lindelwamamba

[lindelwamamba]

Inclusive Education: Occupational Therapy in the School Setting

Education is a fundamental right, and has been described as a great contributor towards full personal development of an individual, and an integral part for moral, social, cultural, political and economic development of the nation at large. Yet, in all this glorious explanation of what education should be, it is unfortunate that vulnerable populations don’t get to share the same privileges, or yet if they do, it is an overbearing journey of continuous battle. Better developed countries have acknowledged the discrepancy with the typical educational system and therefore have made provisions for how a universal design for learning can be utilized. In our normal day conversation, this would be what we usually refer to as Inclusive Education. We have definitely observed the desire to transition to a state whereby the fundamental right of education is granted to all, being in line with sustainable development goals.

Inclusive education can be described as a mission to identify and address barriers to learning experienced by students. Earlier documentation of policies mainly addressed children living with disabilities (special needs), but it has evolved to an even greater model, whereby children experiencing delays (that may not be necessarily be described as a disability) benefit as well. In the Africa, a significant number of children have been excluded from the educational system due to either disability or having an underlying barrier that limits their learning ability; hence exploring occupational injustice within the educational sector. And that’s how Occupational Therapy (OT) features in schools and can be advocated as one of the fundamental cores for the bridge in development of inclusive education policies.

With the process of development, children are expected to learn to complete various tasks which may include (not limited to), taking care of oneself, managing school work at whatever level currently at, playing sports, etc. With me, you, and a child regarded as ‘normal’, it is easily grasped. However, all these processes and expectations can be tricky for a child experiencing developmental delays. Development for children can be termed as physical/cognitive/socio-emotional, and all parts are important, as they allow for acquisition of the skill to be independent. Due to delays and known formal diagnoses children may be hindered/ or experience barriers whilst learning, and quite often these can be minimized through being involved in remedial rehabilitation.

In previous articles a brief scope of OT has been highlighted, and when it comes to school related Occupational Therapy, enabling a student’s participation at school is an important focus of pediatric occupational therapy. OTs are largely responsible for independent participation in the occupation of academics, play, leisure, social participation, provocation activities, self-care skills (ADLs or Activities of Daily Living), and transition/ work skills.  Often the underlying causes of a student’s difficulties may stem from different factors related to the student, such as: sensorimotor, cognitive, emotional and/ or social, as well as from the requirements of the task, environmental limitations or from a mismatch between the student, the task and the environment.

Integration and support of occupational therapy in schools is achieved through working in collaboration with school personnel (teachers) to ensure that every child gets the necessary remedial interventions that they require. Occupational therapy works to ensure that your child can participate in all activities during school and at home. This includes understanding more about how your child moves, how they use their hands, and how your child prints and writes. The process also includes understanding how your child learning patterns, behaviors while focusing on learning materials.  Through collaboration, OT will provide education and resources to teachers and parents about how children typically develop motor skills and how to promote this development in the classroom and at home. OT also puts emphasis on working with teachers to recognize and help children who may have problems with motor skills which is makes some daily activities a challenge to learn or master. This is all accomplished through activity, environmental analysis and modification with a goal of reducing the barriers to participation. A position paper on the rendering of occupational therapy services in schools highlights the main roles of occupational therapy as follows:

Providing basic tools for learning and developing learning strategies: This includes working on various areas such as increasing the attention and concentration span, the ability to cope with, and persist in a task, controlling impulsivity, developing systematic work habits that enable the student to organize his/her task performance, and adjusting tasks according to the student’s cognitive abilities. The end goal for therapy with this area to ensure your child has self-efficacy, competency and motivation to engage in the daily school activities.

Organization and planning in the educational setting: Outcomes for this area include organization of time to enable the student to work at an age relevant pace when compared to peers and organization in space though strategic positioning, as well as learning self-regulation strategies in the presence of problems related to sensory integration

Fine motor challengers (commonly identified with handwriting): OTs focus on underlying skills that are required for illegible handwriting, difficulty organizing written product, slow writing, fatigue or inappropriate pressure. A common misconception is that OTs teach children to write and this is not usually the case, but rather OTs work on pre-functional skills that a child would need to be able to write.

Preparation for independent living in community: The end goal for therapy is to enable the child to exist as a fully functional individual in a community setting, for a school going child this resembles the act of being able to complete self-care on their own, social norms, navigate community mobility safely, have task completion with ability to present an end product of quality and with minimal assistance, social participation with friends and active decision making with leisure pursuits.

When a child is identified to require occupational therapy services, varying of school resources they are referred to an in-house remedial rehabilitation program, government and private health care therapists. An assessment is performed through observations of the children in the different environments they exist in. Formal /informal assessments are used, interviews and questionnaires with parent. An assessment assists with identifying the areas a child may be struggling with, and also serves as a guide to monitor progress. This helps in the development of treatment goals, developing an Individualized Educational Program (IEP) when required, and this process requires collaboration between school, OT and various MDT health practitioners.

Occupational Therapy in schools presents a great advantage, as it’s in keeping with Ottawa Charter principles for health promotion. It allows the educational sector to identify risks of barriers to learning at an early age, and influence the outcomes for children through provision or seeking early intervention services. It also forms the foundational blocks towards delivery of primary health care with reference to the community rehabilitative model as well as inclusion of children diagnosed in the category of special needs. The field of occupational therapy is devoted to improve and facilitate understanding of children’s occupational performance and behavior by addressing environmental, personal, or occupational aspects whilst facilitating children’s independent, active and competent participation in academics

[lindelwamamba]

Occupational Therapy and High Risk Infants

The process of giving birth, or rather bringing life to this world is often an experience expecting women look forward to, although it may not be the easiest road travelled due to some complications experienced, differing in severity, it is explained to be a process worth it. Granted this may be so, it is essential for expecting women and families to understand that should adversity arise, the first steps of action should be assumed quite early, referring to what we know as early intervention for ‘high risk infants’.

 A high risk infant, as according to Mosby's Medical Dictionary, can be described to be any neonate, regardless of birth weight, size, or gestational age, who has a greater than average chance of morbidity or mortality, especially within the first 28 days of life. There have been quite a number of extensive studies that highlight improved long-term outcomes for infants identified to be ‘high risk babies’ who have received monitoring and early intervention. In some of these studies Rossetti (2001) notes that the is an added long-term benefit to the socio-economic burden when intervention is sought out early for a child identified as high risk.

 Clinicians, researchers and advocates are constantly in a battle of ensuring that they are working endlessly to prevent, diagnose and treat childhood illness, so that children are able to enjoy good health and reach adulthood. A program known as ‘First 1000 Days” (conception-2 years) advocates for attainment of the state of health, for developing infants as it amongst the few factors that will promote quality of life, hence the need for early intervention. Early intervention uses a system of coordinated services that will promote age-appropriate growth and development as well as supporting families during the critical early years from being a neonate-toddler (often recognized as a period of 0-6 years).

 A neonate multidisciplinary team (medical practitioners, nurses, physiotherapist, speech therapist, alternative therapies etc.) will be responsible for delivery of neonatal health care, amongst these include Occupational Therapy. Occupational Therapy as a profession presents a distinctive characteristic, which is always to advocate for a holistic approach in the delivery of healthcare to all individuals through integration of multiple healthcare models (medical, physical, and mental models).

 Early sensory and motor experiences between the parent and infant are deemed as the foundational blocks for child development, as well as taking a glimpse at lifelong adaptation, which are common difficulties identified for high risk infants. Occupational Therapists are extensively trained with sensory processing problems, and contribute vastly with using sensory experiences as a tool, to develop sensory integration, stimulate development as well as foster positive parent-infant interaction that is developmentally appropriate for a child. In neonatal care, OTs are focused with helping your baby learn to feed and acquire skills like holding their head up, looking and tracking with their eyes, soothing themselves, and bringing their hands to their mouth and body, all important to develop self-regulatory behaviors.

 An assessment will be done by your attending OT, and this process seeks to identify the challenges your newborn may experiencing and the types of intervention that will be relevant for them. Amongst the relevant aspects to look into particularly, is usually the Apgar score, where your infant’s vitality in a category of 5 items is tested. Our current literature has been suggestive that the may be a relationship in the risk of developing neurological diseases amongst children that presented with a low Apgar score. This may not always be the case, but through using the preventative approach, OTs will monitor a high risk infant within their first year of life. Other areas that the OT may observe will be the functional status of infant, nervous system by assessing habituation, posture, muscle tone, head control, spontaneous movements, abnormal arousal and alertness (not limited to).

By means of completing this holistic assessment, through their own clinical reasoning and support of evidenced based interventions your OT will develop a comprehensive treatment plan and goals alongside the caregivers, with the goal supporting them with the appropriate developmental environment, based on the infant’s age, status and individual needs. The interventions may include the following (working alongside multiple neonate practitioners)

·         Developmentally supportive care

·         Skin-to-skin (kangaroo) care

·         Positioning

·         Infant feeding

·         Parent engagement

·         Parent support

·         Identifying developmental concerns

·         Monitoring and sustaining early intervention treatment

The objectives of the Maximizing Access Project include encouraging parents and health care practitioners to refer their children to early intervention services as soon as they become concerned about an aspect of a child’s development. This is an effective way to ensure that our children are able to transition from being a neonate to adulthood by prioritizing the child development process.

[lindelwamamba]

Covid-19 has brought significant changes to our daily living, alterations of which are very uncomfortable for many human beings, especially to this magnitude. Thankfully, you and I are amongst a majority of the population, blessed at the very least with the basic yet integral capacity, to maneuver such challenges, perhaps not with absolute coolness, yet we nonetheless maneuver. Because we are generally fully functional, our ability allows us the possibility to adapt to survive: shopping once a week as opposed to every other day, video calling loved ones instead of informal gatherings, texting and calling beloveds as an expression of utter warmth, in lieu of regular visits trademarked by tickles and hugs. All to make it to the next day, week, and beyond. Adaptability.

 And yet, for all our supposed challenges in this world today, I imagine our realities are incomparable to the permanence of individuals diagnosed with Autism Spectrum Disorder and related special needs such as Attention Deficit Hyperactive Disorder (ADHD), whose linear logical capacity is severely compromised, or whose “common sense”, as referred to by the ordinary man, does not resemble that which we can relate to.

 Restricted, repetitive behavioral patterns often manifested as insistence on sameness, inflexible adherence to routines, and or ritualized patterns of behavior are among the defining features of Autism Spectrum Disorders (American Psychiatric Association, 2013), whilst children with Attention Deficit Hyperactive Disorder (ADHD) tend to suffer from difficulties with completion of activities, short attention spans, careless mistakes, and an inability to carry out time consuming tasks.

On a day-day basis this is seen as:

· Eating specific foods only

· Sticking to certain times and wanting to visit the same places repetitively

· Meltdowns (described as ‘an intense response to overwhelming situation’ by National Autistic Society)

· Careless mistakes

· Disruptive bahaviours

· Limited delayed gratification

Given the world’s current and intense battle with the Coronavirus pandemic, families in the world abound have been required to almost entirely adjust to the new actuality that includes extremes like the complete sudden closure of all schools, working from home (or not working at all), physical distancing (a term since preferred by The World Health Organization, as opposed to social distancing, which seems to suggest social disconnection from family and loved ones) and travel limitations, to mention but a few

Our beloved nation has not been spared of the challenges brought about by Covid-19, leading our National Government to enforce the aforementioned restrictions and some, with the objective of protecting every individual as best we can, and in turn, the Nation.  Resultantly, Parents have found themselves compelled to fill multiple roles, interchanging between parent, teacher, therapist, and playmates too, to lighten the weight of our current predicament for ourselves and those we are nurturing.

 Expectedly, given that these roles are normally shared between multiple people on a regular week day, repetitively, commanding these tasks can and likely does push most parents and guardians, to the limit and often beyond, in these times. Additionally, undoubtedly, and most noteworthy, the adjustment to entire responsibility for a child with special needs, is incomparable to life in our largely regular households today, given that it primarily requires thorough commitment, patience, awareness, supplementary to the constant challenges and demands now required from parents

This is proving to be unfortunate (to put it mildly) for children diagnosed with such neurobehavioral disorders. As April, known as ‘Autism Awareness Month’, comes to a close, this article serves to address the needs of parents, how they can try and facilitate transition to the current living conditions, whilst reducing the number of meltdowns in relation to negative responses towards the alterations of routines. Worth noting is that, these difficulties with coping are not always attributed to shifts in patterns. These may be due to unmet sensory needs that parents would have been taught about during the different therapies a child may have attended, namely Occupational Therapy, Speech Language Therapy, Behavior Training etcetera. Rehabilitation services are strongly advocated for, given that the ultimate goal is ensuring that the child acquires skills to live in a community safely and independently amidst disruptions to his/her daily schedule.

A few strategies parents can use include:

 Having open communication and explaining using simple language (like one word/broken down phases), picture/videographic/situation cards of what is currently happening, and also of why they need to stay inside safe spaces. Communication is generally understood to be verbal, but some of our children are able to comprehend better what is being said to them using the alternative videographic and picturesque means as mentioned above. These genres assist enlighten the children to the current gravity of our reality, and simultaneously temper down unrealistic expectations of resuming activities they had been engaged in before, and grown used to. Principles of repetition can be employed on a daily basis, wherein as parents you explain and retrain them to understand that they will be home for the foreseeable future. We recognize the challenges that accompany these severe health defects, and therefore appreciate that communication with each child will vary.

 ·Creating a routine schedule using visual pointers at home for your child, allows them to be aware of what needs to be done, and limits an element of surprise. Routines are also a great strategy to use to teach social demands which society requires from us on a daily basis (a practical example is knowing what time I need to wake up, so I can make it to work on time)

 ·Having sets of activities that will fill in the spare time and being present to do these activities with your child for intensive interaction, with the use of over-exaggerated facial/verbal expressions that will provide learning opportunities (social interaction) for your child through having them mimic your actions. Examples being singing song together, playing cars together, building blocks, and lacing beads.

·Ensuring consistency in the child’s repetitive home activities (like mealtimes, bedtime, and shower times) as would similarly be the followed during school seasons. Furthermore, monitor that they get adequate sleep as lack thereof may contribute to their agitation during the day.

 ·Continuation of learning so children continue to progress with and improve on skills they had attained whilst at school, and therapy sessions. Additionally, reaching out to your school to find out what programs for supporting continuation of learning could be implemented, and also communicating with your therapist about how you can continue with therapy at home, would help. Where possible, it is advised that the use of home programs that are reviewed weekly/fortnightly are used.

 ·Parents working at home experience difficulty in attempting to juggle work and parenting during the day. Therefore when possible, a family approach that incorporates delegation of roles between parents, siblings, and helpers may also assist with limiting the demands of caring for a special needs child, enhancing coping strategies amongst family members.

·Encouraging active participation with roles and tasks around the house to achieve balance between structured activities that have academic goals and unstructured activities that promote independent self-care.

 ·Ensuring that children have periods for relaxation, and breaks in-between activities is important to get great participation.

 ·Play is a big component that is used in therapy to ensure that your child’s sensory needs are met, and this is done through knowing their sensory profile so they get sensory input the whole day. Asking your therapist to assist with a sensory diet (free play/tactile experiences/circle time/feeding) that can be implemented at home, ensures your child is consistently receiving sensory feedback throughout the day, which is very important for energy regulation.

Composure, communication, taking an hour, moment, a day at a time, as well as working as a collective, whilst consistently maintaining and implementing preventative health guidelines as advised by the relevant health authorities, will see us overcome, then thrive.

[lindelwamamba]

Five to Occupational Therapist

“If you want to change the world through advocacy, you need two basic things: great strategy and great follow-up” _Dan Smith

Seven weeks is finally over and what I can call a life changing block, has been completed and bagged. At this moment I can say is that my passion for OT is currently on steroids. Amazingly with each and every block I have completed this year, my intuition that OT (Occupational Therapy) is actually a calling for me keeps on being made stronger. In my first blog, regarding my experience of orientation week to community, I mentioned how I could now wait for this block. I can definitely tell you, don’t believe anyone that says community is the easiest block ever. Mate, its LIES. Yes it’s different from the traditional structure that is provided by other blocks we have to go through e.g. Physical, Psych and Paeds, but it’ structured in such a way that you’re not just only an OT, you’re whatever the community needs at that particular time (with just knowledge of OT). What I found to be the icing on the cake for our profession is that every moment was an opportunity dedicated to advocacy, not only for our profession (because OT happens to be one of those careers who is still fighting for a seat at the table), but it was advocacy for health promotion in general. From this experience I finally had a deeper understanding of why SDG’s, MDG’s, Ottawa Charter, Alma Ata Declaration all have correlating themes like eradicating poverty, food security, economy, access to healthcare services, service delivery to promote better health. This is mainly because as described by the World Health Organization, health is not just the mere absence of disease, there’s many factors that contribute into it .

Amongst the three basic strategies for health promotion in the Ottawa Charter is Advocacy, which highlight that good health is a major resource for social, economic and personal development, and an important dimension of quality of life. So the question is why are we intent on advocacy? So I remember a client I saw during my electives, who was diagnosed with Bipolar, and a coexisting condition of HIV/AIDS, with poor medication compliance for Bipolar, but excellent medication compliance for her coexisting condition. Ofcourse I was puzzled by this, oh naïve me! Who thinks everything is as simple as black and white. So my client was an elite member of society, good education, executive position at work and as entertainment socialite, and one would think they have all the knowledge they required. So young aspiring therapist chats to my supervisor about this, and what she brought to my attention is how HIV/AIDS has been massively broadcasted such that the is limited stigma to it now, versus Mental health illness that has so much stigma attached to it, let alone in the African community. So yes, it started to make sense then that actually my supervisors clinical reasoning was not too far from the truth, because my client’s family, friends and coworkers did not even understand her condition nor how it presents, to them she’s always been that one weird person who likes to live beyond her means. My experiences in this block have led to understand the role of advocacy and its importance in the health sector.  Amongst the approaches I had to employ for my then client, was a client centered advocacy approach which was aimed at achieving outcomes of advocacy and self-advocacy to support health, wellbeing, and occupational participation at the individual or systems level” (AOTA, 2014) (Ofcourse at the time, while using the client-centered approach for intervention with her family, I was not aware that I was being an advocate-I know better now)

So believe me when I say that I support the statement made by Stover (2016) who states that recognizing one’s responsibility to provide advocacy for clients is different from knowing how to provide that advocacy. At the beginning of the block I remember how we were all sort of overstimulated by the community of KwaDabeka and the dynamics surrounding it, the big question was where do we begin, who do we want to target and what it the end goal of our project. This explains why Dan Smith say that a great strategy and follow up are required, because honestly,  you’re trying to bring awareness to something that has been overlooked and might be a contributing factor towards the wellness f a community. Client-centered advocacy goes beyond single-client centered advocacy, as in the case of KwaDabeka. During our needs analysis our findings were that the community’s wellbeing was affected by poverty, substance abuse, crime, teenage pregnancy, disability, poor service delivery, domestic violence and it indicated a vicious cycle that would continue to decline the wellbeing of the community’s wellbeing. We found ourselves having to advocate for such matters not only in the community but even through at legislative level. An example of this would be with assisting schools with implementing a policy that is aimed at achieving inclusive education to support learners who experience barriers in the community.

The promise of occupational therapy practitioners is to help clients “live life to its fullest” as stated by the American Occupational Therapy Association [AOTA] (2014), and that’s a great promise to make because if for any reason a client experience occupational depravation/alienation then that’s an opportunity for us to come into light and deliver on the great promise we have said. And that for me has been my biggest challenge because sometimes there is so much I want to do, but things are not always so easy, however giving it your best shot makes a difference. As I prepare for the following year, I am emerging as an advocate that will not compromise with service delivery, especially to those whom just a single encounter can make a difference for them.  As mentioned before, watch this space, new things are happening for OT, and it can only get better. It’s true we'll make a better day, just you and me.

REFERENCES

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd Ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.6820

Stover, A. (2016). Client-Centered Advocacy: Every Occupational Therapy Practitioner’s Responsibility to Understand Medical Necessity. American Journal of Occupational Therapy, 70(5), 7005090010p1. doi: 10.5014/ajot.2016.705003

[lindelwamamba]

OT IN PRIMARY HEALTH CARE

Prevention is better than cure is a longtime standing proverb I have heard being used as far as I can try to jog my memory and in its simple terms it refers to taking preventive steps to keep us away from harm and reducing the amount of time required to deal with the effects of danger.

Ofcourse you’re far too familiar with this proverb as well, and if not clearly you had a better childhood than me. I remember this one of the few phrases which was used to make me eat my vegetables and avoid all things nice (sweets, soda, ice-cream) as a child. So you can imagine how deprived I felt as a child (my mom is a nurse by profession), and wished I had all the luxuries other children. Little did I know,  that I would grow up and start appreciating such habits because they had already been instilled in me from a young age (I can safely say, sweet tooth issues have never been part of my problems). As an adult (and soon to be qualified health professional), I understand why my mother promoted developing healthy lifestyle habits from a young age, I come from a family that has a family history of type 2 diabetes and believe me when I say for the past 3 generations, not even one person has been  spared during their late 30’s . Besides the many reasons I am able to relate with this proverb, the aim of this post is to write about Primary Health Care (PHC), which I believe can perfectly be described with the proverb mentioned earlier. Now, why do I say this? The explanation of PHC according to the Alma Ata Declaration is provided as “essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination” ("World Health Organization “Declaration of Alma Ata: International Conference on Primary Health Care, Alma Ata, USSR 6-12 September, 1978). See the balance scale image above, it compares the cost of prevention vs cure, which is PHC simplified for me.

The purpose of the Alma Ata conference was to create a PHC movement that consists of professionals and institutions, governments and civil society that would address health inequalities in all countries and one of its core principles were based on social justice, the right to better health for all, participation and solidarity. I personally believe that this would not have come at a better time as countries around the world had to bridge the gap between access to services that were being accessed by the poor and rich. PHC in South Africa has been implemented to some degree however it is still a model that needs a lot of work. PHC is important for South Africa because it is a country that has to still rise above the scars of apartheid whereby the distribution of services that include basic sanitation, food supply, and access to health care was unequal amongst different ethnic groups. The PHC approach of the Alma-Ata declaration encourages increased consultation with stakeholders in decision-making and for shared responsibility for health amongst individuals, community groups, health professionals and government ("The Ottawa Charter for Health Promotion", 1986; World Health Organization “Declaration of Alma Ata: International Conference on Primary Health Care, Alma Ata, USSR 6-12 September, 1978).

The adoption or exploring implementation of PHC first began in 1996, with the proposal of the Whitepaper of 1996, which proposed a change in the health system, and shortly was followed by the development of the National Health Insurance whose key strategy is the emphasis on the delivery of a comprehensive PHC service to decrease the burden of the high public burden (Naidoo et al, 2016). While the NHI policy has policy guidelines for the PHC nurse and doctor, Naidoo et al (2016) explains that the is lack of publications for other organizations like non-governmental organizations and health professions organizations (e.g. the Occupational Therapy Association of South Africa) which discuss the role of the related PHC professionals and literature related to whether practice adheres to policy.

Despite all of these challenges of having difficulty to understanding the scope of practice for OT in PHC, at the end of the day we still have to be accountable for the posts we occupy. Institutions of Higher Education have addressed this challenges through restructuring the curriculum for student OTs to be in line with PHC principle (Naidoo et al, 2016). Some of these principles are understanding of universal and equitable access to health care, facilitating community participation in programs, Intersectoral collaboration, and designing population-based programs (Sibiya & Gwele, 2012). Looking at the community if KwaDabeka, some of this principles have been implemented, through using the KZN PHC model ‘Sukuma Sakhe’, an example of this is the war room, which is a monthly meeting that happens in each ward consisting of a team made up of community leaders, representatives from government departments, community health workers and youth ambassadors. Through participation in one of these meetings, as students we recognized a need for advocacy for rehabilitation services in the community as community stakeholders were not aware of the role of these health professionals in the delivery of PHC. This reminded me of a discussion I had recently had with my supervisor, whereby she was pointing out that as OTs, quite often we assume other individuals tasks and responsibilities, which results in our main role being lost along the way because we have become the jacks of all trade, with no special distinct of our own role.

The study by Naidoo et al (2016) continues to highlight findings that state that stakeholders perceived the role of OTs predominantly for impairment and rehabilitative focused services, which is totally different to the approach of PHC. As mentioned in previous blogs, our role in OT is the ability for individuals to participate in activities, Christiansen (1999) explains that, “Health enables people to pursue the tasks of everyday living that provide them with the life meaning necessary for their well-being”. In the discussion of the study done by Naidoo et al (2016) , some of the roles that can be included under the scope of OT in PHC include : role in disability prevention and health promotion in pediatric clients, working in schools and with teachers to identify and assist leaners with learning disabilities, community programs to address substance abuse and educational challenges, teaching life skills, assisting with constructive leisure and social programs, better relationship between OTs, CHWs and other teams of health professionals is essential in order to ensure carryover of therapy and better referral systems to rehabilitation service.

In the movement to reengineer PCH delivery in South Africa, one of the most important aspects has been the recognition that PHC in SA is not fully functional and some of the contributing factors to this phenomenon include geographic and physical access barriers to health services, especially to those that live in poverty. In an attempt to promote  public health and health promotion mass media campaigns have been widely used to expose high proportions of large populations to messages through routine uses of existing media, such as television, radio, newspapers and the ever rising social media (Wakefield, Loken & Hornik, 2010) . I remember the first time I received a chain message on WhatsApp about two years back which had been aimed at raising awareness for breast cancer month and we have seen this awareness being reinverted year by year. So what is clear, is that the media is a powerful tool that can be utilized positively to raise awareness, especiall social media. Remember the tie pod challenge last year, the backpack dance and this year’s Kiki + Level up challenge (if you’re reading this in the future-the year is 2018 ). So the question is if social media is on way of spreading messages, why not jump the same train, at the end of the day, Health is the most important treasure to have. Other forms of media have been used to promote health awareness and these include television, radio, and some examples of this include locally aired shows like Intersexions on SABC 1 which was aimed at raising awareness for HIV and Aids. Media has also been a great tool for raising for issues like Cervical cancer, TB, malnutrition through different media forms to cater for all individuals.

Although a great approach, a question that arises for such campaigns is whether they achieve the purpose they are initially constructed with, for example even though large numbers participated in the WhatsApp breast cancer awareness, only a few women got the meaning behind it and most ended up participation passively. This is similar to HIV/AIDS related sows, from a young age I recall shows like Soul City, Soul buddies, Tshisa which were all meant to promote developing caution with substance abuse, sexual relations and educate people on the disease, however Southern African countries still report a high prevalence for those issues. Despite the education, it is also important to note that some these issues have been perpetuated by culture and societal norms.

It is my opinion that PHC in South Africa still has a long way to go especially in relation to rehabilitative services provided in the country. The movement towards NHI is definitely a step towards a better future, but we cannot deny the challenges that come with this new model, and the government will require to make major shifts in the system to ensure is fully functional. By the way, this can only mean the beginning of a new era for Occupational Therapy, it will definitely get better. Our profession can only get better.

References

American Occupational Therapy Association. (2008). Occupation: A position paper. American Journal of Occupational Therapy

Naidoo, D., Van Wyk, J., & Joubert, R. (2016). Exploring the occupational therapist’s role in primary health care: Listening to voices of stakeholders. African Journal Of Primary Health Care & Family Medicine, 8(1). doi: 10.4102/phcfm.v8i1.1139

SIBIYA, M., & GWELE, N. (2012). A model for the integration of primary health-care services in the province of KwaZulu-Natal, South Africa. Journal Of Nursing Management, 21(2), 387-395. doi: 10.1111/j.1365-2834.2012.01420.x

Wakefield, M., Loken, B., & Hornik, R. (2010). Use of mass media campaigns to change health behaviour. The Lancet, 376(9748), 1261-1271. doi: 10.1016/s0140-6736(10)60809-4

The Ottawa Charter for Health Promotion. (2018). Retrieved from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/

World Health Organization “Declaration of Alma Ata: International Conference on Primary Health Care, Alma Ata, USSR 6-12 September, 1978”. Available at < www. who.int /hpr/NPH /docs /declaration_almaata.pdf> Retrieved from http://www.sciepub.com/reference/12304

KwaZulu-Natal Department of Health. Primary Health Care Re-engineering in KwaZulu-Natal. October 2012.

[lindelwamamba]

POLITICS VS LIFE IN THE COMMUNITY

Occupational therapy (OT) is broadly about the experience of ‘doing’ as the basis of activity participation and this can be done through access to means participation, space, facilities and resources for different forms of human action (Pollard, 2014). In the previous weeks I have tried to provide an overview of the community of KwaDabeka and the challenges that it faces e.g factors that allow a community to flourish vs a low socioeconomic status community like KwaDabeka, and also how economic factors impact on health and wellness of the community. I remember the simplest definition I learned about what OT is, was that it is a profession that promotes the ability of individuals to participate in activities they find valuable irrespective of any disability that may be present(the definition I gave last week in my previous is also correct). By the way, do check out my previous posts, they have a lot information regarding the community I speak about here. As an OT, when a person is not able to participate in an activity due to a certain barrier that provides an area of concern for us, as explained earlier that OT is mainly concerned about doing. Pollard (2014) explains that sometimes individuals who have experienced disability are frequently prevented from engaging in activities which other people can access, and can benefit from, and these things can be classified as barrier and some of these factors are identified as occupational injustice. Occupational justice is described as the right for every individual to be able to meet basic needs, have equal opportunities and life chances to reach toward her or his potential with emphasis specific to the individual's engagement in diverse and meaningful occupation (Wilcock & Townsend, 2009).

Growing up I knew which field I was going to work in, and that has always been the health sciences field. Initially when I got into OT, I never knew that it would allow me to also explore things I was passionate about, for example these include politics, legislation, societal issues and community dynamics which may include culture which never sat well with me (I will just say, I have always been that child that had questions-shout out to my mom who never dismissed my concerns and encouraged me to never let my fire die down). The most amazing part of OT is that it considers client-centered practice (unlike the traditional medical model), which I have talked about previously in my blocks, and how it all comes together during fieldwork with a bit of client-centeredness. As an OT, our contribution to politics is majorly based in advocacy for human occupation and eliminating barriers that prevent individuals from participating in their day to day activities. According to the Occupational Therapy Practice Framework (OTPF), advocacy is occupational therapy and can be defined as efforts directed toward promoting occupational justice and empowering clients to seek and obtain resources to fully participate in their daily life occupations. These can be displayed through efforts usually carried out by the practitioner, client to promote independence which may employ intervention strategies that include education, training, awareness to promote therapeutic use of occupations.

In an article by De Jongh et al (2012) she explores how occupational therapy education programs have been challenged to prepare their graduates to deal with occupational injustices in rapidly changing and different political, social, and economical context. I find that this is important as occupation is a determinant of health, well-being and justice (Wilcock & Townsend, 2009). One of the projects in the community of KwaDabeka includes the implementation of Screening, Identification, Assessment and Support in schools policy (SIAS), which is aimed at improving access to quality education for vulnerable learners who experience barriers to learning. Our main role in this is to ensure that we advocate for successful implementation, which will lead to achievement of some MDGs and SDG goals like, providing quality education and eventually eradicating hunger for all. Studies have shown that access to education and the level of education for an individual is a contributing factor towards job employment and directly impacts the socioeconomic status of a family. OT’s have been involved in this policy through being one of the practioner that can be approached to provide intervention for children that are identified as having barriers towards learning in school. OTs have also led the advocacy of petitioning with the department of education to hire more OTs to ensure the successful implementation of this policy.

Socially responsive education underpins values such as commitment to whole person care, reflective practice, human rights and community development and De Jongh et al (2012) mention that this  can be achieved through the use of 3PArchaeology (3PA) approach to raise political consciousness in the profession of OT. The 3PA refers to an in-depth critical exploration at inter-related personal-, professional-, political- levels of who we are, where we come from, what we value and stand up for ‘actual doing’ (De Jongh et al, 2012) . Through the use of 3PA approach, it would be easier to understand community dynamics, and how to ensure advocacy for community members is reality based. Legislation and policy petition would be made simple as we would know what we are advocating for, as similar to the SIAS policy implementation.

OTs can be directly engaged in the political process both directly and indirectly, e.g during our community research we found that patriarchy in the community was a system that sometimes disadvantaged women and therefore began an awareness campaign with regards to teaching the community about it, condemning such acts in the community and providing victims with awareness of the different centers of assistance thy could reach out to. This mainly because from a political point of view challenging the system of patriarchy would prove to be impossible at this stage, however empowering victims produces ground level for such issues to be explored and raises awareness to policy makers with regard to reviewing law and perpetrators can be discouraged from such cases.

As we continue to bridge the gap and advocate for this profession through exploring the political factors that impact on human occupation within the community of KwaDabeka, you can best believe that change is near.

‘Education is the most powerful weapon which you can use to change the world’-Nelson Mandela

REFERENCES

De Jongh J, Hess-April L, Wegner L. Curriculum transformation: a proposed route to reflect a political consciousness in occupational therapy education. South African Journal of Occupational Therapy. 2012; 42(1): 16-20

Wilcock, A.A. & Townsend, E.A. (2009). Occupational justice. In E.B. Crepeau, E.S. Cohn & B.A. Boyt Schell (Eds.), Willard & Spackman’s occupational therapy (11th ed., pp. 192-199). Baltimore: Lippincott Williams & Wilkins

[lindelwamamba]

Minute-Maid Vendor

The Canadian Association of Occupational Therapists defines occupation as everything that people do to occupy themselves, including looking after themselves, enjoying life, and contributing to the social and economic fabric of the communities (CAOT, 2002). The definition of occupation is constantly involving, and academics agree that occupation is a complex to define in one sentence (Golledge 1998; Wood 1996) and finally agreed that the word occupation can be best understood by elaborating on its dimensions. Now, if you’re reading you probably have figured out that I am an Occupational Therapy student (4th year-“yes I am closer to the finish line”) and what this means is that I am an almost qualified health professional (speaking things into existence) that is primarily concerned with promoting health and wellbeing through occupation. According to the Occupational Functioning model, its foundational principles is based upon the belief that people who are competent in their life roles experience a sense of self efficacy, self-esteem, and life satisfaction (Radomski & Latham, 2008) – also when I see this statement I’m reminded of Maslow’s Hierarchy of Needs.

During the course of the week I had the privilege of participation in the occupation of being a street vendor alongside one of KwaDabeka entrepreneurs *Baba Zungu (pseudo name). Now why do I call him an entrepreneur, this is because according to an article by Steve Tobak (2018) , an entrepreneur is described as a person a person who starts a business and is willing to risk loss in order to make money” or “one who organizes, manages, and assumes the risks of a business or enterprise . Now I understand that he may not be running a multimillion conglomerate, but he still began his business, and currently running it with the risk of losing money, which according to him is common occurrence as a local spaza owner. During conversation with him was that even though he sometimes experiences loss in his business he is motivated to continue operating his business because it is a means of survival for him and his family, as he is the only breadwinner at home. The occupational engagement framework recognizes that occupation is not necessarily an end, but instead, serves as a means to confirmation of self and to maintenance of self over time (Morris & Cox, 2017), which is what we see evident in Baba Zungu’s life. Due to the pressures of having to provide for his family, he is faced with the challenge of keeping at his daily occupation and using it as means for maintenance of his family. Morris &Coz (2017) continue to explain that the act of occupational engagement has positive or negative consequence to participation, which may change over time in response to feedback from social, cultural, and physical environments. Mr Zungu explains that having his own business presents more negative consequences for his family rather that positives, e.g. he explains that yes even though he is able to provide financially for his family, he has to wake up early in the mornings to open up shop and come back later, when he is exhausted. He explains that this has contributed towards not being able to completely execute the roles of being a present husband and father and that has made to feel as if he has been inadequate in terms of providing for his family for their other needs, excluding financial needs.

Through the application of occupational science and occupational therapy, as a community service providers I am able to why Mr Zungu chooses to continue to do his occupation of entrepreneurship even though he experiences difficulty and feels he has poor occupational competence in his other roles. Occupational science also provides a theoretical and scientific foundation for occupational therapy practice to assist with clinical reasoning for linkage between patterns of daily occupations and occupational balance (Morrison et al 2017).   Through Application of the framework of occupation engagement we are able to understand even though being  street vendor may not be Mr Zungu’s ideal job, we explore the contextual environment that may include social factors like having to be able to provide for his family as a Zulu man, which supports the occupational functioning model, in terms of that necessity or desperation, he acknowledges that his occupation provides well for essential requirements, which include shelter, food, and an education for his children (Gamieldien & Van Niekerk, 2017).

As my conversation with Babe Zungu continued about how he started his business, and what motivated him to a street vendor he continued to explain that he had no other options, it was either being a self-made entrepreneur or being unemployed. As I discussed in previous blog unemployment is currently one of the biggest challenges of South Africa, and not only is it impacting non-graduates but also those that have gone into institutions of Higher Education. Mr Zungu is part of the senior generation and through reflecting to the history of South Africa, it is no mystery that he was unable to have access to formal education, which has led him to rely on informal employment as his occupation. The occupational injustice that seniors are currently experiencing can be directly linked to the impact of social injustice that happened to black and colored ethnic groups.

As a local entrepreneur, Mr Zungu experiences occupational barriers that may include bad weather conditions which affect his monthly income as on those day he is unable to be at work due to rains leaking through his wood and plank built spaza shop. The municipality and government also plays an important art as he is required to have a permit, which he pays for, to be able to operate his business on a daily business, and if his permit is not renewed then his business would be suspended. He explains that what he is making at the business is barely enough to cover the needs for his family, however some form of oncome is better than nothing and that is which he has to make sure his permit is always valid. Through this we can observe how the economy of the community is impacting on the ability of his business to thrive as community members are also not able to afford his services as they are also from low socio-economic status.

In my conversation and assisting Mr Zungu with the occupation of being a street vendor I realized how

The importance of understanding the attributed value of occupations of individuals even though it may not be their chosen or ideal occupations, but to review the motivation of why they continue to do that occupation.

PS: I would like to send a shout out to *Mr Zungu who I think is a great man, and tries by all means to ensure that His family’s needs are met always. As Mehmet Murat ildan says “Any man who is good by heart is a great man!”. Thank you for allowing me to invade your space, and being honest about your true feelings in relation to your occupation.

REFERENCES

Brown, C., Stoffel, V., & Munoz, J. (2011). Occupational therapy in mental health. Philadelphia [Pa.]: F.A. Davis Co.

Radomski, M., & Latham, C. (2008). Occupational therapy for physical dysfunction. (Includes DVD). Philadelphia: Lippincott-Raven.

Brown, C., Stoffel, V., & Munoz, J. (2011). Occupational therapy in mental health. Philadelphia [Pa.]: F.A. Davis Co

Morris, K., & Cox, D. (2017). Developing a descriptive framework for “occupational engagement”. Journal Of Occupational Science, 24(2), 152-164. doi: 10.1080/14427591.2017.1319292.

Morrison, R., Gómez, S., Henny, E., Tapia, M., & Rueda, L. (2017). Principal Approaches to Understanding Occupation and Occupational Science Found in the Chilean Journal of Occupational Therapy (2001–2012). Occupational Therapy International, 2017, 1-11. doi: 10.1155/2017/5413628

Tobak, S. (2018). The True Meaning of 'Entrepreneur'. Retrieved from https://www.entrepreneur.com/article/244565

[lindelwamamba]

ECONOMIC FACTORS IN SOUTH AFRICAN COMMUNITIES

Money is power, freedom, a cushion, the root of all evil, and the sum of all blessings-Carl Sandburg

The World Health Organization (WHO) defines health as not just the absence of disease, but the complete sense of physical, economic, emotional, and social well-being at an individual, family, and community level. Obviously one may wondering why I have that one word underlined and in bold, but this is because the economy is closely related to money, which as described by Carl Sandburg is the answer to all problems (mostly) , well at least us who never knew what privilege is. According to my understanding the status of health or wellbeing is attributed to many factors that are meant to be coexisting together, however the main question, from critically analyzing all of this is that  how practicable is such a statement? If we think about it, just observing South Africa’s history can we boldly say that this is the vision we are working towards, I don’t know but it seems far reaching for me to think that our communities can manage to champion against every barrier they are faced with to get to that dream. Without being a pessimist but in this day and age we have to consider how the world has changed and how the government/the people in government/policy makers have forgotten about *Thabo, the young child from KwaDabeka township who has diminished chances of access to opportunities, good healthcare, a safe environment, and appropriate education due to the peak of neoliberalism.  According to news24, South Africa’s economy is lower than what it used to be between the years 1900-2000s (Cronje, 2018).

Through my experiences in this block and being in the community of KwaDabeka, what constantly came up to me is the importance to understand that the economy plays a vital part in the wellness of individuals that are found in a community. Why is this so? As mentioned in my previous blog that some problems that are currently facing KwaDabeka Township include poverty, overcrowding, poor housing, , poor service delivery especially where informal settlements are situated, lack of access to rehabilitation services, substance abuse, domestic violence and high crime rates. It is a basic truth that poverty may affect life expectancy and quality of life in general (Ncho & Wright, 2013).  So let’s revisit the case of *Thabo, who is from an informal settlement in the community of KwaDabeka, and his family of 9 make ends meet, with just an overall income of R800.  *Thabo is currently an outpatient at Clermont clinic receiving intervention for assisting him with achieving his developmental milestones after being admitted for Severe Acute Malnutrition (SAM), who even though is receiving intervention will still present with a poor prognosis due to future relapses he will experience in the future due to continued state of poverty at home. Did I also mention that Thabo is on second line defense of HAART intervention (yes we can already start envisioning a decreased life expectancy)? In our system not only is the economy affected by the government systems but also our cultural context because patriarchy is a real thing. Thabo’s mother passed the virus to him because she agreed late to initiate anti-retroviral treatment due to fear of disclosing her status to her partner at the time. Now what we’re seeing is how the lack of employment in the community for women that come from a lower socioeconomic status have been forced to depend on their patriarchal male partners for financial support.  (Stinson & Myer, 2012) confirm that indeed the refusal of women to be initiated on antiretroviral treatment can be attributed to that women  feared being mistreated by their partners, divorced or being abused by their partners, which does not help the already high prevalence of HIV/AIDS South Africa . The healthcare system Thabo has to access is different to the ones James would receive from a private practioner, who will see him consistently, clearly marking the difference between the two children, one from Westville the suburb, and the other from the township.  

The government has expressed disappointment with its track record of transforming the country after a World Bank report showed that inequality has deepened since the dawn of democracy, with the country being the most unequal society (Feketha, 2018). It is currently reported that in the year 2015 the number of people that were living under poverty in South Africa were as follows: African/Black 64.2%, Colored 41.3%, Indian/Asian 5.9%, White 1%  . This is obviously no myth because just observing the two towns, whom are both populated by predominantly a certain type of population. I can definitely attest to the statement that a good economy equals good health care as health performance and economic performance are interlinked ("Health and the economy: A vital relationship - OECD Observer", 2018), as made by the previous statement of how *Thabo and *James will access different health care systems.

The MDG’s prioritize ending poverty and hunger in communities. With reference to KwaDabeka, the ability to have to better income would improve the lifestyle of families as the community has experienced secondary problems that are due to poverty, unemployment, increased crime rates and a state o lack of motivation for the community members . Poverty in South African communities is also linked to increased chances of community members suffering from mental health illness like depression   (User, 2018) and substance abuse which can be attributed to decreased life skills, poor coping skills, and poor frustration tolerance.

What can be said however is that despite of all the problems faced by South Africa at the moment, we can never ignore the fact that the county has also come a long way since 1994, I think one of the most determining factors for seeing a change in community is to see the same passion that people were fighting with to move out of the apartheid era. I am a firm believer in that in every generation there is always a warrior that will rise up, like previous heroes that include Martin Luther King Jnr, Gandhi and South Africa’s national treasure Tata Nelson Mandela.

See you in the next blog. It really gets better.

 References

Ncho, C., & Wright, S. (2013). Health maintenance and low socio-economic status: A family perspective. Curationis, 36(1). doi: 10.4102/curationis.v36i1.22

Thematic guide: Social and economic determinants of health — MMI. (2018). Retrieved from http://www.medicusmundi.org/topics/addressing-the-social-determinants-of-health/thematic-guide-social-and-economic-determinants-of-health

Stinson, K., & Myer, L. (2012). Barriers to initiating antiretroviral therapy during pregnancy: a qualitative study of women attending services in Cape Town, South Africa. African Journal Of AIDS Research, 11(1), 65-73. doi: 10.2989/16085906.2012.671263

Cronje, F. (2018). South Africa in 2018: Is there still a good story to tell?. Retrieved from https://www.news24.com/Analysis/south-africa-in-2018-is-there-still-a-good-story-to-tell-20171207

ketha, S. (2018). South Africa world’s most unequal society - report | IOL News. Retrieved from https://www.iol.co.za/news/south-africa/south-africa-worlds-most-unequal-society-report-14125145

Health and the economy: A vital relationship - OECD Observer. (2018). Retrieved from http://oecdobserver.org/news/archivestory.php/aid/1241/Health_and_the_economy:_A_vital_relationship_.html

[lindelwamamba]

The Ideal Community in theory- but NOT Kwa-Dabeka

In the year 2000, the United Nations Millennium Declaration was signed, whereby world leaders committed to actively participate in the quest to end poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women ("WHO | Millennium Development Goals (MDGs)", 2018)  . This was followed by the introduction of global goals or (Sustainable Development Goals), commonly known as SDG’s which are a universal are call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity ("Sustainable Development Goals", 2018). Obviously a question arises for me here, why the need for such measures and implementation of such declarations? Well for me I believe this is what defines the ideal community, it represents a possibility whereby people of different backgrounds irrespective of gender, ethnicity, age can actually have an equal chance of having success. Both SDG and MDG goals are a true reflection of factors that would promote the ability of a community to flourish. Now if you are asking yourself about what are these goals consist of, the articles to this pages will be referenced at the end to provide context. Tim Cotter a psychologist who focuses in embedding sustainability in culture has a list of factors he believes that they make a community to flourish, he lists them as follows :

a)      Internal Factors

-Sustainability (Pro-environmental behaviors)

-Active responsibility or participation in the implementation of pro environmental behaviors

-Perceived control for sustainability behaviors

-Support (social norms and cultural standards)

-Knowledge for sustainability behaviors

b)      External Factors

-Community leadership

-Incentives

-Policies and Regulations

-Facilities and Infrastructure

-Transport infrastructure

-Waste management services

-Green spaces

Let me introduce you to Kwadabeka, a suburb of New Germany which falls under the district of eThekwini in the province of KwaZulu-Natal( Handover Block 2, 2018) it has no resemblance to the glorified picture of factors that are meant to make a community flourish mentioned above. Honestly even the goals of SGDs and MDGs from the UN have been poorly implemented in this community. My firsthand experience or exposure to this community was quite an interesting one, obviously because this type of settlement is different from my experience. Not in the sense that I come from a privileged background, but this community is an urban informal township with old four-room state housing, informal settlements and hostel establishments which is different from rural area. The community of Kwadabeka is also known for having the largest hostel complex in the Southern Hemisphere, the hostel was developed first then followed by bonded houses later in the 1980s [EThekwini Municipality, 2008]. KwaZulu-Natal (KZN) bears a substantial part of the national burden of poverty. The District Health Barometer (HST, 2010) reports 63% to 82% of households live on less than R800 per month, which the reality of most inhabitants of this township. This already highlights a gap in the factors that are supposed to make Kwadabeka flourish as a community and its ability to achieve the status of complete community wellbeing. Community wellbeing is described as the ability of a community to have presence of social, economic, environmental, cultural, and political conditions as identified by its member’s essential for them fulfil their potential (Wiseman & Brasher, 2008) . Without doubt one of the first impressions one might draw, with just a superficial view of Kwadabeka, poverty seems to be the most prevalent issues evidenced by high density housing, over population and the type of housing that is seen. This represents that, when compared to the goals of MDGs and SDGs Kwadabeka community has been unable to move forward for poverty alienation, and zero hunger which are important physical and social determinants of health.  Poverty in the community has contributed to social issues like crime, and this is also influenced by the high rates of substance abuse amongst teenagers in the community.

The community of Kwadabeka is also disadvantaged in terms of its ability to flourish as a community due to issues like access to clean water and sanitation, decent work and accommodation, sustainable city and communities and quality education. The township of Kwadabeka is currently experiencing a phenomenon referred to as urban decay, where we saw disrepair and decrepitude of the township and the poor state or condition of the infrastructure in this township. During our visit to schools what was also evident was poor infrastructure and overpopulation in classes. In their report, the previous block of students highlighted that this cause concern as teachers experience burnout and also have difficulty managing these classes, which affects the quality of education provided in these township schools. In can be argued that even though parents may be willing to provide better education for their children, due to their limited finances it is difficult.  

One of the incidents of the growth of the community is the social selection and segregation of the population, and the creation, on the one hand, of natural social groups, and on the other, of natural social areas. Clear distinction exists between Westville, a suburb located near Kwadabeka, highlighting words by van Kempen (1994), who states that individuals of the same race, or same vocation live together in set apart groups, and class interests. In South Africa the institutionalization of repression and discrimination under apartheid may also have begun to promote the location of certain ethnic groups to specific locations(Lewis, 1967) as we observed the contrasting environmental contexts of Westville and Kwadabeka.

Upon reviewing the factors that are currently listed or should be evident within a community setting that is flourishing, the community of Kwadabeka does not resemble that picture due to its many problem which also include poor service delivery from its own government. When doing our community assessment the people highlighted that they feel frustrated with the government they voted for, however due to their past trauma with regards to the apartheid era they would not change their party, but just have to accept their fate. Lewis(1967) explains that he found very little revolutionary spirit or radical ideology among low-income populations and most families were politically conservative. This could be the reason why the community presents an identity or being apathetic.

In just spending a week at this community, one wonders if their community can ever reach its full potential with regards to the present circumstance and whether the community will fully benefit from the goals of sustainable development. We can only hope that this change is implemented in our lifetime and we can testify of this township’s history.

It’s so nice to be back to the experience of blogging. See you in the next post. It gets better.

REFERENCES

Lewis, G. (1967). Culture of Poverty or Poverty of Culture?. Monthly Review, 19(4), 44. doi: 10.14452/mr-019-04-1967-08_7

Wiseman, J., & Brasher, K. (2008). Community Wellbeing in an Unwell World: Trends, Challenges, and Possibilities. Journal of Public Health Policy, 29(3), 353-366. Retrieved from http://www.jstor.org/stable/40207196

van Kempen, E. (1994). The Dual City and the Poor: Social Polarisation, Social Segregation and Life Chances. SPECIAL ISSUE: EUROPEAN HOUSING IN THE WIDER CONTEXT, 31(7), 995-1015. Retrieved from http://www.jstor.org/stable/43196163

WHO | Millennium Development Goals (MDGs). (2018). Retrieved from http://www.who.int/topics/millennium_development_goals/about/en/

Sustainable Development Goals. (2018). Retrieved from http://www.undp.org/content/undp/en/home/sustainable-development-goals.html

Kznhealth.gov.za. (2018). Available at: http://www.kznhealth.gov.za/family/MCWH/KZN-IMAM-Guidelines.pdf [Accessed 18 Jan. 2018].

Ethekwini Municipality (2010) ‘KwaDabeka Clermont Urban Renewal Programme Report’

[lindelwamamba]

“THERE IS NO REAL ENDING. IT’S JUST THE PLACE WHERE YOU STOP THE STORY.”

Occupational therapy (OT) education consists of two essential interconnected components: academic coursework and fieldwork clinical education (Bagatell, Lawrence, Schwartz & Vuernick, 2013).  Accreditation Council for OT Education (ACOTE; 2008) explains that the concept of fieldwork education is best integrated as a component of the OT curriculum design and ‘‘must include an in-depth experience in delivering OT services to clients, focusing on the application of purposeful and meaningful occupation and research, administration, and management of OT services’’. This is how my fieldwork experience can be described for me, with both exposure to midterms and finals. It hasn’t been all Glory and happiness though, much was required from this fieldwork and there were a few breakdowns here and there. But what would OT fieldwork be without 1, 2 or 40 break downs? LOL! It doesn’t seem like a true story right? Or maybe in your opinion we’re just being dramatic? Well, let me introduce you to the lives led be OT students.

It’s been 11 weeks friends, of hard work, dedication, late nights and early mornings. But this wasn’t all in vain, hard work definitely pays off. I went into fieldwork with a lot of fears, insecurities and uncertainty. I was not looking forward into this prac at all if I were to be honest with you, because honestly speaking Psychosocial is emotionally draining man. Unlike Physical, which I would gladly do any day, it involves a lot of abstract concepts. I mean here I am, trying to determine if my client has the ability to understand abstract concepts, when actually I’m struggling with the same. Ha-ha, isn’t it funny right? So my first impressions on my client were not so positive ones. Matter of fact it is safe that we go into fieldwork with preconceived ideas, especially with clients that suffer from mental health disorders as explained by Santalucia and Johnson (2010). Would you believe if I told you that at third year level, we ourselves harbor some feelings of stigma? Well fieldwork highlighted some of these prejudices to me. However the beauty of revelation with knowledge and empowerment is that you suddenly way too much to just do things without conscience. Obviously you would know this by now, because you have learned how I’ve dealt with some of these uncomfortable feelings around me and have moved on to having a deep desire about advocacy for our client’s with mental health disorders.

Also if you remember some of my first blogs you would understand why I felt this prac to be emotionally exhausting. I have some family members who are diagnosed with Intellectual Disability (ID). So for me, this was an experience of being on the other side of the fence, where there is a clear definite line between sympathy and empathy. So both my clients are both diagnosed with ID, and the focus of my intervention was improving quality of life through engagement in leisure activities despite institutionalization. There are definitely lot of hours spent trying to find the right activity, exploring how it’s meaningful for the client. The most wonderful discovery is realizing how occupation can be an inspiration for increasing motivation. Which is where understand theoretical frameworks like MOCA, MOHO, and the Behavioral AFR play a major role.  This is easier done when you have really built a relationship with your client as it allows you to understand them better.

My most fears with our psychosocial block was the ability to make an impact, which we were told in our first mock prac that these happen to be far and few moments in mental health. But also what we look for is just maybe an improvement from that lack of affect to just some quirky smile, and just with that you know that you are making an impact. There was this particular client (he was not assigned to any student) whom for weeks would not give us any recognition, but on a particular day came to participate in a group activity we had because he enjoyed it. We saw him light up and come into full character, and ever since that day he smiles at us when we came in the mornings and will join during our group activities. That for me was amazing to see because not only were we making some progress with our own client but with the rest of the clients in the facility as well.

Lastly, we discovered our ability to deal with conflicts and challenging situations in a professional manner (Derdall, Olson, Janzen & Warren, 2002). We learned to not take things personally and just understand why our clients presented with certain behaviors, especially because ID is characterized by poor impulse control. We all developed personal traits like increased tolerance of others, and the ability to work together as a team. This is where I stop the story as a 3rd year OT student, for now.

Let me introduce you to me, the emerging 4th year OT student and to the new series of psychosocial fieldwork. But first, let’s both cross our fingers that I make a successful landing for exams, and home  cause it’s been a loooong semester .

REFERENCES

1.       Nancy Bagatell , Jennifer Lawrence , Marissa Schwartz & Whitney Vuernick (2013) Occupational Therapy Student Experiences and Transformations During Fieldwork in Mental Health Settings, Occupational Therapy in Mental Health, 29:2, 181-196, DOI:10.1080/0164212X.2013.789292

2.       Santalucia, S., & Johnson, C. R. (2010). Transformative learning: Facilitating growth and change through fieldwork. OT Practice, 15(19), CE1–CE7. 196 N. Bagatell et al.

3.       Derdall, M., Olson, P., Janzen, W., & Warren, S. (2002). Development of a questionnaire to examine confidence of occupational therapy students during fieldwork experiences. The Canadian Journal of Occupational Therapy, 69(1), 49–65.

[lindelwamamba]

Mercy and Grace❤

[lindelwamamba]

I was only good at one thing: words. I had read more, much more, than anybody else, and I knew how words worked in the way that some boys knew how engines worked.

Jeanette Winterson, Why Be Happy When You Could Be Normal? (via stephaniecheryl)

[lindelwamamba]

So the LORD spoke to Moses face to face, as a man speaks to his friend.

[lindelwamamba]

[lindelwamamba]

Every year when January rolls around I have the urge to simplify – to start the new year fresh and clean and uncluttered. This doesn’t mean getting rid of everything (I’m faaaar from being a minimalist), just getting rid of the things that weigh you down. So, here’s the unofficial guide to simplifying without going full-on Marie Kondo. 

physical clutter

What’s the area in your room that stresses you out when you see it? Start there. A few quick tips on how to clean specific areas:

closet

Take allll your clothes out of your closet, wardrobe, or dresser

Put the things you know you’re keeping back in right away – your favorite jeans, that black dress you wear all the time, etc

Once you’re left with just the ‘maybes’, try every item on.

If you wouldn’t buy it all over again, it should probably go.

Don’t just toss what you don’t want, though! Donate it to a local thrift store, charity, or church with a community closet.

desk + shelves

Again, start by completely clearing off your desk and study area.

Go through your binders and make sure everything is in it’s correct place

Migrate materials from old classes into files out of the way if they’re important, or toss them if you won’t use them again.

 Make sure everything has a home – pencils should be in a bag or mug, papers in files or trays, and notebooks neatly stacked.

Make a point to clean your desk regularly!

If you have supplies you don’t need, donate them! Let’s be real – you have way more pens than you could ever use.

Books are also a wonderful thing to donate! Your local library or thrift shop would be my top pick. 

If you still have old textbooks laying around, list them on your school’s bulletin board to sell, since most thrift shops won’t accept them. 

under your bed

Let’s be real: most all of this can go. Grab a trash bag and toss anything that’s not important.

You can get one of those rolling tupperware under-the-bed organizers, or just stick what has to stay under there in a thin  cardboard box.

Be sure not to leave things loose under there, or you may end up with some unwanted pals living under there ~

digital clutter

I don’t know about you, but I feel like I have a lot of digital clutter. It’s so easy to build it up and forget about all that you have stored on your computer!

Go through your phone and delete photos you don’t need, apps you don’t use, and old messages. 

Do a major computer overhaul! Delete old files and programs so that you have more space.

Put all your files into folders so that they’re easier to find later on.

Take a look through your friends and following lists, and delete all those people that post negative things.

mental clutter

This is the big one. Mental clutter comes from all of the above, plus just living your life. Some tips for decluttering your mind:

Do a nightly brain dump. Before you get into bed each night, open up your journal and write down everything that’s on your mind. Once it’s on paper, you can let it go until the morning. 

Find relaxing habits to practice everyday: yoga, taking a warm bath, going for a run, etc

Practice mindfulness or meditation

Keep a planner!

Practice not letting yourself harbor bad thoughts

Stay away from negative people if you can. You don’t need negative attitudes to be adding your already stressful life!

simplify your schedule

Learn to say ‘no’ more – if you don’t want to go to your friend’s-cousin’s-niece’s dance recital, don’t.

Streamline your daily routine;

Get ready faster by nixing the makeup you don’t love to put on and finding quick and easy hairstyles

Make an outfit idea board on Pinterest and fill it with outfits that you can make from pieces you already have in your closet so you spend less time finding an outfit 

Cook meals in advance when possible, or stick an easy meal in the crockpot before you leave for the day

Tidy every room just a bit before you leave it, so that you don’t have to devote an hour to cleaning it later on

Make time for you each week

See if there are any chores that you can outsource (eg, some grocery stores will shop for you for free, all you have to do is order online and go pick it up)

Don’t feel like you have to participate in something you don’t enjoy. If you don’t love the sport, don’t play it

I hope you all have a very simple and relaxing year, good luck to you all!

[lindelwamamba]

Lysa TerKeurst

[lindelwamamba]