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"From Challenges to Connections: My Adventures in the Cato Manor Community"

As I wrap up my journey as a fourth-year Occupational Therapy student in this unique community, I find myself reflecting on everything I have experienced. From the heart-warming moments to the challenging encounters, every piece has contributed to a profound sense of growth both personally and professionally. I have had my fair share of exhilarating highs and some eye-opening lows. From navigating racial slurs hurled my way to feeling the weight of being robbed in broad daylight, these experiences were both challenging and transformative for me.

Understanding the Client-Environment Relationship

When I stepped into the community for the first time, I experienced various emotions, sadness and empathy for the challenges I saw, but also a deep sense of joy. The joy came from knowing that I had the opportunity to work alongside these individuals, in their environment, to make a meaningful impact and difference in their lives.

One of the crucial lessons I learned was about the client-environment relationship, a foundational principle in occupational therapy that is underpinned by Bronfenbrenner’s Ecological Systems Theory. Bronfenbrenner’s ecological systems theory emphasizes that an individual’s development is influenced by a series of interconnected environmental systems, ranging from the immediate surroundings (e.g., family) to broad societal structures (e.g., culture) therefore it is so important that we not only treat the individual but also the environment and external factors that impact the individual. (Guy-Evans, 2024). This is not emphasized enough as many healthcare systems, especially the hospitals that we work in and do our fieldwork practicals tend to stay within the medical model (Jones and Bartlett Publishers, n.d.). Whereas in community practice we adopt a community-driven and holistic approach which is essential for making an impact and achieving lasting change by providing contextually appropriate and realistic intervention plans and recommendations. This shift towards considering the environment is vital, especially in community practice, where resources are scarce and environmental challenges are more pronounced.

Community-Driven Projects and Collaboration

Working within a community requires adaptability and collaboration. I learned that sustainable projects need to be community-driven rather than therapist-driven. A client-centred, community-based approach is essential for long-term success and to ensure the sustainability of projects. According to the World Health Organization (WHO), community participation in projects ensures that the project is more likely to be accepted and maintained (WHO, 2008). By involving community members and the relevant stakeholders in the decision-making processes, we can increase the chances of achieving sustainable outcomes.

During this block, I have also started developing the skill of networking by collaborating with stakeholders and I have learned the importance of collaboration with stakeholders to identify specific needs, especially in the projects that I run in the community. This collaborative approach allows for more holistic and community-centred interventions, benefiting both individuals and the community at large. (Jones and Bartlett Publishers, n.d.).

At Mayville Primary School, occupational therapy students collaborate with the deputy principals and educators to create a learning environment that is conducive, inclusive and supportive of students who require additional support in the classroom. This collaboration enhances community practice by ensuring that educators and OTs are working together toward a common goal which is to ensure that every student has the opportunity to thrive, not just academically, but emotionally and physically as well.

Ensuring the sustainability of our projects, especially since we are the last group of students for the year adds an additional layer of pressure as we have to ensure that the projects that we implemented are sustained until the next block of students arrive next year. Communication is one technique we have used to increase the sustainability of our projects. Regular updates and feedback to stakeholders are essential in maintaining their engagement and ensuring they continue the projects we have started. UCHE et al. (2023) assert that clear, consistent communication is one of the most critical factors for sustaining community development efforts.

Embracing Cultural Diversity

Another significant lesson learned was the need to embrace cultural diversity. Initially, I found it upsetting when community members and patients preferred to speak with my African colleagues. This made me feel excluded, but I soon realized it was an opportunity for growth. By actively listening and engaging in conversations, I noticed a shift: people started making eye contact with me during conversations and even incorporated some English phrases to ensure I understood what they were saying. Cultural competence is an essential skill for healthcare professionals, particularly in diverse cultural settings like Cato Manor (Betancourt et al., 2005). Developing this competence requires not only language skills but also an understanding of cultural values and beliefs that influence treatment and overall therapy outcomes.

Studies highlight that embracing cultural diversity enhances therapeutic relationships and outcomes, as it fosters trust and communication between healthcare providers and community members (Saha, Beach, & Cooper, 2008). This realization has been transformative for me, both personally and professionally. By adopting cultural humility, I’ve learned that inclusivity isn't merely about being present but involves active engagement and respect for different perspectives.

Navigating Resource Constraints and Advocacy

(Making a splint using a dish and hot water:) )

Working in a community setting has also improved my resilience, particularly when faced with resource constraints. The challenges of broken equipment, language barriers, and cultural differences tested my ability to adapt and problem-solve. Resource constraints are common in marginalized communities, and as OT professionals, we often have to advocate for better services and accessibility. According to Schönfeld et al. (2018), healthcare workers in low-resource settings need to develop creative strategies to navigate these limitations. During the past weeks, I had to be creative when planning treatment sessions and problem-solving how to use the resources available in the clinic to meet my therapy aims and to make my sessions therapeutic and meaningful for the patient.

Community practice has also highlighted the necessity of OT's role in advocating for marginalized communities affected by social determinants of health by advocating for better service delivery to improve overall health outcomes. As future occupational therapists, we have a responsibility to promote health equity and work towards addressing these disparities (Whiteford & Townsend, 2011).

As I near the end of my final year as an OT student, I feel more prepared for my upcoming community service. The lessons I have learned during this block have provided me with the tools to navigate different hospital and community settings. Demonstrating cultural humility and competence will be essential in identifying key stakeholders and implementing culturally appropriate interventions in my future practice. Building stronger relationships with the multidisciplinary team (MDT) will be my aim to deliver comprehensive, client-centred care. These past weeks have tested my strength and resilience, but they have also equipped me with the skills and knowledge to truly touch the lives of the people I serve.

As I step into the next phase of my journey, I will carry with me the lessons learned both professionally and personally that will continue to shape my practice as an occupational therapist for years to come.

References

Betancourt, J.R., Green, A.R., Carrillo, J.E., & Ananeh-Firempong, O. (2005). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and healthcare. Public Health Reports, 118(4), 293-302.

Guy-Evans, O. (2024, January 17). Bronfenbrenner’s ecological systems theory. Simply Psychology. https://www.simplypsychology.org/Bronfenbrenner.html

Jones and Bartlett Publishers . (n.d.). Community Practice In Occupational Therapy: What Is It? https://samples.jbpub.com/9780763760656/60656_ch01_doll.pdf

Saha, S., Beach, M.C., & Cooper, L.A. (2008). Patient centeredness, cultural competence and healthcare quality. Journal of the National Medical Association, 100(11), 1275-1285.

Schönfeld, P., Braeckel, S., & Geyer, S. (2018). Healthcare in low-resource environments: Tackling challenges creatively. Health Policy and Planning, 33(1), 88-96.

UCHE, O. A., UZUEGBU, C. N., & UCHE, I. B. (2023). “Strategies that Promote Sustainability of Community Development Projects in Southeast Nigeria.” Transylvanian Review of Administrative Sciences, 68 E, 132–148. https://doi.org/10.24193/tras.68e.8

Whiteford, G., & Townsend, E. (2011). Occupational justice: Bridging theory and practice. Canadian Journal of Occupational Therapy, 78(4), 209-218.

World Health Organization (WHO). (2008). Community participation in local health and care.

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"Thriving Together: Occupational Therapy’s Role in Achieving Sustainable Development Goals for a Better Tomorrow"

As occupational therapists, we stand at the crossroads of hope and action, equipped with the tools to change lives and uplift our communities. We can align our unique skills with the crucial Sustainable Development Goals (SDGs) to achieve transformation within our communities by becoming catalysts for transformation and empowering our communities to become catalysts too. Looking at the SDGs through the lenses of an occupational therapy student working in a community grappling with poverty, hunger and inequality, I realize that there is so much more that we as OTs can do for the community.

SDG 1: No poverty

Poverty is an ongoing vicarious cycle in many communities in KZN. Poverty is not just limited to financial deprivation but encompasses a wide variety of socioeconomic factors like limited access to basic services such as water and sanitation, electricity, waste removal and healthcare services, employment and other equitable opportunities. As I walked through the streets of Cato Manor, there was a putrid smell that filled the air emanating from garbage lying on the side of the road thus highlighting the limitations of waste removal services in the community and this is in accordance with the 60,3% decline in people who had access to waste removal services from 2015 to 2023. (UNDP, 2015).

Poverty often leads to financial stress, which in turn can lead to an increase in crimes such as theft. Growing up in impoverished communities exposes individuals to crime as a normal part of life, significantly influencing their behaviours and choices. Additionally, poverty can result in substance abuse and mental health issues. So as OTs working in these communities, we can partner with local businesses to create mentorship programs to promote vocational skills to empower the youth with practical skills that open doors to employment and constructive use of time. Some of the projects in the Cato Manor Community such as “Mona Lisa” assist learners in developing prevocational skills that they can use to secure job prospects and earn a living to support themselves and their families. This can assist in breaking the cycle of poverty existing in our communities.    

SDG 2 – Zero Hunger

Food insecurity is a major challenge experienced by many households in our communities with limited access to nutritious food often resulting in malnutrition and crippling our communities. According to the Food and Agriculture Organization (FAO) as mentioned in (Stats sa, 2023) world hunger has almost sextupled from 150 million in 2019 to 828 million people in 2021. More than half a million households with children aged five years or younger reported experiencing hunger and 20,1% of these children were from KZN. (Stats sa, 2023). This places these children at a high risk of severe acute malnutrition. However, there are some existing programmes in the community such as Golden Future Preschool and Creche in Cato Crest which offer nutritious meals to the learners to prevent malnutrition which hampers physical and cognitive growth and the soup kitchen which provides meals to the community members. We can also inform our patients of this programme if we see that they are struggling with food security. We as OTs can assist the municipal workers at the soup kitchen by creating sustainable ways to maintain the soup kitchen by creating small gardens in which various vegetables can be grown and harvested to be used in the kitchen for meal preparation to improve the sustainability and longevity of the programme. We can also initiate community garden projects to improve food security in the community and have nutrition education workshops where we can educate families on healthy lifestyles and healthier food choices.

SDG 3 – Good health and well-being

Many people in the community often face limited access to healthcare due to various reasons which results in poor health outcomes. We as OTs can contribute towards this SDG by providing preventive healthcare services which are also in line with the UN’s new goal for worldwide good health (United Nations, 2022). Some of the ways in which we can provide preventive healthcare services include education, health promotion talks, early screening programmes, and the creation of support groups within the community to strengthen support systems and contribute to good overall health and well-being. An example of this is the Philantwana programme. As part of this programme, we screen the children for developmental delays, screen mothers for maternal mental health issues and conduct health promotion talks on various topics including developmental milestones with an overall aim of identifying red flags and providing swift early intervention by referring the children to the clinic for further assessments and treatment. We also do maternal health screening and paediatric screening at the Cato Manor Clinic to screen for any red flags and provide early intervention. Additionally, we are also planning to start a support group for mothers/caregivers of children with special needs to improve their support system and mental health to promote wellbeing.

SDG 4 – Quality education

Education is the key to breaking the cycle of poverty and fostering resilience. When I started my OT journey, I always wanted to work in a school environment and be a school OT however I did not have much exposure to school-based OT, so getting more exposure to the schools in the community was something that I was looking forward to in my community block. In the Cato Crest community, we have been exposed to different schools including creches, primary and high schools and different learning environments. Something that I noticed especially in the primary school and with the learners we work with, is that they are unable to receive the individual support and help that they desperately need in the classroom due to the high student-to-teacher ratio in the classrooms often resulting in them falling behind in class and still being promoted to the next grade resulting in greater problems. A typical example of this is a grade 9 student not being able to read. As OTs, we can aim to support this SDG by working with the educators to identify red flags in the learners and even offer the educators a red flag checklist that they can use to assist them in identifying potential red flags and addressing them with parents to get the learner the help and support that they need.

SDG 5 – Gender equality

Gender equality is not only considered a fundamental human right but also the foundation for a peaceful, prosperous and sustainable world. Despite the progress made over the last decades, gender inequality is still persistent in many communities and stagnates social progress. Sexual violence and exploitation, the unequal division of unpaid care and domestic work, and discrimination in public office, all remain huge barriers to achieving gender equality (United Nations, 2022b). OTs can support this SDG by advocating for policy changes that promote gender equality in the healthcare, education, and employment sectors to ensure that men and women are treated fairly and equally. We can create empowerment programs in the community to empower marginalized women and girls by enhancing their skills and providing access to education, employment, and social participation. We can also create support groups that connect women thus promoting solidarity and shared experiences, which can enhance community resilience.

In conclusion, as we reflect on the various SDGs, it is evident that we as OTs play a vital role in helping communities bridge gaps to meet these goals, one programme at a time, to build a better community.

References

Stats sa . (2023, April 11). Focus on food inadequacy and hunger in south africa in 2021. Statssa.gov.za. https://www.statssa.gov.za/?p=16235

Sustainable Development Goals: Country Report 2023. (2023). https://www.statssa.gov.za/MDG/SDG_Country_report.pdf

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

United Nations. (2022a). Goal 3: Good Health and well-being. The Global Goals. https://www.globalgoals.org/goals/3-good-health-and-well-being/

United Nations. (2022b). United Nations: Gender Equality and women’s Empowerment. Www.un.org; United Nations. https://www.un.org/sustainabledevelopment/gender-equality/#:~:text=Goal%205%3A%20Achieve%20gender%20equality%20and%20empower%20all%20women%20and%20girls&text=Gender%20equality%20is%20not%20only

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“Navigating the OT Maze: My UKZN Journey from Hospital Halls to Community Corners”

As a 4th-year occupational therapy student from UKZN doing my last block, at a community/PHC level, was I prepared enough?  

As I reflect back on my undergraduate years, I feel disheartened. There were many lost opportunities due to the COVID-19 lockdown, from not being able to do dissections due to limited cadavers to limited fieldwork exposure in my first year as an OT student. While current- first-year OT students are given the opportunity to accompany and shadow the 4th year OT students on their community block, this was not an opportunity that I had when I was in 1st year due to lockdown. In 1st year we also did a community studies module and prior to lockdown, the students were taken on field trips into various communities in an attempt to expose health science students to the communities however we were unable to go on these trips due to the lockdown. When lockdown restrictions were eased during my second year, the OT department did not adjust our curriculum to make up for lost experiences and instead when I look back it felt like these crucial learning opportunities were just swept aside, and the gap in our community exposure remained glaring.

For most of my blocks from 2nd year, I was placed in hospitals in which the hospital setting is very different to a PHC clinic setting as you have limited time to assess and treat patients and limited access to resources. The PHC setting requires much more “thinking on the spot” and it is solely based on the “ here and now” which is not emphasized enough in the OT curriculum. We are taught to plan sessions in advance, do an activity analysis of the activity and a session write-up which guides the implementation of our treatment sessions and while this is useful in a hospital setting, it makes it difficult to come up with treatment ideas now suddenly on the spot because we are so used to having a write up that guides our intervention implementation due to the way we were taught. So, while this method is useful in a hospital setting, it is unrealistic at a PHC level. However, I believe that is a skill that I will master with practice, as the saying goes, "practice makes perfect."

In a hospital setting, we also have access to more resources compared to at a PHC level. Thus, at a PHC level, we have to be creative on how to make low-cost assistive devices and other necessary items. In our 1st year, we learnt APT which is a very important skill to know as we can use recyclable materials to make relevant items for therapy, especially in resource-constrained primary health care facilities.  

Despite efforts made to expose us to community practice at a 3rd-year level, it was insufficient because, for my community block in 3rd year, I went to a halfway house rather than being at an actual community and getting actual practical exposure to what community OT is all about. The OT curriculum does not allow for adequate exposure to community practice, which is important because all the patients we see in the hospitals are returning to a community. This limited exposure to community practice also affects our intervention because is it really context-relevant if we do not know and understand the context they are coming from due to our limited exposure to communities?

Suddenly, in your fourth year, you are thrown deep into the community and somehow expected to adjust. Well, lucky for me, I am quite a flexible person and my colleagues on the same block as me who are more familiar with the communities also assist me in understanding the community.

Pros of the UKZN OT curriculum include:

Integration of theory and practicals – After learning the theory in classes through lectures, we get to apply what was learnt by doing case studies, simulated cases and in our fieldwork blocks. This helps us to consolidate the theory learnt by putting it into practice.

Holistic approach – The OT curriculum adopts a holistic approach which teaches students to not only look at and treat the physical needs but also the emotional and social needs that may affect a person’s health and well-being including environmental factors which also aligns with the principles of PHC.

Multidisciplinary approach – The OT curriculum emphasizes the importance of working as part of a multidisciplinary team which is very important especially at a PHC level to maximize the treatment offered to patients within a limited time frame and it ensures person-centred care. The MDT approach is emphasized a lot in PHC and currently, at Cato Manor, I do a lot of joint sessions, with the speech therapist.

Cultural competence – The OT curriculum includes cultural competence and cultural sensitivity within various modules which are important and necessary skills for us to develop as health practitioners working with people from various cultural backgrounds, especially in the community setting. 

Cons of the UKZN OT curriculum include:

Limited exposure to community-based occupational therapy.

Limited focus on resource constraints – Many of us have done blocks at hospitals which had access to resources and materials however at a PHC level, there are significant resource constraints due to limited funds therefore it is essential that students are taught how to adapt and be innovative within these constraints as part of the OT curriculum. According to (Naidoo et al., 2017) many community service OTs also faced challenges due to resource constraints at a PHC level as they completed their undergraduate training at well-resourced hospitals.

Insufficient emphasis on policies and advocacy – The OT curriculum needs to place more emphasis on procedures relating to government departments, new health care policies and procedures for referral within the Department of Health which are practical skills that occupational therapy students and therapists should be aware of especially when working at a PHC level.

Limited knowledge of how to implement health preventive and promotive programmes at a PHC level as the main focus is on remedial and rehabilitative programmes within a hospital setting.

So, was I prepared enough for practice at a community/PHC level? The honest answer is no—I did not feel fully prepared, largely due to limited exposure to community-based OT and perhaps I may never have felt prepared enough however if I had more exposure to community practice, I would have had an idea of what to expect rather than going into the community blindfolded. Overall, the OT curriculum tries to offer a holistic curriculum offering a solid theoretical foundation however students need to be offered more practical experience and exposure, especially in communities to improve preparedness for practice at a community/PHC level.

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From bump to baby: Prioritizing the health and well-being of mothers and their children today in order to build a better tomorrow

“A healthy mother is the foundation of a healthy family and a healthy community” – Anonymous

There is an interdependent relationship between the health of mothers and children that extends beyond the perinatal period, as the health and well-being of the mother inversely affect the health and well-being of the children they care for.

According to (King, Mhlanga, & De Pinho, 2006) strategies to improve maternal health should start even before a woman is pregnant by facilitating women's empowerment by educating young girls in our communities by sending them to school to ensure they receive an education. Another strategy that can be applied in the communities includes ensuring access to contraceptive methods such as condoms and birth control pills and safe abortion to ensure that each pregnancy is planned and wanted which also impacts the maternal mental health and well-being of mothers. Moreover, adequate antenatal care including regular check-ups, prenatal vitamins, and counselling, is also essential for promoting maternal and child health.

Some of the implications that this has on occupational therapy include advocating for the health and well-being of mothers and children which is a basic human right and developing policies that support maternal and child health. We can also develop education programmes and awareness campaigns to improve maternal health by educating pregnant women on healthy pregnancy practices such as proper nutrition and exercise to reduce the risk of complications during birth. We can also screen pregnant women to offer early intervention to women/mothers suffering from mental health conditions such as depression and anxiety. Currently, in the Cato Manor community, we as occupational therapists offer screening to mothers during the post-natal period for their mental health in an attempt to detect red flags to improve their maternal mental health as we believe that their health and well-being affect the health and well-being of their children. However, in addition to this, we can also offer screening to pregnant women in the communities during the perinatal period as it was noted that 1 in 5 women experience a perinatal mental health condition such as depression or anxiety. (Lee-Carbon et al., 2022)

Think of it like this, maternal health is the foundation of a house. Just like a strong foundation supports a stable and sturdy home, good maternal health creates a strong and solid base for a child’s health and well-being. However, if the foundation is weak, it affects the stability of the house. Similarly, when a mother is healthy and well-nourished, her child has a better chance of thriving physically, emotionally and mentally.

In addition to the health benefits as outlined by (Leung, 2023), ensuring maternal health can also have economic and social benefits. According to (Leung, 2023) when women are healthy, they can contribute to the workforce, support their families, and promote economic growth in their communities. Therefore, the health of women is also closely linked to the socioeconomic welfare of the family and community as seen in most of our communities where women are the breadwinners in the families. This was also observed in the community as I noticed that many women were selling fruits, vegetables, and snacks on the side of the road.

To build a better tomorrow and ensure a healthy future, we need to prioritize the health and well-being of mothers and their children today.

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Life Esidimeni Tragedy

Life Esidimeni meaning a place of dignity but instead became a place of indignity. 

“This is a harrowing account of the death, torture and disappearance of utterly vulnerable mental health care users in the care of an admittedly delinquent provincial government.” Former Deputy Chief Justice - Dikgang Moseneke

A very well-known mental health issue that created a dilemma was the Life Esidimeni tragedy which took place in Gauteng in 2016.

This is an absolutely tragic story caused by the negligence of the Gauteng Department of Health and later deemed a stampede. The Life Esidimeni tragedy occurred as a result of the rushed execution of the Gauteng Mental Health Marathon Project when the Gauteng Department of Health (GDoH) prematurely terminated its contract with Life Esidimeni, a facility that provided highly specialized chronic psychiatric care to thousands of mentally ill patients.

Over 2,000 mentally ill patients were moved to ill-equipped and unlicensed NGOs in an attempt to cut costs. These NGOs were not prepared for the influx of patients and became overcrowded. They lacked the basic necessary resources that they needed to take care of these patients. NGOs were not staffed with trained healthcare professionals, lacked appropriate medicine and equipment, and in some cases even basic infrastructure like beds, bedding and sanitation.

In March 2016, they started moving the first lot of people out of life Esidimeni. They moved 54 adult patients to Takalani Children’s Home, which is an NGO for children. Now that in my opinion, is a major red flag because how is an NGO that is specialized in catering for the needs of children now going to adapt to catering for the needs of adults with mental illnesses without trained nurses and health professionals dealing with mental health illnesses?

SADAG, SASOP and families litigated to stop The Department from moving these patients, but the Department misled the court by denying that these patients needed special medical care and guess what? The court ruled in their favour. Without even investigating whether or not this was true. This emphasizes the lack of attention that the government shows towards mental health.

Thanks to the cruel and inhumane decisions of the Gauteng Department of Health, 141 patients with mental health conditions died in undignified conditions, an additional 44 patients still unaccounted for and 63 bereaved families. 7 years later, justice for these patients has still not been served! The court case is still ongoing due to the shifting of blame and responsibility between government officials.

One of the most vulnerable groups of our society that we are supposed to protect yet they were left to die due to negligence, starvation and torture! The patients’ human rights such as the Right to Human dignity; Right to life; Right to freedom and security of person; Right to privacy, right to protection from an environment that is not harmful to their health or well-being, Right to access to quality health care services, sufficient food and water were infringed upon.

As a student studying Occupational Therapy, it saddens my heart to know that people living with mental illnesses had to endure such appalling actions due to no fault of their own. This was a perfect example of a mental health issue that caused a dilemma in South Africa between the rights of Mental health care users and funds.

As a country, I believe that we need to do better when it comes to mental health. We need to prevent mental health from being the Cinderella of health care so that never again will we be faced with a dilemma this big involving the lives of innocent people.

https://section27.org.za/life-esidimeni/#constitutional-damages

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Shutter Island

Shutter Island is a thriller and mystery movie featuring two US marshals, Teddy Daniels and Chuck Aule.

However, Teddy Daniels is a patient at the Ashecliffe Hospital for the criminally insane for murdering his wife. Unable to deal with the grief and guilt of killing his own wife, he becomes delusional thinking that he is a better man who did not kill his wife and he is looking for a way to avenge her rather than to live with the guilt of having killed her. He uses this delusion that he has created as an escape and a way to cope with the crime that he has committed.

His doctor then decides to do a role-play to help him to snap out of the delusion. Thinking back to when I learned role-playing in my psychodrama lectures, I did not really understand how and why I could use it but after watching this movie, I see the benefits of using role-play with a patient that experiences delusions. The 2 US marshals, Teddy Daniels and his partner Chuck Aule were asked to investigate the disappearance of a patient, Rachel Solando, who had previously drowned her 3 children, from a secluded Island asylum called Ashecliffe Hospital for the criminally insane.

Teddy Daniel’s real name is Andrew Laeddis, and he was married to Rachel.

He experiences delusions of grandeur as he considers himself a special US marshal, Teddy Daniels, which he made up to make himself feel more powerful. He also experiences persecutory delusions as he believes that the hospital staff and psychiatrist are attempting to get him admitted to the hospital by giving him medication through cigarettes and headache pain reliever medication.

Initially, Teddy was thought to have schizophrenia however it was later revealed that he showed more symptoms of delusional disorder as opposed to schizophrenia. What I take back from this, is that it is important that we review the patient's diagnosis with the psychiatrist if we see that the patient does not meet the criteria for a particular diagnosis. This helps us to plan effective interventions for our patients.

This movie clearly illustrates how guilt and grief can impact someone's mental health. As depicted in the movie, Teddy's mental health declined due to his family's death.  According to  (Can Grief and Loss Lead to Mental Illness? – Mental Health Program at Banyan Treatment Centers, n.d.) in rare cases, grief can cause psychosis or the development of psychotic symptoms. Grief can be seen as a trigger for the onset of psychosis.

We later learn that Teddy’s dysfunctional and deviant behaviour resulted from withdrawal from his anti-psychotic drug, Chlorpromazine. This caused him to relapse. As an OT, I see the increased need for patients to comply with their medication to prevent possible relapses in the future. This can be done by educating the patient about their condition and improving their intellectual and emotional insight to ensure compliance with medication.

Although the movie portrayed delusional disorder in a superb manner, it reinforced the existing stereotypes that people with mental illnesses are violent and harmful to others. This impacts people with mental illnesses as they do not seek the help that they need due to the stigma and stereotypes. Teddy knew that something was wrong with his wife (supposedly she suffered from a mood disorder) but did not get her the help that she needed and chose to ignore her condition which caused her to murder her children and in turn Teddy murdered her. This was a very typical reaction to mental health illnesses in the past.

Although Shutter Island is not based on a true story, a similar incident had taken place in New Zealand. A South African doctor who immigrated with her family to New Zealand allegedly killed her three children shortly after her husband went out for the night. She suffered from Major Depressive Disorder and was not given the help that she needed in time which could have prevented this tragic occurrence.

As an OT student, I would like to raise more awareness about mental health and where to get help. I feel like there are many movies out there that can impact on people's decisions to seek help due to the stigma which may be caused unintentionally by these movies. Mental Health is still looked down upon in many societies and cultures and this needs to change before we start to lose more people due to mental illnesses that could have been controlled through the use of medication.

“There is no health, without mental health”- David Satcher

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Therapeutic use of self

As an OT student I was always told to use myself as a "therapeutic tool" and to be honest I never really understood what this meant until recently! As a profession, could we be any more vague? LOL.  So what exactly does "therapeutic use of self, mean"?

Well teaching a patient with a T8 complete, spinal cord injury how to use a long-handled sponge in a simulated bathing session so that she can independently wash her lower body or helping a patient with burns to her face, neck and upper limbs comb her hair and engage in self-care activities which are very important to her or incorporating a patients interests into therapy sessions and making an adapted matching game to teach intellectual insight to a patient are all examples of the therapeutic use of self and examples of how I used myself therapeutically in providing effective treatment to my patients.

Having a conversation with the patient is an example of the therapeutic use of self because this helps to build rapport and create a meaningful relationship between the therapist and the patient. As I reflect more on this, I think back to my physical block last semester. I had an isiZulu-speaking patient who did not understand English at all. I was forced to learn how to speak simple isiZulu sentences in order to communicate with her. I would translate everything I wanted to say to her, write it and learn how to pronounce the words. I also made pamphlets for her on how to use the assistive device in isiZulu. This to me, is a perfect example of the therapeutic use of self because instead of getting a translator, I went the extra mile and she appreciated that I was trying to communicate with her in her home language which helped build rapport between the patient and myself. She was even teaching me how to pronounce some of the words.

According to an article published by (MOTR/L, 2023), she said that actively applying any mode of the therapeutic use of self, causes intentional interaction and relationship-building between the patient and the OT.

According to (MOTRL/L,2023) there are 6 modes of the therapeutic use of self, and this is based on the Intentional Relationship Model:

Advocating includes standing up for the patient and providing them with relevant information that can enhance the therapeutic process. For example, I had to advocate for my patient to get a bigger size of TED compression stockings as the ones she had were way too tight, causing her pain and discomfort, which started to affect her volition to engage in therapy sessions.

Collaborating is about including the patient in every aspect of planning and carrying out treatment for the patient. This is an important part because as OTs we want to provide client-centered intervention and in order to do this we need to include our patients in the treatment planning.  

Empathizing is about understanding the patient's internal and emotional experiences.  Before we are OTs, we are human beings, and as human beings, we are very quick to judge people. So, we need to put ourselves in the patient's shoes and look at things from their perspective.

Encouraging includes cheerleading and providing the patient will external motivation to participate and engage in therapy. There have been many times when patients refused to participate in OT sessions, so I had to use encouragement and positive reinforcement to get them to participate.

Instructing is about the therapist taking on a teacher role to educate the patient. This is very common for OTs to do especially when educating the patient on important aspects such as pressure care management techniques or insight building. Similar to what I tried to do for my mid-term demos. What I learnt about this technique is that it is very didactic and not always the most effective way, so it is important to consider your patient's level of functioning, MoCA level and context.

Problem-solving includes working with the patient to reason through and analyse complex situations to come up with solutions. OTs are known for their problem-solving skills.

What I learnt is that the therapeutic use of self is essential in the therapist-patient relationship, and it leads to effective and efficient intervention because you are more involved with the patient. My goal is to always use myself as a therapeutic tool in all my therapy sessions going forward.

[avania1105]

Mental Health is known as the Cinderella of Health Care

As stated by Dr Lochandra Naidoo (President of the South African Federation for Mental Health), ‘Mental health is the Cinderella of health care’. The forgotten child? The imaginary friend? If not seen, does not matter and if they do not matter, we can do whatever we want with them.

Similarly, mental health is always neglected like how Cinderella had been neglected by her stepmother and step sisters. Mental health in the past was often not seen as a priority. In an article published by Cordery (2017) she describes how mental health is last in line for funding, low in any list of priorities and, until recently, not important enough to have NHS constitutional performance standards. She also mentions that if we had to look at the state of mental health care services in children and adults, we can truly see that it is the Cinderella of Health Care.

In many hospitals, mental health care is not a priority. An example of this is a 26-year-old poly-trauma patient who had a BKA and is at rehab learning how to ambulate using a walker and how to adjust to a new way of life, but the psychological effects of amputation are neglected and not even taken into account yet it plays such a big role in the patient's rehab process.

As an OT student who enjoys working with people with mental illnesses, this breaks my heart. One of our roles as an OT is to advocate for our patients so are we able to fulfill this role as there is still a big gap between mental health care users and the care that they are receiving or not receiving?

Yes, indeed we have come a long way in providing care to mental health care users from punitive treatments to actually understanding mental health as a health issue and researching about it leading to the advancements of appropriate treatment. However, the stigma attached to mental health is still a cause for concern.

A real example of how mental health is the Cinderella of health care is the Life Esidimeni tragedy which took place in Gauteng in 2016. The tragedy began when the then-member of the Executive Council for Health announced the termination of a 40-year contract between the Department of Health and Life Esidimeni for the provision of mental health services. Due to not having money, they planned to move these patients to NGOs that were not prepared for the influx of patients, and they did not even bother to inform the families of these patients about what was happening, and this reinforces what Dr L. Naidoo had said. There were around 144 deaths of psychiatric patients due to starvation and neglect. A number of human rights of these patients were violated from the right to food and water to the right to life. Esidimeni means a place of dignity but instead became a place of degradation. This emphasizes the complete disregard for one of the most vulnerable groups of people in our society. The Life Esidimeni tragedy speaks to an overall lack of understanding of mental health and mental health care in the 20th century. Shocking right?

Despite this being such as tragic event, I find comfort in knowing that it was 3rd year OT students at WITS doing their block at Life Esidimeni when they noticed this “illegal move” of these psychiatric patients, and they brought it to their lecturer's attention. A letter was sent to the Department of Health stating what was happening and that these patients were not ready to be moved. When I heard this story from a lecturer I was in total awe and felt so proud to be studying OT. This was a perfect example of OTs advocating for their patients.

I want to be able to advocate for my patients because no human being is any less of a human being because they have a mental condition. Together we can prevent mental health from being the Cinderella of health care because each year approximately 8 million deaths worldwide are attributed to mental disorders. For how long are we going to neglect health mental and pretend it doesn't exist?

[avania1105]

Standing on the edge of becoming an OT

As a first-year OT student, I did not really understand what OT was about and many of my lecturers had said that OT will only make sense in third year and mind you, they were absolutely correct. My OT journey thus far has been a roller coaster, with lots of smiles, cheer, and laughter but also with many late nights and early mornings, breakdowns when things get overwhelming and stress from working in groups with uncooperative people ( but anyways that is a blog on its own, Hahaha :(: )

Over the years, I have learnt so much about OT and the various roles of OT's in psychiatric settings and physical settings. I do not have a preference yet because they both have pros and cons.

I have always been an introvert and studying OT has made me less of an introvert (not yet an extrovert though, lol). I have moved out of my comfort zone and tried lots of different things that I would not have normally tried such as sewing and woodwork. Sewing was one of my worst classes because bobbins kept getting stuck, needles were getting broken, and tears were being shed.

Thomas Edison once said, "Failure is the stepping stone to success." And that is true because with every failure we learn how to do it better and get it right the next time. However, it is important not to give up on the first try or the second or even the third try 😂👀. Every adversity, disappointment, and failure carries with it the seeds of success.  It just takes a little positive mental attitude and a commitment to keep trying.

Even though OT is a gratifying profession, it can sometimes be mentally, physically, and emotionally exhausting. Something that I have had to come to terms with, is the fact that A’s do not matter in university and that is something I struggled with a lot because for me doing well, was getting nothing less than 80% so when I was not achieving that, it started to affect me mentally and emotionally. This caused me to always be on overdrive, aiming for perfection and nothing less. Something that I realized is that University is not just about studying, studying, studying but it is also about making memories with your friends because there is a great chance that you may never get to experience this again. What I learnt from this is, it is okay to make mistakes and not get A’s but rather to enjoy every moment of my OT journey as a student and make the most of it.

Well, I am ¾ of an OT  and closer to the finish line than I am to the starting line. As scary as that may seem,  I am kind of embracing it, with open arms and looking forward to my future of graduating and becoming a qualified OT.

https://www.movingwithhope.org/posts/occupational-therapists-and-mental-health-interventions/

[avania1105]

"To be culturally humble means that I am willing to learn" - Joe Gallagher

According to research done by (Prasad et al., 2016), cultural humility is being aware of how people's culture can impact their health behaviours and using this knowledge to cultivate sensitive approaches when treating patients. Cultural humility is an ongoing process of self-exploration and self-critique combined with a willingness to learn from others. It means entering a relationship with another person with the intention of respecting their beliefs, customs, and values. It means acknowledging differences and accepting that person for who they are.

Cultural humility provides us with a greater understanding of cultures that are different from our own and helps us recognize each patient's unique cultural experiences. As OTs, we treat the whole person. We are involved in the communities we serve, and we maintain ongoing therapeutic relationships with our patients. As health science students we learn that early intervention is extremely important in preventing further dysfunction after the onset of an illness. But yet we still see so many patients that seek late intervention which decreases their medical and functional prognosis because by that time the patient has developed secondary impairments. Being a health science student, one of the first questions I ask myself "is, " Why didn't the patient come in sooner?" However as I learn more about cultural humility, especially in a South African context, I understand that the majority of the patients come from the Zulu culture in KZN and there are certain beliefs that they believe in. Most people adopt the moral and/or religious model which indicates that disability is an act of God and they think that God is punishing them for something that they did. Hence they believe in doing special prayers and pleasing their ancestors in an attempt to recover but it doesn't work and their condition progresses. This is when they decide to seek intervention. Something that I learnt is never to judge a person and always remember that they have their own reasons and opinions for doing what they do. This week I was given my final patient who sustained burns due to her boyfriend smoking next to a highly flammable spirits container. However, I suspect it was gender-based violence due to the circumstances surrounding the incident. She was very cooperative and presented with good volition. Bed mobility was done with the patient as part of my intervention program for this week. She coped well with the session and could perform the movements with minimal assistance. The feedback received from my supervisor was helpful as she was able to show the patient and teach me an easier way of long sitting on the bed which is useful to the patient. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4742464/

[avania1105]

Evidence-Based Practice

This week was midterms and the countdown to finals get closer.

When planning my intervention for my 1st patient, I took into account the research I had done on my patients’ diagnosis and her medical and functional prognosis. My patient has loss of trunk control which limits her ability to flex her trunk to bend effectively. Due to the nature of her spinal cord injury being a complete SCI I decided to use a compensatory approach. I decided to teach her how to use a long-handled sponge (AD) to improve her independence in ADLs such as bathing.

The feedback received from my supervisor was helpful as she mentioned things that I could do to improve my sessions going forward and things to include when teaching the patient about a new device.

Some of the ways I used evidence-based practice to guide my intervention included:

When researching TB spine, one of the symptoms was localized pain and I was already aware that my patient experienced pain in her back which she described as throbbing. Therefore, when planning my intervention sessions, I had to be considerate of pain. So, for my precautions, I included that if the patient is experiencing pain, a 2-minute rest break would be taken and if the pain continues and worsens then I would stop the session and inform the nurses.

My patient is a grade A according to the Asia impairment scale. The absence of sensation and motor function in the lower extremities was determined by doing the ASIA impairment scale which is a standardized Neurological examination used by the rehab team to assess sensory and motor levels which are affected by a spinal cord injury.

I had to ensure adequate precautions by ensuring that assistive devices such as the long-handled sponge had no sharp edges that could cause unwanted injuries. The patient also had medium T.E.D compression stockings which was causing bruises on her legs as it was too tight but she wasn't able to feel it. Hence, I had to advocate for her to get a larger pair.

Research was also done when thinking of what applied frame of reference, would be appropriate to use for my patient. Research indicated that a Rehabilitative AFR would be most appropriate because it is used with patients whose underlying impairments are unlikely to remediate and can be considered permanent. In my case my patient has a complete spinal cord injury and the underlying impairments would not remediate.

This also guided my intervention planning in terms of what approaches and techniques I would use.

[avania1105]

Teamwork makes the dream work

The multidisciplinary team plays an essential role in the intervention and care of a patient. While each discipline has its own role, teamwork and collaboration between the various disciplines bring together the expertise and skills of the different professionals to assess, plan and care for collectively thereby ensuring that the patient is receiving the best care possible. They also come together to achieve a common goal. #Teamwork makes the dream.

Evidence suggests that MDT working can lead to improved job satisfaction for professionals and practitioners because of greater autonomy, skill enhancement and knowledge sharing.

In the medical field, the MDT mainly consists of the doctor, pharmacist, nurse, therapists (PT, OT, ST), social worker, dietitian, psychologist and most importantly the patient. 

At Inkosi Albert Luthuli Hospital, my first patient's MDT consists of her doctor, nurses, physiotherapist, and myself (student OT). I haven't met any of the other members of the MDT which is sometimes a problem as I don't really know what's going on with my patient's treatment and therapy or what progress has been made. However, I had to speak to the nurses in the ward to get collateral information about my patient's progress or any updates. I also had to advocate for my patient to get a bigger size of T.E.D. compression stockings as the ones she had were too tight and were causing bruises on her legs.  One of my intervention sessions also my demo session for this patient was teaching her how to use a long-handled sponge (AD) which was very useful for my patient as she had difficulties with trunk control due to her T8 SCI. When planning for my intervention session, I thought carefully about my patient and what mattered most to her. Something that she mentioned to me in the previous session was that she struggled to wash her legs as she couldn't flex her trunk adequately to be able to reach the distal part of her legs and feet especially when she was in long sitting. Hence, I thought carefully about her diagnosis and medical prognosis and decided to use a rehabilitation AFR that includes compensatory approaches such as Assistive devices. Education about the AD (Long-handled sponge) was also done to ensure that the patient knew what it was used for and how to use it which would improve compliance with the AD. She seemed very happy and responded well to the session. The feedback that I received from my supervisors was constructive regarding principles that I could use going forward when doing intervention sessions with my future patients.

https://www.health.nsw.gov.au/integratedcare/Pages/multidisciplinary-team-care.aspx

https://www.canceraustralia.gov.au/clinicians-hub/multidisciplinary-care/all-about-multidisciplinary-care/multidisciplinary-care-team

[avania1105]

Occupational therapists put the "fun" in functional

Week 1 started with a bang. I walked into Inkosi Albert Luthuli Hospital not knowing what to expect. Was I going to get a CVA patient, a TBI patient or maybe even an amputee? Much to my surprise, my patient has a SCI. I've never had a SCI patient before, and all my knowledge was based on paper cases. So, I had to do some research about a T8-level TB spine, its impairments and the prognosis.

At first, I was nervous, so I took a deep breath and gathered my thoughts. I treated the situation like I would have for a CVA, I looked at what client factors were impaired such as active range of motion of the lower limbs, muscle strength of the lower limbs, sensation, and balance. I gathered my assessment tools for the varies client factors. I had also read through the patients' medical notes so I knew a little bit about the patient and what her problem areas were and her symptoms. I then proceeded to the ward to meet my patient for the first time. Everything was going well, I felt confident and ready. 

Much to my demise, my patient did not understand English and was fluent in isiZulu. I started to panic, I felt my heart beating faster and my palms beginning to sweat. Luckily, there was a nurse there willing to translate for me and my colleagues also assisted me whenever they could. 

I've started learning how to say a few words in Zulu so that I'm able to build my Zulu vocabulary as a language barrier should not affect the effectiveness of my treatment for a patient. 

My patient has pitting oedema in the lower limbs hence I measured the amount of oedema using the lateral and medial malleolus of the ankle joint as my anatomical landmarks. I observed the range of motion of the upper limbs which was intact. I did passive range of motion of the lower limbs and there were no contractures present however the patient has increased muscle tone in the lower limbs. This could be due to post surgical meningitis. I did the OT Pain assessment to find out where the patient experiences pain, what type of pain and what movements or activities increase or decrease the pain. I assessed sensation using light touch and pin prick. It was noted that the patient had diminished sensation in dermatome T8, T9, T11 and T12 and no sensation in T10 and below T12. 

For intervention I decided to do bed mobility and face washing however the patient presented with a low affect and mood on the day, hence only bed mobility was done. The aim of the session was to encourage rolling from side to side to prevent pressure sores by relieving pressure on the back. The session was successful as the aim of the session was met. She was able to assist in rolling by using her upper limbs to pull onto the bed rails to facilitate rolling. 

I was then provided with constructive feedback from my supervisor regarding precautions that I need to consider when doing bed mobility, how better to structure the activity and how to grade it. I was also given tips such as using more physical demonstrations and doing exercises of the lower limbs as a warmup before doing bed mobility. She also provided verbal prompts/cues of things that I needed to do to make the activity a success which was very helpful and going forward I will incorporate these principles into my next session when I do bed mobility as a warmup. 

https://www.spineuniverse.com/conditions/spinal-cord-injury/traumatic-spinal-cord-injury-prognosis-what-you-need-know