REFLECTIONS - ƧИOITƆƎ⅃ꟻƎЯ

                           A million feelings,

                           A thousand thoughts,

                           A hundred memories,

                                One block.

In our short, mortal lives, there are several experiences that could qualify as life-changing. Every new experience was, at one time or another, the first experience. For good or bad, each instance changes the course that life has taken. However, no matter what happens for the rest of my life, this block has been by far the most transformative experience in terms of how thought-provoking it has been, by invoking me to reanimate my mindset and practice as an Occupational Therapist.

 

From being petrified about entering our underprivileged and rural communities to genuinely enjoying my time therein, interacting in a closer context, and seeing the tangible effects of the difference we are attempting to make, this block has been a valuable turning point in my degree. The lessons I have learned are assets I will carry forth into my practice as an OT for as long as I can imagine.

 

Within these four years of my undergraduate Occupational Therapy degree, 90% of my blocks have been in hospital settings and I was content with paving my career path in that direction because (1) I was making a difference in the lives of individuals by assisting with their level of independence and subsequent quality of life (QoL) and (2) I was fangirling and romanticizing our university lives as health professionals in scrubs, working collectively with and amongst several other health professionals- wow, some serious work hey. This was my notion of “helping people”- being within hospitals or chronic psychiatric facilities and providing acute/chronic rehabilitation services to them. However, immersing myself within the Cato Crest Community, I now cringe at my naivety. I stepped out to execute community mapping and health promotion with the intention of accomplishing yet another academic requirement. However, I realise how oblivious I had been because it was within these queues, waiting rooms, homes, and schools that I experienced the turning point in my career. I could not fathom the vast population, who had we not done health promotion, had we not screened, would have wilted away without receiving rehab. Furthermore, through conversing with the community members, we understand why and how is it that they struggle to access this healthcare. Hence, immersing myself into the community by taking the university out onto the streets, was I able to observe the state of urgency in the communities in the dire need of rehab that goes unnoticed and unattended to. This light bulb moment led me to realize what a rather complacent attitude I had adopted- it is not as if I did not know issues like a broken system, poor service delivery, and social injustices existed, however, I never stopped to question WHY and HOW these issues arose and what could I do to manage these injustices. Perhaps I had thought these were the roles of an activist. However, exploring these poignant issues with colleagues and obtaining different perspectives to brainstorm solutions, I came to realize that these are actually issues pertaining to occupational deprivation and alienation, which are indefinitely within my scope of practice, and I should be intrigued by them. Hence, this introspective skill and proactive attitude is a skill I aim to carry forth within my practice.  

 As a health professional, no doubt I will continue to provide medical intervention for physiological ailments. However, my conscience does not allow me to blind myself to a community construct wherein there exists social injustices in terms of occupational deprivation and alienation and subsequent occupational imbalance. Therefore, to curb this cycle, the entire community needed to be developed. This led me to reflect on the efficiency of the medical model and I discern how the medical approach always starts off with what is wrong, what is broken, and what is pathological within the people. Sadly, that focus has caused huge harm to millions of people globally, especially the poor people and communities, and as unintended as they may be, this top-down obsession with what is wrong has created the following consequences:

•  It looks at the people we are trying to help and defines them not by their gifts and capabilities and what they can bring to the solution, but by their deficiencies and problems.
• Money that is intended to go toward those that need help does not directly reach them. Instead, it goes to those who are paid to provide the services to them.
• Active citizenship, the power to take action and to respond at the grassroots level, retreats in the face of ever-increasing technocracy, professionalism, and expertise.
• Entire neighborhoods/communities that have been defined as deficient, start to internalize that map and believe that the only way that anything is going to change for them, is when some outside expert with the right program, and the right money comes in to rescue them.

These are unintended harms and of course no caring professional want these to happen, but it is also clear that no community needs these to happen.

Fortunately, there is another way of thinking about helping. Contrary to the abovementioned medical model, the setting of the Cato Crest Community, demands us to implement a community-based approach to “help” the community and contribute towards sustainable community development. We students could begin to actually reflect on a form of helping which starts with a focus on what is strong, not what is wrong, literally turning our traditional ideas of “helping,” inside out. I find a personal shift from an individual -focus to a collective, community-focus along with initiating with optimism in the face of difficulties. Certainly, OTs promote occupational participation and occupational independence, post-disability. However, is it not our role as OTs to facilitate occupational justice, ensuring that they get an equal opportunity to engage in diverse and meaningful occupations to reach their full potential, and acquire a good QoL? I find myself advocating and planning for improved recreational facilities and programs to upskill facilities, empower residents and contribute to occupational justice within the social construct of the community. You may ask, how is placing benches in the community promoting occupational independence which is the goal of OTs? Now, I am not shunning the medical model as it is incumbent to treat the physical and psychosocial client factors. However, in honing into the community-based approach, I understand how it is our role as OTs to empower, involve and consult and inform the community. Hence, placing benches within the community is going to allow them to engage in their basic right and occupation of sitting as they should not be deprived/marginalized from sitting equipment simply because of their socioeconomic status.

Recently, I have seen the light in taking advocacy onto higher levels such as political and governmental bodies when I comprehend how certain circumstances violate basic human rights. Aside from attempting to contribute to a certain level of social justice, we realize how superficial and inefficient our other intervention could be when residents are preoccupied with the violation of their basic human rights. Certainly, our OT practice involves filling occupational gaps with tangible activities/infrastructure. However, this block pushed me to critically evaluate environments and routines therein, ascertain the plight and injustices unto our mentally challenged, and advocate on every level for basic human rights- because what is the point of facilitating occupational independence, formulating the most comprehensive physical programs and cognitive stimulation programs to achieve an occupational balance, when one’s basic human rights are not even met. Hence, by cultivating courage at the crossroads, we have the potential to be architects for social impact, which rewards through social transformation, an improved QoL, and the conscientization of ourselves/people. This transformation necessitates decolonizing the curriculum through higher education to channel the youth’s impulse for “helping” and to channel academic knowledge by balancing hospital-based skills with the skills and principles needed for community development, including advocating on every level of this degree.

 

Furthermore, not only have my methods of OT practice expanded, but I find myself grasping various concepts of “occupations.” During an enthusiastic interaction in our weekly tuts, my perceptions of occupations were challenged when I stated that the youth are deprived of meaningful occupations when they wander in the streets, in response to which I was prompted to think how even that act of wandering around is an occupation. How so? How is that ever promoting health and well-being when the same youth would much rather be in school to secure a stable future. Upon reading an article by Nicky Kiepek, I discovered how occupational science creates a social construct of occupations as moral/immoral, deviant/normal, and health/unhealthy, which is actually a social justice issue projected by our concealed values and assumptions. This concept of occupation is largely based on the way of life and associated ideology of middle-classed, white, economically secure Westerners (Molineux, 2011). The understanding of health and ideal everyday life are portrayed according to a minority worldview. However, conforming to minority worldviews actually establish norms that may in fact disempower those with alternative values, abilities, and lifestyles. Western conceptualizations view occupations as active, purposeful, temporal, and meaningful which can be problematic when proposed as universal dimensions. Instead, occupations have implications for the human experience that extend far beyond health, well-being, and social justice, which need to be considered within the discipline of occupational science. This critically reflexive approach, led me to question models and theories, bringing awareness to multiple ways of doing and multiple ways of being and contributing to a ‘socially responsive’ discipline (Hocking & Whiteford, 2012). I discovered how in fact, there is a gap in our understanding of ‘social justice'- social justice in occupational science means to be aware of ways in which occupations are shaped as acceptable, normal, and desirable, which in turn creates space for possible ways to act and be. Therefore, it is with deviant behavior, that we ought not to view it as something that is special, as depraved, or in some magical way better than other kinds of behaviors. Rather, we ought to see it simply as a kind of behavior that some disapprove of, and others value, studying the processes by which either or both perspectives are built up and maintained. Hence, I am motivated to endeavor to explore occupations from a broader sense, thinking twice before adopting dualisms or categorizations which imply a certain neatness that is rarely found in lived life (Flyvbjerg, 2001).

 

Upon further introspection, it is now second nature to recognize the power of my personal lens, also known as my positionality. In a separate blog, I delve into the power of our positionalities, especially when assessing and treating as OTs- https://reflectionsot.blogspot.com/2022/09/p-o-s-i-t-i-o-n-l-i-t-y.html

People of the community are SO much more than the statistics, incidents, and exclusive stories we hear, which presently introspecting, I realize how it had biased my approach towards the community members. From always being on the guard and maintaining a healthy distance from the community members, it is heart-warming to feel how we are actually insulated and safeguarded by certain community members. This ignorance was quickly questioned after coming across an article describing the disbanding of the Fund for Urban Negro Development (FUND) in the US following the death of activist, Martin Luther King Jr because it shed light on an urgent area of concern – the subconscious power dynamics that I was projecting into the fieldwork experience. 

The author describes that what started off as good intentions, eventually led to the organization’s ruin- The white funders who believed that they were activists, set up an empowerment program to assist African Americans, promising not to interfere with advice or “white controls.” This then turned into a mentorship program and a low-profit organization which was rejected by those who were “supported” by the initiative. (Harris, 2019) 

Now, whilst reading between the lines, I noticed how the white funders immediately assumed that these African Americans required mentorship. Where else could this stem from, if not a sense of superiority? - This was further emphasized in a reading which concluded that students reported that the most effective way to succeed in community practice was to have conversations and get to know the people and history of the said community (Vermeulen, 2015). Therefore, by placing ourselves on this level, I ascertain how we can work towards removing the “ego” present in helping people whom we consider less privileged and begin to humanize them, thereby ridding ourselves of the significance that comes with an air of superiority.

Similarly, it is vital to consider one's positionality when assessing conditions, working in communities, and co-creating programs/projects with and for the people of the community. The reason being, it is unethical to be biased, based on any condition, as we treat the symptoms and work our way forward for the person without prejudice. Analyzing my positionality has taught me that we often do not see things as they are, but we see things as we are, and we can have a lot to assume about lives we have never lived but have we placed ourselves in their shoes? How can we make sense of the social world we are tackling, if we do not know our own characteristics within the social world? The way we see and understand the world influences how we interact with others, make decisions, and interpret others’ actions. It taught me, on a personal and professional level, that to be equitable service providers and simply humans, we must understand how our identities bias our perceptions.

Especially in the community context, I note the need to consider and change my own positionality in order to see things from their own perspective and to plan treatment more appropriately by not pinning our personal views/ beliefs on the people we work with. Subsequently, this feeds into providing a realistic treatment program vs. an idealistic treatment program. In the event of co-creating programs for the community, not understanding cultural perceptions can actually lead to miscommunications, rendering our carefully detailed and executed projects, pointless. Lastly, awareness of one’s positionality helps to increase awareness and extend greater empathy, compassion, and understanding to others. At the end of the day, all these positions make up the world we live in- all these different perspectives merge into one, in a big social world/society. Hence, we need each other to understand our position in the world, no matter how far one’s belief is from another person- They are both essential to each other in a way that always reflects each other’s social position.

 Aside from these philosophical and axiological learnings, I take with me basic life skills as well such as responsibility and accountability as we were required to navigate our own path and rely on our conscience to provide ethical and effective services, due to working without a supervisor. This skill will be especially relevant in my community service year, wherein I will be required to work independently. Furthermore, I have also refined my skills of acquiring group cohesion and assertive communication skills, as community development was heavily reliant on teamwork, and I understood how a team is only as strong as its weakest link.

 

Despite my block ending, my new-found confidence is only beginning. I surprised myself with my ability to navigate a perceived uncomfortable experience, so constructively, which is something I thought my anxiety would never allow. There are various experiences in life that have changed a part of me as a person. However, nothing so profoundly changed my views and outlook on life as the lived experiences in this block. The community fieldwork has opened my eyes to a world that I did not know existed in the OT profession- a world of advocacy and opportunities which I hope has been forefronted throughout my blogs today and in the previous weeks because community block would be incomplete without it. As the new generation of occupational therapists who have been fortunate enough to authenticate the urgent need for community intervention, it is our responsibility to educate and inform policy to suit the agenda of occupational justice through “taking the university to the streets” (Christopher, 2021) and equipping people with the tools and services that specialize in helping them to succeed. This block has made me think deeper about how I present myself through my identity. I find my mental programming has changed and my brain has been positively rewired.

REFERENCES:

1. Kiepek, N., Phelan, S., & Magalhães, L. (2013). Introducing a Critical Analysis of the Figured World of Occupation. Journal Of Occupational Science, 21(4), 403-417. https://doi.org/10.1080/14427591.2013.816998
2. Pangambam S. (2017). Cormac Russell on Sustainable Community Development: From What’s Wrong To What’s Strong at TEDxExeter [Video]. TEDxExeter.
3. Maphumulo, W., & Bhengu, B. (2019). Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis, 42(1). https://doi.org/10.4102/curationis.v42i1.1901
4. Nyoni, C., Grobler, C., & Botma, Y. (2021). Towards Continuing Interprofessional Education: Interaction patterns of health professionals in a resource-limited setting. PLoS One, 16(7), e0253491.

SUSTAINABLE DEVELOPMENT GOALS- SECURING A MORE PROMISING FUTURE WITH OCCUPATIONAL THERAPY

Do you think that the world can be somewhat of a better place by next year? Or perhaps by the next decade? Can we end hunger, achieve gender equality, and halt climate change, all in the next 8 years? Well, according to the global governments, based on the #Envision2030 goals, to transform the world for persons with disabilities, it is possible to do so.

 The United Nations Conference in 2012 resulted in the formulation of the 17 Sustainable Development Goals as illustrated below. 

These objectives were set in an attempt to tackle the pressing political, economic, and environmental problems we live amidst. They were formulated in such a way that anyone can contribute to them, and every effort, no matter how minuscule or substantial, will spring off some level of a positive transition/shift in the world (Nations, 2012). Since one of our key goals is to not only develop the community but also to ensure that all of our projects and development within the community are sustainable, this concept of SDGs is very pertinent to us students as sustainability leaders for the community in this block. Hence, today’s blog elaborates 5 SDGs that I aim to contribute towards during my community block, here in the Cato Crest Community. The following SDGs will be discussed collectively as working on either one has a ripple effect on the others:

1. Good health and wellbeing
2. Gender Equality
3. Reduced inequalities
4. Decent work and economic growth
5. Sustainable cities and communities 

Essentially, all of these global goals boil down to who we, as humanity, aspire to be. Can this vision for a better world really be achieved? Well, I'm writing this today, because I have scanned the evidence and statistics to reveal a shocking answer- that perhaps, we actually can. Now, the notion that the world is going to become a better place may seem fanciful because from simply watching the news and listening to appalling stories within communities, it is evident how the world seems to be regressing instead of progressing. Frankly speaking, it is tempting to be skeptical about lofty promises expressed by the UN. However, what if I say this belief is suspendable? Because, back in 2001, the UN agreed to another set of goals, the Millennium Development Goals, the flagship target of which was to halve the proportion of people living in poverty by 2015. The target was to take from a baseline of 1990, when 36 percent of the world's population lived in poverty, to get to 18 percent poverty by 2015. However, not only did they achieve this goal, but they far exceeded it by dropping global poverty to 12 percent! Agreed that this may not be adequate to eliminate poverty and the world is still battling several poignant issues. However, the pessimists and doomsayers who say that the world cannot get better, are simply wrong. 

So how did we achieve this success? Well, in order to move a mountain, you begin by carrying away small stones. The steps to achieving any SDG are to listen with understanding, then act, followed by listening again to examine for efficiency and measurement of progress or regress. 

At the crux of any occupation is good health and well-being which we can define as our greatest wealth, without which we are rendered incapable of engaging in anything else. I believe that ensuring everyone has access to the highest level of health and healthcare, including the vulnerable, is the foundation for building prosperous and sustainable societies. This begins with exploring the factors inhibiting the acquisition of such. Working in the heart of Cato Crest, exposed me to a multitude of realities, that I feel at times I did better without. Several residents wilt away due to a lack of knowledge surrounding their conditions, stigmatization of disabilities or mental health perplexities, neglect of maternal health, poor living conditions, geographical hindrances, and subsequent poor accessibility. 

However, as sustainability leaders in the community, we cannot pour from empty cups. Hence, prioritizing OUR health and well-being is vital to ensuring the health and well-being of our community. Therefore, aside from abiding by all Covid-19 precautions and other infection and prevention control measures, I have to acknowledge my needs and take time to replenish my spirit so I can serve from the overflow and not a depleted vessel. Furthermore, healthcare professionals working endlessly at the frontline, indeed require attention to their healthcare as well. Hence, we intend on implementing a socioemotional group for the healthcare workers on a monthly basis to unwind, allowing them room to press pause, re-strategize, and return with a renewed sense of energy and keenness to serve. Once the healthcare providers are in check, then we march off to advocate for health promotion and conduct pediatric screenings regularly to fill the gap of oblivion through intensive advocation for occupational therapy which supports overall health and well-being. Furthermore, we emphasize maternal and child health to secure overall societal health as mothers are the architects of society who lay the foundation for our youth to blossom into functional community members. Additionally, we are tackling issues of occupational alienation and occupational deprivation through our various projects to allow for an occupational balance and improved quality of life (QOL) by promoting meaningful, functional participation across various platforms.

This leads to the 2^nd SDG pertaining to sustainable communities and cities. All our community projects are aimed at making the community optimally inclusive, safe, resilient, functional, and sustainable. We aim to implement this through the following projects in the making-

Cato Manor Clinic	Assistive Devices, Splints, and Pressure Garments Wheelchair measurements, issues, and training entailing w/c mobility and dexterity
Mayville Primary & Secondary Schools	Adaptations for learners with learning disabilities and mental health difficulties Socioemotional Support groups for the abovementioned
Golden Future Creche	Educational & Sensory stimulation to facilitate developmental milestones Facilitating play milestones by incorporating fantasy play objects and additional constructive play objects
Early Childhood Development Project at Thandeka’s Day Care	Introducing a routine Facilitating developmental milestones through early childhood development strategies
Women Empowerment Group	Ergonomic adaptations, Work simplification, and Joint protection principles for the soup kitchen ladies. Socioemotional support group for mothers within the community and the soup kitchen ladies.
OT Hub Area	Therapy, Vocational, and Leisure Hub for community members
Sensory Garden	Upskilling the garden owner to commercialize his produce Individual client sessions using the garden as a therapeutic medium
Azaelea Residential Facility	Introducing a routine Upskilling the staff Upskilling the residents through an IADL program Leisure program for physical and cognitive stimulation

 Sustainable communities and cities are further created through decent work and economic growth opportunities. In Cato Crest, skills that are already present such as the vegetable garden can be commercialized by equipping the garden owner with skills development training in marketing. Therefore, he can be skilled to initiate a vocational cycle entailing selling fresh produce at a farmers’ market or a new community market in which we use a “local is lekker” marketing strategy. Furthermore, we came across a talented community member who is a skilled actor, singer, and entertainer. Therefore, his talents can be maximized by facilitating his admission into an arts college (Howard) and/or commercializing his talent through paid performances. Furthermore, his art can be utilized in the OT hub in entertainment shows which aim to uplift the psychosocial state of the afflicted members.

 These economic growth goals are further facilitated by aiming to acquire gender equality through women empowerment. An article that researched the opinions of male teachers of GBV in an attempt to inhibit gender inequality, found that male staff attributed GBV to their demand for respect…APPALLING, to say the least! However, what is it that may be subjecting women to this treatment in the first place? It is deduced to be due to gender inequality, financial dependency, and culture amongst many more (CSVR, 2016). So how are we going to go about empowering the womenfolk in Cato Crest?

Education is the most powerful weapon which we use to transform the actual situation of our females within the community. We empower the females by enabling them to acknowledge and advocate for their rights. Furthermore, we advise society that both the boy child and the girl child are equal and should have access to all resources.

Training and skills development: We have implemented skills development workshops entailing decision-making, self-esteem, and financial literacy subjects to create a pipeline of skilled women who can suffice for themselves and can be viewed in positions of leadership. These also break cultural stereotypes of submissive and reliant females.

Vocational opportunities: We are equipping women to start their own businesses without compromising cultural roles and expectations, by assisting them with establishing home industries and using their craft skills to commercial advantage. Furthermore, closed corporations such as MrPrice and Superspar/Tops- are known to support community upliftment by discussing with women how to keep stock of their items in which the profit is turned over to the champions – successful projects lead to increased goods demands, thereby increasing employee demands and subsequently tackling unemployment rate. Click here to read more on another such youth employment program founded by Spar and MRP- https://www.spar.co.za/Lifestyle/View/SPAR-Cares/Jumpstart-project. In equalizing gender roles and creating work opportunities, we can see the fruits of the labor in the improvement of QOL, economic growth, increased security, and increase in people who will have access to their basic needs.

 Furthermore, gender equality is promoted by encouraging co-ed working environments and therapy groups where gender-equal norms are promoted. These entail involving males and females to work alongside each other in community development projects and implementing groups that prioritized the responsibility of males in various settings (home, work, school). Some of the ideas brainstormed were, family days where children bond with dads, and exclusive groups for dads and daughters/dads and lads to emphasize the significance of the role of a father in the child’s upbringing. Click here to enlighten yourself on the role of a father in a child’s development- https://parenting.firstcry.com/articles/understanding-how-a-father-plays-the-perfect-role-in-a-childs-development/

This is closely linked with reducing inequalities- It is evident that South Africa is one of the most unequal societies in the world with the highest Gini coefficient (Aljazeera, 2022). There is unequal distribution and access to food, healthcare, education, wealth, opportunities, and wealth, and these are explicitly displayed in Cato Crest. Therefore, through the implementation of the abovementioned projects, we aim to tackle the barriers to equality and facilitate a healthy cycle of functional activities and members to develop the community. However, within the clinical setting, patient files are constantly being misplaced, putting patients and professionals through the hassle of repeating assessments and reports and losing track of intervention progress, thereby compromising the progress rate of intervention, which is unethical and disadvantaging the client. Therefore, I aim to highlight this issue in the next audit meeting to pressurise the staff to act more responsibly, allowing for good health and well-being through, reducing inequalities in the healthcare system within the community.

Hence, the pursuit of developing these SDGs into more than just theory, by educating, advocating, and developing consistently, can be laid with several obstacles. However, making people aware of their potential, results in more fulfillment than the struggle that will be faced in doing so. Furthermore, I believe that one does not necessarily have to be an expert or activist to make the world a better place. You can heal the world just by being human.

To read up on all 17 SDGs, visit this link-  https://sinay.ai/en/what-are-the-17-sustainable-development-goals-sdgs/

REFERENCES:

1. Aljazeera. (2022). South Africa most unequal country in the world: Report. Aljazeera. 
2. Nations, U. (2012). #Envision2030: 17 goals to transform the world for persons with disabilities. United Nations- Department of Economic and Social Affairs Disability. Retrieved 7 October 2022, from https://www.un.org/development/desa/disabilities/envision2030.html.
3. NTU International. (2021). The Importance of the Sustainable Developmental Goals. NTU International.
4. Perspectives on Kwa-Zulu Natal. (2001). Gender Inequalities in South African Society. Profile KwaZulu Natal.
5. Simonetti, P. (2018). SDG 8: What policies are needed to achieve Goal 8. International Trade Union Confederation.

P-O-S-I-T-I-O-N-A-L-I-T-Y

 Who Are You?

Do you know the scenario back in school or amidst an online meeting, or perhaps around a boardroom table where the teacher or speaker asks everyone to introduce themselves briefly... and suddenly, your brain goes into hyperdrive? - “What exactly should I say about myself? I really wish I could fast forward time to skip this tedious task!” - Alas, there are no shortcuts. You start contemplating previous self-introductions when you got tongue-tied or when you forgot to mention something important, or worse when you rambled on for too long. Then, you realize you’re not listening to what the others are sharing, and if there were a quiz on everyone’s name, you would fail. Well, the stress associated with introducing yourself is common and not without a warrant.  However, isn't it perplexing that it's always so challenging to explain one's identity as an individual? Even during adolescence, we struggle to form a strong self-identity which perpetuates into adulthood and our personalities (Erikson, 2021).  This itself tells us how influential identity is. 

The reason why it is potentially always laborious to formulate a paragraph/talk about oneself is that MULTIPLE intersecting factors influence one's identity as illustrated below. 

Identity must be one of the most controversial and delicate matters to discuss nowadays as everyone has a different conception of it and attitude towards it. However, I’ve come to realize that identity is essential and rules our daily lives. Identity determines my actions, my reactions, how I perceive myself, and how others perceive me. 

Therefore, who you are, including your identities, lived experiences, life exposures, realities, truths, traumas, and thoughts, influences how you perceive everything in the world. All these things become a lens through which everything is filtered, and we must recognize the power of the personal lens, also known as our positionality. 

Think about this, when someone tells you they’re African or you see an African male - this small machinery inside your head quickly starts working, adding to the mental document in your head about this person. However, how you perceive this person is mainly based on your past experiences and embedded thoughts and beliefs. Furthermore, this African man’s perception of you is also going to be different, based on his unique experiences of discrimination and privilege. For example, when interacting with a bearded Muslim man, this mental machinery may channel alarm thinking Muslims are associated with terrorism. Alternatively, when interacting with a random African male on the street, I may be extra vigilant because people of all the crimes in my neighborhood are usually executed by the African race. Now, this is not racism but rather shows how everyone’s lived experiences become a lens through which they view the world.  This illustrates “positionality” as it depicts how one’s personal, social and political context influences or biases one’s perceptions.

Reflecting on the factors that establish my positionality I realize how our identities are not fixed but are a result of a complex social network that interacts with each other and oftentimes they are created FOR us and not BY us.

I am a 20-year-old female, currently in my final year of an undergraduate Occupational Therapy degree at UKZN. I originate from an Indian-Islamic community and can conclude that I have the privilege and luxuries of a higher middle-class socioeconomic status. Despite being born and brought up in South Africa, my roots hail all the way back to the rich cultural land of India as my parents immigrated from there in their early 20s. Hence, I am somewhat of a bilingual/polyglot, due to my proficiency in English, Urdu, and Gujarati along with minimal Arabic, Turkish and isiZulu. The first half of my life was spent in Limpopo, my birthplace, and in Port Shepstone. During this time, we related to a lower socioeconomic status, and it was only in my later teenage years wherein my parents climbed up the ladder of success and I grew up as a highly privileged individual. Nevertheless, I cannot say that I have directly experienced the struggle of low socioeconomic status as I have always been insulated and protected, shaping my views of the world in a rather idealistic way. Furthermore, during our geographical shifts across the country, I have always been blessed with residing in convenient locations with easy access to amenities. I am abundantly appreciative of never having to worry about the source of my next meal, or whether I will have a roof over my head or a bed to sleep on. In addition to my household background, my educational background has also been pretty conservative as I attended an all-girls, Islamic high school for most of my schooling years. During the second phase of my life, I experienced a major cultural shock as I transitioned into a multicultural and diverse university environment. As my interest in and enthusiasm for cultural mixing and socialization grew, I became increasingly interested in expanding my social circle to interacting with persons of diverse backgrounds and stories. Lastly, I believe that being the eldest amongst my three siblings, a choice I never had, is a major part of my personality trait, which is present in my instinct to always take responsibility and manage my environment along with its inhabitants. I was raised with the idea that I always need to contribute to a group, and I will be a part of a group with interdependent members.

In my case, we can already see how the threads of my personal life factors, weave my positionality. Due to my close association with a conservative religion and culture, there was always a fine line between modesty and the necessity of my job demands. For example, when interacting with males, I was hesitant, uncomfortable, and reserved due to being comfortable in my traditional bubble which hardly ever collided with the opposite gender, more so on such a personal level. The only way forward was to develop a progressive mindset, step out of my comfort zone and look beyond my positionality to render effective services and bloom as a therapist in the making. In opening myself to growth and challenging my naivety, could I attempt to dismantle my idealistic beliefs into realistic beliefs? I did not compromise my religious beliefs. Instead, I courageously paved a path to navigate beyond my personal beliefs, placing myself in my clients’ shoes to offer the most realistic and efficient intervention. This itself, was a drastic shift in my positionality.

Furthermore, it was enlightening to realize how my socioeconomic privileges had very subtly crippled my mindset. For instance, I had embedded a generalized idea of a basic household, relevant to my exposure. However, in the community context of Cato Crest, something as simple as asking a client “When do you go to bed?” can be inconsiderate when they don’t even have a bed to sleep on. Similarly, being skilled at languages, due to the early pressures of confirming to English, made me feel like everyone should know English regardless, because if I had to do so, then so can they. However, delving into a critical analysis of the community I am in one of the many such communities in South Africa- I realize that not everyone has the same support and attention to their growth as I had. Hence, I am empathetic during sessions and try my best to accommodate Zulu speakers. Several realizations and reflections of these sorts are actively shaping my positionality to make my lens more accommodating of diversity.

Therefore, it is evident how our background gives us a particular lens through which we see the world. We also acknowledge that the same information could have a different meaning for someone with a different identity.

As a South African, I am inevitably a construct of apartheid and coloniality. White people remained in positions of power and kept their high-income jobs and houses while the people of color remained in low-income jobs and areas, as seen explicitly in the image below- a typical poster of the still prevalent effects of apartheid and coloniality in our communities and country (Malala, 2019).

Therefore, I still identify with a divided society, battling the injustices and trauma of the past. However, when my university application for The School of Medicine was rejected due to the QUOTA system, I felt discriminated against and could not help but have second thoughts about the majority of doctors and health science graduates in our country. Frustration and confusion clouded my judgment because I had to work thrice as hard and be competent to get reserve a seat in another degree of choice, simply because of my race and ethnicity. However, this module has been a blessing in disguise as I realize that they are attempting to compensate for the crippling repercussions of apartheid and coloniality and this is in fact THEIR country by right and roots. Hence, I fuel my motivation and channel empathy to provide the most efficient services holistically, so that the community can somewhat experience appropriate health care, contributing to making a difference in their lives in the long term.

Hence, we see how some aspects of positionality are culturally ascribed or generally regarded as being fixed, for example, gender, race, skin color, and nationality. Others, such as political views, personal life history, and experiences, are more fluid, subjective, and contextual (Strater, 1996).

Therefore, it is so important to consider one's positionality when assessing conditions, working in communities, and imagining and co-creating programs/projects with and for the people of the community. The reason being, it is unethical to be biased, based on any condition, as we treat the symptoms and work our way forward for the person without prejudice. Analyzing my positionality has taught me that we often don’t see things as they are, but we see things as we are. We can have a lot to assume about lives we have never lived but have we placed ourselves in their shoes? Would one willingly want to be in that position if they could clearly see it coming? How can we make sense of the social world we are tackling, if we don’t know our own characteristics within the social world? The way we see and understand the world influences how we interact with others, make decisions, and interpret others’ actions. To be equitable service providers, or even simply humans, we must understand how our identities bias our perceptions.

Especially in the community context, it is so important to be aware of and consider your own positionality because the inhabitants of these communities experience a different reality from your own. They have different home environments; they grew up with different kinds of parents/guardians, who were potentially emotionally distant or insufficient for their physical needs and they are tackling many unseen battles. Consequently, they themselves got caught up in this cycle because of the lack of change and opportunities (Bourke, 2009). I note the need to consider and change our own positionality in order to see things from their own perspective and to plan treatment more appropriately by not pinning our personal views/ beliefs on the people we work with. Subsequently, this feeds into providing a realistic treatment program vs. an idealistic treatment program. In the event of co-creating programs for the community, not understanding cultural perceptions can actually lead to a lot of miscommunications, rendering our carefully detailed and executed projects, pointless. Hence, we understand how one’s positionality directly influences how the treatment is carried out and determines the prevailing outcomes and results. Lastly, awareness of one’s positionality helps to increase awareness and extend greater empathy, compassion, and understanding to others. At the end of the day, all these positions make up the world we live in all these different perspectives merge into one, in a big social world/society. Hence, we need each other to understand our position in the world, no matter how far one’s belief is from another person- They’re both essential to each other in a way that always reflects each other’s social position.

 References:

1.      Malala, J.  (2019). Why are South African cities still so segregated 25 years after apartheid? Johannesburg: The Guardian.

2.      Piotrowski, A.  (2019). Colonialism, Apartheid, and Democracy: South Africa's Historical Implications on the Land Reform Debate. Journal of Interdisciplinary Undergraduate Research.

3.      Pollock, M.  (2021). What is Positionality? Engineer Inclusion

4. Bourrelle, J., 2015. How culture drives behaviours. [online] Youtu.be. Available at: <https://youtu.be/l-Yy6poJ2zs> [Accessed 20 September 2022].

 THE IMPORTANCE OF MATERNAL AND CHILD HEALTH IN SOCIETY AND THE IMPLICATIONS OF OCCUPATIONAL THERAPY IN A RURAL COMMUNITY SETTING:

Let us clearly understand the concepts concerning the topic being explored in this reading.

Maternal health: "Maternal health refers to a woman's health and well-being before, during, and after pregnancy and encompasses aspects of physical, mental, emotional, and social health" (RHIHub, 2022)".

Child health: "Child health is a state of physical, mental, intellectual, social and emotional well-being and not merely the absence of disease or infirmity, of the child from birth to adolescence" (FTF, 2007).

Society: "A community, nation, or broad grouping of people having common traditions, institutions, and collective activities and interests" (Webster, 2022).

Hence, a society/community consists of several family units. Within those family units, mothers play a significant role in attending to the health and well-being of the other individuals. Hence, they lay the foundation of the community by birthing the life which inhabits the community. Now, how solid or unsteady that foundation is, depends on the overall health and well-being of the mother. This is because, just like how an imbalance in the physical environment leads to climate change and catastrophes when motherhood falters or is removed from the social equation of societies, it leads to much chaos in the family unit, which ultimately affects societies. Therefore, mothers are the silent architects of society. They are the indispensable builders of society, who lay the foundation of confidence, faith, and moral values in our youth. However, this is rarely acknowledged due to the deeply embedded patriarchy, misogynistic attitudes and subsequent cultural schools of thought. This generational trauma is a perilous problem as it hinders the mothers from acknowledging their problems clearly, hinders them from standing up for themselves without a second thought, and subsequently limits the acquisition of necessary healthcare and social changes in the long term. However, is it realistic to pour into another cup when there is scarcity or emptiness in yours? Likewise, mothers cannot give from a depleted source. Every mother needs emotional, mental, physical and spiritual validation, nourishment and support. Her health determines the quality of care she can provide to her infant to ensure he/she grows into a skilled, competent, dignified member of society. When a mother is respected and well- cared for, she and her whole family will benefit. The impact of this family unit then ripples onto other family units and essentially society as a whole. 

Analysing the Cato Crest community, just from a superficial level it is evident how overpopulated and poverty-stricken the township is. Linking this to our topic of maternal and child health today, at least 700 000 pregnant women in South Africa live in poverty (Laurenzi, 2021). Hence, this poverty affects the access to healthcare and the quality thereof for the mother and foetus/infant from the time the mum is pregnant, the duration within which she births life, up to the time she walks into the community with her new-born and nurtures the infant up until adolescence. The food insecurities leading to vitamin/mineral deficiencies such as low iron levels affect fetal health leading to stunted growth. Furthermore, geographical hindrances limit her access to timeous healthcare and risk maternal health and fetal health, thereby leading to maternal mortality and/or developmental delays. Furthermore, this increases the likelihood of home deliveries wherein semi-skilled or unskilled members are involved, leading to further health complications. Now the solution could be as simple as providing nutritious food, adequate access to healthcare and the delivering of babies by skilled members. However, it does not end there as aside from materialistic poverty, there exists poverty of the heart and mind as well. Subsequently, the community wilts away due to the harshness of these poverties as explained below through a scenario.

Asiphe, a 15-year-old teenager, was brought up in a dysfunctional family and experienced emotional trauma and role confusion by having to constantly be the mediator in her household disturbances. Unable to look to positive parental role models, she was clouded by aimlessness, insularity, and depression. These psychological disturbances manifested in a romanticised idea of seeking love and a happily ever after elsewhere. In her youth, she was manipulated by her "boyfriend" and was appalled to discover she fell pregnant. Asiphe, is the eldest of three children of a single mother who was stranded by her multiple boyfriends in her early youth. Her mother was only a teenager at the time of her birth, who did not seek professional medical help due to (1) fear of her family and societal stigmatisation and (2) obvious inexperience. Hence, she walks out on them to save her skin and start life afresh, far from her present turmoil. How does Asiphe grow up? This will highlight the importance of maternal and child health in society:

•       She had taken on the parental role and the role of breadwinner in her house due to the absence of any adult guidance/assistance. Due to this pressure, she attempted theft, contributing to a statistic of the crime rate within the community. Furthermore, she battles with depression, anxiety and PTSD thereby affecting her learning and performance at school. Due to the gush of pressures, she leaves school. Additionally, she turns to substance abuse as a coping mechanism.
•     Her child was born with major developmental delays due to poor maternal health during pregnancy. She does not know what is wrong with her child, how to help her child and believes that this was her form of punishment for her reckless behaviour.
•     She experiences post-partum depression (PPD) and subsequent lack of motherly instincts, manifesting in feeling disconnected from the child and wanting to hurt the child.  
•     Her battle with her mental health is exacerbated by the stigmatisation of teenage pregnancy and mental along with the cynical cultural beliefs against it. 
•     This flows into the expectations of her new role as a mother when she returns into the community. She is required to immediately resume her roles of breadwinner, student and friend in addition to navigating this new role of motherhood to a disabled child. And sadly, the anguish of the innocent infant who is given no choice or say in the upcoming chapters of his life. A common saying goes that a mother's lap is the first school of a child. By now, we can conclude how this is going to end up for the child- He is likely to encounter stunted growth and is at risk of growing up unskilled or even worse, unloved.

 If this is any indication of the population within the community, what does it say about the mindsets, attitudes and actions of the community members. This brings us back to the poverty of the heart and mind causing the community to wilt instead of blossoming if the root of the problem, maternal health, was to be addressed.

Watch this video should you like to enrich your understanding of the factors which impede maternal health in a rural setting and the measures that can be implemented to improve the societal future:-  https://www.ted.com/talks/sadia_malick_how_to_reduce_maternal_and_newborn_mortality_to_save_our_future

What implication does this have for Occupational Therapy practice at community level? 

If a woman experiences long-term complications (physical and mental) from her pregnancy, she will not be able to care for her child properly or raise them healthily. This then affects the child's upbringing and development, as these children experience deficits in cognition, attachment, emotional skills, and social skills (Dowshen, 2016). The added responsibility of attending regular clinic appointments in addition to the caregiver burden is an added stressor to her life, causing the community to regress. This is where our group of student OTs would like to intervene to provide paediatric therapy inside the home or nearby local point such as the Cato Crest Library in this case, to facilitate the child's development and functional progress, thereby also relieving some of the caregiver burden and subsequently aiding the development of the community. Furthermore, this is a location which is convenient and central to the community as it is in the midst of amenities such as local shops, crèche, preschool and the soup kitchen thereby, which is particularly beneficial due to the lack of transport. Moreover, having sessions in this location allows for young mums to attend lessons or remedial classes at school whilst their child is being seen by OT in a session. 

Furthermore, the mothers are in constant anguish. They are often neglected/gone unrecognised in society due to pressures, guilt and time element of juggling several roles. Hence, we as a group of OT students aim at intervening in the form of weekly group therapy sessions aimed at emotional support, breaking down and managing stigmatisation, extensive caregiver training and assisting in building a supportive network by bringing together mums with similar concerns and filling the gaps by using individual strengths and weaknesses strategically in a group. By doing the above mentioned, we can also change the conversations that are being held in the community. Moreover, whilst the mums are engaging in a culturally appropriate activity during the group sessions, the library allows for a section of children to been overseen by half the students thereby simultaneously tackling maternal AND child health. 

Lastly, maximising health promotion, and emphasising maternal health and child health within the community, has the potential to address the issue thereof by equipping them with the ability to acknowledge their challenges and working collectively to tackle the issues to combat their vulnerability in society thereby leading to the empowerment of the community. 

Consequently, this would enhance maternal health, subsequent child health, and the overall health and well-being of other family members in the family unit, and society as a whole.

Although Asiphe was fictional, she was fabricated from the threads of hundreds and thousands of real-life stories, and women who encounter identical fates. Therefore, it is entirely relevant to the community and life within the Cato Crest setting. Asiphe is the poster child for most young mothers in the community. She and her child then contribute to the macrocosm as statistics in the educational, infant health, mental health, and unemployment statistics of South Africa.

Reflecting back on this first week of community block, I notice how taking my knowledge out onto the streets, working more closely within the community and critically analysing this topic, a burning issue in the community, has revolutionised my thinking and subsequent attitudes in life. I feel a newfound calling and enthusiasm to intervene for mothers and their children, as I have access to them in a controlled environment, and the ability to assist on a primary level.

REFERENCES:

•            https://kidshealth.org/en/parents/teen-pregnancy.html
•           FTF. (2007, October ). Child Health - Definition. Retrieved from Health Workgroup, First Things First: http://www.azftf.gov/WhoWeAre/Board/Documents/Program%20Committee/Health/January%2013,%202011%20Meeting%20-%20Health/07%20Child%20Health%20Definition%20Recommendation.pdf
•           Laurenzi, C. (2021, March 25). One year into lockdown, pregnant women remain the most vulnerable and need support. Retrieved from Institute for Life Course Health Research : https://www.lifecoursehealthresearch.org/post/one-year-into-lockdown-pregnant-women-remain-the-most-vulnerable-and-need-support
•           RHIHub. (2022). Defining Maternal Health. Retrieved from Rural Health Information Hub : https://www.ruralhealthinfo.org/toolkits/maternal-health/1/definition
•           Webster, M. (2022). Society . Retrieved from merriam-webster: https://www.merriam-webster.com/dictionary/society