The first thing community practice taught me was that plans rarely survive the real world. There were days when we arrived with carefully prepared activities, only to find that the situation had completely changed. Sometimes resources were not available, sometimes schedules shifted, and sometimes we entered spaces where we had little information about what to expect. At first, this uncertainty felt uncomfortable. I am someone who likes structure and preparation, and when things do not go according to plan, I tend to feel anxious. However, community practice slowly taught me something important: occupational therapy is not about perfectly executed plans. It is about responding to real people, in real environments, in real moments.

This realisation began to develop through a variety of experiences during our community block. We worked in Early Childhood Development (ECD) centres, conducted school screenings, facilitated an anti-bullying campaign in a primary school, visited clinics and homes, participated in career guidance sessions, and implemented the Healthy Workers Programme at the KwaZulu-Natal Blind and Deaf Society. Each of these experiences contributed to a deeper understanding of occupational therapy beyond the traditional clinical setting. Working in ECD centres was one of the first experiences that challenged my thinking. Observing children playing, interacting, and participating in classroom activities reminded me that occupation begins early in life. Play, learning and social interaction are not simply activities that children engage in; they are meaningful occupations that contribute to development, identity formation and social participation. While some children participated easily in classroom routines, others struggled with attention, coordination or social engagement. These observations highlighted the importance of early identification and support to promote children’s participation in educational activities.

Similarly, school screenings emphasised the preventative role of occupational therapy. Instead of waiting for difficulties to become severe, screening allows occupational therapists to identify potential participation challenges early and provide appropriate support. Conducting these screenings also highlighted that participation in education is influenced not only by the child but also by the environment in which learning takes place. Classroom structure, teaching methods, and available resources all play a role in enabling or limiting participation. Our anti-bullying campaign in a primary school was another experience that stood out for me. Bullying can significantly impact a learner’s emotional well-being, self-confidence and sense of belonging. When a learner feels unsafe or excluded at school, their ability to participate in learning and social activities becomes limited. Addressing bullying therefore goes beyond simply discussing behaviour; it is about creating environments that promote dignity, safety, and inclusion. This aligns with the concept of occupational justice, which emphasizes the importance of enabling individuals to participate in meaningful occupations without barriers (Townsend & Wilcock, 2004).

The clinic visits and home visits were particularly eye-opening. In hospital or clinic settings, therapists often see only a small part of a person’s life. However, visiting clients in their homes provided a much deeper understanding of their daily realities. Seeing the physical environment, available resources, and family dynamics helped me understand how an occupation is shaped by context. Listening not only to clients but also to family members allowed me to see how support systems influence participation in everyday activities.

One experience that was especially challenging for me was visiting the KwaZulu-Natal Blind and Deaf Society. In many community placements, there is usually a clear handover process, where information about the setting is provided beforehand. This preparation allows OT students to understand the context and plan interventions accordingly. However, during this visit we entered the environment with very little prior information. Initially, this made me feel unprepared and uncertain. I realised how much I rely on preparation before entering a new space. Yet this experience became one of the most valuable lessons of the placement. Community work does not always follow predictable procedures or structured protocols. Sometimes, we as OT students must enter unfamiliar spaces and adapt to the needs of the situation as they arise. In that moment, I realised that flexibility and adaptability are essential professional skills in community practice.

From a conceptual perspective, these experiences reinforced the understanding that occupational participation is influenced by the interaction between the person, the environment, and the occupations they engage in. The Person–Environment–Occupation–Performance (PEOP) model highlights how these elements interact to shape occupational performance and participation (Christiansen & Baum, 2015). Observing individuals within their natural environments allowed me to see this interaction in practice. It became clear that participation cannot be understood by focusing on the individual alone; the environment and available opportunities and resources within the environment must also be considered.

From a philosophical perspective, this placement deepened my understanding of what occupation truly means in people’s lives. Occupation is not simply about completing tasks or activities; it is about how people structure their lives, express their identities and experience meaning through everyday activities. Observing children playing in ECD centres, workers engaging in their daily routines, and families supporting one another during home visits reminded me that occupation is deeply connected to health and well-being. From an occupational perspective, health is not only the absence of illness but also the ability of individuals to participate in meaningful occupations that give structure and purpose to daily life (Hunter, 2000, p.1).

From an axiological perspective, this experience reinforced the values that underpin occupational therapy practice. Working within communities requires humility, respect, and a genuine willingness to listen. Communities are not empty spaces waiting for professionals to provide solutions; they are environments that already contain knowledge, strengths, and resources. Recognising these strengths is essential in promoting participation and supporting sustainable community development (Mthembu, 2021).

Working within South African communities also highlighted how social and economic inequalities influence occupational participation. Many communities face barriers such as limited resources, overcrowded schools, and restricted access to healthcare services. These realities reminded me that occupational therapists must be aware of the broader social determinants that influence health and participation (World Health Organization, 2010). Promoting occupational participation in such contexts therefore requires advocacy, collaboration, and a commitment to addressing barriers that limit occupational justice.

As I prepare to transition into community service, this placement has significantly influenced how I will approach future practice. One of the most important lessons I take with me is that clients do not remain in hospitals or clinics. After therapy sessions, they return to their homes, families, schools, workplaces, and communities. These environments ultimately determine whether therapeutic interventions translate into meaningful participation in everyday life.

Because of this understanding, when I work with patients in clinical settings in the future, I will not focus only on the diagnosis or impairment. Instead, I will also consider the environments they are returning to, the resources available within their communities, and the support systems that influence their participation. In this way, community thinking becomes an essential part of occupational therapy practice regardless of the setting. Ultimately, this community block reminded me that occupational therapy does not truly exist within the walls of hospitals or clinics.

It exists in homes where families support one another. In classrooms where children learn and grow. In workplaces where individuals strive for independence. And in communities where people search for belonging and purpose. If occupational therapy is truly about enabling participation in meaningful occupations, then perhaps the real question we must ask ourselves is this: How can we truly support our clients if we do not understand the communities they return to?

References

Agner, J. (2020). Moving from cultural competence to cultural humility in occupational therapy: A paradigm shift. The American Journal of Occupational Therapy, 74(4), 7404347010p1–7404347010p7. DOI: 10.5014/ajot.2020.038067

Baum, C. M., Christiansen, C. H., & Bass, J. D. (2015). The Person-Environment-Occupation-Performance (PEOP) model. In C. H. Christiansen, C. M. Baum, & J. D. Bass (Eds.), Occupational therapy: Performance, participation, and well-being (4th ed., pp. 49–56). Slack Incorporated

Hunter, N. (2000). An occupational perspective of health. Physiotherapy, 86(5), 278. https://doi.org/10.1016/S0031-9406(05)60926-1

Mthembu, T. G. (2021). A commentary of occupational justice and occupation-based community development frameworks for social transformation: The Marikana event. South African Journal of Occupational Therapy, 51(1), 72–75. DOI: 10.17159/2310-3833/2021a10

Townsend, E., & Wilcock, A. (2004). Occupational justice and client-centred practice. Canadian Journal of Occupational Therapy, 71(2), 75–87. DOI:  10.1177/000841740407100203

There is a particular kind of discomfort that comes with realising that the rules you relied on no longer apply. The moment when there is no checklist, no clear protocol, and no one standing close enough to confirm whether what you are doing is “right.” For a long time, I thought learning was supposed to feel safe, structured, supervised, and predictable. I thought competence came from being shown, corrected, and approved. Then I was placed in the community. Suddenly, learning did not arrive neatly packaged. Questions were not answered immediately. Expectations were not always explicit. Instead, I was expected to notice, to listen, to question, and most unsettling of all, to decide. I had to act without certainty, reflect without reassurance, and learn without being taught in the traditional sense. At times, this felt unfair. At other times, it felt overwhelming.

At the start of my academic training, I believed that competent occupational therapists were built through structure: hospitals, clear protocols, close supervision and defined roles. Community practice felt distant, spoken about in lectures but not fully lived. Yet as the curriculum unfolded, my thinking began to shift. The curriculum does not always provide certainty or comfort; instead, it placed me in situations where I had to think independently, act proactively, and sit with not knowing.

My first introduction to community practice came in my third year, during which we were introduced to PHC concepts, community engagement, and health promotion in short, structured sessions. While valuable, this exposure was limited to once-a-week site visits, positioning us as observers rather than participants in systems shaped by structural inequality and resource constraint. It was enough to spark interest but not to develop confidence in applying occupational therapy in real-world settings. In the fourth year, the curriculum is built on this foundation, immersing us in more extended community placements. We were expected to engage directly with community members, conduct audits, plan interventions, and apply theory in complex and unpredictable environments. This progression from third-year theory to fourth-year practice highlighted both the strengths of the curriculum in providing foundational knowledge and its limitations in allowing earlier more sustained hands-on engagement.

The UKZN curriculum demonstrates a clear commitment to community-oriented practice through its strong theoretical grounding. During the community lecture week, we were introduced to essential principles, including advocacy, health promotion, prevention, empowerment, and community development. Frameworks such as the PESTLE analysis, Asset-Based Community Development (ABCD), project planning models, the CBR matrix, and the use of community artefacts provided a structured way to understand communities as complex systems rather than passive recipients of care. This theoretical emphasis aligns strongly with PHC principles promoted by the World Health Organization, which emphasises prevention, participation, equity, and community ownership of health (WHO, 2008). This orientation reflects international occupational therapy guidance that positions community-based practice, participation, and social inclusion as central to ethical and relevant occupational therapy (WFOT, 2019).

South African health policy frameworks, including the Disability and Rehabilitation Services Strategy (Department of Health, 2016) and the National Health Insurance White Paper (NDoH, 2018), further reinforce the need for community engagement and rehabilitation integrated into PHC, while simultaneously exposing the gap between policy intent and lived service realities. The ABCD approach, in particular, challenged my instinct to search for deficits first and instead required me to recognise existing strengths and capacities within communities (Mathie & Cunningham, 2017). This shift was not simply academic; it reshaped how I perceived people, places, and participation. Translating theory into practice revealed challenges. Conducting community audits highlighted how difficult it is to define one’s professional role without explicit boundaries or protocols, except for ethics.

The UKZN curriculum deliberately places responsibility on the student to be proactive. We are expected to identify needs, seek out information, justify our reasoning, and adapt interventions independently. This aligns with calls to reform health professional education to produce graduates who are adaptable, reflective and responsive to complex systems (Frenk et al., 2010).  Another notable strength of the curriculum is its exposure to non-traditional practice contexts. Placements involving Deaf and Blind communities, which were not explicitly covered in lectures. Initially, this felt unfair. How could we be assessed on content we were never formally taught? Yet this discomfort became transformative. It revealed a critical truth: real‑life occupational therapy will always extend beyond what is covered in textbooks. Not every context, condition, or population can be neatly packaged into modules. By requiring students to research independently and adapt practice accordingly, the curriculum fosters professional accountability and lifelong learning.

Yet it is within this discomfort that growth occurs. Being required to conduct community audits, define our professional roles, and work in unfamiliar contexts has shifted my understanding of occupational therapy. I no longer see practice as something that begins and ends in institutions. Clients live in environments shaped by social, economic, and environmental realities. I now understand that if therapy does not translate into the environments where people actually live, then its impact remains incomplete.

The UKZN curriculum has not provided me with all the answers, but it has taught me how to ask better questions, how to stand critically within systems, and how to learn beyond what is prescribed. This reflection leaves me wondering whether the true measure of an effective OT curriculum is not how well it prepares students to follow existing practice models, but how boldly it prepares them to challenge, adapt and reshape practice in response to community realities. Readiness for community practice is not about knowing enough, but about being able to act ethically, reflect honestly, and adapt responsibly when certainty disappears.  If occupational therapy is truly committed to participation, justice and relevance, then perhaps discomfort is not a weakness of the curriculum but one of its most powerful teaching tools.

Reference:

Department of Health (South Africa). (2016). Framework and strategy for disability and rehabilitation services in South Africa, 2015–2020. Pretoria: National Department of Health.

Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., Fineberg, H., Garcia, P., Ke, Y., Kelley, P., Kistnasamy, B., Meleis, A., Naylor, D., Pablos-Mendez, A., Reddy, S., Scrimshaw, S., Sepulveda, J., Serwadda, D., & Zurayk, H. (2010). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. The Lancet, 376(9756), 1923–1958. https://doi.org/10.1016/S0140-6736(10)61854-5

Mathie, A., & Cunningham, G. (2017). From clients to citizens: Asset-based community development as a strategy for community-driven development. Development in Practice, 27(6), 839–851.

National Department of Health (South Africa). (2018). National Health Insurance for South Africa: Towards universal health coverage. Pretoria: NDoH.

The experience of transmission in MMQG unfolds beyond the limitations of verbal instruction, beyond the constraints of conventional curricula and the linear logic of time imposed by dominant educational and professional structures. When one steps into a space defined by meditation, mindfulness, and Qi Gong, the body itself becomes the primary medium through which knowledge, attention, and…

"Not everything that is faced can be changed, but nothing can be changed until it is faced." — James Baldwin. These words resonate deeply as I open my community module in the final year, giving me a glimpse into my future career. Going to a community in any particular area different from the one you grew up in will always be a culture shock. As a health practitioner, openness and understanding are crucial to exploring what and who makes the community. Are we as future practitioners equipped to meet community and primary healthcare challenges effectively? Let's discuss.

The OT curriculum is structured so that foundational knowledge, practical skills, and specialized areas are all met over 8 semesters. This allows for a broad knowledge base with a crucial understanding of human development, behaviour and physical function. This foundational knowledge is structured to assure effective assessment and intervention which prepares a wide range of needs within community practice (UKZN School of Health Sciences, 2023).

The Community Studies module in the first year was meant to give students a basic understanding of community practice. However, it was not a major focus in the middle years and only came back into focus in the final year. This raises two questions: Was this done so that practical fieldwork could provide real community experience, or was it to allow all the earlier learning to come together in the final Community Theory and Fieldwork 4 module? This approach has had both positive and negative effects. On the positive side, waiting until the final year has helped integrate earlier learning with practical experience, leading to a deeper understanding of community practice. On the negative side, the long gap between the first-year and the final-year module has made it harder to connect what was learned earlier with practical experiences. This delay has affected the ability to effectively apply knowledge in community settings (Wilson & McCabe, 2020).

The re-engineering of Primary Health Care (PHC) in South Africa offers a practical example of how community health practices are evolving. The Green Paper on National Health Insurance (NHI) outlines a re-engineered PHC platform with four key components: Municipal Ward-based Primary Health Care Outreach Teams (WBPHCOTs), the Integrated School Health Programme, District Clinical Specialist Teams, and contracting private practitioners (South African Government, 2023). WBPHCOTs are particularly relevant, as they are designed to assess health status, provide health education, and facilitate referrals to appropriate facilities. This referral system ensures that patients receive comprehensive care across different levels of the health system.

It's no secret that the broader community often doesn't receive the attention it deserves from today's occupational therapists. Many prefer the familiarity of hospital settings, where their unique skills are sometimes underutilized, or they find themselves invading the roles typically filled by physiotherapists. But community? Community is where the skills of an occupational therapist are truly put to the test. During my practical experiences in hospitals around Durban, I've observed how occupational therapists often struggle to maintain departments, be occupation-based, and miss opportunities to engage with surrounding communities through home visits. And when in those types of hospitals whether being there for physical or psychosocial block, anything community practice-based has not been given attention, this has made a significant impact and overwhelm now being placed in a community in the final year.

One might think that the required 1000 hours of practical work should be enough to prepare students to become competent practitioners. I believe this is generally true. The 1000 hours, which include electives, typically provide sufficient experience. In practice, we often accumulate more than the required hours due to the structure of the fieldwork. This extended exposure not only provides a safety net in case some hours are missed but also provides extensive experience in hospitals, rehabilitation centres, and other settings where occupational therapists work. By the fourth year, students would have interacted with a diverse range of people from different communities and backgrounds. This broad exposure helps prepare for community practice by familiarizing with various social contexts and client needs.

According to a study done by Deshni Naidoo, the UKZN Occupational Therapy curriculum has both strengths and challenges. Participants noted insufficient exposure to preventive therapy and various age groups and felt unprepared for hospital politics and inter-professional teamwork which is important in community practice. They also desired more focus on government procedures and administrative duties. However, the program was praised for providing strong theoretical knowledge and clinical skills, effective service-learning experiences, and a solid orientation to ethical practice and research skills, which positively impacted their work in both hospital and community settings (Occupational therapy graduates' reflections on their ability to cope with primary healthcare and rural practice during community service, 2017)

While the curriculum includes an intense community module in the final year of study, this timing has its cons. Community healthcare practices are rapidly evolving due to technological advances, urbanization, and globalization. Migration and globalization have led to more multicultural communities like the one in Kenville, creating both opportunities and challenges for integration and cohesion (Brown & Harris, 2019). Economic shifts and diverse community engagements add further complexity. Modern challenges, such as digital divides and social isolation, present new opportunities for engagement and collaboration (Smith, 2022). Placing the community module at the end of the curriculum allows for tackling these current issues and application of knowledge to contemporary community practice, making the timing of this module more relevant. Looking at the application of Assets Based Community Development, which is taught in the community module, the curriculum being structured like this may allow to apply these principles to current and relevant community contexts, reflecting the latest trends and challenges faced by communities. "Opportunity is missed by most people because it is dressed in overalls and looks like work." — Thomas Edison. This quote emphasizes that early opportunities, which might require effort and preparation, are often overlooked. It underlines the importance of recognizing and seizing opportunities before they’re fully realized. Something the OT curriculum may benefit from.

As we venture into the world of community and primary healthcare, the journey isn’t just about clocking hours or ticking off modules. It’s about diving into the vibrant diversity of communities, embracing the chaos and charm of new environments, and using our skills to make a real difference. After all, the real adventure begins where theory meets practice, and that’s where we’ll discover the true impact of our work. Ready to jump in? The community awaits!

References

Smith, J. (2022). Understanding Community Evolution. City Press.

KZN School of Health Sciences. (2023). Bachelor of Occupational Therapy Curriculum Overview. Retrieved from [UKZN website link].

Brown, J., & Harris, J. (2019). Community Health and Development: Current Trends and Challenges. Health Press.

Wilson, L., & McCabe, A. (2020). Connecting Theory and Practice in Occupational Therapy: Insights from the Field. Occupational Therapy Review, 32(2), 157-168

Evaluating UKZN’s OT Curriculum: Bridging the Gap Between Theory and Community Practice.

The journey  of being an occupational therapy student at UKZN has been a blend of theoretical knowledge and practical experiences, all aimed at shaping  us as student to be competent occupational therapists. However, as I currently find myself in the community  block  at Mariann ridge and Thornwood, the reality of our curriculum’s effectiveness comes into sharp focus. Was I truly  prepared for the challenges of community and primary healthcare (PHC) practice? In this  blog  I will dive deeper and examine the UKZN OT curriculum, arguing that while it lays a solid theoretical foundation, it falls short  of preparing students for real-world community engagement  up until they reach fourth year, We will look at pros and cons of the curriculumn.

Upon reflecting on my own experience in the UKZN OT program,  I have identified both strengths and limitations that have impacted my preparation for practice. On one hand, the curriculum has provided a solid foundation in occupational therapy principles and theories, for instance, courses such as Anatomy and Introduction to Psychology offered in the first year gave us a deep understanding of the human body and mind. This foundational knowledge is important for any healthcare professional, as it improves  our understanding of how physical and mental health interact and impact daily functioning (UKZN, 2021).Furthermore, the OT Fundamentals modules   went deeper  into core occupational therapy concepts,  such as the Person-Environment-Occupation (PEO) model, which is frequently used in practice. This model helps us understand how various factors influence a person's ability to perform and engage in meaningful activities. Learning about such models has been in shaping my  approach to assessment and intervention (Smith & Jones, 2022).  The OT module has been helpful in actually  teaching about assistive devices in first year, especially about different devices for different conditions.

Additionally, the course  module such as  Psychosocial Theory and Fieldwork and OT Therapeutic Media. These modules  have been particularly beneficial in providing insights into different areas of OT practice, such as mental health and the use of therapeutic activities to support client goals. For example, through these modules, we have learned how to  assess and do  interventions that address both the psychological and social aspects of a client's well-being, which is essential for holistic and client centeredness (Brown et al., 2021) especially when you are looking at the client who has MVA and CVA. furthermore, opportunities for practical application through fieldwork placements,  has allowed me to "apply theoretical knowledge in real-world contexts."

However, one would encounter areas where the curriculum "falls short," leaving me feeling "underprepared for the complexities of community rehab at the PHC level” the overwhelming emphasis on theoretical learning, especially in the first year, can be a double-edged sword. During the pandemic, the shift to online learning forced us to cram amounts of information, particularly in anatomy, to pass exams. This made us student to have little knowledge and  understanding rather than deep, meaningful learning. Practical application of this knowledge in  community practice, was severely lacking.  For instance , In the community studies module we  missed an opportunity to go into the community and see the lived experiences of the clients  ,  we were not exposed to this part of our field.  

The absence of hands-on experiences, especially in community settings, left us unprepared for the realities of fieldwork. During the past three years, our practical training was primarily hospital-based. However, this year we were given the opportunity to work within communities at the primary healthcare level. It was our first experience working in a peri urban areas and I discovered just how limited the occupational choices and activities are for people living there. This situation is even more challenging for individuals with disabilities. In our final year of studies, we’ve increased  our focus beyond the medical model to include the  betterment of people through activities and occupations.

Occupational therapy education should prepare students to work in a variety of settings, including community and PHC settings." (Doe, 2023). Throughout our training in the UKZN OT program, a big  gaps exist in key areas, especially in paediatric occupational therapy and hand therapy. Despite the importance of paediatric practice, we received minimal exposure in our second and third years, with an overwhelming influx  of content only in our final year. This sudden concentration of paediatric information makes it challenging to grasp and apply effectively, highlighting the need for earlier and more consistent integration of paediatric training especially in third year .

Similarly, our hand therapy training is  limited, with only brief exposures to splinting in the third and fourth year . This limited  hands-on experience leaves many of us  feeling unprepared and lacking confidence by the fourth year. While our lectures  are dedicated, these gaps in the curriculum suggest a need for restructuring to provide continuous and  effective training in both paediatric and hand therapy throughout the program, ensuring students are adequately prepared for real-world practice.

In addition to the gaps ,our third-year practical experiences also lacked depth. During this period, we were  visiting homes rather than going to the  actual communities. This  failed to provide a deeper  understanding of the community's struggles. Currently, in Marian ridge and Thornwood, I encounter children with visual perceptual and sensory problems, issues that are deeply rooted in their living environments and adults who live in unfavourable conditions . Seeing these challenges firsthand during our earlier years of study would have been invaluable.

Real-world community exposure from the start would have better prepared us for developing effective, contextually relevant interventions.Engagement with different stakeholders  in the community is a critical component of our training. It taught me  the importance of collaboration and interprofessional relationships. In Marian ridge and MCC, we interacted with di stakeholders, creating programs and conducting health talks, which is a valuable learning experience.

Doing this work has really made us aware and to think twice about recommendations we make as occupational therapists. You experience the people’s way of life, getting close to them and the context of the challenges they face.  Nombuso(OT student)  once said  “You see the person rather than just a patient and want to build them up so that they can reach their full potential and have a fair chance at various opportunities”(Dlamini, 2023) .

 In conclusion reflecting on the UKZN OT curriculum, becomes evident that while it offers a strong theoretical foundation and hospital based practical , it lacks in preparing students for community and primary healthcare (PHC) practice. Limited exposure to paediatric and hand therapy training, combined with insufficient community  practical experiences, leaves students underprepared for real-world challenges. To address these gaps, the curriculum should be restructured to include continuous training throughout the course and prioritize early, community-based experiences.

reference list

Adams, P. (2023). Practical application of health promotion strategies. Journal of Community Health, 45(3), 112-119.

Brown, T., Lee, M., & Williams, J. (2021). Interprofessional education and its impact on community health outcomes. Healthcare Education Journal, 38(2), 98-105.

Doe, J. (2023). Online learning during the COVID-19 pandemic: Impacts on student engagement and understanding. Education Research Quarterly, 29(1), 45-59.

Green, R., & Black, S. (2022). Preventive healthcare in occupational therapy. Health Promotion Journal, 34(4), 235-244.

Johnson, L. (2023). The importance of early community exposure in occupational therapy training. Community Health Review, 27(2), 78-85.

Smith, A., & Jones, B. (2022). Community-based practice in occupational therapy: A comprehensive guide. OT Practice, 39(1), 12-20.

UKZN. (2021). Bachelor of Occupational Therapy (BOCTH) curriculum. University of KwaZulu-Natal.

“Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure.” (Mandela, 1994)

I ask myself, What are the terms that measure my adequacy? How can I serve, be present, and be critical in my performance to impart change in someone else? What are the tools set to ignite life back into the voiceless, marginalized individuals when existing oppressive belief systems and structures are set to perpetuate inequalities?

Our country's diversity and rich history—looking at the beauty and darkness—tells a story of how our differences can be scars, but they are also a call for humanity. I started to recognize that the most significant change begins with me as an aspiring health professional. One of the “Ahaa moments” in my experience was realising how my own internalized beliefs engraved in me in my childhood were how I viewed marriage at a young age as something unusual and, to some degree, wrong. It originated from the cultural perception that dating young is terrible, which clouded my thoughts about the therapy and its impact on the client’s life. How it was easier to accept the grievances, ready to dismantle the broken and abusive relationship, not realizing the value it served for my client. How culture has influenced and moulded her identity solely on being a wife and a follower in society and her home.  It indicated how we as students are eager to call for cultural competence when we do not understand or agree with the social patterns and principles that have changed over time, proving to disempower women, causing stagnation, if not progression of gender inequalities.

My biggest lesson was the importance of critical analysis. You can deduce connections, patterns, gaps, realities, and scars behind the clouded story through analysis. There is a need for iterative approaches in therapy to allow for an understanding of the lived experiences and the acting influences, good or bad, in everyday life. It shows how our enriched history isn’t just a landmark representing where we came from, our identity, and the trail to destined current issues, social patterns, inherited behaviours, and cultural practices. What I mean is the impact of apartheid on health and educational disparities, looking at the social and economic consequences. We see the rising unemployment rate and poverty in the communities, which indicate the looming mental health crisis looking at depression, low self-esteem, hopelessness, and maladaptive coping behaviours that feed into crime, substance use, broken interpersonal relationships and burden of care. You start to wonder how can an overburdened healthcare system cater for the needs of the community, depicting the need for support systems within marginalized communities to deal with the trauma, the pain and the barriers within their context. To prioritize the community needs, motivating the importance of OT in community practice. Doing more from the resource deficiency inaccessibility, finding the tressure in the trenches, and making a difference.

"South Africa has the third highest suicide rate on the continent, with more men than women committing suicide."

(Mbele,2020)

The growth calls for not just seeing the injustices but being critical in reflecting on the cycles and trends we see in the community, how we hardly see males, young or old, seeking health services. It later turned out that the health promotion talk was about maternal mental health, forgetting the other drivers of the community being the men. I learned to see beyond what is presented, asking why and how to gain an understanding of how societal norms and cultural influences have given men power as patriarchs but also chained them in terms of the expectations in an environment that does not sustain or support their societal role figures of being providers and decision-makers. This feeds into gender-based violence due to the mental health issues that are swept under the rag, bottled up, hoping to disappear, only to burst open and hurt the people who had no hand in the pain caused. You start to wonder about the implication of the barriers to the health and wellness of men when they express the solution being solely on economic liberation in a country far from reaching economic transformation. What it means for OT is how we can achieve and be in base to serve as a bridge in promoting good health-seeking behaviours overcoming the crippling stigma and toxic masculinity that perpetuate health disparities. A goal is to have partners, fathers, brothers, and sons actively engaging in the community effectively and harmoniously, removing the layers of barriers hindering cohesiveness within a community and belonging.

Learning and collaborating with the community structures shifted my experience in therapy as I learnt the importance of recognizing the roles of these structures and their impact on the client’s well-being. How can a CCG change the therapy process to add value to the client’s life by ensuring progression and treatment goals? They serve as catalysts for the sustainability of treatment and alleviate the barriers and burden of care by supporting clients and health professionals.

Retrieved from: (Scott, 2022)

"As we are liberated from fear, our presence automatically liberates others." I began this block with fear of not knowing; the anxiety of reaching my fullest potential was holding me hostage from exploring the possibilities and experiences beyond the safe borders that have comforted me for the past three years. Community practice knocked with urgency to open my eyes and see the beauty beyond the layers and layers of pain, inequality, patriarchy, culture and social determinants of health. Knowing the person to understand how to assist holistically and give it my all is essential within the first session, even when I'm too scared, with an understanding that it may be the last time I see them, be impactful and therapeutic. Fear holds us back from the future we envision.

My takeaway message for this week is the importance of looking beyond the issues and seeing the beauty of the individual, which requires doing more. Doing more in therapy means understanding that before the client starts to feel a sense of belonging, they need to unbecome, stripping off the influences of culture, patriarchy, poverty, and socio-political issues and redefining their values to become. Ultimately, we strive for community collaboration, growth, cohesiveness, and health to ensure self-reliance.

OT enthusiasts, the green scrub won't be hanged as I take my final bow. Thank you for walking this journey with me. See you in my next chapter.

References

Mandela, N. (1994). 1994 Inauguration speech of Nelson Mandela. University of Houston. https://uh.edu/~hwagan/pnl/mandela.pdf

Scott, M. (2021, February 3). Overcoming Fear | University of Central Florida News. University of Central Florida News | UCF Today. https://www.ucf.edu/news/overcoming-fear/

Patterson, T.-L. (2022, March 16). Men’s mental health:no longer taboo. Health-e News. https://health-e.org.za/2022/03/16/mens-mental-health-guys-must-man-up-and-get-help/

Wilson, F. (1996). Challenges for the Post-Apartheid Economy. The American Economic Review, 86(2), 322–325. https://www.jstor.org/stable/2118145

Embracing Rhythms of Work and Rest, Ruth Haley Barton, foreword by Ronald Rolheiser. Downers Grove: InterVarsity Press/Formatio, 2022. Summary: Describes the journey to life-giving sabbath practices as well as planning for and taking sabbaticals. Ruth Haley Barton is a gifted speaker, writer, and Christian leader. And like many such people she pushed herself hard in a high-performance church…