communities to occupy time as it brings meaning or purpose to life, or they are supposed to do it.

There are a lot of things that affect our occupational engagement such as life-changing events that lead to physical impairment or psychological impairment.  In our blog today we are going to discuss mental health that have been neglected so much in our societies or the last thing we address or notice just like Cinderella in the ”Prince Charming” stories. According to WHO (2021), they are largely unrecognized and untreated because mental health conditions are particularly vulnerable to social exclusion, discrimination, stigma, educational difficulties, risk-taking behaviors, physical ill-health, and human rights violations. These are mostly induced by our cultural norms and lack of knowledge of what mental illness is.

Having not heard of mental health presentations in my life until I was exposed to the course that deals with mental health had a negative impact on how I viewed mental illness. You can visit my previous blog on my journey battling with mental illness at https://www.tumblr.com/mzeken/726054270181457920/i-may-not-be-there-yet-but-im-closer-than-i-was?source=share.  But now I can proudly say I am equipped when it comes to mental illnesses and interventions. With fewer people understanding what mental illness can be, does impacts how people seek mental illness intervention and when. When I look back and reflect on what some of my family members have been going through, I see the need for health intervention. But because there was none too little exposure to mental illness, awareness, or campaigns from the health department they didn’t understand what they were going through and that even if you are suffering from depression and substance abuse, your life can still be meaningful again.

With more articles being published on mental health, especially in South Africa, we see that in the ancient days, it was totally neglected but now, according to the Policy Framework and Strategic Plan 2013-2023, they plan to further transform mental health services and ensuring that quality mental health services are accessible for everyone, equitable, comprehensive and are integrated at all levels of the health system. This is done by paying a huge amount of money to Mental Health which used to be the last thing on the health budget, given that it has been producing high death rates not only in SA but the whole world. Developing monthly awareness of mental health conditions, giving out posters, and being active on social media about these campaigns is how they are trying to reach out to everyone. Living in South Africa where public health is prioritized, we can count ourselves as privileged.

If you know a friend or see anyone suffering from mental health conditions you can suggest some of these sites to them SADAG online, Adcock Ingram Depression & Anxiety Helpine, and https://www.youtube.com/watch?v=qLS8wVJP9i8 on YouTube. Sharing information anytime is important, they might not need it now but in the future, they might recall your name. I know what it feels like to be drowning underwater and having to suffer in silence. With 14.3% of deaths worldwide, or approximately 8 million deaths each year, we cannot do everything alone, but together we can help save lives.

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Link to the DSMV: the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013

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“I may not be there yet, but I’m closer than I was yesterday” Jose N. Harris.

Image from Google (meme generator)

What once seemed impossible, and not for me, feels more tangible and right in front of my eyes these days. Me becoming an Occupational Therapist.  This is a journey for me, and I am feeling every step of the way. Steve Maraboli once said the road to success is always under construction. Fasten your seat belt as I take you through my journey up until this far.  I have always wanted to be something in the Health and Sciences profession, but I couldn’t figure out what until I overheard the title of OT.

In every classroom either in primary or high school there will always be a high-flyer. I overheard one from my matric class stating that she will be an OT if not a medical doctor. The title of being an OT fascinated me as I have never heard of such before and never knew that it existed in my town hospital, Ingwavuma Mosvold Hospital.  I did not only end up applying for OT via CAO but getting to meet an interesting local OT.  She explained to me what occupational therapy is and the areas under occupational therapy (geriatrics, pediatrics, psychiatry, general physical conditions, and medico-legal. Occupational therapy is defined in the OTPF as the therapeutic use of everyday life occupations with persons, and groups for the purpose of enhancing or enabling participation. I never knew what OT is until my first year. I knew the definition but didn’t understand the concept nor was I able to describe it to others and it all started making sense in my second year (https://carrieschmittotd.com/wp-content/uploads/2021/04/AOTA-Occupational-Therapy-Practice-Framwork-OTPF-4th-edition.pdf.).

I did my first year in 2020, and there was the outbreak of covid which resulted in no longer having contact classes on campus but moving back home and adjusting to online learning. This was a hard time for me given the area I am from (connectivity issues, electricity problems. Basically, deep rural areas). With being unable to attend and do my work I ended up not passing all my modules as I was also not submitting on time. I got depressed as had my goals that after 4 years this degree must be put in motion and helping others. I did not even know about sites like SADAG (https://www.sadag.org/. ) that could have helped me cope with depression. Having to swallow the pill that my friends passed did not cause more only heartache but also negatively affected my self-esteem. If I knew what Occupational Therapists are capable of, I would have also seen one for myself for anxiety management and time management sessions.  Sometimes I do get very anxious and depressed I use the skills that I was taught during lectures and have been sharing with others not only my patients on practicals but also family.

Time went by and did my second year, 2022 as during 2021 I was redoing the module I failed. Started going on practice putting the theory into practice. With the lecturer, helping friends, supervisors, and sites like OT rex on YouTube (at  https://www.youtube.com/@OTRex) helped me understand what our focus as Ots is and how we also use activities as assessment tools and interventions. It made me realize that what is normal in me, my family, my culture, or my community may not be normal for others. This emphasized the importance of being open-minded, respectful, sympathetic with others, non-judgemental, and patient.

This journey has been a roller coaster for me. It does happen that you put in effort on your work and marks don’t reflect that, you are reminded of your failures. Then this calls one to go back to their drawing board and strategies.  It is when you keep on pushing. We are no longer driven by the clock but the passion. Looking at the differences we can make in other people’s lives, we must keep on keeping on. Khalid once said, “You can do anything if you put your mind to it” Eastside. This time around I feel like I am closer to being a certified Occupational Therapist with no student at the end compared to 2020. I am standing on the edge.  For more information on what occupational therapists do please visit this page: (https://www.aota.org/-/media/corporate/files/advocacy/state/resources/practiceact/ot-definition-for-aota-model-practice-act.pdf. )

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“Humility is the solid foundation for all virtues.” Confucius

Humility at its highest is when you allow selflessness and dignity for a better world. This in other words means that forgetting about who you are and taking into consideration what others value. According to Merriam-Webster humility is staying stable and maintaining power on the inside and not needing to control others on the outside. I understand this statement as having your own beliefs and perspective on life as an OT but not trying to impose it on other people, clients to be specific.  Cultural Humility is allowing the patient or client to believe in what they believe in and not control or try to change their perspective but work around that, taking it into consideration when planning and implementing intervention with respect as it influences therapy.

One of my lecturers Mr D.M Mpanza once said “Understanding your client’s culture is the most important part of your intervention”. Therefore, this emphasizes that we need to have thorough assessments with our patients so we can get to understand their beliefs, ideas, values, customs, or perspectives on a certain matter. In other words, understanding the client’s Cultural identity is important. Culture is diverse we may be of the same culture but believe in different things. During assessment what I am looking for mostly when doing cultural assessment is understanding cultural explanations of the illness and how it will affect the clients treatment, which may relate to the stigma related to that. In my journey to becoming an occupational therapist the growth of understanding culture is building up every time I meet these individuals.

 2nd year of my degree focuses mainly on doing assessments, I once had a male spinal cord patient which meant I had to assess. I did not understand the cultural concept that much, which lead to incorrect interpretation of assessments. I was supposed to perform a sensation assessment (Asia), this assessment is done with the client naked. The client refused on the first try but when explained thoroughly why the assessment is done he allowed the assessment to take place. I had already concluded and said the client is not compliant with treatment as he also refused a bathing session with the student therapist.  Before the end of fieldwork, I then  asked why he refused the assessment earlier on he said “It is against my culture to undress in front of a young female especially since I am married.” I then got to understand that my findings were not accurate and I had no insight in what the client actually believes in, it also gave me an insight that I can only understand this by asking the patient not by doing research. This equipped me by instilling that cultural bearers may rise during assessments. Juan E on transcultural psychiatry article emphasizes the importance of interview to obtain this information which also opened my eyes https://pubmed.ncbi.nlm.nih.gov/19837778/.  

There are cultural factors that affect the experience and interpretation of illness, as understood by the patient, the family, and the social network. Roberto Lewis emphasizes the importance of understanding. Cultural explanations of illness as cultural factors that affect adherence to clinicians’ recommendations may be compromised without careful attention to patients’ cultural views of treatment. If there is a negative stigma attached to that condition in their society, home, church or work the client might not comply to treatment. For example, other cultures believe that physical illness is a  form of possession or ancestral punishment, or they are trying to pass a message. This changes the way the occupational therapist in making handles and presents assessment and treatment. This forced me as a student to always try and explain in detail why certain assessments are done and how the client is going to benefit from the intervention whilst taking into consideration what the client believes in. This wasn’t the easiest as it came off early as disrespectful when it happened on the first encounter. Because I took this as a learning curve and tried to apply it on other patients (being detailed in handling and presentation) it has resulted in compliance with assessment and treatment in patients I have treated just like the CVA patient that believed in possession when having a CVA. This proves what Confucius said when saying “Humility is the solid foundation for all virtues.” Respecting client’s cultures and understanding resulted in working towards achieving their highest functional capability.

https://www.researchgate.net/publication/11048241_The_Cultural_Formulation_A_Method_for_Assessing_Cultural_Factors_Affecting_the_Clinical_Encounter. Lewis- Fernandez (online source) goes into detail on how the cultural factors affect the clinical encounters which I have also experienced and used to guide my clinical experiences when it comes to culture. My takeaway in this was understanding the importance of interviews, good handling, and presentation skills when respecting cultures, and being open-minded taking what they believe in, into consideration which adds to making us a client-centered and holistic rehabilitation multidisciplinary team member.

Unfortunately, we have come to the end of the road with writing blogs for this semester. This was my last piece to you. I hope you have enjoyed my blogs. Please revisit my page for more insight in a multidisciplinary team and client-centredness approach on tumbler at https://www.tumblr.com/blog/mzeken.

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“After all, the ultimate goal of all research is not objectivity, but truth.” Helene Deutsch

Picture from BrainyQoutes.

Being an OT student means research is part of your daily bread. Occupational therapy is known as a health profession that has a positive attitude toward research. The Oxford Dictionary defines research as being a systematic investigation into a study of material ad sources to establish facts as new conclusions.  In my understanding research analysis and results are based on evidence. This evidence guides us to being therapists that use evidence-based practice. This evidence helps us understand the factors influencing our client’s prognosis- functional and medical prognosis. By giving us an idea in terms of is the condition that we are treating is reversible or not and whether is there any curability such as spinal cord injuries. This guided me as a student therapist when formulating the clients’ overall aims that are realistic looking at the possible outcomes.

Research guides our clinical reasoning in the way we approach and handle treatment sessions. The research I have been doing included me looking up articles online on websites such as google scholar and Research Gate https://www.researchgate.net/ ). What is challenging about these sites some of these are not from South Africa and you need to be selective about what you digest by looking at your client’s environment and how you can incorporate or modify that to suit your client as we always aim to be client centredness. The main model which is researched base that I used was PEO. This made me understand how Environment is important, how modification is important, and working along with other people. Mdt forms a huge part in being client-centered and there’s research and evidence based on those facts. Please visit my blog on Tumblr explaining the importance of these members at: https://www.tumblr.com/mzeken/716414209923170304/alone-we-can-do-so-little-together-we-can-do-so?source=share. The environment is important when looking at the patients holistically.

The OTPF 4Th edition https://carrieschmittotd.com/wp-content/uploads/2021/04/AOTA-Occupational-Therapy-Practice-Framwork-OTPF-4th-edition.pdf  which is also evidence-based mention how we can obtain information that we can need to plan the treatment. It talks about getting collateral information from external sources such as caregivers or MDT members. This was done prior to meeting the clients by looking at the client’s file and researching the diagnosis to get an idea of what the client will present like. The OTP mentions how understanding the client context in terms of internal environment, financial support, and physical support. These were used to understand how as a student therapist I can prepare the client back to their highest level of independence, which I see as a strength.   These enlightened how financial stability influences access to community resources. These truths from the articles helped also to encourage me to look at my patients holistically and the important things I need to look at. Just like Helen said, the ultimate goal of all research is not objectivity, but truth.

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“Alone, We Can Do So Little, Together We Can Do So Much.” Helen Keller

Adobe Images: https://stock.adobe.com/search?k=teamwork&search_type=autosuggest

Teamwork or working in collaboration is mostly a requirement in every working place or organization, and even though this is not liked by many, still it is practiced every minute. Participants in group work with different roles are also known as multidisciplinary team members (MDT) (https://www.mm3admin.co.za/documents/docmanager/3C53E82B-24F2-49E1-B997-5A35803BE10A/00134971.pdf.  In health care, it is important to understand these occupants and their roles. The most important member of the team is the client or patient, my lecturer once said, ‘Without this team member there is no driving force or foundation of the team”. The other team members are caregivers or family members, doctors, nurses, occupational therapists, physiotherapists, dieticians, speech therapists, and social workers or psychologists. Understanding their roles will help you to correctly refer the client to the correct practitioner.

In all the MDT is a group of professionals from diverse disciplines who come together to provide comprehensive assessments and consultants for a common goal (Front Oncol, 2020). The main goal is the continuity of care and a more holistic approach towards patients’ needs.  A good team also results in cost savings, workforce retention, reduced length of stay, and reduced turnover in the facility. Based on my experience and observations for you to be a good team member, you need to develop leadership skills. These skills that I think are important are good listening and communication skills, time management, problem-solving, accountability, and collaboration. (for more details on these skills on Chrome visit https://www.herzing.edu/blog/7-important-teamwork-skills-you-need-school-and-your-career.)

As much as occupational therapists are known for a client entered or holistic approach, we cannot do everything hence the importance of other team members. Helen Keller says ‘Alone, we can do so little, together we can do so much’. This emphasizes the importance of teamwork, understanding, and respecting every role and scope of practice of every member.  

It is not only us OTs that need to understand the roles of each member, but it is in my hopes and dreams that everyone knows this from patients to doctors. Let me give you a glimpse of my experience with the MDTs I have been exposed to. So, I have been exposed to a public hospital and a private hospital and how things are done is different. There’s a lack of knowledge especially in public hospitals in terms of understanding the roles of members which pains my heart. A lot of incorrect referrals are made which wastes patients’ time and then puts your relationship with other members on the spot. If you have no good relationship with your members, then you wouldn’t know that there is a patient that needs your services resulting in poor service delivery which I have witnessed.  The experience I am getting now at Entabeni Rehabilitation Centre is different (available MDT members please visit: https://www.lifehealthcare.co.za/hospitals/kwazulu-natal/durban/life-entabeni-hospital/.) The unity among team members is evident in the clients’ lives.

There are times I have discussed with the physiotherapist my goals with the client, and she discussed hers which were different, but we found a common ground of how we can incorporate both aims in our client’s sessions even though they were different to get the best outcome for our client. This was after I learned how as a student therapist, I can be client centered. Working with the MDT sharing the same goal forms a great part of client-centredness as this is part of clients’ rehabilitation or treatment.

The feedback I receive from the supervisor based on the intervention sessions pointed that I need to understand the client’s needs, wants, and goals it forces me to go back to the other team members and ask about the client’s improvement so that I can include that in sessions as I aim for the highest level of independence. This will change how I plan my sessions in the future by consulting the team members, be it the caregiver, the doctor not only the patient.   With the large number of clients that I see now and will see in the future working alone to give back a quality life to individuals is impossible.  Working hand in hand with other members has given me an opportunity to understand more about different diagnoses such as how a CVA patient can learn to speak again or even walk after the accident. The availability of these members plays a big role in executing a holistic intervention.

For more understanding of client-centeredness please visit my piece on Tumblr: https://www.tumblr.com/mzeken/715676516917362688/medicine-adds-days-to-live-occupational?source=share

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“Medicine Adds Days to Live, Occupational Therapists Add Life to Days”- Unknown.

Being not able to fly high as you would like, in terms of being able to do any of your occupations as much as you want because of life-changing events is scary and depressing. Being unable to be you just like you were before can be too much for everyone to handle. Life is unpredictable, so they say. Having to live with a certain condition or being diagnosed with a diagnosis at a certain stage of life can be too demanding for a person and require a client-centered intervention.

The OTPF 4th edition (http://carrieschmittotd.com/wp-content/uploads/2021/04/AOTA-Occupational-Therapy-Practice-Framwork-OTPF-4th-edition.pdf. ) mentions that just like any medical profession we share the same process when planning a treatment intervention as OT’s: we evaluate, intervene and target outcomes but then OT have something different. Occupational therapy is a profession known for its client-centredness and holistic intervention. This means that we must focus on using what is meaningful to the client to make a difference in their lives, hence why a thorough assessment is important. I understand client-centredness as a person-directed intervention because it must focus on what a patient likes, is expected to do, needs to do, and wants to do.

Knowing this but not knowing how to use it when planning one of the client’s subprograms resulted in a therapist-based intervention. I used all leisure activities that I thought were going to help me improve the impacted client factors such as hand function, active range of motion, and muscle strength. I planned a session and the client engaged very well when implemented which I thought is what was supposed to happen only to find out that the client did not relate to what we were doing in the session because it was not part of any of her likes. I was happy during the session because of her participation, and it was short-lived when I realized that the client does not relate to the session we had. This takes us back to why critical planning is important, you can have a look at one of my blogs trying to explain that: https://www.tumblr.com/mzeken/715046142108401664/week-1-blog?source=share

“You must find a balance between the client’s therapeutic activities and the client”, Zainab Ayob. This was a life-changing statement for me as a student therapist. This opened my eyes that I will have to focus on the client’s interests,  previous occupational engagement, roles, habits, and hobbies when planning to have a more meaningful and client-centered intervention. We must use what is within the client’s preference when planning intervention. This also created a picture of why involving the client during goal setting is an important part of intervention planning so that they will be aware of why certain things are done which I didn’t take into consideration when planning.

This opportunity to plan and implement intervention taught me that with every diagnosis be it CVA or Spinal cord, thorough assessment and goal setting together with the client is important. Our goal as OTs is to add meaning to every day by making sure we aim for the highest level of independence with every patient.  Another note: Whenever you planned a session do not only focus on improving what you have written down just like I did on my sessions but learned that look for any other arising opportunities. Medicine adds days to life, but occupational therapists add life to days. As occupational therapist students let us start practicing aiming for a meaningful life in every stage of our patients by adapting to client-centered intervention!

The following link also explains very well how OT intervention is different from other professions: (https://www.regiscollege.edu/blog/occupational-therapy/what-does-occupational-therapist-do-roles-and-responsibilities.)

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Being not able to fly high as much as you want because of life-changing events is scary and depressing. Being unable to be you just like you were before can be too much for everyone to handle. Life is unpredictable, so they say. Having to live with a certain condition or being diagnosed with a diagnosis at a certain stage of life can be too demanding for a person and require a client-centered intervention.

The OTPF 4th edition (http://carrieschmittotd.com/wp-content/uploads/2021/04/AOTA-Occupational-Therapy-Practice-Framwork-OTPF-4th-edition.pdf. ) mentions that just like any medical profession we share the same process when planning a treatment intervention as OT’s: we evaluate, intervene and target outcomes but then OT have something different, (Hanna & Rodger 2002). Occupational therapy is a profession known for its client-centredness and holistic intervention. This means that we must focus on using what is meaningful to the client to make a difference in their lives, hence why a thorough assessment is important. I understand client-centredness as a person-directed intervention because it must focus on what a patient likes, is expected to do, needs to do, and wants to do.

Knowing this but not knowing how to use it when planning one of the client’s subprograms resulted in a therapist-based intervention. I used all leisure activities that I thought were going to help me improve the impacted client factors such as hand function, active range of motion, and muscle strength. I planned a session and the client engaged very well when implemented which I thought is what was supposed to happen only to find out that the client did not relate to what we were doing in the session because it was not part of any of her likes. I was happy during the session because of her participation, and it was short-lived when I realized that the client does not relate to the session we had. This takes us back to why critical planning is important, you can have a look at one of my blogs trying to explain that: https://www.tumblr.com/mzeken/715046142108401664/week-1-blog?source=share

“You must find a balance between the client’s therapeutic activities and the client”, Zainab Ayob. This was a life-changing statement for me as a student therapist. This opened my eyes that I will have to focus on the client’s interests,  previous occupational engagement, roles, habits, and hobbies when planning to have a more meaningful and client-centered intervention. We must use what is within the client’s preference when planning intervention. This also created a picture of why involving the client during goal setting is an important part of intervention planning so that they will be aware of why certain things are done which I didn’t take into consideration when planning.

This opportunity to plan and implement intervention taught me that with every diagnosis be it CVA or Spinal cord, thorough assessment and goal setting together with the client is important. Our goal as OTs is to add meaning to every day by making sure we aim for the highest level of independence with every patient.  Another note: Whenever you planned a session do not only focus on improving what you have written down just like I did on my sessions but learned that look for any other arising opportunities. Medicine adds days to life, but occupational therapists add life to days. As occupational therapist students let us start practicing aiming for a meaningful life in every stage of our patients by adapting to client-centered intervention!

The following link also explains very well how OT intervention is different from other professions: (https://www.regiscollege.edu/blog/occupational-therapy/what-does-occupational-therapist-do-roles-and-responsibilities.)

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Week 1 Blog

“Knowledge is of no value unless you put it into practice”.

It is the first week of assessment and intervention implementation. This is a great, scary adventure I am looking forward to which is about assessing and treating clients ensuring positive changes in the client’s lives, and gaining skills as a future professional as much as I can, not from only my supervisor and other professionals within the rehabilitation center.

Transitioning from theory into practice with real clients is different. With theory, we created cases or use created cases and apply the knowledge we have been taught to the case with no physical handling or contact with the client. With practice, it comes with challenges. There are challenges I have faced this week. Having to wait for hours to be assigned a patient was a struggle and resulted in not having enough time to do assessments on the longest day we have on fieldwork, as we are also not allowed to see patients after the supervisor has left. With a clear explanation from the supervisor that it does happen that at the placements it gets busy and ends up not being able to see your patient and in other placements and blocks it is also a struggle to get patients. This created a picture that we are supposed to use the time we have with the patient and on fieldwork effectively and get most of the things done. This emphasized how time management and proper planning are important. All time management starts with planning, Tom Greening. Having to take all that being said and taught in class into real-life situations was a bit overwhelming but planning prior did help.

Being able to build rapport with the client that I finally got made things easier for me to work with. Day 2, I was then able to conduct formal and informal assessments, standardized and non-standardized assessments. Watching videos and other resources online such as OT Rex (https://www.youtube.com/c/OTRex) as a way of preparing really helped calm the anxiety and nerves that I had. Assessments such as Muscle tone (Ashward Scale), Muscle strength (OS), Range of motion using the goniometer, Trunk Impairment Scale, Pain, Sensation and Hand function, Balance, and posture were done and used observations as a tool. Placing prior the assessments goniometer was also a struggle but the tut, we had with the supervisor made it easy and showed us when to specifically use the goniometer to save time as our focus is no longer on assessments but mostly treatment.

This was a great experience but a confusing one at the same time. With the findings of the muscle tone, I expected not to have normal tone in the LUL as the client is a Right CVA, and mostly the UL are usually affected. With assistance from the supervisor, I was able to make more correct readings and assessments.  Not knowing where to start with planning the client’s intervention was a bit stressful since now it is a real client, not a made-up patient. The help of the supervisor asking questions such as the focus of our intervention and what are factors such as age, roles, and occupational preferences of the client made it a bit clear where I can start planning the client intervention. To plan the intervention books and articles such as Stroke with a focus on the Elderly by family medicine will be used (http://www.diva-portal.org/smash/get/diva2:140187/FULLTEXT01.pdf) and all the other information from the theory work done with lecturers.

“Knowledge is of no value unless you put it into practice”, these are the words by Anton Chekhov. I hope as a student therapist I will see changes in the client’s life that I am working with and all others in the future also using feedback, knowledge from books such as Trombly, and skills gained from the supervisor.

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