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