Hey, Earth? You're broken.

 It is truth universally acknowledged that if given a choice, half of Earthlings would be on the first spaceship out. Our world, (both the little bubble we live in, and the big bubble be live in) has a-ways to go before the wrongs of the past are righted. Knowing the end is nigh prodded some Earthlings into action, and thus, the Sustainable Development Goals were borne. Though there lie some issues with practical implementation, accountability and…erm…sustainability, using SDGs to guide programme planning can certainly only be positive additions to communities... and may even save mankind!

Image taken from: https://www.pinterest.it/pin/236016836691780358/

The journey towards achieving the Sustainable Development Goals at a community level is riddled with roadside dump sites you have to jump over, suspicious puddles of water, and loads of red tape to tear through. The SDGs were set in 2015 by the UN with the aim of showing considerable progress in the 17 identified areas by 2030. The whole premise of the SDGs is providing a “blueprint for peace and prosperity for people, the planet and the future” (United Nations, 2020), which could do with a bit of realistic flair. What they should have said was “providing a way for things to be a bit less terrible than they currently are on social, political and economic fronts”. I’d buy into that. I do believe that there is a role for health practitioners to play in working towards the SDGs, because not only can we become playmakers at a grassroots level, we have the ability to objectively see (when we have our thinking caps on nice and tight) the interrelated and dynamic factors that are shaping circumstance. Particularly as OTs, where evaluations of environments, populations and their choices are second nature and we have the expertise to intervene. The SDGs I believe I can practically work towards in the communities I work in are:

SDG 1 (end poverty in all its forms everywhere)

SDG 2 (zero hunger)

SDG 3 (ensure healthy lives and promote well-being at all ages)

SDG 4 (Inclusive and equitable education with lifelong learning opportunities)

SDG 8 (Sustained economic growth and work opportunities for all)

It’s difficult to work in a community setting and not want to turn it on its head, shake it all about and sprinkle on some fairy dust. For me, coming from a background of average South African suburbia and working in an informal settlement, was a rude awakening for someone who thought they understood what poverty was. The sad reality is, I’ve probably only been exposed to the “good” parts of the community, and they’re enough to set my teeth on edge. To consider then, how little old me can end poverty in all its forms and eliminate hunger in this context, is incredibly daunting because the damage seems too deep. What I’ve come to realise, is that creating change requires a flip in perspective. I don’t need to build an entire community from the ground up, I only have to change one person at a time- and that’s what we do as a part of our work every single day. Ending poverty and hunger begin firstly with a mindset shift, yes, easier said than done but still essential. I had a client once tell me that he returned to working as an engineer, climbing pylons, after his leg was amputated because he needed the work. How many people would do that? It’s naïve to think that poverty and hunger can ever be solved with just a shift to a “can do” attitude, but I honestly think that that’s step one- seeing yourself as an “agent of change” and not a “subject of change”. Galvaan et al. (2012) used that analogy in their analysis of how community OT projects could liberate the collective mindsets of residents. This stuck with me because it’s what we need to do as OTs in the community, we need to use what we know best- occupations- and create sustainable opportunities. For me, this was pairing a recently unemployed client with an entrepreneurial initiative and helping a naturally artistic homeless client see that he’s more than capable of turning his hobby into a money-making opportunity. The challenge I’m setting for myself though is to advocate more, I want to reach out and link the community to initiatives and programmes that can address their needs because I know that I can’t do everything. The start of the end to poverty is helping people to see opportunity. The end of the end to poverty will be helping people sustain those opportunities.

Image taken from https://blog.aoec.com/mindset-shift-whoa

Making progress on one front within communities, does automatically address numerous related factors. Whilst working at the clinic I’ve expanded on my own understanding of my role as an OT. Projects that we’ve implemented have leant towards economic development (in the form of vocational training and income-generating initiatives), environmental development (in the form of subsistence farming) and even educational initiatives (training caregivers at a local creche). All of these initiatives address far more than their primary focus area, they have ripple effects on the community. Hone, Macinko & Millet (2018) discuss that interventions at a PHC level, such as the community clinic I work in, provide services of health promotion which go on to positively impact many aspects of a service-users’ life including healthier living, employment and educational opportunities. I agree with this, interventions at a PHC level have the capacity to result in empowerment and behavioural change that is supportive of the SDGs vision because of the power that knowledge and support can give to community members. In many ways major progress towards SDGs may only be made within the PHC level, because in the upper tiers of society Big Business and private healthcare systems have vested interests in not making the world a healthy and happy place. We, as community-based practitioners, then bear the brunt of the burden. In my work with the homeless at the clinic, I’ve seen a need for life-skills training groups. By teaching goal-setting, money management and coping skills, we would be creating progress towards SDG 3. More than this, would be providing these individuals with the foundation of a healthy mind that is the first step to working towards developing oneself and paves the way for occupational choices in accessing work (SDG 8), pursuing an education (SDG 4), healthier living (SDG 2 and 3) and eventually clawing one’s way out of poverty (SDG1). This same positive ripple effect can be seen across all initiatives we start within communities, because exposure to a new activity or a new way of thinking will inevitably filter across many choices that individuals make in their daily life.

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The Sustainable Development Goals ask A LOT from us as a country, as professionals and as individuals. Unfortunately, 2030 is looming and Earthlings still haven’t gotten their acts together. Being the change-makers that we are, OTs are in prime position to intervene at a community level and have considerable positive impacts on the lives of our clients, through our individual work and the sustainable projects we set in motion. Our small acts will have big ripples within the community, as one liberated mind has the capacity to empower countless others. Before you know it, we’d have saved mankind.

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P.S

Check out https://www.youtube.com/watch?v=S-eR6qT0D0c -Caution, foul language-for some necessary real-talk about capitalism in healthcare. If we look at the big picture impact, we have to ask ourselves would pharmaceuticals really allow healthy lives for all? What does that mean for SDG 3… woe is me. All hope is not lost though! According to the SDG Country Report (2019), South Africa has made notable progress in reducing the maternal mortality rate, the under-5 mortality rate, the neonatal mortality rate, and the infant mortality rate. So, there’s that!

Now to just keep the rest of the population alive and well…

 

Image taken from https://media.tenor.com/images/ad6f2861f0b34cda2001e4063f535e6f/tenor.gif

References:

Flagrant2clips. (2020). Capitalism in healthcare kills people- Andrew Schultz and Akaash Singh. [Video File]. YouTube. Retrieved from:  https://www.youtube.com/watch?v=S-eR6qT0D0c.

Galvaan, R., Peters, L., Cornelius, C., & Richards, L. (2012). Occupation-based community development: strategies for promoting potential. In Proceedings of the «Towards Carnegie III» Conference.

Hone, T., Macinko, J., & Millett, C. (2018). Revisiting Alma-Ata: what is the role of primary health care in achieving the Sustainable Development Goals?. The Lancet, 392(10156), 1461-1472.

Statistics South Africa. (2019). SDG Country Report South Africa. Pretoria. Stats SA. Retrieved from http://www.statssa.gov.za/MDG/SDGs_Country_Report_2019_South_Africa.pdf.

United Nations. (2020). The 17 Goals. Department of Economic and Social Affairs. Retrieved from https://sdgs.un.org/goals.