“Surthriving” Hand Rehabilitation: Proposing Interventions to Support Novice Occupational Therapists Working in Underserved Contexts
Table 3
Composite vignette of participants’ experience of delivering hand-injury care.
“Welcome to my corner of the hand therapy world. It’s beautiful – is not it? The rolling green hills dotted with rondavels (round mud huts) and grazing animals. Shacks and spaza shops (informal convenience shops) line the dirt road as I approach the hospital. The effects of poverty run very deep in this community, but so does a deep sense of community life: a sharing of life in both its beauty and struggles.”
“This is a typical day: typical in that I navigated the same roads in my little Hyundai and waited patiently for the resident cows to cross our shared road. I am here completing a compulsory year of service after graduating – a strategy that my government uses towards delivering quality healthcare for all – especially rural and underserved communities.”
“We’ll start the day at the hospital with the psychiatry ward round. We have the cerebral palsy group at nine and then we can head out for two clinic visits and a home visit. Let us hope that the hand patients that I’ve booked are able to attend their appointments. Many travel 4 hours or more to the clinic so when resources are tight, follow-up therapy is not an option.”
“My first patient, Mrs Jabavu, speaks English – this is great for me but very rare. You can just imagine how client-centred I manage to be most days gesticulating and using the 10 phrases of isi-Xhosa that I know. Collaborative goal-setting? How is that even possible without being able to communicate the basics?”
“Anyway, Mrs Jabavu tells me what happened to her hand: her husband beat her with an axe. I hold my pose. My horror. My anger for the wrongness of it all. And the fact that I will now proceed to attend to the, seemingly smallest of her problems – her lacerated hand. I scan her medical notes to understand what structures have been injured and hopefully repaired. But all I can find is, “For OT Assessment”. As usual, I’ll be figuring out this diagnosis on my own.”
“I’ve felt overwhelmed by hands most of the year. My hand therapy knowledge and skill feel about as robust as my splinting equipment. You’re on your own. It’s all on you! You know nothing, or so it feels. You figure out the diagnosis and with some hope, you remember that you have a protocol for that! But this does not last long as you realise this patient had flexor tendon surgery six weeks ago and his hand remains safely wrapped in a Plaster of Paris backslab. At least that situation did not require me to make a splint with my 1.6 mm thick splinting material that expired 2 years ago in a frying pan that has two settings: boiling point and off. Anyway – back to Mrs Jabavu: I’ve learnt to acknowledge the panic and then remind myself: You know the basics. Start with the basics....”
