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What Kenville Taught Me About Being an Occupational Therapist

“Health is created and lived by people within the settings of their everyday life” (World Health Organization, 1986).

As I first stepped into the doors of Kenville as an aspiring occupational therapy student, I thought I knew it all: assessment, screening, and intervention. I thought occupational therapy happened in a clinic with equipment, a plan of treatment, and activities. Community work has a way of putting one in their place. Kenville taught me that occupational therapy is not only about the hand, the muscle, or the joint. It is about people, power, opportunity, and justice.

The streets of Kenville, the classrooms of the schools, and the waiting rooms of the clinic became a classroom without walls. And the people of the community, mothers, workers, children, and patients, became some of my most effective teachers.

When occupation meets reality

However, one of the moments that stuck with me was the time I had a man with a fractured wrist come in for assessment. He had gotten the injury during an escape from a robbery. While medically the case was simple, reduced mobility, pain, and a plaster cast restricting his use of the limb, there was a lot more to the story. While the injury may have been a fractured wrist, it was also an injury related to violence, safety, and the reality of a person’s occupation in an environment where crime dictated people’s occupations.

As an occupational therapist, one of the biggest discussions in the profession is about the concept of enablement of participation. However, in Kenville, I found myself asking a rather uncomfortable question: how does one participate in an environment that limits them at every turn?

This reflection is related to the idea of occupational justice, which is that everyone has a right to participate in meaningful occupations that promote health and well-being (Whiteford & Townsend, 2022). However, in some communities in South Africa, inequality limits opportunities for occupation. Violence, unemployment, and lack of access to services are some of the invisible barriers that subtly shape people's lives.

In that moment, I knew that I had learned something important. Sometimes, as a therapist, we cannot “fix” the environment right away.

Waiting from the clinic waiting room

Another significant learning experience was from a woman who brought her child for immunization. She had just given birth and had also lost her job. Although the situation may appear simple, where a mother is simply taking care of her child, there is a deeper layer to the situation. This woman was struggling with issues of identity, independence, and the unknown future.

Work is not just about earning a living. It is also about having a sense of worth, a sense of identity, and a sense of belonging. According to Wilcock and Hocking (2024), “occupation is the central aspect of people’s experience and is the primary means by which people experience and understand the world.” Therefore, losing a job is not just about losing a job. It is also about losing a sense of who you are in the world.

In South Africa, unemployment is considered to be one of the largest social determinants for health (Koka, 2024). Witnessing these situations in Kenville has changed my perspective on therapy. Occupational therapy is not just about rehabilitation after a person has gotten sick.

This view is consistent with the Primary Health Care approach that prioritises the importance of prevention, community involvement, and the social determinants of health (Department of Health, 2017).

Power, Access, and Injustice

The most challenging reflection was from the pregnant woman who was unable to access hospital care due to her immigration status. Listening to her story reminded me of the intricate power relationships that exist within the healthcare system.

Hospitals have institutional power. The system decides who will receive care and who will be denied. But if the system denies access to the vulnerable, healthcare becomes more than an access issue, it becomes a political issue.

As students, we tend to believe that politics is far removed from us and that it occurs in parliament. But Kenville taught me that politics occurs in the waiting rooms as well. The capacity to access healthcare, education, or employment is influenced by the power systems that occur behind the scenes.

The World Health Organization Commission on Social Determinants of Health states that “health inequalities are shaped by social and political, as well as biological, factors” (Marmot et al., 2008). Seeing this in action helped me realize that my preconceived ideas about health issues being individual problems was not always true. Instead, they can be structural problems.

Seeing this in action also made me realize that I was not exempt from these issues. As a student entering the community for learning, I have the privilege on my side. I have education, support from an institution, and the privilege of leaving after I am done. This made me realize that I was not only seeing these injustices, but I was also preparing myself to be an agent of change in these communities.

Children, Play, and Possibility

Not all of my reflections from Kenville were sad, though. Some of the most hopeful moments I have witnessed were from working with children at Kenville Primary School. While working on an assignment where learners stepped on shapes and colors while playing movement games, I witnessed an almost complete shift in room dynamics. Children were laughing, moving, and competing with each other.

The activity itself was not very complex, but behind that activity were some very deep and therapeutic benefits. Children could improve coordination, cognitive processing, and even classroom participation.

Witnessing these children play and participate in this session made me realize that play is very powerful. Play can give children the opportunity to participate in occupations that can lead to learning and social skills. According to Black et al. (2017), “early childhood development is critical in determining future health and educational outcomes.” Seeing these children participate in an assignment made me realize why occupational therapy is so important. Small assignments can lead to big opportunities.

How Kenville Changed Me

Prior to this community block, I thought of occupational therapy as a clinical practice. Now I realize it is so much more. It is a social practice, a political practice, and at times an activist practice.

Kenville was a reality-checker for me. It made me realize that health is not only about environments and opportunities but also about policies. It made me realize that therapists cannot remain neutral observers in a society where injustice impacts people's ability to participate in life.

As I prepare to go out and engage in community service, I have a few realities with me:

Listen to people's stories before rushing in with solutions.

Understand the social and political context of people's occupations.

Advocate for people whose voices are rarely heard.

Start with small steps.

Professional identity in occupational therapy develops like a river shaped by experiences, challenges, and reflection over time.

Moving Forward

If there is one thing I have learned from my time at Kenville, it would be this: Occupational therapy is not only about helping people adapt to the world; it is also about helping people adapt to a world that should be questioned.

Community practice invites us to go beyond the treatment room and engage with the real environments in which people occupy. It invites us to become aware of injustice, inequality, and the need to support people's occupation in a manner that is meaningful.

As I leave Kenville, I am left with one question that I have no doubt will follow me through my community service practice:

If occupation is a human right, what does it mean for us as occupational therapists to uphold that right?

EXTRA RESOURCES

Students and practitioners who are interested in community-based occupational therapy and primary health care can seek resources and support from various associations, including the Occupational Therapy Association of South Africa, World Federation of Occupational Therapists, South African Department of Health, and World Health Organization, which offer guidelines that ensure equitable access to health services and community participation in occupation.

World Federation of Occupational Therapists  -   https://wfot.org/

Occupational Therapy Association of South Africa -  https://www.otasa.org.za/

World Health Organization Primary Health Care resources –   https://www.who.int/

South African Department of Health PHC policies - https://www.health.gov.za/

South African Department of Health - https://www.health.gov.za/  Phone: [phone]

Gift of the Givers Foundation - https://giftofthegivers.org/ Phone: [phone]

References

Black, M. M., Walker, S. P., & Fernald, L. C. (2017). Black, M.M., Walker, S.P., Fernald, L.C., et al, “Early childhood development coming of age: Science through the life course”, Lancet 389 (10064), 77-90, January 2017. Sciepub.com. https://www.sciepub.com/reference/301232

Department of Health. (2017). RE-ENGINEERING PRIMARY HEALTH CARE FOR SOUTH AFRICA HUMAN RESOURCE IMPLICATIONS 15 SEPTEMBER 2011 PRESENTATION HWSETA. https://cpmh.org.za/wp-content/uploads/2020/07/Re-engineering-Primary-Health-slide-show.pdf

Koka, P. (2024). Poverty and Inequality Statistics in South Africa Presentation to NCOP. https://www.parliament.gov.za/storage/app/media/Pages/2024/23-08-2024_NCOP_Three- sphere_Planning_Session/session1/Statistics_South_Africa_Patricia_Koka.pdf

Whiteford, G., Parnell, T., Ramsden, L., Nott, M., & Vine-Daher, S. (2022). Understanding and Advancing Occupational Justice and Social Inclusion. Springer EBooks, 181–210. https://doi.org/10.1007/978-3-030-89594-5_10

Wilcock, A., & Hocking, C. (2024). An Occupational Perspective of Health. Taylor & Francis. https://www.taylorfrancis.com/books/mono/10.4324/9781003525233/occupational-perspective-health-clare-hocking-ann-wilcock

World Health Organisation. (2008, August 27). Closing the gap in a generation: health equity through action on the social determinants of health. Www.who.int. https://www.who.int/publications/i/item/9789241563703

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UKZN’s OT curriculum, the pros and cons in terms of preparation for practice at a community/PHC level.

Have you ever taken a moment to reflect on what it truly means to “serve the community”? When I first entered Cato Manor as a first-year OT student, I thought my role was simply to check boxes: cook with community workers, play with kids, and fulfill my hours. I had no idea that community practice is more than simply being physically present; it is about grasping the intangible factors that govern people’s lives: walking uphill to collect water, waiting hours at clinics, and witnessing the triumph of a child learning to tie their shoes. As Whiteford (2011) so elegantly puts it, “Occupational therapy is not simply a set of interventions; it is a commitment to social justice and participation.”

This blog will be a reflection on my journey through the OT curriculum, from my first-year placements where I felt lost to my fourth-year community practice, which has been truly life-changing. I have come to learn that being physically present is not the same as being professionally present.

First Year Exposure: A Glimpse without a Lens

First time entering the community block, my mind was elsewhere, buried in anatomy books and in survival mode, with occupational justice, primary health care, and the social determinants of health nowhere on my radar screens. I was worried about passing exams, not the larger picture of what it means to serve communities.

In reflection, I see how being simply exposed, rather than being exposed with context, is rather like floating in a boat and moving, but having no way of steering or moving in a particular direction. Experiential learning theory (Zee, 2006) suggests that experience alone does not lead to learning, and reflection and concept development are what make experience lead to professional learning. I also ask myself, had I been provided with a stronger foundation in occupational justice, health promotion, and PHC, might my first year of experience have been a different experience in terms of the development of my professional identity? Was I learning to be an occupational therapist, or simply learning to show up?

The Gap in Second Year: Missed Opportunities

Second year was a quiet time, no community placements, no exposure. This was like missing a rung on the ladder of competence. Biggs and Tang (2011) explain that learning in health professions is cumulative and layered. Community practice is not something you learn in a few short weeks but it is a long-term process of learning that builds with repetition. WFOT (2020) highlights the importance of learning that builds competence progressively, in diverse contexts, including PHC. Constant annual exposure could have helped us learn to become more confident and ready for third and fourth year, rather than feeling like strangers in a complex environment for the first time.

Third-Year: Evening Placements and Limited Access

When we went back to the community block in the third year, it was on Friday evenings. The crèches were closed, the clinics were empty, the schools were locked, and the children that we did see at the library had difficult behaviours, but we had not even done our paediatric lectures yet. It felt like we were given a puzzle with missing pieces. Curriculum sequencing is an important factor in learning; it is not always the case that the sequencing is logical or optimal (Biggs & Tang, 2011). I felt anxious, unprepared, and overwhelmed. This led me to wonder, is paediatrics actually put in the wrong place in the curriculum, especially when the community programs are full of complex cases with children?

Strengths of the Curriculum

Yet, in the face of these challenges, the OT curriculum in UKZN has some positive attributes. For instance, the community-based interventions in the first year, the chance to work in a group in the second and third years, the autonomy in the fourth year, and the theoretical knowledge are some of the positive attributes in the OT curriculum in UKZN. Real-life scenarios in South Africa force us to come out of our comfort zones and think critically, reflect, and practice in a real-life context (Trede et al., 2012). In the fourth year, this is a transformative experience, and we begin to see the links between occupational therapy and issues of social justice, health equity, and the realities of PHC systems (Whiteford & Townsend, 2011).

Areas for Improvement

However, there is room for improvement. Orientation could be better; students need to understand the rationale behind their entry into the community setting. Without this, it is almost a sense of service rather than practice. Further integration of paediatrics and annual exposure would facilitate the integration of knowledge and the development of confidence. Better coordination between the admin and the students would reduce stress levels, allowing the students to focus on the learning experience rather than the stress of navigating the admin system. Reflection, cycles of experience, and integration (Zee, 2006) facilitate the transformation from exposure to competence.

Conclusion

First-year placements were confusing. Third-year placements were underprepared. Fourth-year placements are transformative. The intention, preparation, and potential are all here. However, the integration, alignment, and coordination can always be better. Community practice is not an ‘add-on’ in South African occupational therapy. It’s core to who we are, our professional identity, our role in PHC systems (Whiteford, 2011). Occupational therapy, if the tree, is community practice the root system. Without the root system, the tree struggles to thrive.

My journey has changed my perspective. I now understand the value of reflection as much as I value doing. I now understand that, as an occupational therapist, I don’t just practice exercises, I practice the landscape of the social, political, and physical world to ensure the communities I serve, like Kenville, flourish. I now wonder: how can we, as future occupational therapists, serve individuals, but also advocate for systems that ensure the right to health, participation, and justice for all?

EXTRA RESOURCES

Exploring the Occupational Therapist’s Role in Primary Health Care (South Africa):

Tanimu, T., Yohanna, S., & Omeiza, S. (2016). Exploring the occupational therapist’s role in primary health care: Listening to voices of stakeholders. African Journal of Primary Health Care & Family Medicine ISSN, 2071–2928. https://doi.org/10.4102/phcfm

 Are Final‑Year OT Students Adequately Prepared for Clinical Practice? A Case Study in KwaZulu‑Natal:

Naidoo, D., Van Wyk, J., & Joubert, R. (2026). ‪Are final year occupational therapy students adequately prepared for clinical practice? A case study in KwaZulu-Natal. South African Journal of Occupational Therapy.. Google.com. https://scholar.google.com/citations?view_op=view_citation&hl=en&user=SBFpesIAAAAJ&citation_for_view=SBFpesIAAAAJ:IWHjjKOFINEC

References

Biggs, J., & Tang, C. (2011). Teaching for Quality Learning at University Fourth Edition. https://cetl.ppu.edu/sites/default/files/publications/-John_Biggs_and_Catherine_Tang-_Teaching_for_Quali-BookFiorg-.pdf

Trede, F., Macklin, R., & Bridges, D. (2012). Professional Identity development: a Review of the Higher Education Literature. Studies in Higher Education, 37(3), 365–384. https://doi.org/10.1080/03075079.2010.521237

WFOT. (2020). World Federation of Occupational Therapists. WFOT. https://wfot.org/education

Whiteford, G. (2011). From Occupational Deprivation to Social Inclusion: Retrospective Insights. British Journal of Occupational Therapy, 74(12), 545–545. https://doi.org/10.4276/030802211x13232584581290

Zee, J. van der. (2006). kolb84] Experiential learning: experience as the source of learning and development. Www.academia.edu.  https://www.academia.edu/42033149/kolb84_Experiential_learning_experience_as_the_source_of_learning_and_development

Artificial intelligence (ChatGPT, OpenAI, 2025) was used to assist with formatting and grammar editing only.

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5 SUSTAINABLE GOAL DEVELOPMENT AND HOW I WISH TO APPLY THEM AT KENVILLE

Others may ask, what is sustainable goal development, and what are they created for? Well, then look no further, in this blog, we will explain to you what are SGD’s are and what they are created for. So, the Sustainable Development Goals, or SDGs for short, are a set of goals that the United Nations created in 2015 to help countries improve the world by the year 2030 (UNDP, 2025). The aim of the SDGs is to end poverty, protect the environment, and bring peace and prosperity to the world, so that everyone in the world can live a better life. There are approximately 17 SGDs, but in this blog, we will focus on the 5 SGDs and how I will apply them in Kenville.

Quality education

SDG 4 focuses on ensuring inclusive and equitable quality education for all, and this is to be achieved by the year 2030 (UNDP, 2025).

Early Childhood Care and Education (ECCE) is important because the period between birth and the age of eight is critical in the development of the brain, which in turn determines the way children learn, think, and interact with the world around them. Just as the foundation of a house is essential in ensuring the stability of the house, a strong foundation in early education is essential in ensuring lifelong learning, enabling children to reach their full potential, and addressing inequalities between disadvantaged and advantaged children (UNESCO, 2022). However, disadvantaged children are still not accessing education, and I have seen this in the community, where the 10-year-old boy I see in therapy has not been going to school since he was expelled due to his behavioral problems, leaving me to wonder if children are being pushed away or helped.

From an OT lens, this child’s actions are not simply “bad behavior” but, rather, it is a means of communication. We worked with this child to help him develop skills so that he will be able to participate in school once again. We do this by using play to help this child identify his emotions so that he might be able to communicate these emotions. At the same time, I have also observed the number of children in the community who are five years old but are not in crèches. In these cases we speak to the mothers about the importance of children to attend creche and we give mothers a tips on how to cognitively stimulate the children at home. It is like seeing seeds that are left outside the soil, and although they still have the potential to grow, their cognitive development will somehow lag if they are not given the right environment to develop in, this is about giving children a fair start in the race of life.  In schools, occupational therapists help students develop fine motor skills to participate effectively in classroom tasks, ensuring they can complete assignments without being hindered by physical limitations (Team, 2023).

Gender Equality

This SDG aims to achieve gender equality by ending discrimination, violence, and harmful practices against women and girls, ensuring equal participation in leadership and decision-making, recognizing unpaid care work, guaranteeing access to sexual and reproductive rights, expanding economic opportunities and technology access, and strengthening laws and policies that empower women and girls (UNDP, 2025).

Occupational therapists promote gender equality by creating inclusive, affirming environments, challenging oppressive gender norms in healthcare, and enabling LGBTQIA+ individuals to engage meaningfully in their occupations through advocacy, holistic support, and trans‑positive practice (Tintinger et al., 2024).

Since working with the community, I have encountered the harsh truth behind the term gender-based violence. I was approached by one woman who requested my guidance after she had been kidnapped and subjected to sexual violence by men. She told me that since that day, her confidence had been broken, like the reflection of the mirror that had fallen to the ground, broken into pieces. From an OTs lens, our role is not to cure the trauma, but rather to guide the woman in picking up the broken pieces of the mirror. This may involve helping the woman create a space where she can rebuild her sense of control through engaging in occupations that have significance for her, such as building up her self-confidence, helping her rebuild her sense of control, and eventually helping her re-engage in occupations such as social participation, self-care, etc. At times, the first step towards healing is the smallest one, like learning to trust your own voice.

Reduced Inequalities

According to UNDP (2025) the goal is that by 2030 there will be reduced inequality in the world by accelerating income growth for the poorest 40 percent of the population, ensuring the social, economic, political inclusion of all people, and getting rid of discriminatory practices. Occupational therapists contribute to reduced inequalities through socially transformative, reflexive, and participatory practice, which focus on addressing social factors that impact health and working with marginalized groups to facilitate equitable opportunities for occupation (Richards & Galvaan, 2018).

My colleague and I were working with a woman whose HIV infection was the result of her partner's abusive behavior. She wasn't ready to leave the relationship, and I felt like I was at the edge of the cliff, seeing that she was at risk of falling, but also wanting to provide her with the skills to climb safely when she was ready to leave the relationship. This experience impacted me personally because it changed my perspective on the importance of patience and providing support without judgment. This experience impacted me professionally because it increased my ability to think critically from a harm reduction perspective. This experience also connected to my academic studies, the social determinants of health, and my political perspective, the ways in which the system fails women and the ways in which occupational therapists can help clients safely navigate the system.

Clean water and sanitation

By the year 2030, the world aims to achieve universal access to safe and affordable water and sanitation services, improve the quality and efficiency of water, protect and restore water-related ecosystems, enhance international cooperation and capacity building, and promote active community participation in the achievement of the goals (UNDP, 2025).  

This week, during the two home visits, I noticed that the people in both families store water in bottles and buckets. The first person had to climb a long and steep hill to fetch water and then carry it back, while the second person was using water from the months before. Using old water is unhealthy because it will eventually start to produce bacteria and infections, turning the simple bucket into a health hazard (PailHQ, 2026). The availability of public toilets and washing facilities was also far away and sometimes closed, causing more strain to the people in the community. I couldn’t help but think, why should water be like climbing a mountain?

As an OT, this reinforced the value of practical interventions. For example, providing safer storage containers, trolleys for carrying water, or moving essential services closer might reduce health hazards and the energy expended on survival. On a personal level, this experience gave me a new appreciation for OT practice, as it’s not just about exercises and fine motor skills, it’s about being able to see and alleviate the “invisible uphill battles” people are fighting. On a professional and political level, it reminded me that access to basic needs is also a social justice issue, and small changes make a big difference.

Good health and wellbeing

The world’s goal is to end the major causes of death, end the major epidemics, increase universal and affordable healthcare, and increase the world’s ability to prevent or handle health risks by the year 2030 (UNDP, 2025).

Occupational therapists help to maintain good health and well-being in the workplace by assessing the physical and psychological needs of the individual, adapting the work environment, educating the individual, rehabilitating the individual, and implementing strategies that are safe, sustainable, and meaningful to the individual in the workplace (Soeker, Shaheed Moghammad, 2024).

In Kenville, I recently had the opportunity to work with a security guard who had been on his feet for long hours, leading to back pain and fatigue. However, just as an engine that is not serviced will eventually break down, he was gradually breaking down. In my capacity as an occupational therapist, I recognized that the security guard’s physical and psychological needs had to be met, with the repetitive strain not only causing him physical problems but also psychological issues such as a loss of satisfaction in his work.

This was an eye-opening experience. On the personal side, I learned that OT is not simply about solving problems, but about preventing problems from arising in the first place. On the professional side, I recognized the significance of the interplay between health, safety, and meaningful participation. Politically, I must admit that I also thought about the larger picture. How many people in Kenville, for example, are in dangerous working conditions, physically demanding working conditions, and receive little support? How do we, as occupational therapists, support people in the fight for better working conditions and better labor laws.

Extra resources

Understanding the Sustainable Development Goals:

United Nations. (2015). The 17 sustainable development goals. United Nations. https://sdgs.un.org/goals

SGDs in South Africa, the progress and Challenges:

Utsav Kumar Singh. (2024). Sustainable Development Goals in South Africa: Progress and Challenges. Advances in Geographical and Environmental Sciences, 93–146. https://doi.org/10.1007/978-981-97-5846-3_3

The Role of Occupational Therapy in Africa

Jansen van Vuuren, J., Okyere, C., & Aldersey, H. (2021). The role of Occupational Therapy in Africa: A scoping review. South African Journal of Occupational Therapy, 50(3). https://doi.org/10.17159/2310-3833/2020/vol50no3a2

Developing Socially Transformative OT Practice (South African OT education & SDGs):

References

PailHQ. (2026). 5 Gallon Bucket Water Storage: Safe for 5+ Years [2026] | PailHQ. PailHQ. https://pailhq.com/blog/5-gallon-bucket-water-storage-guide

Richards, L.-A., & Galvaan, R. (2018). Developing a socially transformative focus in Occupational Therapy: insights from South African practice. South African Journal of Occupational Therapy, 48(1), 3–8. https://doi.org/10.17159/2310-3833/2017/vol48n1a2

Soeker, Shaheed Moghammad. (2024). Laying claim to occupational therapy practice, one rapid review at a time. South African Journal of Occupational Therapy. https://doi.org/10.17159/2310-3883/2024/vols4n1a1

Team, P. (2023, May 9). The Role of Occupational Therapists in Education. Planbook Blog. https://blog.planbook.com/occupational-therapists/

Tintinger, S., Ncwane, T., & Ebrahim, N. (2024). The role of occupational therapy serving LGBTQIA+ people: Retrospective perceptions of an occupational therapist. South African Journal of Occupational Therapy, 54(1), 95–99.  https://doi.org/10.17159/2310-3883/2024/vol54no1a11

UNDP. (2025). Sustainable development goals. United Nations Development Programme; United Nations. https://www.undp.org/sustainable-development-goals

UNESCO. (2022, November 10). Why Early Childhood Care and Education Matters | UNESCO. Www.unesco.org; UNESCO. https://www.unesco.org/en/articles/why-early-childhood-care-and-education-matters

Artificial intelligence (ChatGPT, OpenAI, 2025) was used to assist with formatting and grammar editing only.

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UKZN’s OT curriculum, the pros and cons in terms of preparation for practice at a community/PHC level.

When I entered the community block as a first-year student, I was not considering occupational justice, primary health care, or social factors that influence health. I was considering my anatomy exams. I was considering my survival.

This reflection is not about what was good or bad about the curriculum. It is about the way in which the structure of the curriculum contributes to our confidence, our professional identity, and our ability to serve the community, such as the community at Kenville.

First Year Exposure: A Glimpse without a Lens

In first year, I was exposed to Cato Manor. At the time, I was unaware of the value of being within this environment. We assisted fourth-year students, cooking with the community workers, and working with primary school children. Yet there was no exposure to the bigger picture of community-based occupational therapy practice. I now realise that early exposure without theoretical framing can feel disjointed. We were present physically, but were we present professionally?

Experiential learning theory emphasises that experience alone does not automatically lead to professional growth; learning requires reflection and conceptual framing (Zee, 2006). Without exposure to the value of occupational therapy within school and community settings, I found the placement as participation without clarity, or just a placement to complete my clinical hours. I often ask myself: If I had been given a stronger foundation about occupational justice, health promotion, and the OT role in PHC, would that experience have shaped my professional identity differently?

In reflection, I think it was exposure to being within the environment; however, was it exposure to being within the environment as occupational therapists?

The Gap in Second Year: Was It a Missed Opportunity?

There was no community placement in second year. Looking back, I think this was a gap in the continuum of developing competence. Learning in health professions is cumulative and layered (Biggs & Tang, 2011). I sometimes wonder if constant annual engagement in community practice would have aided our progression into third and fourth year.  WFOT’s (2020) Minimum Standards for the Education of Occupational Therapists emphasise that curricula should progressively develop competence across diverse practice contexts, including community and PHC environments. Community practice is not something that is learned in a few weeks or even a few months. It is a process that is learned over a long period of time.

Third Year: Evening Placements and Restricted Access

In third year, we went back to the community – but only in second semester, and on Friday evenings. At this point, crèches were closed, clinics were empty, and schools were closed. We saw kids at the library with difficult behaviours. At this point, we had not yet done paediatrics. Curriculum sequencing plays a critical role in student confidence and perceived competence (Biggs & Tang, 2011). This made me nervous rather than confident. I felt like I was not equipped. I felt like I was observing complexity without the ability to make sense of it.

But here’s the thing: Is paediatrics too late in the curriculum, especially knowing that community-based programs will have large paediatric caseloads?

Strengths of the Curriculum

Although there are challenges, the OT curriculum at UKZN has its strengths, which include:

Early exposure to community settings

Opportunities for group-based interventions

Increasing autonomy in fourth year

A strong theoretical foundation

The curriculum promotes autonomy and problem-solving, particularly in the final year.  Professional identity develops through responsibility, reflection, and authentic practice engagement (Trede et al., 2012). It forces us out of our comfort zones. It presents us with real South African scenarios instead of stimulated cases.

The intention of preparing students for socially responsive practice is evident and aligns with WFOT (2020) standards and occupational justice principles (Whiteford & Townsend, 2011).

Areas for Improvement

Nevertheless, preparation for PHC practice could be enhanced in a number of ways, such as:

Clearer Orientation - Students need to have a clear idea of the "why" before entering community spaces. Otherwise, it is more of a service rather than a professional practice.

Curriculum Sequencing - It may also be more beneficial for paediatrics to be introduced earlier to better align with community practice. Experiential learning theory supports repeated cycles of experience, reflection, and integration for deep learning (Zee, 2006).

Consistent Exposure -It may also be more beneficial for annual community placements to be undertaken to help build student confidence more consistently.

Administrative Coordination - It is essential for clear communication regarding submission dates, coordination of supervisors, and ensuring that handovers are checked to avoid unnecessary stress for the students and ensure that they can focus on their learning instead of worrying about other issues.

In retrospect

In first year, community block was confusing.

In third year, it was underprepared.

In fourth year, it is transformative.

The UKZN OT curriculum does provide us with preparation for community practice – perhaps not as well integrated as it could have been, though. The preparation is there. The intention is there. The potential is there. What is needed is greater integration, better orientation, earlier contextual alignment, and better coordination. Community practice is not an ‘add-on’ in Occupational Therapy in South Africa – it is an integral part of who we are. It is central to occupational therapy’s identity and responsibility within PHC systems (Whiteford, 2011).

References

Biggs, J., & Tang, C. (2011). Teaching for Quality Learning at University Fourth Edition. https://cetl.ppu.edu/sites/default/files/publications/-John_Biggs_and_Catherine_Tang-_Teaching_for_Quali-BookFiorg-.pdf

Trede, F., Macklin, R., & Bridges, D. (2012). Professional Identity development: a Review of the Higher Education Literature. Studies in Higher Education, 37(3), 365–384. https://doi.org/10.1080/03075079.2010.521237

WFOT. (2020). World Federation of Occupational Therapists. WFOT. https://wfot.org/education

Whiteford, G. (2011). From Occupational Deprivation to Social Inclusion: Retrospective Insights. British Journal of Occupational Therapy, 74(12), 545–545. https://doi.org/10.4276/030802211x13232584581290

Zee, J. van der. (2006). kolb84] Experiential learning: experience as the source of learning and development. Www.academia.edu.  https://www.academia.edu/42033149/kolb84_Experiential_learning_experience_as_the_source_of_learning_and_development

Artificial intelligence (ChatGPT, OpenAI, 2025) was used to assist with formatting and grammar editing only.

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WHY IS MATERNAL AND CHILD HEALTH IS IMPORTANT TO SOCIETY

Maternal and child health forms the foundation of a healthy society. A mother’s physical and emotional wellbeing directly influences pregnancy outcomes, infant survival, early development, and long-term health trajectories.

Healthy mothers lead to healthy children because a mother’s physical and mental well-being directly affects the fetal outcomes, how the child develops, and the child’s long-term health. Poor maternal health such as malnutrition or mental issues can result in low birth weight, developmental delays, and long-term impairments in children (Puji Rahayu et al., 2024).

Maternal and child health is also important for decreasing maternal and infancy mortality rate. Without the appropriate intervention for the prenatal, childbirth, and postnatal care, pregnant women and infants pregnant are at greater risk of complications and death (Albarqi, 2025).

Now how can a society thrive if its mothers are unsupported and overwhelmed?

MCH is not only a health issue it affects social stability and economic productivity! Now why do I say this, some mothers do work so imagine if she or the child are not in a healthy space the social stability and economic productivity will be affected. And a healthy early childhood development are associated with better school readiness (Open Access Pub, 2020). This then creates a long-term societal benefits and reduces future healthcare costs.

And now the questions are: Can we truly speak about economic development without investing in maternal and child wellbeing? Are we preventing future societal challenges, or merely responding to crises after they arise?

IMPLICATIONS FOR OCCUPATIONAL THERAPY PRACTICE (ESPECIALLY AT COMMUNITY LEVEL)

Occupational therapists have a direct and a major role in maternal and child health. Such as postnatal support and mental health.

Because maternal health isn’t only physical its also emotional and psychological which are all essential. Studies indicate that postnatal stress, depression, and fatigue can negatively affect mothers' capacity to care for themselves and their children and can influence attachment and child development (Puji Rahayu et al., 2024). OTs can help mothers manage transitions in daily routines, build coping strategies and promote self-care practices to prevent mental health difficulties from affecting family wellbeing. Sometimes I cannot help but wonder, what does “meaningful occupation” look like for a new mother?

Maternal health impacts early childhood outcomes. Children born to mothers with poor health are at greater risk for developmental delays, sensory-motor challenges, and participation barriers later in life (Puji Rahayu et al., 2024). OT involvement in community-based early intervention programmes (e.g., mother-infant groups, developmental screenings, caregiver coaching) can reduce barriers to participation and support child development within the family context (Rencken et al., 2025).

OT at community level involves not only direct interventions but also health promotion and education. Empowering mothers with knowledge (e.g., nutrition, safe childcare practices, stress management) enhances the health of mothers and children collectively.

COMMUNITY-LEVEL IMPLICATIONS IN KENVILLE

In communities like Kenville socioeconomic challenges, unemployment, and limited access to resources can increase stress on mothers and families. Maternal health is not biological it is social, economic, and environmental.

Many residents rely on community health workers and primary health services for maternal and child care. Strengthening these services could reduce risks associated with maternal and infant morbidity. The 4th year OT’s offers opportunities for home visits, education sessions, and support groups that directly address maternal stress, child development, and parent–child occupations.

In Kenville, OT students help by providing developmental screenings, caregiver education, and mother-infant interaction support at clinics, schools, and homes. These services help ensure early detection of delays and reinforce healthy routines.

Well, some may ask: What barriers prevent mothers from accessing support in Kenville?

Maternal and child health is not equally accessible to all; socioeconomic barriers affect how and when women seek care. OTs can advocate for improved access, culturally relevant practices, and community empowerment so that mothers and children in Kenville have equitable opportunities to thrive.

                                                     References:

Albarqi, M. N. (2025). The Impact of Prenatal Care on the Prevention of Neonatal Outcomes: A Systematic Review and Meta-Analysis of Global Health Interventions. Healthcare, 13(9), 1076. https://doi.org/10.3390/healthcare13091076

Open Access Pub. (2020). Openaccesspub. Open Access Pub. https://www.openaccesspub.org/womens-reproductive-health/maternal---child-health?

Puji Rahayu, T., Suparji, S., Wahito Nugroho, H. S., Sulikah, S., Setiyani, A., Nuryani, N., & Hanifah, A. N. (2024). Impact of maternal health on child development: why early intervention is crucial? (a commentary). PAMJ-One Health, 15(19). https://doi.org/10.11604/pamj-oh.2024.15.19.45308

Rencken, G., Uys, C. J. E., & Govender, P. (2025). Development of content for an early intervention mother-infant programme for vulnerable infants. South African Journal of Occupational Therapy, 55(1), 1–8. https://doi.org/10.17159/2310-3833/2025/vol55no1a6

Artificial intelligence (ChatGPT, OpenAI, 2025) was used to assist with formatting and grammar editing only.