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occupational therapy

  • Haaay BUDOY... [a review]

    When “Budoy” was first aired, I was so happy to learn the fact that, finally, the media is paying more attention to what could be a rapidly growing problem in our society today – the increasing number of kids and individuals who have developmental delays of various causes. I’ve been practicing Occupational Therapy for more than 3 years now and I’ve handled different cases of children and adults with special needs – from autism, ADHD, cerebral palsy, mental retardation to adults with physical and psychiatric conditions. To have a teleserye that empathizes with a lot of parents and families with kids with developmental disabilities would be a great help in rising awareness to those who would resort to confining their loved ones with mental retardation at home for life, or even wasting several years in “denial” then later on deciding to act on it only to find out there’s so much more they could have done years before.

     Only to my dismay when instead of what I thought would be like the film “Oasis” or “I Am Sam”…or even something like House MD or Grey’s Anatomy, if I would dream big. Budoy is starting to be more like a fantaserye to me now.

    It was so disappointing that they didn’t conduct a thorough research when they attempt to deal with medical cases. Gerald Anderson’s acting ability is unquestionably very plausible, the way he deliver and portray a mentally challenged individual. It’s primarily the loopholes in the script and story line that is making this television series not as excellent as to what it could have been.

    If I would watch Budoy as a medical professional, I’d look for the big details they missed out such as, Budoy‘s exact medical diagnosis. Now that the character Budoy found out that he came from a rich family, they could have tried all medical interventions a mentally challenged individual might need (and a medical doctor would always recommend) say, Occupational Therapy and Special Education. It would have been better if from there, they gradually habilitate Budoy to be a more functional individual, instead of miraculously making him so smart right after he incurred a coma from a lightning shock. Who are they kidding? Moreover, the story is more focused now in the sibling rivalry and love triangle among the characters.

    Now the even greater problem remains…how the parents with children with mental retardation and developmental delays perceive Budoy. I have parents constantly asking me, “teacher paglaki ba ng anak ko magiging katulad din ni Budoy?”… “ibig sabihin teacher may pag-asa ring tumalino yung anak ko kahit nadiagnose with severe MR?” And so, I go on and on explaining to them… Budoy is a fictional character. What works with somebody might not necessarily work for everybody. It’s always best to consult your developmental pediatrician or doctor regularly. Collaborate with your child’s SpEd teachers and therapists as to how to follow-up treatment at home. Above all, always be vigilant to the changing needs of your growing child.

  • I'll Be Happy When

    Right now, I’m just overwhelmed with a mixture of feelings… I was never used to writing at the height of my emotions because then I would be irrational. It happened yesterday, right when I’m starting to get used to the hang-ups of what has been starting to turn out to be my daily work routine. You wake up on a Monday…go to work. You wake up on a Tuesday…and go to work. Then it’s Wednesday. Then it’s Thursday and so on. Next week it will be Monday again, Tuesday again, so on and so forth. Until yesterday, I was shaken up or should I say beaten up by one of my ‘big’ kids that it served as a point of realization for me.

    I was riding on the fx bound home and, really, I couldn’t help but cry. Good thing it’s dim as tears are welling up beneath my eyes. It just feels so sad… Earlier that day, my ‘big’ kid as I have said threw tantrums because of a petty thing – I didn’t fix her hair into a “pigtail” just because I have only one rubber band with me at that time and she doesn’t want a “ponytail”. She got really agitated, she was hurting herself, and she almost broke the wooden tables and chairs inside the room. She banged and pushed all the things on the table that they scattered all over the floor. Worse, she broke the aircon, and she almost broke the window. I was trying to restrain her, as any OT would do, but I just can’t. I can’t remember how many times I hit my head on the wall just because I was trying to protect her from getting harmed or from hurting herself during the incident. I admit she was so much stronger, taller and faster than I am that I can’t contain her. Finally, her nanny came in and she tried to calm her. When she finally relaxed, and her nanny was out already, we continued with our session. I tried my best to control my emotions, I didn’t want to cry as she performs the activities… I was crying not because I got hurt. Really, it was nothing to me. I’ve seen or handled worse. Her nanny even told me that it was not the worst yet that she did. As an OT, I was used to handling kids with behavioral problems ranging from mild to severe – from simple pinching, biting, kicking to almost ruining the entire therapy room. I cried because…I felt worthless during that time. I wasn’t able to do anything. Being a licensed occupational therapist…who am I to lecture caregivers and parents regarding behavioral modification techniques when I can’t even restrain or control this kid from throwing tantrums?or from wrecking the room? After 4 years of college, I felt like I’ve learned nothing. I definitely felt terribly awful… Before our session ends, right when she’s about to finish our coloring activity, I gave her a blank sheet of paper where she could scribble or what we call in psychiatry, “sublimate” her aggressiveness. I was surprised to see her drawing circles which later on turned out to be “smiley faces”, and she filled out the entire sheet of paper. She colored them and after that she folded the paper into four. I was watching her as she does it and I was shocked that she handed it to me then kissed me on the cheek. Oh I get it! She actually made a sorry card for me. *aww..* This kid is non-verbal and she has autism. Although she can imitate verbally the words “sorry” when her nanny asked her to say so after she threw tantrums…this is really a big deal for me - to think that she actually thought of making a card to make up for what she has done? Isn’t that sweet! =)

    When I’m finally bound home…that’s when I pondered over the things that happened. Now I realized, all those “clinical reasoning” and “self-reflection” lectures by Mam Cabatan really come in handy in the real work setting. You begin to notice your mistakes and at the end of the day, you learn from them. How could I forget our psych lectures during internship?that to manage an aggressive patient, it’s not always best to confront him. If he’s mad to death, be calm and objective. That’s what I should have done during that incident. I should have tried to calm her down instead right when I see that being firm no longer works - that is what Behavioral Modification Technique is all about.

    “I’ll be happy when…” Now I realize how sad that sounds and how many people commit that same mistake. According to the book I’ve read entitled “Being Happy” - If we’re unhappy, it’s because life is not as we want it. Life is not matching our expectations of how it “ought” to be and so we’re unhappy. Happiness is a decision.” Like what the father of one of my patients told me, I’ve been living a fast-tracked, clock-driven life, I should take a break every once in a while. Wu-wei…just go with the flow. I think that’s how other happy people’s lives are. Hoff said: “When we learn to work with our Inner nature, and with the natural laws operating around us, we reach the level of Wu Wei. Then we work with the natural order of things and operate on the principle of minimal effort. Since the natural world follows that principle, it does not make mistakes. Mistakes are made – or imagined – by man, the creature with the overloaded Brain who separates himself from the supporting network of natural laws by interfering and trying too hard.” I’m always setting standards for myself. I’ve always been obsessive-compulsive, perfectionist-idealist type of person…and now it has consumed me. It’s starting to set boundaries of what I could measure up for happiness. “I’ll be happy when…” Now I know I should be happy because I’m blessed for all these. And just like Winnie the Pooh’s philosophy – while Eayore frets, and Piglet hesitates and Owl pontificates…Pooh just is. I am what I am now, and it’s exactly what I need to be happy. I commit mistakes, I learn from them, and everyday I grow as a better person.

    Right now, my head still aches during that incident...but it doesn't matter. It would continue to remind me of my desire to shape the behavior of my kid, to fulfill my wish if it's ever possible, to see her live as normally as any individual could. ^_^

  • I was touched

    The Lord really has a wonderful way of amusing us…and today, I was deeply touched. I got home today at around 8:30PM, instead of around 7PM on regular days. The reason for it is because my 2PM patient couldn’t make it on their allotted time for therapy session for some reasons so they requested if they could have it at 7 or 8PM instead. I was hesitant to give them the 8PM schedule because a 3-year old boy should have been sleeping at that time, or may be sleepy to say the least. Fortunately, the parents of my 7PM patient cancelled their therapy session for today because they have other things to take care of, so I placed them at 7PM. After our session, the father of my kid offered me a ride home and a dinner. I rode with them on the way, they just dropped me off at the corner of our street, and I no longer agreed with the offer of dinner for my family is also waiting for me for dinner. Besides, it’s too much already. =) While on our way, the father of my patient told me how denial he was at first regarding their son’s condition; that he cried so hard when they found out that his child has autism. It was an expected baby and they prepared for it for almost 11 years. They’ve given the best of everything to have this kid delivered and brought up as a healthy normal child.. Well I guess you can never really tell… At the back seat, I can’t help but wonder…this man…the father of my patient, of whom I’ve handled for only 3 sessions now, has been pouring his heart out to me that I could almost see tears welling up beneath his eyes.

    “You’ve been such a blessing to us and for my child. The fact that you gave us your time, the time when you should have been already home with your family...I can never be grateful enough that you’re sharing yourself with our child..”

    His words have deeply touched me that I wanted to cry right at that moment, hehe..

    “Nitong mga nakaraang linggo ko lang medyo natatanggap na ang lahat…Ngayon nga naiiwan na naming syang nakaupo mag-isa sa front seat, dati ang likot-likot niyan, karga-karga ng yaya sa likod..It was actually our first time to go out together without his yaya.”

    I wanted to say…”it was nothing, really.” When I started to work as an OT, I’ve conditioned myself already that I am here to help other people…that’s why I never really take it as a big deal because it is my job. I wanted to find the right words then, to comfort him, to make him better understand his child…and that God has better plans for him, but I choke on my words.

    What moved me more was when he said, “there’s a book on the seat, beside you…it’s for you.” I reached for the book. I was amazed when I saw it, and It was entitled: “Why this lady can laugh (A Portrait of a Virtuous Woman).” I could hardly believe that someone appreciates me that much…the simple things that I do.

    When I said this day was quite among the strangest that I’ve had, I mean it. I woke up this morning getting a little tired of what have been becoming my usual routine every day, of every week, of every month…and tomorrow is already October by the way. This past few weeks, I’ve been doubting what I do…I get a little paranoid on how the parents of my kids perceive me…on how the quality of my treatment has been affecting my kids. I get easily frustrated if I don’t get the progress I want to see from my kids, or that I don’t see a little improvement from their previous level. Then again, I spoke to soon. I realized just now that I’ve been hurrying my life so much, now I can no longer enjoy it. All of a sudden, things like this happen, sweeps me off my feet that I can’t help but say, “..the Lord loves me so much because He makes me love other people…and they love me back.” =)

  • Life after graduation

    Alas! I finally have the time to sit back, think of all the years that gone by…update my blog (darn, after like what – gazillion years! Nah,, just an overstatement..;p) here I am, alone, doing my regular “reflections..” Indeed, it kind of help me a lot applying all those “thinking back”, reflecting over the things I had done…and had not done, or was not able to do so due to a number of reasons; making a sense out of my shallow life.

    In my life now, transition is really a big word. At first I was wondering how I would ever get out into college life struggles, not because I did not enjoy my college life, but the hours and hours I spend inside the four corners of our classrooms get longer and longer.. and it only gets harder every time. Now that I am finally out of it all, I wonder, what now?

    I always find myself stuck on one corner of my room...looking back…I never understand why it feels so great to reminisce all those memories of younger years until I realize why - simply because those are the days when everything was better.

    Now that I’m beginning the life of a working individual…I’m having a lot of apprehensions.. First, should I work and use my diploma? Or should I use my diploma and work? Haha! What I really mean is that, I know some of my classmates who’d resort to working in a call center instead of using everything they have learned to do what they ought to do…to practice what they really worked hard for, and most importantly, to help other people.

    I was grateful and I really appreciate everything that I learned from internship. Not only did it help me apply all the theoretical knowledge we have learned from our lectures and discussions but I also get to mingle with different kinds of people…and learn from them. Internship has taught me a lot of things – from the “what-to-dos” to “what-not-to”. I had the opportunity to get along with various kind of people – from my colleagues to the parents and caregivers and patients with which we offer our services.

    It’s amazing how I do this technique and then it works in an actual patient, you realize, hey that’s evidence-based practice. Haha! One example of which was when I handled a 60-something year-old patient with Parkinson’s disease. I was pretty amazed by how I see before my eyes how a cog-wheel rigidity looks or feels like, how a masked fascies looks like, how an intention tremor differs from resting tremor, and the like…stuff I only get to read from books before; and a lot more conditions I got to handle that I was only able to hear and read from medical books and online reference materials.

    A big bulk of what I learned was on how to relate with other people. I admit I was never that loud or outgoing person. I was rather shy. But an experience from one affiliation center served as an eye opener for me. I remember one professional that I worked with told me, “kailangan marunong kang makisama sa mga magulang ng mga pasyente…kasi sila ang maaaring makatulong o makasira sayo..” Indeed it’s true. For me, OT as a profession, lives on because of: the parents/caregivers who trust you, and the occupational therapist who has the skills and competency to practice. Establishing rapport is not that difficult for me. I have learned along the way how to interact and get to the level of my kids and their caregivers. But to stay in the profession means you have to be tough. One life-changing incident that could almost crash down my level of self-esteem was when I worked with my colleagues (who were supposed to grade me for my performance), thought we got along well but then all of a sudden, they failed me for reasons I never understood. For one thing, you cannot make all people like you. Even if I grew that way, that I always get what I want…I never argued with anyone or had a fight with someone before…no matter what you do, or how goody-two-shoes you are, you cannot please everyone. And sometimes, you just have to bear with that. If you’d get yourself affected, you’ll only suffer. You’d only prove them that they are right all along. The best counter-attack is to always do the best that you can, prove to them what your real worth, and never settle for a substandard or “okay” performance. When in every circumstances you have the chance to shine and leave a mark. Fortunately, I got the sympathy of my clinical supervisor, he believed in my potentials and he took my side. I couldn’t put into words how thankful and how grateful I was of him then. Coming from a different university than us, I thought he would be bias and all, but then, he fulfilled his job as a clinical supervisor – fair and objective when it comes to all his interns no matter what school they come from.

    I remember when another clinical supervisor from one of our affiliation centers talked with me personally about my strengths and weaknesses as an OT. One thing that really marked to me then was when she said, “I think you have the skills…you just have to get out of your nutshell..” I never really understood what she meant until I was undergoing this volunteership program that I applied for to keep me busy during summer, while I was reviewing for the boards this July and my menthor reiterated that to me. Sometimes, it really helps when you have that someone who would make you realize what’s lacking, and what you already have that you need to polish. I know what we have learned and practiced during internship was not enough, and it’s not an excuse that you are not able to give your best shot. I was talking with one parent one time and she was asking me of the summary of the re-evaluation I had done for her child. I was not able to make the summary of re-evaluation because it was no longer required of me by my clinical supervisor since it was only a make-up duty. The parent told me, “hindi mo naisip na kailangan ng anak ko yun pag magpapacheck-up kami sa doctor..” Although it was stated in a manner as a joke, I felt terrible. She has a point. I was no longer doing this to graduate…I am now doing this for my patients. I admit, at some point in my life, I was also like the others who were conscious of their grades…to meet the deadlines of their papers… and what gets compromised? The quality of the service you deliver. It feels sad seeing patients not improving…just because their treatment was not well planned and carried out. Why? Because there’s a rapid transition (not even a transition) or change from one intern to another and kids find it difficult to adjust that’s why they regress; because every OT intern has a different treatment plan from the other even though they handle a similar kid; because the OT intern’s priority is: “basta matapos lang..” Duh, patients are not guinea pigs of the internship, they are people seeking for help and because they get there, found you, they deserve at least a decent intervention to address their problems properly! Who cares if you have no or little make-up days? who cares if you have an average of 1 or 2 in your transcript? Parents don’t have to know your GWA every time they’d walk into the clinic. What they see is your performance, how you handle their kids, and how their child improves even at home because you offered them the help they needed.

    I am not saying all these because I do very well in my craft. I, as a practicing OT in the future, have my own flaws and inadequacies. This doesn’t mean that I’d stop here once I realized what’s wrong for we always have the option to do better every time. And before you know it, you’ll feel that you are really happy once you realized that everything is in its place…and a major part of it is because of YOU.

  • Psyche Case Story


         During my fieldwork at NCMH, I was able to handle a 40-year old, female patient with schizophrenia of undifferentiated type. We were not informed of the diagnosis of the patients at the start of the session so as I was going on with the interview; I relied solely on my observations and on my pre-conceived notions about mentally ill individuals. It was in fact difficult to determine the case of my patient per se because in one look, you wouldn’t actually notice anything wrong about her. She has no delusions or hallucinations. She wasn’t aggressive at all, and there weren’t even any hint of flight of ideas or loose association of thoughts. Her mood was euthymic and her affect was appropriate. The only clue that gave her away was the fact that she was actually staying in a mental institution. It was only after I had gone through history-taking that I noticed some discrepancies in the information she provided as compared to that contained in her medical charts. It was documented in her charts that she was 40 years old, single and was admitted in the year 1998. Contrary to what she told me that she was 39 years old married with a 15-year old son and was admitted on 2002. I was asking myself then, was it a question of orientation or deficits in memory? Or was it her reliability as an informant? Since there wasn’t any caregiver/family member present at the time the interview was conducted to compare the information gathered.

        Throughout the interview and the evaluation session, I kept wondering, was it a case of MDD or schizophrenia?what type then? Occupational therapists don’t make diagnoses, that I know, so medical diagnosis given before hand will be very useful. But in cases such as I had encountered, I tried to recall all my stored bulk of information about psychiatric conditions from the back of my mind to help me figure out what to do in the evaluation. There wasn’t stated an exact or clear cause of her condition except that client sustained a fall from the rooftop to the ground a couple of years ago and I presumed it to have contributed to the etiology of the disorder. I know that schizophrenia is idiopathic in nature. At the end, I verified my speculations to be true. My client told me that the barangay officials of their town brought her to NCMH when she was seen wandering aimlessly around the streets for days. She admitted that none of her family in Parañaque, even her relatives in the province knew where she was, of what had happened to her and what has been going on with her now. It was a bit disheartening but then, one must not be overridden by emotions.

        Client stated that her primary goal is to get back to her previous work as a helper and a nanny to a one-year old child. This sort of served to be my first dilemma. I’ve decided that my target for treatment would be reality orientation and prevocational skills training since these cater her goals for intervention but I realized that there’s a lot of factors that I need to consider in coming up with these goals. First, if ever I should decide to target prevocational skills training for reintegration to work, will there be a possibility for discharge in the first place, and when? I know it is not unlikely since client has already established near-normal level of functioning. The question would then be, supposing the client will be discharged soon, will she still have a home to get back to considering almost 9 years had lapsed and that none of her family nor relatives ever knew where she was and what happened to her? Considering also her age and history of psychiatric illness, would there be a sound opportunity to get back to her work or at least to be able to work again?    The OT diagnosis I formulated then was difficulty in participating in work secondary to impaired process skills associated with schizophrenia, undifferentiated.       

        When I evaluated my client, I hardly found predominant problems with her participation in occupations. Our clinical supervisor was right when she said that the more functional the client, the finer the problems and the more we’ll have to dig deep to understand the client’s context of occupational performance. No problem was noted in the COPM. She has already established fair working behaviors. Her MSE results were mostly good except in the visuospatial ability and insight part, and some noted deficits in her remote memory.  Client generally has intact cognition and sensorium. Upon administration of Interest Checklist, client’s preference of activities helped me decide as to what intervention strategy that I should use that would best suit her. I was aiming then of providing her a task-oriented activity that is just-right and motivating for her age, at the same time, incorporating reality orientation techniques and relearning of prevocational skills. Client has a good potential to be reintegrated back to community and to return to work considering her strengths: intact cognition; good orientation to time, person, place, and activity; ability to maintain meaningful eye contact; appropriate mood and affect; absence of speech and language deficits; presence of social interaction with fellow patients; motivation to get back to previous role; absence of motor problems and physical dysfunction and; absence of comorbid medical condition.

        According to Haley & McKay (2004), cooking is the most ideal activity to provide to psychiatric patients especially those with chronic schizophrenia as compared to craft and sensory awareness activities primarily because of the satisfaction it gives to the client. It is very motivating especially to adults because there’s a presence of an end product that is either retained or consumed. It is also age and culturally appropriate and it is concrete and understandable hence meaningful and valued.   

        Cooking or baking captures the interests of patients and at the same time, targeting improvement of an array of problems and performance deficits. In the case of my client, for example, I preferred to provide cooking as an activity to target her problem areas because she wanted to return to her previous role as a helper, and cooking is just one of the tasks accomplished by a helper.    

        During the treatment process itself, I was grateful to have learned that my client usually cooks in the ward during OT sessions. It was something she really enjoys doing – cooking and preparing a simple meal and later on, eating and sharing it with the other patients whom she usually hang out with within the ward.    

        Over all, I used a top-down approach to target my goals. I considered my client’s primary goal to return back to her work and this is what I concentrated on. The intervention method I used was more of a remedial approach since I provided a cooking activity incorporated therein were to target reality orientation and prevocational skills training by focusing on enhancing specific work behaviors that client would need if ever she decide to return to work in the future. I adopted an attitude of active friendliness to establish rapport and to gain client’s trust. Verbal cues prompts and demonstrations were also provided.      

      My client recognized me as soon as she saw me but she hardly remembered my name. And when she found out that we’re going to cook pudding on that day, I saw that she became enthusiastic about it. She was aware of the need to wash hands and utensils before and after an activity. She was also able to orient self to person, date, place and activity and to time while looking at the clock when asked. She demonstrated good and sustained attention and she was able to concentrate on task throughout the activity. She was able to demonstrate safety awareness while cooking (turning off and pulling the plug of the stove after cooking, and using potholders in handling hot pot and handles). She was able to follow through task with the aid of written and verbal instructions. Client was also able to do aftercare (disposing off garbage and waste products in the trashcan). She generally demonstrated appropriate affect and euthymic mood throughout the activity. She revealed good insight after the session and was able to recall steps in cooking pudding. Client was able to distinguish materials and ingredients needed to cook pudding upon presentation of materials and reading written instructions. Client was able to perform tasks when asked to, given verbal prompts.  

          During the cooking task, I made sure that all sharp utensils like fork and knife were just within my working area and out of my client’s reach as a safety precaution. I was also the one to open the can of milk for her. Because even if my client appeared high functional, I couldn’t really tell what might happen or what she might do that may compromise our safety and performance of the activity. I also provided a written instruction of the ingredients and the procedure in making pudding. I made sure that the steps were brief, specific and written in tagalog and in larger font so my client would easily understand. At first, she was hesitant about reading it and she told me that she couldn’t read that well. I just pushed her and reminded her that during our first session she was able to read though she encountered difficulty, at least she was able to read. So there, she finally read. I knew it was just a matter of motivation and convincing her, since I think she perceives the task of reading as stressful and requires a lot of processing. There were just instances that she was really having a hard time to read and was taking a longer time in reading and I just gave her prompts to help her. It was either, she really has problem in reading skills, or she was just less motivated to read, or she may have visual-perceptual deficits as well, since she needed to lean closer to read the material. And during the evaluation, she revealed fair performance in the visuospatial task; she needed to turn the paper to complete the figure.   

        I observed that during the session, her clothes hang loose over her shoulder and she didn’t seem to mind it at all. So even if it wasn’t originally indicated in my goals, I decided to include education on awareness of appearance, of which I received positive response from my client. She became more aware of her clothes hanging loose over her shoulder after reminding her of it twice that even after our treatment session was done, she fixes her clothes whenever it hangs loose over her shoulders.

            Client was able to remain sitting and patient while waiting for the pudding to cook. There were very minimal signs of impulsivity (i.e. asking to include all the breadcrumbs to the mixture). She was also able to demonstrate good social interaction with other patients when she decided to share the pudding with them. She even took the initiative to prepare the plates and spoons to put the cooked pudding into after cooking, and asked me to divide it among them. Client was able to wait until the pudding cooled, and listened for my instructions before eating. I also provided additional instructions regarding safety awareness, which had been easily grasped by my client.   

          Client was able to recall all the steps and the information I told her after the activity, what I just noticed was that, she seemed to dislike the idea of having to process for questions that require her to ponder over. She answers impulsively without taking time to think it over. When I asked her, “do you think we’re going to need this (cheese spread) in making a pudding?” she answered with, “hindi ko alam, ikaw bahala..” She doesn’t seem to like the idea of having to problem-solve; she was too receptive to information. To her it was like, tell me what I need to do and I’ll do it. Hence in her succeeding OT sessions, I would recommend providing her more activities that would target improvement of problem-solving and decision-making skills. Cooking activities may also be done, given she has to cook a variety of dishes graded from simple to complex. Also, SST of buying in the market, education on proper grooming, pre-vocational skills training targeting saving money or marketing and, Discharge Planning and Transition Planning.

        At the end of the treatment session, I was really grateful that my client finally remembered my name, and she was able to call me by my name every now and then. I felt glad when after the activity she was constantly thanking me for giving her the chance to cook pudding, which they later on enjoyed eating in the ward. It was fulfilling for her because it gave her the feeling that she made it herself, it came out well and she said that it really tasted good.   

    When I first got into NCMH, I always thought I wouldn’t make it. I didn’t have any idea how to handle psychiatric patients. I was too scared to face clients with chronic mental illnesses but then, I was glad that I was able to accomplish my three days of fieldwork fulfilled that I thought I had just done what I ought to do. My clinical supervisor told me after the treatment session that I was more at ease and spontaneous during the treatment than how I did during the history taking and evaluation. I guess, indeed I was. Because on the treatment session I already have an idea of what my client is and what I’m planning to do to her. Unlike during the evaluation session when it was almost like I was facing the unknown and I hadn’t the slightest idea of how severe or functional my client will be.

        The major difficulty I encountered throughout my fieldwork would be on deciding for my intervention plan. When I decided that cooking would be the most appropriate and suitable activity for my patient, the question that was going on in my mind was to whether they would allow me to cook within the ward. Whether it would be safe to let my client cook, handle cooking utensils and manage a stove. Supposing they’d allow me to cook with my client, what if the other clients crowd around us during the activity? I was also wondering then as to how my client is going to respond to the idea that we’ll be cooking pudding on that day. So on the actual treatment session, I prepared all the materials I will need in making a pudding. At the same time, I planned an alternative activity, which is tuna sandwich making of which I also brought the materials that I’m going to need, in case they won’t allow me to cook with a stove. When the supervisor in the facility told me that I can cook using the electrical stove in the ward, and when my clinical supervisor asked me on which of the two activities I proposed I am going to pursue, I proceeded with pudding-making. For reasons that, cooking is a very motivating activity, I personally love to cook. Second, tuna sandwich making is a relatively very easy step to provide my client, it is not as complex as cooking and it doesn’t provide enough challenge to target a number of skills.  

        Generally, I could say that I performed well during the evaluation and treatment process. I have targeted most client factors and skills including work behaviors, insights and over all performance in the occupation of cooking and meal preparation. While we perform cooking pudding, client was able to relate previous experiences in cooking in the ward. She also told me that pudding was her favorite food and that she usually asks one of their supervisors in the ward to buy her pudding with her money.  I told my client that now that she knows how to cook pudding, she has the option to cook every now and then in the ward or share the knowledge with her friends in the pavilion. But the problem is the opportunity to cook and the availability of the resources. Since client only gets to cook during OT sessions and of which she is supervised. The generalization of skills cannot be promoted and learning cannot be monitored unless a follow-up treatment and re-evaluations will be conducted.    

        More or less, the fieldwork provided me the experience and the learning I needed in dealing with mentally ill patients. My motivation has always been like, “kung hindi ko ito magagawa hindi ako OT.” But then, the patient I handled was more or less functional already, and not all mentally ill patients would be as easy to handle as such. It really requires a lot of knowledge, experience and competence in this field to not just pull it through but to be empathic enough in understanding the needs and the situation of psychiatric patients. People whom I just usually see roaming around the streets in their rugged clothes and keep me wondering what went wrong.    



    Haley, L. & McKay, E. A. (2004). Baking gives you confidence: User’s views of engaging in the occupation of                         baking. British Journal of Occupational Therapy, 67(3), 125-128.


    *Here are pics during our last day of fieldwork at NCMH in Mandaluyong: 




                       medium_finger.jpg                     medium_kulitan.jpg