The OT Diaries

Just a fourth year Occupational Therapy student trying to find her way!

[the-ot-diaries]

23 days, 3.5 weeks, 552 hours

23 days, 3.5 weeks, 552 hours. If you had told me 23 days ago that I’d grow immensely in such a short space of time, I probably wouldn’t have believed you. If you had told me 3 weeks ago that I’d learn so much about my own profession in such a short space of time, I also probably wouldn’t have believed you. If you had told me 552 hours ago that I would feel way more equipped with the necessary skills and knowledge for community service next year, I most definitely wouldn’t have believed you! There’s no doubt that these past 3.5 weeks of embedding myself within the KwaZulu Natal communities of Kenville and Mariannridge have been physically, emotionally, and professionally challenging, however I have come out the other side drenched in knowledge, skills, and perseverance to be taken forward into community service next year, as well as into my career as an Occupational Therapist. Let’s unpack some of these professional and personal lessons I have learnt.

There have been endless lessons learnt in terms of my profession. The biggest lesson I have learnt over the past 3.5 weeks is about the famous medical model. As students, this model is taught to us as a golden key in aiding the understanding different injuries, diagnoses, and impairments. The medical model is a model that draws on the fact that mental and emotional problems are akin to biological problems, meaning that they have specific physiological causes and should be cured through specific treatment (American Psychological Association, 2023).

Figure 1. The medical model of disability

(NeuroDiverCity, 2017)

Whilst being on this community-based rehabilitation block, I have learnt that although the medical model serves as an important vehicle to navigate, as occupational therapists we need to look beyond this model, steering more towards a social model of disability, which demonstrates disability as the result of an unaccommodating and oppressive society, as opposed to an individual and medical issue (Hogan, 2019). This has been a huge revelation to me and opened my eyes up to the dire need of social transformation within these local communities, due to the negative impact the fractured healthcare system in South Africa has on the health, well-being and livelihood of these people in the communities.  

Figure 2. The social model of disability, which we need to strive towards

(NeuroDiverCity, 2017)

Another professional lesson that has revealed itself to me includes that home visits are an absolute necessity when working in these communities and are currently an enlarging gap within occupational therapy practice in South Africa. Prior to this experience, I never thought of home visits as such as integral part of our professional practice, however I now understand how much of an impact they have on our clients’ lives. This was particularly evident through the words of a young mother of a 4-year-old boy with hydrocephalus; “You have no idea how much these home visits mean to me; it is such a struggle to take him to the clinic by myself”. Her words will stick with me for a very long time, and I have seen the value of home visits with a freshened perspective.

As much as I have learnt so much about my profession, oh how I have learnt SO much more about myself! First and foremost; I have learnt that the most beautiful thing that you can wear is confidence. At the beginning of this block my mind was flooded with self-doubt and insecurity, as I found it difficult to approach people in queues and get a conversation going, however I have seen my confidence grow in leaps and bounds since then. This has taught me the true value of courage and assertiveness, and how integral they are in this profession.

Figure 3. Relevant quote on the importance and value of self confidence

(Frida Howard Coaching, 2019)

Secondly, I have l learnt that nothing beats contextual learning! Even if you can recite a whole textbook, if you can’t put those theoretical ideas into practice, then what’s the point? Being deeply embedded within the community has aided in my understanding of the real life experiences the community members endure daily, helping us as occupational therapists provide holistic assessment and intervention in an environment that is familiar to the client. Although I still have a lot to learn, I feel as if this block has revealed to me the importance of integrating theory into practice appropriately, allowing me to have a more mature lens of both my personal and professional life.

Figure 4. Quote by Albert Einstein on the true value of practice

(AZ quotes, 2017)

In addition to the previous point, another personal lesson I’ve learnt during this community experience is that mistakes are only proof that you are trying, so try not to take it too personally. It is vital to learn to take the criticism you receive from your superior, and turn it into constructive criticism, learn from it, and then move on (don’t dwell on it!). The last personal lesson I’ve had to learn throughout this block, and trust me this was a difficult one, is do not fall into the imposter syndrome trap! It is so easy to become flooded with those feelings of self-doubt and neuroticism, however we need to learn to believe in and love ourselves and recognise that nobody in life is perfect.

Although there are endless lessons I have learnt from this phenomenal experience over the past few weeks, the above are just a few of the most treasured ones to me, ones that have equipped me for and will stick with me not only throughout my community service, but throughout my career and personal life too.

So, to anyone reading this considering studying occupational therapy, about to go on fieldwork, or any community-based health worker; don’t forget to be compassionate, creative and charming! My handover to you is to just be your authentic self, never undermine the value of self-reflection, and always remember that it could be a 10-minute consultation to you, however a life changing experience for the client!

In conclusion, the bottom line is; don’t underestimate how much personal growth you are capable of in a mere 22 days. Don’t underestimate how much you can learn about your own profession in 3.5 weeks. And don’t underestimate how many lives you can change in just 552 hours.

References

American Psychological Association. (2023). APA Dictionary of Psychology. American Psychological Association. https://dictionary.apa.org/medical-model

AZ Quotes. (2017). [Photograph]. Top 25 theory and practice quotes: A-Z quotes. AZ Quotes. https://www.azquotes.com/quotes/topics/theory-and-practice.html

Frida Howard Coaching (2019, September 21). [Photograph]. 15 quotes to boost your self-confidence. Frida Howard Coaching. https://fridahoward.com/self-confidence-quotes-for-girls/

Hogan, A. J. (2019, January 7). Social and medical models of disability and Mental Health: Evolution and Renewal. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312522/

NeuroDiverCity. (2017). [Photograph]. Medical & social models of disability. https://www.neurodivercitysg.com/medical-model-vs-social-model.html

[the-ot-diaries]

Let's GOal!

17 goals, 169 targets (Shapovalova et al., 2015). The Sustainable Development Goals (SDG’s) were adopted by the United Nations in 2015. A call to action to eradicate poverty, protect our beloved planet, and make sure that by 2030, every human being is enjoying peace and prosperity (United Nations Development Programme, 2022).

Figure 1. Summary of the 17 Sustainable Development Goals

(United Nations, 2015)

According to the UNECE 2022 SDG progress report, the region is on track to achieve only 26 out of 169 SDG targets (UNECE, 2022). Despite the future not looking too bright for the achievement of these goals by 2030, as community healthcare workers, we should still strive to make as much as a difference as we possibly can. After reading this, one should have a better understanding of some of the SDG’s and what they are, as well as how they are currently being integrated into and worked towards in community practice within the South African context, more specifically within the KwaZulu Natal communities of Kenville and Mariannridge.

Figure 2. Only 26 targets are on track to being achieved, for 64 targets progress needs to be accelerated, and 15 target current trends need to be reversed.

(UNECE, 2022)

First and foremost, the goal that screams healthcare; goal 3. This goal centres around ensuring healthy lives and promoting well-being for all, at all ages (United Nations, 2015). This goal aims to address major health priorities, such as maternal, newborn, child, and adolescent health, communicable and non-communicable diseases (UNICEF, 2021). With this being said, this goal will be worked towards in the Kenville and Mariannridge communities, through regular health promotive talks at the clinics in these communities, spreading awareness about pertinent issues in our modern society, such as maternal health. This goal will further be worked towards within these communities, through providing rich education to the clients we see, on topics such as HIV, improving the disease awareness and insight in the community. Working towards these goals, day by day, targets such as reducing the global maternal mortality rate to less than 70 per 10 000 live births (United Nations, 2015) will slowly be contributed to and hopefully become a reality by 2030. This will ensure people lead healthy, balanced lifestyle, increasing their quality of life.

Goal 4; ensuring inclusive and quality education and promoting lifelong learning opportunities for all (United Nations, 2015). At first, I thought to myself that occupational therapy had zero affiliation with this goal. However, I soon realised that education doesn’t have to involve sitting in a classroom, or in a lecture hall getting taught by a qualified professional. Education has no bounds; it could include that elderly man you spoke to for 10-minutes during health promotion about the pain in his back and how to manage it, that 5-minute conversation you had with that mother in passing about the importance of sensory stimulation for her toddler. This has enriched my view of my profession. Without even being conscious of it, we are working towards goal number 4, through daily conversations with people in need. Additionally, target 4.4 is also relevant is this context, as it speaks to increasing the number of youth and adults who have skills for employment, decent jobs, and entrepreneurship (United Nations, 2015). This is being worked towards through the upskilling of the residents of Kenville community, through a skills training course, such as panel beating. The aims of this are to increase their employability, allowing them to go out and obtain work, as well as to inspire entrepreneurship within the community itself.

The next goal being worked towards within the current community settings, is SDG 5; achieve gender quality and empower all women and girls. This includes ending all forms of discrimination against both women and girls, enabling the empowerment of all women and girls at all levels (United Nations, 2015). In the current community setting, this goal is being worked towards through women empowerment projects, both at Kenville and Mariannridge, where unemployed women are being employed by the University of KwaZulu Natal (UKZN) 4th year Occupational Therapy students, to sell second hand clothes and make some money for themselves. Within the 3 weeks I’ve spent within these communities, these projects have provided me with rich growth as an individual, as they have made me see things through a richer community-based lens and made me realise how powerful initiatives that seem so small can be so massive for an unemployed women, making me even more grateful to be a women myself.

Figure 3. Thought provoking quote on the oppression of women.

(Quotes Gram, 2021)

This further leads to the work being done towards goal 8, which includes promoting sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all (United Nations, 2015). In the current communities, we are indirectly working towards target 8.6, which is reducing the proportion of youth not in employment, education, or training (United Nations, 2015). In addition to the vocational skills project mentioned above, which will aid in reducing the number of unemployed people, we are further contributing towards this target through the work done at the primary schools and high schools in both the Kenville and Mariannridge communities. Within the primary schools, this is being done through helping these learners with their difficulties, such as in reading or writing, to allow them to grow and learn comfortably in class. Furthermore, educating the high school learners about study skills, study methods, as well as the importance of attending school. This will allow for these learners to finish school with the skills, knowledge, and capabilities to go out and find employment, reducing the proportion of youth not in employment, education, or training.

Figure 4. The alarming unemployment rate of men and women as of quarter 2 of 2022.

(Stats SA, 2022)

Lastly, but certainly not least; goal 10. Reducing inequality within and amongst countries (United Nations, 2015). The target that truly speaks to the work of occupational therapy in the community context is 10.2; to empower and promote the social, economic, and political inclusion of all people, irrespective of their age, sex, disability, race, ethnicity, origin, religion, or economic status (United Nations, 2015). Although this may not seem as clear as the other goals mentioned above, this is undeniably a goal being worked towards. Through providing the basic service of OT at the clinic, as well as to all the other people we work with in these communities. Through teaching people new skills, whether it’s a Cerebrovascular Accident (CVA) client to put on a shirt using the hemiplegic method, or upskilling the residents in sewing, we are helping them live meaningful, occupationally balanced lifestyles. In turn, this empowers them to be better people in society, creating a society of substantive inclusion for all members of the communities. Through practice-based evidence, I have realised that I don't want to be that OT that stops talking to a potential client the minute they say they're coping. I don't want to be that OT who does a baseline assessment and charges a fortune. I want to be that OT who is able to spread my knowledge of my profession far and wide, through delving deeper into the client's health and well-being, providing them with a basic service that they deserve, unlike at some government facilities in our country - contributing towards reducing the inequality and injustices in the public healthcare system.

It is evident from the above, that whether beknown or unbeknownst to us, we are in fact making valuable contributions towards SDG’s, particularly goal 3, 4, 5, 8 and 10. My challenge for OT’s in community practice is to make a conscious effort to contribute towards these goals, to break the barriers of the exclusive and oppressive societies we work in. No matter how big or how small, to make a difference in creating a better life for yourself and those around you. Because, you never know, your 7-week contribution could increase the goals being on track to being achieved from 27 to 28. Let’s do this!

References

Quotes Gram. (2021). [Photograph] Retrieved May 4, 2023, from https://quotesgram.com/quotes-on-oppression-of-woman/

Statistics South Africa. (2022). Nearly half of SA women are out of the labour force in Q2: 2022. Statssa.gov.za. Retrieved May 4, 2023, from https://www.statssa.gov.za/?p=15668

Shapovalova , N. de F., Meguid , T., & Campbell , J. (2015, March 11). Health-care workers as agents of Sustainable Development. Retrieved May 3, 2023, from https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70104-X/fulltext

UNECE. (2022, March 25). Halfway to 2030: UNECE report shows we must accelerate progress to achieve sdgs in the region. UNECE. Retrieved May 4, 2023, from https://unece.org/statistics/press/halfway-2030-unece-report-shows-we-must-accelerate-progress-achieve-sdgs-region

UNECE. (2022). [Photograph]. Progress in the UNECE region. UNECE. Retrieved May 4, 2023, from https://w3.unece.org/sdg2022/progress-assessment.html

UNICEF. (2021, July 20). SDG goal 3: Good health and well-being. UNICEF DATA. Retrieved May 4, 2023, from https://data.unicef.org/sdgs/goal-3-good-health-wellbeing/

United Nations Development Programme. (2022). Sustainable development goals: United Nations Development Programme. UNDP. Retrieved May 2, 2023, from https://www.undp.org/sustainable-development-goals

United Nations. (2022). The 17 goals | sustainable development. United Nations. Retrieved May 2, 2023, from https://sdgs.un.org/goals

United Nations. (2015). [Photograph]. United Nations. Retrieved May 2, 2023, from https://www.un.org/development/desa/disabilities/envision2030.html

United Nations. (2015). The 2030 agenda for sustainable development. United Nations. Retrieved May 2, 2023, from https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdf

[the-ot-diaries]

Light at the end of the injustice tunnel

Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane – Dr. Martin Luther King Jr. (Zabel and Stevens, 2006). A profound statement, yet so relevant in the South African context. Unequal distribution of healthcare workers such as occupational therapists, a shortage of human resources, and a lack of education and skills are only a handful of many, many contributing factors to the injustices of the South African healthcare system.

Figure 1. Quote by Dr. Martin Luther King Jr.

(Lockhart, 2021)

The mal distribution of occupational therapists between the private and public sectors of healthcare acts as an injustice to the public healthcare system. Most of the occupational therapy workforce are located in the more densely populated and urbanised provinces within South Africa, such as Gauteng (Ned et al., 2020).

Figure 2. Percentage of occupational therapists working in the public and private sectors in South Africa

(Ned et al., 2020)

This leads to very limited healthcare professionals, such as occupational therapists, in rural areas, leading to physical and mental exhaustion due to a lower number of healthcare professionals having to attend to a higher number of clients. Thus, resulting in ineffective and inefficient healthcare services in these rural areas, causing an even further injustice to the clients in dire need of quality healthcare. Recent practice-based evidence from the current community setting of Kenville, portrays this significantly, where a lady trying to assist a child was turned away from a well-known hospital in KwaZulu Natal, due to not having a Road To Health chart. Before this block, I would’ve comfortably said that this was due to poor work ethic or lack of education, however I have realised that it may very well be due to the burden of these healthcare workers having a client volume far beyond their capacity, leading to this lady receiving inefficient healthcare. Occupational therapy graduates were less likely to select rural placements to work in, due to a lack of understanding of what to expect, how occupational therapy is applied to the rural setting, therefore having concerns about being unprepared and unskilled to work in a rural setting (Maseko et al., 2014). Taking this into account, as occupational therapists, we need to be advocates for our profession and increase the exposure of occupational therapy students to rural areas in the public sector, not just in their final year of studies. This will ensure the equipping of the necessary skills, knowledge, and resources of working in a rural setting, increasing the number of occupational therapists working in these settings and slowly dismantling the injustice of unequal distribution.

This leads to the next injustice in the public healthcare system; a shortage of human resources. The World Federation of Occupational Therapists (WFOT) proclaims that the minimum number of occupational therapists should be 750 per one million population, and data collected from 71 countries worldwide in 2018 shows that the current ratio is 89.7 occupational therapists per one million population in South Africa (Ned et al., 2020). For more information about the current OT statistics, please visit https://www.wfot.org/. Considering the increasing burden of disease in South Africa, this factor causes the healthcare receivers to face an even greater injustice, as the quality of the healthcare they receive is inadequate, particularly in rural settings. This injustice is further worsened by local political issues within the smaller communities, such as authorities purposefully employing less workers, in order for them to all receive higher salaries.

Figure 3. Long queues at public health facilities in Cape Town due to staff shortages

(Mlamla, 2021)

In terms of a way forward in this regard for the occupational therapy profession, education needs to be utilised as a tool, to educate the people of South Africa; including increasing the awareness of the scope and role of Occupational Therapy, such as in high schools and local communities, striving to increase their understandings of the profession. Additionally, approaching local community authorities, such as in the Kenville Community in KwaZulu Natal, who currently have no permanent OT, and educating them about the benefits of occupational therapy services. This may result in the permanent employment of an Occupational Therapist in the community, combatting the injustice of human resource shortages.

Last, but certainly not least, a lack of proper education and training within the multidisciplinary teams also leads to healthcare injustices in South Africa. Education is supposed to be a central tool of public health (Hahn and Truman, 2015), yet there are many healthcare workers lacking the necessary skills and knowledge. This results in an injustice to healthcare receivers, as they are not receiving treatment at an adequate level, due to the lack of education, knowledge, and skills. Politics also play a role in this matter, as the corruption in the recruitment and promotion of workers in healthcare has a negative impact on the poorest and most vulnerable members of society (Kirya, 2020), where healthcare workers are only put in positions due to “knowing the right people”, and not due to their official qualifications. This also leads to injustice as due to the lack of education, the necessary referrals aren’t made to fellow healthcare professions, such as Occupational Therapy, leading to client’s not getting the necessary treatment for their conditions. As a profession going forward, it is vital that we centralise the upskilling of healthcare professionals, such as nursing staff, through educating them, increasing the awareness of the profession, and increasing the number of referrals made to Occupational Therapy. Through this, healthcare receivers will receive necessary and appropriate healthcare, dismantling the injustice of a lack of proper education and training.

Despite the injustices our healthcare profession is currently facing, of an unequal distribution of workers, a human resource shortage, and a lack of education and training, there is indeed light amidst the darkness. Exposing students to the rural communities at an earlier stage, using education as a central tool in our profession, and centralising the upskilling of healthcare professionals, will ensure that the future remains bright for the occupational therapy profession.

I leave you with the wise, profound words of Frank Kronenberg; “Those who have intergenerationally experienced having being treated as less than human should take the lead” (mOTivate OTs, 2022), meaning that those who have personally experienced these injustices are vital in ensuring the dismantling of these injustices, ensuring light at the end of the injustice tunnel.

References

Hahn, R. A., & Truman, B. I. (2015, December 25). Education improves public health and promotes health equity. International journal of health services : planning, administration, evaluation. Retrieved April 27, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691207/

Kirya, M. T. (2020). Promoting anti-corruption, transparency and accountability in the recruitment and promotion of health workers to safeguard health outcomes. Global health action. Retrieved April 28, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170355/

Lockhart, S. (2021). [Photograph]. Sutter Health. https://vitals.sutterhealth.org/healthcare-systems-goal-fulfill-mlks-health-equity-ideal/

Maseko, L. J., Erasmus, A., Di Rago, T., Hooper, J., & O'Reilly, J. (2014, January). Factors that influence choice of placement for community service among occupational therapists in South Africa. South African Journal of Occupational Therapy. Retrieved April 27, 2023, from http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100008

Mlamla, S. (2021, December 3). The queue outside Delft Community Health Clinic where people are gathering in tight-knit crowds, creating a perfect opportunity for the coronavirus to spread [Photograph]. Independent online. https://www.iol.co.za/capeargus/news/patients-demand-action-over-the-long-queues-at-day-hospitals-and-clinics-in-cape-town-ce32c9fb-3c27-4a10-b0b7-845b8493653b

mOTivate OTs. (2022, July 28). The Idea of Occupational Therapy is too Radical and Powerful to be Contained by a Profession [Video]. YouTube. https://www.youtube.com/watch?v=yZXmsDfOI0I

Ned, L., Tiwari, R., Buchanan, H., Van Niekerk, L., Sherry, K., & Chikte, U. (2020, March 20). Changing demographic trends among South African occupational therapists: 2002 to 2018 - human resources for health. BioMed Central. Retrieved April 26, 2023, from https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-020-0464-3

Ned, L., Tiwari, R., Buchanan, H., Van Niekerk, L., Sherry, K., & Chikte, U. (2020, March 20). Percentage distribution of occupational therapists employed in the public and private sectors by province [Photograph]. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083000/#:~:text=Nationally%2C%2074.8%25%20of%20occupational%20therapists,for%2084%25%20of%20the%20population.

Zabel, M. R., & Stevens, D. P. (2006, June). What happens to health care quality when the patient pays? Quality & safety in health care. Retrieved April 26, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464852/

[the-ot-diaries]

Nurturers, resilient, givers of life. Pure, future leaders, innocent. Words often used to describe women and children respectively. However, in the same breath, both parties; vulnerable, victims, violated. In this blog, the concept of maternal health will be discussed, some maternal health challenges, the importance of women and children in society, as well as the implications this has on the practice of occupational therapy.

Maternal health is the status of women’s health during pregnancy, childbirth and during the postpartum period (WHO, 2023). This refers to all aspects of a women’s life, including her physical, emotional, psychological, and spiritual state. If a mother isn’t healthy in a certain aspect of her life, the chances are high that her baby will not be healthy either. Maternal and child health is important to society as their personal wellbeing determines that of the generations to come.

Every day in 2020, approximately 800 women died from preventable causes related to pregnancy and childbirth (WHO, 2023). There are many, many challenges that mothers-to-be and mothers face, but two major challenges to general health and maternity care include a lack of resources and the HIV infection epidemic (Mhlanga, 2008). Many women are put at a disadvantage and risk during pregnancies, due to not having access to necessary resources, such as adequate infrastructure, and poorly trained healthcare professionals. This leads to a low quality of care during one of the most vital periods of their lives, leaving them at risk for developing complications, such as maternal bleeding and infections. Secondly, maternal HIV is closely linked to adverse pregnancy outcomes such as low birth weight and postpartum mortality (Twabi et al., 2020). However, can you blame these mothers? No access to healthcare, no education on mother-to-child transmission, stricken poverty, a fractured public health system...

Source: https://www.sapromo.com/news/sas-public-health-system-is-in-crisis-because-of-negligence-corruption-and-mismanagement/

As I stand here and watch the female street vendor in the Mariannridge community, breastfeeding her baby in the one hand, and selling packets of chips to a customer with the other, I have a revelation about the importance of women in society. Why are we failing to see the integral value women and children have in our society? Women make up an integral part of society, naturally taking on the responsibility of caring for their children, and still trying to make a living on top of that. Hidden beneath her smile, that mother may be taking strain at home. That mother may be finding it difficult adapting to her role of being a new mother. That mother may be lacking the motivation to work every day. However, she paints a smile on her face, is resilient and gets the job done, because that’s what women do.

Source: https://www.afro.who.int/publications/report-addressing-challenge-womens-health-africa

Due to what we already know about the high mortality rates of women during pregnancy and childbirth, this has implications on the practice of occupational therapy. Good child health begins in early pregnancy; enhancing maternal health, screening, and treating conditions that are likely to affect the development of the foetus (Mhlanga, 2008). This means that as occupational therapists, we need to forefront education in ALL stages of motherhood and pregnancy, making health promotion a key aspect of our practice, especially within the communities, such as Kenville, where there are inadequate resources. Educating mothers on the expectations and potential complications of pregnancy, as well as the physical, emotional, and psychosocial demands that motherhood brings, can aid in spreading awareness about these matters, and in turn reduce the mortality rates of women. Aside from education, as OT’s we are also concerned about people’s roles. This means that as OT’s, we also need to prepare mothers for this transition into a new role of being a mother and caring for her infant, but also herself. Looking at it on a community level, such as in the community of Mariannridge, weekly groups can be done with pregnant women, as well as postpartum women, providing them with the physical, emotional, and psychological support structure they deserve. Mothers should also be encouraged to join organisations or utilise the resources available to them in order to surround themselves with a support structure, such as the Families South Africa, a counselling agency. There is also an NPO called Mums Support Network, who aim to provide a safe space for mothers to connect with other mothers. For more information visit https://www.mumsupport.co.za/

Source https://bettercare.co.za/maternal-mental-health/08-resources.html#4-resources-for-pregnant-women-and-new-mothers

Unfortunately, we cannot control the healthcare system and the challenges thereof, however we can control the effect that we, as occupational therapists, have on these women. Are we going to continue to let 800 women die daily from preventable causes of pregnancy and childbirth?

REFERENCES

Bettercare. (2023). 8. resources. 8. Resources – Maternal Mental Health. Retrieved April 21, 2023, from https://bettercare.co.za/maternal-mental-health/08-resources.html#4-resources-for-pregnant-women-and-new-mothers

Mhlanga, R. E. (2008). Understanding poverty: Causes, effects and characteristics. Retrieved April 20, 2023, from https://journals.co.za/doi/epdf/10.10520/EJC164841

Twabi, H. S., Manda, S. O., & Small, D. S. (2020, June 22). Assessing the effects of maternal HIV infection on pregnancy outcomes using cross-sectional data in Malawi - BMC Public Health. BioMed Central. Retrieved April 20, 2023, from https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09046-0

Walker, J. (2018, October 19). SA's public health system is in crisis because of negligence, corruption, and mismanagement. South African Magazine - SA PROMO. Retrieved April 21, 2023, from https://www.sapromo.com/news/sas-public-health-system-is-in-crisis-because-of-negligence-corruption-and-mismanagement/

World Health Organisation. (2019). Pregnancy-related deaths. Centers for Disease Control and Prevention. Retrieved April 20, 2023, from https://www.cdc.gov/vitalsigns/maternal-deaths/index.html

World Health Organization. (2023). Maternal mortality. World Health Organization. Retrieved April 19, 2023, from https://www.who.int/news-room/fact-sheets/detail/maternal-mortality#:~:text=Every%20day%20in%202020%2C%20almost,dropped%20by%20about%2034%25%20worldwide.

World Health Organisation. (2012). Report of the commission on women’s health in the African region. Retrieved April 19, 2023,  from https://www.afro.who.int/publications/report-addressing-challenge-womens-health-africa

[the-ot-diaries]

Advice to my future self as a person and as an Occupational Therapist

Let’s talk about this precious gift known as “life”. In many ways, life is like a river. Powerful, wild, and sometimes full of surprises. Consisting of ups, downs, and many obstacles along the way. Along it’s path, it meets a few changes that shift its course – storms, shallow water, rocks, waterfalls, to name a few. However, an urge to meet that final destination.

Conveniently, there is a model used in Occupational Therapy that uses a metaphor of a river to depict one’s life journey; The Kawa Model. This model has four components: the water in a river, riverbanks, rocks, and driftwood (My OT Spot, 2022). Firstly, the water in the river represents the person’s life flow or energy. This component affects all elements and structures of the river, and the weakening of this results in a state of disharmony and the person being unwell. The riverbanks represent a person’s environment, determining the boundaries, the shape, and the flow of the river. This is representative of the physical and social environment of the person, consisting of the objects or people that make them who they are. Thirdly, the rocks depict the problematic life circumstances, that may be difficult to remove. These rocks can come in all shapes and sizes and obstruct the flow of the river. The driftwood represents the personal assets and can either positively or negatively affect life circumstances. These may be used to move the rocks out the water, increasing the flow of the water, restoring harmony in the person’s life.

Using this model, I will share some advice I have for my future self as a person, as well as an Occupational Therapy professional.

To be honest, it is only in the last 3 years that I have come to realise the true value of life. If you had spoken to me more than 3 years ago, you would have probably gotten a shallow, half-hearted answer about how life is important, blah blah blah. But wow has my perspective changed. The past 3 years has really taught me the true delicacy of life and how to cherish those most important to you.

My first piece of advice for my future self is that no rock is ever too big. When first presented to you, this rock may seem like a mountain, but in actual fact, you can overcome anything you put your mind to! Secondly, don’t ever let your river stop flowing. Even if some days have a weaker flow than others, make sure you always remain positive and keep your river flowing, to increase the quality of your life.

To my future OT self, you’ve got this! A piece of advice I have to my future self as an OT is the importance of maintaining a balance in your life. Although your river may be flowing quickly and productively, your riverbed may be stable, and you may have lots of driftwood in your river – don’t forget to set time aside for yourself, refocus, and spend time with those you love. Secondly, make sure you have big, valuable driftwood in your river! The most important driftwood being your personal character and values – amidst the hustle and bustle of your future professional life, never lose who you are and what you stand for. Always make sure your driftwood positively affects your river flow and zest for life. Lastly, don’t be afraid to ask for help!! Within your riverbed are those people in your life, who help you with your boundaries, determining the flow of your river. Don’t be scared to ask those around you for help, whether it be colleagues, family, or friends – this will strengthen the soil in your riverbed and keep that river flowing smoothly and graciously.

To end off, two words that I want to remind myself to live by, both personally and professionally, is tenacity and persistence. Without this, you will find yourself experiencing many rocks, limited driftwood, and an unproductive flow.

Keep going, you’ve got this!

References:

Brittany Ferri, O. (2021, June 04). Using the Kawa model in occupational therapy. Retrieved October 30, 2022, from https://www.myotspot.com/kawa-model/

Conceptual Frameworks. (n.d.). Retrieved October 30, 2022, from https://vula.uct.ac.za/access/content/group/9c29ba04-b1ee-49b9-8c85-9a468b556ce2/Framework_2/lecture5.htm

[the-ot-diaries]

Occupational Barriers in Mental Health in SA

Imagine. Imagine being disowned by family members or work colleagues because of something out of your control. Imagine being told you can’t get see the necessary health professionals because you don’t have money and it’s “not in the countries budget”. Imagine staying indoors day in, and day out, because you’re not seen as a “normal” person. Scary thoughts, yet a daunting reality for many South Africans with mental health conditions.

Just last week we celebrated World Mental Health Day. To raise awareness about various mental health conditions globally. Yet the question remains, why is there still such a stigma around mental health, especially in South Africa?

According to the South African Depression and Anxiety Group (SADAG), 1 in 3 South Africans will or do have a mental health issue at some point in their lifetime. SADAG also states that as many as six South Africans suffer from anxiety, depression, or substance-use problems. As of March 18, 2022, South Africa has been identified as the lowest-ranked country based on mental wellbeing, on the Mental State of the World Report. Scary, isn’t it?

A common occupational barrier to mental health in South Africa is occupational marginalisation. This occurs when people attempting to participate in occupations are not allowed to, lacking the power for occupational choice, due to being stigmatised by their age, sex, race, illness, or disability (Taylor and Francis Online, 2020). Stigmas surrounding mental health pose as a major stumbling block when it comes to treating mental health conditions in South Africa. In Zulu, there isn’t even an official word for depression, it is not even seen as a “real” illness in the African culture. Sufferers of this condition are afraid of being discriminated against, disowned by their families, or fired from work. Due to there often being absent physical symptoms with mental illness, some family members consider it a “figment of the imagination”. Some families or workplaces may disown other family members or employees due to their mental health condition, leading to occupational marginalisation.

Occupational apartheid is when individuals, groups, or communities are deprived of meaningful and purposeful activities, through segregation because of social, political, or economic factors (DBpedia, 2022). South Africa only spends 5% of its total health budget on mental health (William Gumede, 2021), making the less fortunate South Africans worse off when it comes to accessing mental health care, due to them not being able to afford mental health care services. This leads to occupational apartheid, as they are being segregated due to their economic status, resulting in disengagement in meaningful activities (e.g., work), as they cannot get the treatment/medication they need to cope.

Occupational imbalance occurs when a person is unoccupied, underoccupied, or over occupied. It is the loss of a balance of engagement in occupations and affects health and well-being of a person (Physical Therapy and Rehabilitation Journal, 2013). Research has shown that people with mental illness are at risk for occupational imbalance (BMC Psychology, 2019). To put it in context, a person with a mental illness, such as major depressive disorder, may lose interest or pleasure in meaningful activities. This, along with other signs and symptoms of their condition, may cause them to stop working, stop spending time with friends, and following leisure pursuits, resulting in an occupational imbalance, as they may isolate themselves, and lead a sedentary lifestyle. This ultimately leads to their condition worsening, a never-ending cycle of depression. Has it hit home yet?

The Person-Environment-Occupation Model is a theory stating that the interaction of the person, environment, and occupation facilitates engagement. A good fit between these factors, results in meaningful participation increasing. On the other hand, a poor fit can threaten occupational engagement or performance. Using the PEO model to put the above into perspective, people with mental health issues may have impaired occupational performance, due to their occupational imbalance, occupational marginalisation, and occupational apartheid. Thus, their environment may be negatively affected, as their mental health condition may result in them staying at home, neglecting the areas of work or school. Additionally, their personal sphere may also be affected, as they may present with a decreased self-esteem, low mood, and a poor volition to complete tasks, to name a few. This results in a poor fit between the person, environment, and occupation, resulting in poor occupational performance and engagement.

Speaking on a more personal level, I have not experienced any occupational barriers myself. However, a client I have seen have experienced being disowned by their families due to their mental health status, as well as a client being denied mental health services due to their socioeconomic status. At first, I did not think too much about it, however looking back, these client’s did not deserve this treatment, and have equal rights as a mental health care user.

Imagine. Imagine a South Africa where there was no stigma attached to mental health conditions. Imagine a country where everyone was accepted, regardless of their mental health status. But unfortunately, there’s still a lot of work to do until we reach this. So many South Africans are still facing the hurdles of occupational barriers due to their mental health conditions. Together, we can do better. Together, we can create a better South Africa. Together, we can.

References

(2022). Retrieved 16 October 2022, from https://health-e.org.za/2022/03/18/mental-wellbeing-sa-hits-rock-bottom-on-global-list/

(2022). Retrieved 16 October 2022, from https://www.sacap.edu.za/blog/management-leadership/mental-health-south-africa/

(2022). Retrieved 16 October 2022, from https://www.theothub.com/article/occupational-deprivation

Occupational apartheid. (2022). Retrieved 16 October 2022, from https://dbpedia.org/page/Occupational_apartheid

Social participation of seniors: Applying the Framework of Occupational Justice for healthy ageing and a new approach to policymaking. (2022). Retrieved 16 October 2022, from https://www.tandfonline.com/doi/full/10.1080/14427591.2020.1843069

The University of the Witwatersrand, J. (2022). 2021-10 - Untreated mental illnesses impact SA's economy, social and family stability - Wits University. Retrieved 16 October 2022, from https://www.wits.ac.za/news/latest-news/opinion/2021/2021-10/untreated-mental-illnesses-impact-sas-economy-social-and-family-stability.html

User, S. (2022). South African Depression and Anxiety Group. Retrieved 16 October 2022, from https://www.sadag.org/index.php?option=com_content&view=article&id=3197:world-mental-health-day-10-october-2021&catid=149&Itemid=132

[the-ot-diaries]

COVID-19 - trick or treat?

31 December 2019. The day that will go down in history. The first ever reported COVID-19 case. Yet the question remains 2 and a half years later – has this been a blessing in disguise for people’s mental health? Or not so much?

In the ever-growing field of Occupational Therapy, The Model of Human Occupations (MOHO) developed by Dr Gary Kielhofner, is a model that describes how humans generate and modify their occupations in interaction with the environment, which presents a dynamic open cycle system of human actions (The American Journal of Occupational Therapy, 1980).

This occupation-centred model can be applied to the impact of COVID-19 on people's mental health, as it is intended for use with any person experiencing problems in their occupational life. And whether we like to admit it or not, everyone’s occupational life was affected by this pandemic!

Firstly, MOHO states that humans are made up of 3 internal, interrelated subsystems – volition, habituation, and performance capacity. These can either be enablers or barriers to occupational performance, and a change in one variable will result in a change in one's motivation, behaviour, and performance (since we are open systems).

Volition – this refers to how people are motivated and make choices regarding their daily activities, regarding values, interests, and personal causation. Due to having to stay at home, a person’s internal drive and motivation to participate in everyday activities were affected, as many weren’t able to go out into the world and fulfil their occupations, such as go to work. According to the MOHO, interests are what a person values and finds enjoyment or satisfaction in doing (Lee & Kielhofner, 2017). According to Head to Health (2019), spending time on activities you’re interested in can improve your mental health and wellbeing. Therefore, through people not performing these interests due to COVID-19 and lockdown, this led to a decline in mental health and wellbeing, leading to feelings of incompetence.

Recurring patterns of occupational performance leads to habituation - leading to routines, creating a predictable daily pattern. However, due to COVID-19, these routines were disrupted. People were no longer able to go to the shops, gym etc. and fulfil their daily routines, leading to increased levels of anxiety due to a dark, unknown future. When the dreadful COVID-19 happened, these habits became non-existent. Think about it for a second. You get into the habit of going to university/work) every day from 8am-3pm. Every day, you follow a routine of waking up, having morning coffee, getting ready, and fulfilling your duties – giving you a purpose and sense of satisfaction in life. And then suddenly you’re forced to stop. Without any notice. Anxious? Afraid? Confused? That’s certainly how I felt. According to Rachel Goldman from NYU School of Medicine, “when people don’t have a routine or structure to their day, it can cause increased stress and anxiety”, inevitably worsening your mental health. When analysing this point, I have come to the realisation that life is unpredictable, which emphasises the importance of being flexible and adaptive to any curve ball that may come your way.

Performance capacity – this is influenced by an individual’s physical and mental abilities, as well as how these are used and experienced. In laymen terms, it is the ability to do perform occupations.  COVID-19 has shifted people’s subjective perception of their physical and mental capacity, due to changes in routine, changes in life roles, and loss of social interactions. According to the World Health Organisation (2022), "a great number of people have reported psychological distress and symptoms of depression, anxiety or post-traumatic stress" since COVID-19. When thinking about this quote, I've realised that COVID-19 has led to a decrease in performance capacity of people, due to an increase in mental health problems. In order to improve on this, changes to volition and habituation are required.

Tying it up, the environment in which people found themselves in also had a role to play in their mental health, more specifically their home environment. On the one hand, some people gained support and positive reinforcement from their environment. On the other hand, some people experienced constraints and negative feedback from their environment at home. For some, it was a family-bonding, rewarding experience. But for others, it was a lonely, abusive, and dark one.

After 2 and a half long years of COVID-19, our lives are slowly returning to normal. When thinking about this at first, I was scared. Anxious about the future, I found myself pondering if I was even ready to go back to how things were 2 and a half years ago. But then, I realised that things will never be the same again, WE must create a “new normal”. New norms need to be set, and people need to adjusted to a new way of living.

After some deep thought, I have realised that in some ways COVID-19 could be seen as a blessing in disguise, other times it could be seen as a curse. The truth is, COVID-19 has impacted people differently - some positive, some negative.

It all lies in your perception.

References

About the Model of Human Occupation | Kielhofner’s Model of Human Occupation | University of Illinois Chicago. (2022). Retrieved 4 September 2022, from https://moho.ahs.uic.edu/about/

Model of Human Occupations (MOHO) | OT Theory. (2022). Retrieved 4 September 2022, from https://ottheory.com/therapy-model/model-human-occupations-moho

Payal Pawar, O. (2022). Model of Human Occupation (MOHO) Frame of Reference. Retrieved 4 September 2022, from https://occupationaltherapyot.com/model-of-human-occupation-moho-frame-of-reference/

The impact of COVID-19 on mental health cannot be made light of. (2022). Retrieved 4 September 2022, from https://www.who.int/news-room/feature-stories/detail/the-impact-of-covid-19-on-mental-health-cannot-be-made-light-of#:~:text=Plenty%20of%20us%20became%20more,anxiety%20or%20post%2Dtraumatic%20stress.

The Importance of Maintaining Structure and Routine During Stressful Times. (2022). Retrieved 4 September 2022, from https://www.verywellmind.com/the-importance-of-keeping-a-routine-during-stressful-times-4802638

[the-ot-diaries]

Finding My Way

As I stand here at the top of the Valley of a Thousand Hills, arriving at my second and last fieldwork block for third year, I stop and reflect on my journey thus far.

I gaze behind me at the long, steep hill I’ve just climbed, and cannot help but feel proud of how far I’ve come. I stare deeply into the midst of the valley and notice how some parts are rough and some are smooth, just like my journey so far. Some days have been good, positive, and productive, others have been tough, stressful, and dark. The houses alongside the dirt path, a symbol of all the people who support, love, and ground me. Like these houses, these people nourish, comfort, and provide me with safety. I see cows roaming around the streets along the way, making cars stop in their tracks – which reminds me of all the obstacles I’ve faced throughout this course so far, that have stopped me in my tracks; COVID, fieldwork, online learning, the riots – you name it. However, these cars seem to find a way around the cows, just like I found a way to overcome my obstacles. I see the Umgeni River down below flowing rapidly, like my determination, resiliently flowing against the upstream - a pure representation of my ever-growing passion for the field of OT.

I must admit, at the beginning of this OT journey, I had a very basic and shallow understanding of what OT was. I thought “occupation” just meant someone’s work, and that OT’s mainly work with children who have learning and writing difficulties. Looking back three years later, I was so wrong! I now have a deeper and fuller understanding of what OT is, what we do and how rewarding it is. Despite the rocky terrain and slippery slopes, there has been so much reward and growth for me. In the wise words of Rachel Thibeault, “we don’t fix people, you see: with them, we simply try to find a way to meaning, balance, and justice”. This quote encapsulates why I am studying OT.

Shifting my gaze from behind to what lies in front of me, yet another mountain. Another steep, rocky path, symbolising the remainder of this degree. An area of untouched beauty, waiting to be explored. Knowledge and information waiting to be learnt, relationships waiting to be made and memories to be cherished – this mountain climb will shape the future OT I am going to be. From the end of this mountain range, I do see obstacles blocking my destination, however I’m not feeling deterred. Rather, I feel excited about the climb and what the future mountains contain.

The famous singer Miley Cyrus once said in her lyrics; “there’s always gonna be another mountain, I’m always going to want to make it move”, and this is my inspiration with my future journey in OT. She emphasises the fact that there will always be mountains, and sometimes you will lose, but it’s all about “the climb”. It isn’t always about reaching the top of the mountain. It’s about the people you meet along the way, the rich knowledge and experiences you have, and the person you grow to become. This really resonates with me and reminds me not to focus so much on the future, but rather about what is happening in the present; the journey.

Over the past three years, I have learnt more about myself than I thought I ever would. I have found a passion for influencing the lives of others and become confident in who I am and what I stand for. Rachael Adams once said, “we cannot become what we want by remaining who we are”, which is spot on. Growth is required to become the person we want to be. How can we expect to grow if we remain in our comfort zones?

I leave you with a quote by Valerie Pena; “Occupational therapy. Hopeless into hope. Can’t into can. Impossible into possible”

Keep growing, keep learning and keep climbing your mountain!

References

14 Quotes to Encourage and Inspire Growth - JOURNEYSTRENGTH. (2022). Retrieved 21 August 2022, from https://journeystrength.com/14-quotes-to-encourage-and-inspire-growth/

Cyrus, M. (2009). The Climb.

Rachel Thibeault Quotes. (2022). Retrieved 21 August 2022, from https://www.goodreads.com/author/quotes/17337856.Rachel_Thibeault

Sarah Stromsdorfer, O. (2022). The 11 Best Occupational Therapy Quotes - myotspot.com. Retrieved 21 August 2022, from https://www.myotspot.com/occupational-therapy-quotes/