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Reflecting on the Mariannridge placement as a whole has made me realise that many of the experiences and insights gained throughout this block are connected. Individual moments that initially seemed separate – screening learners, engaging with teachers, observing community dynamics, and reflecting on participation – have gradually begun to form a clearer picture of how occupational therapy functions within a community context.  

I can see this process through the idea of a thread. Throughout the block, there have been different experiences that have revealed small pieces of understanding about occupation, participation, and health. The more we've experienced, the more these pieces have begun to connect, interlinking into a broader understanding of the relationship between people, their environments, and the opportunities available to them. The Mariannridge placement has therefore not only provided practical experience but also helped integrate many of the theoretical ideas learned throughout the occupational therapy years.  

Earlier in my training, I often imagined occupational therapy practice primarily in terms of individual treatment sessions, structured activities, and clinical techniques aimed at improving specific skills. While these aspects remain important, working within a community setting requires a much broader perspective. The Mariannridge context highlighted how the social and environmental factors influence occupational participation. Access to resources, educational opportunities, family circumstances, and community structures all influence the occupations people are able to engage in. As a result, participation cannot be understood by focusing only on individual ability or impairment.  

Working within this environment encourages one to consider how occupational therapy can support participation through collaboration, education, and engagement with the broader community. It hasn't been easy, as this required developing skills such as effective communication, adaptability, and cultural humility, which proved essential as we work within diverse contexts.  

Another important thread that emerged throughout the placement is the connection between occupational therapy practice and the Sustainable Development Goals (SDGs). As we explored in a previous blog, the SDGs aim to promote health, equality, and sustainable development worldwide (United Nations, 2023). The experiences in Mariannridge showed me how closely occupational therapy practice and these goals are linked.  

For example, SDG 3 focuses on promoting health and well-being. Occupational therapists contribute to this goal by supporting individuals to participate in activities that promote independence, health and quality of life (Reitz et al., 2020). In community contexts, this may include health education, early identification of developmental challenges, and supporting families to access appropriate services.  

SDG 4 focuses on inclusive and equitable quality education (United Nations, 2023). During the placement, interactions with learners and teachers highlighted how health and developmental factors can influence educational participation. When children experience barriers to participation in learning environments, this can affect not only their academic progress but also their future opportunities.  

Wagman et al. (2020) highlight that occupational therapy has an important role in making sustainability visible through everyday practice. Similarly, Pollard et al. (2020) emphasise that occupational therapists contribute to sustainable development by addressing environmental, social and occupational factors that influence participation and well-being. 

As these experiences come together, a central thread emerges: the importance of occupational justice. Within Mariannridge and similar contexts, it is seen that opportunities for participation are not always distributed equally. Socioeconomic circumstances, access to services and environmental barriers among other factors, can limit people’s occupational engagment in meaningful tasks. Recognising these challenges reinforces a key role of occupational therapists as  advocates for participation and inclusion. Addressing barriers to occupation may involve working with individuals, families, schools and communities to support environments that enable participation rather than restrict it.  

Reflecting on the Mariannridge placement reveals how different experiences, observations and insights gradually connect to form a broader understanding of community-based occupational therapy. 

As occupational therapists, we are uniquely positioned to recognise how everyday occupations are influenced by the social environments, and  access to resources. By supporting addressing the barriers to occupation which enables meaningful participation, we can contribute to the broader goals related to health, education and equality.  The lessons from Mariannridge, therefore, extend beyond the placement itself. They represent part of an ongoing process of learning and professional development. 

Another important reflection that emerged during this placement relates to the realities of community-based occupational therapy practice. Community OT is unique in many ways and often differs significantly from hospital-based settings. Rather than focusing on a single client or ward environment, community practice requires therapists to engage with multiple projects, settings, and populations simultaneously. At times, it can feel as though one needs to function ''like an octopus", with many hands involved in different initiatives, community engagements, and responsibilities. 

Reflecting honestly on this experience on a personal level, one of the most valuable lessons has been recognising the importance of self-compassion within the learning process. While it is possible to describe the theoretical concepts and professional insights gained during the placement, the deeper learning has been understanding that growth in practice takes time. It takes discomfort. In environments that are complex and constantly constantly evolving, progress often matters more than perfection. Allowing ourselves the space to learn, reflect, and improve gradually is an important part of becoming a practitioner who is confident and can pass on those words of wisdom to the next generation of OT's.  

Community service is another mountain that will undoubtedly bring new challenges, but I hope to take the experiences from this block to guide how I approach it. Going forward, I hope to take the insights and feedback I have gained from the community into the next chapters of this career. To use collaboration, awareness of broader systems that shape occupational participation to provide therapy that is meaningful to the populations I will serve.  

References  

Pollard, N., Galvaan, R., Hudson, M., Kåhlin, I., Ikiugu, M., Roschnik, S., & Whittaker, B. (2020). Sustainability in occupational therapy practice, education and scholarship. World Federation of Occupational Therapists Bulletin, 76(1), 2–3.  

Reitz, S. M., Scaffa, M. E., & Dorsey, J. (2020). Occupational Therapy in the Promotion of Health and Well-Being. American Journal of Occupational Therapy, 74(3). 

United Nations. (2023). Sustainable development goals. https://sdgs.un.org/goals  

Recently, I have observed a recurring theme in my reflections: there is a consistent gap between the theoretical knowledge and its practical application within the community. There always seems to be that space between understanding the concept and truly grasping it’s weight in reality.  

This reflection is no exception. When I was first introduced to the Sustainable Development Goals (SDGs) in class, they appeared to be another set of policies and frameworks. Although I understood each goal and could explain them academically, they held little weight in my lived experience during practice.  

My experiences in Mariannridge are beginning to bridge this gap. Seeing how the presence of the primary health care clinic in the area provides important access to basic health services and support, as well as interacting with Grade 12 learners and hearing how transport costs, financial pressures, and limited exposure to opportunities shape their career decisions, has helped me understand how these broader issues influence everyday participation in the community. Theoretical frameworks are now directly connected to the lived experiences of individuals in the community. 

The SDGs are no longer something the World Health Organization just “put out there.” They can be seen in the occupations, disruptions, and goals of a community. 

So, what are some of the SDG’s that I, as a student OT, can work towards in my placement?  

The aim of SDG 3 is to ensure healthy lives and promote well-being for all (United Nations, 2023). In many communities, including those in South Africa, the imbalance in access to health services and preventative care persist, affecting overall well-being and participation in daily life (Mishra et al., 2024). In the South African context, as we've discussed in the previous blog, this also involves addressing maternal health, child mortality, and service accessibility.  

Joining this SDG with a Primary Health Care lens, this is where our role shifts from only intervening when the dysfunction appears, to promoting well-being and preventing dysfunction through early intervention. Some of the things we already doing such as facilitating developmental screenings at the clinic, health education, and asking about maternal mental health, becomes a way of strengthening long-term occupational participation. This aligns with growing recognition that occupational therapy has a meaningful role to play in advancing health and sustainability within communities (Pollard et al., 2020). 

SDG 4 focuses on inclusive and equitable quality education. Education is not only about access to schools but also about the ability of individuals to participate meaningfully in learning opportunities that support future occupations (WHO, 2023). 

Our career guidance session with matric learners is probably just the starting point. While it is not necessarily our role as occupational therapists to deliver the Life Orientation curriculum or guide learners through university applications, moving forward, we can maybe view this space through an occupational competence lens. 

As OT students, we could focus on the skills that sit behind academic success — planning, organization, confidence, decision-making, and adaptability. These are essential skills that enable learners to transition successfully into tertiary education or the workplace. By facilitating discussions, reflection, and skill-building activities with the learners, we could support their ability to manage the demands of new occupational roles as students, employees, or young adults entering the working world. 

SDG 8 advocates for decent work and inclusive economic growth (WHO, 2023). Engagement in meaningful work is closely linked to health, dignity, and social inclusion, making it a significant focus in occupational therapy practice (Pollard et al., 2020). In Mariannridge, there is a substantial gap between completing school and obtaining employment, a gap that is even more pronounced for youth and individuals with disabilities. 

While we are not currently running employment-focused groups, largely because similar projects have been implemented in the past, it does not mean that the goal of supporting work participation has been set aside completely. 

Instead, this goal can still be addressed on a more individual level. Through one-on-one interactions with clients, we are able to explore personal barriers to employment, develop work-related skills, and support individuals in building confidence and readiness for future occupational roles. 

Thus, SDG 8 is not limited to large-scale programs or structured initiatives. It can also be advanced through routine therapeutic interactions that empower individuals to pursue meaningful and sustainable employment. 

SDG 10 calls for reduced inequalities and greater inclusion. Within communities like Mariannridge, inequality is not only visible in income levels or access to services, but also in who is able to participate fully in everyday occupations. 

For individuals with disabilities, these barriers include limited transportation, inaccessible environments, stigma, and reduced educational or employment opportunities which can restrict participation in meaningful activities. Something as simple as inaccessible spaces, negative perceptions about disability, or limited opportunities can prevent individuals from engaging fully in their communities. As occupational therapy students, this reminds us that inclusion is not only about providing services, but about recognising people’s abilities, advocating for accessible environments, and creating opportunities for meaningful participation. 

SDG 17 highlights the importance of partnerships in achieving sustainable development (WHO, 2023). As a student,there is only so much I can do alone. In order to make sustainable changes,  it needs collaboration with the local schools, clinics, community leaders, and organizations. 

Effective partnership requires humility, attentive listening, and the recognition that communities possess inherent knowledge and resilience rather than being passive recipients of development. 

Using this perspective is beneficial as it aligns with current discussions in occupational therapy that emphasize sustainability and collaboration, to promote contextually responsive practice (McAdam & Rose, 2020). 

Ubuntu is transformed from a guiding philosophy into a practical approach. Genuine partnership is characterized by the question, “What can we build together?” 

I think that the SDGs are an important tool as they provide a language for what occupational therapy has always aimed to do: enable meaningful participation in life. They have sharpened my critical reflection and reminded me that clinical work is never separate from social structures. 

My experience in Mariannridge has demonstrated that sustainable development involves recognizing existing strengths and removing barriers to occupation, rather than imposing external solutions. 

REFERENCES:  

McAdam, J. C., & Rose, C. M. (2020). Opinion piece: People need nature to thrive – a case for inclusion of environmental sustainability in occupational therapy practice in rural South Africa. World Federation of Occupational Therapists Bulletin, 76(1), 25–31. https://doi.org/10.1080/14473828.2020.1734307 

Mishra, M., Desul, S., Santos, C.A.G. et al. A bibliometric analysis of sustainable development goals (SDGs): a review of progress, challenges, and opportunities. Environ Dev Sustain 26, 11101–11143 (2024). https://doi.org/10.1007/s10668-023-03225-w 

Pollard, N., Galvaan, R., Hudson, M., Kåhlin, I., Ikiugu, M., Roschnik, S., … Whittaker, B. (2020). Sustainability in occupational therapy practice, education and scholarship. World Federation of Occupational Therapists Bulletin, 76(1), 2–3. https://doi.org/10.1080/14473828.2020.1733756 

As a fourth-year Occupational Therapy student at UKZN, I recently began my community block placement. This placement involves being situated within a community and working in Primary Health Care settings such as schools, clinics, crèches, and conducting home visits. Unlike our previous blocks in hospitals or long-term care placements, this block places us directly within people’s everyday environments, where we engage with individuals and families in the contexts in which they live, learn, and participate. 

The focus shifts from individual, hospital-driven intervention to include health promotion and prevention. We work within people’s home and school contexts, provide more environmentally grounded interventions, conduct screenings and early identification of developmental delays in children, and collaborate closely with families, teachers, and community stakeholders. The aim is not only short-term intervention, but to contribute toward sustainable occupational therapy outcomes within the community. 

It is only in these first few weeks, out of lecture rooms and into real community spaces that I am beginning to grasp what community practice truly involves and the extent and value of our role within Primary Health Care. 

In the classroom, I thought I knew what Primary Health Care was. We learnt it theoretically, and we tried to apply it hypothetically. But if I am honest, I could not truly define PHC in its entirety, nor explain how community-based rehabilitation unfolds in real time. It is only now that the webs of knowledge are starting to connect. I hope by the end of the block, I’d be able to define and describe PHC, and our role within it, in a way that does its justice.  

This reflection is not a complaint for its own sake, but an honest account of how I feel the timing and layout of the curriculum experiences impacts readiness for practice. 

In our programme at UKZN, physical and psychiatric placements begin as early as the second year. By the fourth year, we have had multiple hospital-based exposures. In contrast, paediatrics and community placements are reserved for the final year. 

The impact of this is that our first real experience of OT in community settings – where we engage with schools, local clinics, and resource limited environments, happens near the end of our degree. At a time when we are expected to be close to ready for community service, and to function as relatively independent practitioners.  

Nyoni et al (2021) emphasizes that meaningful community engagement during training supports students integrating theoretical knowledge and real-world involvement, strengthening professional identity and preparedness. This highlights the value of early community exposure in health professional education.  

It is a well-known concern that occupational therapy students feel underprepared when graduating and go into community service. Research studying community-based health professions education (Assefa et al; 2020) also suggests that students often report feeling insufficiently prepared when community placements are brought about late in the curriculum, rather than scaffolded progressively across the years of training. This article supports the idea that early exposure to community contexts supports the gradual development of confidence and competence.  

An article from Naumann et al. (2020) reinforces that experiential and community-embedded learning promotes impactful understanding, but only when students are given sufficient exposure and reflective support. 

Using the literature to reflect on my own experience reminds me that feeling uncertain at this stage is not a personal failure, but it is a part of the process of learning within a complex community system. I acknowledge that I am only in my second week of placement and allowing myself the time to learn through the experience. However, I also feel a responsibility to work intentionally and proactively to get the most out of it and to do justice to the community I am serving. My clinical reasoning may not be fully developed yet; however, I am navigating into thinking like a community OT and beginning to apply community-based principles in ways that are real, imperfect, and continually evolving. 

At this stage, I do still feel both challenged and overwhelmed. I am learning slowly how to work with community stakeholders, families, and systems in ways that require flexibility and responsiveness. Yet I also feel the gap between what we were taught and what we are now being asked to do. 

If my understanding of PHC and community-based rehabilitation is only beginning to form now, in my final year, then it is natural for me to question how confident I will feel entering community service. The literature consistently suggests that preparedness for complex practice environments develops through extended, scaffolded engagement rather than isolated exposure (Assefa et al; 2020). 

This leads me to think solution-focused rather than purely critical. What if community engagement were intentionally threaded across all four years. What if, from second year onward, structured community exposure was embedded within placements. Early observation, gradual responsibility, and scaffolded community projects could allow students to build confidence and contextual understanding progressively, instead of encountering the full complexity of community practice only at the end of training. 

As a supervisor once said, “Don’t just complain, be solution-driven students.” 

Community practice should not feel like a final-year addition. In a country where Primary Health Care underpins the health system, community exposure should be foundational, progressive, and sustained.  

Starting community placement in fourth year has been eye-opening. I am beginning to understand the depth and degree behind concepts I once thought I knew. But I am also increasingly aware that timing matters. Theory alone is not enough. And late engagement, even when its meaningful, may leave students feeling underprepared just as they approach the threshold of professional practice. 

If occupational therapy is to respond effectively to South Africa’s PHC and community needs, then our training needs to provide progressive, situated, and early engagement with community life. Hopefully then future graduates feel as prepared as we hope to be for the work that makes an impact.  

REFERENCES:  

Naumann, F., Mullins, R., Holland, J., McWilliam, A., Best, T., & Raymond, J. (2020). Clinic-as-Classroom Program: Preparing Students for the Transition to Clinical Placements. Journal of Clinical Exercise Physiology, 9(4), 142–147. https://doi.org/10.31189/2165-7629-9.4.142 

Nyoni, C.N., Dyk, L.HV. & Botma, Y. Clinical placement models for undergraduate health professions students: a scoping review. BMC Med Educ 21, 598 (2021). https://doi.org/10.1186/s12909-021-03023-w