What is culture?... And what does it mean for us health care providers...

Culture... A word we all know but do we know what it means?
It may not seem important to most but it is becoming more and more pertinent in Health Care as it forms an integral part of the services we provide therefore allowing the 'delivery of high-quality medical care to all members of society'

In an article I read based on this very topic there were a few things that stood out to me. These were:

If we 'treat the concept of culture as static you are at risk of objectifying individuals whose appearance, language, national origin, religion, sexual orientation is different from majority into overly simplistic descriptions of character and behaviour'....

And culture 'is not rigid and is beyond knowledge, skills and attitudes more a type of thinking and knowing- a critical consciousness- of self, others and the world'

And lastly..
'To have this critical consciousness is not learning lists of attributes or a set of questions. It is the development of knowledge and awareness to carry out the social roles and responsibilities of a physician"

SO culture.. a very simple easy word but with a very complex, extremely broad definition. For me, culture is a hard concept to grasp and so my "critical consciousness" is definitely still developing. I even youtubed videos to try gain some clarity.. This is what I stumbled upon:

https://www.youtube.com/watch?v=57KW6RO8Rcs

Culture is our way of life... Culture is everything really...

But anyway one a lighter note, maybe we all just need a little bit of a culture shock.. watch this:

https://www.youtube.com/watch?v=EkZyvDZFC8Q

OT's and substance abuse :)

Project presentations are over and its hit home that prac is finished until next year.. We were required to make a video promoting an  OT service at the prac placements we were at. We did our video on promoting OT for drug rehabilitation as its an area many are unaware that we work in! I've been waiting to post this so please sit back and enjoy :):)

simply words...

Its not mystery that a lot has been running through my poor brain over the last 9 weeks of prac and something's that I and those close to me continuously repeated to say are similar to what is represented in these pictures below... and I want these to stay in the back of my little brain especially now going into final third year exams and  then of course the big daunting 4th year.... 

MY SOUTH AFRICA

This warmed my heart whilst reading it.. hope it warms yours too

“My South Africa is the working-class man who called from the airport to return my wallet without a cent missing. It is the white woman who put all three of her domestic worker’s children through the same school that her own child attended. It is the politician in one of our rural provinces, Mpumalanga, who returned his salary to the government as a statement that standing with the poor had to be ...more than just a few words. It is the teacher who worked after school hours every day during the public sector strike to ensure her children did not miss out on learning.

My South Africa is the first-year university student in Bloemfontein who took all the gifts she received for her birthday and donated them – with the permission of the givers – to a home for children in an Aids village. It is the people hurt by racist acts who find it in their hearts to publicly forgive the perpetrators. It is the group of farmers in Paarl who started a top school for the children of farm workers to ensure they got the best education possible while their parents toiled in the vineyards. It is the farmer’s wife in Viljoenskroon who created an education and training centre for the wives of farm labourers so that they could gain the advanced skills required to operate accredited early-learning centers for their own and other children.

My South Africa is that little white boy at a decent school in the Eastern Cape who decided to teach the black boys in the community to play cricket, and to fit them all out with the togs required to play the gentelman’s game. It is the two black street children in Durban, caught on camera, who put their spare change in the condensed milk tin of a white beggar. It is the Johannesburg pastor who opened up his church as a place of shelter for illegal immigrants. It is the Afrikaner woman from Boksburg who nailed the white guy who shot and killed one of South Africa’s greatest freedom fighters outside hishome.

My South Africa is the man who went to prison for 27 years and came out embracing his captors, thereby releasing them from their impending misery. It is the activist priest who dived into a crowd of angry people to rescue a woman from a sure necklacing. It is the former police chief who fell to his knees to wash the feet of Mamelodi women whose sons disappeared on his watch; it is the women who forgave him in his act of contrition. It is the Cape Town university psychologist who interviewed the ‘Prime Evil’ in Pretoria Centre and came away with emotional attachment, even empathy, for the human being who did such terrible things under apartheid.

My South Africa is the quiet, dignified, determined township mother from Langa who straightened her back during the years of oppression and decided that her struggle was to raise decent children, insist that they learn, and ensure that they not succumb to bitterness or defeat in the face of overwhelming odds. It is the two young girls who walked 20kms to school everyday, even through their matric years, and passed well enough to be accepted into university studies. It is the student who takes on three jobs, during the evenings and on weekends, to find ways of paying for his university studies.

My South Africa is the teenager in a wheelchair who works in townships serving the poor. It is the pastor of a Kenilworth church whose parishioners were slaughtered, who visits the killers and asks them for forgiveness because he was a beneficiary of apartheid. It is the politician who resigns on conscientious grounds, giving up status and salary because of an objection in principle to a social policy of her political party. It is the young lawman who decides to dedicate his life to representing those who cannot afford to pay for legal services.

My South Africa is not the angry, corrupt, violent country whose deeds fill the front pages of newspapers and the lead-in items on the seven-o’-clock news. It is the South Africa often unseen, yet powered by the remarkable lives of ordinary people. It is the citizens who keep the country together through millions of acts of daily kindness.” -Jonathan Jansen

DOWN SYNDROME IS NOT AN ILLNESS

We had an external lecture last week on Down Syndrome which I was unable to blog about until now. The lady who spoke to us has a daughter with Down Syndrome and she spoke a lot about her daughter, showed us pictures etc. and a few things that I found valuable that I took away from her lecture was these:

• Down syndrome may cause disabilities however IT IS NOT an illness
• People with Down syndrome have thoughts, feelings, hopes and interest and they know what they want from life!!!! Something I think most forget
• They have their own individual personalities just like we all do!
• They will be as independent as we ALLOW them to be
• They have the same needs that we do

Watch this video of  Megan as I think she gets the point across better than I can :)

https://www.youtube.com/watch?v=YOwDfnoek6E


     Don't limit them... allow them to teach you something about yourself

Closing of yet another chapter...

So 9 weeks later prac has come to an end but somehow it doesn’t even feel like it. Extremely fast 9 weeks. Extremely full 9 weeks. So much occurred in my time on prac that it’s kind of hard to think back and take it all in…

I think one of the biggest realisations I have had this semester due to being placed at a drug rehabilitation centre is that the PEOPLE we work with are human beings. They are not patients. They are not clients. They are not service users. They are simply people… and they need to be treated that way. Maybe it’s because I was working with very high functioning people and could form proper relationships with them all. But having a relationship with the guys I was working with was so great. It helped to move away from the stress and pressure of doing our treatment demonstrations and presentations and whatever else and just sit down and have a conversation with them. And not only that but upon leaving prac on our last day when they turned around and thanked us for what we had done for them. It’s not often that you get that and for me it made the last unbearably stressful 9 weeks worthwhile.

Going into prac I had a picture in my mind of a drug addict. This low life, good for nothing person. A picture most of us go through our entire lives carrying. But wow was I so wrong. Not only were these guys at NPC PEOPLE, they were more intelligent, genuine, friendly and willing than 99% of the people in our lives that we call ‘normal’. I found myself sitting up late at night working on prac stuff not because I was worrying about my marks and passing prac but because I wanted it to help and benefit my guys as much as possible. I wanted desperately to help them as much as I could. And for me that’s what I walk away from this prac with. The satisfaction of knowing I did at least something, no matter how small that something may be, that helped to change the lives of the guys I worked with…. The satisfaction of that….. Not marks…

I knew going into this prac that it was going to be nothing but tough. I knew I was going to be pulled and pushed in a thousand ways. So yes it was hard, the hardest prac has ever been for me but weirdly enough having said that it has been my favourite prac thus far. It has grown me and moulded me and most of all it has humbled me. I am undoubtedly not the same person I was when I arrived at NPC 9 weeks ago on the 13 August 2013.

About 4 weeks ago I was collecting sports equipment so that we could take it to NPC for the guys to use and whilst doing this someone very close to me turned and said “why would you want to get stuff and give it to drug addicts”. I was so angry at the time I could not even give an answer to that ignorant comment. But now I’ll tell you why. Because those drug addicts are people, really great people. People who can teach you and make you realise more about this life and yourself than anyone else.

                                                           "An addict is someone who
                                                          uses their body to tell society
                                                            that something is wrong." ~
                                                                   STELLA ADLER

HAPPY MAIL

It sounds really awful to say but during most of my practical's in the last 2 years I've always at some point had thoughts that the treatment and things that I'm doing with my clients isn't really beneficial or making a difference because sometimes it is unrealistic because we only there certain days of the week and for a few weeks... sometimes our learning and academic reasons out weighs the benefit for the client as horrible it is to say that, it is true... This is something that's always sat in the back of my mind and has bothered me and so I have always tried my best to ensure that my clients are benefitting as much as possible...

Today I received an email that changed this for me and gave me such intense happiness. Last semester on my physical prac at a chronic hospital I did a vocational rehabilitation programme with my hemiplegic client where we set up a muffin baking business for him to sell within the hospital. I made him adapted equipment and trained him in all the skills he needed in order to bake the muffins and sell them. Even though I had set it up in a way to ensure sustainability, ever since I walked out of that hospital on the last day of my prac there I have wondered whether he was still baking and selling his muffins. This is the email I received from my supervisor who was with me on prac:

Dear Amy

 

Just a quick encouragement to let you know that Mr Ndlovu is doing really well at Hillcrest hospital… he comes every Friday to bake the muffins.

 

It truly is remarkable how this has impacted his life.  Thank-you for your contribution

 

Knowing that I made some form of a difference whilst being a student in the process of learning has made me extremely happy. The satisfaction that I feel is amazing and if this is what it feels like to help people and change lives through occupation I really cant wait until I'm doing it every single day of the week, not just twice a week.

Two steps back...

This week on prac I learnt a big lesson... I have a new client who undoubtedly has a personality disorder (which I feel very strongly is the borderline type) although there is no formal diagnosis as yet. Tuesday was my first treatment session with him and before that because we went on holiday we left all our clients with some things to work through during the week we were away. Mainly things like values clarification, self discovery exercises and some questionnaires. So I arrive on Tuesday all planned for a session with him in my mind thinking I wont let him manipulate me I will be in control blah blah blah....

Well did that turn out badly.. I could not even do the session I had planned because he proceeded to question me as to why I was asking him so many questions in the documents I gave him, what did I want from him and it progressively got worse until he started interrogating me and telling me I was a young white girl that knew nothing and many other rather soul piercing things.

Naturally you want to get defensive but I knew that would only make the situation worse and in my head I kept saying he is manipulating you, he is just doing this to get his way....

But I then thought no, maybe he has reason to feel threatened. I had literally just gone in asked him a long spread of questions and then given him more stuff that picked at very personal pieces of information. Fine for a client without a personality disorder who can understand the process and what my intentions were but for someone like him it made him very paranoid and resulted in intense feelings of dislike towards me.

So now I have to take it two steps back with him and purely work on forming a trusting open relationship with him before I even think of starting to address some of his problems.

Even though this client does have a personality disorder I needed to take a look at my own actions and see that what I had done was actually causing the problem and it could easily cause problems with a client who has no personality disorder.

First take a look at yourself...

WFOT Position Statement Human Right's

We were told to read the WFOT Position Statement on Human Rights which has the purpose of stating the World Federation of Occupational Therapists (WFOT) 'position on human rights in relation to human occupation and participation.' When I was reading it for some reason the fact that the word 'occupation' was in nearly every line just made me think about the word and everything that is attached to it. Maybe it is also to do with the fact that I have been exposed to so many different definitions and explanations of the word that I still do not really know what it is, which is weird because I am studying to be an Occupational Therapist.
 Here is examples from the paper to illustrate what I am talking about:

'People have the right to participate in a range of occupations that enable them to flourish, fulfil their potential and experience satisfaction in a way consistent with their culture and beliefs'

'People have the right to be supported to participate in occupation and, through engaging in occupation, to be included and valued as members of their family, community and society'

'People have the right to choose for themselves: to be free of pressure, force or coercion; in participating in occupations that may threaten safety, survival or health and those occupations that are dehumanising, degrading or illegal'

This paper is speaking from an Occupational Therapy perspective and because we are Occupational Therapist then we may say it is obvious why occupation comes into everything and is so important. But I don't actually think it is that obvious because why occupation? Why is occupation so important? And quite honestly what is occupation? Most people don't fully understand occupation and how rich the word occupation actually is which is okay but us as OT's owe it to ourselves and our clients to understand this concept of 'occupation' that is central to our field of practice. WFOT defines Occupational Therapy as a 'profession concerned with promoting health and well being through occupation' so our therapy is THROUGH OCCUPATION. Because of this we should view humans and their occupation through very different eyes compared to the rest of the world. Instead of looking at a client and thinking this person has poor range of motion, poor memory, grade 2 muscle strength etc we think or at least we should think what are the occupational problems so what are the difficulties that they are having in order to be engaging in what they want to or need to. But when occupation is so hard to define or pin point its not that easy to identify these 'occupational challenges' that the person is facing.
 
All occupational therapists dread the question 'what is occupational therapy?' and I believe this is the reason why we hate it. Because occupation can be simple but at the same time it can be so complicated. Occupation can be defined as 'anything that people do'. There plain and simple. But then what is anything and why do we do that anything or in what way or when do we do that anything. We should be the one's that understand the complexity of occupation. Occupations are not just something that happen to us, we engage in them in a very active sense.
 
I think one of the big problems with us as OT's is that we get stuck in this literally 'active' sense of occupation so we think ah but you just sitting there you not doing anything. But one does not need to be physically doing something in order to be 'actively' involved in an occupation. We may look at an old man sitting staring out a window thinking as doing nothing and not being engaged in an occupation. But him sitting there thinking about his childhood and memories from his youth well that is an occupation.... Ya not so simple anymore... What is also complicated about occupation is the exact same occupation for example going for a run can be very different in terms of meaning, purpose and importance for two different people.
 
Something that can help this pickle about occupation and its importance is an example I saw where an HIV positive patient measured his health in terms of his occupations. He was not interested in his CD4 count and all the rest but instead identified his health status in terms of his changes in occupation, his occupational patterns and the occupations he could and couldn't do. I find that interesting because that is actually how we should be viewing people and their illness as OT's. But because occupation is so hard to pinpoint we often move towards treating memory or treating muscle strength because it sometime seems easier but at the end of the day we are beyond those individual components of memory, tone, joint range, coordination etc we are the bigger OCCUPATION picture and we need to not be afraid and allow ourselves to view the world through different eyes and make use of our very specialised skills and expertise. But easier said than done.. its not that simple

"MEDIA'S DAMAGING DEPICITIONS OF MENTAL ILLNESS"

 

Movies provide us with endless entertainment and there is not many people that can say they don't like to get under a warm duvet on a cold day, make some popcorn and watch a marathon of movies. Many movies have portrayed mental disorders or have had mental disorders as underlying themes, some paint a great picture of what these disorders are truly like but most paint an unattractive and inaccurate picture. You may be wondering why this is a problem because "It's just a movie right?" but research has proved that most people get their knowledge and perceptions about mental illness from these types of movies. This results in them having this fear of and discrimination towards people with mental illness feeding directly from the perspective they have had painted from them in their minds from a movie they have watched. These movies don't only cause damage to the viewers and their perceptions, it also leads to discrimination of people living with mental illness as a result of the stigma that has become attached to it.

 

We were requested to do an essay on a movie depicting a mental illness focusing on how accurately the movie depicted the particular mental illness with reference to the DSM IV criteria. I did mine on Silver Linings Playbook and below is the essay that I wrote. It should give some insight into the issue that I am talking about here. Quite honestly though if I weren't studying OT I would not know any better and my perception of mental illness would be the one was given to me from the media. So here it is:

Silver linings playbook is a film about a man, Pat, who snaps upon discovering his wife in the shower with another man and in pure rage beats the man almost to death. As a result he loses his job and is sent to a mental health facility when it is discovered that he has undiagnosed bipolar mood disorder. After eight months of treatment he is released from the facility into the care of his mother and father. He soon learns that his wife has left him and obtained a straining order against him after the violent episode. He is determined to get his life back and to reconcile with his wife. The main focus of the analysis will be on how the main character Pat displays symptoms common in bipolar mood disorder during the film.

People with bipolar disorder can experience both manic and depressive episodes due to the fact that it is a mood disorder that involves both ends of the spectrum. Pat displays characteristics typical of a manic episode throughout the film. The following are common symptoms displays during a manic phase:

• “Excessive happiness, hopefulness, and excitement
• Sudden changes from being joyful to being irritable, angry, and hostile
• Restlessness, increased energy, and less need for sleep
• Rapid talk, talkativeness
• Distractibility
• Racing thoughts
• High sex drive
• Tendency to make grand and unattainable plans
• Tendency to show poor judgment, such as impulsively deciding to quit a job
• Inflated self-esteem or grandiosity - unrealistic beliefs in one's ability, intelligence, and powers; may be delusional
• Increased reckless behaviors (such as lavish spending sprees, impulsive sexual indiscretions, abuse of alcohol or drugs, or ill-advised business decisions)

Some people with bipolar disorder become psychotic, hearing things that aren't there. They may hold onto false beliefs, and cannot be swayed from them.” (Goldberg, 2012)

At the beginning of the film Pat is in denial about his illness which is a common symptom for patients with a mental illness and serves as a defence mechanism for them. It is very common for patients in the recovering process to begin lacking in compliance with their medication as they begin to feel better. This is not only an issue of denial but also a lack of intellectual insight into their condition. For patients with bipolar it is hard to find a reason to take medication if they do not have insight into the fact that there is something wrong with them. This is displayed by Pat in the movie through actions such as spitting out his pills when no one is watching, arguing with his mom about going to therapy and saying “I am not sick, I do not want help” as well as when another character in the movie who is also mentally ill says to him “I’m like you” his reaction is one of pure shock and offense as he does not believe that he has an illness and is “crazy” like her. These all display to us that Pat is in denial and is extremely defensive when it comes to accepting that he has a mental illness - he does not think he is sick, he is angry with his doctors and does not want their help and believes that he can beat his illness on his own which tells us that he has decreased intellectual insight into his condition which is a typical symptom of bipolar disorder. (Watkins, 2012)

During a manic phase patients can present with an elevated mood and hyperactivity where they have delusions of grandeur, meaning they have an inflated self-esteem and feel they are invincible and are superior to others. This leads to characteristics such as having a decreased need for sleep, channelling of their increased energy into a particular behaviour or task as well as disturbances of speech such as flight of idea’s, pressured speech and loosening of associations. In the film Pat has no desire to sleep and stays up all night reading only sleeping for short periods of time when he does go to sleep. Pat also runs excessively. He goes for extremely long distance runs every day during which he wears a black plastic bag so that he can sweat more in order to lose weight which he explains is so that he can get into shape for Nikki his ex-wife. Pat also displays disturbances in his speech as throughout the film he talks incredibly fast rarely stopping to take a breath. He is also grandiose in the film which is evident in a particular scene in the movie when he passes the comment “Maybe people like me, Dani and Tiff (all characters in the film with mental illnesses) know something you guys don’t know. Maybe we understand something you guys don’t”. This displays that he believes he is superior and has some form of “super power” that the average normal person does not. These indicate to us that Pat meets the criteria for mania as he does not sleep, he is grandiose and he has pressured speech.

Patients experiencing a manic episode not only have impaired intellectual insight but also impaired emotional insight. This can be combined with impaired judgement resulting in behaviours and features such as not considering other people and their feelings, not understanding the consequences of their behaviour and often being intrusive and tactless. These particular characteristics are very evident in the film. Pat upon finding his wife in the shower with another man nearly beats the guy to death. This seems like a perfectly normal and explanatory reaction to such a situation however it is his reaction to the situation afterwards that shows us that his behaviour is abnormal and is characteristic of a manic episode. After being released from the facility Pat believes he is going to get Nikki his ex-wife back, he lacks insight into the situation and does not understand the consequences of what he did. He cannot recognise that what he did was over the top seen through his confusion and disbelief as to why his ex-wife would have a restraining order against him. He believes he can get her back by simply reading every book in her syllabus. Pats impaired judgement and emotional insight is also displayed when he gets angry about the ending of one of the books he was reading and consequently wakes his parents up in the middle of the night and throws rage at them because of this frustration. It is acceptable to get frustrated over a book however it is inappropriate to throw the book through a window, wake up your parents and scream and shout at them about it. Pat also makes inappropriate comments to people such as when asking another character about her husband’s death he up right says “how did Tommy die” and saying blatantly to his friend that “his marriage is a f**k up” and  “you are the problem”. This therefore clearly displays Pat’s inconsideration, tactlessness and lack of understanding of the consequences of his behaviour on other people. (Watkins, 2012)

Often during a manic episode patients can be emotionally labile meaning their emotions fluctuate randomly often resulting in unpredictable moods that can be explosive and aggressive. Pat during his rage over the ending of the book hits his mother and ends up in a tussle with his father after which he suddenly breaks down and cries. Another situation where this symptom of mania comes in is when he accompanies his brother to a football match during which his doctor, who he happens to bump into there, gets into argument with a group of men resulting in Pat getting involved in an aggressive fight with these men due to him being unable to contain his anger. 

As previously stated bipolar mood disorder involves both ends of the mood spectrum. Throughout the film Pat only displays symptoms characteristic of a manic episode but there is no alternating to periods of depression. Pat never goes through a period of isolation, loss of interest in activities, suicidal ideation or feelings of extreme worry and emptiness. The movie only hints that he may have been in a depression previous to his admission into the facility when he is sitting in his psychologists room and explains how the week before the incident with his ex-wife having an affair he called the cops and told them his wife and the history teacher were plotting against him which he himself states was not true but was actually a delusion. It is common for people in a depressive state to experience delusions however Pat’s particular delusion of paranoia is only one indication and there is not enough evidence to say that he experienced a period of depression.

The film therefore creates a good picture of the manic side to bipolar disease however it does not capture the entire spectrum of what bipolar disease is in terms of the alternating from mania to depression on a cyclic basis. This may give viewers who have limited knowledge about mental illness an incorrect perception of this particular disorder. In this film it could be said that Pat is in actual fact just experiencing traumatic stress after the incident that happened and is therefore experiencing a manic episode as a result of this. Bipolar mood disorder has its name because of the two “opposite sides” it has to it and so the film needed to include both of these in order to truly depict this mental illness. (Stewart, 2013)

 

A question that makes you think is worth asking

This week has had its challenges one of them being a big test we wrote but the bigger challenge for me this week was to do with some stuff at home. I have been living in a flat with my older brother for the last two years. We have always been close in our own way, he looks out for me all the time and I genuinely am proud to be his little sister. However when you living together things do not always run smoothly. For a while now we have not been seeing eye to eye and both of us have just been living around one another not with one another. Family is of great importance to me and when something isn’t right it weighs me down and I guess this thing with my brother has been doing just that for quite a while. It’s been a tough year for me in terms of varsity work and unfortunately its meant that a lot of my time is spent at my desk working. It’s really hard to explain and make those around you understand all the work that you have to do and what exactly it is that we do as OT’s. So my brother’s natural response to me working all the time is ‘you work too hard’, ‘you always so stressed and miserable’ and ‘you stress for nothing it’s not that bad’. I’ve become so frustrated with his ignorance that I just gave up with him completely, hence the situation of the two of us merely existing together in one flat. But this week when one of our usual fights began I just could not take it anymore and in between many tears I told him everything. Things that have been happening at varsity, my prac, my clients, how I hate living away from home, how hard it is to try and balance everything that has been slapped onto my plate. And all of a sudden I could just see my brother’s eyes being opened to everything that I had been fighting to tell him over the last few months. Shortly after this I was reading stuff on the internet and an article came up with a whole lot of pictures and the title “A question that makes you think is worth asking”. This were two of the

pictures:

 

 

 

 

 

These pictures made me think…. What have I done to make those that I love understand what is happening in my life? What have I done to show them the love I have for them? If I had just spoken up and said something would my brother and I be in the position we have been for the last few months? What has he done as my elder brother to try and help me? And one day when I am old, my parents will not be around but my brother probably will be. He is the only brother I have and is something like varsity work worth that much that it can get in the way of a relationship with a sibling. My soon to be career means the world to me but in the midst of it all I am not only a university student, I am also a sister, a daughter and many other things. I tend to forgot that sometimes.

DOUBLE CHECK

Almost a week ago now nearly 30 people were killed in an accident in which a trucks brakes apparently failed. It has been part of everybody's conversations this last week and its no wonder because it really was a horrific accident that has left many questioning as to what went down that very evening.... I am not talking about this accident on my blog for the reasons everybody else is talking about it for but rather because it got me thinking when watched it and after doing midterm demo's on prac yesterday, here is the footage of the accident, it is not a pretty sight but if you can please try have a look at it.

https://www.youtube.com/watch?v=aB-9VtMiXqE

Its unbelievable how quickly and out of nowhere that truck enters and wipes out everything in its way, literally within a second it comes in and takes over. Well when watching that I had to think to myself when I did my drivers license test a few years ago before pulling off from a robot one was required to check left and right. Now after doing your license and having been a licensed driver for some time you think you know it all and never do you look before you pull off. You trust that everybody at that intersection is just going to obey the rules and nobody is going to be coming through that intersection when you pull off. Well for those drivers of the cars that got taken out by that truck had they maybe hesitated for a second longer and looked to their left and right to check before they pulled off they probably would have seen that truck coming at the high speed it was and therefore would've stayed put and not pulled off. Yes this does seem silly but its kinda true. Sometimes we just assume and we do not double check or make sure and its often those very times that we don't make sure that something goes wrong. And then you end up kicking yourself afterwards, why didn't I check, if only I had made sure....

Well that just about sums up where I am at after my demo yesterday. You can never be too sure is the lesson I learnt. After a treatment session goes well I think to myself why did I get so stressed and worried about it, I need to just relax. But the truth is all that stress and worry helps because it makes me check and make sure all is well, it makes me prepare 110%. So for me, just like the drivers of those cars, maybe that one time they didn't check and make sure the coast was clear was the one time they needed to. I am kicking myself now but it was a lesson for me and I will never make that mistake again.

Look left, look right and look left again, you can never be too sure.

Bittersweet...

So midterms presentations have come and gone and after all of it I am left with many different feelings about it all…. First let me start at the beginning. When I first got my client I really battled with deciding what treatment to do with him. He was not as “bad” as the other clients. He did not have this long term intense alcohol or drug problem, he did not completely lack any insight into his problems and he did not come from a broken or dysfunctional home. I sat for hours on end trying to figure him out, researching, thinking about this thinking about that and doubting myself the entire time until all of a sudden it all just made sense to me and I had this clear picture of what I needed to do with him. But I worked hard, really really hard at everything to do with this client and his treatment. So when I did my presentation I did everything I could to paint the picture that I had in my head for the people listening so that they could understand my client and what he needed the way I did. Receiving the positive feedback that I got from the supervisors gave me such a happy feeling inside but also this feeling of a huuuuuge relief. Relief that what had made sense in my head had made sense in the heads of professionals. What I was even happier about was that what I had been doing with my client was right which meant I was helping him and making a difference which for me is the biggest reward.

But now two days later after thinking about all that happened on presentation day I am feeling a little scared and worried. Now that I have set this standard for myself, what happens if in finals I do not achieve what I did now?  I don’t want to be the person who goes backwards when everyone else shows huge improvement. Maybe I had it easy this time?.... I am going to do all I can, work twice as hard if I have to to understand my new client the way I understood this one because that feeling of just knowing what to do and how was incredible. Maybe I should be seeing this as a challenge to myself to outdo my last performance, take it to the next level.

So mixed feelings about presentation day but from another perspective it was a great day of learning. Although we all stress ourselves out about it, at the end of the day it’s just a day to figure out where you went wrong, where you went right and why which is a great opportunity so that we can do what we need to to improve for finals, when it really counts. Seeing what the others students have been up to at their prac sites was really interesting and it was great for us to see where they were going right or wrong for next year when we find ourselves at those placements. I personally just feel there is too much negativity around midterms and maybe we should start being grateful that we get a chance to ‘mess up’ and be told why so that we can fix it…. 

A VALUABLE LESSON...

This week I did a values clarification sessions with one of my clients. After watching my client struggle away at trying to identify his top core values I walked out of the session thinking wow that was the biggest flop of a session ever. But when I sat down and thought through what had happened it was actually far from a flop. Until the first time we did a values clarification session in lectures one day I had never sat done and really identified what my values are. Ya I know what values are, I had heard of them, probably had a few conversations centred around them but I had never thought about what mine actually are. It was the same for my client, he had battled and found the activity hard because he like many people walking around today had never really given much thought into “what are my values”. Just because he had struggled to do the activity in my session did not mean the session was a complete fail. After the day when we did values clarification at varsity I became consciously aware of the decisions I made, the choices I made and the way I was behaving and how they related back to what I had identified as my values that day. We never think about why we behave the way we do or why we make the choices we do. It all boils down to our values and what we place importance upon. For someone like my client who is sitting at a place in his life where he knows that change needs to occur but is still wary of how to bring about that change, identifying his values or even just beginning the process of identifying and thinking about his values is such a big and important step to take. Gaining insight into what is important to him is one of the first stepping stones towards leading the life he is yearning to live. But even though it is important for people like him to do values clarification I strongly believe we could all do with some clarity on these kinds of things in life not only the drug addicts or alcoholics. Everybody will find a values clarification activity hard because everybody has an idea in their head of how they want to live and who they want to be but when you really take a closer look you will find that what you are actually doing, the decisions and choices you are actually making may reflect some underlying values you didn’t even know you had.

 

Experiences in life or life situations can sometimes change our values, when I saw this video I just had to post it - moving to Durban to study OT and being away from my family has made me value time with my family and my dogs so much more than I used to. This is pretty much what my dog does when I go home. I think its safe to say I am one of her top values :):)  

https://www.youtube.com/watch?v=vF_o-iJ1Rk4

 

 

 

 

THREE THOUSAND TWO HUNDRED AND TWO DAYS...

https://www.youtube.com/watch?v=BOksW_NabEk

After spending literally the entire weekend sitting at my desk planning and writing up my treatment programs for my clients at Newlands Park Centre I must admit I was thinking to myself I can’t believe I spent my whole weekend working. But then I watched the video posted above and it says something like you spend approximately 3202 days doing work, hopefully something that is satisfying. I immediately thought of my weekend of work and I realised hey, those two days spent fussing over my clients and their problems was actually kinda satisfying. Putting everything together and eventually getting to the bottom of all that is your client and realising this is what I need to do was really satisfying when I think back on it now. What was even more satisfying was yesterday doing sessions with my clients and seeing how well they responded and then when one of them turned to me and said “wow thank you that was really great”. My work is satisfying. Sometimes when I am on prac and working with my clients it doesn’t feel like work. They say if you enjoy your work and do what you love you will never spend a day working and I am beginning to feel that way about my soon to be career. Those 3202 jelly beans set aside for work do not need to be removed and written off like they are in the video. Those 3202 jelly bean days that I will spend working are important days for me and I want to keep and cherish them.

STUCK ON THE FENCE

After just one day at Newlands Park my emotions, thoughts and worries have done a complete 360. Although I am still feeling fairly anxious about this prac in terms of being able to understand what the true core issues of my clients are and being able to deliver therapy suitable to address those issues I am actually feeling quite positive and excited about it. I think the reason for this is because these clients are SO high functioning - proper relationships can be formed with them and therapy has the potential to be so effective and rewarding because these guys can actually work with you, set goals for themselves in terms of their therapy and visible results can be achieved and seen both by you and them. I just think if done properly therapy with these guys can do amazing things for them. We ran our first groups and it was so awesome to see for the first time what we had been taught in group work lectures. The individual roles of each group member beginning to develop, the group dynamics and the whole process of reflection on the task done during the group.

A problem I am experiencing however is establishing if what my clients are saying and telling me is because they think it’s what I want to hear or if it really is the ‘truth’. Being the person that I am I naturally just want to believe them and buy into what they are saying but because they are people who unfortunately typically have characteristics of being manipulative and untruthful and want to hide their past and make themselves sound like a changed person I have to stop myself from doing that. My one particular client has identified and told me the reason he abused alcohol and has a set plan to change it, and quite honestly it is all very logical and makes sense to me and without a second thought I would buy into it but how do I know if that really is the reason? Am I being naïve or am I actually just being too suspicious?

I previously spoke about how these clients would have such rich stories to tell and one of my client’s proves this to be very true. There is so much too him – so many experiences and parts to his story that it is actually quite difficult to “figure” him out even though he’s not really hiding any details. I think it’s going to be challenging for me to figure out what the core issue behind his drug abuse is.

So once again I am standing with mixed emotions. Some things I feel positively about and some things that are playing at the back of mind worrying me. BUT I am excited to get back there on Friday!

THE WEEK AHEAD...

After an extensive meeting with our supervisors during which the module was broken done and all our expectations and requirements were given to us it is hard not to feel at least slightly overwhelmed. The reason for me having these feelings is because I know this prac is going to be challenging for me. Mainly because my previous psych experiences were not enjoyable for me so I already have this negative feeling towards it and also because I have chosen to go to a substance abuse institution which is a field I have limited knowledge and experience in. I also know that the client’s I will be dealing with are going to be higher functioning and may also be manipulative and test me as a therapist which for me is going to be a huge learning experience as one of my weaknesses is not being firm enough and taking control over client’s. However I do have this feeling of excitement hiding behind all the anxiety and worry. I am excited to grow as a therapist and to develop some skills I think I am lacking. I am also looking forward to working alongside the three other girls in my prac group as they are girls I haven’t really done much work with and it is always fun to see how different people approach their therapy. We can learn a lot from each other not only from our supervisors and clients. I am also excited about my individual clients as I believe that the clients at this institution will have such rich life stories and experiences to tell. So for me based on my previous blog I am going to try to find the positives in every situation I find myself in during this prac, yes I am feeling anxious but there is also excitement in me that cannot be squashed by my anxiety. So I am ready for the challenges, the tears, the late nights but I am also ready for the growth, the experiences and the lessons.  

THIS IS WATER

Ever been stuck in traffic and your thoughts immediately are along the lines of "agh look at that idiot blocking the traffic", "what a waste of my time this is" ,"why is this stupid guy in front of me letting everybody in" etc etc etc... When you think about what is actually running through your mind you might realise how negative your cycle of thoughts is. How selfish and self-centred are those thoughts? How easily have we slid into a pattern of me me me! What if the traffic is the result of a huge accident where paramedics are working frantically to save the lives of 3 children? Or what if the guy blocking the traffic is just trying to get home to his wife and two kids that he hasn't seen for 6 months because he has been away doing work? We are free to choose how to think and what to think about. Being aware of our thoughts and what is around us is so vitally important. We as human beings seem to live unconsciously- missing life because we aren't actually aware of it but how can we miss life if it is such an obvious thing? Because we are so stuck in our own thoughts of me me me we miss what is right in front of us. Naturally as humans we find things to worship, not just religious worship such as god but things like money, beauty, power. Having awareness about what we worship and what we choose to worship is a hugely important choice that we as human beings make, most of the time without even knowing we have.

 

Please take 20 minutes out of your day to listen to this speech: This Is Water by David Foster Wallace! May just change the way you think :) 

https://www.youtube.com/watch?v=PhhC_N6Bm_s

 

TEXTBOOK KNOWLEDGE OR WORLDLY KNOWLEDGE ?

There have been three particular occurrences over the last month that have stemmed my current thoughts. The first being whilst on electives when the head OT said to me “You can be a top A student but still have no clinical reasoning”. The second being when we arrived back at holidays and our lecturer explained to us how this module was going to challenge us and really test our knowledge that we have built up over the last two and a half years – knowledge that even though we may have passed previous years, we may still not have because we could’ve been as she simply put it “skating through” without really learning or understanding much. And then finally a few days ago when we got given some articles to read in preparation for our lecture, the one in particular was talking about the importance of medical professionals having knowledge of and being aware of different cultures. This particular sentence from that article got my attention: “It is not rigid and is beyond knowledge, skills and attitudes more a type of thinking and knowing”. These three occurrences have made realise that even though you may be able to recite an entire textbook and get an A for the test does not mean that you know how to use that knowledge, where to use that knowledge or even when to use that knowledge. Basically it does not mean that you understand that knowledge. And just having textbook knowledge is so limiting, what about worldly knowledge, knowing what is happening all around us and how it may be affecting us?  And it may be great that we can memorise our notes and textbooks but we cannot simply put those bits of knowledge into boxes and leave them there, possibly forget it all over a couple of weeks holiday. We need to be able to combine it, intertwine it and apply it to a real life situation. We need to be aware of what is happening in the world because it is probably affecting us without us even realising it and more so it is probably affecting our clients that we are trying to help – well how can we help if we have no knowledge of it? So maybe sitting in front of our textbooks for hours is actually not making us anymore ‘knowledgeable”. Maybe we need to spend less time at our desks and more time out in the real world observing, analysing and possibly just reading the newspaper.

“Many highly intelligent people are poor thinkers. Many people of average intelligence are skilled thinkers. The power of a car is separate from the way a car is driven.” Edward de Bono

You are only as knowledgeable and intelligent as you make yourself.

CHALLENGING NEW SEMESTER

Back to reality after a few weeks break and it’s hard to fall back into the routine of lectures. This semester is our Psych block which admittedly I’m very nervous for. In previous years my practical placements have been at old ages homes and so this year when we were allowed some choice in our placements I decided to go for a Drug and Alcohol Rehabilitation centre in Newlands Park. Although I am quite anxious about what lies ahead I think that I need to challenge myself through working in an acute setting with a supervisor who I know is going to push me. I want to ensure that I have a good foundation so that I am prepared for my fourth and final year next year…

To prepare myself for the weeks ahead I am going to look back on work done in previous years (it has been a year since we did Pysch last :/) but most importantly I am going to ensure I sleep as much as I can now because I have a feeling sleep will be a luxury in a couple of weeks’ time. To stay motivated, I think the experience that I talked about in my previous blog will help me keep my head down.

 

What motivates us ?... https://www.youtube.com/watch?v=u6XAPnuFjJc

A lesson learnt during Vac

Every year we are required to do two weeks of elective work in hospitals during our time off from varsity in order to make up some of our practical hours that we need in order to graduate. This year a fellow class mate and I decided to venture into two of the more rural settings to gain some experience as well as to prepare ourselves for our community service year. So we set off to our chosen hospitals, one in Harding and one in Kokstad hitting pot holes the size of my car on the way there which began to make us doubt our choice to be adventurous. However it turned out to be the most emotionally moving experience that I have had since I began studying OT. One day in particular stood out for me and that was when we accompanied the Kokstad Hospitals comm serv OT and Physio to one of their clinics in a community called Ndawana just outside of Underburg. We packed the back of the double cab bakkie with wheelchairs, mobile plinths, walking frames, toys and all the rest and off we went. When we arrived at the clinic there was not a soul to be seen which the community caregiver (CCG) explained to us was due to the cold. So we got her (the CCG) into the bakkie with us and off we went to each individual house to find the clients we went there to treat. What we found in these tiny hut houses was hard to believe. We saw multiple cerebral palsy children but one in particular being a 17 year old boy who was terribly contracted due to the fact that his family had rarely brought him outside of their hut and left him in the dark on a mattress due to the stigma attached to disability and their lack of knowledge about his condition. We saw elderly stroke clients with home-made crutches that could barely hold their weight whose smiles were enormous when we handed them brand new walking frames and walking sticks and taught them how to use them. And so our day went on, now climbing the hillside by foot from one hut to the next carry wheelchairs on our backs seeing things we had never dreamed we would see before, some things that broke our hearts and some things that gave us hope.

 

 

Standing on the top of the hill now close to the end of the day I began to feel extremely useless. The people in the community of Ndawana are there crying out for help and they humbly welcome and appreciate any form of help that comes their way. And this was only one community, there are thousands just like it that need help too. But standing there as a third year Occupational Therapy student I felt as if there was no way I could give these people what they needed. It made me think of how I lose sight of things when I’m stuck in my daily routine of ploughing through copious amounts of varsity work wondering why I got myself into this and how I think my life is so hard because I have to sit and study when everyone is out. But standing there on that hill in the freezing cold was one of those situations that brought me back down to earth and reminded me why I’ve chosen to study OT. Although what we experienced that day was tough to accept it has made me realise how much more there is to what I am studying and it has given me the determination to come back to a new semester at varsity and absorb as much knowledge and gain as much experience as I can so that one day I can stand on that hill knowing that I have helped those people.

That day in Ndawana we could have turned around and gone home when we saw that there were no clients at the clinic. But we didn’t. We went and found them and as it turns out they needed us more than anyone back at the hospital would have needed us that day. I think as Occupational Therapists we need to do this, instead of just assuming there is no problem and turning our backs to it we need to search and dig deeper until we find it. We will help all those that we decide to help no matter how insignificant that help may seem, even if it means simply giving them a walking stick.

 

A cute little video to remind us about the value of group work :)

BEING A GROUP MEMBER

For some unbeknown reason during this third year of studying Occupational Therapy we have had to do a large amount of group work within our class. And let’s just say it has its pro’s and con’s. It’s always helpful to have different ideas, opinions and knowledge coming together but when those ideas, opinions and knowledge are from two opposite ends of the stick it’s never easy to find common ground. Not to mention that the work load is never evenly distributed and someone always ends up having to tie together all the loose ends that everyone else left undone.

There is definite value in working in a group and one of the things that has become evident to me particularly this semester is that we all have our ways of doing things or our way that we see certain things and we are often adopt the attitude of ‘it is my way or the highway’. We are so often driven by the end goal of getting an A for the assignment or group project that we do not even reap the benefits of working in a group. Could it be that we cannot trust in other people’s abilities. That we are too scared to risk not getting an A for that assignment because we opened our mind to alternative idea’s or ways. Is putting our mark in the hands of others really that bad? Maybe the learning process and knowledge gained through working with you group members is worth more than the mark.  

Everybody has strengths and weaknesses and there will be times when your weakness is somebody else’s strength but will you let that person have that strength. The challenge is letting go of the known even if that known is a weakness at the possibility of allowing someone’s strength to play a part.

Aristotle - "The whole is greater than the sum of its parts."

For the last 10 weeks I was placed at Hillcrest Hospital for my practical during which I, together with two of my class mates, had to run a group with Cerebral Palsy clients. The group sessions had to be centred around domestic, leisure and game activities. We were presented with the clients names on a sheet of paper and as we made our way through the hospital putting these names to faces I very quickly became more and more worried. Every single one of our group members was severely severely physically disabled and most of them could barely communicate. I left the hospital that day with one thought running through my head: How on earth were we going to run a successful group with these people?

The answer to that question now 10 weeks later is very simple....

Yes our group members were all very physically limited and yes their communication was either nothing or three or four incoherent words strung together but that didn’t mean that a group with goals, a group with cohesion and dynamics could not be formed with these people. As the weeks swept by our group began to emerge. We had individual roles becoming evident - an energiser who boosted all the other group members, an opinion giver who always had something to say about the task at hand even if it took him a while to say it, an information seeker, an encourager and a handful of followers just going along with things.  Although it took a fair amount of probing and initiating from us as therapists the group members begun to interact with one another and respond to one another. They formed this silent bond that was so evident at 9:30am every Tuesday morning in the loud noise coming from them doing their favourite musical warm up.

 By the last group session there we had a group of middle aged cerebral palsy clients playing a game of picture bingo with the more ‘physically able’ members assisting the less able members and a member who arrived at the group aphasic now laughing uncontrollably and saying the odd word or two to the person next to her. It was only then that I as therapist leading that group really looked at and reflected on the process of how we got from week one to week ten.  

Looking at the obvious...

What did we just do? We took seven cerebral palsy clients, we got them together in a group every Tuesday and we ran group sessions based on leisure, crafts and games.

What were the steps? Discussing with the group members what they would like to do, planning activities for the sessions, fetching the clients and bringing them to the group, running warm up activities, running main activities.

How did we work together? We took it in turns to plan activities, we came up with ideas on how to adapt things, how to improve things, we discussed what went wrong, what went right and why, we helped each other run the sessions and we utilised each other’s strengths.

However looking deeper I realised I had come into this with a mindset that this group of people would never be able to perform and grow as a group just because they physically were very limited in what activities they could do and because they would not be able to communicate and socialise with one another on anything more than a superficial level. I had been so narrow minded immediately placing this barrier on them that didn’t necessarily exist. However, I learnt that the non verbal communication and interaction that occurred between our group members probably bonded them more as a group then any amount of verbal communication could have. I learnt that no matter how limited one may be physically, engaging in an activity and getting joy from it is possible even if it means ninety percent of it is done with the help of someone else. And lastly a group can and will go as far as the therapist leading them is willing to take them.

And so the answer to my now seemingly stupid question on day 1 is: Giving them the chance to.