#proactive ot

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.