Peer Support Workshop

Just imagine walking into a room of complete strangers, most of whom are younger than you, and divulging your most personal life details and allowing open questioning in response. How comfortable would you feel? How comfortable would they feel? Now imagine talking candidly from personal experience about one of society's most stigmatized afflictions: mental illness. Now how comfortable would you and your audience feel?

The considerable contributions of Peer Support Workers have been recognised for a number of decades but only recently has financial backing begun to viably support this movement. From a generalized perspective, the principles of peer support make perfect sense. In life generally, we gravitate towards people who we feel understand us and can share our life experiences. This is particularly the case if you have been through a traumatic life experience. In such situations, even the people that really want to understand what you have been through or are going through (which is probably the minority), struggle to comprehend in a tangible way. Whether an individual has experienced cancer, spinal cord injury or mental illness, connecting with someone who has undergone a similar experience is likely to be, in most cases, a comforting and spirit-boosting experience. Peer support workers are further along in their rehabilitation or recovery and offer tangible signs of coping's most powerful ingredient: hope.

Some of the most meaningful and instructive sessions during the OT program so far have been when we have interacted with 'real' potential clients (as opposed to written case studies). Part of the OT's skill set is the way in which we interact with people. You can read all the books and research papers dedicated to exposing the 'lived experience' of having a life changing illness or injury, but hearing it straight from someone's mouth is so much more powerful. Attending the Richmond Mental Health Consumers and Friends Society workshop was one of these powerful learning experiences. Students from different health care disciplines were invited to attend and the format was like the scenario described above. The peer support workers took turns to tell their story - their experience of living with mental illness and their road to recovery. The stories were touching and they showed great humility and insight. Yet the overriding tone that threaded through the stories was one of recovery and hope - a sense that no matter how low someone had felt during the worst times, there was a way back. Often the route was not a direct highway back to the same place they were before, but rather a winding country road to a different place, sometimes a more settling place. Either way, the fact that there is a route and it had been found is what's important. We discussed the stigma associated with mental illness, the non-linear recovery path, aspects of spirituality and the importance of occupation in facilitating recovery. All of the peer support workers are currently employed by Vancouver Coastal Health and in many cases this was their first paid position after experiencing mental illness. In life, you have got to love win-win situations and this is one of those situations. The peers provide an invaluable service by representing a beacon of hope and offering support and practical advice from a unique empathetic perspective to their clients. The peers in turn have meaningful employment and some financial renumeration - huge stepping stones in the recovery process. They are skilled employees with rights and responsibilities. Empowerment. They help to foster positive change in their clients and gain great satisfaction from their work. How many people can say that about their respective professions?

I felt very privileged to have been involved in this experience. I have so much respect for the peers for telling their illness and recovery stories for the benefit of our learning. By speaking up, the peer support workers are on the front line in the battle against societal stigma associated with mental illness. Throughout the session, I was reassured to hear the messages we are taught at school resonate in the peer's stories: the small steps towards recovery, the need for a mix of medication and occupation, family involvement, hope, spirituality, empowerment and the list goes on. Hearing these themes being discussed helped me to realise that I am on the right track in my learning. Phew! In ten month's time, when I graduate, I'm not sure I'll feel fully competent to help people along the rehabilitation path. However, I will feel, thanks in part to this experience, that I have a better idea of my approach to supporting recovery.

Who is Stationed on the Front Line?

A woman in her early forties hurries into a medical clinic. She is relieved to be out of the rain and does not notice the sign above the door of the newly opened facility. She is directly by the receptionist down a bright hallway into Room 2. Inside the room, sitting behind a tidy desk is a man with a pleasant smile and approachable looking face. The man waits for the newcomer to sit down and asks, "What brings you to the integrated health clinic today?" The woman is taken aback. She is surprised to be in front of a doctor without having to wait and falteringly begins to express her problems, not knowing how or where to start. "I've been working so hard recently...I haven't been getting much sleep - I have young children and it's only me to look after them. I've felt very down...quite depressed". "I am not a doctor" says the man, directing his eyes to the sign on the desk which reads "Integrated Triage", "but I can give you an appointment with an occupational therapist in five minutes". The woman thinks there has been a mistake - she is not having troubles with her job, although she has been struggling a bit recently. The man goes on to explain that an occupational therapist can help her to identify where she is having difficulties in different areas of her life and provide her with strategies for resolving her problems. The woman feels relieved that someone can see her so quickly and gladly accepts the appointment.

Ok, I've snapped out of my fictitious world, but as a student, I feel I have an obligation to conjecture with a dose of idealism. Entering into the second year of a Master of Occupational Therapy program, I feel that my eyes are being opened to the potential of this health discipline. Occupational therapists work with people who have a range of disabilities within a variety of settings: hospitals, rehabilitation centres, schools, long-term residential care and in people's homes for clients living in the community. The focus of the profession is on supporting people to engage in meaningful activities following disabling physical impairment - whether this means dressing, shopping in the community or fulfilling parental obligations - it all comes within the discipline's scope. Most occupational therapists work with people who have health issues. The dream scenario described above projects forward to a time in which occupational therapists and other health care professions can work in a more preventative manner; i.e. seeing clients prior to serious health problems occurring. I believe that occupational therapists and other health care disciplines can play a vital role on the front line of health care service provision as part of an interdisciplinary team.

Health Canada and the BC Medical Association recognise the importance of shifting the health care focus towards an emphasis on greater primary care. There is also recognition that primary care needs to be more interdisciplinary in order to operate efficiently. Having a unified team available at the first port of call seems not only to make sense - it seems blindingly obvious. As patients, we are conditioned to visiting the doctor when we have health concerns. Sometimes, it may be more appropriate to see another health professional, but we do not have that option readily available. How can GP’s be expected to work effectively when they have an unrelenting stream of patients listlessly flipping through glossy magazines in the waiting area? If other health care professionals can ease the burden of the GP's by providing discipline-specific expert advice, this has got to be a preferable situation.
Despite the good intentions of educators to push the interdisciplinary agenda, from my experience there is scant evidence of health care students getting together to carve out a model that could translate into 'the real world'. The two opportunities I have had to collaborate with my future colleagues in nursing, physical therapy, pharmacy, medicine etc. have been inspiring and enlightening experiences. As representatives of our respective professions, we sat around a table explaining to each other exactly how we would approach the treatment of a fictitious patient. Misconceptions, of which there were many, were dispelled. We felt empowered, unified and emboldened as we contemplated the prospect of entering into the often maligned health care system – together as a team. There are also emerging frameworks that have the potential to foster greater collaboration between disciplines. The World Health Organization (WHO) has changed the way in which ‘health’ and ‘disability’ are conceptualized. It is recognizes that all humans experience variability in health condition over a lifetime. Therefore, disability is not seen as something occurring to the minority, but something that everyone is subject to. Viewed this way, health and disability can be measured on the same continuum rather than the more traditional view of distinct ‘healthy’ and ‘disabled’ populations. WHO’s International Classification of Functioning model depicts a holist view of health determinants rather than focusing solely on the physical body and symptoms. This biopsychosocial model provides a blueprint for health care professionals to work from, where everyone can identify their area of expertise and see the continuity between scopes of practice. Importantly, it provides a means of communicating in a common language, allowing for improved interdisciplinary understanding.

The initiatives to change the emphasis of primary health care and foster greater interdisciplinary collaboration are in place (e.g. Enhancing Interdisciplinary Collaboration in Health Care), but the momentum is slow. There are various interdisciplinary primary health care units around the country and reports show improved satisfaction from all stakeholders, including patients. When I qualify as an Occupational Therapist, I want the option of working within a primary health care setting to provide vital services to all people in the health continuum. Ultimately, change is an economic issue, but it is also a philosophical and ethical one. We have the ideas for developing a more efficient and inclusive medical system. Now is the time to make it a practical reality. It is either that or a less rosy outcome to the above scenario: the woman is discouraged when she is told she must wait at least 45 minutes to see a doctor so she decides to go home. Her problems are unresolved. What happens next?

Inspired again!

I have a confession to make: I love maps. I would like to put it down to being male but maybe it's not as simple as that. When heading into unfamiliar territory, I can't resist buying a map of the region and planning out the best route to each destination. The touristy maps with the little illustations of noteworthy buildings are especially juicy. I feel sorry for people who travel with me because of my reluctance to venture far without my map (or maps) in hand. They also have to deal with my frustration when the map doesn't seem to match up with the surroundings and of course, similarly to following Ikea instructions, it is always the map's fault! Of course, maps are so 20th century. The trusty map is underthreat by GPS and maybe one day, like when I reluctantly converted from buying tapes to buying CD's, I will have to bow to modern technology once again and buy a little machine that speaks to me in a reassuring, yet slightly pompous robotic voice, and in theory, I'll never get lost again. But what's the fun of that? Some of the best experiences come from getting lost - meeting the friendly local who is more than happy to put you back on track or meeting the suspiciously too friendly local who is more than happy to take adavantage of the clueless tourist vibe given off in such situations. For a map geek such as myself, there is nothing more satisfying than getting lost and then finding your way out of the labyrinth without even using a ball of wool. Who needs GPS? (Well, probably me, but I refuse to admit it at the moment!).

Towards the end of my first year of OT school, I got lost. Whatsmore, my map seemed to be lost too. Somewhere between placements, online courses and neuroanatomy, I practically forgot what program I was taking. My OT flame was not burning quite as brightly and I lost track of why I entered into the course to begin with. However, I'm happy to say, I'm inspired once again and excited to be beginning my second and final year. How did this turnaround occur? Well the three weeks of summer holiday might have had something to do with it as it allowed me to step back and reflect. I realised that over the course of the first year, I had developed many questions about the occupational therapy profession but not really found many answers. In discussions with peers, we realised that we had become good at trotting out standard theoretical responses but we were not taking the time to get to the real nitty gritty of issues. It seemed like a raised toilet seat and energy conservation strategies were the answer to everything no matter what the client needs or the diagnosis (of course, when 'meeting the client' consists of reading a case study, it's hard to replicate real life client-centeredness). They say that if you recognise a problem, you are well on the way to resolving it and now that we've chatted about this, I think we can move to the next level and start to become real experts rather than superficial ones. Also, I'm not too detered by this educational confusion as I used to preach to my students that confusion is ok and a necessary part of learning; however, it's one thing to smuggly say this as a teacher - another to accept this with total coolness, calmness and collectedness as a student.

The main reason for the rekindling of my inspiration has been having the good fortunate to listen to a number of preeminent OT gurus in the past week. I heard the first two during the Capstone Conference during which this year's graduates presented their research projects. The two keynote speakers were contrasting in style, but both were equally effective in translating their knowledge. Sue Baptiste talked about aspects of professionalism and Pam Andrews spoke about resilience. I had been watching the Democratic Party's National Convention the night before the conference and had been amused to see the rapturous applause and standing ovations that met every other sentence Hillary uttered. Listening to these two OT champions, I felt like I needed to get on my feet and cheer, wave my OT flag and pump my fist in the air in a victorious manner - but thankfully I controlled myself. The third wave of inspiration came in the form of a former head of our OT department. Having been out of formal teaching for a while, Margaret McCuaig played a cameo role, returning as a guest lecturer at the end of our 'get your minds back into gear after the summer' week. She offered many pearls of wisdom, but one of her parting expressions resonated particularly. Reflecting on her career in OT she said (in full sincerity), "I am just as passionate about this profession now that I'm leaving it as I was when I entered it". This statement definitely marks highly on the inspiration scale as I bet not too many people could genuinely say that about their respective professions. Thanks to these people, I've found my map. I just hope I can hold on to it until around this time next year.

A New Line of Work for OT's?

Occupational Therapy’s Identity Crisis

"So what do you do?" is a handy question to ask when meeting people for the first time at social gatherings. The answer gives an insight into who that person is and provides us with avenues for further conversation depending on whether the response is considered interesting or worthy of follow up. My reply used to be "I'm an elementary school teacher". Some people found this interesting and pursued their line of questioning; to others, this answer maybe seemed too 'normal' a profession to warrant further comment. Whether people are interested or not, everyone has a strong conception of teaching as a profession. Most people don't have to think too hard to conjure up images of their favourite or most detested teachers in days gone past. Stories of chalk board erasers flying across the classroom aimed at disruptive pupils' heads or the teacher that could make learning seem interesting and dare I say it, fun, are fondly recounted at reunions of school friends. So like it or not, telling someone you're a teacher immediately provides people with conceptions and probably also misconceptions of who you are, what you're like, what you stand for etc.

Responding to the 'so what do you do?' question with the answer 'occupational therapist' probably makes some people wish they had never asked. When it comes to knowing what OT's do, people seem to divide into three groups: the majority have no idea at all of what an OT is or does - these people are then faced with the awkward decision of whether to pretend they know and then divert the conversation without being discovered or admitting that they don't have a clue what an OT is (I fell into the first category before beginning my OT training); the second group try to posit a definition of what being an OT entails - "so is that like helping people to find jobs or helping people when they are having difficulty doing their jobs" - which is a reasonable attempt considering the words of the job title; the minority of people break into a knowing smile and usually express some favourable comment about the work of OT's - these people, or maybe someone in their family or a friend, have usually experienced OT first hand.

For most people, the word occupation means 'job' so why wouldn't people think OT's are job counselors or career advisers? We don't have any popular tv dramas to publicize, or more accurately sensationalize and glamorize, the nature of our work. Lawyers have Ally McBeal and Boston Legal; medics have ER, House and Gray's Anatomy; teachers have Boston Public and Degrassi High (actually, did those kids ever go to school?); The police have CSI Miami, New York, Vegas and also Cagney and Lacey and CHIPS to take it back a few years. Even members of special intelligence agencies that investigate paranormal phenomena and extraterrestrial beings have their own tv show (The X-Files) even though this must be a pretty niche career.

Explaining to people what an OT does is tough. Launching into definitions of "enabling people to maximize their potential in valued activities" is vague. "Helping people to do, be and become" is even vaguer. When it comes down to it, unless a close friend or family member has had a debilitating illness, injury or condition, most people would not really understand why someone would need help with tasks and activities where the skills required for successful completion are normally regarded as second nature or just 'common sense'. OT's are keen to advocate and publicize their profession. On one level, this is out of necessity to compete for funding dollars, but also it stems from a passion for the profession and having first hand experience of its effectiveness. But the most convincing advocates, from my experience so far, are the recipients of OT services, the clients themselves. The experience of living with disability is a unique perspective from which to explain the challenges that everyday life presents. People with disabilities are likely to express the need for a profession that assists in remediation of every day life challenges in a more meaningful way that most OT's could. Maybe the time has come for a television drama based on the lives and work of OT's. After all, haven't Lindsay Lohan, Amy Winehouse - not to mention Britney - made rehab part of popular culture? Watch out for the new series 'Rehab' - coming to your tv screen soon.

OT Joke

Five healthcare students sat in a room: a medic, a pharmacologist, a nurse, a PT and an OT…

It sounds like the beginning to a joke, but alas it’s not (skip to the end of the article if you want a joke!). It was, in fact, the situation I found myself in last week. And was this meeting of prospective healthcare professionals from an array of disciplines a spontaneous get together? Of course not – we’re all far too busy for meetings not scheduled into our curriculum! During our mini-summit, we all lamented at the fact that while we worked towards a common goal – best possible patient care – rarely, if ever, did our academic worlds coincide.

If truth be known, part of the reason I was in the room was the lure of $100 for taking part in this interdisciplinary problem-based learning research project and the promise of a free pizza meal. Along with this considerable draw, I was also intrigued by the prospect of getting a snapshot of what working with future colleagues would look and feel like. And my conclusion is: the future is bright.

Our task was to discuss a case study of a patient who had a diagnosis of lower back pain and post-partum depression. We received some initial information and then more details were revealed by the facilitator as we asked pertinent questions. It was a bit like a more sophisticated version of ‘Twenty Questions’. My trepidation in being unable to convey the OT perspective slowly subsided as a few key concepts jumped out at me as we were introduced to the case. The main concept that struck me was ‘role’ – this lady was a wife, a mother, an employee (and the list goes on). I begun to get excited when I realized that ‘role’ was a very ‘OTish’ concept and just by mentioning this word, I felt that my place at the table was justified.

Discussions hadn’t progressed very far when the pharmacology student turned to me and boldly declared, “I have to admit, I don’t really know what an OT does”. Suddenly I felt the pressure of four sets of eyes looking in my direction all expecting an eloquent and succinct explanation of the occupational therapy profession. And I’m sorry to admit that I didn’t do a great job of providing them with the answer they were looking for. I began to explain it by comparing OT to PT – an attempt to provide a meaningful context - but I soon tailed off with that approach when I realized that I didn’t truly know what PT’s do and there was one sitting right in front of me (awkward!). Then I changed my tact to utterings of “support people to resume or reintegrate into meaningful activities after the onset of illness or injuries”. Although it made sense in my mind, I could tell I wasn’t doing a lot to help them visualize what OT’s actually do.

Returning the following week after doing some research into potential OT interventions for this case, I think I managed to enlighten my team a little more. There were a few surprised mutterings and impressed looks as I reeled off a number of potential OT interventions. The medical student said he would often refer patients to OT’s in his action plans (or whatever the medics call them) but like a road you feel may suddenly terminate over the crest of a hill, he had no idea what actually happened when they arrived in the OT department – he just assumed they rehabilitated…somehow. My hypothetical action plan seemed to cover most bases: it involved biomechanical, rehabilitation and psychosocial approaches. The others were surprised that OT’s could delve into mental health issues. I felt satisfied, maybe a little smug if truth be known, that I represented such a diverse and holistic-thinking profession.

The whole experience of working as part of an interdisciplinary team was invigorating and exciting. I would go as far as saying that I can’t wait to work in an environment where there is constant exchange between different disciplines. Maybe it won’t be as relaxed and responsibility-free as this little taster experience, but it will certainly be dynamic and interesting.

This experience coincided with ponderings over my progress through the Masters program so far. For better or worse, I feel like I am steadily acquiring the lingo of OT’s and healthcare. I also feel like I can view situations through an ‘OT lens’ (I love this expression – it’s like a special prescription for glasses; I might try asking for it when I visit the optometrist next time). I am getting the “What” of OT – I just don’t quite get the “How”. When it comes to thinking of realistic plans and actually implementing them in real life situations, my mind goes a bit blank, the furrows on my brow deepen and my cognitive cogs start to churn. Oh well, I’m only a quarter of the way through the program and only have one fieldwork placement under my belt out of six and the placements are where the real and lasting learning happens.

And now for an actual OT joke (I totally plagiarized this from another OT blog so I take no credit or responsibility for its funniness/lack of humour, delete as appropriate):

Q: How many Occupational Therapists does it take to change a lightbulb?
A: None. We’d teach the lightbulb to change itself.

Hmmm…maybe we shouldn’t give up our day jobs quite yet.

The Healing Touch of Tango

It's so refreshing to read articles like this once in a while. Just when I'm starting to get lost in the maze of learning experienced by OT students (I'm generalizing hopefully - it's not just me is it?) and lose focus, I am reminded about the power of occupation. This is another article by Tasleem Rajwani, the author of 'Salsa as Medicine' (mentioned on this blog a few months ago). I wonder how many amazing and inspiring stories there are like this out there just waiting to be written.

Click the link below to read the article:
http://salsavancouver.net/articles/healingtango.html

Guinness and Anatomy

For me, studying anatomy was like becoming a Guinness drinker. As a beverage, Guinness is big and scary. It is not something to take on with a light heart and without full considerations of what you’re getting yourself into. It is seemingly straightforward at first (how difficult can a black and white beer be?), but as soon as you taste it, you discover its depth. As time goes on, you begin to appreciate the subtleties of consuming Guinness – the correct angle of poor (45 degrees if you’re interested) and the optimal serving temperature (5-8 degrees Celsius apparently). The first few times, the taste of the beer may seem overwhelming, but its intriguing and multi-layered taste makes you want to come back for more. You persevere and after a while, its complexity which once seemed unlikable and unconquerable becomes the reason you begin to like this new flavour. Everything at last begins to fit together and make sense. While appreciating the tumultuous journey you have taken together to become friends, in the end you see Guinness as a straightforward and honest pint – it’s just black and white after all! Guinness and Anatomy: for me, as they like to say in South-East Asian markets, “same same, but different”.

Not coming from an anatomy background, I felt like the man in the parable who tried to build his house on sand. Like him, I would keep trying to build, but with limited foundations, my knowledge kept slipping away. However, I was intrigued from the start and inspired by the teachers who seemed to fully appreciate the beauty of every muscle, nerve and artery. We were also very lucky to have cadaver specimens to practice on which ironically really brought the subject alive. I am eternally grateful to those good souls who graciously dedicated their bodies to the scientific cause. Without them, it would have been pretty tricky to figure out how the body really works. I remember the first time our class went down to the ‘wet lab’. I think on the whole we looked apprehensive and those of us who had not worked with prosections before were probably wondering how we were going to cope with the experience. As the door to the huge specimen fridge was opened for the first time, I heard someone ask if they should move out of the way so that someone behind could get a better look. “It’s ok, I’m fine where I am, thanks” came the reply. This was partly the way I was feeling too, though intrigued to see at the same time.

Having been told at the start of the course that we (OT’s and PT’s) go into more detail in our Anatomy studies than the Meds and Dents, it should have been no surprise that preparing for the exam was tough. The ‘bell-ringer’ is quite the experience: 80 stations, each with a specimen, a radiograph or surface anatomy photo tagged for identification. One minute per station, then the buzzer sounds and everyone breaks their intense inspections, scrambles down an answer and moves on in unison to the next challenge. I was totally unprepared for this type of examination at the midterm. In retrospect, speed-dating may have been a good way to get ready. I can’t think of anything else where you get a short time to make your acquaintance, make the best possible effort to understand exactly what is in front of you before being ordered to move on by a buzzer. At least the bell ringer is civilized enough to have rest stations; one whole minute of pure luxury, a chance to sit down, compose yourself, contemplate life, before…BUZZ and you’re back into the game. My slight angst with the whole process was eased as I arrived at my first station which happened to be a photo of the Governor of California’s back, but in the Terminator days rather than his current Governator role. So muscle-bound was Mr. Schwarzenegger’s back, I actually had difficulty identifying which muscles were which. Studying for the exam was all-consuming. One of my study partners had remarked her husband had romantically stroked her tenderly on the hand a few days earlier and all she could think about was which dermatome was receiving the sensation. What dedication to anatomy studies!

So in OSCAR-esque spirit, here are this year’s Anatomy Academy Awards. The award for having the biggest name for the smallest feature goes to Flexor Digiti Minimi Brevis. The Darwin Award for possibly being a casualty of evolution goes to Plantaris (due to being one of those muscles that is getting smaller and may evolve out of the human body in time). The award for inconsistency goes to Palmaris Longus for not being present in all people (draw your fingers and thumb together and flex your wrist to 90 degrees. Can you see a tendon popping out by your wrist – that’s the Palmaris Longus. If it’s not there, you’re like about 30% of the population that don’t have this muscle.) Palmaris Longus also wins the award for the muscle sounding most like a cheap Mexican resort. The Arnold Schwarzenegger award for the coolest name goes to Buccinator (Supinator was one of the nominees). The award for the best supporting muscle goes to the Pectoralis Minor (an unexpected decision as Teres Minor had been widely tipped to win this award). And finally, the Student’s award for the most functional muscle goes to the Brachioradialis (which is dubbed as the ‘beer-drinking muscle’). Without this small but purposeful muscle, drinking a smooth pint of Guinness would be a lot harder.