Prepared to provide intervention, Still Learning to Serve the Community: Reflecting on UKZN's Occupational Therapy Curriculum
Looking back on my four years at UKZN, I can confidently say that one of the biggest lessons the occupational therapy curriculum has taught me is to always think beyond the hospital. From the first year, we have been encouraged to assess and treat a patient while already thinking about discharge. Every intervention we plan should prepare the client for the environment they will return to, the people they live with, and the occupations that are meaningful to them. This way of thinking has helped me understand that occupational therapy is not only about treating a condition but also about preparing a person to participate in everyday life after leaving the hospital.
Throughout the course, we have also been taught to make our interventions as client centred as possible. Rather than focusing only on what the therapist thinks is important, we are encouraged to understand what the client wants to achieve. If a client cooks on an open fire or bathes using a basin at home, then my intervention should prepare them to safely perform those activities in the way they will do them after discharge. This reflects the client-centred approach in occupational therapy, where clients are recognised as experts in their own lives and actively participate in setting meaningful goals (Townsend & Polatajko, 2013). This has helped me appreciate the importance of adapting therapy to the client's real-life environment instead of expecting the client to adapt to the hospital environment.
Another strength of the UKZN curriculum is its emphasis on sustainability. Almost every project, assignment and intervention we have completed has required us to think about whether it is affordable, sustainable and appropriate for the community. This has shaped the way I now approach occupational therapy. Instead of immediately thinking about expensive equipment, I first think about what is already available in the home, school or clinic and how those resources can be used creatively. This aligns with the principles of Primary Health Care, which emphasise appropriate technology, affordability and sustainability in healthcare (World Health Organization, 1978).
I remember collecting empty cooldrink bottles from my residence during my paediatric block because the hospital did not have skittles for one of my therapy groups. Instead of seeing it as a limitation, I used the bottles to create the activity. My supervisor appreciated this creativity, and it reminded me that many South African clinics and schools are under-resourced. As occupational therapists, we need to provide effective interventions using the resources that are available rather than waiting for ideal conditions.
The curriculum has also strengthened my clinical reasoning. Through countless case studies, presentations, reports and blogs, I have learnt that successful intervention depends on understanding the client as a whole person. We are expected to know far more than a diagnosis. We consider the client's family, values, interests, occupations, home environment and physical abilities before making clinical decisions. Clinical reasoning allows us to integrate assessment findings, client values and environmental factors when planning intervention (Schell & Schell, 2019). Although this process can sometimes feel overwhelming, it has prepared me to think critically and provide individualised interventions instead of following a standard treatment plan.
Another strength of the course is the wide variety of clinical placements. I have worked in physical rehabilitation, paediatrics, mental health, community settings and different hospitals serving diverse populations. These experiences have exposed me to clients from different backgrounds and with different occupational needs. As a result, I feel more confident adapting my approach depending on the setting and the person I am working with.
Despite these strengths, my community placement has shown me that working at a Primary Health Care level requires a different way of thinking. In hospital settings, my focus was usually on the individual patient sitting in front of me. Community practice has challenged me to think about the needs of the whole community. Instead of asking how I can help one child, I now must think about programmes that can benefit an entire crèche, school or community organisation and continue long after we have left.
One challenge I identified is that community practice only becomes a major responsibility in fourth year. Although we were exposed to community settings in earlier years, most of that experience involved observing fourth-year students rather than planning and leading our own interventions. Looking back, I think earlier opportunities to independently manage community projects would have helped me develop confidence before entering my final year placement.
I also realised that I was not fully prepared to deliver health promotion programmes. Health promotions are a very important part of occupational therapy. “Health promotion requires health professionals to enable people to improve and maintain their health through education, participation and supportive environments” (WHO, 1986). During my previous placements, I had very little experience standing in front of a group to educate communities about health-related topics. As a result, I initially lacked confidence when planning health promotion sessions during this block. Although I understand the theory behind health promotion, I have realised that confidence only develops through repeated practice.
Another area where I would have benefited from earlier exposure is home visits. Before fourth year, I had only accompanied a senior student on one home visit. At the time, I did not fully understand what to observe or how to assess the home environment. During this placement, I have realised that home visits are about much more than checking on a client's progress. They allow occupational therapists to recommend home modifications, assess accessibility and understand the client's daily life in ways that cannot be achieved by simply drawing a floor plan during an assessment.
Finally, this placement has broadened my understanding of the occupational therapist's role within the community. When I was told that one of our community sites would be a public library, I struggled to understand how occupational therapy could contribute in that setting. After reading about occupational therapy in community libraries, I realised that libraries can promote health, inclusion, mental well-being and participation for people of all ages. This experience challenged my understanding of our scope of practice and reminded me that occupational therapy extends far beyond hospitals and clinics (University of Alberta, 2020).. Community practice requires us to collaborate with community organisations and stakeholders to improve participation and well-being where people live, learn and interact.
Reflecting on my journey so far, I believe the UKZN curriculum has given me a strong clinical foundation, particularly in client-centred practice, clinical reasoning and sustainable intervention. However, my community placement has also shown me that confidence in community practice develops through experience. As a future occupational therapist, I hope that earlier opportunities for independent community work, health promotion and home visits will better prepare future students for Primary Health Care practice. This placement has reminded me that community occupational therapy is not only about treating individuals, but also about working alongside communities to create meaningful and lasting change.
References:
1. Townsend, E. A., & Polatajko, H. J. (2013). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation (2nd ed.). CAOT Publications ACE.
2. World Health Organization. (1986). Ottawa charter for health promotion.
3. Schell, B. A. B., & Gillen, G. (Eds.). (2019). Willard and Spackman's occupational therapy (13th ed.). Wolters Kluwer.
4. University of Alberta. (2020). Occupational therapy in public libraries.
5. University of KwaZulu-Natal. (2026). Occupational therapy undergraduate programme. https://ot.ukzn.ac.za/
