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