Does the curriculum at UKZN sharpen my skills in community practice at the PHC Level?
Occupational therapy in South Africa is often nuanced to be community-oriented and community-driven, deeply rooted in community members’ realities and lived experiences rather than clinical walls. The training institutions strive for this vision by preparing students for primary health care practice. However, stepping into these communities feels like a transition to a different world and more like being thrown in the deep end. The uncertainty, limited resources, and different social dynamics expose the gap between the theory taught and what is required. The sense of feeling overwhelmed is unusual but very telling. Therefore, this leaves me with a critical question: are our training institutions equipping future Occupational therapists with practical skills, confidence, and the ability to adapt and navigate different realities of primary health care practice in South Africa?
A Curriculum that builds theoretical foundations:
During my first two years of training at the University of KwaZulu-Natal in occupational therapy, I was introduced to the profession as one that encourages a client-centred, holistic, and ethical practice, enabling occupational participation in meaningful occupations. The primary focus on building the foundation of practice lay on anatomy, psychology, an introduction to occupational theory and a clear emphasis on community relevance through community studies, where the early exposure to community practice commenced (University of KwaZulu-Natal, n.d).
A year later, we were introduced to models such as PEO-P, which made perfect sense in theory, highlighting the encouragement of occupational justice by practically eliminating environmental limitations that inhibit occupational participation in the clients, which therefore emphasised that health cannot be separated from context. However, having a sense of these theories intellectually does not translate into the actual practice in the community.
Another encounter was in in my third year at Kenville community,I remember being present in an environment where my role involved the management of an intervention exercise amidst constraints like scarcity of resources, lack of supervision, and clients whose needs were more complex than anything else described in case studies in the past. At that time, theory seemed far-fetched. Knowledge wasn't enough, but at the same time, I had to manage issues like poverty, language problems, cultural issues, and structural inequalities.
This realization aligns with the broader debate in health profession education, where it is believed that knowledge alone is inadequate without developing context and adaptation skills (Naidoo et al., 2020). Although the curriculum offered me a way to think about an occupation, it did not always offer me the tools to deal with unforeseen situations.
Exposure to clinical fieldwork:
One of the strongest parts of the UKZN OT curriculum, from my perspective, is its focus on fieldwork and clinical exposure. Students must complete at least 1000 hours of practical experience before graduation (UKZN, n.d.). These placements include hospitals, schools, community centers, and rehabilitation settings. This variety allows students to connect with different populations (UKZN, n.d.). In my experience, this exposure was invaluable. It helped me to develop clinical reasoning, work with real clients and understand the social factors that affect health firsthand. However, I also noticed a key limitation, such as that being in a setting does not guarantee preparedness for it. There were moments when I felt like an observer instead of an active practitioner. The supervision varied, and in some places, I had to rely on trial and error, which is sometimes time-consuming in community practice.
Community practice and exposure:
The UKZN curriculum puts a strong focus on community engagement and primary health care principles, which match South Africa’s health care priorities. Students are often introduced to community studies early on and get involved in outreach initiatives and projects aimed at promoting health and well-being (UKZN, n.d.). At first, these experiences felt rewarding. Through working with communities, leading group sessions, and addressing real needs, gave me a sense of purpose. However, as time went on, I started to question the sustainability and depth of these efforts. Many of our projects were short-term and led by students. While they tackled immediate needs, I often thought: What happens when we leave? Are we making lasting change or just temporary fixes? This raises a broader issue in community-based education, where interventions might unintentionally become sporadic instead of sustainable, reducing long-term impact (World Health Organization, 2021).
Personally, this created a conflict for me. I appreciated the exposure, but I also felt responsible for making sure my work mattered beyond my placement period. This drove me to think more critically about ongoing care and community ownership, rather than just fulfilling academic requirements.
Cultural exposure and responsiveness:
An important part of the curriculum includes isiZulu language modules and exposing students to diverse communities. This aims to improve cultural competence (UKZN, n.d.) as the communities we attend to are usually Zulu dominated. While this was helpful, I quickly realized that being culturally responsive goes far beyond knowing a language. During one of my placements, I worked with clients whose lives were affected by unemployment, substance use, and complicated family situations. I found myself uncertain. It wasn’t due to a lack of knowledge, but rather a lack of confidence in handling these realities respectfully and effectively.
Cultural humility requires ongoing reflection, not just theoretical understanding (Hammell, 2020). It means recognizing power dynamics, questioning assumptions, and adjusting interventions to fit the lived experiences of clients. I didn’t fully grasp this in lectures; it developed through discomfort, reflection, and engagement. Over time, I learned to listen more, impose less, and collaborate more meaningfully with clients.
Primary Health Care practice:
The most important difference I felt was between the training I had had and the real world of PHC practice. In PHC, I found that limited equipment, high caseloads, time constraints, and minimal interdisciplinary support are the conditions that need innovation and adaptability but were not necessarily taught in an explicit way. For example, when standardized equipment is not available, materials at hand must be used instead. Instead of following structured intervention plans, one has to prioritize based on urgency and feasibility. This aligns with literature that suggests problem-solving, adaptability, and resourcefulness are necessary for PHC practitioners beyond traditional clinical skills (Pillay & Kathard, 2022). At first, this was overwhelming. I felt underprepared and unsure. But eventually, I started to gain some confidence and not because I had every answer, but because I could learn how to think on my feet and adjust.
In conclusion, though the UKZN OT curriculum does provide a strong foundation in theory, clinical exposure, and social relevance, my experiences have shown a continued gap between preparation and what happens on the ground in PHC practice. Bridging this gap will require more emphasis on resource-constrained simulations during training, greater student autonomy under supervision, stronger supervision frameworks, and sustainable community engagement. Ultimately, preparing occupational therapists practicing within South Africa requires much more than knowledge—it requires critically engaged practitioners who can navigate complex realities with resilience. I have realized that true preparation is not an endpoint but rather a continuous effort that extends far beyond the classroom into real-world practice.
REFERENCES
Hammell, K. W. (2020). Engagement in living: Critical perspectives on occupation, rights, and wellbeing. Canadian Journal of Occupational Therapy, 87(2), 91–101.
Kolb, D. A. (2020). Experiential learning: Experience as the source of learning and development (2nd ed.). Pearson.
Naidoo, D., van Wyk, J., & Joubert, R. (2020). Contextual responsiveness in health professions education in South Africa. African Journal of Health Professions Education, 12(3), 134–138.
Pillay, M., & Kathard, H. (2022). Decolonising health professions education: A South African perspective. Advances in Health Sciences Education, 27(2), 377–390.
University of KwaZulu-Natal. (n.d.-a). Bachelor of Occupational Therapy programme.
University of KwaZulu-Natal. (n.d.-b). Hands-on opportunities in occupational therapy.
World Health Organization. (2021). Community-based health care, including outreach and campaigns, in the context of the COVID-19 pandemic. WHO.
