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[survivingot]

From Lecture Halls To Beyond The Walls: Is Community Practice The Better Teacher?

Walking through a community like Kenville as an “outsider” has started to feel like a privilege. The respectful nods from those whom we pass, the cheerful greetings from familiar faces who have passed through the clinic and the joyful screams from the young ones within the crèche have stirred within me feelings of a warm welcome, appreciation, and dare I say belonging. As I spend each day in Kenville, I’ve found myself observing far more that I have ever expected, not only in the people around me but within myself. Somewhere between these interactions with clinic patients, conversations with caregivers and walking amongst the stores and homes as we navigate to our sites, I realised that I was no longer asking, "What intervention should I provide?" Instead, a different question has begun to surface: What does it actually mean to be prepared for community practice?

(A glimpse at a part of the Kenville Community through the bus window)

I entered my final year of Occupational Therapy at UKZN believing that preparation meant knowledge. If I was asked if I was prepared, I would look to my understanding of anatomy, mastering of assessment tools, memory of developmental milestones and how to select an appropriate frame of reference. Although I acknowledge that those things are undoubtedly important—they form the language of our profession- Kenville has shown me that community Occupational Therapy speaks another language as well: one of relationships, adaptability, humility and partnership.

(Snapshot of personal lecture notes on Primary Healthcare taken in my first academic block of my final year)

As I reflect over this week, I have discovered something profound: the curriculum has taught me what Occupational Therapy is. Kenville is teaching me how to be an Occupational Therapist. Community practice has challenged me in ways that no practical examination ever could. At university, learning theoretically made intervention feel structured and predictable. In Kenville, every home, every family and every conversation tells a different story. People's occupations are influenced by far more than physical ability. They are shaped by transport, employment, housing, education, safety, culture and access to resources. These realities cannot simply be acknowledged in an assessment—they must become part of our clinical reasoning.

The Alma-Ata Declaration reminds us that "health is a fundamental human right" (World Health Organization [WHO], 1978). Before this placement, I understood those words academically. In Kenville, I have begun to understand them personally. It has encouraged me to think differently about primary healthcare. Rather than viewing it as the small part of medical care, I now see it’s true importance. It is the place that provides hope, through healthcare, in the lives of each community member.

This week has also introduced me to the concept of occupational consciousness. Ramugondo (2015) encourages Occupational Therapists to become aware of how history, power and inequality shape people's everyday occupations. As I have spent more time within the community, I have started to notice these influences more consciously. Occupations in Kenville are not simply personal choices; they are shaped by opportunities that society either provides or withholds. Recognising this has challenged me to look beyond individual performance and consider the broader systems that enable or restrict participation for each of my clients.

Kenville is making me question my political beliefs and support, something which I find extremely relevant as we approach the 2026 elections. Throughout our degree we have frequently engaged in discussions about occupational justice. Whilst those conversations have been integral to our education, I believe that it is only through this opportunity on the ground that I have found myself contemplating on the political sphere in terms of our healthcare system. It has made me question whether our healthcare system truly provides equitable opportunities for participation. If occupation is central to health, why do some communities continue to face barriers that limit their ability to engage in everyday life over 30 years post Apartheid? Why should the quality of healthcare, education or occupational opportunities differ depending on where a person lives? These questions have no simple answers, but they have strengthened my belief that Occupational Therapists have a responsibility not only to provide interventions but also to work towards more just and inclusive communities.

As I continue to learn each day, I have realised that university can never be expected to prepare me for every situation I will encounter in a field as diverse and dynamic as Occupational Therapy. It has however trained me in something far more valuable: the ability to think critically, reflect honestly and continue learning from every person I meet. Kenville is teaching me that competence cannot be measured by having all the answers. It is measured by being willing to listen before speaking, to learn before leading and to work with communities rather than for them.

Perhaps that is what being prepared truly means. Perhaps, somewhere between the lecture hall and the community, I am not only learning how to practise Occupational Therapy—I am beginning to develop into the kind of Occupational Therapist my lecturers have encouraged me to become.

References

Galvaan, R. (2015). Occupation-based community development and occupational justice in South Africa. South African Journal of Occupational Therapy, 45(1), 3–6.

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

Townsend, E., & Wilcock, A. A. (2004). Occupational justice. In C. H. Christiansen & E. A. Townsend (Eds.), Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation (pp. 243–273). CAOT Publications ACE.

World Health Organization. (1978). Declaration of Alma-Ata.

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

[survivingot]

Mother & Child : Reflections of A Bond Beyond Understanding

Wrapped in thick blankets, beanies and jackets, sitting in the laps of the most important person in their lives, I observed the phenomenal bonds between mothers and their children this past week at Seacowlake Clinic. Maternal and child health had never been so visible to me, even as I completed my paediatric training block, as it was this first week in community. I have come to realise that maternal and child health is about far more than reducing mortality or preventing disease—to us, as future occupational therapists, it is about creating opportunities for mothers and children to participate in meaningful occupations that shape healthy, fulfilling lives.

"Every child deserves the best start in life." A seemingly simple statement from UNICEF (2023), but one that sits on my conscience since the very first day on this community block. What defines “the best start in life”? Is it simply physical resources such as the house a child is born in, the toys they have or the food they eat? Or does their family, particularly the mother, whose body nourished them before they took their first breathe, have a greater impact on them? The World Health Organization (2023) emphasises that the health of mothers and babies forms the foundation of healthy families and communities. This statement resonated with me because I realised that maternal health affects far more than pregnancy outcomes. A mother's physical health, emotional wellbeing, social support and access to healthcare all influence her ability to care for her child. In turn, these factors shape a child's development, participation and future opportunities.

As student therapists, our day begins with health promotion to those in the clinic queues. What stood out to me was despite our inclusion of full occupational therapy services in these educational talks, there was only one mother who requested assistance regarding signs that she had noticed in her young child. This highlights the incredible concern of mother’s towards their children, which in turn affects their own health. This experience challenged my previous understanding of Occupational Therapy. Before this placement, I tended to associate Occupational Therapy primarily with rehabilitation after illness, diagnosis or injury. However, this week in Kenville has reinforced that community Occupational Therapy is equally about prevention, health promotion and early intervention. Rather than waiting until developmental delays become apparent, occupational therapists have an integral role in supporting caregivers, promoting responsive caregiving, facilitating developmental play, educating families and advocating for environments where children can thrive.

The Nurturing Care Framework highlights that good health, adequate nutrition, responsive caregiving, opportunities for early learning and safety provide the foundation for child development (World Health Organization et al., 2018). As a future occupational therapist, it made me realise that each of these elements is closely connected to occupation. Responsive caregiving forms everyday routines. Early learning occurs through play. Healthy development happens through participation in meaningful activities with others. These are areas where occupational therapists should aspire to make a significant contribution at community level.

Image showing key components of the Nurturing Care Framework (Image credit: Hope Worldwide South Africa)

Another topic that was covered theoretically as a student but has come to the fore is occupational justice. Townsend and Wilcock (2004) argue that all people should have opportunities to participate in meaningful occupations. After exploring the “Thrive by 5” index, and seeing the reality in the Early Childhood Development Centres and Primary School, this made me question whether every child in South Africa truly has the same opportunity to thrive. Should the quality of a child's development depend on the community in which they are born? Should access to nurturing environments, developmental opportunities and quality healthcare be determined by socioeconomic circumstances? These questions are indeed uncomfortable, but absolutely necessary if we truly seek to promote equitable health outcomes.

Despite recognising the glaring challenges, I have also recognised the strengths within this community. Families continue to care for one another despite limited resources. Community members support one another, share knowledge and demonstrate resilience every day. These strengths remind me that community-based occupational therapy is not about "fixing" communities; rather, it is about working alongside communities to build on existing foundations and support meaningful participation.

As I go forth into my second week, I hope to develop into an occupational therapist who sees beyond diagnoses and clinical interventions. I wish to understand the contexts in which occupations occur and to assist in building environments where mothers and children truly have opportunities to flourish. My first week in Kenville has reminded me that maternal and child health is not only a healthcare issue—it is an occupational justice issue. Our mothers are the first nurturers of our children. Our children are the future of our communities. Undoubtedly, when communities flourish, society flourishes with them.

Occupational Therapy paediatric set up for assessment and treatment at the Seacowlake Clinic serving the Kenville Community

References

Black, M. M., Walker, S. P., Fernald, L. C. H., Andersen, C. T., DiGirolamo, A. M., Lu, C., McCoy, D. C., Fink, G., Shawar, Y. R., Shiffman, J., Devercelli, A. E., Wodon, Q. T., Vargas-Barón, E., & Grantham-McGregor, S. (2017). Early childhood development coming of age: Science through the life course. The Lancet, 389(10064), 77–90.

Townsend, E., & Wilcock, A. A. (2004). Occupational justice. In C. H. Christiansen & E. A. Townsend (Eds.), Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation (pp. 243–273). CAOT Publications ACE.

UNICEF. (2023). The State of the World's Children 2023.

World Health Organization. (2023). Maternal health.

World Health Organization, UNICEF, & World Bank Group. (2018). Nurturing care for early childhood development: A framework for helping children survive and thrive.