#ukznot

[thandoluhlengema]

"Mastering Community Practice: Is UKZN’s OT Curriculum Up to the Challenge?"

"Not everything that is faced can be changed, but nothing can be changed until it is faced." — James Baldwin. These words resonate deeply as I open my community module in the final year, giving me a glimpse into my future career. Going to a community in any particular area different from the one you grew up in will always be a culture shock. As a health practitioner, openness and understanding are crucial to exploring what and who makes the community. Are we as future practitioners equipped to meet community and primary healthcare challenges effectively? Let's discuss.

The OT curriculum is structured so that foundational knowledge, practical skills, and specialized areas are all met over 8 semesters. This allows for a broad knowledge base with a crucial understanding of human development, behaviour and physical function. This foundational knowledge is structured to assure effective assessment and intervention which prepares a wide range of needs within community practice (UKZN School of Health Sciences, 2023).

The Community Studies module in the first year was meant to give students a basic understanding of community practice. However, it was not a major focus in the middle years and only came back into focus in the final year. This raises two questions: Was this done so that practical fieldwork could provide real community experience, or was it to allow all the earlier learning to come together in the final Community Theory and Fieldwork 4 module? This approach has had both positive and negative effects. On the positive side, waiting until the final year has helped integrate earlier learning with practical experience, leading to a deeper understanding of community practice. On the negative side, the long gap between the first-year and the final-year module has made it harder to connect what was learned earlier with practical experiences. This delay has affected the ability to effectively apply knowledge in community settings (Wilson & McCabe, 2020).

The re-engineering of Primary Health Care (PHC) in South Africa offers a practical example of how community health practices are evolving. The Green Paper on National Health Insurance (NHI) outlines a re-engineered PHC platform with four key components: Municipal Ward-based Primary Health Care Outreach Teams (WBPHCOTs), the Integrated School Health Programme, District Clinical Specialist Teams, and contracting private practitioners (South African Government, 2023). WBPHCOTs are particularly relevant, as they are designed to assess health status, provide health education, and facilitate referrals to appropriate facilities. This referral system ensures that patients receive comprehensive care across different levels of the health system.

It's no secret that the broader community often doesn't receive the attention it deserves from today's occupational therapists. Many prefer the familiarity of hospital settings, where their unique skills are sometimes underutilized, or they find themselves invading the roles typically filled by physiotherapists. But community? Community is where the skills of an occupational therapist are truly put to the test. During my practical experiences in hospitals around Durban, I've observed how occupational therapists often struggle to maintain departments, be occupation-based, and miss opportunities to engage with surrounding communities through home visits. And when in those types of hospitals whether being there for physical or psychosocial block, anything community practice-based has not been given attention, this has made a significant impact and overwhelm now being placed in a community in the final year.

One might think that the required 1000 hours of practical work should be enough to prepare students to become competent practitioners. I believe this is generally true. The 1000 hours, which include electives, typically provide sufficient experience. In practice, we often accumulate more than the required hours due to the structure of the fieldwork. This extended exposure not only provides a safety net in case some hours are missed but also provides extensive experience in hospitals, rehabilitation centres, and other settings where occupational therapists work. By the fourth year, students would have interacted with a diverse range of people from different communities and backgrounds. This broad exposure helps prepare for community practice by familiarizing with various social contexts and client needs.

According to a study done by Deshni Naidoo, the UKZN Occupational Therapy curriculum has both strengths and challenges. Participants noted insufficient exposure to preventive therapy and various age groups and felt unprepared for hospital politics and inter-professional teamwork which is important in community practice. They also desired more focus on government procedures and administrative duties. However, the program was praised for providing strong theoretical knowledge and clinical skills, effective service-learning experiences, and a solid orientation to ethical practice and research skills, which positively impacted their work in both hospital and community settings (Occupational therapy graduates' reflections on their ability to cope with primary healthcare and rural practice during community service, 2017)

While the curriculum includes an intense community module in the final year of study, this timing has its cons. Community healthcare practices are rapidly evolving due to technological advances, urbanization, and globalization. Migration and globalization have led to more multicultural communities like the one in Kenville, creating both opportunities and challenges for integration and cohesion (Brown & Harris, 2019). Economic shifts and diverse community engagements add further complexity. Modern challenges, such as digital divides and social isolation, present new opportunities for engagement and collaboration (Smith, 2022). Placing the community module at the end of the curriculum allows for tackling these current issues and application of knowledge to contemporary community practice, making the timing of this module more relevant. Looking at the application of Assets Based Community Development, which is taught in the community module, the curriculum being structured like this may allow to apply these principles to current and relevant community contexts, reflecting the latest trends and challenges faced by communities. "Opportunity is missed by most people because it is dressed in overalls and looks like work." — Thomas Edison. This quote emphasizes that early opportunities, which might require effort and preparation, are often overlooked. It underlines the importance of recognizing and seizing opportunities before they’re fully realized. Something the OT curriculum may benefit from.

As we venture into the world of community and primary healthcare, the journey isn’t just about clocking hours or ticking off modules. It’s about diving into the vibrant diversity of communities, embracing the chaos and charm of new environments, and using our skills to make a real difference. After all, the real adventure begins where theory meets practice, and that’s where we’ll discover the true impact of our work. Ready to jump in? The community awaits!

References

Smith, J. (2022). Understanding Community Evolution. City Press.

KZN School of Health Sciences. (2023). Bachelor of Occupational Therapy Curriculum Overview. Retrieved from [UKZN website link].

Brown, J., & Harris, J. (2019). Community Health and Development: Current Trends and Challenges. Health Press.

Wilson, L., & McCabe, A. (2020). Connecting Theory and Practice in Occupational Therapy: Insights from the Field. Occupational Therapy Review, 32(2), 157-168

[rambling22yearold]

Unveiling the Essence of UKZN's Occupational Therapy Curriculum

Walking through the corridors of healthcare education, we stumble upon a treasure chest of wisdom and wonder—the UKZN Occupational Therapy curriculum. Like a map to hidden treasures, it promises to guide aspiring therapists.

As the role of Occupational Therapists continues to be dynamic and continuously evolve, the need for practitioners who are well-prepared to work in community and primary healthcare (PHC) settings has become increasingly apparent. At the University of KwaZulu-Natal (UKZN), the OT curriculum plays a pivotal role in shaping the future of OT practice. In this blog, we delve deeper into the fabric of this curriculum, it becomes imperative to scrutinize its efficacy and in this,, we embark on a journey of reflection, dissecting the curriculum through the lens of community care.

At the heart of UKZN's OT program lies a four-year undergraduate journey, crafted to shape empathetic professionals equipped with the knowledge and skills to transform lives. Guided by seasoned educators, students delve into a myriad of subjects ranging from Anatomy, Psychology and Physiology to the philosophical underpinnings of OT Theory and Practice. Theory comes to life through hands-on experiences during Fieldwork Placements. Here, students immerse themselves in clinical settings, applying classroom knowledge to real-world scenarios where these placement within the KZN province  are the crucible where theory meets reality, fostering the development of competent and compassionate practitioners. Complementing the core curriculum are electives designed for the curriculum. From assistive technology to community-based interventions, these electives empower one to carve your niche within the profession, nurturing unique talents and interests.

Delving into the heart of occupational therapy education at the University of KwaZulu-Natal (UKZN), one finds a curriculum that transcends the confines of clinical walls, embracing the principles of community-based practice and primary healthcare (PHC). Within the fabric of core courses like Occupational Therapy Theory and Practice and Professional Issues in OT, the curriculum intricately weaves discussions on community interventions and the imperative of addressing health disparities in diverse populations.

Moreover, UKZN's commitment to community-centric care is palpable through dedicated courses and clinical placements designed for this purpose. These courses delve into community assessment, program development, and advocacy strategies, equipping students with the tools to effect change beyond traditional healthcare settings. Clinical placements then provide the crucible for experiential learning, immersing students in community health centers, schools, and nonprofit organizations. Here, they apply theoretical knowledge to real-world contexts, fostering cultural competence and collaboration within multidisciplinary teams.

The community I currently serve has numerous areas requiring the intervention of Occupational Therapists. However, once students depart, the community lacks ongoing support. This reality is disheartening and requires attention, with no profession better suited to address it than ours. We consider the individual holistically. We assess their home environment, support systems, available resources, mental health, HIV status, nutrition, and sleep patterns. Despite having much to offer, our valuable work isn't fully utilized where it's most needed.

I found this amazing article that highlights our readiness to practicing within rural settings, please have a quick look.

There are several challenges and limitations that warrant consideration. Significant challenges being resource constraints, potentially impacting the availability of state-of-the-art equipment, technology, and facilities essential for comprehensive training. Limited clinical placements in community settings also poses a barrier, as hands-on experience in diverse environments is crucial for developing practical skills and cultural competence. In the beginning of my degree we were faced with the unfortunate introduction of the COVID-19 pandemic in which we were not able to go into the community and gain essential practical knowledge from the Community Studies module present withing the OT curriculum. Additionally, there might be gaps in the curriculum content, such as insufficient emphasis on advocacy training or addressing the social determinants of health, which are essential for effective community-based practice. Overcoming these challenges requires a concerted effort from educators, policymakers, and healthcare institutions to allocate resources effectively, expand clinical placement opportunities, and continuously review and update curriculum content to ensure that students are adequately prepared to address more complex needs of communities in PHC settings as communities are constantly evolving.

One notable aspect is the emphasis on experiential learning opportunities embedded throughout the curriculum. Through clinical placements in diverse community settings, students gain first-hand experience working with individuals and populations in need. 

Moreover, the Community module in our final year fosters a culture of community engagement by encouraging us to participate in community-based projects and service-learning initiatives. By collaborating with local organizations, such as community health centers, schools, and advocacy groups, we have the opportunity to apply their knowledge and skills to address real-world challenges and contribute to positive social change. These experiential learning opportunities not only deepen our understanding of community health issues but also cultivate their empathy, cultural competence, and advocacy skills—essential attributes for effective practice in community and PHC settings. The way that the curriculum is structured allows for being a dynamic OT who is able to work in various community settings, encourages working under pressure to meet goals and prepares us for the real word by the hours we spend within the communities.

One of the common responses found from the study below was that the participants found it challenging to practice within the realities of a rural setting because of the resource constraints and because the undergraduate programme and clinical skills development had mainly occurred in well-equipped tertiary hospitals. It's not uncommon for practitioners to find it challenging to transition to rural settings due to resource constraints and the focus on training in well-equipped tertiary hospitals during our education. This disparity in experiences and resources can create barriers to effective practice in rural areas.

In reimagining the Occupational Therapy (OT) curriculum at the University of KwaZulu-Natal (UKZN) to better equip students for community and primary healthcare (PHC) settings, several key recommendations emerge. Firstly, integrating more robust community-based learning opportunities throughout the curriculum, including extended clinical placements in diverse environments, could provide invaluable hands-on experience. Additionally, fostering interprofessional education (IPE) initiatives would enhance collaboration skills essential for interdisciplinary PHC practice. Strengthening cultural competence training and expanding community-based research projects could deepen students' understanding of the complexities of working with diverse populations. Moreover, integrating advocacy training and offering elective courses in community health would empower students to advocate for policy changes addressing health disparities. Finally, forging stronger partnerships with local organizations would facilitate expanded clinical placements and community-based projects, enriching students' engagement with PHC initiatives. By embracing these recommendations, UKZN can ensure that its OT curriculum remains dynamic, relevant, and impactful in preparing future practitioners for the multifaceted challenges of community-oriented practice.

As we draw the curtains on our exploration of the UKZN Occupational Therapy curriculum, one thing becomes abundantly clear: the journey to community care excellence is a dynamic and evolving one. Through the lens of our analysis, we've glimpsed the strengths and opportunities embedded within the curriculum, each a testament to the dedication of educators and the aspirations of future therapists.

Yet, within this journey to finding the treasure chest, there are obstacles in the road and peaks to conquer. My reflection on the curriculum's pros and cons serves as a guide towards innovation and improvement. Let us harness the insights gleaned here to nurture a curriculum that not only prepares students for the rigors of community and PHC practice but also instils within them the spirit of compassionate care and unwavering dedication to those they serve.

As the sun sets on our discussion, let us carry forward the torch of inquiry and advocacy, knowing that the seeds of change we plant today will bloom into a future where community care thrives and flourishes.

In the ever-evolving landscape of healthcare, the role of occupational therapists as champions of community care and primary healthcare has never been more crucial. Through our exploration of the UKZN Occupational Therapy curriculum, we've journeyed through the corridors of learning, uncovering both its strengths and areas ripe for growth.

References

Hayes, K., Santos, V. D., Boyd, N., Connelly, B., & Lustig, K. (2024). Preparing occupational therapy students for practice in rural areas: a scoping review protocol. BMJ Open, 14(2), e075886. https://doi.org/10.1136/bmjopen-2023-075886

Home - Discipline of Occupational Therapy. (2018, January 11). Ot.ukzn.ac.za. https://ot.ukzn.ac.za

Naidoo, D., Van Wyk, J., & Waggie, F. (2017). Occupational therapy graduates’ reflections on their ability to cope with primary healthcare and rural practice during community service. The South African Journal of Occupational Therapy, 47(3), 39–45. https://doi.org/10.17159/2310-3833/2017/v47n3a7

[otwannabe]

Occupational barriers experienced in mental health in SA.

We all have an innate need to engage in occupations, our occupational performance defines the very essence of who we are, our roles, our beliefs, our desires and wishes. When one experiences barriers to occupational performance whether it is imposed by “societal norms”, environment, availability of resources and other factors, an occupational injustice is committed which challenges and goes against what the very core and basis of what occupational therapy is and the narrative occupational therapists are advocating for which is independence in occupational performance.

According to (Coombe,2021) occupational injustice is any undue limitation on a person’s freedom to have or to pursue meaningful occupational engagement in society. Occupational injustice includes the following: occupational imbalance, occupational deprivation, occupational apartheid, occupational alienation, and occupational marginalization.

Many factors contribute to occupational hinderance in mental health in south Africa, the following are among those factors:

Stigma, according to (Caddell,2022) this term refers to negative attitudes or discrimination against someone based on a distinguishing characteristic such as a mental illness, health condition or a disability, stigma is not only limited to the aforementioned, but it can also be related to characteristics including gender, sexuality, race, religion, and culture. People living with mental health issues in SA are deprived of occupations such as work, for example a person diagnosed with minimum intellectual disability with no comorbidities can learn skills that will allow them to hold a job but due to their diagnoses the work realm does not allow for them to engage in this occupation (occupational deprivation), A study by (Prinz, 2011) found that people with a mental disorder are two or three times as likely to be unemployed when compared to people with no disorders.

2. Institutionalization, according to (Lingah, 2021) this term refers to the admission to and the detainment of a person within an institution either by court order or as a voluntary resident. (Kruger, 2011) further mentions that institutionalization is important to ensure that everything within a facility runs effectively, efficiently and order is maintained, however this systematic routine robs individuals of things such the ability to make choices when it comes to their occupational performance. Many mental health facilities in South Africa are guilty of this act, you find that individuals end up participating in occupations that are not only not of choice by them but also occupations that are not meaningful to them (occupational alienation).

3. Lack of resources (shortage of healthcare practitioners that specialize in mental health including OTs), there are a lot of people living with mental disorders that are undiagnosed roaming in township streets, some are even referred to as “omadoti” these people are robbed of a meaningful life and intervention. These people end up not participating in Occupations such as ADLs (Bathing, dressing, eating etc.), health management and maintenance, work or education depending on the age of that person because sometimes society writes them off and don't see the value in their lives.

Mental health is a pandemic within the Southern African context, occupational performance hinderance should not be!

#Occupational therapy #burnt student #ukznOTs

Reference list:

Caddell, J. (2022) What Is Stigma?, Available at: https//verywellmind.com [Online], Accessed: 15 October 2022.

Coombe, H. (2021) Occupational Science, [lecture notes], OCTH 243. University of KwaZulu-Natal (Westville Campus).

Kruger, C. (2011) An Audit of Attendance At Occupational Therapy by Long-term Psychiatric in-patients at Weskoppies Hospital., Available at: https//scielo.org.za [Online], Accessed: 15 October 2022.

Lingah, J. (2021) Long-term Care and Institutionalization, [lecture notes], OCTH 245. University of KwaZulu-Natal (Westville Campus).

Prinz, C. (2011), Employment: Mental Health Issues Rising in Workplace, Says OECD. Available at: https//oecd.org [Online], Accessed: 15 October 2022.