CBO reflection - Visit 1
My first visit to the Ron Smith elderly care centre was a real eye-opener. When we got there, the supervisor explained that this was a home for residents, not a hospital for patients. This really stuck with me because it showed how much they respect the people living there. The place was divided into different sections based on how much help the residents needed with their Alzheimer's.
I liked how they encouraged everyone to do things for themselves. It wasn't about just doing everything for them. We joined in a bean bag toss game, and I was on the yellow team. It was fun to see how seriously everyone took the game, and the staff made sure it was fair for the residents who were playing. After the game, I went with some residents back to their area. The halls were decorated with their own paintings, which made it feel personal.
During tea time, the mood was happy with music and dancing. I got to talk to two ladies. The first one told me all about her life working as a lawyer a long time ago and how she taught ballet. It was amazing to hear her stories and remember that she had a whole life before this. The second lady loved knitting, which I also like, so we had a great chat about that. It felt like a normal conversation, not like I was just interviewing a patient.
But it wasn't all easy. One lady told me a very sad story about her son who was killed and how her husband died soon after from a broken heart. It made me realize that even in a nice place like this, people can be carrying a lot of pain inside. The centre had nurses and therapists, but it made me wonder if they had enough help for dealing with that kind of deep sadness.
The centre had everything there—a salon, a coffee shop, a little store—so the residents didn't have to leave. This was especially good for those who got confused or upset easily. I helped one lady get to lunch in her wheelchair and poured water for another. Small things like that made me feel useful.
This visit taught me a lot. I saw how important it is to treat elderly people with dignity, to listen to their stories, and to help them stay independent. I also saw that mental health is just as important as physical health. I felt grateful for the experience and it made me want to be a doctor who really listens and cares for the whole person, not just their illness. Next time, I want to talk to even more residents and understand their lives better.
References:
Biro, D. (2010). *The language of pain: finding words, compassion, and relief*. W.W. Norton & Company
Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196(4286), 129-136.
Kretzmann, J. P., & McKnight, J. L. (1993). Building Communities from the Inside Out: A Path Toward Finding and Mobilizing a Community’s Assets. ACTA Publications.
World Health Organization (WHO). (2007). Global age-friendly cities: A guide. Geneva: World Health Organization.
World Health Organization (WHO). (2010). Framework for action on interprofessional education and collaborative practice. Geneva: World Health Organization.
CBO reflection - Visit 2
For my second visit to the elderly care centre, we began with a meeting with the supervisor. She informed us that a doctor was present and conducting rounds, and I was assigned to shadow in the late Alzheimer's wing. However, we first joined the doctor in a different wing that provides temporary care for independent villagers who had fallen ill. The first resident we saw was an elderly lady complaining of chest pain. The doctor clinically assessed her and felt she was well enough to return to her village home. However, the resident expressed a strong desire to stay, and her wishes were ultimately respected. I asked the supervisor about her biggest operational challenges. She explained two key issues: firstly, resistance from overseas families who, during video calls, don't see the need to move a resident to a higher level of care, creating a conflict between perceived and actual need. Secondly, she described the poor treatment their residents receive at the nearest hospital, where nurses lack communication about patient progress, forcing the centre to use a farther, more respectful facility. I then participated in admitting a new resident from the village with a teammate. We helped with form filling, checking her oxygen saturation and heart rate, documenting her bruises, listing her belongings, and assessing her independence levels for activities like showering. Finally, I spent time in the late Alzheimer's wing, participating in music therapy by playing instruments and later attempting to engage residents with board games, though meaningful interaction was limited due to their advanced condition.
During this visit, I was curious to see the clinical side of the centre with the doctor present. I felt deep respect witnessing the doctor and supervisor honour the first resident's wish to stay, even against clinical advice. It felt like the right thing to do, putting her comfort and autonomy first. Talking to the supervisor, I felt frustrated and saddened hearing about the families overseas. I understood their perspective, but I also felt the supervisor's helplessness. It's difficult to convey decline through a screen. I felt angry on behalf of the residents hearing about the poor treatment at the local hospital, especially due to their old age. During the admission process, I felt useful and professional, like I was playing a real part in someone's care. However, in the late Alzheimer's wing, I felt a sense of poignancy and helplessness. The music therapy was beautiful, but the board games highlighted the profound isolation of the disease, and I felt unsure of how to truly connect.
What was good was the centre's unwavering commitment to resident autonomy. The decision to let the woman stay, despite her being medically "fine," was a powerful example of patient-cantered care. The admission process was exceptionally thorough and systematic, ensuring the new resident's safety, dignity, and personal property were respected from the moment she arrived. The music therapy was a clear strength, providing a non-pharmacological, engaging form of stimulation for residents with limited communication abilities. What was challenging were the systemic issues the supervisor revealed. The conflict with distant families represents a significant social determinant of health; access to care can be blocked by financial and familial disagreements, not just medical need. The situation with the local hospital points to a critical breakdown in interprofessional communication and a lack of compassion in the broader healthcare system, which the centre must actively work to circumvent.
This experience was a deep lesson in the realities of applied ethics and healthcare systems. The centre's decision to prioritise the resident's autonomy over a purely clinical recommendation is a practical application of the biopsychosocial model (Engel, 1977). They treated her not as a biological case (chest pain) but as a whole person with psychological needs (feeling safe) and social needs (being in a familiar environment). The challenges the supervisor outlined are classic examples of how social determinants of health, like family dynamics, geographic location, and socioeconomic status (the cost of care), directly impact health outcomes. The difficulty with the hospital further illustrates the World Health Organization's (2010) emphasis on the need for Interprofessional Education and Collaborative Practice (IPECP). The lack of communication and poor treatment signifies a failure in collaborative, respectful practice between different healthcare facilities, ultimately fragmenting patient care.The admission process, while excellent, also made me reflect on the concept of personhood. In meticulously documenting her bruises and belongings, the centre was formally recognising and protecting her identity and dignity at a vulnerable time of transition.
References:
Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196(4286), 129-136.
World Health Organization (WHO). (2010). Framework for action on interprofessional education and collaborative practice. Geneva: World Health Organization.
Visit 3
Our third visit to the Ron Smith Care Centre began earlier than usual to observe the doctors' rounds at 08:00. The first patient we saw was an elderly woman with Alzheimer's disease who had a severe lesion on her foot. The doctor explained that while the lesion was serious, amputation was not considered a viable option due to the patient's cognitive state, as the procedure and recovery would be excessively traumatic for her. Next, we visited an elderly lady suffering from vomiting. The doctor contextualized this, explaining that in geriatric patients, vomiting is often not a gastrointestinal issue but a potential sign of systemic problems like kidney failure. She checked her vitals and spoke to her in a soft, calm voice, despite her minimal responsiveness. Later, our supervisor shared a case about a resident with a chest tumour whose family refused to approve hospital treatment, reportedly due to cost. The supervisor had to escalate the matter to court, but by the time the resident was admitted ten months after diagnosis, the tumour had metastasised extensively.
Later, I interacted with residents in River Lodge Three, which houses patients with late-stage dementia. During lunch, we assisted with feeding. One resident was particularly emotional, and we comforted her with reassuring words and a pat on the back. A nurse mentioned she had been emotionally labile all week. I also poured orange juice for another resident who expressed it was her favourite. Finally, we observed a different doctor care for the foot lesion mentioned earlier. She meticulously debrided the excess scab but stopped after about ten minutes as soon as the resident showed signs of pain. She explained that continuing would risk the patient refusing future care, and mentioned she performs this palliative wound care twice weekly.
This visit was a profound lesson in person-centered and geriatric-centred care. The decision against amputation was my first direct encounter with a quality-of-life decision overriding a purely biomedical solution. I initially felt a sense of frustration and helplessness seeing the lesion, but I now interpret the doctor's decision as an act of profound empathy and clinical wisdom, prioritizing the patient's overall well-being and dignity over aggressive, potentially harmful intervention. The supervisor's story about the resident with the tumour introduced a devastating ethical and systemic challenge. It highlighted a tragic gap in understanding between families and healthcare providers, where financial constraints or a lack of comprehension can lead to fatal delays, forcing caregivers into legal advocacy for their patients' basic rights to care.
The explanation about vomiting in the elderly was a key learning moment. It highlighted that geriatric medicine requires a different diagnostic framework; symptoms are often atypical pointers to more serious underlying conditions. The doctor's calm, patient demeanour with the unresponsive patient demonstrated that communication retains its value even when a cognitive response is unlikely. Her tone was a therapeutic tool in itself, preserving the patient's dignity. Observing the wound care was a masterclass in building therapeutic trust. The doctor’s willingness to stop at the first sign of pain was not a failure but a strategic choice to ensure long-term compliance and minimize suffering. This shifted my understanding of a "procedure" from a task to be completed to a negotiated, patient-led interaction. Finally, helping with lunch and providing comfort reinforced that in this setting, psychosocial care is as critical as medical care. A simple act like providing a favourite drink is a direct intervention into a resident's emotional well-being. This was an immensely valuable experience that fundamentally deepened my understanding of healthcare beyond acute cure. The supervisor's story served as a sobering evaluation of the systemic and social barriers to effective care, revealing that a healthcare professional's role often extends beyond the clinic walls to include patient advocacy in the face of familial or financial obstacles. The visit was highly effective in demonstrating the core tenets of geriatric medicine: multidisciplinary care, symptom management, and dignity preservation. The strengths of the approach I witnessed were its immense patient-centredness and long-term perspective. However, it also revealed the emotional weight and complex decision-making involved in chronic care, where success is often measured in comfort and stability rather than cure.
Moving forward, this experience has solidified key actions I plan to integrate into my future practice. I am committed to prioritizing dignity in all my communications, emulating the doctor’s calm and respectful tone, understanding that how I communicate is inherently therapeutic, especially with non-responsive or cognitively impaired patients. Furthermore, I will implement a patient-led approach to procedures, always viewing them as a collaboration and prioritizing the patient's comfort and trust above the completion of a task, as demonstrated by the wound care doctor. Finally, I will strive to be a vigilant advocate for my patients, recognizing situations where their voice is diminished and being prepared to act in their best interest, while also valuing the profound impact of psychosocial interventions like listening and offering small comforts as integral to holistic, compassionate care.
Visit 4
Our final visit focused on presenting our group's evaluation to the supervisor. We delivered our analysis of the centre's operations, strengths, and challenges, followed by our recommendations. The supervisor provided positive feedback, specifically praising our evaluation and proposed interventions. We concluded by thanking her for the learning opportunity.
This session marked our transition from observers to active participants in community healthcare. The supervisor's validation confirmed that our student perspective could offer meaningful insights. Presenting our analysis, especially sections on Ubuntu and person-centred care, helped solidify how theoretical principles apply in real-world settings. This experience underscored that effective healthcare relies not only on clinical skill but also on structured advocacy and communication.
This visit successfully closed the learning cycle, connecting our direct observations to analytical presentation. Receiving positive feedback from a professional affirmed the relevance of our coursework and the importance of person-centred frameworks like the Eden Alternative. The main value was gaining confidence in our ability to contribute meaningfully to healthcare discussions.
This experience reinforced my commitment to advocacy and person-centred care. I will carry the principles of Ubuntu and Batho Pele into my future practice, consistently prioritising patient dignity. I plan to maintain an analytical approach in clinical settings, always looking for ways to improve care systems. This reflection has strengthened my interest in geriatric care and community health.