Pd2ot Becomes an Occupational Therapist.

IMG_20150323_223948I miss blogging. I could make excuses about my lack of posts being due to being busy at work, but that wouldn’t fully explain it. When I first started writing I had so many ideas to explore and I made time for the blog. Now it’s dropped into that rather full  category of “things I’ll do when I have some free time/am not so tired/am bored”, which has a very low probability of being the chosen occupation if/when any of those situations arose. Why am I not blogging any more? I suspect it’s a combination of feeling a little like I’ve moved on a lot from ‘needing’ to explore pd2ot-type topics and a less conscious disconnection from pd2ot. However, in recent weeks I’ve had a little more time for all things pd2ot, which has reminded me how much I enjoyed writing.  So, this is going to be a pretty basic ‘catch up post’ to get me writing.

This week actually marks the beginning of my PhD. I’ve spent the last six months working full-time in my clinical role to have time to embed my skills as a newly-qualified occupational therapist and develop a better understanding of the client-group and service my research will be focused on. It’s been great. Tough, challenging, I’ve learned a lot, AND I’m really ready to start work on the research. I’ve always struggled a lot with routine and getting bored, and although my clinical work is so varied and without time to breathe,never mind get bored, I do find that I’m grateful for a new dimension to my weekly routine. I’m really excited to have 3 days every week to just focus on research.

It’s probably good timing that I’ve just returned from the College of Occupational Therapists – Specialist Section: Mental Health’s (COTSSMH) Conference at the University of Liverpool. I’m feeling motivated and ready to start my study. As I first discovered at Emerging2OT, live-tweeting added a valuable dimension to my participation in the event. I always enjoy reading other delegate’s perspectives and thoughts on the session they are attending. The only downside is when you’re following the hashtag you may read tweets from a different session that sounds unmissable. At least with tweeting you still get the opportunity to read the tweets even if it can feel like you missed out!

The live-tweeting may not have been a new experience for me. However, presenting at the Conference certainly was. I was fortunate enough to have an abstract accepted for a 45 minute seminar on self-defeating occupation, a concept I developed from this blog post. I’ve always been a little ‘last-minute.com’ with my preparation for assignments/presentations, however I was probably pushing it to the extreme with this paper as I was frantically trying to decide what to say and scribble some notes in the break immediately before the session. Fortunately it all seemed to come together in the minutes before and I actually really enjoyed presenting my work. Who knows, maybe I won’t avoid thinking about it so keenly before the next one…

Public-speaking and presenting is not something I get too worried about normally, however I suspect the content of this presentation meant I was more concerned about its reception than a piece of assigned academic work. It was my original thoughts and ideas, rather than an answer to a question set by others. I’d debated whether to include my Twitter name on my title slide and to explain where the concept originated from during my preparation. In the end I didn’t include it, but actually felt quite sad that I didn’t ‘join things up’ so fully in the end. The paper was received well and the live-tweeting that accompanied it allowed for pd2ot to be joined up with Sarah, the presenter, which felt really positive and congruent.

My experience at the COTTSMH Conference prompted me to reflect on how I feel about the ‘pd2ot’ side of me. At times I almost forget that that side ever existed. I think in my current line of work it’s quite easy to forget. So how have the first six months of being qualified occupational therapist been given my history of mental health problems? To answer that I’ll explain a bit more about what’s been happening in that time. I work in a service that is in the early stages of becoming an integrated care team, but at present the physical health side of the job dominates. I work with a great team of people, including a large team of district/community nurses. However there’s minimal formal mental health experience within the team. I think this leaves me wondering ‘how much do my colleagues understand about mental health’.

Unlike when I was a student I haven’t needed to disclose much about my mental health history as I am well and don’t need significant adjustment to my work pattern. I do, however, where a uniform that exposes my arms which are very scarred from previous self-harm. As I student I was absolutely terrified of this, and generally agreed with educators that I would wear long sleeves other than when it was necessary for infection control reasons. So in general I’d have a cardigan on when I was in the office. In fact, my university supported me to have a first placement that didn’t require me to be bare below the elbows at all, and allowed me to gradually develop the confidence to expose my arms. On my first day in this job I decided I’d just make sure I was in my short sleeves even when in the office so that I stopped needing to be self-conscious about it (fortunately my office is very warm, so that became a promise I was very relieved to keep!). In terms of reactions from colleagues it has been minimal. One person said “that looks sore” and another asked “Sarah, what happened to your arms?”. Out of the two approaches I prefer the latter. It allowed for a brief, yet honest, discussion about it. Most people, however, have not commented. Partly it feels like it’s a difficult thing for people to talk about and I’m left wondering if people actually know the cause of the scarring – I find it difficult to appreciate how much awareness of self-harm people have if they don’t work in mental health or have personal experience of self-harm. Mostly, though, it feels that my colleagues simply accept me as I am. I’ve always wondered how I’d feel if a patient commented on them. I suspect it will happen at some time but my experience to date would suggest that most people I visit have far bigger things to worry about or even notice, than some old scars on my arms.

As many people with be very conscious of, mental health problems are often invisible. Given that my mental health is pretty good at the minute, the only indicator of previous problem is the scarring. I think this probably explains why the ‘pd2ot-side’ can feel very distant at times.  As ever, I feel grateful for my experience as a service-user. There are numerous skills/experiences I wouldn’t have without it. I’m also really glad that it is not a defining feature of my experience as a clinician. I feel like I’m a BETTER occupational therapist due to my experience as a service user, but that it is not the only thing I offer the profession.

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The Challenge of Language

klavesniceLanguage, and specifically the meaning of the words we choose is something that fascinates me. In healthcare it feels very important that we pay attention to the words we (as service-users/patients/clients, carers or professionals) use. There may not be a way of agreeing words that are acceptable to everyone but in exploring the words chosen, a dialogue about the implications and meaning can occur; allowing reflection, insight or understanding to develop.

I remember reading this post by Lisa Egan and it causing me to reflect. As I read I thought, “Yes, she’s absolutely right, I hadn’t considered it that way before” and yet while I fully accepted her reasoning and argument it didn’t feel ‘right’ for my own situation. That was something Lisa was clear about – how a person identifies it entirely up to them. So, I decided to write this post to explore why for me I felt it was important to refer to myself as a person with ‘x’ condition. Also, as is typical for me I wanted to explore the occupational perspective.

I recently read a chapter of an occupational therapy textbook that referred to someone as ‘suffering from [a mental health condition]’ and a ‘personality disordered individual’. I had a strong response to it but those two examples highlight two different issues. I’ll deal with the ‘suffering’ one first…

Suffering the use of the word suffering.

Well, no, actually I don’t ‘suffer’ the use of the word. It upsets me and I feel irritated, but I don’t think I am suffering. In an old post I explored this concept a bit more – wondering about the potential for it to put the person with the condition they were ‘suffering’ with into a helpless and passive role. I also wondered if the widespread use of the word for everything from ‘suffering from a cold’ to ‘suffering with schizophrenia’ had lead to it being used without question. I recently heard a news story on BBC News that emphasised just how routine this use of suffering has become. The feature was discussing a new medical test that could diagnose several conditions that had not yet shown symptoms that a person was ‘suffering’ from. Well, if the person is unaware of their illness I really question that they could be suffering. It could be argued that everyone knows that when ‘suffering’ is used it is actually shorthand for ‘is living with’, ‘is experiencing the symptoms of’ or some other form, but I question how damaging it could be in suggesting an acceptance of powerlessness to the condition. Also, what about the times when people really do feel their experience is of extreme suffering – will we be unable to hear their distress due to the normalising of the word? My final issue with it is the level of (often unquestioned) assumption by the person using it. The experience of illness, injury and disability is an incredibly personal one – the only person who can say they are suffering is the person who has that condition, and therefore experience.

Being ‘bulimic’.

I have recovered from anorexia, bulimia and borderline personality disorder (BPD). When I was unwell I often referred to myself as my condition. At the times I was fighting the urge to binge or purge and would then find myself eating vast quantities of food I would often say to myself with disgust, ‘I’m bulimic, it’s what I do, it’s the only thing I’m any good at’. So yes, I would probably have happily accepted labelling myself with diagnostic conditions as it felt so closely tied up to my identity at the time. Was it helpful? Probably not. I’ve written before about the meaning the eating disorder held for me, and how it really was a valued occupation and so it fits that ‘being bulimic’ was my occupational identity. Given that in society we often base our identities in the occupations we engage in (I’d describe myself now as an occupational therapy student and a rower as they are the two most significant occupations I engage in), it fits that at that time I was ‘a bulimic’ as the occupations related to having an eating disorder took up the majority of my day. My earlier explorations of occupations that were self-defeating helped me understand why they were so powerful for me and this realisation then makes me wonder about the effect of viewing myself as a bulimic occupational being. It feels congruent to how the experience was, and for that reason I can really understand why other people who are ill may refer to themselves as their condition, but I also think it was quite dangerous as it meant I had little reason to change. I had an identity, albeit not a desirable one but it was something, and all I had.

The issue of being ‘personality disordered’ is a little bit different. My main objection to this is to do with the level of stigma associated with the diagnosis. In my mind it evokes memories of professionals who use the term pejoratively and with a tone of hopelessness (‘personality is fixed; change cannot occur’). There is perhaps need for a separate blog post about the right name for BPD, but in the context of this one I really do feel that being a person with BPD is more helpful. There can be a tendency for people to become lost behind the stigma of the diagnosis and consideration of language choices can be a good starting point in preventing this.

Is there a ‘right’ choice of words to use?

Probably not. I think there are some uses of language to be avoided, but another person might not find the same things as unhelpful as I do, and equally may not like the words I use. Like many things I believe we need to listen (properly) to the person whose experience it is, question, reflect and be prepared to challenge our own views.

Pro-Eating Disorder Websites – a Personal, Occupational Perspective.

1-1259162961jHiYI have a number of issues with Channel 4’s ‘Supersize vs. Superskinny’ programme, which returned for a new series last night. However, I often find myself watching to ‘keep an eye’ on the messages they are promoting. There are so many areas I could discuss but the purpose of this post is the reflections it prompted for me on the topic of pro-eating disorder (pro-ED) websites (often referred to as pro-ana or pro-mia sites, using the abbreviated versions of the illness names to promote a familiarity  with, or even personification of , the condition), which they included as a feature in the first episode. I wanted to consider my view on the ‘should they be banned’ debate, as well as analyse my own experience of engaging with them from an occupational perspective.

What was my experience?

When I had an eating disorder (ED) I initially drifted towards some excellent recovery forums and websites designed to provide peer-support to people who had EDs. They provided me with some understanding and insight into my experience and I could tell I wasn’t alone, but they didn’t quite ‘fit’. The problem was that I wasn’t in recovery. I wasn’t ready to consider it and so any support given wasn’t congruent with the situation I was in. I soon discovered the world of pro-ED sites. While I did come across the type often cited in the media – those promoting anorexia as a normal lifestyle choice, or those involving high levels of competitiveness between members – the majority were simply spaces for people living with a very challenging illness to find a shared understanding and support.

The site I mostly used allowed sections for posting ‘thinspo’ (images designed to motivate people to meet their goals), and also posted things like the foods we’d eaten or binged on that day, however tip-sharing was strictly prohibited by a moderating team. Along side the ‘encouraging’ posts there were serious posts about emotions, challenges, recovery as well as a forum full of games and distractions to help cope with the isolation often experienced when eating disordered. I’ve already acknowledged in Self-Defeating Meaningful Occupation that these sites provided me with a level of companionship. I made real friends there – some of whom I am still in contact with now that we’ve made our individual steps into a life after an eating disorder. I never felt that the sites prevented recovery – when someone was ready to recover they were supported to do so genuinely and sensitively. The nature of social media use meant that supportive friendships could be maintained through sites like Facebook or via MSN Messenger (it was a little while ago…) for those who wanted to step away from the site. For me, the pro-ED site definitely maintained my eating disorder – it provided a space where I was accepted and some level of comfort. However, I feel things could have been much worse without it.

Should pro-ED sites be banned?

I was never under any illusion that my eating disorder was healthy, ‘normal’ or ‘OK’ but I felt I needed it and was unable to stop. It provided me with a means to cope with high levels of distress and really was a lifeline at a very difficult point in my life, as well as nearly killing me. That’s the thing with eating disorders, they are full of conflict; allowing survival whilst simultaneously contributing to demise. Perhaps that’s the reason why it’s hard to have a clear view on pro-ED sites – they sustained my life AND my eating disorder.

I don’t feel proud of my engagement in the site – I hate to think I could have encouraged someone else to develop or maintain an eating disorder by discussing what I’d eaten that day, however, I was very unwell and have compassion for myself. I also worry about those people for whom a pro-ED site makes their eating disorder worse (mine was very serious long before I found the websites). I don’t believe, however, that a website like that can create an eating disorder that doesn’t already exist. Perhaps the question should be, ‘Do pro-ED sites encourage eating disorders to be sustained and potentially cause harm?’. I suspect they do. I also suspect that their existence saves an equal number of lives by providing a level of understanding that pro-recovery sites cannot, for those not ready to consider recovery. I feel very sad that there are still thousands of people out there who will tonight be posting on a pro-ED site, I wish there was a way to take away all of their problems this instant. Sadly that’s not realistic. I don’t know how I feel about banning the pro-ED sites. I don’t want to glorify them or say they’re OK, they really aren’t, BUT they do provide something very valuable and I really feel that without them I would not still be alive. Perhaps a greater understanding of the function they serve would be more useful that debating whether they should exist?

What did the occupation of being involved in a Pro ED site involve?

The occupation of posting on a pro-ED site involved so much! It was something I felt was a classic ‘self-defeating meaningful occupation’ meeting many of the occupational needs highlighted in the linked blog post. The forum provided a frame for my day – allowing conversation about emotional issues, current affairs or ‘fun’ topics as well as a space to report the food-based occupations I’d participated in. I developed habits relating to times of day I would post in the various sub-types of forum (evenings were about food, day time about distraction). Also, due to the international nature of participants, there would always be someone online to chat with when chronic insomnia meant you were wide awake at 4am. I also established roles; from ‘newbie’, to established member, to friend. At a time in my life when relationships were very challenging this was significant and valued. I understand my engagement with this occupation as being one that synthesised experiences of productivity, pleasure and restoration (Pierce, 2003) in such a way that made it very fulfilling and important to me. The pro-ED site was a perfect record of all the energy I was putting into my eating disorder – there were significant elements of productivity involved and this almost felt like the ‘office-end’ of the job – the public (but anonymous) record of my work. The pleasure came from elements of satisfaction at this productivity as well as the connections with others and the light-hearted conversations that were had (which, when in a dark, all-consuming abyss of an eating disorder, was quite remarkable). The restoration was experienced as it was a place of acceptance of, and occasionally peace with, the chaotic world I was living in. I did not have to hide the life I was living (I use the term loosely), I could be me – someone in the grips of a very serious eating disorder.

I hope this post provides a little more insight into what the experience of engaging in pro-ED sites was really like, for me at least. I think the image portrayed in the media is very short-sighted and the problem is much more complex than described.I honestly don’t know what the answer is, but I think it might need to be the ‘question’ that is reconsidered first.

Reference

Pierce, D (2003). Occupation by Design, Building Therapeutic Power. Philadelphia: F.A. Davis Company.

The ‘Perfect’ Recovery

wisdom-92901_640I usually fiercely deny that I am a perfectionist about anything, because my self-expectations are often much lower than people assume, however I’ve recently realised how much pressure I was putting on myself to have the perfect recovery.

‘Recovery’ is a pretty contentious term, and I suppose one that I hadn’t given sufficient thought to. I suspect it’s something that each person will have their own definition of, from a life totally free of symptoms, to something  more akin to a life that allows a satisfactory level of function for that person. As for what I thought, and perhaps what I now think, well, that’s the purpose of this blog post.

When I completed my time at a therapeutic community (TC) I was very worried about my ability to keep on making the level of progress I had made over the preceding twelve months. I was scared that without the high level of support a TC provides that I wouldn’t be able to cope with difficult emotions without using self-harm or an eating disorder to manage. I also believed that if I slipped at any way at all I wouldn’t be able to get back up. However, as I’ve discussed in previous blog posts , having meaningful occupations to engage with was central to my continued recovery and my progress actually continued quite quickly to a point where I felt I was ‘recovered’. It had been months since I could have been diagnosed with Borderline Personality Disorder (BPD), and while I still had some ‘symptoms’ (I had problems with dissociation and a poor sleep pattern) I was managing a very different life and one I was very happy with – in fact I felt I’d achieved the oft quoted ‘life worth living’ that Dialectical Behavioural Therapy aims to facilitate. I also felt very sure that that could be maintained with a life full of occupations that fulfilled and empowered me, as well as providing challenge, fun and restoration.

When I commenced my training to become an occupational therapist just over two years ago I know I felt I had something to prove. While my university have never been anything other than supportive and accommodating, I had a huge internal motivation to complete my course without any adjustments or help. I felt I needed to be perfect, not in terms of academic achievements, but in terms of health. During my second year I realised I wasn’t superhuman and had to accept some support to allow me to complete my placements in a way that allowed for a continuing poor sleep pattern and to attend ongoing therapy, but still I was determined that so long as all my assignments were completed without extensions then I was still doing ‘OK’. Did I still feel ‘recovered’ at this time. Yes, I think so.

In the Autumn third year began. After a long summer and my time in Moldova I had changed quite a lot and I initially struggled to adjust back to university life. But soon I was enjoying the work and the opportunity to have much more autonomy and independence in my studies, rather than completing the heavily structured modules we had in the first two years. And then I crashed. My mood dipped and I found it very difficult to engage in any of the occupations that kept me healthy and functioning. Apparent competence meant that I put on a reasonable ‘show’ of being ok to those around me, but I wasn’t. I ended up taking a few weeks off university and am now just returning to my studies. I now will be breaking my own ‘no extensions’ rule, and surprisingly it feels OK. This happened because I began to understand that I didn’t have to have a perfect recovery. I had felt that my history of BPD meant I had to prove I was 100% ‘fixed’  (this was an entirely internal feeling and not imposed by anyone else) but with the support (and most importantly acceptance) received from university tutors I suddenly realised that it was ‘OK’ to ‘not be OK’, and in doing so I began to get back towards feeling recovered.

So, for me, what is recovery? I seem to have a definition that doesn’t relate to being free of symptoms (for me some symptoms are acceptable – poor sleep or trauma-related problems, while eating-disordered behaviour, persistent low mood or self-harm would not be), but rather one that involves the level to which I can participate in the occupations I wish to. My ‘norm’ is being tired and having variable emotions related to past experiences, but so long as I can motivate myself to row, attend university and complete necessary work, look after my flat and my own self-care then I feel things are fine. When I can’t manage those things I don’t feel recovered.

I suppose this understanding is unsurprising from someone who studies the value of occupation in improving health but I’m not sure I’d been aware of how much I used occupation as a marker of health before. I had previously believed I needed to have a perfect recovery, but now understand it’s OK if it’s not always a straight path. I used to feel terrified of ‘losing’ valued occupations through low mood, lack of enjoyment or motivation but now realise that my ‘occupational health’ may dip and it can also be restored.

Day 27 – my final working day

Thursday

Today was my last working day in Moldova. We had seven young people in attendance at the Centre as well as my supervisor who had, very kindly, broken her vacation week to be there for my last day. This actions exemplifies my experience of being a volunteer here – I have felt so valued every step of the way.

Our first activity was making a crafty name card for each person as we were planning a ‘gourmet sandwich making session’ in the afternoon and wanted a way to mark up each sandwich. This was an interesting one for me as my supervisor was absent at this point and as it wasn’t ‘my’ activity I was getting my instructions from another member of staff. She knew a few more English words than I do Romanian and with a combination of the two I got my instructions to help run the task. It gave me an insight as to what it may have been like to be a participant in the tasks I ran. After this we spent some time outside playing party games to celebrate (but in a very sad way, I was assured) my leaving.

After lunch we had a ‘reflective session’ where we viewed all the photos I’d taken at the Centre to a backing of our Latin Dance music. I think everyone enjoyed seeing all we’d done and it really did emphasise just how many experiences we’d had this Summer. I also felt quite sad seeing photos of the clients who were absent this week due to the lack of alternative travel options during the bus driver’s holiday.

Then it was time for our Gourmet Sandwich session. We had some ‘recipes’ from magazines and each person selected the one they wanted to make. The available staff provided some assistance and it was then I really got thinking about one of the cultural differences I’ve noticed here….

Perfectionism.

I’ve been attending some Zumba classes while I’ve been in Moldova and been very aware of a different approach to the class. In the classes I take in the UK an instructor may highlight a particular piece of footwork before each song but essentially the aim of the session is to get moving and keep moving. Working hard an having fun are key, if you get the steps right it’s a bonus. In the classes I’ve attended here the instructor runs through each track without music, breaking down the steps and showing good technique. If anyone makes a mistake in this marking stage, the instructor repeats the step. To me it has felt a little frustrating. While I am a dancer, I do not consider Zumba a dance class; I just want to dance about for an hour, get my heart rate up and I’ll figure the steps out as we do it. I do admire such attention to detail though and it fits with some of the Soviet style approaches I’ve observed. Anyway, back to my point. I also have experienced this approach on placement. When I’ve been working with the young people, as is normal for me, I’ve been getting to do as much of the task as they are able to do independently and help as little as is needed. Some of the other staff help those they are working with a lot more. As I result their finished products are neat and ‘perfect’, whereas the ones belonging to the clients I’ve worked with are often a little wonky or not so neat. It doesn’t bother me in the slightest – I want to see my clients produce their work, not mine, but I do wonder if the other staff have had any feelings about me allowing such ‘imperfection’.

During this task the manager of the centre came to present me with a report on my placement and the most touching thank you gift; a beautiful framed quotation surrounded by paper flowers. It was so special and meaningful, and feels quite strange to feel so valued during such a short placement, especially as the Centre has numerous volunteers (many of whom are Occupational Therapy students) throughout the year.

The party vibe continued with a late afternoon snack of the sandwiches and chocolates I’d bought. Moldova certainly has good chocolate products that I will miss! When the young adults went home the staff and I shared some freshly baked pizzas. It was lovely to sit together and have time to say goodbye and thank you properly. Usually, when I’ve been on placement in the UK, service demands mean that endings are a bit rushed and unplanned. This is totally understandable and not a big problem but it definitely made me appreciate how lucky I was to have a whole leaving day.

We then locked up and went our separate ways. Definitely the saddest ending to a placement. Going through the photos reminded me of just how much I’ve enjoyed working with each client in the Centre. The staff team were also brilliant, and unlike when I leave a UK placement, I know it’s unlikely our paths will cross in the future. Although, maybe I’ll come back to Moldova to spend some more time and at least we have the wonders of Facebook and email to keep in touch.

I also had a phonecall from the director of the company that organises the placements here thanking me for all my hard work. He said he felt I was one of the best volunteers they’d had at the Centre. Quite a compliment given all the good things I’ve heard about other volunteers. I told him it wasn’t hard work at all, but simply a pleasure and privilege to get to spend my days with the clients and staff here and that he and his team had made it so easy to be here and immerse myself into life at the Centre and in Chișinău.

It feels quite unbelievable that I’ve ‘only’ been here for four weeks. I suspect the range and nature of experiences, as well as the amount of personal growth that has happened, is why it feels much longer. When I first had the idea to arrange something like this I initially dismissed it as ‘that’s the type of thing other people do’. I wonder if that means I’m another person now, or perhaps that I already was that person but didn’t have the confidence in myself.

I have a full day in Chișinău tomorrow as I leave for the airport at 7.30pm. I’m hoping to spend the afternoon with my host and will use the morning to capture a couple of photos I’ve been meaning to take all month. I’ve just packed up my stuff and I have a lot more space as the majority of my baggage consisted of items for placement and toiletries. I have a few more blog pieces in mind, based on this trip, so I will aim to write them in the next week.

But for now, la revedere!

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Days 25 and 26

Tuesday

Tuesday wasn’t a great day. Many frustrations and not enough ‘good bits’. That said, it was the only day that i haven’t enjoyed in my time here so i can’t really complain. I arrived at the Centre to find we had another powercut. This meant no dancing to start our day (I think I get as much benefit from dancing first thing in the morning as the young adults do). We also had to rethink our next activity as while the activity didn’t require electricity to complete, we had not photocopied the sheets of pictures of daily occupations needed. So, the group spent some time playing outside and then drawing. Not the most imaginative of mornings. The power returned before lunch and the manager, my translator and I spent another frustrating hour trying to get the daily occupations task ready and contending with a photocopier that would only produce the faintest images from the print we provided.

I left work after lunch for my Romanian lesson, and the frustration continued. I then travelled back to my accommodation on a trolleybus that firstly disconnected from the overhead cables, then broke down (in a lovely spot right in the direct sunlight, though the driver did at least leave the doors open, not that it provided much relief from the intense heat), once moving again got stuck in traffic, and finally got wedged behind another trolleybus that had disconnected from its cables. When I arrived home after 6pm I was hot, tired and a little bit fed up! Thankfully some food, a shower and a trip to the gym cheered me up.

Wednesday

What a difference a day makes! I appear to have caught a cold. So that, combined with a slight ‘hangover’ of the frustrations from yesterday, meant that I felt a bit under par when I started my day. I then got the news that my flight home had been changed by the airline and instead of arriving at 7pm on Friday it will now be landing at 11.30pm. At this point I did wonder if the frustration theme was set to continue but somehow, mindfully, I got on with my day.

I spent my whole day working individually with the 5 young adults in attendance today. One by one we talked through their daily routine and made a poster of the times they engage in all of their important occupations. The aim was to create a focus on independent personal hygiene with the hope that an individual poster might be used as a prompt sheet at home. It gave me a great insight into their lives and also, due to having a translator, I got to hear a lot more of their conversation that when I’m working with my supervisor who only has time to briefly summarise the content – having a translator is definitely a ‘pros and cons’ type experience.

I was struck by how similar each person’s day was. The times varied due to the person’s proximity to the Centre, but the nature of occupations participated in was so similar. Part of this is cultural. People in Chișinău do lead lives that are full of domestic activities; daily trips to the market for food, food preparation, eating as a family and watching television together. But, I imagine that most young people here would have a bit more variety and independence in the occupations they participate in and I suspect people with learning disabilities experience significant inequality in the opportunities they have to choose how they spend their time. Their daily routines seemed more akin to those of a young child who is entirely reliant on their parents and there was an absence of time spent with friends or in participating in any leisure activities other than television. I’m not sure why this surprised me, it certainly fits with my observations of the expectation for people with learning disabilities to be hidden from society, but I suppose just seeing it in black and white really confirmed this for me. I certainly feel very glad that they attend the Centre and experience the social interactions and range of activities available to them there.

Despite feeling a little sad about the above I valued working with each person today. It was an absolute privilege to get that time with them as normally we are trying to run group activities. I can’t believe tomorrow is my last day on placement. Working with everyone out here has been the absolute highlight of my trip. I also feel so lucky that I can get so much personal benefit from ‘doing OT’, I’ve had many days on placements where I have felt tired, sad or grumpy at 8am and then found my mood has lifted the minute I start working with people. I feel very hopeful about, and lucky to have, a career full of ‘doing OT’ ahead of me.

Days 23 and 24

Sunday

I rounded off my fourth and final weekend in Chișinău with a visit to the stunning Organ Hall to attend a concert given by the capital’s youth orchestra. They were fantastic. In particular their fifteen year old piano soloist was quite remarkable, she performed with the maturity of someone much older.

While the quality of the performance could have permitted me to believe I was at a concert in Vienna there were certain moments that reminded me I was most definitely in Chișinău…

Entrance to the concert was free and so when the doors opened there was a mini stampede for seats. The other volunteers and I were not quick enough to get a seat but we soon noticed people bringing in chairs from the rooms outside the main hall. We joined them and added our chair to the end of the ‘reserved’ 3rd row. Fortunately for us, the health and safety attitudes that had prevented baking at the day centre were not adopted here; no problem at all with blocking the aisles!

We were sitting by the official cameraman who was using a Sony video camera that probably dated from the 1980s. Definitely not digital and the battery pack had to be changed three times during the performance (might I add the batteries were about the size of a house brick).

The ‘encore’ baffled me slightly, too (they have a different name for it but I didn’t catch it). After the final piece was played the house lights went up and there was lots of applause. The encore was called for, along with a type of uniform handclap, and the orchestra obliged. And then a second encore was called, this time the orchestra responded with my favourite piece from ‘Swan Lake’. More applause. And another encore. We sat through 5 extra pieces, with people gradually leaving after each one. I’m not sure when the poor orchestra were finally allowed to stop, I think the appreciative audience were in danger of exhausting their repertoire!

What else? Oh yes, the heat! It was 32 degrees outside the venue and about the same inside. I’m definitely glad I wasn’t playing the clarinet for 2.5 hours.

Monday

My final week on placement is going to be a little different as my supervisor is on annual leave. Consequently I have a translator to allow me to communicate effectively with both staff and clients. It was a strange experience. My translator is lovely and someone I’ve got to know throughout my time here. I was slightly apprehensive about taking an ‘outsider’ to work with me, given that she wasn’t familiar with learning disability settings. I needn’t have worried as she fitted in perfectly, joining in with our cleaning and dancing activities – all ‘above and beyond’ her duties as my translator. She admitted to me as we left she had been nervous about being there today, simply due to not being sure what it would be like to be around people with learning disabilities. She then said that she’d really enjoyed it and liked the centre. I was so pleased that she’d had such a positive experience, especially because people in Chișinău who don’t work in healthcare, and even many who do, are unlikely to meet people with learning disabilities as they are so protected and almost ‘hidden’ here.

As for the effect of having a translator on me, definitely a mixed experience! It afforded me much more autonomy as I wasn’t conveying my ideas to a supervisor who then implemented them in the way she imagined, given that she was often involved in leading the activities too. But, in a strange way it also reduced my independence. When I worked with my supervisor I’d often find she disappeared when I was starting a group session and so I figured out how to run the session and communicate with lots of non-verbal gestures and demonstrations. Today, however, I was ‘on my own’ but had someone to translate my intentions/questions/prompts. While both I and my translator were clear on what was happening I think for many of the clients it appeared as if my translator was the one running the session. She was the one they were hearing their instructions, encouragement and feedback from, despite them being my words. While I was able to complete a more complex intervention today, I almost preferred it being just me and them and few words. I hadn’t expected that.

Due to our low number of clients this week (seven today), I grasped the opportunity to do some individual assessment and work. I introduced the clients to my tablet PC and we spent some time working through a variety of logic games, artistic apps, puzzles, music games and sports games. They were so engaged, I suspect because both individual work and tablet use was different for them. I hoped it would engage them well as many of them enjoy games on their ‘phones (most have a ‘phone but they are pretty basic, non-smartphone types) and they do not have access to computers at the centre. Chișinău is a city that is very rapidly catching up with the technological age, with free WiFi in the many public parks, so it felt relevant as an occupation that will be becoming increasingly prevalent in their society. It also allowed me to provide a range of app choices to suit their interests and the areas I thought might be useful to work on.

Tablet use is great for being able to show a range of options and letting the client pick the games they want to try. Happily, by choosing their own games they all seemed to pick things that they were interested in AND addressed the skills I thought they could do with working on. I’m not sure if that was coincidental or not. I suppose allowing that element of client-centredness ensures that the ‘meaning’ is present. It also means that the right challenge level is found as the client doesn’t pick a game with no demand for them. As for how it worked that those with good fine motor skills picked the games most challenging for process skills, I’m not sure.

I’m so impressed with the types of apps out there. I only have free apps on my tablet and yet I managed to find so many options that are also age appropriate – something which I have noticed is a challenge here, in terms of the printed materials available at the centre.

While I loved the app session it certainly has prompted me to reflect on the challenge of ensuring client-centredness due to the language barrier. I’ve done my best to adapt tasks to suit individual’s strengths and needs, their interests and their engagement/participation levels. But so much of it has been supposition and guess-work. If I had longer here I’d definitely work on ways of assessing and identifying goals and priorities with, and not for, the young adults. It definitely hasn’t felt comfortable for me to work this way (which, ultimately, reassures me) but I think adopting a different approach would be a considerable task. Not only would I have to work out how to do it, which probably wouldn’t be that hard, but I think I’d have to do a lot of explaining of my reasoning and theory to all the staff as this would be a very different approach for them. Part of me thinks ‘why didn’t I start this in week 1?’. However, I didn’t and I know I did the best I could at the time. I also am not sure it would have been achievable in a month long placement, so perhaps incorporating small glimmers of client-centredness is Good Enough. Who knows? I’ll keep reflecting.