Year 4: Week 2
After a month and a half of refreshing holiday, setting foot on campus again for my last year (my last "First Day of Campus") was a strange, but exhilarating experience.
Two and a half weeks into fourth year, the journey has already been phenomenal. I have laughed until my ears hurt, been awed into glorious silence numerous times, held back tears as I heard mothers talk about the challenges and blessing of having disabled children, and had my senses flooded with new sounds, strange smells and amazing sights as we delved into our role as Advocates for the voiceless, the disadvantaged and disabled.
We started off three years ago as roughly hewn- but strikingly different- blocks of marble, steadily chiseled away by the years of training , until the vague outline of the therapists we will become has been made visible in the stone. All that's left this year is the intricate work: polishing and perfecting our skills, until we're ready to be released into the world to start the next stage in our OT journey.
In our first year of training, we began to understand some of the basic fundamentals of our profession: the idea that human occupation is vital to an individual's sense of wellbeing.
In our second year, we learnt to assess a person: their context, capabilities and functional impairments. In third year, we discovered how to use a holistic approach to restore function and quality of life to a person, through client-centred intervention programmes.
This year, we go one step further: not only do we now look at an individual through an integrated lens of physical, psychosocial and functional ability within their context, but we begin to expand, to look at the source of dysfunction. What causes people to require health intervention, and how can this be prevented?
According to the World Healthcare Organisation, 49% of disease and injury in South Africa can be prevented (WHO, 2008). As healthcare professionals, it becomes our role to move beyond treating the symptoms of societal ills and towards creating healthier communities that actively promote health and prevent these issues from occurring.
To understand the dynamic of a community before attempting to apply intervention within it, we have to experience what life is like in that community. If there's one thing that OT training has taught us, it's that the best way to learn about something is to immerse yourself in it as fully as possible. For that reason, week two was dedicated towards improving our understanding of the communities we will be working in over the next few months. In true OT style, that meant that this week was yet another epic learning experience.
Teaming up with speech therapy and audiology students, we spent the week discovering each others' professions, while at the same time rediscovering our diverse city and the variety of people and cultures contained within it.
Tuesday's trip to the KwaDabeka and Marrianridge communities, in which we will be working over the next few months, was a reminder of how much we have to learn about the people of our own city. KwaDabeka, home to the largest hostel in the Southern hemisphere, was a stark mix of people. Richer inhabitants, with smart homes and cars, lived right next to the ramshackle homes of the poor. A mix of informal and formal businesses dotted the streets, between taverns and shebeens, where men gathered to socialise. Schoolchildren on their way home, some as young as five or six walking alone, filled the pavements, waving at the bus as we passed. 
We all had perceptions in our minds of what the community would be like before we arrived. For me, the trip brought about the realisation that this community, like many in South Africa, was heterogeneous.
As Head described in his article: Community Engagement: Participation on Whose Terms, the commonly held idea of 'community' is:
'a euphemistic term that glosses over the social, economic and cultural differentiation of localities of peoples' and that 'implies a (false and misleading) sense of identity, harmony, co-operation and inclusiveness'
(Head, 2007, pp. 441-454).
Simply because a group of people have been brought together by necessity, living restrictions imposed by the Apartheid system, or socio-economic reasons, does not mean they share the same values or community identity.
Hence, assumptions about the community, in terms of culture, values and personal expression can not necessarily be generalised to all members of it. It's therefore essential that each person within the community be approached with a dynamic mind-set, allowing our understanding of the person, their context and their occupational expression to develop as we interact with and learn more about them.
Two other highlights of the week, both of which are imprinted in my memory as undisputed proof that I made the right career choice, were the visit by two disabled individuals from the community, and the trip to Durban's famous Markets of Warwick.
The lecture room on Wednesday was enveloped in one of the most positive atmospheres I have ever experienced as we sat in peals of laughter at the brilliant presentation given by a young man with athetoid cerebral palsy, using a computer text-to-speech device. Not only did he have a refreshing sense of humour, particularly surrounding his disability, but he raised poignant points about the lived experience of being disabled. He likened disability to a sale at a shop: have one disability, get the others free, referring to the tendency of people to assume that people with a physical difficulty also have cognitive or social disabilities as well, simply because they 'look disabled'. It brought to mind the concept that a person is only as disabled as the context in which he lives is dictates: society is what 'disables' people. 
The mother of the second individual, a young woman with visual impairment and intellectual disability, gave a heart-warming account of her daughter's struggle to find a place within her community in which she could find a sense of belonging and worth. We all smiled inside (and out) when we learnt of her placement as a teaching assistant at a local crèche, where she was able to fulfil her dream of becoming a teacher. Closing with a beautiful song that brought goosebumps to my arms, we were all awed at the power of a dedicated team determined to fulfil the dreams of the disabled.
Listening to the love in the voices of the mothers of these individuals, and the worry that lined this love: that their child would be harmed within the community, or that they would one day become too old to take care of their child, was a stark reminder that working with disabled people does not stop at the individual, but extends to the family and community as well.
Friday's trip to the Markets of Warwick was a spectacular end to a stereotype-shattering week.
Disembarking from the bus into the middle of the Market area, I could see my classmates surreptitiously tucking all jewellery into their bags and eyeing the nearby homeless people with a wary eye. We had been brought up on the idea that this part of Durban was dangerous and dirty (crime and grime...) and had consequently hardly ever set foot in this area.
However, it was interesting to discover that the vendors had taken it upon themselves to stop crime (which is, naturally, bad for business...) through mob justice persecution and election of 'safety officers' from the vendor community, meaning that crime levels had dropped significantly. This highlighted the importance of community members taking the initiative and being an active part of bringing about change within the community, because this often results in more effective and long-lasting transformation.
As we walked through the streets, passers-by and taxi conductors waved merrily, calling out 'ama-tourist' as we walked by. Being referred to as a tourist in my own city was a strange experience, reiterating the socio-economic divide that still persists nearly twenty-two years into democracy.
The sense of novelty persisted as we walked throughout the market: past little stalls of fruit and sweets, and through the health market, specialising in traditional medicine: herbs, dried animal parts, various types of wood, and centuries of knowledge passed down through the generations, which the local people claim works faster and more efficiently than modern medicine. 
We passed through the lime and incense market, filled with balls of limestone used for traditional and medicinal purposes, and incense for both health reasons and for communication with the ancestors.
The bead market dazzled our eyes with the arrays of intricate, delicate work, from jewellery to pots and hats.
The fruit and vegetable market, with prices 120% lower than the average chain store supermarket, according to our guide, held a range of fresh produce under the watchful eye of apron-clad women.
The meat market was an experience: fresh cow head, grilled and served on a wooden board, with a side of coarse bread, on one of a dozen tables laid out on the side of the road. Ash fluttering in the breeze, flies zooming overhead, cow heads lying in buckets of water, and a lone eyeball on the ground made this market a feast for all the senses...
The trip, and in fact, the week, was a reminder that I have a lot to learn. My own city holds so much knowledge, diversity and richness, much of which I have never experienced before. Working with all these people means I have to attempt to understand all these cultural nuances and identities. It goes back to cultural competence: broadening the mind to understand and adapt to the manifestation of different cultural expression in each of my clients.
If this week was anything to judge by, this year is going to be epic...
World Health Organisation (2008). Non-communicable Disease Prevention and Control, Risk Factor Reduction, Mental Health and Injury and Violence. Retrieved from: http://www.afro.who.int/en/south-africa/country-programmes/4248-non-communicable-disease-prevention-and-control-ncds.html
Head, B.W. (2007). Community Engagement: Participation on Whose Terms? Australian Journal of Political Science, 42(3), pp. 441-454
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