Are we truly ready for next year???

After 4 years of studying and working in hospitals and clinics we now need to be ready for Community Service. I look at my class and certain students that i have worked with or have heard stories about a few and what comes to mind is: Are they ready for next year? Now i know we cannot know everything and Community Service year is still a learning year. But at certain placements you might be the only physiotherapist there, so are we all competent enough to run a department?

How do we know we ready? And how does our department know we ready?
Surely a test should be given in some form or other to see if we are ready to be on our own?

Some students have really scraped through and might be in charge of an entire department next year? One can easily make a mistake, even more so when you are alone and have nobody to look up to.

I too could be one of those that are alone next year but i feel up to the challenge. Everything is what you make of it, and i have the attitude to make the most of things.

Community service is a major step up and mistakes cannot and will not be tolerated. Again i have tried to look for malpractice or a community service practitioners being let go due to not following contract stipulations and i have come out blank. Blogging about an issue without evidence is not really concrete however incompetence is widespread in the health industry and even more so from students.

My thoughts are still : How do we know if we are ready? Is passing enough?
Thoughts like these fly through my head. I feel ready and I will pass but is that enough?

Community Service.. Hardest part is the options

So 4 years of study have nearly come to an end. It has really been a long road for me, but one that i have prospered on. I have truly grown as a person and as a physiotherapist. As this is the last stretch we now need to choose our placements for Community Service. This is a year whereby you work back a year to the government in order to fully obtain your degree.

After receiving our lists, a week later, my other half (Callan) who is an Occupational Therapist received her Comm Serve list. We would like to be placed together or nearby each other but chances aren’t the greatest.

This got me thinking about what people have done and also what i have heard. When i asked past health practitioners that have already done their comm serve they said that if you have children or if you are married you have a greater chance of going where you would like if you write a motivational letter.

In all honesty i am not 100% sure if this is true or not, however i do know of a physiotherapy student who got married and got placed in Cape Town as he wrote a motivational letter.

Hearing all the stories got me contemplating whether myself and Callan should write a motivational letter asking to get placed together even though we do not want to stay in CPT. We want to work rural and be nearby each other. Now if i write a letter is this the right thing to do? Why should a letter depict my future? And should whether i have a child or if I’m married work in my favour?

All this really is building up, as this is really a major decision for me to make. I was not able to find anything online about whether anybody has been denied with a letter or if somebody lied in there letter. If you are married do you attach your marriage certificate? if you have a child do you attach their birth certificate? This is really a grey area surrounding placements.

My point around this post is that people can really lie about their situations regarding marriage, children and personal circumstances. Exaggeration could easily be used to make things sound worse or more drastic than what it really is.

I want to explore the great SOuth Africa and COmm Serve gives me the best opportunity to do this. Below are some pictures of our great country, our rural country.

Overworking? Might aswell drink on the job?

My heading isn’t really the greatest but I thought it would catch the eye of most quicker as it is really “out of the box”. I recently read an article on how intern doctors are the slaves of the state (Erasmus, 2012).

As a student physiotherapists we often work in clinics and hospitals in and around Cape Town where we interact with intern Doctors. During our journey on each rotation which is generally 5-6 weeks we seek to gain as much knowledge as possible, which in turn means asking doctors a lot of questions.

Occasionally I’ve asked a doctor a question and not really gotten an answer out of them or a response of sorry I cannot now etc.. After hearing that I used to think they could at least assist me somehow instead of blowing me off. My attitude towards them would instantly change and I would not ask them another question from that point on.

It’s only recently that I read the article about the hours that they work and I instantly felt terrible. I never once thought about what was going in that doctors life.

Owing to a chronic shortage of medical staff in South Africa, sleep-deprived medical interns and community service doctor’s work up to 200 hours of overtime per month under the state’s commuted overtime policy.

(Erasmus, 2012)

Only up to 80 actual overtime hours worked are paid; overtime in excess of 80 hours per month is unpaid. The corollary is that interns are assured by JUDASA (Junior Doctors Association of South Africa) that ‘no intern is to work more than 80 hours of commuted overtime per month. So doctors have to join the JUDASA for protection of their rights. They have to sign a contract for 2 years of internship whereby its non-negotiable. The non-negotiable aspect is clearly stated as well as if they break any part of the contract it would be terminated and further actions could be taken. Having said that I read further into the article whereby it stated the following:

South Africa has a chronic shortage of skilled medical staff. With too few doctors and nurses for the patient workload, they are grossly overworked. Interns rotate through training blocks of approximately 4 months each in various disciplines, during which they are routinely allocated 120 – 200 hours of overtime per month – up to four times that permitted by the Basic Conditions of Employment Act 75 of 1997 (BCEA), and more than double the number of overtime hours for which the state contracts to pay them.

Now if institutions can clearly break a contract with regards to overtime what could be done to insure safety of the doctors? Working those incredibly long hours should certainly have a major negative effect. The reason for my heading above is due to a study done whereby they tested the difference between driving while slightly over the limit and also driving with sleep deprivation. The results were that sleep deprivation was worse than driving slightly under the influence.

Lack of sleep strongly impairs human functioning, and leads to memory loss, attention deficit, negative mood changes, over-optimistic risk-taking, prolonged post-call recovery, road accidents, mistakes on duty and in surgery, adverse health conditions, and HIV needle-stick injuries.

Effects as such are extremely dangerous not only to their health but also to the patients that they see. After i read the entire article I began to re-think my situations with intern doctors. As i now have a better understanding of the things they go through i have a new found respect for them.

Below is a link to a really interesting article about a doctor in Tygerberg Hospital.

http://www.iol.co.za/news/south-africa/western-cape/doctor-s-25km-walk-in-one-shift-1.1694025

References:

Philp R. Hospital hell. Sunday Times, 24 May 2009. http://www.netassets.co.za/article.aspx?id=1006006 (accessed 13 May 2012).

Erasmus, N. (2012). Slaves of the state – medical internship and community service in South Africa. The South African Medical Journal, Vol 102, No.8. Retrieved from The South African Medical Journal: http://www.samj.org.za/index.php/samj/article/view/5987/4343

Bias.. are we really that small because we study at UWC?

 

I was placed at TBH in Neuro ICU along with a Stellenbosch student. At TBH there were a quite a few stellenbosch students. Along with this block we have a thesis to do. Our topic for our thesis is Bias between universities. After my block was complete my feelings towards my Thesis topic is now stronger than ever before. Each and every day we as UWC students went through some form of bias from the other students. I myself experienced this tremendously each and every day and that wasn’t even from the student that was working with me in the ICU.

Daily comments from only one or two students who always had a strong opinion would always label themselves as better without any real reason or proof that they are. The one student even said that ya her physiotherapist at the Sport Science centre would never hire a Physiotherapy student from anywhere besides Stellenbosch. My question is why? what reason? and where did he study?

Another comment was that her professor in her department said that she should know better than another student because they from UWC. Again with what reasoning? I stayed calm and just nodded. I’m a strong headed person and if I have an opinion i usually voice it, but this time i kept it to myself. All this happenings just made me feel really strong about my thesis and I’m sure we will provide strong evidence of a bias towards UWC.

“Buried prejudice and biases are surprisingly influential underpinnings to all the decisions we make, affecting our feelings and consequently actions. Biases can be positive or negative aspects of human nature; they all influence how we act and interact with other people and events.”  (Biases, 2014)

My thoughts on this are why should my actions as an aspiring physio be changed or undermined due to her feelings? She is just as much of a student as me and everyone else, so what makes her so special. I’m glad that i never said anything to her and instead used that to my advantage and took that forward into my thesis which I’m extremely excited for.

If someone that wasn’t as strong headed as me in terms of being able to use her comments to my advantage and rather took it personally and demeaning, what would be the consequences?

Major and O’Brien (2005) report that stigma is a powerful phenomenon that has long lasting and ranging effects on its targets which consists of poor mental health, physical illness, academic underachievement, infant mortality, low social status, poverty and reduced access to housing, education and jobs.

According to Major and O’Brien things such as academic underachievement and poor mental health are effects from having a stigma attached. Effects like these can be really detrimental to someone, and not having these currently affect me is a positive thing. I have really grown as a physiotherapist if i do say so myself and not having these kind of things get the best of me really does prove that

Missing a treatment? Can’t be bad can it?

Bryan Capes                                     

4^th year Ethics

1^st Term Reflections

 

Missing a treatment? Can’t be bad can it?

 

Fourth year has been an intense year so far and certain days aren’t good. Some nights are extremely long without any sleep due to the workload and deadlines. Within my fifth week at my current block, I was having an extremely bad day due to lack of sleep, fatigue and just no energy at all. With all this in mind I know I have some difficult patients and then you get some extremely difficult patients who just do not co-operate at all.

All of this was becoming too much for at this stage and I still had to see my most difficult patient. I’m currently in Neuro-surgical ICU so these patients aren’t always orientated and are confused. All that came to my mind was I can say I treated this patient even if I don’t right? Like one day of treatment won’t make that much of a difference.

I stopped myself and excused myself from my patient and walked into the passage way to clear my mind. How could I be thinking like this? Yes I’m exhausted but this patient is relying on me even though his not co-operative. It’s not his fault he’s confused, it’s typical of a head injury and I see this every day.  After clearing my mind and sucking up the fact that I’m running on empty, fatigued and exhausted I continued to see my patient and treated him effectively. To my amazement he was becoming more co-operative and orientated that made my treatment session so much easier. He followed commands and showed motivation. I walked out of that session proud of myself but also disappointed that those thoughts came to mind. I went home that night and thought to myself what would have happened if I didn’t treat him and I did some research.

There aren’t much articles or journals on not treating your patient but on ethics and clinical values. The article suggests that by understanding the origins of ethical principles and duties, one is in a position to make an informed decision based on both ethical and clinical values (Voors, 2000). We are the patients link to full independence.

 

 

We are taught to make informed decisions on what we are presented with and I feel strongly that I did treat my patient to the best of my ability even though those previous thoughts came to mind. A patient’s life especially in ICU is my hands and I play a major role in how they progress and on their life. I’m glad I had those thoughts because now I know I am strong enough to overcome that and that I’ve grown since then.

References

Voors, M. (2000). Duty to treat: Ethics and HIV/Aids. Physiotherapy, Volume 86 (12), pages 640-644. doi:10.1016/S0031-9406(05)61301-6

 

 

Judgement.. who are we to judge??

Bryan Capes
4th year Ethics
1st Term Reflections

Judgement

At any stage in one’s life everyone will go through some form of judgement. Judgement can be used or done in various ways such as demeaning somebody or using judgement to raise one’s own self-worth.
According to Douglas Harper (2010) judgement is the ability to judge, make a decision, or form an opinion objectively, authoritatively, and wisely, especially in matters affecting action; good sense; discretion: a man of sound judgment.

With that definition in mind how often do we actually judge correctly in relation to that? Often judgement is done with cruel and demeaning intentions and without much thought. Currently I’m placed at a public hospital within the Western Cape. Here at this hospital I encountered a serious form of judgement and, I too was part of that judgement. I got a referral for a patient stating patient is in the maternity ward and needs to be mobilised. At first thought I was okay this is all as per normal and then I continued to read the referral. In the referral it stated the patient’s Body Mass Index (BMI). It stated that the patients BMI was extremely high. Body Mass Index (BMI) is a number calculated from a person’s weight and height. BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems (Centres for Disease control and prevention, 2013).

Earlier in the day I heard a few physiotherapists and doctors discussing this patient not knowing I would be receiving the referral. They said things such as they so glad she’s out of their ward and remarks on her weight. Of course after hearing all of this and reading the referral letter I to was judging this patient.

In order to become a good physiotherapist you need to empathetic, and also consider the patients feelings and lifestyle, not just what’s presented in front of you. Gaining a patients trust and co-operation is vital. I went to this patient with an open mind thinking that this patient has clearly been judged by everyone and she does not need it from anyone else. Upon meeting this patient I noted she was sitting over the edge of the bed with a chair next to the bed, both clear indicators that this patient is mobile of some sort. She was an amazing lady, extremely friendly and co-operative. I explained why I am here and that I need to assist her with mobilization where necessary and continued with my assessment.

After my assessment I noted patient’s chest was clear with an effective and dry cough. I then noted that the patient was independently mobile who walks to the toilet and moves from the bed to the chair as she feels. Without a doubt in my mind I discharged the patient from physiotherapy and wished her well.
It is argued that while healthcare is not value free, the role of a therapist is not to judge, but treat according to need rather than merit (Voors, 2000).

I walked out of her room smiling and at the same time I was extremely upset. A doctor, a health professional who’s opinion should be of great worth, clearly never fully assessed this patient and just assumed this patient needs assistance because of her increased BMI. I was proud of how I handled myself, the manner in how I did things and how I’ve matured as a physiotherapist. I know that nearly on a daily basis I’ll be faced with ethical dilemmas and I’ll do my best to not add to those dilemmas but rather attempt to be a solution.

References:
Harper, D. (2010). Judgement. Retrieved: March, 07, 2014 from http://dictionary.reference.com/browse/judgement
Centres for Disease control and prevention. (2013). Retrieved: March, 07, 2014 from http://www.cdc.gov/healthyweight/assessing/bmi/
Voors, M. (2000). Duty to treat: Ethics and HIV/Aids. Physiotherapy, Volume 86 (12), pages 640-644. doi:10.1016/S0031-9406(05)61301-6

Euthanasia… I want to die with Dignity.. Mercy Killing

Euthanasia will be a forever on going topic in discussion among many as there are many aspects and views to look from. As a health professional i know i would never be able to make a decision like that to end someones life even if they begged me to do so. But in terms of myself I do not want to live like a “vegetable”. If i cannot do what i did previously then what kind of life am a living. I would like to die with dignity and I would want it to be my human right to end of own life.

In a post that i read earlier from Adam he stated something that I also looked past. When we picture euthanasia we immediately see an elderly person on there last.

What if it was a young child on life support or on their last in pain, would we still be all for euthanasia?

For myself i would want to make that decision myself and not put a responsibility like that in someone else’s hands.. I would like to put that decision in my Will.

Torture?? Really now?

After a few weeks of these blogs i was really getting into the swing of things until now.. I really do not like this topic as there are faar to many variables.

I’m not for torture, but if someone close to me has been kidnapped for example and I had the person who did it, I would for sure torture him/her to get the information I need to get my loved one back. So does that mean I’m pro torture?
The variables list can continue for ever!

There isn’t much I can say about this without sounding biased and/or contradictory.

All I will say is that torture can never be justified, however some people may have a better reason over the next to torture someone.

In a Health professional sense, what would I obtain out of torturing one of my patients? delayed treatment and just having to spend more time with the patient? Doesn’t add up does it?….

Nobody is equal! we all unique..

In South Africa there is the forever on going argument about equality and who deserves more than others…

… We are all equal but we want more than them ..

That statement above shows the intelligence of some in our Beautiful country! They would argue that we are all equal but at the same time with the same breathe they would argue that they deserve more!

There will always be the on going racism and sexism in our country. We have a history thereof which is not easy to forget especially when some just dont want to. If we argue that all races should be treated as equals then each and every single individual should have an equal opportunity at a job for example, as long as they have the correct stipulated experience and education. Saying that, then why do we need BEE? Black empowerment? Does that mean that being white or coloured that we can not empower?..

In the country we live in we say one thing but mean thee opposite. We can cry help, but we are the ones with the gun in the hand. We cry wolf so often that now no one can help us. In order for equal opportunities through race and sex we need to get rid of these categories. Being a certain race should say nothing but the colour of your skin and your heritage. It should not determine whether you deserve a job or not. Race should not have that power over us.

Equality should stream through out race and sex, and whatever you choose to do.

Morals.. who has them nowadays

Morals should be seen as unwritten laws of society whereby we abide by these rules with no one having to uphold them. We have these unwritten laws stating what is good and what is bad with only ourselves to look at. Morals are different intentions, decisions and actions we take and do, and whether they are good or bad.

My morals and your morals will certainly differ, as i might see one thing as good and do that with the greatest of intentions but may not be perceived as such.

Morality in a health professional sense should be a no-brainer whereby we simply do what is right, and not to allow our emotions to play a role in treatment as we are professionals. However we do need to have some emotion involved in order to understand the pain and suffering some patients experience. We need to have the balance between sympathy and empathy in order to treat our patients effectively and for us as health professionals to learn from each and every experience.