Field Work - round 1

Last week I had the opportunity to spend three working days with an occupational therapist. As part of field work there were some assignments associated with the experience but it was great to be out of the classroom and see how what we are learning actually applies in real life. All of my previous exposure to OT has been in a hospital setting so I didn't really know what to expect when I was assigned to home care. Home care is for those who are considered "home-bound." In most cases the client has recently come home from the hospital but it is exhausting to go anywhere so the additional care they need comes to them. Most of the people we saw were over 65. The diagnosis ranged from by-pass surgery to a fractured vertebra to chronic obstructive pulmonary disease to Parkinson's. Each visit could be a story in itself but that would go against confidentiality rules so I'll stick to some of the things I learned.

During one of our visits the first day, I found myself rather uncomfortable. I couldn't really put it into words but I found myself wondering if I really wanted to do this job. As the OT did a cognitive evaluation and tried to help the client figure out what had happened to one of her medications something didn't seem right. As we drove to the next appointment, the OT put words to my uneasiness when she said, "I know there is really nothing I can do that will make a difference in her life." I suppose that is part of every job that works with people and it is better to recognize it and focus on those you can help.

Another visit that first day left me flabbergasted. Instead of seeking medical help following an injury, this particular person had sat on the couch--for months--waiting for it to get better before seeking medical help. Sitting around that long leads to extreme weakness and muscle tightness that, in this case, made it almost impossible to stand. I was shocked. How could something like this happen?! The OT didn't really know what to do in the situation either. She could help the person obtain a wheelchair to allow movement around the home. But beyond that, "This one is going to take a team meeting (with the nurse, physical therapist, & social worker...) to figure out what to do."

Almost all the people we visited had simple home exercise programs. Some of them used the thera-bands for resistance but for the rest, gravity was enough. Just move the arms in and out, punch, walk in place and kick. In every case, people were making progress. One woman had gone from not being able to do any of the exercises standing to doing each for 1 minute while standing and recovering quite quickly. She needed to be at 2 minutes each before she was ready for cardiac rehab but she had already come a long way. The OT taught me that simple is almost always better.

Several people we visited had spouses who were doing a lot of work to help with care. It's can be a hard adjustment for them. The OT talked about how she can tell which spouses will burn out if they don't get help. We met one of man who is a good candidate for burn-out. It was obvious that he loved his sweet wife but he was also very aware of the new limitations that her illness brought to their life. He was mourning all the outdoor activities he loved to do that were no longer available to them.

One of the most encouraging things I saw was some great families: sisters, children, and grandchildren who came together to care for Mom/Grandma on a short-term or more long-term basis. The last day we did several evaluations to see if a particular person needed anything within the  new living situation. In the case of one great-grandmother, the doctor requested a cognitive evaluation. She was living with one of her children, was able to get around on her own and was rarely left alone and then only for a few minutes. The results of the cognitive evaluation wouldn't change anything the family was doing to care for her so the OT just asked her a few questions. In another situation, the client was in quite a bit of pain so the evaluation was more related to looking at what her kids were doing to make things work for their mom following a recent hospital stay. They were doing a great job. A few suggestions and a plan for when to return reassured the family. In home care, working with the family is just as important as working with the client.

An OT quote

In the midst of the 2nd-to-last week of the semester which requires more writing than I care to do, I came across the following quote from the 1991 Wilma West Lecture by Linda L Florey. It's a reminder of what occupational therapy is all about.

Children with sensory integrative dysfunction, neurological impairments, musculoskeletal dysfunction, conduct disorders and attention deficit disorders also have "Cub scout disorders", "playmate disorders", "kicking the soccer ball disorders", "getting dressed in gym class disorders", "best friend disorders", "no one to eat lunch with disorders". These are important disorders... with which we must ultimately concern ourselves. We must not lose our commitment to ordinary activities nor to the interpersonal context in which they occur."

As Pierre Teilhard de Chardin said, "What matters is not to do the remarkable things, but to do ordinary things with the conviction that their value is enormous."

Group work

Yesterday (Sunday evening) our final group project of the semester was due. The first week of the semester we were told to divide into groups of four loosely based on geographic area since we would need to go together to interview someone. We didn't know each others names much less personality and work style so it felt somewhat like the Russian Roulette. At the same time, I figured that everyone who got into the program was a good student so it shouldn't really matter. I was thankful to have ended up with a good group who worked hard and well together.

Our task was to identify a community organization that promotes health and well-being, learn about it, interview someone in the organization and then develop a plan for how occupational therapy could enhance what they are doing. We chose the Wilder Foundation in St Paul and specifically looked at their Southeast Asian Services. Since the early 1980s Hmong, Cambodians, Vietnamese and more recently the Karen have been coming to the US and there is a large pocket that has settled in St Paul. They are more refugees than immigrants and many have been through significant trauma. Most have experienced an extreme lack of food, lost a member of their family, been separated from family members, and/or spent time in refugee camps. By coming to the US they may now be safe, but they have lost their country and have to adjust to a new language, culture and climate.

Because of all this trauma and upheaval it is little wonder that they experience a high rate of mental illness. Wilder is providing a unique service in that all of their service providers are also 1st generation refugees. They have been through the same horrors, understand the cultural gaps and speak the language of their clients. As we learned about their program, we wondered what we could possibly offer. They are already using many occupational therapy principles. I'm sure an experienced OT could look at what they are doing and offer suggestions that would make a big difference. We are not experienced OTs, but 1st semester students. However, we came up with an idea and got our 27 page paper (double-spaced) written by the due date. The true challenge will be going back to Wilder on Wednesday and presenting our idea. The supervisor who is our contact, has invited all the service providers to come as well. This part of the assignment made it more real-world than just turning in a paper to our professor. I hope we can be of some help to them and at least give them some resources that will enhance their work.

Living with Disability

This week one of our professors brought in a group of her friends so we could listen to their stories of what it means to live with a disability on a daily basis. Two of my favorite had cerebral palsy which is a group of disorders that impacts brain and nervous system functions. It affects people differently. Lori, a woman in her 50s was able to speak but it obviously took effort and her hands shook. She gets around in a wheelchair but is able to stand up and move short distances. Jim, on the other hand, was very difficult to understand, has the use of one hand and a wheelchair is his only mobility. Despite these difficulties they have lived with for as long as they can remember, both are full of life and have a great sense of humor.

Lori began by telling us that her favorite part of disability was the opportunity to be creative. She preceded to show us her creative solutions to some of the challenges she faces. She doesn't like winter in part because the waterfalls in the area where she lives are turned off. So she wanted to take a video of the waterfalls with her iPhone. For most of us that would be a simple task but for Lori it is a challenge because she can't hold the phone steady. Her creative solution: tape the phone to a yard stick that she could prop up. Her video didn't move at all. Lori has her own version of the serenity prayer, "Lord, show me what I can do, what I can't do and give me the wisdom to know the difference."

Jim is 76 and has been married for 23 years. His wife was also present and she too has cerebral palsy. One of her roles was to translate for Jim though she wasn't that easy to understand either. Jim wrote out his story in a power point presentation and we took turns reading it out loud. The first slide said a lot about how the way society has viewed those who aren't "normal."

a "crippled" child

a "handicapped" young adult

a "disabled" adult

a senior with abilities

Jim's parents were told to put him in an institution. They refused and took their 2 year old boy home and did the best they could. An uncle noticed how bright this boy was who couldn't speak so his mother began to teach him. Later she advocated for him and the school system provided a tutor. He did just as well as any of the others his age. As a young adult he took college level courses in accounting and opened his own accounting and tax preparation business. He soon became known as the man no one can understand but who can save you lots of money on your taxes. His life was revolutionized by the computer which made the accounting work much easier and allowed him to communicate so much more easily with others.

Jim ended his written presentation with, "Don't label a child born without some function 'disabled.' Rather call them uniquely challenged with all the possibilities of uniqueness." Then he turned to us and said, "I hope you understand more about how interesting it is to be disabled."

Healthcare systems

I spent quite a bit of time this past week looking at different healthcare systems. For one of my classes I had to try to understand the Affordable Care Act (not an easy task). I also wrote a paper comparing the French healthcare system with the American one. I came to the conclusion that every system has negatives and positives.

The French system provides health coverage for every person living in the country at half the cost per capita of the American system. The negative is that 81% of the funds come from payroll taxes (called "dues" or "contributions"). About 15% of a person's gross income goes to "social security" which includes healthcare, retirement, disability, workman's compensation and family benefits. Most of the burden falls on businesses who pay an additional 30% of each employee's gross income to the government to cover the rest of the costs. As one might expect, this leads to higher unemployment.

The French are able to keep the costs down by controlling what healthcare providers can charge. It only costs 23 euros to go the doctor (about $30). From my experience in France, medical personnel have little risk of being sued, pharmaceutical companies aren't spending millions on ads in the general media, and aesthetics at the doctor's office, clinic or hospital are not a priority. These are small things that help keep overall healthcare costs down and also stand in sharp contrast to the American system.

One of the affects of universal coverage is that people run to the doctor far more often. I discovered that the French go to the doctor almost twice as often as Americans each year. On the other hand, Americans have about twice as many tests such as an MRI or CAT scan as the French. Maybe the French are able to keep their overall costs down because they are at the doctor more often so serious conditions are caught when they are easier to treat. And our extra tests costs more without really contributing to better health. 

Whatever your view on the Affordable Care Act, the American healthcare system needs a dramatic overhaul. However, no matter what the system, resources are limited and decisions have to be made as to how to allocate those resources. Even more importantly, the health of the nation is far more closely linked to the lifestyle of the people than the healthcare system in place.

So what does an OT do anyway?

Over the past two years as I've told people that I'm going to school to become an occupational therapist, I've often been asked, "so what does an OT do anyway?" The question didn't surprise me. After all when I first thought of being involved in some type of therapy I thought of physical therapy and had to do some research to figure out what OT was. Most people haven't heard about it unless they have been on the receiving end of their help. One reason why it is hard to describe what an OT does is because they work in such a variety of situations: in schools, mental health, hospitals, nursing homes, rehab centers and in the community.

It also doesn't help that most people think of an occupation as a job. In my reading it seems that even OTs can't agree on what "occupation" means. After all, a publication put out by the American Occupational Therapy Association (AOTA) includes 6 definitions. Despite all that, there are commonalities. Basically an occupation is anything we do that gives meaning and structure to our days. It follows than that an OT helps people do what they feel is important to do. It's the patient or client who sets the agenda and occupation is not only the goal of therapy but also the means. Sometimes exercises and stretching are needed but for the most part an OT session is spent actually engaged in doing something, whether that is bathing and getting dressed or making something to eat in the kitchen. Besides those basic activities of life, occupation also includes rest and sleep, education, work, play, leisure and social interaction. That pretty much covers everything we do. No wonder one of the things most OTs love about their job is the constant variety.

First week of class

This morning at church a friend asked me what classes I was taking. My eyes immediately glazed over as I said, "I don't know. I have six classes and they all have something to do with occupational therapy," as my stack of books can attest. Evidently we will be using those thick ones for several semesters.

It's been an intense week. I got started on the online portion of my classes on Tuesday. Wednesday and Thursday I was in class and orientation all day. Friday I studied until almost 11 pm and was up at 5:30 to work security at the Gopher football game. By the time I got home at 3:30 I was beyond tired but I still managed to work on one of my classes until I had to write something of substance. At that point I quit and headed for bed.

The students who are a year ahead of us informed us that this was a writing intensive semester. I don't even want to count how many essays or papers I've written this week but I did finish them all before the Sunday midnight deadline. I don't usually do homework on Sunday but I had no choice this time around. I was elated to find that the last list of things to do isn't actually due until Wednesday. In that case, it can wait for tomorrow. I hope to get all of next week's work done by Friday evening now that I have a better idea for how it all works. As the semester goes on I'll fill you in on my classes as I get a better handle on them myself. But since there is no word count on this blog post and nobody is going to comment on my critical thinking I can end here and head for bed.