OVERALL COMMUNITY EXPERIENCE IN PREPARATION FOR COMMUNITY SERVICE
The community block has been more than just a clinical practice; it has been a stepping stone to a transformative encounter with humanity, resilience, and growth in the realities of South Africans from underprivileged backgrounds. Immersing myself within the Cato Manor, Zwelibomvu and Thornwood communities was more eye-opening; it challenged and deconstructed my assumptions and biases I unknowingly carried. It made me look at these communities through a different lens, that despite the socio-economic struggles, the spirit of Ubuntu still runs within the community streets. The engagement with different settings such as schools, clinic, home visits, etc., made me realize that we cannot separate people from their contexts, as it shapes their occupational choice, opportunities, and participation. The experience outlined that without proper and genuine immersion and engagement with these communities, as therapists, we subject ourselves to the risk of our assumptions and biases remaining unchallenged. Therefore, this journey not only became a professional lesson but also an opportunity for self-reflection, humility and occupational consciousness.
One of the profound lessons I learned in the community was that health is not only a concern of the human body but also of the environment in which people live and its dynamics. During my first week in the community practice, I focused on intervening in clients’ problems, forgetting the impact of their environment. At Cato Manor, people face significant poverty, and given this, engagement in therapy is affected. The therapist must schedule appointments once a month, considering the distance clients have to travel and how much they can realistically afford for transport. This, overall, affects the progress of therapy, which in turn impacts their recovery and health. Many clients possessed motivation to engage in therapy and one of the cases is of the client with CVA, whom I have seen for intervention. He has reported that the space constraints impact his transfers from the wheelchair to the bed, moving around the house, etc. This contradicts the intervention and progression of his therapy because while on the other side, noticeable changes in transfers are observed, they cannot be applied to his context due to this environmental limitation, which then delays his independence and health. Recent South African studies on stroke rehabilitation similarly found that poor housing conditions, limited space and inaccessible environments significantly hinder community reintegration and independence among stroke survivors (De Witt et al., 2024).
This interaction taught me that as therapists we must adopt socially responsive and contextually relevant approaches which takes the clients’ environments into account beyond physical limitations. I also learnt that human occupation does not need a perfect environment to be understood; communities such as Cato Manor have many occupations that people engage in, yet without close watch, they may be left undervalued.
In my second week, it was difficult to adapt to an environment where there were limited resources. It started to discourage my plans I had for the community. Every morning, I had already planned the day, but because of limited resources, I had to adapt, be creative, and be flexible to meet the challenges that I faced. In the community, interventions cannot rely on expensive equipment or our ideal clinical ideas; it is about using available and low-cost resources that are largely accessible to the community members who seek therapy, while building transfer of skills to the caregivers who are usually with them in their appointments.
During the school visits, the impact of educational and social environments on occupational participation requires more than what I initially thought. Many children demonstrated challenges in attention, handwriting, and social interaction. Initially, I was thinking about these challenges in only a client-individualistic way, mostly focusing on the performance aspects of the child. But continued engagement with teachers in the creche and primary school, however, revealed that these difficulties are intertwined with overcrowded classrooms, poverty, and unstable home environments. Some children came to school hungry or without the right school materials, which affected their participation and concentration during learning activities. This helped me to realize the relationship between occupational performance and social determinants of health and education. Galvaan (2017) states that occupational therapists in South African communities need to acknowledge how socio-economic and political shapes the child’s performance in their relevant occupations. As a team of occupational therapy students, we had to improvise how sessions would be within their concentration span.
One of the most emotional experiences during this block was doing home visits at the Zwelibomvu community. Accessing these clients’ homes required vulnerability, respect, and humility as it meant entering their personal spaces shaped by hardship, resilience, and survival. One experience that stuck with me was watching a family change their daily routines to accommodate the needs of a family member, who is an 11-year-old boy with cerebral palsy, even with limited financial resources. The family demonstrated collective caregiving, problem-solving and emotional support even in adverse living conditions. Before community practice, I described independence as being able to do things independently. But interdependence forms part of the cultural identity and survival of many South African communities. Ubuntu was no longer simply an academic concept that we learn from textbooks, but a lived reality, expressed in caregiving, sharing, and communal support. This is in line with the work of Mji et al. (2018), who found that caregiving within African contexts is often embedded in collectivism and shared responsibility, rather than individual independence.
In the typical clinical setting, professionalism is often associated with keeping up structure, control and competence in procedures of the hospital where we are normally placed. However, in the community, being authentic, listening actively, being flexible, and being present emotionally were needed to build therapeutic relationships with the community. Sometimes clients are not always looking for exercises or programmes that we come prepared with; they simply need someone to really listen to their frustrations, their fears, their hopes, just like the mother in the Thornwood community who has lost hope in the healthcare team and expressed her frustrations to us. On that day, I learned that therapeutic use of self is not only about intervention techniques, but also empathy, humility, and the ability to form meaningful human connections. Hammell (2017) argues that occupational therapy needs to move away from Western assumptions and adopt relational and contextually grounded approaches to practice.
Personally, this block contributed to my self-awareness and self-growth. There were times I felt emotionally drained, discouraged, and unsure if my interventions were making a real difference. The emotional toll of witnessing poverty, substance use, neglect and environmental barriers often stayed with me after the clinical encounter. But these moments also taught me resilience, adaptability, and the importance of reflective practice. I learned that community work requires emotional stamina but also compassion and empathy. The experience also reminded me that self-care is important, as a future healthcare professional, because burnout can affect the quality of care that is provided to communities.
Looking ahead into community service, this experience creates a platform for a more conscious, reflective, and socially responsive approach to practice. Outside of the treatment room, the future role of a community service occupational therapist is one of advocacy, empowerment, and system transformation as I have learnt from this block. Indeed, there is an increasing awareness that good therapists need to be culturally sensitive, flexible, and able to work within less-than-ideal systems while still advocating for important change. Community service will allow me to continue to grow my clinical competence and still remain grounded in humanity, ethics, and occupational justice in the community in which I will be placed.
Overall, Cato Manor, Zwelibomvu and Thornwood not only taught me about occupational therapy practice in their spaces; they taught me about humanity, resilience, and the responsibility that comes with becoming a healthcare professional in South Africa. It challenged me to question whether therapy is truly meaningful if it ignores the realities people return to after intervention. As I move forward into community service, I leave with the understanding that healing cannot occur in isolation from context, dignity and social justice. Perhaps the greatest lesson from this journey is that communities do not merely need therapists with knowledge and techniques, but therapists who are willing to listen, adapt, reflect and stand alongside people within the realities of their everyday lives.
This is the Thornwood community…picture taken from the internet.
REFERENCES
Galvaan, R. (2017). The contextually situated nature of occupational choice: Marginalised young adolescents’ experiences in South Africa. Journal of Occupational Science, 24(4), 424–436.
Hammell, K. W. (2017). Opportunities for well-being: The right to occupational engagement. Canadian Journal of Occupational Therapy, 84(4–5), 209–222.
Mji, G., Rhoda, A., Statham, S., & Frantz, J. (2018). Understanding the lived experiences of caregivers of persons with disabilities in a South African context. African Journal of Disability, 7, 1–9.
De Witt, P., Crous, L. C., & Mlenzana, N. (2024). Environmental barriers affecting community reintegration among stroke survivors in South Africa. African Journal of Disability, 13, 1–10.