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: +27 12 395 8000
Gift of the Givers Foundation - https://giftofthegivers.org/ Phone: +27 21 276 1150
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












