Physiotherapists in under-resourced South African communities reflect on practice

Abstract

Increasing access to health services and the introduction of primary health care are the cornerstones of transforming healthcare initiatives in South Africa. Sustainability of healthcare provision in rural and under-resourced areas is secured by legislation of a year-long community service (CS) contract with graduating healthcare practitioners. This study explored how the first cohort of physiotherapists experienced their year-long CS and how they felt their undergraduate training prepared them for practice. A survey was conducted at the end of 2003 amongst the first cohort of CS physiotherapists who emerged from the physiotherapy programme of a South African university. All 23 of the graduates from the 2002 final year class were invited to participate in the study. A self-administered open-ended questionnaire was faxed to the participants. Twenty of the 23 questionnaires were completed and returned within a month. The questionnaires were coded and the data were analysed using content analysis methodology. The results were categorised into emerging patterns. CS physiotherapists assessed their preparation for practice largely in relation to the technical skills that were acquired through the curriculum. Community-based physiotherapy practice in under-resourced areas was under-emphasised in the curriculum in relation to practice opportunities within hospital and institution-based settings. The curriculum was found not to advance the role of physiotherapists as socially responsive agents and appeared to pay little attention to knowledge underpinning socio-cultural and inter-professional relations. Physiotherapy academic knowledge alone was inadequate to support novice physiotherapists within under-resourced communities in their multiple roles as clinician, manager of physiotherapy department, as member of a multidisciplinary team, health educator and advocate for social justice.

Home-based rehabilitation: Physiotherapy student and client perspectives

“…[2,4,6] The students stated that being proficient in isiXhosa would have helped in HBR to minimise the verbal communication barrier. They reported that an introductory isiXhosa course in their 1st year seemed irrelevant to them at the time.…”

“…[2,4] These communities are often situated in under-resourced areas. Experiencing the real-life context of clients is vital for students so that they will ultimately provide effective interventions and develop social responsibility.…”

“…Students report feeling overwhelmed when witnessing the realities of life in poor households. [4][5][6] Factors such as diverse socioeconomic, racial, language and cultural backgrounds may affect healthcare interventions. Developing cultural competency, i.e.…”

“…[8] Other skills students may develop in this context include: increased insight, coping with complexity, ability to think on one's feet, assertiveness, building rapport, empowering others, enhanced observation skills, functioning in someone else's space, consideration of quality of life and function as applicable to the client, knowing when to discontinue treatment, integration of services, and ability to function as a professional with limited resources. [4,9,10] The theory of situated learning, i.e. learning through active participation within a community of practice, underpins the educational experience of HBR.…”

“…[2,3] However, to gain maximum benefit from the learning opportunities available, students should be prepared effectively before exposure to HBR. [4] There is a scarcity of literature on HBR in the physiotherapy context, specifically with regard to the students' or clients' perceptions. This study sought to discover the perceptions of final-year physiotherapy students and their clients regarding their experiences of HBR during a PHC clinical training placement in resource-constrained and diverse settings.…”