Is Social Media the Answer to Health Promotion? An Occupational Therapy Student’s Perspective

In times such as these, during a pandemic, social media has been a huge support in creating awareness, informing people of restrictions and disseminating advice. But are the communities which make up the vast majority of South Africa’s population really going to gain knowledge about the Coronavirus through Facebook posts and twitter videos?  So what else is there? What can be done to improve health and educate the people that make up South Africa's impoverished communities?

I have been working as a student occupational therapist within the Kenville community in Durban for the last 5 weeks and I have been able to observe the response to the Coronavirus in this community. The weekend after it was known that there were a few Coronavirus cases in KZN, posters were put up in the Kenville community clinic and pamphlets were handed out with regards to hygiene advice. It made me realize how the health promotion and education strategies within the communities are vastly different to the world that I know. Please find attached a link which describes why the next two weeks with regards to the Coronavirus in SA are so critical: https://m.news24.com/SouthAfrica/News/next-two-weeks-are-critical-20200318

The limitation of social media is a result of the digital divide in the population. Socially disadvantaged groups often do not have access to new media and social networking due to language, literacy disability or other barriers (Korp, 2006). Also, when the server is down or when the internet connection is not available, participants are disconnected from the program and do not have access to the information available on these websites.  In a community such as Kenville, where smart phones are few and far between, social media is the last resort to health promotion for this community.

Of course, Social media, such as FB, Instagram and twitter, have been found to make a difference in terms of promoting health, such as exercise for those susceptible to obesity or promotion of education around certain diseases. Examples of successful media advocacy are the use of the media by Treatment Action Campaign in South Africa to raise public awareness regarding the lack of access to adequate care for HIV infected people in the country. (Sana, 2006) However, the vulnerable populations that require education around health aspects the most, include members of the South African communities who do not have access to these apps.

The mass media helps health workers expand their audience reach, which is crucial considering the fact that face-to-face channels of communication often require too many human resources and reach only a small number of people in large, underserved rural areas. The mass media provides an important link between the rural residents and vital health information. Here are some examples of alternative health promotion options from Unite for Sight (2010).

1) Radio and television are effective mediums for persuading target audiences to adopt new behaviours, or to remind them of critical information. They can help inform the public about new diseases and where to seek help, or even keep the public updated about immunization campaigns. They can empower rural populations to fight major causes of infant mortality such as diarrheal dehydration and diseases which can be prevented through vaccination, teach new health skills, promote new health behaviours and increase community acceptance of health workers. (Unite for Sight, 2010)

2) The pillar of the Unite for Sight mass media programme is a 45 second radio spot. Radio spots are quick and easy to produce and broadcast. Unite for Sight broadcast dozens of spots on over ten FM stations in South Africa. As the results were successful, they developed short rural radio programmes by recording local skits and brief interviews with parents. In places where radios are still the primary medium of entertainment, they can be used with great success as health communication tools. They are not only cheaper and more readily available in rural areas, their programmes can also be adapted to suit local needs in terms of language, culture and values. (Unite for Sight, 2010)

3) The distribution of posters, pamphlets and leaflets in clinics created by specialized health bodies can circulate vital health information reliably. Alternative mass media health promotion activities include: Articles in newspapers and magazines, as well as health promotion talks about different illnesses / disabilities to the masses of people in the clinic lines. As students we have been assigned a task to publish an article in a magazine or newspaper for health promotion purposes.

Through this block I have realized the importance of OT’s working at a primary health care level. At the beginning of the block I questioned our importance at the clinic, suggesting to my supervisor, “I feel as though those children at that creche require our help more than the children that we are screening at the clinic?” This statement showed my lack of understanding of primary health care in OT at the beginning of the block and how much I was about to learn!

Please find attached a link if you wish to read further on health promotion strategy techniques: https://www.annualreviews.org/doi/pdf/10.1146/annurev.pu.10.050189.001145

We as OT students have encouraged health promotion during our time at Kenville community. Examples have included speaking to community members in the clinic lines, providing health promotion tips for mothers and their babies/ children as well as working with the schools.

The OT students in Kenville perform many health promotion projects within schools. The concept of ‘Blaumier’ was implemented with high school students in Grade 11, from Sea Cow Lake Secondary High School. This initiative uses drama, art and music to educate the students on health promotion concepts. For example, the pupils have performed substance abuse poems in groups, as well as teenage pregnancy role plays. The OT students also travel to the primary school to present to the grade 5 and 6 classes on substance abuse, with a meaningful educational activity regarding the topic.Parenting skills regarding disability prevention and health promotion  is a specific role of OT’s involved in primary health care. An important primary health care concern is the screening of children for developmental delays during immunisation visits to the clinic. (Naidoo et al, 2016) An example of this is when I had to inform a mother that her 3-year-old child has autism and provide weekly therapy, together with creating a home programme. A second form of health promotion is with regards to maternal health and well-being, which the OT students screen for and provide necessary therapy. 

Naidoo et al (2016)’s study also suggests OT’s need to be working with teachers in schools to identify and help pupils with learning disabilities. The OT students are working with Kenville primary school, once a week, to provide occupational therapy to specified learners. The OT students have also formed relationships with a couple of creches in the community where children are screened and health promotion strategies are provided to the creche volunteers, such as teaching some English, as well as teaching basic numbers, shapes and colours.

In conclusion, impoverished communities in South Africa rely on a multitude of health promotion tools for education purposes. Social media is therefore not the ultimate form of health promotion in South Africa. Health professionals need to work hard, through the use of relevant media, to ensure adequate health promotion and prevention strategies are performed in these communities and improve health awareness. My challenge to OT’s is to ensure health promotion is in as much of your practise as rehabilitation strategies are, and to ensure social media or small talk are not your only efforts in this regard. OT’s are extremely necessary in primary health care settings.

References:

Korp, P. (2006). Health on the Internet: Implications for health promotion. Health Education Research, 21(1), 78-86.

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), 9 pages. doi:https://doi.org/10.4102/phcfm.v8i1.1139

Sana, L.. 2006. Community Health Advocacy. Epidemiol Community Health. 60:458–463. doi: 10.1136/jech.2004.023044 

Unite for Sight. (2010). The Role of Media in Health Promotion. Retrieved on 20/03/2020 from https://www.uniteforsight.org/health-communication-course/module5

A Focus on Sustainable Development Goals in Communities for Aspiring Occupational Therapists

Will South Africa Achieve the sustainable development goals (SDG’s) by the projected years? For example, the goals suggest ‘complete poverty and food insecurity eradication by 2030’. Although the country-wide goals are seemingly hopeful and a lot of change needs to occur within the next 10 years for them to even seem possible, I can play my part. Within the Kenville community at which I am placed, I can ensure greater SDG achievement. As an OT student at this community we have provided health promotion and implemented multiple effective projects. Five of the sustainable development goals shall be discussed with how we as OT students have aimed for systematic change, relating to these goals, within this community. Please click on the link below if you would like to understand the situation of poverty in SA more http://www.un.org.za/sdgs-series-article-1-poverty-in-south-africa/

The first SDG which will be discussed is goal 2: No hunger. This goal suggests that food security is more than just the availability of food; it also encapsulate issues of affordability, nutrition/food utilisation and stability of food supply into the future. (Statistics, South Africa, 2017) The OT students are starting a project to assist community members who do not have food security and suffer from nutritional deficiencies, through starting a vegetable garden. Community members have poor nourishment, as a result of poverty and do not ensure a balanced diet. The CCG’s will distribute the crops to the most-needy families at the time of crop harvest. An example of someone who would benefit from this initiative is a client with a leg amputation, who has recently suffered from a stroke and lives alone on top of the community hill, with no family support.

‘Ensure healthy lives and promote well-being for all ages’ is the third goal. The NDP envisages South Africa having a health system that works for everyone and produces positive health outcomes by 2030. (Statistics, South Africa, 2019) Health promotion is encouraged through speeches given in the Kenville clinic community lines. The OT students have also improved health promotion strategies through an interesting initiative known as Blaumier, at the high school. Topics such as substance abuse and teenage pregnancy are discussed and educated through dramatic performances, done by the pupils.  Once a week, the students have also been going to the pre-primary school discussing substance abuse with the children in grade 5 and 6. The mothers and babies’ groups have proven successful, as well as the screening of babies and children have ensured important health promotion towards child development and maternal health. The OT students also screen young children at the various community creches when going on home visits. The OT service provision has been extremely effective in providing rehabilitation to clients, as well as home visits to particular clients. Two examples of this include a 17 year old spinal-cord injury (SCI) client who is no longer using his wheelchair but rather a walker, enabling greater independence in every day activities. Another example is the OT student recognizing a client from the community recently had a stroke without him being informed by the hospital, and therefore ensuring a weekly treatment stroke programme is performed.

Please find attached a link which describes the SDG’s of SA in more detail file:///C:/Users/sutto/Pictures/SDG_Baseline_Report_2017.pdf

Goal number 4 states that the country should ensure inclusive and equitable education and promote lifelong learning opportunities for all. Free, quality education leading to effective learning outcomes should be apparent by 2030 ( Statistics, South Africa, 2019) I am currently facing the difficulty of finding an appropriate school for my client with a physical disability after his SCI.  According to one of the young Community Care Giver males, the cost of school fees for the year at Sea Cow Lake Secondary High School is R1200. This is a reasonable price considering the socio-economic status of the Kenville community and the community members can therefore afford their necessary education. The students are currently working with the foundation phase pupils of Kenville Primary School providing intervention to the pupils who are not coping, such as autistic, ADHD and fine-motor problem cases.

The poor stimulation of children causes a delay in child development for many of the community babies and children. This poses threats towards their ability to cope when they begin school. The OT students have started a programme with Siyasizana creche, allowing for greater education stimulation, as well as provided them with toys and the opportunity for occasional outdoor play. Unfortunately, the creche has an estimated 20 children, in a small shack, with limited air flow. The children are between the ages of 6 months and 5.5 years and there are only either one or two ladies to look after all of them each day. Attending to children of multiple age groups threatens the stimulation and growth necessary for the older children before entering primary school. For example, the children have poor English skills, including naming shapes and colours. The students have put up multiple posters, provided education cards and stimulated the children through activities once a week. The students have also encouraged carry over by the ladies who run the creche. The OT students are also performing a study skills workshop for pupils within the Marion ridge community to assist with greater educational performance.

Another South African SDG goal by 2030 is to achieve full and productive employment and decent work for all women and men, including for young people and persons with disabilities, and equal pay for work of equal value. According to the NDP, South Africa must find ways to urgently reduce the alarming levels of youth unemployment and to provide young people with broader opportunities. (Statistics, South Africa, 2019) An alarming number of clients who come to occupational therapy are unemployed. The students encourage return to work through rehabilitation, work hardening and work conditioning, however the community is drastically poor and the reality is that many clients have not had a job within the last 5 years. The students encourage their clients to return to work or find a job. My SCI client’s 27 year old brother is unemployed. He is a strong man with great potential. In a discussion with him he has agreed to find work again as a butcher, with previous experience and skill in this work field. Another opportunity to encourage the youth to find employment would be to educate the Grade 11 and 12 learners at the high school, of the potentials after high school. It would also be important for them to understand the bursary and scholarships available for them to apply to, in order to receive a tertiary education

Goal 11 states that we should make cities and human settlements inclusive, safe, resilient and sustainable. The average residence period within urban informal settlements has increased from about two to four years in the early 1990s to 10 years currently. (Kgame, 2018) The community suffers from poverty related crime and violence. The high school stated that they have lost all their expensive equipment e.g. computers due to theft. An unfortunate case that the OT students are dealing with is a 10 year old pupil who has been roped into a gang of high school boys who do drugs and steal from houses. The students have informed the principal of this and are having weekly sessions with the child. The provision of health care rehabilitative services has created an awareness of care and inclusivity for the community and creating an element of greater health safety assurance and efforts.

Please find attached the link which explains how SA is doing in achieving these goals: https://www.globalcitizen.org/en/content/south-africa-progress-UN-global-goals/

There’s no doubt that South Africa faces various significant challenges when it comes to achieving the SDGs — mostly as a result of the injustices caused from its apartheid past. Ending extreme poverty by 2030 is an ambitious goal, and to achieve it energies must be focused on supporting the most vulnerable. It requires everyone, including ordinary individuals and leaders, to play their part to ensure that the Sustainable Development Goals remain our focus. 

References:

1. Statistics, South Africa. (2017). Sustainable Development goals: Indicator Baseline Report. Retrieved on the 13/3/20 from file:///C:/Users/sutto/Pictures/SDG_Baseline_Report_2017.pdf

2. Statistics South Africa. (2019). Sustainable Development Goals: Country report 2019. 1-316. ISBN 978-0-621-47619-4

3. Kgame, M. (2018). How Close is South Africa to Achieving the Global Goals. Retrieved on the 13^th of March 2020, from https://www.globalcitizen.org/en/content/south-africa-progress-UN-global-goals/

4. Picture retrieved from Facebook.

My positionality and its new found realities, which have significantly impacted my life.

My heart broke as I gazed into the 10-year old boys eyes from Kenville Primary school, who described his experiences over the past few months to me, Jenna (Cue child’s possible mindset: ‘A western, white girl, wearing scrubs, who probably wouldn’t understand the realities of his world’). Hugging the boy I asked, “You aren’t escaping school for no reason, why have you been absent for 12 days? I am here to help you”. The pupil would not open up to the principal and his teachers. I began asking yes or no questions as his teary-eyed face would shake yes or no. My mind flooded with options as I realized what it was. Are you being forced to do bad things? Head nods. Do these high school boys beat you up if you refuse to climb through the window and steal? Head nods, as he lifts up his chin to reveal the scar from their forceful hands clawing him down on the tar road. THIS IS THE REALITY OF SOUTH AFRICA – this 10 year old little boy. Not the well-kept, strict and highly academic, model C schools that I’ve come from. This leads me to the important topic of positionality and how it can affect our occupational therapy community-based practise.

At first when I looked at the topic for this blog, I will be honest and state that I cringed and rolled my eyes. It is a very subjective topic, which would call on me to reflect deeply. Positionality can be defined by the experiences you’ve had which shape you as well as your opinions on social situations. (Witmitz, 2015) I then started to recall the realities of this topic and delve further into the impact it has on my community occupational therapy practise. I’ve decided to compare the truths of what I’ve experienced during the community block to my own reality.

I am currently sitting on the veranda overlooking the Mount Edgecombe golf course, at sunset, as I write. Yes, the place where the Carona Virus is suspected. Of course, as only the well-off would have been able to afford to travel to these affected places. I have this yearning for all of these people to experience what I finally have. How their worlds are currently shaped, their minds formed, and their hearts moulded based on inauthentic realities of their own country. And of course, our generation doesn’t quite grasp it, as we weren’t born in the era of apartheid. We sit on our comfy couches, understanding that there are extremely hungry children and homeless people a couple km’s away, or even under our nearest bridge, begging. But do we really understand it???

Subjectivity is deeply connected to the social and political structures in our lives that outline our behaviour and experiences. (Thomas, 2014) Let me introduce myself: My name is Jenna Sutton and I am 21 years old. I am a female who has grown up in a middle class, white family. I have had the privilege to be raised by a wonderful caring family, with strong values. However, every large extended family has their possible conflicts and complications. I understand that the ability for families to live up to such values can be greatly inhibited by unequal access to power and resources. I have been going to church since the young age of 5 and find comfort in the understanding of the gospel and Jesus’ unconditional love.  I have been extremely fortunate to complete my matric and go on to study. I am currently in my final year of occupational therapy at UKZN. I have been in a relationship with my boyfriend for 5 years. South Africa, Durban, has formed my home my entire life, and I have travelled overseas on two occasions, to New York and England. Now that I have stated my own positionality, I would like to take you all into the world I have currently been journeying through, whilst describing why it’s important to consider positionality when assessing conditions and creating programmes for the people of these communities.

Working in the community has exposed me to the truths behind poverty. An example of my experience in this situation is going on home visits and walking alone in the community. I entered my stroke client’s home hesitantly, not knowing what to expect. A shack - not even the size of my bedroom. With multiple gaps, allowing the rain to sweep through. Their two year old child stays with her grandmother as a result of their poor living conditions. They get to see her during occasional holidays, such as Easter. His wife had significant burns after their paraffin stove burnt her. The family sometimes chooses to not use the broken, disgusting communal toilet and rather find a bush. Although, these realities weren’t what opened my mind the most. My walk back to the clinic took me at least 20 minutes and there were multiple steep hills I had to climb. My stroke client has to do this walk every few days to get to the clinic. This was a new experience of truly understanding context. The difference between asking the patient to draw their house for you in order to suggest adaptations etc, was insignificant in comparison to viewing it with my eyes and commuting the way they have to. This truly exposed me to delving deeper into understanding one’s context before treating the patient.

Viewing the poor creches and the lack of stimulation for the children, crammed in the small shack, from the ages of 6 months to 6 years deeply saddened me. It in fact, almost, made me a bit angry. I had to reflect on this and remember the realities of poverty in Kenville. The wonderful ladies running the creche are most likely not well educated, they definitely don’t have a teaching degree and they are more than likely volunteering to look after these children. My positionality and degree in OT evoked my emotions and I needed to remind myself of the truth behind the matter.

Another significant situation of the Kenville community includes substance abuse. I have never been exposed or offered any significant drug my entire life. The realities of the community are that they are exposed to drugs at an extremely young age. Alcohol abuse is considered a norm and broken bottles litter the dusty streets. My colleague and I are currently working with a grade 11 class promoting health promotion through dramatic pieces. We have noticed a few children (even only within this class) who were not in the right mind frame and had definitely been taking a substance that morning or between classes. Please click on the following link if you would like to read more on drug use amoung the youth of South Africa: https://citizen.co.za/news/south-africa/1179509/drug-abuse-is-growing-in-sa/  I finally understand the true reflection of drug abuse. I never understood it completely until now. This leads me to my next eye-opener topic: The experiences of the homeless. Please find attached the link to the Denis Hurley Centre, a foundation which provides many services to the homeless to which you would be able to donate food to, if you wish: http://www.denishurleycentre.org/?AspxAutoDetectCookieSupport=1

United States Conference of Mayors, 2008 asked 25 cities for their top three causes of homelessness.  Substance abuse was the single largest cause of homelessness for single adults (reported by 68% of cities).  Drugs consume people’s lives and easily destroy them. I only recently learnt that it’s not just about being addicted to the substance, but it is more importantly the withdrawal symptoms which cause the substance to sabotage their lives. Without the substance they go crazy, and therefore have to take it daily. This is a main cause for the crime as they need to get money to consume the substance. Without understanding this and the context behind it, I would have treated the clients in an insignificant and meaningless way. Another understanding of context include their experiences. One of my homeless clients stayed in prison for four moths after the police planted heroin on his bag, in order to arrest someone for the day. After engaging with homeless people and understanding their poor circumstances and the reason behind their lack of support, I have a new found respect for them. A type of respect that only they deserve. I have witnessed a man protecting his disabled wife by placing her in a safe shelter, so that she was no longer on the dangerous streets of our city centre. He cares for her on a level I cannot explain. An incredible artist, an amazing song writer and a beautiful poet all form part of them.  They don’t want this life. Many people think they do. It’s extremely difficult to escape. Please find attached a link which further describes the lives of the homeless living in Durban if you would like to understand this extremely vulnerable population more: https://www.groundup.org.za/article/homeless-durban-dumped-outside-city/

I have realised that I need to ensure the values, assumptions and beliefs which I have inherited don’t affect the work I do in assessing clients and formulating programmes for the communities which I work with. I need to constantly be mindful of how I am constructing myself, which influences my decision-making for the community and I must understand how others might choose to construct me. I would like to conclude my blog with this quote, as it exposes the mindfulness that needs to be inherited, despite being 25 years post-apartheid.

References:



Mcintosh, P. (2020). Picture Quotes. Retrieved on the 6^th of March 2020 from http://www.picturequotes.com/olusegun-obasanjo-quotes

Thomas, A. (2014). Exploring my Identity through my social context. Retrireved on the 5^th of March from https://www.youtube.com/watch?v=Sz3RPZeqGFk

United States Conference of Mayors. “Hunger and Homelessness Survey:  A Status Report on Hunger and Homelessness in America's Cities.” 2008. Available from http://www.usmayors.org/uscm/home.asp.

Witmitz, B. (2015). Positionality. Retrieved on the 6^th of March 2020 from https://otmakingyousmile.blogspot.com/2015/04/positionality.html

The Realities of Maternal and Child Health and the Impact of Occupational Therapy Services

As one of the mothers stumbled through the Occupational Therapy doors of Kenville clinic, after trudging a couple km’s along the community’s river streets, in treacherous rain, with her one year old on her back, no umbrella and just a large, plastic bag to try keep them dry; it was then that I realized how important motherhood is. This is her first born baby and she will do everything she can to receive support and advice on how to raise him and maybe receive a little company. On the other hand, a teenager as young as 14 and a half will walk through the door with her 5 month old baby and her 5 year old brother. Support, education, advice and encouragement of all mothers and their children can make the world of a difference.

ODPHP. (2020) describes maternal health as the health of women during pregnancy, childbirth, and the postpartum period. With reference to the Clark, O. (2016) article, it states that the care of the mother has to be intensive in prenatal care, but also postpartum. The mother needs to be well, both physically and mentally, to take good care of her child. While motherhood is often a positive and fulfilling experience, for too many women it is associated with suffering, ill-health, and even death. (ODPHP, 2020) Improving the well-being of mothers, infants, and children is an important public health goal. Their well-being, healthy growth and development determines the health of the next generation and can help foresee future public health challenges for families, communities, and the healthcare system. (Murphy, 2017)

The findings of (Parush, S., Lapidot, G., Edelstein, P., & Tamir, D, 2018) support the two hypotheses: early intervention performed by occupational therapists had a significant influence on the knowledge, attitudes, and practices of mothers with regard to their infants' development. It is understood that the structured developmental stages provided by the occupational therapist maximizes the mothers' awareness and understanding of their children's needs for optimal development. The youngest mothers and the mothers with firstborn children were the ones most positively influenced by their program. This suggests that intervention programs are most beneficial for those who have not had previous child-rearing experience and therefore have not experienced handling techniques. Detailed guidance in sensory development information equipped the mothers with knowledge to provide their infants with appropriate sensory stimulation, stimulation that results in adaptive motor responses in the infant. 

After having never worked in paediatrics in OT before and then having to assess and treat babies who are a couple weeks, or months old as well as children, it was extremely overwhelming. I stumbled my words, had every file possible alongside me (just in case), tried my best to look and sound a little professional and then realized: “All I really need to do is play and make those critical observations, decide on my clinical reasoning and display health promotion techniques towards a healthy development for the child to the mom”. I realized it wasn’t as daunting as it seemed. As each baby walks in it gets easier. Running the mothers group today was a fun experience- singing songs, blowing bubbles, playing with toys and chatting to the moms about their babies. They all felt encouraged by the group and enjoyed it. 

Rahman, A. & Surkan, P. etc. (2013) reminds one that the myth that maternal depression is rare has been proven extremely unfitting. Another common perception is that depression is a construct of well-off Western societies that is uncommon in traditional communities. Perinatal depression has been reported in all cultures. Contributing factors related to depression in women include poverty and persistent poor health; a poor relationship with a partner (including intimate partner violence); insufficient practical or emotional support from the family; few confiding relationships and lack of assistance in crises; social adversity; limited control or participation in financial decisions or reproductive health, crowded living conditions, lack of employment; and coincidental adverse life events. A number of these contributors are realities faced by mothers in rural communities. Sepulveda, A., & Hanish, k, 2019, reports that maternal mental health disorders affect 10-20% of new mothers and can negatively impact infant development as well as maternal well-being. Furthermore, MMH disorders can disrupt the mothering role, mother-infant attachment, and cooccupations which can further negatively affect the health and well being of the infant, the family, and the society at large.

Occupational therapists (OTs) in paediatric settings treat the child as their client. However, they fail to fully consider a mother’s mental health. (Sepulveda, A., & Hanish, k, 2019) As I reflect on this past week I realize I too have fallen short of this standard, assuming the mother’s are always well, if no instantaneous sign of depression is apparent. This research has reminded me to not only assess the baby’s health and development but also ensure the mothers are coping.

Whilst starting to comprehend OT’s role in maternal health, I then wondered what specifically we would attend to. Leanne, LLC. (2017) discusses the following: OT’s may serve in child and maternal health in the following ways: Adaptations and Environmental modifications, Analysis of daily activities, Breastfeeding support, Energy conservation, Ergonomics and body mechanics, Exercise and sleep, Infant development, Pelvic and core health, Play as a co-occupation, Postnatal mood disorders, such as postpartum depression and postpartum anxiety, Stress management and Time management.

In conclusion, the complications that arise in a rural community when it comes to raising children as new mothers, single mothers, teenage mothers, working mothers or as special needs mothers causes extreme challenges for the child, as well as the mother’s health. This is why a primary health care opportunity such as OT health services is an important means of support for maternal and child health. This research opened my eyes to the benefits we provide. Maternal and child health is an important component of healthy societies and economies. I’d like to end this blog with this thought-provoking quote as it enlightened me exponentially to the realities of our world. Although it does not necessarily relate to maternal health, the reality of poverty in a rural setting deeply affects mothers and child-rearing. 
“It would be nice if the poor were to get even half of the money that is spent in studying them.”   — William E. Vaughn, columnist

References:

Clark, O. (2016). Maternal health: the importance of caring for mothers is a crucial factor in the health of children. Retrieved on the 27^th of February from https://www.kantarhealth.com/blog/otavio-clark/2016/05/06/maternal-health-the-importance-of-caring-for-mothers-is-a-crucial-factor-in-the-health-of-children

Leanne, LLC. (2017) Maternal insights. Retrieved on the 28^th of February from https://www.maternalinsights.com/news/occupational-therapy-and-maternal-health

Murphy, C. (2017). Boone County Health Department: Public health: Maternal and Child Health. Retrieved on the 28^th of February from https://boonecounty.in.gov/Offices/health-department/Public-Health-Nursing/Maternal-Child-Health/Child-Health

ODPHP. (2020). Healthypeople.gov. Maternal, Infant and Child Health.Retrieved on the 27^th of February from https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health

Parush, S., Lapidot, G., Edelstein, P., & Tamir, D. (2018). Occupational Therapy in Mother and Child Health Care Centers . American Journal of Occupational Therapy, Vol. 41(9), 601-605. https://doi.org/10.5014/ajot.41.9.601

Rahman, A., Surkan, P., Cayetano, C., Rwagatare, K., & Dickson. (2013). Grand Challenges: Integrating Maternal Mental Health into Maternal and Child Health Programmes. Retrieved on the 27^th of February from https://doi.org/10.1371/journal.pmed.1001442

Sepulveda, A., & Hanish, k. (2019) The Role of Occupational Therapy in Maternal-Infant Mental Health. Retrieved on the 28^th of February, 2020 from https://congress2018.Los Angeles,USAwfot.org/downloads/abstracts/SE%2077/The%20Role%20of%20Occupational%20Therapy.pdf

Learnings in this block

“Vulnerability is the birthplace of innovation, creativity and change” (Brown, 2011).
I feel as though I have had to be vulnerable and have expressed many emotions throughout this block with the friends I’ve shared it with. I have had to expose my areas of weakness, lack of understanding and develop in vital areas, to create a more admirable therapist. This block was emotionally and physically draining, however my prac group were very supportive of each other and I am extremely grateful for them.

“There are no secrets to success. It is the result of preparation, hard work and learning from failure” (Powell, C). This block has taught me so much as a person and a developing therapist. As a person it has taught me to take every day as it comes and keep going, because the end is near. As a student OT, I have realized the great impact research, clinical reasoning and client context has on the treatment you provide and sessions you plan.

According to (Greenwood, Beth) these are the qualities which make a good OT. I will elaborate on how I have grown in these areas.

Communication and Listening

“Interpersonal skills and ability to communicate with your patients are vitally important. First, you must listen to your patients, who can explain how they feel or what their symptoms are”. I feel I have developed in my interpersonal skills, when communicating with my patients. I have learnt how to handle many new situations, when dealing with acute psychotic patient’s, such as using a therapeutic face when they dive into their world of delusions. I learnt how to express my concerns with empathy and how to ask my patients questions about their concerns, which are vital to gain context to formulate a problem list. I also learnt through midterms how important it is to receive collateral information, as Mr L’s sessions would have had a complete turnaround, had I gathered this information sooner. The client, blinded by the word ‘discharge’, barely answered any of my tests, or interview questions honestly.

Organization and Problem-Solving

“Much of OT work involves solving problems, according to OT Career Path. An OT needs organizational skills to manage her own daily activities and schedule as well”. As a student OT, I have come to terms with the fact that organization is the key to successful sessions. Even having a note written for reminders during the session, a notebook, pen and forms readily available allows created a more productive day. Organization in terms of researching and planning treatment also falls into this section. I have improved greatly in this area and will continue to grow through its value. Time management is also vital. I have definitely learnt to treat faster and use my time more wisely. Through this I have grown in my confidence and handling of patients during treatment sessions.

Compassionate Care

“Compassion, empathy and patience are necessary skills for an OT and are often driven by a desire to help others. A patient who is suffering from an illness may be grieving for her lost skills or the life activities she once enjoyed”. I do my best to develop therapeutic relationships with my clients so that they feel we have developed a safe, trustworthy relationship. I have learnt to show compassion for their struggles and develop aims alongside them. 

I learnt something valuable through my finals client, and I was mad with myself for doubting her strengths until the last second. Mrs J is a shizoaffective client and she explained in my first session with her that she had published a book. She mentioned the title and that it was on amazon. After having dealt with an extremely delusional client for midterms, I completed disregarded this achievement not believing it was true. After observing her writing strength through a poetry session, I decided to research the book she had mentioned. My client had a five star book published on Amazon. Not only would she possibly have felt saddened by me not ever mentioning that I had looked up the book, but it would have improved her mood and self-esteem too. This was an important learning experience.

My plan for my psychiatric block in fourth year is to not be as shy; to try more complicated activities, such as baking, cooking and extravagant art work. Psychiatry treatment, through occupational therapy, is abstract. I have always been frustrated by this, but I have realized this provides an opportunity for me to explore my strengths in psych and I should make the most of it! After fourth year, we will need to determine our OT path and I am undermining my strength in psych. I should therefore grab it by the hands and explore it on a deeper level, because I have finally discovered its great importance and worth. Dealing with Bipolar Disorder, Schizophrenia Spectrum Disorder, Personality Disorders and Schizoaffective Disorders in third year will be an experience I will never forget. I am extremely grateful for this opportunity.

It is the first time I have effectively worked in an MDT, despite the difficulties a student faces with this important skill. When I called the client’s social worker for collateral and I was the first to inform her of  the client’s discharge, I began to experience the true feeling of being health professional.

In conclusion, this psychiatric block showed me the impact OT’s can have on psychiatric patient’s lives. The patient’s don’t realize how much they give to us as students, whilst we try our best to improve their quality of life and enrich their circumstances. This acute hospital taught me valuable life skills, taught me how to deal with discharge (haha) and forced me to understand patient’s context on a much deeper level, in order to do what is best for them. 

References:                                                                                

1. Greenwood, Beth. "Qualities of a Good Occupational Therapist." Work - Chron.com, http://work.chron.com/qualities-good-occupational-therapist-26306.html. Accessed 24 April 2019.

2.  Gibbs, M. 5 Powerful Quote’s from Brene Brown’s Ted Talk. http://empowerlounge.com/5-powerful-quotes-from-brene-browns-tedtalk-about-shame/

3.  Powell, C. Failure Quotes: Brainy Quotes. https://www.brainyquote.com/topics/failure

Research Day

On the 25^th of September, the OT department had their research day. This is the day in which the fourth years take to the stage and present 1.5 years’ worth of blood, sweat and tears, in just 10 minutes! The third-year students were responsible, along with Mr P, to ensure the day ran successfully and we got the opportunity to listen to the 5 fourth year research presentations.

It was really interesting to learn more about the different topics, which were each so unique and interesting.  The groups were so well co-ordinated, from the attire worn, to the quality of the PowerPoint presentations. It left me in awe of the hard work they had put into this, but also left me speechless for what the year ahead is going to look like. Am I equipped to produce such efficient work? I thought that this day was very important for us to gain insight into what is expected of us in fourth year and how the Research Day of presentations will berun.
The research presentations quality were exceptional and really set the bar for the UKZN, OT research standard. Some of the topics which interested me were “The Impact that Strike Action has on OT Students”, “Substance Abuse in OT” and “The Impact that Oculocutaneous Albinism has on Individual’s Occupational Participation”. Their presentations were all so well-rehearsed, it was immaculate.

At the end of the day the students gave us advice for Research and working in teams. Some advice was humorous and some was extremely useful. They told us to use our strengths and to be honest about our weaknesses.

Research has definitely hit my group with a bang. I have never exactly been the leader in my previous groups, as other personalities, who stress more than I do, have taken over in the past. However, when I realized my group was extremely passive and nothing was being said, and therefore, nothing was being done, Iknew I needed to take on this role. Wow... it has not been easy. To be honest, I am extremely jealous of the fourth years who are about to be finished with the Research module.  

Some people don’t do their work. Full stop. Other people do their work, but unfortunately struggle to perform sufficiently in certain sections, as a result of writing in their second language. It is my first time witnessing the struggles that my fellow friends face, trying to study in their second language.

This has lead to me having to redo people’s parts, or rather informing my supervisor that I will redo them, after this hectic week. Unfortunately, this puts a huge burden on the rest of the group to perform at the necessary standard.

As Gina informed us last week Monday to have our proposal in by Friday, we had to divide the work into 6 and each person chose their roles. This method did not work out, as students had chosen sections they were not competent at and within a very hectic week, students did not put in great effort.

In our meeting with Gina, we discussed our difficulties in communication. With advice from fourth years in the same room too, we have developed new strategies.

1)      The group will not split up the parts but will rather meet weekly, for two hours, with defined objectives to complete.

2)      Each person is required to respond with a yes or no to suggestions made on the group to show alignment and take responsibility.

3)      Within our group of 6, we will pair up, and each have objectives to complete within those two hours.

According to University of Waterloo. (2019), To function successfully in a small group, students need to be able to communicate clearly on intellectual and emotional levels. Effective communicators:

• can explain their own ideas


• express their feelings in an open but non-threatening way


• listen carefully to others


• ask questions to clarify others’ ideas and emotions


• can sense how others feel based on their nonverbal communication


• will initiate conversations about group climate or process if they sense tensions brewing


• reflect on the activities and interactions of their group and encourage other group members to do so as well.

According to University of Waterloo, 2019, the following is necessary when forming a new group: Individual responsibility and accountability, constructive feedback, problem solving, management and organization and knowledge of roles.

“Intra-professional team building in occupational therapy is critically important to the vitality and expansion of the profession. Teamwork must be a cognizant process; knowledge and multiple skills are required in order for therapists and assistants to work together successfully” (Blechert, Christianson & Kar, 1987). Our profession requires necessary team work skills and experience, which is why a task like this, provides us with important learning opportunities.

I am excited by my groups research topic and Research Day made me realize how the effort will all be worth it in the end. Here’s to learning to work in a team with many different personalities, growing my leadership skills and working together to produce an impactful report and presentation in 2020.

References:

University of Waterloo. (2019). Teamwork Skills: Being an Effective Group Member. Retrieved on the 6^th of October 2019, from https://uwaterloo.ca/centre-for-teaching-excellence/teaching-resources/teaching-tips/tips-students/being-part-team/teamwork-skills-being-effective-group-member

Blechert, T.F., Christiansen, M.F., & Kari, N. (1987). Intra-professional Team Building. American Journal of Occupational Therapy, 41(9), 576-582.

FunnyAnd. (2019). Every Group Project at School. Retrieved on the 6 of October 2019, from http://funnyand.com/every-group-project-of-school-file/

An Inspirational Day

On Thursday, the 26^th of September, the OT third year class fell in love with OT again. As Debbie put it, OT students become more drained by their degree as the years progress. A day, such as this, sparked a sense of motivation in each individual again, after months of exhaustion. Most students fall out of love with the degree, because of its intensity and the way it takes over ones life.

The first person to speak was a lady who is the founder of the foundation, Action in Autism. Her speech was extremely comprehensive and interesting. I enjoyed the examples she gave of her child who has Autism. She established the foundation after realizing the poor support for Autism in our province and country. The Action in Autism, (2019) website describes autism as follows: Children with autism show marked impairment in social interaction, verbal and non-verbal communication, and limited and restricted interests and behaviour. It is a neurodevelopment disorder and occurs in the first three years of life. There is ongoing uncertainty about the cause, treatment, intervention and prognosis within the condition. International statistics indicate that 1 in 68 children have autism. The cost of caring and providing for a child with autism is huge – the child in most cases requires 24-hour care. Many parents are unable to take their children into public spaces. Since the young age of 2, I have spent a lot of time with a family friend who has autism. My family friend is 22 and I have had multiple unique experiences with autistic behaviour, as a result. Many people don’t understand this diagnosis, which is why these client’s struggle to integrate into their communities effectively.

An autistic man, age 19, came to speak to us about his experience with autism. As a young boy, his anxiety was a major problem. He explained that it was his occupational therapist that got him where he is today. What I found to be extremely interesting was his emphasis on the fact that an autistic child’s sensory problems should be the main priority and the psychological problems are secondary. The speaker continued, describing his discomfort with psychiatrists compared to his OT and this is because they did not understand this concept. He provided us with a tip wih regards to how his OT managed to use brushing and compression to remove his hand-gesturing, flapping tendencies when he was in an anxiety-provoking situation. The client struggled through schools, with some only suited to physical disabilities, others with poor teachers, trying home school and then the difficulties he faced with teachers showing him ‘special attention’, when going to a regular school from Grade 9 to 11. The speaker has since gotten a diploma in IT and is planning on moving to the UK next year to live independently and get a job there. As you can imagine, each one of our OT hearts were bursting with pride, understanding how far he has come through therapy.

We then had a discussion from a head social worker at NPC about how the centre is run, followed by a client from the rehabilitation unit. This is what this client had to say, “I started in the name of fun and it led to me killing someone. Don’t do drugs and choose friends wisely. I grew up in a good, supportive home. I ended up stealing from that home”. To hear the raw truth of how the drug completely took over his life captured all of us. He would steal, destroy, lie, abuse ad even kill someone to support this poor habit. This put the diagnosis into perspective for me. He described how his OT student, this semester, has helped him delve into the inside, as he has always focused on the outside. Through this he realized his relapses on many occasions was not only out of boredom, but to seek attention from his mother. He stated that his OT student has helped him more than his professional social worker. This had the whole class in laughter and very proud of our friend. Getting to ask these clients raw questions about their diagnoses, which we had not yet been exposed to, really helped grow my experience as a student. According to Opp, A. (2019), Occupational therapy practitioners study the habits and behaviours of clients that occur each day, throughout the week. They display to clients how their behaviours and thoughts revolve around drugs or alcohol and how they lose their identity, as they lose the roles most meaningful to them. Practitioners then construct or rebuild those occupational roles by determining what activities bring clients the most joy and sense of well-being—without drugs or alcohol. I researched this to understand our role in this sector and thought this paragraph appropriately reiterated our purpose when dealing with substance abuse.

Down Syndrome is a diagnosis I have not been exposed much to in my life time and it was therefore interesting to listen to a mom share her wisdom on this diagnosis. I have a great heart for children with this diagnosis and am excited to work with them in the future.

In conclusion, a session like today was extremely educational. To hear patients’ explain their positive experience with OT and how it helped them, definitely re-inspired our class and reminded us of the purpose and impact we can make. I believe sessions like this should take place once a term.

References:

Action in Autism. (2019). What is Autism? Retrieved from https://actioninautism.org.za/what-is-autism on the 27^th of September 2019.

Opp, A. (2019). American: Occupational Therapy Association. Recovery with Purpose: Occupational Therapy and Drug and Alcohol Abuse. Retrieved from https://www.aota.org/about-occupational-therapy/professionals/mh/articles/recoverywithpurpose.aspxn on 27th of September 2019.

MB. (2019) 21 Motivational Quotes to Motivate You to be Successful in 2019. Retrieved from https://www.mulliganbrother.com/single-post/2019/01/30/21-Motivational-Quotes-to-Motivate-You-to-Be-Successful-in-2019 on the 28^th of September 2019.