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What Kenville Taught Me About Being Human Before Being an Occupational Therapist

“What counts in life is not the mere fact that we have lived. It is what difference we have made to the lives of others.” (Mandela, 2002)

When I first entered the Kenville community in Durban, I thought I was arriving as a student occupational therapist prepared to help others. I believed I would bring knowledge, intervention ideas, health promotion strategies, and therapeutic skills into the community. What I did not expect was that the community would become my teacher. Entering the Kenville community changed not only my understanding of occupational therapy, but also my understanding of humanity, dignity, and community itself.

This placement has not only shaped my professional identity but also challenged my values, assumptions, and understanding of what it means to practice occupational therapy in a South African context. Kenville forced me to confront uncomfortable realities about inequality, access to healthcare, poverty, education, and dignity. More importantly, it taught me that occupational therapy in the community is not about “fixing” people. It is about walking alongside them.

At the Kenville clinic, we screened patients daily and participated in ongoing health promotion activities. On paper, these tasks may appear simple. However, behind every screening form was a person carrying invisible burdens such as unemployment, chronic illness, stress, violence, hunger, poor housing, and limited access to resources. I began to understand that occupation cannot be separated from context. A person cannot fully engage in meaningful occupations when survival itself becomes the primary occupation (Wilcock & Hocking, 2015).

This reminded me of the work of Elelwani Ramugondo, who discusses occupational consciousness and the need for therapists to recognise how social and political systems shape people’s opportunities for occupation (Ramugondo, 2015). In Kenville, occupation was deeply political. Something as ordinary as handwriting difficulties in a child was connected to overcrowded classrooms, under-resourced schools, family stress, and unequal educational opportunities. Health was never just health. Disability was never just disability. The image gives a deeper explanation of occupational consciousness.

Working in crèches and schools transformed my understanding of prevention and early intervention. At the crèches, we saw children with developmental delays and worked towards school readiness. At primary schools, much of our intervention focused on handwriting and learning difficulties. In high schools, we addressed stress management, bullying, emotional wellbeing, and coping skills. Initially, I saw these as isolated intervention areas. Over time, I realised they are all connected through occupation, identity, and participation.

One of the greatest lessons I learnt was the importance of listening before acting. Communities do not need therapists who arrive believing they have all the answers. They need therapists who can listen, collaborate, and respect lived experience. As African philosophy teaches through Ubuntu “umuntu ngumuntu ngabantu” a person is a person through other people (Tutu, 1999). This principle became visible in Kenville. Healing happened collectively. Teachers supported learners beyond academics. Community healthcare workers knew families personally. Care was relational. The below image shows the Africa philosophy.

Professionally, I have grown in confidence, communication, adaptability, and cultural humility. I learnt how to explain health information in ways that people understand. I learnt that professionalism is not measured only by clinical knowledge, but by empathy, consistency, respect, and presence. Some days there were no perfect interventions, no expensive resources, and no ideal therapy spaces. Yet meaningful occupational therapy still happened through creativity, relationships, and responsiveness to community needs.

Personally, this placement disrupted many of my own assumptions. I realised how easy it is to unintentionally view communities through a deficit lens, focusing only on problems instead of strengths. Kenville is not defined only by hardship. It is also defined by resilience, humour, support systems, culture, and persistence. I saw caregivers continue despite exhaustion. I saw learners show determination despite barriers. I saw communities creating spaces of hope even when systems fail them. The image below shows that community working together lead to success.

This experience also deepened my awareness of power relations within healthcare and education systems. As students and future professionals, we often occupy positions of privilege because of our education. However, community practice taught me that knowledge is not owned only by professionals. Communities themselves hold valuable knowledge about survival, adaptation, and participation. Decolonising occupational therapy means recognising African ways of knowing and ensuring that therapy is relevant to local realities rather than imported ideals (Freire, 1970).

As I prepare for other blocks and community service, I carry more than clinical skills with me. I carry questions. How do we create healthcare systems that are truly accessible? How do we advocate for occupational justice in under-resourced communities? How do we ensure that therapy does not become disconnected from the realities people live in daily?

Community service, for me, is no longer just a requirement before independent practice. It is an ethical responsibility. It is about entering communities with humility, recognising systemic injustice, and using occupational therapy as a tool for empowerment rather than authority. Kenville taught me that occupational therapy is not confined to hospitals or therapy rooms. It exists in classrooms, clinics, homes, playgrounds, and conversations. It exists wherever people strive to participate meaningfully in life despite barriers. Most importantly, Kenville taught me that before becoming a good occupational therapist, I must first become a better human being. The image below shows the space used in Kenville clinic to provide services which shows that OT happens everywhere.

Resources and Links

South African Society of Occupational Therapy (OTASA) Supports occupational therapists through advocacy, professional development, ethical practice guidance, and community-based healthcare initiatives within South Africa.

World Federation of Occupational Therapists (WFOT) Promotes occupational therapy internationally through research, education, human rights advocacy, and community-centred practice.

Department of Health South Africa Provides information on South African public healthcare policies, health promotion programmes, primary healthcare services, and community health initiatives.

South African Journal of Occupational Therapy (SAJOT) Publishes South African occupational therapy research focused on community practice, occupational justice, disability, education, and culturally relevant interventions.

References

Freire, P. (1970). Pedagogy of the oppressed. Continuum.

Mandela, N. (2002). Nelson Mandela’s address to the Nelson Mandela Foundation launch.

Ramugondo, E. L. (2015). Occupational consciousness. Journal of Occupational Science, 22(4), 488–501.

Tutu, D. (1999). No future without forgiveness. Rider.

Wilcock, A. A., & Hocking, C. (2015). An occupational perspective of health (3rd ed.). Slack Incorporated.

Image 1-https://www.researchgate.net/publication/279280483_Occupational_Consciousness

Image 2- https://www.thecollector.com/ubuntu-philosophy-introduction/

Image 3- https://www.jrossrecruiters.com/blog/strong-community-connections-are-key-hospitality-success

Image 4- Taken by the student.

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Small Changes, Loud Resistance: Whose Development Counts in Kenville?

“Until the lions have their own historians, the history of the hunt will always glorify the hunter.” I keep returning to this proverb because it unsettles the way development is often spoken about. It makes me question whose voices are shaping the narrative and whose realities are being simplified or ignored. In Kenville, I did not find a community waiting to be developed. I found people already working, organising, and surviving within systems that continue to exclude them. This forced me to confront an uncomfortable truth that development is not neutral. It is shaped by power, history, and by whose knowledge is taken seriously.

This realisation has shifted how I intend to engage with the Sustainable Development Goals. They are often presented as universal, but in practice, they must be interpreted within context. For me, this means grounding them in what is already happening in Kenville and being intentional about how I position myself within that process.

In working toward SDG 1: No Poverty, I am becoming more aware that poverty here is not simply about income. It is about instability, limited access to opportunities, and systems that make it difficult for people to move forward. What stood out to me is that people are not passive, but they are already engaging in ways to generate income, such as through the KITE project. My intention is to support these efforts in practical ways such facilitating conversations around budgeting that are linked to actual income, helping structure pricing within the project, and identifying ways to connect the initiative to more sustainable sources of support. Mkandawire (2005) argues that poverty in African contexts must be understood within broader socio-economic systems, and this has pushed me to move away from individualised solutions toward more collective, context-driven approaches. Below is the KITE project.

When engaging with SDG 3: Good Health and Well-being, particularly mental health, I have had to rethink what “care” looks like. I have seen that medication adherence is not just about following instructions, but it is shaped by stigma, daily routines, and how people understand their condition. Moving forward, I intend to focus on integrating health practices into everyday life by developing routine-based strategies that are simple and realistic. I also plan to be more intentional about communication, using isiZulu and culturally relevant explanations to ensure that interventions are understood and meaningful. My approach to mental health within the community is guided by a holistic understanding of care, as illustrated by picture below. The image highlights that effective mental health practice is not limited to treatment, but includes building therapeutic relationships, reducing stigma, integrating recovery, and advocating for systemic change. In my work in Kenville, I intend to apply this by not only supporting clients individually, but also creating safe spaces for discussion, challenging stigma, and engaging in community-level advocacy. This aligns with the understanding that mental health is shaped by social context and relationships, rather than existing only at an individual level (Swartz, 1998).

SDG 4: Quality Education has also taken on a different meaning for me. In Kenville, learning is not confined to classrooms because it happens through doing, observing, and sharing. I intend to work toward this goal by creating opportunities for peer learning during activities, encouraging individuals to take on leadership roles, and recognising that knowledge exists within the community. This requires me to step back from the role of “expert” and allow learning to be more participatory. Freire (1970) speaks about education as a process of liberation, but in this context, it also reflects African ways of knowing that prioritise collective learning. This has challenged my previous assumptions and continues to shape how I approach teaching.

In relation to SDG 8: Decent Work and Economic Growth, I have started to think more critically about what counts as work. Many people in Kenville are engaged in meaningful occupations, but these are often informal and undervalued. My intention is to support these activities by strengthening skills, improving organisation within projects, and reinforcing a sense of dignity in what people are already doing. This includes helping individuals recognise the value of their roles and contributions. Standing (2011) discusses how precarious work affects identity and security, and I have seen how important it is to acknowledge both the challenges and the resilience present in informal economies.

The most challenging, but also the most necessary, is SDG 10: Reduced Inequalities. This is where the political dimension of my practice becomes unavoidable. Inequality in Kenville is not accidental as it is shaped by historical and structural factors that continue to influence access to resources. Ndlovu-Gatsheni (2013) argues that these inequalities are rooted in colonial legacies that are still present today. This has forced me to reflect on my own position within these systems. As a student, I carry a certain level of privilege through my education and institutional affiliation. If I am not careful, I can easily reproduce the same power imbalances I am trying to challenge.

Because of this, my intention is not only to support individuals but also to engage more critically with the systems around me. This includes advocating for resources where needed, questioning practices that exclude community voices, and being intentional about how I use my own voice. It also means recognising when to step back and allow space for others to speak. This is not comfortable work, but it feels necessary if I am serious about addressing inequality rather than simply working around it. The picture below shows advocating actions that can be done to reduce inequalities.

Reflecting on my own growth, I can see that my thinking has shifted from being task-focused to being more critically engaged. I have become more aware of how my assumptions shape my practice and how important it is to remain open to learning. I am also starting to understand that being a therapist in a community setting requires more than technical skills, but it requires reflexivity, humility, and a willingness to engage with complexity. I now see that working toward these SDGs requires action at multiple levels. At a community level, I intend to continue supporting initiatives like KITE in practical and sustainable ways. At an institutional level, I believe universities need to introduce community-based learning earlier so that students are better prepared for this kind of work. At a systems level, there needs to be greater recognition of informal economies and more support for community-led initiatives. Without these shifts, the burden of change continues to fall on communities that are already doing the most with the least.

If development continues to be defined without communities, it will continue to miss the point. If inequality is acknowledged but not challenged, it will remain unchanged. If we recognize resilience but do not support it, we risk romanticizing struggle instead of addressing it.

So, the question I am left with is this: am I willing to use my position not just to work in the community, but to challenge the systems that shape it?

Because if the answer is no, then everything else becomes performance.

RESOURCES

Free, culturally relevant mental health services (SDG 3)

Heal South Africa (Heal SA) Provides free mental health services, especially for youth and women, and focuses on culturally relevant care.

National mental health helplines and support groups (SDG 3)

South African Depression and Anxiety Group (SADAG) Offers free counselling, helplines, and nationwide support groups, reaching thousands daily.

 Community-driven development approach (SDG 1, 8, 10)

Indlela Mental Health – Asset-Based Community Development (ABCD) Explains how development should focus on community strengths, not deficits, and be driven by local people.

Community social development and advocacy networks (SDG 10)

African Alliance for Health & Rights Works across Africa to promote health rights, dignity, and community-led advocacy, helping communities hold systems accountable.

Community mental health and social cohesion work (SDG 3 & 10)

Khulisa Social Solutions Runs community dialogues and programmes to address stigma, trauma, and social inequality through grassroots engagement.

African social work and development knowledge hub (SDG 4 & 10)

Africa Social Work & Development Network (ASWDNet) Provides African-centred resources on development, decolonisation, and community practice.

REFERENCES

Freire, P. (1970). Pedagogy of the oppressed. Continuum.

Mkandawire, T. (2005). Targeting and universalism in poverty reduction. United Nations Research Institute for Social Development.

Ndlovu-Gatsheni, S. J. (2013). Coloniality of power in postcolonial Africa: Myths of decolonization. CODESRIA.

Standing, G. (2011). The precariat: The new dangerous class. Bloomsbury Academic.

Swartz, L. (1998). Culture and mental health: A Southern African view. Oxford University Press.

Picture 1- Taken by the student at the community.

Picture 2- https://www.researchgate.net/figure/Unique-contributions-of-psychiatric-nurses-a-framework_fig1_341094268

Picture 3- https://openlab.bmcc.cuny.edu/culture-in-ece/what-can-we-do-2/

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“We Were Sent to Observe, Not to Act”: Rethinking UKZN’s OT Curriculum for Community Practice

I remember standing outside a patient’s home during a community placement, holding a clipboard and watching a fourth-year student lead a home visit with confidence. She greeted the family, navigated the space with ease, and adapted her communication to the situation. I stood slightly behind her, observing quietly. At the time, I accepted this as part of the learning process. But when I reached fourth year and was expected to lead similar visits myself, I realised that I had never been practically taught how to do it. Observation had been mistaken for preparation.

The structure of the Occupational Therapy curriculum at the University of KwaZulu-Natal reflects a strong emphasis on theoretical grounding in the early years. First year focuses heavily on anatomy and foundational modules, which are essential for understanding the human body and the principles underpinning therapy. In second year, we engage in physical and psychosocial blocks, developing clinical reasoning and theoretical application. However, despite this academic progression, community engagement during these years remains largely observational. Even in third year, we returned to community settings, and our role often remained passive. It is only in fourth year that students are expected to actively engage in community-based practice, often with minimal structured preparation for practical skills such as home visits and patient screening.

This delayed transition from theory to practice creates a significant gap. While students may be academically competent, we often feel underprepared for the realities of Primary Health Care (PHC) settings. In South Africa, where healthcare is deeply shaped by inequality, poverty, and resource limitations, Occupational Therapists are required to work effectively within communities, not just clinical environments. The World Health Organization (2010) emphasises that community-based rehabilitation and PHC approaches require practitioners who are adaptable, culturally responsive, and practically skilled. Without early and consistent exposure to these practices, students may struggle to translate theoretical knowledge into meaningful intervention.

At the same time, the curriculum does demonstrate important strengths. Its holistic approach to health, integrating both physical and psychosocial perspectives, aligns with the core philosophy of Occupational Therapy as shown by the picture below. This prepares us as students to consider the person within their broader context, rather than focusing solely on diagnosis. Furthermore, the inclusion of community placements, even at an observational level, reflects an institutional recognition of the importance of socially responsive practice. This is particularly relevant in the South African context, where health policies advocate for a shift toward PHC and community-based care (Department of Health, 2011).

However, intention alone is not enough to ensure competence. The lack of structured, scaffolded training in community-based skills highlights a critical limitation. Practical skills such as conducting home visits, engaging with families, assessing environmental barriers, and performing screenings in low-resource settings are essential components of Occupational Therapy practice in South Africa. Yet these are often not practiced before students are expected to perform them independently. As Elelwani Ramugondo argues, Occupational Therapy in South Africa must actively address issues of occupational justice, which are rooted in systemic inequalities that limit individuals’ participation in daily life (Ramugondo, 2015). Without adequate preparation for community engagement, students may find themselves ill-equipped to address these complex realities.

This gap in training also reflects broader issues of power within healthcare education. Lesley Swartz highlights how health professions education can unintentionally reinforce hierarchical relationships, positioning professionals as experts and communities as passive recipients of care (Swartz, 2012). When students are primarily placed in observational roles, they may internalise this dynamic, learning to watch rather than to engage collaboratively. This not only limits their learning but also undermines the principles of client-centred and community-based practice.

Engaging with these ideas has shifted my own perspective significantly. Initially, I viewed my lack of practical skills as a personal shortcoming. However, through reflection, I began to understand it as a structural issue within the curriculum. This realisation has been both challenging and empowering. It has forced me to critically examine my role as a future practitioner and to recognise the importance of actively seeking learning opportunities beyond what is formally taught. It has also deepened my understanding of the kind of therapist I want to become, the one who is not only knowledgeable, but also confident and responsive in real-world contexts.

The implications of this gap extend beyond student experience to broader questions of equity and justice. When students are underprepared for community practice, it is often the communities themselves that bear the consequences. In under-resourced settings, where access to experienced healthcare professionals may already be limited, students are frequently required to take on significant responsibilities. Without adequate preparation, this can compromise the quality of care provided and perpetuate existing inequalities. In this way, curriculum design becomes a matter of social justice, influencing who receives effective care and who does not.

Addressing these challenges requires intentional and practical changes. Firstly, community-based skills should be introduced earlier in the curriculum, with structured opportunities for supervised practice. For example, second-year students could begin engaging in basic screenings or guided home visits, gradually building confidence and competence. Secondly, these skills should be scaffolded across all years of study, ensuring a progressive development rather than a sudden expectation of independence in fourth year.

In conclusion, the UKZN Occupational Therapy curriculum provides a strong theoretical foundation and demonstrates a commitment to community engagement. However, the gap between knowledge and practice, particularly in relation to community-based skills, limits students’ preparedness for PHC settings. As future Occupational Therapists, we are called not only to understand health, but to actively engage with the conditions that shape it. This requires more than observation it requires practice, reflection, and a curriculum that supports both. If we are to contribute meaningfully to equitable healthcare in South Africa, we must be trained not just to know, but to act.

RESOURCES

World Health Organization – Community-Based Rehabilitation Guidelines. Download CBR Guidelines

WHO / UN CBR Framework (Expanded version). Full CBR Guidelines (NCBI)

Reference List

Department of Health. (2011). National Health Insurance in South Africa: Policy Paper. Pretoria: Department of Health.

Ramugondo, E. (2015). Occupational justice: A conceptual review. South African Journal of Occupational Therapy, 45(1), 29–33.

Swartz, L. (2012). Able-bodied: Scenes from a curious life. Cape Town: Zebra Press.

World Health Organization. (2010). Community-based rehabilitation: CBR guidelines. Geneva: WHO.

Picture 1- https://surgery.wustl.edu/three-aspects-of-health-and-healing-the-biopsychosocial-model/

Picture 2- https://www.instagram.com/p/C0CNNhzMAJ4/

Picture 3- https://www.dreamstime.com/photos-images/thoughtful-african-american-young-man-writing-clipboard.html

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Beyond the Clinic Walls: Why Maternal Health is the Blueprint for a Thriving Society

“Maternal and child health is what we do together as a society to ensure the conditions in which all women, children, and families can be healthy” (Lu, 2018).

When I first saw this statement in Michael Lu's analysis, I had to pause. Not because it was complicated, but because it was very simple. It reframes health as a community, societal commitment, rather than an individual medical event (a successful delivery, a clean immunization record). We frequently talk about "saving the children" or "supporting mothers" as moral values. But what if we viewed it as something more essential? What if maternity and child health is the single most effective tool we have for creating a resilient, fair, and successful society?

The World Journal of Advanced Research and Reviews' (2024) global review makes it obvious that good MCH policies are more than just clinics and doctors. They are "key players in the broader picture of public health". However, as an OT student working in a community setting, I find myself asking a provocative question: If MCH is so vital, why is our profession so often overlooked in these discussions? More importantly, how can I, as a future practitioner, go beyond the role of technician to become a meaningful advocate for the societal conditions that enable moms and children to thrive?

Before engaging with these readings, my understanding of MCH in OT was narrow. I thought of it as postpartum home visits to check a new mother’s physical recovery, emotional health or developmental screenings for infants. But then I read that 38% of American kids now have a chronic health condition, and rates of anxiety and depression are rising (Lu, 2018). This was an issue. I realised my clinical thinking was too limited. To properly honour the value of MCH I can't simply wait for a referral to "fix" a feeding or sensory issue. By then, the initial stage determinants had already caused damage. A mother suffering from postpartum depression in a dangerous and disadvantaged neighbourhood requires more than simply coping strategies, she also requires safety, community, and economic security. Her child's ability to "do" childhood occupations like play, learn, and sleep depends on these conditions.

What does this mean for community-based occupational therapy practice? I notice two non-negotiable moves based on the readings.

First, our operational structure needs to be based on a "life-course perspective." Policies must go "beyond childbirth to adolescence and beyond," according to The World Journal (2024). This implies that OT's job begins prior to the birth of a child. Preparing for motherhood is a pregnant teen's main occupation, but her capacity to do so is influenced by prenatal education, school policies, and transportation availability. Co-creating prenatal programs that target not only physical health but also the social and environmental factors that support maternal role competency could be part of community-based occupational therapy.

Second, we must support "precision MCH" while advocating for equity. Lu (2018) envisions a future of personalised care using wearables, AI, and big data. However, he cautions: "technology can widen health disparities if there is differential access". In my community, which is under-resourced, the "high-tech" solution will not arrive. However, "high-touch" community engagement will. The case study of Ghana in the World Journal (2024) demonstrates that community health workers are the true technology. For occupational therapists, this involves educating local leaders, co-creating culturally relevant home programs, and utilizing mobile health platforms as a bridge to human interaction rather than a replacement.

I am no longer happy with being a well-meaning clinician downstream, rescuing children from the river. According to the global review, the "greatest benefits in MCH will continue to come from improving social conditions" (Lu, 2018). That is not the responsibility of a social worker or a politician alone. That is the responsibility of any profession that purports to value doing, being, and becoming.

My call to action does not address another person. It is to myself and my occupational therapy colleagues, let us earn a seat at the MCH policy table. Let us learn to communicate the language of "health in all policies" (Lu, 2018). Let us use our unique lens to show that when a mother has access to paid parental leave, a child has a secure attachment. When a society invests in MCH, it is not spending money; it is building its own future.

A thriving society doesn't just happen. It is built, one policy, one relationship, one community at a time. And as occupational therapists, we have an important role to play in its development.

REFERENCES

Lu, M. C. (2018). The future of maternal and child health. Maternal and Child Health Journal, 23(1), 1–7.

World Journal of Advanced Research and Reviews. (2024). Maternal and child health policies: Current practices and future directions. World Journal of Advanced Research and Reviews, 21(2), 1770–1781.

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The Good, The Bad, and The Ugly

“If you want to go fast, go alone. If you want to go far, go together.” - African Proverb

Community fieldwork has a way of humbling you. It doesn’t hand you neat clinical cases, but it throws you into the deep end of humanity where the “good,” “bad,” and “ugly” coexist in one space. As I look back on my first and second community rotations, I see more than community placement and health talks. What I see is growth, disruption, and purpose taking root. At Kenville Community Clinic, “the good” was found in the smallest moments like a child’s laughter during a play activity, a nod of understanding from a caregiver, or a youth choosing to stay and listen during a sexual health talk. These moments reminded me that occupational therapy thrives on connection by engaging in health promotion, informal childcare visits, and youth education I witnessed the essence of OT which is enabling participation despite barriers. Applying MOHO (Kielhofner, 2008) helped me see how even brief interventions could ignite volition that spark of motivation to act meaningfully. It was fulfilling to see teens begin to reflect on their health choices. These victories were meaningful though small because they represented occupational justice in action by empowering people to engage in roles and routines that matter to them (Townsend & Wilcock, 2004). They reminded me that the power of OT lies not in consistent and compassionate presence.

“The bad” became clear on days when exhaustion overshadowed hope. Walking into the clinic and seeing patients waiting since sunrise for care, only to leave unseen, was deeply unsettling. Our health promotion efforts often competed with hunger, fatigue, and frustration. It wasn’t disinterest but was systemic fatigue which is a product of long-standing inequalities in the public health system (Abrahams et al., 2021). I initially felt helpless as a student because I asked myself that “how could health talks matter when people’s basic needs were unmet?’ I began to recognize that advocacy is also intervention through supervision and reflection. OT is not limited to the intervention setting it also extends to challenging unjust systems. I learned to adapt by adjusting the timing of health talks, engaging with nurses for collaboration, and acknowledging the community’s struggles rather than ignoring them. This experience shifted my view of health promotion that it is not a one-way transfer of knowledge, but a dialogue grounded in empathy and context. I learned that an effective community OT begins by listening, not lecturing.

The “ugly” moments were uncomfortable but transformative. Seeing men arrive intoxicated on Monday mornings asking for medical excuses and children left in overcrowded informal childcare centers revealed the deep intersection between poverty, substance abuse, and social exclusion (Iyejare, 2023). I realized how easy it is to blame individuals for their circumstances without understanding the systemic barriers shaping their choices. Drawing from Hammell (2020) and Mthembu (2021), I learned that true OT advocacy means addressing occupational injustices promoting not only participation but also fairness and dignity. My community experiences have shown me that being an OT is not about saving people but it’s about standing with them as allies in rebuilding their own capacity to thrive. Community fieldwork has prepared me for fourth year not by perfecting my skills, but by deepening my humanity. I have learned that the good gives hope, the bad builds resilience, and the ugly fuels advocacy.

“We don’t fix people as OTs, but we facilitate their rediscovery of meaning.”

REFRENCES

Abrahams, Z., et al. (2021). Systemic challenges in South Africa’s public health system: A review. South African Medical Journal, 111(4), 321–327.

Hammell, K. W. (2020). Engagement in living: Critical perspectives on occupation, rights, and wellbeing. Routledge.

Iyejare, O. (2023). Substance use and unemployment among South African youth. Journal of Social Development in Africa, 38(1), 55–72.

Kielhofner, G. (2008). Model of Human Occupation: Theory and application. Lippincott Williams & Wilkins.

Mthembu, T. (2021). Occupational justice and inclusion in South African communities. South African Journal of Occupational Therapy, 51(1), 34–41.

Townsend, E. & Wilcock, A. A. (2004). Occupational justice and client-centred practice: A dialogue in progress. Canadian Journal of Occupational Therapy, 71(2), 75–87.

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Movie that has a mental health them

Watching A Beautiful Mind (2001) is a film based on the life of mathematician John Nash who lived with schizophrenia deeply shifted my understanding of the intersection between mental health, occupation, and professional practice. As an Occupational Therapy student the film invited me to reflect not only on the lived experiences of individuals facing psychiatric conditions but also on how these challenges influence their daily occupations, identity, and participation in society.

At first I watched Nash’s experiences through the lens of “illness” due to his hallucinations, paranoia, and struggles with relationships. However as the story went on, I realized how easy it is to reduce a person to their diagnosis. This challenged me to disrupt my own thinking that Nash was not “a schizophrenic,” but a man with rich capabilities, passions, and relationships. The disruption of his roles as a husband, parent, and academic demonstrated how mental health issues may affect multiple aspects of one's life. This movie encouraged me to be more mindful of how I perceive and describe individuals.

The film highlighted the necessity of holistic OT practice in mental health. I observed how Nash’s illness disrupted his occupational balance, with prolonged withdrawal from social life and teaching, and how his recovery was supported by structured routines, medication adherence, and social support. It reinforced my belief that OT practitioners can facilitate recovery not only through skills training but also by enabling participation in meaningful occupations that restore identity. I recognized the importance of MDT as psychiatry provided symptom management but ongoing engagement in meaningful tasks supported Nash’s long-term stability. This has shifted my perspective on practice that I must not only focus on deficits but actively enable resilience and inclusion (Creek & Lougher, 2011).

When linking this to fieldwork experiences I recalled working with a patient with bipolar mood disorder who, like Nash faced stigma and occupational disruption. In both cases the challenge was not only the diagnosis, but also societal perceptions and environmental barriers. Research has shown that stigma remains one of the greatest barriers for individuals with schizophrenia to return to work, study, or community participation (Corrigan et al., 2014). This movie raised critical questions for me like How often do health professionals unintentionally reinforce stigma? How can OT better advocate for systemic change in universities, workplaces, and communities to enable participation for people with psychiatric conditions?

This film resonated with OT models I have studied. The Model of Human Occupation (MOHO) explains how volition, habituation, and performance capacity interact with environment (Kielhofner, 2008). Nash’s volition remained strong, but environmental barriers like stigma, institutionalization, and loss of occupational roles disrupted his occupational identity and competence. This demonstrates how OT can restore balance by targeting both individual skills and contextual support. Similarly, the Person-Environment-employment (PEO) Model reminded me that Nash's occupational dysfunction was caused not only by personal problems, but also by a poor fit between person, environment, occupation (Law et al. 1996).

"A Beautiful Mind" revealed to me the significant occupational challenges that people with mental illnesses experience as well as the opportunities for resilience and healing when meaningful occupations are restored. As an occupational therapy student I learned an important lesson which is to see the individual before the diagnosis, use occupation as an instrument for identification and inclusion, and advocate against stigma in all practice settings. This perspective challenges me to become a practitioner who not only treats but also empowers others.

References

Creek, J., & Lougher, L. (2011). Occupational therapy and mental health (4th ed.). Elsevier Health Sciences.

Kielhofner, G. (2008). Model of Human Occupation: Theory and application (4th ed.). Lippincott Williams & Wilkins.

Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63(1), 9–23. https://doi.org/10.1177/000841749606300103

Image 1- https://www.facebook.com/tasneemabrahamsOT/posts/what-are-occupations-according-to-occupational-therapyi-found-this-great-graphic/317753467481982/

Image 2- https://www.aota.org/practice/domain-and-process

Image 3- https://occupationaltherapyot.com/model-of-human-occupation-moho-frame-of-reference/amp/ Image 4- https://www.myotspot.com/peo-model-and-brain-injury/

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THE ROLE OF OT IN THE COMMUNITY

“Health is created and lived by people within the settings of their everyday life” (World Health Organization, 1986). This statement captures the essence of Occupational Therapy in community settings, where promoting participation in meaningful occupations is as important as treating illness. At Kenville Community Clinic, I experienced firsthand the barriers and opportunities that shape people’s health, from engaging high school learners on sexual health to interacting with community members at the clinic gates. They revealed how OT extends beyond hospital walls into the realities of daily life.

Arriving in the afternoon we noticed how community members were disinterested during our health promotion talk which made me realize that timing, accessibility, and the unmet expectations of waiting for medical care significantly impact participation. This challenged me to think critically about how OTs can adapt health promotion to suit context for example, by collaborating with nurses earlier in the day. Working with children in informal childcare setups highlighted the vulnerability of young ones whose mothers work long hours. I recognized the potential OT role in supporting caregivers with structured play routines and early stimulation activities, ensuring children’s development is not compromised (Scaffa & Reitz, 2014).

Our role play with high school learners on pregnancy prevention and condom use was met with mixed reactions due to that some were engaged while others laughed. This taught me that as OTs we must use creative, age-appropriate methods and recognize that health education requires persistence and trust-building. The encounter with intoxicated men seeking doctor’s letters emphasized the broader social determinants of health, including unemployment, substance abuse, and poor coping strategies. Here, OTs can intervene by advocating for community-based rehabilitation and life skills programmes to foster healthier routines and choices (Lal, 2010).

All these experiences raised questions about how health promotion is delivered in underserved communities, if people are disengaged due to long waiting times or socio-economic stressors, how effective are our interventions? OT in the community must balance prevention, empowerment, and advocacy. For example, while our role play addressed teenage pregnancy, the broader issue of poverty influencing risky behaviour was evident. This taught me that health education cannot be isolated from the lived realities of the people we serve.

Community-based OT emphasizes participation, empowerment, and occupational justice (Townsend & Wilcock, 2004). At Kenville, our experiences reflected barriers to occupational engagement such as waiting systems, unemployment, and limited recreational opportunities. According to Hammell (2020), OTs must challenge systemic inequalities by promoting occupational rights, not just individual rehabilitation.

The experience at Kenville Clinic revealed that OT in the community is not only about health promotion but also about understanding context, adapting interventions, and addressing barriers to participation. The disinterest of clinic attendees, the vulnerability of children in informal care, and the complex realities of teenagers and unemployed adults all showed me that OTs must step into roles of facilitators, educators, and advocates. The challenge is to move beyond one-off sessions toward sustainable, community-driven change. As future practitioners, we must ask ourselves: How can we design community OT programmes that not only teach but transform?

REFRENCE LIST

Hammell, K. W. (2020). Engagement in living: Critical perspectives on occupation, rights, and wellbeing. Routledge.

Lal, S. (2010). Prescribing recovery-oriented practices in mental health occupational therapy. Canadian Journal of Occupational Therapy, 77(5), 302–309.

Scaffa, M. E., & Reitz, S. M. (2014). Occupational therapy in community-based practice settings. FA Davis.

Townsend, E., & Wilcock, A. A. (2004). Occupational justice and client-centred practice: A dialogue in progress. Canadian Journal of Occupational Therapy, 71(2), 75–87.

World Health Organization. (1986). Ottawa Charter for Health Promotion. WHO.

Image 1 https://www.istockphoto.com/photos/kids-community-service

Image 2 https://www.saot.ca/promoting-ot/ Image 3 https://otpotential.com/blog/community-occupational-therapy

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GETTING TO THE HEART OF COMMUNITY

Name: Minenhle Lembede

A community is more than a geographic location, it is a dynamic network of relationships, shared values, and collective resilience. In public health, a community is often defined as a social unit where individuals interact and collaborate to improve health outcomes and address common challenges (Hove et al., 2022). In South Africa, this concept is deeply rooted in the principles of Ubuntu where interconnectedness and mutual care form the backbone of survival especially in underserved areas.

We arrived at the Kenville community clinic on a Monday afternoon and went to do health promotion, but we were greeted not by enthusiasm but by exhaustion. Many of the patients had been waiting since morning, hoping to be seen by nurses and were already overwhelmed by the demand. Our health promotion efforts were met with limited engagement which at first felt discouraging, but this was not that they were not interested it was the fatigue of a community accustomed to waiting to being underserved. This moment echoed broader systemic challenges in South Africa’s public health sector, where long wait times and staff shortages are common (Abrahams et al., 2021). Health promotion cannot thrive in spaces where basic access is still a struggle.

Later we visited children being cared for by a woman in the community, which is an informal childcare arrangement that allows working mothers to pursue employment or errands. These setups though unregistered are vital in low-income areas where formal early childhood development centres are inaccessible or underfunded (Project Preparation Trust, 2014). This caregiving reflects the resilience of women who fill systemic gaps with communal solutions.  

Outside the clinic we sold second-hand clothes priced between R5 to R20. Sales were slow but revealing. A few men arrived intoxicated seeking doctor’s letters to excuse their absence from work on a Monday. This moment showed the intersection of substance abuse and unemployment. In South Africa alcohol and drug addiction are increasingly linked to youth unemployment and diminished productivity (SABC News, 2025). Substance use is often a coping mechanism in communities facing economic hardship and social exclusion (Iyejare, 2023)

Personally, I felt a shift because I entered Kenville with no plan, but I left with a perspective. As an Occupational Therapy student, I saw the importance of empathy, flexibility, and cultural humility. The community doesn’t need saviours, but they needed listeners and allies. This experience deepened my understanding of occupational justice, which emphasizes equitable access to meaningful occupations and the right to participate fully in society (Mthembu, 2021). Health promotion must go beyond education it must advocate for systemic change.

Kenville is not just a clinic site, it is a mirror reflecting the resilience and struggles of its people. Behind every disengaged glance is a story. Behind every drunk Monday morning is a system that needs healing. And behind every child being cared for by a neighbour is a community that refuses to give up.

To truly get to the heart of community, we must listen not just with our ears but with our hearts.

REFERENCES

Abrahams, G. L., Thani, X. C., & Kahn, S. B. (2021). South African public primary healthcare services and challenges. University of South Africa. https://journals.co.za/doi/pdf/10.10520/ejc-adminpub_v30_n2_a7

Iyejare, O. (2023). The problem of substance abuse in South Africa: Causes & effects. Self-Discovery Blog. https://theselfdiscoveryblog.com/the-problem-of-substance-abuse-in-south-africa-causes-effects/

Hove, J., D’Ambruoso, L., Kahn, K., Witter, S., van der Merwe, M., Mabetha, D., Tembo, K., & Twine, R. (2022). Lessons from community participation in primary health care and water resource governance in South Africa: A narrative review. Global Health Action, 15(1), 2004730. https://doi.org/10.1080/16549716.2021.2004730

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. https://scielo.org.za/pdf/sajot/v51n1/09.pdf

Project Preparation Trust. (2014). Informal early childhood development centres in informal settlements in South Africa. https://www.pptrust.org.za/wp-content/uploads/ecd-centres-in-informal-settlements-full-report.pdf

SABC News. (2025, June 15). Drug, alcohol addiction fuelling youth unemployment. https://www.sabcnews.com/sabcnews/drug-alcohol-addiction-fueling-youth-unemployment/

Image- https://www.alamy.com/african-patients-in-hospital-waiting-room-image5451646.html

Image- https://www.shutterstock.com/image-vector/ubuntu-arms-holding-each-other-teamwork-342964172

Image- https://en.wikipedia.org/wiki/Child_care

Image- https://twyg.co.za/selling-secondhand-clothes-is-a-bustling-trade-in-mfuleni/