Paralympic Care

George Louw looks at what it takes to prepare mindsets and pick up the pieces before and after a big event for professional athletes

When watching big sport events, we cheer the modern-day gladiators for putting their bodies on the line to out-perform their competitors. When they win, we celebrate. When they perform less well, we are disappointed. As couch-potatoes, we tend to think that the lives of sporting heroes must be great; all the glitz, glamour and accolades.

But while reading an interview with the wife of a great South African Springbok rugby player a few weeks ago, my eyes were opened to another reality: the sacrifices that underlie success and the toll that it places on emotions, relationships and life at large, not just for the athletes but also their families.

Team South Africa had some inspiring words to motivate them at the event.

If this is so for athletes without disabilities, how much more are athletes with disabilities affected in their build-up to, during and in the aftermath of an event? To find out more, I interviewed the Paralympic team psychologist Kirsten van Heerden and doctor Carolette Cloete.

Kirsten was not able to accompany the team to Tokyo. She discusses the pre and post- care, while Carolette focussed on their time at the Paralympics.

It must be noted that not all athletes react the same. Many take it in their stride and have the resilience to be unbothered by tough times. This article focuses on those who struggle, but are brave enough to compete and excel, despite their struggles; those with the courage to pick themselves up and try again when they fail or things go wrong.

Preparing mindsets

Pieter du Preez were one of the athletes who excelled at the Games, winning gold in his event.

Kirsten explains that the mental (and emotional) preparation of the team had the added challenge of athletes having to live in a bio-bubble at the Games and thus unable to mingle and socialise with athletes from other countries – often friends whom they had not seen for a long time.

Preparation took the form of two team workshops, which were aimed at mental preparation and COVID-related logistics. This also provided the opportunity for the team members to get to know one another and to start building comradery.

The 18-month delay for the Paralympics created pent-up stress that also had to be managed. When the Games finally arrived, it brought forth even more emotions that had to be channelled positively. However, despite the stresses and anxieties, the athletes were excited and raring to go.

Kirsten mentioned that, as a sport psychologist, she finds working with Paralympic athletes so fulfilling for this exact reason. She loves seeing people strive for excellence no matter their background or situation. This made the preparatory workshops to be a very positive experience.

Kirsten explains that, with her work, unlike physical skills that are already present, abilities often have to be honed from scratch through mental skills training with unique needs for each athletes. In order to really perform, mental skills must compliment physical skills. Training of the mind includes mental mindfulness, pre- competition routines and techniques that focus the mind.

For the athletes, these skills need to become a constant way of thinking. It is very much like physical fitness. To stay fit, you have to keep on training. In the same way, to remain mentally aware or ‘in the zone’, you have to constantly work at it.

In a nutshell, sport psychology is caring for the person behind the athlete; to ensure an emotional resilience, tenacity and strength of mind that prevents the largeness of the event and surrounding circumstances to consume the person; to create a mental freedom that allows the athlete to excel physically. No matter how mentally tough an athlete is, if depression and anxiety sets in, it gnaws away at toughness…


Now that the mental preparations were done and dusted, the team finds itself in the Tokyo bio-bubble. This is where Carolette continues the experience of caring for the team. She does so with anecdotes that describe the team spirit and challenges during their stay in the Olympic Village. Starting with the very real effect that COVID had on the athletes before and during the Games.

Carolette mentions the travel and accommodation challenges experienced. The team showed courage, resilience, interdependence and a wonderful sense of humour that transformed the athlets into a close-knit community and even a family.


Just as inspiring is how the Paralympians picked themselves up to forge ahead.


The biggest impact of the pandemic on the team was the complete uncertainty that it caused. Will I stay healthy? Are we going to travel? Will the Games indeed happen? Some athletes recovered from COVID immediately before the Games and this caused doubt of their own body’s abilities. Will they have the strength to excel? After they trained so hard! For so long…

Another concern was the effects of such a very long flight on the athletes, especially wheelchair users where the risks of pressure sores, swollen legs, and developing blood clots were a real possibility. Amputees can experience swelling of their stumps that could prevent them from fitting their prostheses on landing in Japan.

The challenge of the team doctor is to mitigate these in-flight challenges and similar obstacles during the Games. An amputee, for example, who develops a pressure sore on the stump cannot compete. Or, if they do, will struggle to compete optimally. So too a wheelchair athlete who developed a pressure sore.

Puseletso Michael Mabote at the 2020 Tokyo Paralympic Games.

During the Games, the athletes underwent daily COVID tests, which further added to anxieties. Fortunately, resilience prevailed. As one athlete remarked smilingly: “COVID did not steal my race from me. I tested negative, so, today I’m going to run!”

But for all their bravado, these athletes really needed nurturing. A comment from another athlete: “You know, Carolette, we need people to care about us.” They needed to be cared for as a person and not just as an athlete. This is what Carolette came to understand from her time as team doctor.

A blind girl discovers a blister on her foot, but cannot find the treatment room. It is the person that is troubled, not the athlete. The blister is an emergency for the athlete, but the fear is experienced by the person.

Carolette also experienced the comradery between team members; the way that they look out for one another. She gives the example of a visually impaired girl and another in a wheelchair who stayed together.

During one incident the athlete in the wheelchair couldn’t pick up her dropped credit card because of impaired hand function. Then her roommate with a visual impairment couldn’t find the card. It became an example of the first being the eyes and the other the hands to work together. Their jokes, humour and laughter about this became contagious.

Words by South African para athlete Kerwin Noemdo that helped keep Team South Africa focused and inspired for the 2020 Tokyo Paralympic Games.

The way in which the athletes mocked their own disabilities, making jokes and having fun, was inspiring. If you can laugh at yourself, you immediately are in a better space.

Just as inspiring is how the Paralympians picked themselves up to forge ahead. The absolute tenacity shown. Many come from very difficult and challenging backgrounds, but they bounced back to tackle the challenges of life.

This makes them extremely resilient and fiercely competitive. They often perform despite injuries and significant pain. The team comradery was backed further by cheering each other on as they battle through their injuries and pain.

Picking up the pieces

The Games are over. The athletes back home. Those with medals celebrate, but all that really remain are the memories. Many take it in their stride. It happened. It is past. Life goes on. But, there are also casualties: mental and emotional. This is where Kirsten picks up again.

For many athletes, the Paralympic Games are an opportunity to catch up with old friends from different countries. This year, athletes were in bubbles to prevent the spread of COVID. As a result, they were unable to socialise with athletes from other countries.

Post-Olympic depression is well-known among athletes across all sporting events. They call it “Post Olympic Blues”. Michael Phelps narrated a piece called “The Weight of Gold”, which speaks of many Olympians and Paralympians who lived in “preparation-bubbles” during the preceding four year. Their whole lives revolving around this event. But, now, they are back home.

So, what now? It is sort of an anti-climax. You spend so many years preparing, then it is so fleeting. Was it worth the effort? The sacrifices? If you didn’t perform well, there is the disappointment with which to deal. Even those who did well can have the morbes: “Did I give up my life for this chunk of metal?”

It is amazing in the moment. For a few days you bask in glory, but then you just return to normal life. And often for persons with disability, “normal life” can be tough to re-integrate back into. There is a sense of loss.

Loss of Paralympic comradery, friendships, of sharing, nurturing and a loss of shared community. Going back can be very hard. I can attest to Kirsten’s comments: “Soon after the Paralympians returned I asked one of the athletes, ‘Are you happy to be back home?’. After a rather pensive silence, she replied, ‘I suppose so, but I miss my Paralympic family terribly.’.”

This was what made me write this article. As onlookers we tend to say, ‘Hey, you were at the Paralympics. It must have been fantastic!’. To many, it was fantastic, but to others, not so much. It is tough and not always what it seems.

Post-Olympic and Paralympic care is something that we all need to get better at. We pour everything into the preparation and the event itself, but when it is over we say: “Well it is over now. Go home and have a nice rest.”

Often emotions are mixed, the athletes feel down and often somewhat confused. We cannot just leave them to their own devices. This period in their lives can often be quite traumatic, almost like a Post-Traumatic Stress Disorder.

We all know the saying: “It ain’t over till the fat lady sings.” For some, the fat lady has not yet sung. We all need to be aware of this.

Ida’s Corner is a regular column by George Louw, who qualified as a medical doctor, but, due to a progressing spastic paralysis, chose a career in health administration. The column is named after Ida Hlongwa, who worked as caregiver for Ari Seirlis for 20 years. Her charm, smile, commitment, quality care and sacrifice set the bar incredibly high for the caregiving fraternity. email:

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