#reflective ots

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

When I first heard about the Sustainable Development Goals (SDGs), they felt distant. They sounded like something meant for world leaders, policymakers, and global organisations, not something that would show up in my everyday work as an occupational therapy student. Seventeen goals. Ending poverty. Ensuring health and well-being. Reducing inequality. Transforming the world. They felt big. But somewhere between home visits, school screenings, and sitting on tiny plastic chairs in Early Childhood Development (ECD) centres, my perspective began to shift.

I started to realize something important: The Sustainable Development Goals are not only achieved in global conferences or policy documents, but they are also achieved in communities through small, everyday actions (United Nations, 2015; United Nations, 2023). I began to see how occupational therapy fits into this global vision from the United Nations. The screenings we conduct, the conversations with teachers, the education we provide to caregivers and teachers, and the home visits we make may seem small in isolation. But together, these actions quietly contribute to something much bigger. They contribute to the sustainable development of our communities or society (OTASA, 2015).

Good Health and Well-Being (SDG 3)

The World Health Organization (WHO) defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1946 as cited in WHO, 2010). This definition highlights that maintaining health is not only about treating illness but also about promoting well-being, preventing problems and supporting people to function in their everyday lives. During our community block, much of our work contributing to good health and well-being took place at the local clinic, where many community members access primary healthcare services. The clinic environment allowed us to engage directly with community members and address health issues through education, screening and health promotion.

One of the areas we focused on and addressed was maternal mental health. Many mothers experience emotional and psychological challenges during pregnancy or after childbirth, but these challenges are frequently not openly discussed, shared or addressed. Through health promotion activities at the clinic, we provided information about the importance of maternal mental well-being and how it can affect both the mother and the child’s development. We also engaged with caregivers about the importance of developmental screening for children. Many parents are unsure about when to seek help if they notice developmental concerns. During our health promotion sessions, we emphasized the importance of bringing children for early screening, assessment and intervention if caregivers notice difficulties with development, learning, behaviour or participation in daily activities.

These conversations aimed to increase awareness and early help seeking, which is an important part of a health preventive programme. These experiences reinforced the idea that promoting health does not always require complex interventions. Sometimes it begins with something simple, sharing knowledge, raising awareness and encouraging people to seek help early and where to seek help. Through these small actions, occupational therapy can contribute meaningfully to improving health and well-being within communities (OTASA, 2015).

Quality Education (SDG 4)

Education plays a critical role in shaping a child’s future opportunities, owever, learning does not occur in isolation. It is deeply connected to a child’s motor skills, sensory processing, cognition, emotional regulation and ability to participate in the classroom environment. During our visits to schools and ECD centres, we worked alongside teachers to identify children who might be experiencing challenges that affect their learning. We conducted developmental screenings in ECD centres and primary schools, assessing areas such as attention and concentration, early learning skills, fine motor development, visual-motor integration and participation in classroom or play activities.

What stood out to me was how many children had never been assessed before. Some teachers had noticed that certain children struggled with concentration, holding a pencil, or following classroom routines, but these concerns had never been formally explored. Through our screenings, we were able to identify children who may require further assessment and provide feedback to teachers and caregivers. Together we discussed simple strategies that could support children in the classroom, such as incorporating movement breaks or introducing activities that strengthen the hand muscles needed for writing. These moments reinforced something important: occupational therapy supports education by supporting participation. Education is not only about delivering curriculum content. It is also about ensuring that children are able to engage in the occupation of learning.

Reduced Inequalities (SDG 10)

One of the most visible realities in Mariannridge was inequality in access to healthcare and rehabilitation services. Many families face barriers that make accessing occupational therapy services extremely difficult, including financial constraints, transport challenges, work commitments and long waiting lists at hospitals. For some parents, missing a day of work to attend a hospital appointment simply is not possible. Others live far from healthcare facilities and cannot afford regular transport. As a result, many children who require support may never receive an assessment or intervention from any healthcare service.

Our school-based screenings helped bridge part of this gap. By screening children directly within the school environment (with parental consent), we were able to reach children who might otherwise never access occupational therapy services. Similarly, home visits allowed us to support individuals who could not easily leave their homes. Some community members we visited were wheelchair users, bed-bound individuals and people with severe mobility challenges. For some individuals, leaving their home was extremely difficult due to environmental barriers such as stairs, uneven pathways, or inaccessible transport. By bringing occupational therapy services into homes, schools, and community spaces we were able to meet people where they are and reduce inequalities. This experience reminded me that equitable healthcare requires outreach, flexibility and community-based services.

Sustainable Communities (SDG 11)

A sustainable community is one where individuals are able to live, move, and participate safely within their environments (UN, 2015). Through our home visits, we were able to see how the physical environment can either support or limit participation in daily tasks. Some homes had structural barriers that made mobility extremely difficult. In some cases, individuals who used wheelchairs were unable to leave their homes independently due to stairs or narrow entrances. During these visits, we worked together with caregivers and our clients to explore practical strategies such as positioning techniques, pressure care education, environmental adjustments and adaptive ways of completing daily tasks.

Often the changes we suggested were small, but their impact could be significant. A small positioning adjustment could help prevent pressure sores. A different way of completing a task could increase independence. Occupational therapy frequently focuses on adapting environments and tasks to support participation in daily life. When people are able to function safely and independently within their homes and communities, those communities become stronger and more sustainable.

Partnerships for the Goals (SDG 17)

One of the biggest lessons I learned during this experience is that community-based OT practice cannot happen in isolation. Every activity we implemented required collaboration. We worked with teachers in primary schools, ECD teachers and workers, community healthcare workers (CHWs), clinic staff, Mariannridge Coordinating Committee (MCC) and caregivers and families. These partnerships helped ensure that the activities we implemented were relevant, practical and sustainable. Rather than simply introducing activities and leaving, we aimed to ensure that community members understood why the activity was important, how it supports development and participation and how they could continue implementing it independently. Sustainability is not about doing something once. It is about building knowledge, ownership and confidence within the community so that the work continues even after we leave (UN, 2015).

Before this experience, the SDGs felt like distant global ambitions. Now they feel much closer. A screening in a classroom, a home visit, a conversation with a teacher, small adaptation to a daily activity. These moments may seem ordinary, but they contribute to something much larger. They contribute to healthier communities, more inclusive education systems and improved access to care. Occupational therapy often works at the level of individuals, families, and communities, but the impact of this work extends far beyond those immediate interactions. It contributes to a global vision of sustainable development (UN, 2023).

This experience reminded me that occupational therapy is not only about rehabilitation. It is also about advocacy, prevention, empowerment, and community development. Sometimes the work we do may feel small. But when viewed through the lens of the Sustainable Development Goals, these small actions become part of a much larger movement toward a healthier and more inclusive world. So perhaps the real question is this: When tiny, everyday interventions such as a screening, a conversation, a home visit contribute to something far bigger, how intentionally are we using our skills to leave a lasting mark on the communities we serve and the world beyond?

References

Occupational Therapy Association of South Africa. (2015). Position statement on occupational therapy in primary health care (PHC). South African Journal of Occupational Therapy, 45(3), 58-59. dx.doi.org https://doi.org/10.17159/2310-3833/2015/v45n3/a11

United Nations. (2015). Transforming our world: The 2030 agenda for sustainable development. https://sdgs.un.org/2030agenda

United Nations. (2023). The Sustainable Development Goals Report 2023. https://unstats.un.org/sdgs/report/2023

When I first heard about the Sustainable Development Goals (SDGs), they felt distant. They sounded like something meant for world leaders, policymakers, and global organisations, not something that would show up in my everyday work as an occupational therapy student. Seventeen goals. Ending poverty. Ensuring health and well-being. Reducing inequality. Transforming the world. They felt big. But somewhere between home visits, school screenings, and sitting on tiny plastic chairs in Early Childhood Development (ECD) centres, my perspective began to shift.

I started to realize something important: The Sustainable Development Goals are not only achieved in global conferences or policy documents, but they are also achieved in communities through small, everyday actions (United Nations, 2015; United Nations, 2023). I began to see how occupational therapy fits into this global vision from the United Nations. The screenings we conduct, the conversations with teachers, the education we provide to caregivers and teachers, and the home visits we make may seem small in isolation. But together, these actions quietly contribute to something much bigger. They contribute to the sustainable development of our communities or society (OTASA, 2015).

Good Health and Well-Being (SDG 3)

The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1946 as cited in WHO, 2010). This definition highlights that health is not only about treating illness but also about promoting well-being, preventing problems and supporting people to function in their everyday lives. During our community block, much of our work contributing to Good Health and Well-Being took place at the local clinic, where many community members access primary healthcare services. The clinic environment allowed us to engage directly with community members and address health issues through education, screening, and health promotion.

One of the areas we focused on was maternal mental health. Many mothers experience emotional and psychological challenges during pregnancy or after childbirth, but these challenges are often not openly discussed or addressed. Through health promotion activities at the clinic, we provided information about the importance of maternal mental well-being and how it can affect both the mother and the child’s development. We also engaged with caregivers about the importance of developmental screening for children. Many parents are unsure about when to seek help if they notice developmental concerns. During our health promotion sessions, we emphasised the importance of bringing children for early screening and assessment if caregivers notice difficulties with development, learning, behaviour, or participation in daily activities.

These conversations aimed to increase awareness and early help-seeking, which is an important part of preventive healthcare. These experiences reinforced the idea that promoting health does not always require complex interventions. Sometimes it begins with something simple: sharing knowledge, raising awareness, and encouraging people to seek help early. Through these small actions, occupational therapy can contribute meaningfully to improving health and well-being within communities (OTAS, 2015).

Quality Education (SDG 4)

Education plays a critical role in shaping a child’s future opportunities. However, learning does not occur in isolation. It is deeply connected to a child’s motor skills, sensory processing, cognition, emotional regulation, and ability to participate in the classroom environment. During our visits to schools and ECD centres, we worked alongside teachers to identify children who might be experiencing challenges that affect their learning. We conducted developmental screenings in ECD centres and primary schools, assessing areas such as attention and concentration, early learning skills, fine motor development, visual-motor integration and participation in classroom or play activities.

What stood out to me was how many children had never been assessed before. Some teachers had noticed that certain children struggled with concentration, holding a pencil, or following classroom routines, but these concerns had never been formally explored. Through our screenings, we were able to identify children who may require further assessment, provide feedback to teachers and caregivers and suggest classroom adaptations or strategies. Some of the most meaningful moments were not the screenings themselves, but the conversations with teachers afterwards. Together we discussed simple strategies that could support children in the classroom, such as incorporating movement breaks or introducing activities that strengthen the hand muscles needed for writing. These moments reinforced something important: occupational therapy supports education by supporting participation. Education is not only about delivering curriculum content. It is also about ensuring that children are able to engage in the occupation of learning.

Reduced Inequalities (SDG 10)

One of the most visible realities in the community we worked in was inequality in access to healthcare and rehabilitation services. Many families face barriers that make accessing occupational therapy services extremely difficult, including financial constraints, transport challenges, work commitments and long waiting lists at hospitals. For some parents, missing a day of work to attend a hospital appointment simply is not possible. Others live far from healthcare facilities and cannot afford regular transport. As a result, many children who require support may never receive an assessment or intervention.

Our school-based screenings helped bridge part of this gap. By screening children directly within the school environment (with parental consent), we were able to reach children who might otherwise never access occupational therapy services. Similarly, home visits allowed us to support individuals who could not easily leave their homes. Some community members we visited were wheelchair users, bed-bound individuals and people with severe mobility challenges. For some individuals, leaving their home was extremely difficult due to environmental barriers such as stairs, uneven pathways, or inaccessible transport. By bringing occupational therapy services into homes, schools, and community spaces, we were able to meet people where they are. This experience reminded me that equitable healthcare requires outreach, flexibility, and community-based services.

Sustainable Cities and Communities (SDG 11)

A sustainable community is one where individuals are able to live, move, and participate safely within their environments (UN, 2015). Through our home visits, we were able to see how the physical environment can either support or limit participation. Some homes had structural barriers that made mobility extremely difficult. In some cases, individuals who used wheelchairs were unable to leave their homes independently due to stairs or narrow entrances. During these visits, we worked together with caregivers and community members to explore practical strategies such as positioning techniques, pressure care education, environmental adjustments and adaptive ways of completing daily tasks.

Often the changes we suggested were small, but their impact could be significant. A small positioning adjustment could help prevent pressure sores. A different way of completing a task could increase independence. Occupational therapy frequently focuses on adapting environments and tasks to support participation in daily life. When people are able to function safely and independently within their homes and communities, those communities become stronger and more sustainable.

Partnerships for the Goals (SDG 17)

One of the biggest lessons I learned during this experience is that community-based OT practice cannot happen in isolation. Every activity we implemented required collaboration. We worked with teachers in primary schools, ECD teachers and workers, community healthcare workers (CHWs), clinic staff, Mariannridge Coordinating Committee (MCC) and caregivers and families. These partnerships helped ensure that the activities we implemented were relevant, practical, and sustainable.

Rather than simply introducing activities and leaving, we aimed to ensure that community members understood why the activity was important, how it supports development and participation and how they could continue implementing it independently. Sustainability is not about doing something once. It is about building knowledge, ownership, and confidence within the community, so that the work continues even after we leave (UN, 2015).

Before this experience, the SDGs felt like distant global ambitions. Now they feel much closer. A screening in a classroom. A home visit. A conversation with a teacher. A small adaptation to a daily activity. These moments may seem ordinary, but they contribute to something much larger. They contribute to healthier communities, more inclusive education systems, and improved access to care. Occupational therapy often works at the level of individuals, families, and communities, but the impact of this work extends far beyond those immediate interactions. It contributes to a global vision of sustainable development (UN, 2023).

This experience reminded me that occupational therapy is not only about rehabilitation. It is also about advocacy, prevention, empowerment, and community development. Sometimes the work we do may feel small. But when viewed through the lens of the Sustainable Development Goals, these small actions become part of a much larger movement toward a healthier and more inclusive world. So perhaps the real question is this: When tiny, everyday interventions such as a screening, a conversation, a home visit contribute to something far bigger, how intentionally are we using our skills to leave a lasting mark on the communities we serve and the world beyond?

References

Occupational Therapy Association of South Africa. (2015). Position statement on occupational therapy in primary health care (PHC). South African Journal of Occupational Therapy, 45(3), 58-59. dx.doi.org https://doi.org/10.17159/2310-3833/2015/v45n3/a11

United Nations. (2015). Transforming our world: The 2030 agenda for sustainable development. https://sdgs.un.org/2030agenda

United Nations. (2023). The Sustainable Development Goals Report 2023. https://unstats.un.org/sdgs/report/2023