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Why is maternal and child health important to society? How does this impact on Occupational Therapy Practice at a community level?

Picture this: a mother-to-be who was impregnated for the 5th time in half a decade and raising four others, mostly independently, whilst dad works or engages in other manly occupations that she need not know about. She is in constant survival mode as she attempts to balance her other occupations and roles, such as being an obedient wife, amongst others. Any illness can be treated with a visit to the nurse, but she must not slack in any way. Her monthly walks to collect ARVs from the local clinic (who are often low in stock, so she often misses doses), and grocery stops at the spaza shop are really her only alone-time she takes for herself, as she inhales the potent smell of burning garbage as she commutes. She is sleep deprived, as she spends every waking moment fulfilling her caregiver role and her nights are spent fulfilling her “wifey” duties. Now picture this: a mother-to-be rushing to the bathroom to throw up her stomach's contents. It is her first trimester and her ensuite bathroom is especially convenient for these regular sick episodes. She consumes the medication prescribed to her by her gynecologist and makes her way to her two other little ones who are already up and ready for the day since Gogo the domestic helper will always be here to care for them. She eats a nutritious breakfast as she pages through the Mayo Clinic Guide to a Healthy Pregnancy. She feels particularly unwell today but still contacts her husband to drive her to a prenatal class. Luckily, if need be, there is a General Practitioner, Psychologist, Occupational Therapist, Physiotherapist, Pharmacy and many other healthcare professionals in this convenient building.

We are aware that the victims of pathologies vary in number amongst different country classifications and the emphasis on improving these numbers GREATLY vary amongst different social classes. Sad, or disgusting isn’t it, that emphasis on health and healing is given greater priority if you have a fat bank balance or paler skin tone, as if we aren’t all made from the same human genome?! In the above scenarios, I attempted to paint you a picture of a common scenario in a low-income community setting and that of a middle to high income community. Do you notice how maternal health, and therefore child health is acknowledged amongst different social classes? The highest maternal and child mortality rates are prevalent in low-income communities and are due to causes that can be prevented such as the lack of or inaccessibility to healthcare.

Maternal health largely impacts child health from the beginning of pregnancy and throughout the stages of life. The link between a mother-to-be and her unborn fetus transfers nutrition but also pathologies that can persist in the child after birth. The conditions that a child grows up in affects how a child develops – this includes living conditions, socio-economic status, accessibility to public services and persistence of illness in that society, all of which nurtures or threatens the future of that society. Children are what will make future generations, and their wellbeing can largely affect the challenges that families face, the demand for health care, and how they can contribute to society in the future. I think that there are various reasons why society considers maternal health as somewhat valuable. We need strong caregivers to raise strong children. A healthy mother can nurture her child, she can fulfill her role of being what most of society deems a “good” mother/wife/or any other stereotypical gender role usually burdened on her. Therefore, the question I have reflected on and encourage you to give some thought to is, is maternal health really that valuable to most societies because of how it can benefit the mother, or is it because of whether society can benefit from that mother?

“By obtaining the necessary skills and competencies in maternal mental health, occupational therapists can be equipped to screen mothers for maternal mental health disorders and can play an important role in overcoming gaps in maternal mental health care and providing the necessary support to both mothers and children that will positively affect their health outcomes and the well-being of the entire family.” [Annals of International Occupational Therapy. 2019; 2(4):195–200.] Occupational Therapy practice in a community setting has the potential to improve that society, even if it is on a small scale and despite the huge lack of resources. When we prioritize health promotion in an easily comprehendible way, it allows us to screen mothers for any pathologies or causes that can be detrimental to her or baby, identify any preventable causes that are in our capacity to eradicate or change in some way, educate on ways to improve those circumstances or manage diagnoses and guide our intervention when treating these clients. Early childhood intervention has proven to be one of the most effective ways of treatment and by being aware of such situations at an early stage, we can contribute to some betterment of a childs life. Although the unequal access to healthcare, especially that of a multi-disciplinary team, will still be prevalent in many communities and often, our intervention strategies will not or cannot be carried over due to obvious reasons stated throughout my blog, (let's face it, such a huge change will never happen overnight), a small difference is better than no difference and is some start to making a difference!

References:

Call to action: Addressing maternal mental health in pediatric ... (n.d.). Retrieved April, 2023, from https://journals.healio.com/doi/epdf/10.3928/24761222-20190813-02

Child rights and why they matter. (n.d.). Retrieved April, 2023, from https://www.unicef.org/child-rights-convention/child-rights-why-they-matter#:~:text=The%20healthy%20development%20of%20children,water%2C%20housing%20and%20environmental%20pollution.

Mabaso MH, Ndaba T, Mkhize-Kwitshana ZL. Overview of Maternal, Neonatal and Child Deaths in South Africa: Challenges, Opportunities, Progress and Future Prospects. Int J MCH AIDS. 2014;2(2):182-9. PMID: 27621971; PMCID: PMC4948143.

Maternal health. (n.d.). Retrieved April, from https://www.who.int/health-topics/maternal-health#tab=tab_1

Maternal, infant, and Child Health Workgroup. (n.d.). Retrieved April, 2023, from https://health.gov/healthypeople/about/workgroups/maternal-infant-and-child-health-workgroup#:~:text=Improving%20the%20well%2Dbeing%20of,and%20the%20health%20care%20system.

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Blog 4: Advice to my future self as a person and as an OT

The last blog topic as a 3rd year Occupational Therapy student is one that’s forcing me ponder a little harder about…how would I advise my future self as an OT & a person in general?

During our fieldwork days as OT students, we spend a lot of time advising our clients on ways to improve, whilst considering all of their strengths and weaknesses. We also spend time advising our fellow classmates when things become overwhelming for them, or just about life’s challenges. But as I sit here trying to think of what I would tell my future self, I realise that regarding advice - it’s sometimes easier said than done.

As students, it’s never just about focusing on our studies until our degrees are complete - there are a million other obstacles that we have to overcome while juggling an often challenging degree. So my first advice to my future OT self from my past self, and probably the most important one is - never succumb to life’s challenges, no matter the magnitude. Every single person faces difficulties, but it will never be beyond what we can bear. To quote my beautiful religion’s holy book, “God does not charge a soul except (with that within) its capacity” - The Quran. To put this simply, there will always be some challenge or the other but it will never be bigger than what I can handle, so never giving up is the best way to overcome it.

My next advice to myself as an OT but as a normal person too is, never give up on anyone. Prior to starting my degree in Occupational Therapy, when someone made a mistake that affected me or a loved one directly or caused some type of harm to us, I would often just “wash my hands off them” so to speak. I would never directly retaliate and harm them in return, but I would just avoid them at all costs. After studying the different parts of OT (such as psychology and the things that affect someone’s behaviour) and hearing tales from various clients on fieldwork, I realise that my approach was wrong. Sometimes if we lucky, the client we meet at the beginning of a block and that same client that we leave at the end of fieldwork are worlds apart. Their improvements with a little guidance and by just getting a chance to develop into their best selves are astonishing. So, I will keep reminding myself that everyone deserves a chance to change. No one is perfect, not you and definitely not me - it’s human nature. So allow others to make mistakes as long as they grow from them.

Find a healthy coping mechanism. This is my next advice to my future self. Currently, my coping mechanism is to sleep or cry whenever I’m overwhelmed. While sleeping may be essential to survival, in my case it wastes a lot of time that I could have instead used on something productive. With crying, the occasional tears is a healthy reset to the body - if anyone else has used this as a coping mechanism, they would be familiar to that light-hearted feeling after a good cry. However, I don’t see either of these being long-term solutions to survival. As the years progress, there will be new obstacles to face and potentially more challenging ones. Finding a healthy way to handle these challenges will be crucial to avoid burn-out. This piece of advice is one that I have already started exploring but one that I always need to keep reminding myself to implement.

In life, we are always moulded by change and developing as we age. My final advice to my future self is, always strive to achieve self-actualisation. Self-actualisation is the highest level of psychological development that one can achieve. It is reaching our fullest potential while also remembering our limitations. In essence, it is having full occupational balance. I have many different goals for the future. My OT goal is to become a Paediatric Occupational Therapist and open up my own practice as a safe space for all my little clients. I will always aim to treat any child, without being driven by any financial gain. Some of my other goals are to improve as a Muslim, make my parents proud for the rest of my life, be an incredible wife to my future husband and raise my kids in a loving, healthy environment. These are only a small portion of my goals and to me, none of them are impossible. But I must reflect on my limitations as a human being. That is the only way I can ever achieve true self-actualisation.

Like I said, advice is often easier said than done so when pondering all of the above, I often reminded myself to be realistic. I know that my future self will face many challenges and some might even push me to limits I’ve never been pushed. However, I will think back at this particular blog and remind myself to never succumb to a challenge, never give up on myself or others, try to cope in a healthy way and ALWAYS aim for self-actualisation.

Thank you for taking the time to read my thoughts as a 3rd year OT student. I hope the advice I have for my future self will also benefit you in some way.

- Raeesa 🫶

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Blog 3: Occupational barriers experienced in mental health in South Africa

There are various Occupational Barriers to mental health that are unique to our country and to name a few:

South Africa is a rainbow nation. Her people are of different cultures, religions and backgrounds, such as the different African Tribes, Indians, Afrikaners, Asians, Caucasians, to name a few. Although the various cultures are all so different, many of them have commonalities - one being the stigma around Mental Health. From what I’ve seen first hand in my Indian culture, if someone has a physical ailment such as a migraine, they are considered “sickly and unwell” and are treated with care, with the hope of them being cured or made to feel comfortable during illness. However, if someone has a mental ailment such as depression, it is downplayed and they are made to feel less-than, family and friends start avoiding them and they are often gossiped about due to their disability. This directly leads to the decline of one’s mental health and also prevents someone from coming forward to receive the care that they need to manage the symptoms with the fear of them facing social exclusion. Therefore, the first Occupational Barrier experienced is the STIGMA surrounding Mental Health.

The unemployment rate in South Africa is currently at 33,9% ("South Africa Unemployment Rate - 2022 Data - 2023 Forecast - 2000-2021 Historical", 2022) and the poverty rate is around 34% ("South Africa: worries about poverty 2021-2022 | Statista", 2022). This means that more people are faced with mental illness due to challenges of not finding work but also, less people are able to seek intervention for their mental health because they cannot afford it. If you give a breadwinner the choice between feeding their dependents/consuming a feel-good substance such as alcohol to numb the pain of their challenges, or seeking expensive psychiatric treatment for a mental illness, the decision is an obvious yet detrimental one. South Africa’s HIGH UNEMPLOYMENT AND POVERTY RATES are huge Occupational Barriers to Mental Health.

South Africa in all its 3rd-world glory, does not have the funds or equipment to address the growing need for psychiatric intervention, making LACK OF FUNDING a big Occupational Barrier. This is mainly due to the mismanagement of funding at a government level which directly affects our people - “one-third of the world’s population lives in countries that allocate less than 1% of their health budget to mental health.” ("Barriers to Mental Health Care", 2022) Treatment for psychological disorders are often in the form of medication which is inaccessible and unaffordable to majority of South Africans. Aside from the lack of funding, there is a lack of mental health care professionals. These professionals are often not compensated enough for the work that they do and choose to relocate to other, higher-paying shores further North, leaving behind a great need for them in our country.

The lack of mental health awareness means that many have not even heard of most mental illnesses in South Africa. This is directly related to the LACK OF EDUCATION in our country. This prevents people from recognising symptoms of mental illnesses when they persist, which delays or stops them from seeking intervention for themselves or mentally-ill friends & family. Early intervention and a stable treatment plan are crucial, which is almost always neglected since people are not educated enough to realise that they need help. When it comes to mental health, many are of the impression that it will get cured over time or they can cure themselves. Whilst the treatment involves accepting the illness and complying with the prescribed treatment methods individually, just like with physical illness, medical intervention from health care professionals is necessary. Mental Health awareness needs to be both regular and accessible to people of all backgrounds in our country.

These Occupational Barriers are many and huge! They definitely can’t be corrected by just you and I, but if we all make small efforts to the best of our ability like simply educating as many people as we can on the various psychological disabilities or just fiercely advocating for our psych clients, these small efforts can reap great rewards! Happy Occupational Therapy Month! 🌈 :)

[raeesadarsot]

Blog 2: COVID - Trick or Treat - how has COVID impacted on the mental health of people and your reflections on returning to normal

Covid-19 hit South African shores in my 1st year at university. In March 2020, when walking past scattered groups of students on campus, everyone had a similar facial expression - one of utter disbelief that covid was really here! Within a few days, schools began closing, workplaces began moving operations online and talks of a lockdown began emerging and yet, university students were still preparing for our upcoming on-site tests. It was a Sunday evening when our President announced that schools will close during the course of that week and I sat with my OCTH notes, trying to study for the next day’s test amidst the chaos and anxiety. Within 3 hours of the President’s announcement, we received an email from the Dean which stated that “the academic program is suspended until further notice”. That email brought on a whole range of emotions for me - relief that my test was postponed, sadness that the academic program was suspended because I was really enjoying university despite attending for less than a month, anxiousness at what this pandemic had in store for us.

From March 2020 onwards, everyday brought on new scares and emotions. During the 1st lockdown, despite the chaos, I admit to feeling content. I know this comes from a place of privilege because lives were turned upside-down, but getting to spend that time with my immediate family and just reconnecting with each other in the simplest way, made everything feel okay. Towards the end of those 3 weeks, everyone was eagerly awaiting a return to work and some normalcy. However, our President spoke and the lockdown was extended. Every breadwinner began to fear because no work meant that they were unable to feed their dependents. Whenever we left home to replace essentials, the number of homeless people just seemed to increase. Along with the poverty rate continuously increasing, the number of covid-positive cases were also on the rise. Doctors and other healthcare professionals were fighting against a virus that they knew little about. Everyone was paranoid and anxiety levels were through the roof. Amidst all of this, we began to navigate through the challenges of distance-learning. For 1st semester, we attended occasional Zoom sessions where lectures were being delivered, but for the most part, there was a lack of communication from the university (definitely justified to an extent considering this new world we found ourselves in). Somehow, we made it through the semester and whilst we were writing online tests, covid-19 hit home and my dad tested positive. I can speak for my whole family when I say that it was a terrifying time. Every few hours, new symptoms emerged and other symptoms worsened. Everything became so unpredictable. He was admitted to ICU and remained in hospital for 14 days. During this time, I grudgingly met deadlines without really caring about the outcome of my effort - being there for our families, friends and community seemed like the more important thing.

During each wave of the pandemic, many people who tested positive never made it through and passed away. Families lost many loved ones, especially the elderly. Many people lost their jobs due to business being so bad, people did not know where their next meal would come from and the unemployment rate of our country increased. The mental health of everyone was declining rapidly everyday. Somehow, through all of this mess, my 1st year came to an end and 2nd year began. On one hand, passing the year online was slightly more manageable but on the other hand, my knowledge of all our 1st year modules was nowhere near what it was supposed to be. Our 2nd year meant the start of on-site practicals. This was an anxiety-filled yet equally exciting time because we were finally about to see more of what OT is about and meet many of our classmates after a year, but we also had to visit hospitals & other facilities with high viral loads and put ourselves at risk of contracting the virus or passing it on to more vulnerable people. We safely made it through the year but mentally, it was not easy. (Refer to my blog 1 to read up on my experiences with studying OT thus far.)

2022 and my 3rd year as an Occupational Therapy student has by far been the most exhilarating and exhausting year of my life because with the return of normalcy comes a whole lot more responsibility. Apart from navigating through a normal year at university, everyone has been trying to build themselves up again in this post-covid era. For a long time, we all thought that life would never go back to normal. We assumed that compulsory mask-wearing was here to stay. We forgot what it was like to freely socialise without such strict social-distancing rules. Many things have changed since covid and although my anxiety levels have dropped slightly since the end of lockdown, trying to make it in this new world is still very terrifying. Good luck to all of us!

[raeesadarsot]

Blog 1: Standing on the edge of becoming an OT - reflections on your journey thus far

What a year, I think to myself only half way through 3rd year! It is only 8 months into this year but my personal growth, the lessons that I have learnt, the experiences that I have experienced, are many. For me, my decision to study Occupational Therapy (OT) was never a maybe or a mere after-thought. For me, it was either OT or nothing. If I did not get accepted on my first try, the plan was to continue trying until I eventually got in. Thankfully the first try was a success! After a short period of job-shadowing and fresh out of matric, 18 year old me began pursuing the journey towards my dream career. As cheesy as it sounds, during the first 3 weeks at university, any time the word “Occupational Therapy” was mentioned, my body would tingle with the best possible type of goosebumps…I MADE IT. 2020 - the year of the pandemic. During the 1st weeks of my 1st year, all I could feel was intense excitement. I would get up early every morning, choose an outfit that was stylish but practical, eat a good breakfast and eagerly rush for my 7:45am lectures alongside my classmates. Although I remained friendly with everyone, I was still very shy and making friends was not the easiest. However, during each lecture, I’d chat to the person seated next to me with the hope of eventually forming bonds with all of my classmates. It was three weeks of my newly-acquired routine and BAM!, after a total of 3 academic weeks of on-site learning, covid-19 wiggled it’s way into South African (SA) shores and our lives changed drastically. In March 2020, after the first few covid-positive cases were reported in SA, on-site university was suspended and online learning began. Distanced learning was new to everyone and UKZN, through no fault of their own, took longer to adapt to this new normal. 1st year was the year that we needed to build the foundation for our degree and studying anatomy online was painful. Many long days and nights were spent trying to make sense of the learning material and yet, there is still much that I do not know. Since online learning began so early into my 1st year, I had not properly formed friendships with many classmates and my university support system was small. Each day passed and to top off the academic instability, the pandemic was not kind in any way. Business was bad, lives and livelihoods were lost, there were lockdowns after lockdowns, meeting-up with family & friends was rare and dripped with extreme caution and my family suffered the loss of my grandfather, amongst many other family members and friends. However, somehow, the months of 2020 flew by and 1 out of 4 years was complete.

After a long, relaxing, scary December holiday, 2nd year began. Again, it was online but we slowly became accustomed to this method of learning. Many new waves of the pandemic hit and towards the middle of 1st semester, our psychiatric fieldwork block began. I was placed at Philakade Care Home in Hillcrest, together with 5 unfamiliar classmates. We formed a WhatsApp group prior to starting pracs and on the morning of the first day at Philakade, we all finally met at the bus stop, for the first time as a group. This group will always remain special to me. Every person was friendly and helpful and we formed our own bond. Together, we helped each other through our first fieldwork block, navigating through each obstacle, until June holidays approached. After a quick break, physical block began. At this point, the pandemic continued to wreak havoc and our personal lives kept changing - many more lives were lost and life was difficult in some way for every person. Through online learning, we were taught how to conduct all physical assessments and again, towards the middle of the semester, physical fieldwork block at King Edward Hospital began. It was our first time working in an actual hospital and conducting physical assessments in-person, on actual clients, for the first time was DIFFICULT. I always felt like I would cause more harm to an already physically-impaired client. “Imposter syndrome” was REAL throughout those 6 weeks and everyday I questioned whether I have what it takes to be an OT. Those 6 weeks on prac highlighted all the many gaps that I had and still have in my OT knowledge. I tried to learn as much as I could during that time and spent hours practicing my assessments on any family member who was willing. Each week was difficult and I counted the days until the end of semester. Again, the group of people I was placed with were amazing. We helped each other through all of the tears and fears and I can honestly say that I would not have made it through without their constant help and motivation. November drew nearer and before we knew it, that was the end of 2nd year.

In February 2022, 3rd year began. I could not believe that we passed the half-way mark of our degree. By the beginning of this year, I formed many new friendships and our classmates slowly started feeling like family. Together with the easing of many restrictions, more on-site learning began and for an easily-distracted procrastinator like me, learning became slightly easier. The workload for this year has not been subtle in the slightest but finally getting to learn intervention has been intriguing. In March 2022, alternate-block fieldwork began. For me, I found this to be an eye-opening and exciting experience. We went to 3 different facilities during that time - Action in Autism, Jirah Academy and Cato Manor Clinic. Each facility was so different yet we learnt so many lessons, and not getting formally assessed on our fieldwork progress during alternate block made for an easier and less stressful experience. After our weeks on alternate block came to an end, we began our actual physical fieldwork block. I was placed at Hillcrest Hospital with another new, amazing group of my classmates. Hillcrest Hospital was simply phenomenal. There were many notable differences in resources and infrastructure here compared to other public facilities. Since we could now do intervention alongside assessing, the point of OT in Physical Therapy finally started making more sense to me. Although going on fieldwork 3 times a week in 3rd year was a huge difference from our once a week prac days in 2nd year, every week brought on new and exciting experiences and the time did not feel long initially. However, a few weeks before the end of the semester and after being on prac for many many weeks (alternate block and actual fieldwork block), I began feeling burnt out and dreaded how much effort finals would require from me. Since Hillcrest Hospital is a Chronic, long-term institution, I did not see much progress in my clients and I constantly felt like I was not doing enough to help them even though now when I look back on it, I was doing my best with the knowledge I have. Our supervisor was a constant motivator and together as a group, we pulled each other along until the end of the block. After our final case studies were submitted, I took 3 days off to just do NOTHING productive. I slept, watched series and movies, ate junk food and stayed in my pyjamas until I was fully recovered from that mentally-draining (yet extremely productive) few months. But hey, as an OT student I can say that those Areas of Occupation were definitely meaningful to me and in-fact, crucial for my mental health. :) After my 3 days of laziness, I began my electives at Cato Manor Clinic. My wonderful experience at the clinic made me want to go back for more during electives and I learnt so much everyday that I was there. 

Before I knew it, the holiday period was up and we began our 2nd semester of 3rd year - Psychiatry. For this semester, I am placed with a new group of classmates who are all as equally amazing as all the other groups I was placed in thus far. Our placement for this block is Northbay Lodge which is a lovely place with a vast number of experiences waiting to happen. Although this semester just started less than a month ago, I am feeling slightly more confident that OT is the profession for me. However, there are still many many gaps in my knowledge which I hope to fill soon and being on prac for three months (August to November) seems daunting because burn-out towards the end is to be expected, I am also excited to be able to spend this time in such a great facility with such great people. I can’t wait to experience more and to reach the final steps of our road towards becoming Occupational Therapists! (Also, that tingly feeling of hearing the word Occupational Therapist is still very much here after all of this time.)