Week 4...It is nearly over

The stress is starting to creep its way in with the end drawing near, how time has flown by.

There was a huge change from last week in the Wellness Group which is a group I run on a Monday for the older ladies in the community. The week before was disastrous with nothing going right and I was ready to give up but decided to push on and try something different this week. It started on Monday morning phoning to see who was coming and reminding them to bring their photos. There were a few that mentioned that they weren't interested in scrap booking so I had planned to do it with those that had brought photos. Well by the end of it everyone that didn't have a photo was planning their scrap booking page for the next week because they could see they were missing out. I think it was because the session was more activity based than a discussion. One of the key aspects of group formation is for the leader to build rapport and I really left that principle out for the first session so by bringing in an activity that allows me to learn more about them and help them do it really helped with forming relationships with each of the ladies. I was also surprised with how much they got into the activity, I had to upgrade a lot by giving them the decorative scissors and not so much assistance and they came up with some brilliant end products as you can see in the picture below. Unfortunately I only have one more session left with these lovely ladies but this is definitely a group the next team needs to carry on because they are the heart of the community and are needing more constructive things to spend their time on.

Khetiwe this week was a challenge because the lady who normally runs it was out on a home visit and there was only one child coming and it was for the Speech Therapists and not us OTs so we were confused as to why we were there. Nevertheless we decided to play some games with the child and screen and see what OT intervention could be done. This child has a very mild form of Cerebral Palsy so therefore was very functional but wasn't communicating, she had difficulty with gross motor, hand function and perception. We made up activities on the spot for treatment because we had no knowledge of the case and no time to plan so we did what OTs do best, on the spot therapy planning. We did an activity with sticking numbers one-by-one onto the mirror with water and then taking them off one-by-one again which worked on hand function, body awareness, sensory etc. The child responded so well to the activity and was motivated afterwards to be involved with other therapy activities placed in front of her. It was so encouraging because we haven't had much experience with children yet and we were able to have a 2-hour therapy session with the child and the Speech Therapists even got involved and added their bit to the activities. It just showed us what it is going to be like when we are qualified and how important it is to maximize the time that you have with a child because they are only seen once a month and you need to make that time count.

Friday was such an amazing day because we finally got around to painting a play area for the children. The majority of the children that attend the schools in the community are bused in and because of this they are left with nothing to do after school while they wait to be picked up. The group before us came up with the idea of painting on the tarred open area and turning it into a play area for the children for better use of their time after school. Play is defined as a transaction between the individual and the environment that is intrinsically motivated, internally controlled and free from many of the constraints of objective reality (Bundy, 1991, Another more simpler definition of play is it can be spontaneous or as part of a planned activity. Play can be defined as a physical or mental activity that has no purpose or objective outside of pure enjoyment or amusement (Definition of play, 2004). Play is a very important area in a child's life and has many benefits such as:
1. Better Behaviour- It gives the child a chance to blow off some steam and therefore will be less frustrated and perform better in the classroom.
2. Teamwork- Teaches children to play together by making them aware of other's feelings and their own which therefore teaches them skills that they can use later on in life.
3. Movement- Play that is physical will encourage children to become more active in their later life and therefore will lower their risks of getting heart disease and other illnesses.
4. Learning- It has been proven that children that are able to acheive and pass tests during play are more likely to do well in academic tests because they are learning fundamental concepts during play.
5. Fun- Play is a natural part of childhood and it is a chance for a child to explore their imagination and have fun with their friends.
and lots more.

One very exciting project that has been started in this block is a Facebook page. This was started to keep the residents informed of what projects we were running in the community and updates of any events or pictures that we want to share. The residents already have their own group where they discuss important issues happening in the community but this is closed to the community members. We have been very excited with the response we have gotten on our Facebook page with people liking and commenting. Here is the link to the page if you would like to view it-https://www.facebook.com/otinmariannridge. There is still a lot more that can be done with the Facebook page but it will be a handover for the next group.

So this is it....FINAL WEEK!!! This brings with it a lot of work and the tying up of loose ends. There is also lots of fun things happening this week like finishing the play area, assessing a child, hippotherapy, newspaper articles etc. So watch this space for a full report on my final week in the community.

History of Mariannridge

Here is a link to a site explaining the history of Mariannridge and some stories of the people involved in the community.

http://wiki.ulwazi.org/index.php5?title=Marianridge

Week 3...Not the greatest

So this week was a toughie. It was filled with letdowns and having the strikes happening at the schools meant that we couldn't do a lot of what was planned. But we just did what OTs do best, we made a plan on the spot.

The teachers have been on a go slow since the April holidays because they are wanting a wage increase and added to this the parents are wanting to strike because they have not received the term 1 reports because of the go slow. The teachers have been warned that they need to attend school for the whole day in order to get paid but the ones in Mariannridge have been at the police station during the day and the schools have been closed. These strikes have been going on for the whole week and it has caused them to close the schools for the childrens' safety even though their is no violence happening. This all has caused the children who are bused in and live in the community to come and sit around, waiting to see when the school will be open in order to get an education. This is a huge concern to my group and I because there is a big drug and alcohol problem in the community and they are needing something to spend all this extra time on. We have intervened with impromptu educational sessions with the smaller children with the use of play dough, stories, games outside etc. We need to look into a programme that we could run with the high school children that are sitting around because they are loosing out on important lessons. An idea that was put onto the Mariannridge residents forum was getting the parents to take over some of the lessons in order to ensure there is some continuation of their studies. This is something that will be spoken about this next week when we will identify a solution to this problem that has affected the community. For articles on the strikes please refer to the following articles:
http://www.news24.com/SouthAfrica/Politics/Dept-Poor-hardest-hit-by-teacher-strike-20130424
http://www.news24.com/SouthAfrica/Politics/Govt-shocked-disappointed-in-Sadtu-20130425
http://www.news24.com/SouthAfrica/Politics/Strike-and-be-disciplined-teachers-warned-20130423
And here is a video done on the Mariannridge Community about the strikes:

This wellness group I am running seems that it is also going to be a challenge. The grannies that attend have a tough life at home taking care of their families and their households so when they come and attend the wellness group they are just wanting to gossip and forget about their own lives, this is not constructive. I tried to run a reminiscent group reflecting on their lives and sharing their photos but nearly everyone forgot their photos or everyone spoke during the group. They had said in the book I am using for the group that it should be done in a big group but I think they will benefit more from smaller groups in order to focus their attention on what is happening in the activity in front of them. We will be testing out scrap booking with them in the next session.

One of the highlights of the week was going to Hippotherapy on the Tuesday.The American Hippotherapy Association, Inc., defines hippotherapy as a physical, occupational or speech therapy treatment strategy that utilizes equine movement. The word hippotherapy derives from the Greek word hippos, meaning horse. The term hippotherapy refers to the use of the movement of the horse as a treatment strategy by physical therapists, occupational therapists and speech/language pathologists to address impairments, functional limitations and disabilities in patients with neuromotor and sensory dysfunction. This treatment strategy is used as part of an integrated treatment program to achieve functional goals. This has been an interest of mine so I was extremely excited to attend. We worked with SARDA (South African Riding for the Disabled Association) www.sarda.co.za at their stables in Shongweni. We were inspired by the stories they told us of hippotherapy helping children communicate, calming them and improve their muscle tone. Here is a video explaining what Hippotherapy is and the benefits of it done by an organisation in America, a similar one was filmed while we were there which we star in so keep a look out for the SARDA promotional video.

The one thing that I love about Occupational Therapy is that you can have a really bad week but you will always find the positives and use them in order to improve the negatives, we look at a person's abilities rather than focusing on their disabilities. I look forward to this next week and know that it can only be better than the last week because we are looking forward and change will happen.

Autism=Intelligence

An amazing story of a girl who has Autism and the amazing progress she has made.

Week 2 in the community...."on the way up"

WOW what a week it has been, coming in from last week when we were so overwhelmed with everything happening and the things that we still needed to do, and now its the end of the week and we have found new ways to overwhelm ourselves. The thing about community is the more you start to understand the community, the more you find the needs and want to meet all of them. We have added a few new projects this week because we have found a need and its too big to just ignore. It has been great though because we have all found projects that we have a passion for and are coming up with great ideas. 

My new project is the wellness group that runs on a Monday from 10 till 1, it involves a group of older ladies that get together to perform Leisure activities but mainly gossip with each other. Meeting them on Monday was just such a great start to the week because they all welcomed us with open arms and there is so much love in that room. There is though a need for them to be involved in more planned activities with the aim to prevent the effects of old age e.g loss of memory, joint problems. So I have decided to base the group on Reminiscence Therapy which is defined by the American Psychological Association (APA) as 'the use of life histories-written, oral or both-to improve psychological well being." It is used to help maintain good mental health, boredom reduction, reducing stress, prepare for death, conversation, finding identity, maintaining and introducing new relationships, problem solving, and to teach/inform. These aims and principles will be melded with activities to make it fun and functional. For the first week we will be doing a scrap booking activity. They will be using a photo from "the good old days" and will each be required to explain why they chose that photo and the importance of it to them. They will then get creative and design a special page around this photo to put up in their houses. Other activities that will be introduced are knitting items for the community, cooking meals together which will focus on their senses, memories related to everyday objects etc. This is such an exciting project because these ladies are the heart of the community and have a huge influence on it. To target them and help them will in turn help the community because they are living with the families and have influence on those younger than them. 

One of the biggest breakthroughs this week was our meeting with the counselor  The group before had struggled the whole of their block to see him but we finally got through to him and were able to meet with him. During the meeting we discussed with him the projects that we were doing in the community and what the problems and drawbacks were that we had found. He showed lots of interest in what we were doing and identified with the problems that we had found. He then asked us to make a list for him of the things that we would like him to do for us because he was having a meeting with the big boss and wanted to bring up the list. He also organised a meeting with us on Monday when he will bring the people who could help us and discuss what the plan would be to move forward and better the community. All of this got us very excited because if he came through on all of the asks we would be able to do even more in the community. After the meeting however we discussed it with our supervisor and members of the previous group and they voiced some concerns of us being too excited and the possibility of him not delivering on all his promises. It took me back because I tend to be very optimistic and always think the best of people and believe that they will deliver on what they say, but getting this reality check was good for me because it made me realise that he might not deliver on everything and I shouldn't be disappointed if he does. I am still excited and hoping for the best but even if we get one thing that we asked for it would be great because we are also wanting to improve his relationship with the community members. 

One of my tasks that I had for this week was assessing both the Grade R classes at the creche which proved tougher than I thought. I designed an obstacle course to assess their gross motor abilities, they then moved onto a cut and colour activity and finally copied one part of the VMI. The children took a great liking to the obstacle course and all wanted to do it at the same time which was a problem for the one doing the course because they were being distracted by those wanting to do the course. This was solved by having the rest of the class waiting inside till they were called to come do the obstacle course. The other two parts of the assessment were done as a group which helped show the difference in the work speed. We noticed lots of delays in gross motor, fine motor and perception. One child was struggling with the activities because he was unable to see out of one of his eyes, his glasses had broken a long time ago and nothing had been done about it so he was struggling in school. It is so sad that a lack of information and finances could lead to this child been delayed in school because he is unable to see. Plans are being made to take him to Spec Savers for a free assessment and frames so that the assessment can be redone and see if there are any problems. 

All in all it has been a very productive week with lots of planning and foundation work that will hopefully start producing change from this next week. We are all so excited about the meeting with the counselor on Monday and are hoping he comes through with his promises. There are three short weeks left and so much still to do. I will leave you with this quote, I have found this in community, it isn't about you and your ego but rather about the bigger picture and wanting to make a change and using your talents to do so.

This is what gets us through each week...

Adolescent Community Reinforcement Approach

The Adolescent Community Reinforcement Approach (A-CRA) is a behavioural intervention that works on improving family, social and educational areas in an adolescent's life to support recovery from substance abuse and dependence. This also involves sessions with the learners by themselves, then with their guardians alone and then finally them together. Treatment sessions would include problem-solving skills to cope with stress, communication skills, and participation in constructive social and recreational activities with the goal of improving life satisfaction and eliminating substance use problems.

The goals of the Adolescent Community Reinforcement Approach (A-CRA) are to:

• Promote abstinence from alcohol, marijuana, and other drugs.
• Promote positive social activity. 
• Promote positive peer relationships and improved relationships with family. 
• Motivate caregiver participation in the A-CRA treatment process. 
• Promote the caregiver’s support of the adolescent’s abstinence from alcohol, marijuana, and other drugs. 
• Provide information to the caregiver about effective parenting practices. 
• Help the adolescent and caregiver(s) create a home and community environment conducive to recovery. 
• Teach the adolescent problem-solving, communication, and other important skills through the use of role-playing

A-CRA can best be understood as a toolbox of different procedures that clinicians are trained to use as appropriate with a participant. For these procedures please go to the link below for the list in order to implement this approach. 

Taken from: http://www.cebc4cw.org/program/adolescent-community-reinforcement-approach/detailed

This would be a good approach to use with the High School Learners in the Mariann Ridge Community because they are needing to be empowered so therefore by learning all these skills they will be able to implement them in their lives and therefore make a change. One of their biggest problems is the use of substances in their free time or to help them forget about their problems. so these skills will also help them find better ways to use their time and therefore leave their use of substances. An idea that this approach has is to give the learners homework to do to reinforce skills that have been learnt and also to give them responsibility which could work well with the learners because it will also assess their level of commitment and participation in the group.This group of girls and boys is going to be a challenge but this approach could help assist with the drawing up of the programme with regards to the aims and group discussions done. 

Start of something new...*Community Block*

This community was established in 1976 and was where coloured families from Durban were relocated during the Apartheid era. Sarason defined community as "a readily available, mutually supportive network of relationships on which one could depend" (Dalton, Elias & Wandersman, 2007). If you compared this community to what this definition is saying you would see that the Mariann Ridge Community is providing supportive relationships for those in the coloured community but not to others and therefore aren't reaching their full capability of what they could be to one another. 

This week has been an eye opener, after going in with all the confidence in the world I took a big knock. Having experience in working with communities before didn't help me much with what I discovered on Monday morning when we arrived at Mariann Ridge. This community has similar problems to others with regards to unemployment, poverty, children not attending school, disabled people etc yet it is unique in the history it is has and the politics that have made it what it is today. 

Before we entered the community we had a tut with our lecturers as an introduction and to help prepare us. During this a lecturer said something very profound, she said that when we are doing our projects we must not be driven by our personalities and what we want but rather about what the needs of the community are. This really hit me because I often tend to go with what I want and what I think would work best but that is wrong because the people in the community know more than me with regards to what the needs are and what needs to change. 

One of our projects in the community is in the Creche and Primary School in the area, we were coming in and running groups with the children to provide stimulation in order to encourage normal development and to pick up any delays in individuals. We have looked at it and because the OT students come and go it isn't sustainable to only treat the children, a more beneficial way of doing the project is to run an educative programme with the teachers to equip them with the skills and resources that they need. This is focusing on changing the environment that the child is in rather than just treating the child's problem, which in turn aid the treatment of the child's problems. 

We have also started a new project which involves working with the clinic in the area, There is no OT or Physiotherapist that comes to service the clinic so the clinic lacks knowledge of what we do and how we can assist them. We met with the head sister there who sat down with us and told us what patients they see and how we could help them. So from that we have established a need for intervention with mothers and young children with regards to developmental milestones and education for the mothers on stimulation for the child.The checklist we will be basing the project on is the WITS Developmental Profile which gives us the gross motor, fine motor and social developmental milestones a child should of reached at a certain age.This age group is my passion and it fits in with a need of the community but i also want to increase my knowledge and scope of practice so I am going to be speaking to the clinic to see what other needs there are and maybe start a support group with the older members of the community who suffer from chronic illnesses and are needing assistance with regards to function and some education. 

There is also a project at the high school which the Katey and Haseena will be heading up to do with empowerment of the adolescents. This is a tough project because you have to motivate the learners to attend the groups and make them fun but at the same time teaching them valuable things that they can use to change their lives. I will be working as a co-therapist in the groups and I am very excited to be involved because I have been involved with Micah 6 (http://micahsix.blogspot.com/). Katey and Haseena have also been doing a lot of research into this field and have found such amazing resources so I know that it is going to be a success. It is so important to target these adolescents at this age because they are going to be the next generation and the change needs to start with them in order to see long term change.

There have been breakthroughs with some of the things the group before us wanted to achieve. The first of which was getting into contact with DSW in order to get bins for the area outside the Library and Cafe where all the children congregate after school. Bins in the area are normally used to make drugs in so we ordered concrete bins but in the meantime we had new plastic bins delivered and these will have to be taken inside every night so that they aren't stolen. Me and a fellow student got so excited when this happened that we hugged each other and did a happy dance because we know how this will create pride in the area. We are also wanting to create a play area so a clean environment will make it more welcoming for the children after school to use it to play in. This seems like such a small win in the community but all these small wins add up in the end for the change this community needs. 

Another breakthrough was learning about the Institution Level Support Team (ILST) which is a supportive structure at schools that focuses on the screening, identification and support of areas needing development. This team includes the whole school committee, educator support committee and the learner support committee. The support group is still in its formative stages but will be a vital resource to us working in the community as soon as it is up and running. There is going to be a meeting where this team will be discussed and we will be attending in order to give our input and see if they can help sustain our project in the school. 

This is the Social-Ecological Model of Health that focuses on the different factors that will impact on an individual's health. A person's health is impacted by these different factors. It can be used to help us identify the different factors at different levels that contribute to poor health and to develop action plans and approaches to change the physical and social environments rather than modifying only the individual. This is very helpful when working in the community because all the community members are affected by different environments throughout each day so in order to treat them we need to be aware of how each of these environments are affecting them.It is also important to include in therapy their cultural beliefs, religion and values in order to treat them holistically. To see change happen there has to be action on each of these levels in order to reinforce and produce change.

My mind is going crazy with information and trying to solve the problems that we have identified in the community. Think I still need to learn that I can't solve all the problems but rather focus on a few that will make a change. Looking forward to having a weekend to get my mind around what needs to be done, reading up on theory to base my projects on and coming next week with an action plan. 

Mariann Ridge does have a blog although it is outdated, but it does have some information about the community and some of the projects that are running. http://mariannridge.wordpress.com/

Strongest Dad in the World

I love finding inspiring stories about disabled people and supportive family members. This story I have heard quite a few times but each time I read it, it touches my heart in a different way. Please take time to read it and be inspired by not only the dad but his son as well.

Strongest Dad in the World by Rick Reilly 
(Taken from a Facebook Page)

Eighty-five times he's pushed his disabled son, Rick, 26.2 miles in marathons. Eight times he's not only pushed him 26.2 miles in a wheelchair but also towed him 2.4 miles in a dinghy while swimming and pedaled him 112 miles in a seat on the handlebars – all in the same day.

Dick's also pulled him cross-country skiing, taken him on his back mountain climbing and once hauled him across the U.S. on a bike. Makes taking your son bowling look a little lame, right?

And what has Rick done for his father? Not much – except save his life.

This love story began in Winchester, Mass., 43 years ago, when Rick was strangled by the umbilical cord during birth, leaving him brain-damaged and unable to control his limbs.

"He'll be a vegetable the rest of his life," Dick says doctors told him and his wife, Judy, when Rick was nine months old. "Put him in an institution."

But the Hoyts weren't buying it. They noticed the way Rick's eyes followed them around the room. When Rick was 11 they took him to the engineering department at Tufts University and asked if there was anything to help the boy communicate. "No way," Dick says he was told. "There's nothing going on in his brain."

"Tell him a joke," Dick countered. They did. Rick laughed. Turns out a lot was going on in his brain.

Rigged up with a computer that allowed him to control the cursor by touching a switch with the side of his head, Rick was finally able to communicate. First words? "Go Bruins!" And after a high school classmate was paralyzed in an accident and the school organized a charity run for him, Rick pecked out, "Dad, I want to do that."

Yeah, right. How was Dick, a self-described "porker" who never ran more than a mile at a time, going to push his son five miles? Still, he tried. "Then it was me who was handicapped," Dick says. "I was sore for two weeks."

That day changed Rick's life. "Dad," he typed, "when we were running, it felt like I wasn't disabled anymore!"

And that sentence changed Dick's life. He became obsessed with giving Rick that feeling as often as he could. He got into such hard-belly shape that he and Rick were ready to try the 1979 Boston Marathon.

"No way," Dick was told by a race official. The Hoyts weren't quite a single runner, and they weren't quite a wheelchair competitor. For a few years Dick and Rick just joined the massive field and ran anyway. Then they found a way to get into the race officially: In 1983 they ran another marathon so fast they made the qualifying time for Boston the following year.

Then somebody said, "Hey, Dick, why not a triathlon?"

How's a guy who never learned to swim and hadn't ridden a bike since he was six going to haul his 110-pound kid through a triathlon? Still, Dick tried.

Now they've done 212 triathlons, including four grueling 15-hour Ironmans in Hawaii. It must be a buzzkill to be a 25-year-old stud getting passed by an old guy towing a grown man in a dinghy, don't you think?

Hey, Dick, why not see how you'd do on your own? "No way," he says. Dick does it purely for "the awesome feeling" he gets seeing Rick with a cantaloupe smile as they run, swim and ride together.

This year, at ages 65 and 43, Dick and Rick finished their 24th Boston Marathon, in 5,083rd place out of more than 20,000 starters. Their best time? Two hours, 40 minutes in 1992 – only 35 minutes off the world record, which, in case you don't keep track of these things, happens to be held by a guy who was not pushing another man in a wheelchair at the time.

"No question about it," Rick types. "My dad is the Father of the Century."

And Dick got something else out of all this too. Two years ago he had a mild heart attack during a race. Doctors found that one of his arteries was 95% clogged. "If you hadn't been in such great shape," one doctor told him, "you probably would've died 15 years ago."

So, in a way, Dick and Rick saved each other's life.

Rick, who has his own apartment (he gets home care) and works in Boston, and Dick, retired from the military and living in Holland, Mass., always find ways to be together. They give speeches around the country and compete in some backbreaking race every weekend, including this Father's Day.

That night, Rick will buy his dad dinner, but the thing he really wants to give him is a gift he can never buy. "The thing I'd most like," Rick types, "is that my dad sit in the chair and I push him once."

There comes a time in life, when you walk away from all the drama and people who create it. You surround yourself with people who make you laugh, forget the bad, and focus on the good. So, love the people who treat you right. Think good thoughts for the ones who don't. Life is too short to be anything but happy. Falling down is part of LIFE...Getting back up is LIVING...Have a great life