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Discuss the OT role in primary health care. Give examples of how you can use media as a tool for health promotion and prevention.

Occupational therapy….

Primary health care…

Health promotion…

Health prevention…

When reading this blog topic, I saw so many terms and concepts that took me all the way back to first and second year. At a fourth year level, all the concepts mentioned in the blog topic should hit quite close to home; however the most familiar and relatable term (apart from occupational therapy - of course), was MEDIA. While performing my roles in my personal life as well as my university life, media is a tool which is always being utilized. The reality is that in today's technology-dependent world, most people have either heard of, visited or actively make use of media within their day to day lives (Levac & O'Sullivan). This brings me to the ultimate question - how can we, as occupational therapists, use the internet as a tool to create and provide healthful interventions, programmes and opportunities for service users and service providers who  offer or seek  primary health care.

As a student occupational therapist, it has been reinforced over years of training that being healthy requires far more than merely not having a disease or illness (WHO, 2016). In fact, according to (SAOT, 2016), primary health care is an approach to health care that looks closely at health promotion, prevention and overall wellness; It considers lifestyle factors such as housing, relationships, spiritual beliefs, income and workplaces in ensuring and improving an individual's health status. As occupational therapists, we are grounded in the belief that humans have an innate need to engage in occupations. According to the American association of occupational therapy, the path to health and well-being strongly correlates with participating in meaningful daily activities (AOTA, 2015) . Owing to our specific training and understanding of the complex interactions between people, the environment and occupations; we play a significant role in promoting healthful behaviors and preventing sickness and disease.

Working within the community over the past 4 weeks, my colleagues and I have offered health promotion and preventative care at an individual and organizational level.  For instance, whether we were screening clients at the local clinic, doing home visits or addressing learners at the local school; we were providing a service which looked at promoting healthy, constructive behaviors while trying to prevent unhealthy, destructive behaviors.  

Health promotion can be defined as a wide range of social and environmental interventions that are designed to benefit and protect people's health and quality of life. This is done not merely by focusing on treatment and cure, but also in the prevention of ill health (WHO, 2016). In both communities, the OT students developed and implemented a health promotion programme which targeted grade 7 learners. While most of the individuals were healthy, it was brought to our attention that some learners were highly exposed to substances and were at risk of developing substance use issues. In this programme, the focus of intervention was not solely spreading awareness  but also  in providing the learners with life skills and other coping mechanisms which would serve to maintain optimal health and prevent disease.  This integrates both health promotion and prevention levels of care (Mpanza, 2015).

In another health and wellness related programme implemented in both communities, the OT students targeted the elderly population; some of whom had chronic diseases such as diabetes, arthritis and cardiac conditions. In attempts to optimize health and wellness, the OT students ran a self-management programme which aimed to enable the "Gogo's" to participate in meaningful occupations and adopt appropriate, balanced daily routines.  Though our programme provided awareness speeches on the management and prevention of different conditions, it also provided the service users with aerobic and zumba routines which facilitated physical and mental wellness.

Owing to the broad scope of the profession, occupational therapists are able to provide primary care to various populations of people in a multitude of ways. Whether it requires performing assessments for health risks, evaluating children for developmental delays, teaching strategies to incorporate healthy habits or even providing life skills training - we are well equipped and able! However, if there's one thing that I've learned throughout my four weeks on community block, it's that:  IT TAKES A VILLAGE!! 

While occupational therapists are well positioned to bring a distinctive skill set to primary care, I strongly believe that individual clients and the community as a whole would better benefit from an inter-professional collaboration. During the community block, we were able to work alongside NGO's and other valued members of the community which enabled our services to be relatable, effective and widespread. However, we did not have the opportunity to work alongside other health science disciplines which would have been useful in the planning and implementation of holistic health promotive and preventative programmes and intervention.

For instance, while screening children at the local crèche in community A, I noticed a baby who had developmental delays and it was reported that she aspirates whenever she eats. The care giver at the crèche was very concerned and did not know the cause or how to manage the aspirations. In providing feedback to the care giver, it would have been more effective to have a speech therapy student available who could more appropriately provide insight and management strategies. During fieldwork, UKZN health professional services would be better rendered if students across all health science faculties were placed within the communities along the same time frames. Not only would this be effective in providing holistic treatment to the various clients, but it would teach students the importance of multi-disciplinary work. Within my four years of training, I've noticed in so many hospital settings that rehabilitation services work in isolation. Not only do we do our clients a disservice in providing primary care, but we also limit ourselves as health care professionals in learning from one another and growing as therapists.

This brings me back to my original question: how can we, as occupational therapists, use the internet as a tool to create and provide healthful interventions, programmes and opportunities for service users and service providers who  offer or seek  primary health care.

While on community block, there were a lot of questions that I didn’t have answers to. Often times, there were no other health professionals present for me to seek guidance from. For instance, when that care giver at the crèche asked me questions about the aspirating baby - I immediately whipped out my phone and did a Google Search!  

"What would a speech therapist do with an aspirating baby"

"How do you explain aspirations in layman's terms??!"

Literally any question, as ignorant as it may have been, Google was readily available.

Apart from  providing me with medical insight in my times of need, I find media to be an excellent platform to get inspired, network and communicate with other health professionals. I have a pinterest account and I am a member of various Occupational Therapy groups on Facebook where OT's from across the world share their attitudes, values and beliefs about health care.  This is opportunistic for me as a student, as I am able to plan intervention using various platforms to inspire my treatment ideas.

Apart from assisting health care providers, media also allows benefits for healthcare users. According to Levac et al, social media allows for the widespread dissemination of information (Levac & O'Sullivan). In doing so, information can be made accessible and relatable to diverse populations with a simple click of a button! Many times, when I am sick and need to go to the doctor - I access media in order to gain some background knowledge into what symptoms I am experiencing.  In actual fact, sometimes media acts as my doctor; and it's not only me, I see my dad do it, my grandmother do it and sometimes, even my little cousin! Media is beneficial in health promotion and health prevention as it provides easy access to information  to diverse audiences.

Media has its own way of helping service users and service providers in health promotion and prevention strategies. It allows for therapists to attain information about treatment, and it allows for health care users to obtain insight into their conditions and management thereof. It also can provide a platform for accessible, continuous support to both service users and providers. However, it is important to remember that with benefits comes consequences.

Media plays an integral role in the lives of many, whether it be technology based or even in the local newspaper or magazines. It is crucial to remember that not everything we read and see in media is accurate and there to help us. Furthermore, socially disadvantaged  groups don’t always have access to new media and social networks owing to language barriers, literacy disabilities or other socio-economic barriers.

In my opinion, media is a good tool which can be used in the primary health care sector - however, nothing beats personal, intimate, face to face health care! As it easy as it is to get connected - it is just as easy to get disconnected!

REFERENCES  

AOTA. (2015). The American Occupational Therapy  Asssociation. The role of Occupational Therapy with Health Promotion .

Levac, J. J., &  O'Sullivan, T. (n.d.). Social Media and its use in Health Promotion. Interdisciplinary  Journal of Health Sciences , 47-53.

Mpanza, D. (2015).  Occupational Therapy in Health Care. Durban, Kwa-Zulu Natal, South Africa .

SAOT. (2016,  Novermber). Society of Alberta Occupational Therapists. Retrieved  August 1, 2019, from The role of Occupational Therapy in Primary Care: https://www.saot.ca/wp-content/uploads/2016/10/The-Role-of-OT-in-Primary-Health-Care_November-2016.pdf

WHO. (2016, August). What  is health promotion. Retrieved August 2, 2019, from World Health  Organization: https://www.who.int/features/qa/health-promotion/en/

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BLOG No. 3: Open/directed topic: utilize a political practice model of OT to discuss life in the community

Before qualifying as a certified Occupational Therapist, OT students are required to do fieldwork in order to gain practical experience. Starting in second year, we are assigned fieldwork locations and given clients whom we have to assess, plan and implement treatment for. Prior to fourth year - third block, my fieldwork experiences had been limited to hospital settings with clients who had physical or mental impairments. Often enough, I would be required to plan for client discharge, which involved obtaining information about the client's discharge location. As students, we go into practice with a general understanding of what the community is like, and we are equipped with the interviewing skills to ascertain from our clients their home contexts.  However, after being placed in the community for just three weeks, I have realized that there are no amount of interview questions that will enable one to clearly capture what life in these "discharge locations" are really like.

Over the past few weeks, I have found myself in the most welcoming of places, as well as some of the most scariest of places. The community members are so inviting, they go out of their way to ensure that we feel "at home". This has made it all the more easier to understand the context and environment of the community and its members. In doing so, my perception of the term disability has changed significantly.

In my mind, I previously understood disability to be an umbrella term for any injury or condition which makes it difficult for one to perform their daily occupations (dictionary, 2019). My understanding of disability was supported from a very medical perspective. However after being in the community for the past three weeks; I have observed certain things which make me question whether disability is owing to ones impairment, or rather their societal circumstances.

The social model of disability challenges medical approaches to disability. The former model defines two concepts; namely impairment and disability. Impairment is seen as the physical or cognitive limitations that an individual endures as a result of their illness or condition, while disability refers to the public barriers which are imposed upon by society. The social model argues that social organizations fail to include and accommodate people whose bodies or minds function differently than others, which results in disability (Taylor, 2005).

Some fundamental barriers within a society to be prejudice, ignorance and over protective families, among other factors (Foundation, 2019). Within both communities I noticed such barriers which limit individuals with both physical and cognitive impairments from engaging in their preferred, meaningful occupations. For instance, in community A, there is an individual who has residual effects from a CVA. Though she presents with certain physical impairments such as double vision and abnormal gait, her occupational dysfunction is rather owing to her home and community environment. Within her community, there are social and attitudinal barriers which impact her engagement in daily activities. For instance,  the prevalence of substance abuse, crime and violence within the community results in her family fearing that she may be taken advantage of, or treated differently when she goes outside and leaves the comfort and protection offered at home. Owing to this, she is rarely allowed to leave home, make friends, explore work opportunities or even achieve fitness goals at the outdoor gym park. These societal barriers results in occupational deprivation as she is unable to successfully engage in various areas of occupation such as leisure, work and social participation owing to her overprotective family and community context.                  

The social model of disability looks at ways that such societal barriers can be removed, therefore enabling independence and equality among all individuals living in a particular community (Lej1123, 2015). In community A, there are NGO's, police members, church leaders and community workers who come together to fight such societal barriers. In my time within community A, I attended a meeting which was held to address the crime and substance issue which impacts all members of the community, more so the vulnerable and "disabled" members. In this meeting, I was happy to see community members advocating for increased police protection, substance abuse programmes and strategies to make the environment a more safe, friendly place. In something as simple as increasing police patrol, families may be less reluctant to allow certain individuals to engage and explore occupations outside of the home context.  

In the same meeting, there were organizational leaders, such as the principle from the local high school, who made herself available to hear possible strategies to reduce the prevalence of substance abuse among adolescent learners. In an individual session done with a recovering substance user, it was brought to my attention that when he goes to school, in every corner he turns, he feels tempted to use substances again owing to the increased exposure in that particular environment. In this setting, it is the poor implementation of policies and procedures, as well as the social climate among the learners which pose as a major barrier to individuals who are trying to recover from substance abuse.  

The social disability model places a lot of emphasis on non-hierarchical relationships, peer mentors in empowerment oriented support efforts and peer based social advocacy networks (Taylor, 2005). Though I witnessed a lot of socio-structural barriers which impact engagement in daily occupations, I was hopeful in attending such a meeting where I saw community members fighting to break down societal barriers and help integrate all members of the community as equals.

Over the past few years, I have only experienced "community life" through simple, superficial interview questions upon discharge planning. However, these past three weeks have opened my eyes to the gravity of certain contexts and environments, and the extent of barriers to being and barriers to doing. As an OT student placed in these communities, I will continue to empower community members and advocate for social justice!

   REFERENCES

dictionary, C. (2019). Cambridge University Press. Retrieved July 26, 2019, from Disability: https://dictionary.cambridge.org/dictionary/english/disability

Foundation, M. h. (2019). Foundation for people with learning disabilities. The social model of disability . Scotland .

Lej1123. (2015, February 15). GOTTA BE OT. Retrieved July 26, 2019, from OT & Disability culture: Person first, Language, The social model of disability, and Not knowing what to say : https://gottabeot.wordpress.com/2015/02/18/ot-disability-culture-person-first-language-the-social-model-of-disability-and-not-knowing-what-to-say/

Taylor, R. R. (2005). Can the Social Model Explain All of Disability Experience? AJOT , 59, 497-506.

[hnotcommunity]

OT: Economic factors that impact health and wellness in SA communities

BLOG NO. 2: 

 In my first essay that I was required to write for community block, I did extensive research on the apartheid era, and the effects that it had on Black south Africans. This research wasn’t at all intentional; in fact, the essay topic was focused on the state of early childhood development in South Africa! Somehow, in a majority of the articles that I sourced, apartheid continued to creep into the context. When reading this blog topic, I began looking at articles on Google scholar regarding the economic factors that play a role in health and wellness; once again…. guess what key word continuously made an appearance?

Frozen at my laptop for a couple of minutes; I wrecked my brain trying to figure out how to write this blog. I'm supposed to be captivating, and entice my audience.. and the only thing on my mind was, you can't possibly speak about apartheid AGAIN!

The fact of the matter is, the discriminatory economic and social policies of apartheid have had a significant role on the health behaviors, clinical care and physical environments that many South Africans are accustomed to today. In doing further research, I looked closely to the term Occupational Justice and likened it to my work in communities A and B as a student occupational therapist.

Occupational justice is the right of every individual to be able to meet basic needs and to have equal opportunities and life chances to reach toward her or his potential, but specific to the individuals engagement in diverse and meaningful occupation (Stadnyk, Townsend, & Wilcock, 2004). Historically, our country denied Black south Africans their basic rights and did not allow for individuals of colour to have equal opportunities and life chances; not at home, in school or even at work. It's true that since the end of the era, South Africa has seen substantial change; However being in the community I see people of all ages still suffering from the socio-economic strain that the apartheid legacy left behind.

From what I've experienced over the past two weeks, I feel as though this diagram accurately represents the cycle of poverty which occurs in both of the communities. Owing to the high unemployment rates, families are very much dependent on government subsidies for support. However, in community A, a client explained to me how a single child support grant is not enough to provide her family with food, clothes, hygiene products etc. for the month. Additionally, a client in community B explained how she cannot afford the taxi fair in order to come for occupational therapy. This tragedy is unfortunately the reality of many individuals in several economically disadvantaged South African communities. which directly impacts health and well-being.

Having a "low personal income" ultimately results in inadequate access to food, water and clinical services and other basic needs. While running a life skills workshop in the local community B high school, it was brought to my attention that many learners come to school on an empty stomach. In an under resourced school, with approximately 60 learners per class, service delivery  and quality is impacted. Furthermore, it is mind boggling for me that learners are expected to concentrate and excel in such environments, over and above being malnourished. I feel as though the circumstances under which our learners are being educated are poor, to say the least. It does not provide them with the best opportunities to further their education and find a job post matric. This further contributes to economic insecurity, and the cycle of poverty which negatively impacts the health and wellness of all individuals within these communities.

The occupational justice framework speaks to the structural and contextual factors which sustain or hinder healthy, meaningful occupation such as in going to school, eating healthy meals or even visiting the clinic. In the South African context, there are policies and programmes which have been put in place to rectify the social and economic burdens that the apartheid government placed. For example, the African National Congress (ANC) produced an economic development agenda known as the Reconstruction and Development Policy (RDP) . There were 5 programmes included in this policy which sought to improve the level of poverty and the health status of the nation (Seekoe, 2007).  

In 2014, the eThekwini municipality started an outdoor gym initiative which aimed to promote health through exercise  (Municipality, 2016). On the first day of prac, I was overjoyed to see an outdoor gym park which was made accessible to the  members of community A. I thought to myself, this is such a GREAT way to encourage health and wellness to people who cannot access privately run gym facilities. In my time spent in the community, I attended a safety campaign meeting where I was I was heart sore to hear that this outdoor gym park was now being used as grounds for drug deals, substance use and other destructive activities.

While there have been structural changes (refer to table) implemented to improve health and wellness, there are several contributors that lead to occupational imbalance and deprivation among community members. As an occupational therapy student working in this setting, I am unable to get rid of poverty. However, I can empower individuals, work alongside NGO's and implement sustainable programmes which can be used to combat the effects of poverty and to promote the health and well being of the community members.

  REFERENCES  

Municipality, e. (2016, December 10). eThekwini  Municipality. Retrieved July 18, 2019, from Facebook:  https://www.facebook.com/eThekwiniM/posts/1332303556819755/

Seekoe, E. (2007).  Poverty and health in developing countries: a South African perspective.  Johannesburg, South Africa .

Stadnyk, R.,  Townsend, E., & Wilcock, A. (2004). Occupational Justice. In E. Townsend,  & C. Christiansen, Introduction to Occupation: The art of science and  Living (pp. 307-323). Canada: PEARSON.

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BLOG 1:

utilise readings to describe factors that allow communities to flourish and then compare these findings to low socio-economic townships/inner city and the life within the context you are working in. 

A week ago, if somebody asked me what a community is, an eager Henna would've probably jumped at the opportunity to provide the oxford dictionary definition! She would've said with her head held high, a community is defined as a group of people who live in the same place and share certain commonalities (Oxford Learner's dictionaries, 2019). I may have even included some OT jargon in my definition; adding that they share similar values, beliefs and cultures. The truth is, before entering the community block, I had my own preconceived ideas about what a community comprises of.

Spending a few days in community A and B has made me realize that my highly prestigious, oxford dictionary interpretation of a community has been quite shallow. In reality, a community is both simple and complex, it is isolated yet intertwined and it most definitely cannot be defined in a single sentence. Being a community based occupational therapy student, it is vital to understand what a community is so we can promote positive change. Which brings me to the question, what actually makes a community flourish? And how can I, as an OT student facilitate prosperity in the communities of which I have been placed in.

After day 1 of being in the community, I knew the first thing I had to do was let go of Oxford dictionary!!!! Upon research, I stumbled upon a concept - Community wellbeing. Community wellbeing speaks to the social, economic, environmental, cultural and political factors which are necessary for a community to thrive (University of Minnesota, 2016). It was noted that for a community to be successful, there needs to be; equity, livability and connectedness.

So what is equity? Equity is concerned with justice; it is the idea that all individuals should be treated equally and allowed the same life opportunities. I thought long and hard about this term, and the more I thought, the more frustrated I got. Within a week at the community I was able to identify so many inequalities which have just become the "way of life" for so many community members.  

Which made me think: WHY ???

I narrowed it down  to the legacy of apartheid. Historically, communities A and B were areas where non-white South Africans were displaced and forced to live during the Apartheid era. Owing to this, many community members grew up in an environment where they were denied their basic human rights and were disadvantaged by inadequate resources and opportunities. In an article I read about Equity in development, Jones talks about how there is a pattern of inequality that is reinforced through each generation owing to inherited circumstances (Jones, 2009).

Upon a school visit in community A, my colleagues and I were trying to arrange a 4 week programme with the grade 9 students. In speaking to the grade 9 coordinator, I casually asked her "Well, in which periods are their free's held?" … to my embarrassment, she was very confused. It was my understanding that all schools have free periods where students could either get extra help from teachers, catch up on assignments or study for tests and exams. I was well aware of this free period, because it helped me get through matric!! However, in community A where the schools are underfunded, over crowed and run by overworked teachers; having a "free" period is unheard of.  The schooling environment and opportunities is just one example of an evident inherited inequality which was noted when I compared my schooling career with a student from the high school in community A.

   Moving past equity, the next concept identified was livability. While this was a foreign word to me, I realized that it was just a fancy way of referencing a communities infrastructure. According to AARP, a livable community is one that is safe and secure, has affordable and appropriate house and transportation options and offers supportive features and services (AARP LIVABLE COMMUNITIES, 2019). Once again, owing to the effects of apartheid, both communities A and B have inherited land which comprises of RDP housing and a growing number of informal homes. A problem which I found in the community, is gaining access to supportive services.

For example, both communities have clinics available. When screening at the clinic in community B, a lot of the individuals said that they would be unable to return to the clinic within the next 5 weeks. As most community members live below the poverty line (which to my better understanding, was GREATLY inherited) a majority of the community members do not have money to take a taxi and come receive the offered services. If they cannot access health care, they do not have the opportunity to be educated on their health nor can they receive the necessary interventions. This effects their function across all areas of occupation, which further contributes to the cycle of poverty. In my opinion, and from what I've observed, the livability of any community is highly dependent on ACCESS and EDUCATION.

The last concept was connectedness, which refers to the connection fostered by a communities social networks (University of Minnesota, 2016). In a nutshell, it is understood that a community will flourish, if it is supported. This refers to concepts such as social cohesion, civic engagement, and social support.  In both communities, I was overwhelmed by the welcome I received as an OT student. When walking along the street, you are 110% guaranteed to be greeted with a "How are you".. When in the clinic, I received referrals for friends and neighbors who were considered during health promotion speeches. The support that community members have for one another is commendable, and is also one that goes over and above when compared to the community in which I grew up in.

The concept of community was redefined for me in the past week. According to UNIVERSITY …. a community clearly requires systemic things to flourish. Initially, I believed that as an OT I needed to be the vehicle to affect change for the community and by the end of my block, the community would be great! However, I have soon come to realize that it takes a movement. And the way forward is not to be the OT WHO IS MAKING CHANGES but rather the facilitator who is empowering community members, listening to the CCG's and working alongside the NGO's to promote sustainable growth, even after the block has finished.

With that being said, I look forward to the journey which awaits in the next few weeks and I anticipate working WITH the community rather than FOR the community.

 AARP LIVABLE COMMUNITIES. (2019). Retrieved July 12, 2019, from What is a livable community: https://www.aarp.org/livable-communities/about/info-2014/what-is-a-livable-community.html

Jones, H. (2009, November). Equity in development: Why is it important and how to achieve it.

Oxford Learner's dictionaries. (2019). Retrieved July 12, 2019, from Oxford univeristy press: https://www.oxfordlearnersdictionaries.com/definition/english/community

University of Minnesota. (2016). Retrieved July 12, 2019, from What is community wellbeing: https://www.takingcharge.csh.umn.edu/enhance-your-wellbeing/community/what-community-wellbeing