by Linda Swanepoel, occupational therapist at Montrose Manor.
I have been working with eating disorders for many years and have often wondered what is actually happening in this field in the rest of South Africa. It was for this reason that I decided to plan a trip to Johannesburg, Pretoria and Durban to meet with professionals working with Eating Disorders.
I started out knowing only a handful of people, but by the time I left for the trip I had filled 2 weeks with appointments. My plan was to learn what services and facilities are available for treating Eating Disorders, what approaches people are now using and also to inform other professionals about Montrose Manor as Montrose has always been better known to overseas referrers than to South African referrers.
I was impressed from the start at the enthusiasm and interest that almost everybody I contacted expressed. They all seemed very eager to talk about their own work and to find out about Montrose Manor. It seemed that everyone was feeling the lack of communication in this area.
I was also relieved to realize that the approach to the treatment of Eating Disorders has changed significantly and more and more professionals are moving away from the focus on calorie counting and weight, but rather on forming a healthy relationship with food and balanced eating.
Clients with Eating Disorders are definitely on the increase! Unfortunately the financial demands of providing affordable treatment for this condition is extremely challenging, as the staff/client ratio is so high and the treatment is slow and intense. Never the less, most of the hospitals and clinics I visited were full with a waiting list. Although some offered a 3 month program, similar to Montrose, many provided shorter treatment periods of 3 to 6 weeks. Medical Aid pays for 21 days, which is not nearly enough. The psychosocial programs were all fairly similar, with strong cognitive behavioral theme. None of them offered dialectics which is a coping tool taught at Montrose Manor that has proved very useful in the management of Eating Disorders.
The lack of primary treatment was also of great concern and as a result a few professionals were making plans to start a primary care facility. As anorexia also has a strong OCD component, focus on calorie counting and weight at this stage has not been beneficial as clients then have to “unlearn” these habits when they start secondary.
Although there was one workshop being offered a few days after I left, most of the people I visited felt isolated and there was little knowledge of what each other are doing. Unlike Europe and America, South Africa does not seem to have organized many workshops or conferences for Eating Disorders. Many of the professionals I met with were planning the trip to Europe to attend the BEAT EDIC conference in London. It would be really exciting if more could be done in our own country!