Our Journey has Advanced

 

Some say Emily Dickinson's poem 'Our Journey had Advanced' is about death: nearing the end of life and preparing ourselves for the final hurdle: death itself, pondering whether our destination would be the sweet respite of Heaven, or the harsh torment of Hell.

 

Whether or not the poem truly is about death, when I first read it, it seemed to speak to where we are in our OT journey: our feet are nearing the end of the windy gravel road that has been third year, with just a few final steps before we hit the base of the mountain that will be fourth year.

It seems like we've been studying for eternity, but we know that somewhere ahead lies the glittering dream of Graduation. All that lies between us and that dream is "the forest of the dead", a.k.a fourth year...

We have heard enough horror stories from the current 4ths to dread the incline ahead of us, but at the same time, we know there's no going back...

 

As much as we fear the obstacles that we will encounter in this last stretch, we know that it's going to be one of the most exhilarating journeys of our lives.

The good news is that we will not be going in blind: throughout the year, our experiences have begun equipping us with the tools we need to successfully complete this quest.

The torch of theory illuminates the path we take with each client, ensuring that we're moving in the right direction. 

During this block, I began to understand the value of the using the models and frameworks developed by the various theorists within our field. They provide a guideline that we can use to analyse our clients, as well as plan appropriate intervention.

The two models I have begun to become particularly fond of are the Model of Human Occupation - which ties together all the aspects of a person and their context into a comprehensive whole- and the model of Creative Ability- which allows clients to be placed at a particular level based on their ability to initiate action and participate in various life tasks. MOHO gives me a good mental picture of my client, and indicates where my intervention should be focused: on changing the environment to enable occupation, or on changing the person's skill or routines to allow them to perform a task better.

MoCA allows me to place my client at a level of participation, which then provides a guideline for determining the principles required for treatment sessions, to ensure it was set at the correct level for each clients. MoCA also gave an idea of the way a client was likely to present in each situation, allowing their response to be predicted, to a certain degree, which I found helpful.

 

Beyond theoretical frameworks, this block taught me the importance of research. Living in the 'information generation', we have access to almost unlimited bodies of knowledge online, not to mention the range of physical resources available in the library. The barrier to seeking knowledge is no longer so much the lack of resources, as the lack of motivation. I can attest to this, as there are books I have borrowed (and accumulated numerous library fines on...) that have sat on my desk unread for weeks at a time; articles I have downloaded and transferred to my 'OT Resource' folder without taking a moment to peruse them; and stacks of OT notes from previous students cluttering up my cupboards that I have yet to organise.

However, when I do eventually sit myself down to go through some of these resources, I find that it has a distinct effect on the way I think through my case, as it highlights aspects of a particular condition or way of looking at a particular phenomenon that I had never considered previously. With my current clients, both diagnosed with intellectual impairment, reading up on the condition highlighted areas of concern that I had not previously anticipated, such as the wide range of social implications associated with the condition. I also found that thorough research allows me to be able to justify my intervention, improving my confidence in my own abilities.

As Leonardo da Vinci said,

"He who loves practice without theory is like the sailor who boards ship without a rudder and compass and never knows where he may cast".

With the wellbeing of human beings in our hands, it's an immense responsibility to ensure we do the necessary research regarding client diagnoses, as well as keep ahead of emerging data that could affect the way we function in the professional domain. This is one aspect I have made a commitment to improve on, as although I have done more research in this one fieldwork block than I have in my two and a half prior years combined, I don't feel I have done justice to the resources I have at my disposal.

Another tool I have gathered through my travels within the wonderful realm of Psychosocial block is the importance of teamwork and collaboration with supervisors. Just as company makes a journey so much less interminable, so does having the support of colleagues and supervisors make fieldwork bearable. It goes without saying that there is a lifespan's worth of experience that we can pick up from our supervisors, but what I have begun to realise is that there is a lot we can learn from each other as well. We all interpret the world in different, unique ways, and sometimes the way someone else understands something resonates with me, and gives me an entirely deeper perspective on it. Listening to presentations on Tuesday, I was awed at the level of creativity and complexity at which each person had planned their intervention. Our minds had been pushed further than ever before, and they had begun to expand.

 

Every journey needs a solid plan. Without an idea of where we're headed, we may just fall over a canyon into the deep depths of burnout. I know that time-management is not my strong suit, so my planning for the road ahead needs to start now. From small aspects like leaving home half an hour earlier so I have enough time to park perfectly between the lines without rushing up to lectures like a maniac (which is crazy considering I live close enough to see campus from my garden) to larger aspects, like planning assignments and studying for tests earlier, so that my time spent on each task doesn't end up looking like a severely negatively skewed bell-shaped curve teetering on the tip of a mountain of stress... (I recently learnt that stress kills brain cells... which explains why I've been forgetti...)

 

 

 

I have cleared my holiday schedule (more-or-less...) so that I can review my Theory again, from anatomy and physiology to core OT concepts. I refuse to settle for being a merely mediocre OT, but rising above that will take effort: a lot of effort and discipline. My English teacher used to remind us often about being self-disciplined; when we would go over the assigned word-count in essays, she would warn us not to be 'self-indulgent'. I think the same advice needs to be applied here, to control my own life, so that I can still maintain the same balance (or attempt at balance, at least) of academic-social-sport going into fourth year, to ensure that I still lead a life worth living inbetween the demands of my course.

 

 

So as I gather myself for the last few steps of third year, and brace myself for the climb ahead, I'm thankful to be sharing this journey with so many amazing, different classmates. We may not have the same perspective all the time (and some of us have distinct weird streaks...) but that's part of what makes us get along so well. As I pack my torches of theory, and batteries of balance, I will remember to add a table-cloth of time management and canteen of collaboration to the prac-pack of my OT trek...

 

 

Beyond Cultural Competence: The Jar of Life

South Africa. Beyond our gold, diamonds, Springboks Rugby team and sunny beaches, we are known for our diversity. Not only does our multiculturalism have a rich history, we also have an amazing and unique dynamic that exists between the different cultures that make up our rainbow nation.

As we move into the third decade of democracy, this dynamic is now beginning to make its way into the healthcare sector, raising questions about what it means for healthcare providers to be 'culturally competent' and whether we need to start moving beyond competence, into a 'critical consciousness' in which culture is not restricted to a set of characteristics, but is viewed as more fluid, ever-changing and differing from person to person.


In 1999, Dr Jerome Hanley, a clinical child psychologist, published a paper entitled "Beyond the Tip of the Iceberg: Five steps towards Cultural Competence".
In it, he described a continuum developed by James Mason that moves towards the achievement of cultural competence, which he described as "the ability to work across cultures in a way that acknowledges and respects the culture of the person or organization being served" (Hanley, 1999)

The five steps along the continuum include:

• Cultural Destructiveness: lying at the most negative end of the continuum, this represents the attitudes, practices and policies that cause damage to cultures, and the individuals within these cultures. An example of this would include the infamous Tuskegee Syphilis study, which brought many ethical and racial issues to the forefront. 

• Cultural Incapacity: this occurs when the health care system unintentionally lacks the capacity to assist a particular community or minority group. For example, not having an isiZulu translator to convey important information to the patient, which can result in misunderstandings, lack of informed consent or non-compliance to treatment.

• Cultural Blindness: this refers to the provision of services with the intention of being completely unbiased, or in other words, working on the 'melting pot' theory that everyone is the same, and that culture makes no difference to provision of services. An example would be the belief that all patients should be treated equally, regardless of different cultural backgrounds and expectations

• Cultural pre-competence: Falling on the positive end of the spectrum, this represents efforts to recognise the differences between people of different cultures, and make attempts to take these into consideration when planning treatment or interacting with these people. For example, this would include using appropriate music or décor that would be relevant to the individual

• Cultural Competence: This refers to accepting and respecting the cultural differences between individuals, as well as actively working towards assessing our own cultural awareness and working towards improving our knowledge and awareness of cultural practices of different populations. This also includes building resources and cultural models that can assist with providing service to individuals of a particular culture.

 (Hanley, 1999)

According to Dr Henley,  there are three important factors that a person needs in order to build cultural competence:
1. Self-knowledge or deep thought, which allows a person to begin understanding their own viewpoints and perspectives and introspect deeply.
One lesson that OT has taught me is the importance of reflection, as it highlights innate perspectives that colour how we see the world around us. Our experiences often determine the way we relate to people of other cultures, therefore it becomes important to be aware of these potential biases, especially within the South African context.

2. Experience: Immersing yourself in a culture is the best way to understand it.
A Sierra Leone proverb that Henley uses to explain the importance of immersion: "a paddle here, a paddle there, -the canoe stays still," indicates that it takes much more than superficial efforts to truly understand a different culture.
This has never been more true than in South Africa, where there are subtle nuances between cultures in different regions, and where the more you experience a culture, the more layers and depth of each culture become evident.

3. Active efforts towards positive change
Change in behaviour is necessary, as simply being aware of the cultural background of another but not using this knowledge to actively improve healthcare provision is of no use.

However, a 2009 article by Kumagai and Lypson proposes the idea that we need to start moving beyond the current idea of cultural competence, which, they argue, restricts the idea of culture to something that can be characterised, categorised and learnt, undermining its complexity (Kumagai, Lypson, 2009).

They state that cultural competence
"is not a static requirement to be checked off some list but is something beyond the somewhat rigid categories of knowledge, skills, and attitudes: the continuous critical refinement and fostering of a type of thinking and knowing—a critical consciousness— of the self, others, and the world" (Kumagai, Lypson, 2009). 

They assert that the way in which culture is addressed in higher education needs to move away from compartmentalised teaching aimed at gathering information about other cultures, as this tends to put everyone of a certain culture into one neat basket, risking over-generalisation. (Kumagai, Lypson, 2009). 

Instead they promote a move towards integrating the development of a 'critical consciousness' into learning, training students to view each individual through a 'conscientized' lens, taking into account the various factors that interplay within the person and their context.(Kumagai, Lypson, 2009). 

Within the OT course, I feel that our learning pushes us towards development of a critical consciousness, as we are trained to look at each client from various angles, whether cultural, medical or functional. In addition, we place greater emphasis on the person's own interpretation of their culture rather than on the characteristics they would be expected to have, given their ethnicity and area of origin.
However, the responsibility lies with us to ensure that we do not approach clients with preconceived notions based on our own knowledge bases and let these beliefs cloud the true cultural expression of the client.
  

Henley, J (1999). "Beyond the Tip of the Iceberg: Five steps towards Cultural Competence". Retrieved from: http://aacu.org/sites/default/files/files/hips/Beyondthetipoftheiceberg.pdf

 

Kumagai, A.K., Lypson, M.L (2009). Beyond Cultural Competence: Critical Consciousness, Social Justice and Multicultural Education. Academic Medicine, 84 (6).

 

 

Substance Abuse: a brief review

substance abuse

n.

The use of an illegal or unprescribed drug, or the inappropriate habitual use of another drug or alcohol, especially when resulting in addiction. Also called chemical abuse.

---

substance abuser n.

 

 

 

 

 

According to the World Health Organisation (WHO), substance abuse is defined as:

 

" the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome - a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state." (WHO, 2015)

 

Substance abuse is a global issue. Not only does the uncontrolled use of substances pose a health hazard to the individual, but poses societal risks as well. According to a 2015 publication by the WHO, between 162 million and 324 million people globally had used some form of illicit drug, with

between 16 million and 39 million people experiencing dependence, or some form of drug-related disorder (WHO, 2015). Drug abuse is a risk factor for various neuropsychiatric disorders, and has been linked to acts of crime, sexual abuse and interpersonal violence (WHO, 2015).

 

A 2009 study published in the South African Medical Journal analysed the type of substances generally abused throughout the country, and the socio-demographic factors associated with substance use. The findings generally reflected that while prevalence of general drug use is steadily growing, alcohol still remains the most commonly abused substance, followed by tobacco and cannabis. In general, the highest prevalence of drug abuse was found in the White and Coloured populations, followed by the African population, with Indians having the lowest prevalence. In all populations, men tend to have a higher rate of substance abuse than women (Van Heerden, Grimsrud, 2009).
 

In the South African context, social problems, including poverty, crime and lack of healthy leisure resources, contribute to the high and ever-increasing numbers of people suffering from substance-related disorders (Crouch, Alers, 2014). There is therefore a growing need for healthcare intervention in substance-related disorders, including a need for OT intervention.

 

According to the WHO, the primary intervention for substance use remains preventative, through educational and legislative approaches (WHO, 2015). By reducing the likelihood of individuals engaging in illicit drug use, through education regarding the dangers, and preventing harmful substances from being easily accessible (except for medical purposes) the prevalence of substance abuse can potentially be reduced.

 

The unique role Occupational Therapy plays in the rehabilitation of people with substance abuse disorders is in assisting these individuals to regain the roles and patterns of occupation that previously held meaning to them, many of which have been altered by the use or abuse of a substance (AOTA, 2015). This can be done through teaching clients better ways of coping with stressors without resorting to substance use, improving the clients' assertiveness skills to withstand external pressure and improving specific other skills, such as vocational, financial or leisure-related (Crouch, Alers, 2014).

 

Other interventions would focus on improving the insight of these clients into their condition, so that they can understand the degree of their problem, and the impact it has on themselves, as well as those around them. Goal setting also becomes important, as it allows the client to set a trajectory for improvement, towards an end-state that they are motivated to achieve (Crouch, Alers, 2014). This will also allow them to monitor their own progress.

 

Especially with substance related disorders, OT handling becomes particularly important, as the therapist must be assertive and aware of any possible manipulation, but at the same time be understanding, consistent and non-judgemental (Crouch, Alers, 2014). As many people with substance dependent disorders have accompanying dependency personality disorders, it is also important that the therapist prevent the client from developing a dependent relationship with the therapist, which can exacerbate manipulative behaviour (Crouch, Alers, 2014).

 

Substance abuse and dependence is a particularly relevant issue in both the South African and global context. There is a great deal that Occupational Therapy can contribute towards the multi-disciplinary treatment of substance-related disorders, as it plays a significant role in ensuring that these individuals can return to being functional, valued members of society.

 

 

WHO (2015).WHO’s role, mandate and activities to counter the world drug problem: A public health perspective. Retrieved from:http://www.who.int/substance_abuse/publications/drug_role_mandate.pdf?ua=1 on 3 October 2015

 

van Heerden, Margaretha S, Grimsrud, Anna T, Seedat, Soraya, Myer, Landon, Williams, David R, & Stein, Dan J. (2009). Patterns of substance use in South Africa: results from the South African Stress and Health study. SAMJ: South African Medical Journal, 99(5), 358-366. Retrieved October 03, 2015, from http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000500025&lng=en&tlng=en. .

 

American Occupational Therapy Association (2015). Recovery With Purpose: Occupational Therapy and Drug and Alcohol Abuse. Retrieved from http://www.aota.org/about-occupational-therapy/professionals/mh/articles/recoverywithpurpose.aspx on 3 October 2015

 

Crouch, R, Alers, V (2014). Occupational Therapy in Psychiatry and Mental Health. 5th ed. John Wiley and Sons: West Sussex 

Pause to Ponder

In the last week before the mid-term break, tests, assignments and fieldwork days were all struck out of my diary one by one, as progressive University closures due to student protests melded into the start of our holiday, leaving us with un unexpected extra week of midterm-break.

Although there was admittedly some degree of relief at being given an unexpected reprieve from campus, what concerns me is how intense the protests were this year- the worst I've seen since starting university-, as well as how all this lost time will be regained...As it stands, my lovely colour-coded year planner is now filled with a mass of black lines and arrows as lectures, tests, fieldwork and assignments have been rearranged or postponed.

After four years on campus, my strike routine is familiar:

1. Once rumours start circulating, check social media: Facebook, where strikers proclaim their grievances and plans of action for everyone to see (but which the university and police have since failed to use effectively to identify perpetrators of violence and damage...), WhatsApp, where on-the-scene updates are rapidly posted on the various campus groups, and the student Email system, where the university sends out official (albeit extremely delayed) updates on the situation


2. Go outside and climb onto the picnic table in my garden, from which I have a view of the entire campus, and look for black smoke signifying burning tyres, chairs, washing machines, or whatever the strikers have gotten hold of to barricade entrances

3. If I happen to be on campus already, listen out for heavy marching footsteps and protest songs, sometimes interspersed with various banging noises, announcing the approach of a group of striking students. (This is sometimes preceded by the sight of panicked first-years bolting past lecture venues on their way to the nearest exit...)

However, this year, the level of destruction and intimidation far exceeded anything seen at this campus before. Although the frustration experienced by students at the decisions taken by the university regarding student funding is understandable, I do not believe that it justifies the degree of destruction that has occurred over the past week.

Driving past a news billboard the week the protests began, I was saddened to see that the damage to university property was estimated at R30 million, to replace the destroyed vehicles and equipment, and repair the buildings that were burnt during the protests.

Discussing the situation with a few older friends from other campuses brought up some thought-provoking points about generation Y, and whether the sense of entitlement common to this generation has any link to the escalating violence of student protests over the years.

According to a 2014 article by Forbes magazine, Generation Y, encompassing individuals born in the 1980s and 1990s, are characterised by a tendency to question authority, place great importance on their own opinions and are motivated by autonomy. Generation Y tends to be ambitious, likely as a result of constant sought-after affirmation by parents, the media and peers (GAIA Insights, 2015).

Having been bombarded with messages about how special and unique we each are, and how powerful our contribution to the world is, through advertising, media messages- what I call the Disney mentality- and the success stories of popular Gen Y entrepreneurs, it is possible that students believe that they are unconditionally entitled to tertiary education, which for many people equates to success, and that they are capable of achieving this through radical means.  As a generation that tends to push the boundaries, the escalation of these protests may signify the attempt to go beyond what was done before by previous students, in the hope of achieving more as a result.

However, it is equally possible that the protests are simply a symbol of the deeper anger and frustration evident in all sectors of society, that is manifesting on our campuses in a similar way as in the widespread service delivery protests across the country. 21 years into democracy, many people still live in similar socio-economic conditions as they did pre-1994, with a growing sense of frustration at the persistent inequality and poor conditions that many people expected the new Government to alleviate (Allan, Heese, 2012). With education perceived as the only way out of a spiral of poverty, it is possible that students may, out of desperation to retain their place at University, go to any means possible to ensure their grievances are heard. Seeing the tired, bleak looks on many faces as I drive past informal settlements or walk through hospital waiting rooms, I can understand why many students will go to such lengths to escape the same future.

However, I must admit that I find the strikes to be incredibly inconvenient, especially at a tertiary institution, where every day lost is a nightmare to reschedule. Usually coming at a time when tests and assignments are due and we're working frantically to meet deadlines (which a lecturer I spoke to feels is more than a coincidence... ) student protests undoubtedly cause unnecessary upheaval and distress, especially to the students living in the university residences, who bear the brunt of the disruption and intimidation. Prevented from attending lectures and practicals, and seen as "traitors" if they do, risking damage to their rooms or belongings in their absence, many res students are trapped between fear of missing out on valuable teaching, and fear of retribution from protesting students. Needless to say, the environment these students find themselves in during times of protest is not conducive to studying, putting them at a distinct disadvantage...

Nevertheless, the extra week gave many of us some time to recuperate from the first half of the semester, and review how Psychosocial fieldwork has played out so far.

Translating theory into practice has never required as much effort in other OT modules, (perhaps with the exception of Neurodevelopmental Therapy...) as, unlike working with the body in Physical Fieldwork, working with the mind in Psychosocial fieldwork is a far more abstract and complex thing.

Psychiatric disorders are not visible, therefore unlike in Physical, a lot depends on the client's subjective experience, and how they express this through their words and behaviour during therapy sessions. For the first few weeks, I felt as though I was inferring too much out of each observation with my client, and drawing conclusions based on little concrete evidence. Using craft or leisure activities, I was trying to deduce the client's functioning in daily life.
The breakthrough came during one of our student-supervisor discussions, when the importance of functional assessment and intervention was drilled into our brains.
It may seem obvious- it certainly seems like common sense to me now- but it took an absurdly long time to finally hit me that the best way to determine how a client functions in real life is to literally observe how they function in real life... by taking them into the community, or if that's not possible, to simulate as accurate a situation as possible to determine the client's real level of function.

That changed the way I approached Psychosocial assessment and intervention- instead of using arbitrary activities to assess and treat performance components, I learnt to go straight to functional simulations more suited to my client's level of creative ability. With intellectual impairment, clients have difficulty transferring skills from one context to another, meaning that it is important to teach a skill in the particular context it will be used in for the client to be able to use it effectively post-intervention.

With intellectual impairment, how a client performs in one situation does not necessarily indicate how they are likely to respond in the real world, where unfamiliarity, anxiety and poor social skills come into play (DSM IV), therefore the importance of accurate simulation and carry-over of therapy by managers and parents into real situations is of utmost importance to ensure true functionality.

Another important lesson I learnt was to narrow my focus. Instead of creating an airy-fairy treatment programme that attempted to fix everything in one go, I learnt to focus on single, practical aspects at a time. Mastery takes a great deal of repetition. Teaching a client a single task that they can carry over into their everyday lives, and reinforcing the behaviour thoroughly, is far more effective than teaching them complicated tasks that a parent will have to assist with and will therefore most likely be forgotten. Instead of teaching a client how to cook a few meals, teaching them to master making their own lunch in the mornings instead is something more realistic and relevant to their context and the time available for therapy.

Working in a psychiatric setting has, so far, been one of the most rewarding experiences. Every time one of our clients makes the smallest accomplishment, our day is made, and we go around grinning arbitrarily like lunatics. We have developed unique bonds with each client; it's heart-warming when they come to us with their problems and accomplishments, showing that we have become a part of their lives just as they've become a part of ours.

There is a lot I still have to learn: improving the carry-over of my therapy into the real world, and perfecting the balance between a holistic, but realistic lesson plan, among others.
However, I can see the growth in myself and my colleagues, as we have begun to grasp the idea of what it means to be an OT in Psychiatric and Mental health. This block has pushed us to develop more assertiveness, better people skills and stronger analytical thinking. I know that one of the aspects I need to work on is my knowledge base, as despite my ongoing research around mental health, one thing I have found is that the more I read, the more I realise how much I still have to learn, as each new bit of information opens a whole new door of exploration. I have found that the more information and experience I gain, the more confident I am in my own therapy, and the more faith my clients have in me. Therefore, I feel it's important that I continue to explore new OT models and ways of approaching intervention, so that I can offer my clients accurate and effective therapy.

We still have a way to go in terms of our learning, but with one week left of fieldwork, it's time to tie together all we've learnt, and do the best we can for our clients before we leave.

Allan, Heese (2012) Understanding why service delivery protests take place and who is to blame . Retrieved from: http://www.municipaliq.co.za/publications/articles/sunday_indep.pdf

 

GAIA Insights (2015). Generation Y Characteristics. Retrieved from http://www.generationy.com/about-generation-y-in-the-workforce/characteristics/

 

DSM IV

 

Research Day: from the safe side of the podium

 

 

The word 'research' has begun to have a strange effect on my class: a slight groan, followed by a half eye-roll, culminating in a long, tired sigh. We've just begun working on our group research proposals, selecting a suitable topic, drawing up our first concept papers and scanning library bookshelves and the world wide web for any relevant literature. It seems a mammoth task to us at this stage, with so many big words and foreign concepts, but within the space of a year, our very first research dissertation (we hope and pray) will be complete.

 

A stressful day for the OT 4th years, Monday marked Research Day: a day to present a year's work of research to an audience of parents, students supervisors and adjudicators in the dignified space of the Senate Chamber. As third year students, we were present to assist with the smooth running of the day- which for many of us involved a lot of smiling and being generally helpful- as well as to get a glimpse of what we would be in for this time next year...

  

Glancing at the programme in the morning, I was surprised at the diversity of the research, from assistive devices and prosthesis use, right up to the lived experiences of teenage mothers. Within the single field of OT, the research focus varied from children to the elderly, from the higher socio-economic bracket of society to the lower and from institution-based to community based. The range of ideas and perspectives was a stark indication of the wide scope of Occupational Therapy, incorporating nearly every aspect of society. 

The Occupational Therapy Practice Framework  defines occupational therapy as

"the therapeutic use of everyday life activities (occupations) with individuals or groups for the purpose of enhancing or enabling participation in roles, habits, and routines in home, school, workplace, community, and other settings."  

 (AOTA, 2014b)

Townsend and Polatajko describe occupational therapy as,

" the art and science of enabling engagement in everyday living, through occupation; of enabling people to perform the occupations that foster health and well-being; and of enabling a just and inclusive society so that all people may participate to their potential in the daily occupations of life"

(Townsend& Polatajko, 2013, p. 380).

Given that each person has unique roles, occupations, interests and contexts, it is not surprising that OTs are often referred to as the 'jack of all trades', having to master our understanding of each role or occupation that a person values, so that we can accurately rehabilitate our clients and return them to the occupations that have meaning to them.

According to the Canadian Association of Occupational therapy,

"The essential elements of occupational therapy practice are:

1. Presence of an occupational challenge
2. Possibility of solutions that enable occupation
3. Client–specific goals/challenges/solutions and client-centred enablement
4. Multidisciplinary knowledge base
5. A reasoning process that can deal with complexity"

In the South African context, occupational challenges are everywhere: the low socio-economic conditions faced by the majority of the population, high HIV rates, issues within the healthcare system and other contextual problems such as crime. Hence, occupational therapy has a huge role to play in our society, which we began to really appreciate after seeing the many diverse foci on Research Day.

The guest speaker made an interesting point in his opening presentation, highlighting the importance of OT in the healthcare system. He pointed out that OT is one of the few professions where the training extends beyond the course requirements and leads to personal growth as well as professional growth. I've seen this first-hand, watching my class, and myself, develop over the years.
People I've known since first year have matured in an amazing way, revealing deeper talents and complex worldviews that were hidden just a few years ago.
Three years into the course, I find it difficult to meet people without automatically starting to analyse their life. I see a beggar on the roadside, and wonder what events have led up to him being there, and what other roles he holds in life. I go into someone's office and can't help looking for clues about their personality and interests beyond the work sphere. It fascinates me to ponder how complex we all are, shaped by our context and experiences.
I once met a student from Wits who asked 'What do they teach you guys in OT? You all have such a different way of looking at the world'. It's true: OT teaches us to see beyond face-value, converting our 2D, black and white perceptions of people into glorious 3D colour wheels.


Watching the fourth year students on Research Day, I could see the years of training emerge, as each group considered the various factors contributing to their participants' experiences, tying it all together succinctly. The use of narratives and personal quotes from participants highlighted the person-centred approach of our profession.
It was a bit intimidating to hear how they wielded heavy OT and statistical jargon and watch their creative presentation styles, considering that we would be in their shoes- and what beautiful heels some of them managed to manoeuvre in...- in just a year.

Research Day was a great opportunity to gain some inspiration for our own research. We noted down some wonderful ideas from the 4th's, such as the use of creative diagrams and flow charts to present our information in a more visually appealing manner , as well as the use of auditory input, in the form of voice recordings or quotations, to add to the richness of the presentation. Watching how the Person-Environment-Occupation model and the Model of Human Occupation were used to explain and interpret research findings was helpful, as it made us start thinking along better lines when planning our research design.

Research Day was a wonderful event. Not only did we get to see our colleagues at their most professional (there is hope for us!), we were reminded of the many opportunities for advancement within our field. In the unique dynamic that is South Africa, we have access to an amazingly diverse population, with a plethora of issues that come into play. This presents us with an unparalleled opportunity to add valuable input to the global body of Occupational Therapy knowledge, which is currently distinctly Western-centred.

Research Day presented us with a new challenge: to learn from our predecessors and return in a year to add our small bit to the volume of knowledge built up by those who came before us.

Canadian Association of Occupational Therapists. (2012). Profile of occupational  therapy practice in Canada. Ottawa, ON: CAOT.

Townsend, E.A. & Polatajko, H. J. (2013). Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation, 2^nd Ed.. Ottawa, ON: CAOT.

Casual Day 2015

 I made the long walk from my car to the campus bus stop on Friday morning (a walk that always seems much longer on the way back in the afternoon...) laden with bulging activity bags, a chalkboard and a small mint-coloured sticker affixed to my jacket.

Casual Day had arrived, a day to celebrate people with disability, and we were pulling out all the stops to make sure our clients had an unforgettable experience.

Unlike the usual sea of blue, black and white, made up of the uniformed OT and Physiotherapy students, the bus stop on Friday was dotted with the colours of our various spring-themed outfits, garlands and flowers, in accordance with the 2015 Casual Day Theme: Spring into Action.

According to the Casual Day website,

"Casual Day is South Africa’s foremost fundraising campaign for persons with disabilities and is the flagship project of the National Council for Persons with Physical Disabilities in SA (NCPPDSA).(It is) a campaign that invites all fun-loving South Africans to dress differently for a day to raise funds and raise awareness of persons with disabilities."

 

(Casual Day, 2015)

To celebrate Casual Day at our fieldwork venue- a protected workshop setting catering for individuals with intellectual disability and various mental illnesses- we decided to hold an adapted Sports Day, incorporating fun activities, music and team spirit.

Our aim for Casual Day was threefold: to reduce institutionalisation of the clients by breaking their usual routine and encouraging spontaneity, to encourage teamwork and a sense of team spirit, as well as to simply make the day a true celebration of the people we were working with.



As our taxi pulled up to the venue that Friday, we experienced a moment of collective affection for our clients as we noticed the splashes of red, blue and yellow amongst the green, marking the three teams for casual day: the Red Ferraris (my amazing team!), the Blue Violets and the Yellow Lions. The clients had taken a great deal of care with their appearance, sporting flowered hats, multi-coloured temporary tattoos and a variety of floral accessories.
We were impressed.


Excitement was in the air as we disembarked from the taxi with all our luggage and began to set up.
The first activity, musical chairs, was a firm favourite of the workshop clients. The combination of movement, music and competition got everyone energised, starting the day off on the right foot. What I loved most about this classic game was that it was an equaliser for all the clients- whether high- or low-functioning- as it was simple enough that everyone could grasp the rules and have an equal chance to do well.



The competitive element became more evident in our second game of 'duster hockey', a hockey-like game played with brooms and a rag or paper ball. Initially, we had teams of two playing against each other, but after a mild altercation and one broken broom, the game was downgraded to a series of one-on-one matches, with people of equal abilities paired together. The best part of the game was watching how team members cheered for their participants, reinforcing a sense of inclusion and team spirit.

After tea, the merriment continued, with a tennis-ball and spoon relay, a hula-hoop competition, and finally a beanbag toss. The excitement mounted as the scores on the scoreboard rose steadily, and students, staff and clients all joined the fun.

It was wonderful to watch the way quieter individuals gained confidence as the day progressed, and the way those who were initially reluctant to participate were drawn in by the fun atmosphere.


On Friday, I developed a deeper understanding of what it means to develop an 'enabling environment', a space that encourages and allows clients to perform to the best of their capabilities (WFOT, 2012).
By setting the games at a level suited to every client, and creating an atmosphere that encouraged participation, people who would ordinarily have been unable or unwilling to engage in activity were able to join in, increasing their sense of self-efficacy and self-esteem.

Although it had been stressful to plan a day that we hoped everyone would enjoy, we hadn't anticipated the level of fun and learning we would get out of Casual Day. It will definitely remain one of the more positive memories of Psychosocial Fieldwork, the sort that overrides all the stress we associate with this module and makes it all worthwhile.

 

 

 

 

 

Casual Day (2015). What is Casual Day? Retrieved from http://www.casualday.co.za/what-is-casual-day/ on 4 September 2015

 

World Federation of Occupational Therapists (2012). Definition of Occupational Therapy. Retrieved from http://www.wfot.org/AboutUs/AboutOccupationalTherapy/DefinitionofOccupationalTherapy.aspx on 4 September 2015