It is truth universally acknowledged that an Occupational Therapist and a chameleon share at least one DNA marker. Evidence to support this include; eyes that roam everywhere (oft times in opposite directions), the ability to adapt quickly to any environment, and often emerging in the most obscure of places. Like the chameleon, OTs are one of a kind, with a role that is continuously changes based on the situation an OT finds themselves in. As OT students, many of us working in primary health care settings for the first time are taken aback by the blurring of lines and expansions of margins, but always... the chameleon will adapt.
The
toughest question for an OT to answer is “what do you do?”. This question takes
a student approximately 7-minutes to answer, a qualified OT 2-minutes, and an
OT working in PHC: the whole day. The expansion of OT practice into community
settings is essential to the well-being of South Africans, and for the survival
of the profession. Hospital-based OTs and private practitioners alike, are
threatened by the overlapping spheres of practice between OTs, physios,
psychologists, and even social workers. With budget cuts and limited monitoring
of allied health practitioners’ spheres of practice, the role of an OT in
hospital-based care or even private practice is becoming smaller. Through the
country’s restructuring of healthcare to an emphasis on primary health and
access to rehabilitation services at this level, the OT role has been
rejuvenated in a sense. Where OTs practicing at District level and beyond are
primarily centred in rehabilitation and management of conditions and
constrained in these practices by budget restrictions and the continuation of
care limitations, OTs at PHC level are take on a more innovative role that
solves these problems. Naidoo, Van Wyk, & Joubert (2017) note that the
re-conceptualisation of OT practice in a PHC setting includes greater advocacy
for persons with disability, promoting social reintegration in activities, as
well as collaboration with members of the community in project development. In
this way, the role of an OT at a PHC level expands beyond textbooks,
conventions of practice, and “the basics”, instead, it is to pioneer healthcare
to suit the needs of the community. At each PHC OT department, there is an
explorer… seeking new methods, new perspectives, and new ways to improve lives-
beyond convention.
Having
never been to a community clinic before, I had no idea of what to expect my
role to be. And. Would have never imagined it could be what it is! To me, OT at
a PHC level gives one a new perspective of what ‘health’ truly is. In all my
previous experience of working at a hospital in the past, ‘health’ referred to
a diagnosis and co-morbidities. I now have a very different understanding of
health. Health is knowing you have a place in the world, it is knowing that you
have options, it is imagination, it is being able to learn, it is seeking
opportunities, it is having time, and most importantly, it is freedom of
choice. Whether we are visiting creches, educating mothers, offering people
services, or initiating projects- we are expanding not only our minds but the
minds of community members. Influencing identities. Challenging behaviours.
Listening. Learning. Collaborating. No other level of OT practice, aside from
PHC, can truly include these roles. Jejelaye (2019), notes that OT at PHC level
is able to provide unique rehabilitation in its ability to foster community
participation that helps to ensure sustainability of intervention. It is not
just the individual who has been assessed and a relationship established with,
it is the community too. In their position statement on the role of OT in PHC,
OTASA states that OT embodies the spirit of PHC through the profession’s focus
on bridging biomedical health services and the understanding of social
realities. Furthermore, OTASA states that the role of an OT in PHC allows for reducing
the burden of care, prevention of complications, and increased rates of social
and economic productivity. In truth, this scratches the surface of what OTs are
able to do within communities. Our role is to engage; to walk up to community
members and tell them who we are and what we can do. Our role is to nurture; to
provide physical and emotional support for the young and the old. Our role is
to expand; to show individuals the skills they have to offer the world. Our
role is to mitigate; to step in with alternatives and bring awareness to risks.
Our role is to create; to conjure up something from nothing and forge
opportunities for community growth. How we do this, is completely up to us!
Whilst
working as an OT at a PHC level, I’ve noticed that the ideas for intervention
and development flow constantly. There’s always an opportunity. I’ve also
noticed that there will be challenges to sustainability and practicality, and
that caving to these challenges can stunt a whole community’s growth. A
solution to many of these challenges, is innovative use of media. In our work
at the community clinic, we figured out pretty quickly that having students
approach you in pseudo-hazmat suits and babble for 10-minutes is a big
turn-off. We decided that the best way to do health promotion was to use
posters and audio recordings, which are far easier to follow and far less
intimidating than staring into a foggy face-shield. By using these forms of
media, we’re also able to keep our health promotion consistent and ensure that
this essential information about healthcare practices is readily available to
those who need it, even when we aren’t. The continuation of care, even when we
are not present, prompted me to create brochures for home programmes and general
education, to allow for my clients to carry this information to their families
to help them to implement- but also so that family members can be educated and
use this information to inform their own healthcare practices. Practically, it
doesn’t take nearly as much effort to introduce media into my work as I
expected it to, so it will certainly be something I add to my repertoire. While
investigating health promotion mechanisms for Covid-19, Mugoni (2020) found
that the radio, television and social media were the best mechanisms to reach
the youth. However, I’ve found that reliance on social media for health
promotion in the community I work in is less effective, as the number of
individuals without smart phones is high. Our approach as OTs in health
promotion and prevention must be adaptable and innovative. Music has also been
added to my OT toolbox. Never underestimate the power of a speaker! I firmly
believe that none of my outreach with youth in the community would have been
possible without including music. This has been an instant mood booster,
ice-breaker and attention-grabber, and has allowed me an audience to impart
important health promotion and prevention education to… as soon as the song stops.
In an ever-changing world, I’m lucky to have chosen an ever-evolving profession. The adaptability, creativity and sheer limitless possibilities for OT within communities has allowed for its indisputable role in PHC. This role extends beyond education of communities and preventing illness, and into empowerment, development and collaboration. In this way, OTs are the chameleons of the community healthcare team, we are who the community need us to be: constantly adapting, and using every tool at our disposal.
References:
Jejelaye, A. O. (2019). Intergration
of occupational therapy services at primary healthcare level in South Africa (Doctoral
dissertation).
Mugoni, P. C. (2020). Lessons for the COVID-19 response from a multidrugresistant tuberculosis study in South Africa: How public health promotion can reach vulnerable young women. Southern African Journal of Public Health (incorporating Strengthening Health Systems), 4(2), 34-40.
Naidoo, D., Van Wyk, J., & Joubert, R. (2017). Community
stakeholders' perspectives on the role of occupational therapy in primary
healthcare: Implications for practice. African Journal of Disability
(Online), 6, 1-12.
OTASA., (2015). Position Statement on Occupational Therapy
in Primary Health Care (PHC). South African Journal of Occupational Therapy,
45 (3): 58-59.
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