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:
- 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
- Pangambam S. (2017). Cormac Russell on Sustainable Community Development: From What’s Wrong To What’s Strong at TEDxExeter [Video]. TEDxExeter.
- 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
- 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.
