ARTICLE

 

Transformation of Higher Learning in South Africa: Perceptions and Understanding of Speech-Language Therapy and Audiology Undergraduate Students

 

 

Farieda Abrahams^I; Nomfundo Floweret Moroe^II; Katijah Khoza-Shangase^III

^IUniversity of the Witwatersrand, South Africa fariedaabrahams81@gmail.com https://orcid.org/0000-0003-3885-4370
^IIUniversity of the Witwatersrand, South Africa nomfundo.moroe@wits.ac.za https://orcid.org/0000-0001-7186-5632
^IIIUniversity of the Witwatersrand, South Africa Katijah.Khoza-Shangase@wits.ac.za https://orcid.org/0000-0002-6220-9606

 

 

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ABSTRACT

The professions of speech-language therapy and audiology in South Africa developed under apartheid and historically consisted of and catered to a predominantly white English- or Afrikaans-speaking minority population. Over 25 years into democracy, there continues to be a stark incongruence between the demographic profile of the South African population and the speech-language and hearing (SLH) professions in terms of "race", linguistic, and cultural diversity, and this has implications for training as well as clinical service provision within the South African context. This article explores undergraduate students' perceptions and experiences of transformation within South African SLH university training programmes through a cross-sectional descriptive survey research design. A self-developed questionnaire was used to collect data from students enrolled in SLH programmes at South African universities. Thematic analysis identified two themes: 1) progress towards attainment of transformation and, 2) visibility of transformation. These findings highlight the need for diversity through inclusivity, redressing past injustices and incorporating local knowledge into current training and practice. These findings have global relevance for transformation in higher education, not just in the field of SLH. Implications for translation of theory and/or knowledge into practice, with more visible and deliberate application of policy in curriculum reform and institutional culture, are raised.

Keywords: decolonisation; transformation; higher education; speech-language and hearing professionals; undergraduate students; university; South Africa

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Background

South Africa is often touted as an ideal example of racial integration and harmony-the proverbial "rainbow nation" (Knight 2013). It is often looked upon by the international community as having overcome the injustices of colonisation and apartheid relatively peacefully (Knight 2013). Meanwhile, colonisers enjoy primacy of tangible items such as natural resources and intangibles such as language and culture in the colonised land, at the expense of "colonised" indigenous peoples who still grapple with generations of poverty and loss of identity in their own land. Indeed, indigenous communities worldwide continue to be plagued by lower levels of education, social ills and inequities, and poorer health outcomes (Flood and Rohloff 2018; Sharma and Kuper 2017). It can be argued that almost 30 years post-apartheid, utilising population registration groups (whites, Indians, coloureds and Africans) as "race" classifications poses a limitation to levels of arguments, particularly when considering critical race theory. Critical race theory investigates racism by emphasising the historical and sociopolitical roots of contemporary disparities. It studies how a field's conventions may inadvertently constrain movement towards equity; it focuses on structural forces and the intersectionality of racial and other axes of inequality, and investigates the links between white racial identity and inequalities. It uses allegory as an antiracism educational tool (Ford and Airhihenbuwa 2010). Critical race theory provides a comprehensive framework for connecting research endeavours, a vocabulary for advancing understandings of racial constructs and phenomena, critical analysis of knowledge-production processes and a praxis that builds on community-based participation approaches to link research, practice and communities (Ford and Airhihenbuwa 2010).

The current study has deliberately used these categories-whites, Indians, coloureds and Africans, as they remain in core use within the field of speech-language and hearing (SLH), the training programmes, and within the regulatory body-the Health Professions Council of South Africa (HPCSA). The authors do not by any means support the continued use of these categories, but understand that for the foreseeable future, these unscientific categories for defining people will unfortunately remain the main conceptual access points for any evidence that is published for implementation, as seen in some South African policies and legislations such as the Broad-Based Black Economic Empowerment (B-BBEE).

Higher education was one of the vehicles used to propel the apartheid ideology by producing like-minded professionals who, save for a small minority of white liberals, served to align teaching and learning with the views of the state (Dirk and Gelderblom 2017). School and university education was put under distinct racial authorities resulting in higher education being disproportionately spread, unequally funded and resourced, and varying in size, research capacity, ethos, and quality of management (Habib 2016; Kamsteeg 2016; Robus and Macleod 2006). The schism produced historically advantaged institutions for white people, further divided along more liberal, English universities and more conservative institutions for the Afrikaans populace. Historically disadvantaged institutions were set aside for black people, disparagingly perceived as "bush" or "rural" universities (Kamsteeg 2016; Robus and Macleod 2006; Seabi et al. 2014). Black South Africans were denied access to better resourced educational institutions (Durrheim et al. 2011; Weddington, Mogotlane, and Tshule 2003). Over 25 years after the dismantling of apartheid, South Africa remains one of the most unequal societies in the world (Amosun, Maart, and Naidoo 2018; Mayosi and Benatar 2014; Pentecost et al. 2018), where black African medical students have remained negligible (Mayosi and Benatar 2014), despite women and people of colour now being reported as representing the majority in South African medical classrooms (Pentecost et al. 2018). This reality raises questions about transformation in these spaces.

Internationally, the concept of transformation in higher education has been discussed by numerous authors (Duffus et al. 2014; Durrheim et al. 2011; Fellner 2018; Jackson et al. 2019; Karani et al. 2017; Sue et al. 2007). Aina (2010, 33) defines transformation as "an intentional social, political, and intellectual project of planned change aimed at addressing historical disadvantages, inequities, and serious structural dysfunctions". Amosun, Maart, and Naidoo (2018) accede that the term "transformation" is used with a laissez- faire attitude in higher education to denote that it should manifest the changes proceeding in society without much substance on the specific approach to be taken. Badat (2011, 2) essentialises transformation as "(having) ... the intent of the dissolution of existing social relations, cultures, policies and practices, and of recreating and consolidating all of these anew". Similarly, wa Thiong'o imparts a critical definition of decolonisation as "a means of recentering one's perspective without necessarily having to reject other streams of thought" (cited in Pentecost et al. 2018, 221). This sentiment is echoed by Fellner (2018), who asserts that several very real and very personal and professional reflections are necessary to both decolonise curricula and indigenise pedagogy. The four key reflections recommended are enumerated as:

• Firstly, creating indigenous counter-narratives in order to deconstruct colonial ideologies;

• Secondly, personifying decoloniality in both talk as well as action inside and outside the classroom;

• Thirdly, critically identifying and addressing the harm caused by a Eurocentric epistemology; and

• Finally, identifying and dismantling the overt as well as subtle pervasiveness of colonial ideologies and resultant power imbalances and over-pathologisation in the assessment, diagnosis, interventions, and research involving indigenous communities. (Fellner 2018, 287-89)

The term transformation is often used in a purely rhetorical sense at universities, and although academics have debated and deliberated around its implementation, there is yet to be substantial progress, as deep-seated ideas and vested interests and practices will not go gently into the good night as it were (Kamsteeg 2016; Khoza-Shangase and Mophosho 2021). Despite the fact that transformation of higher education has been a key discussion point since the outset of democracy, black South Africans' continued experiences of racism, discrimination, marginalisation, and dehumanisation at universities remain clear indicators that the myriad policies and debates have not been translated into day-to-day experiences (Khoza-Shangase 2019; Pentecost et al. 2018; Pillay and Kathard 2018; Vincent, Idahosa, and Msomi 2017). Within higher education, black students continue to be dehumanised by institutions and curricula that devalue local knowledge and being (Pentecost et al. 2018), what Khoza-Shangase (2019) refers to as intellectual and emotional toxicity.

In the wake of apartheid, South African universities have accomplished the remarkable, where the system has more than doubled its student enrolment figures. Nevertheless, Habib (2016) points out that almost 55% of students who enter university in South Africa do not complete a degree at all, and that less than 25% of enrolled students will complete their degrees within the prescribed timeframes. Of particular significance is the steep increase in the admission of black students who are more often than not financially, educationally, linguistically, and arguably socio-linguistically on the back foot (Seabi et al. 2014). Additionally, hostile and toxic institutional culture within institutions of higher education perpetually place black students at a disadvantage (Khoza-Shangase and Mophosho 2018), with prejudicial university culture being labelled as responsible for the alienation and underperformance of black students in South African universities (Kamsteeg 2016).

In the apparent absence of patent descriptors of transformation in South African institutions of higher education, certain academic institutions have used the facade of autonomy to protect the prevailing state of affairs (Habib 2016), and historically white institutions go to lengths to avoid transformation while maintaining their privilege (Khoza-Shangase 2019; Seabi et al. 2014). For instance, the North-West University's Language Policy of 2012 states "die taaldemografie en taalvoorkeure van 'n bepaalde kampus binne n omgewing waar die taalregte van al die persone wat betrokke is, gerespekteer word" [that the language rights of all people within certain demographics and preferences of campuses be respected-as translated by the current researchers] (Venter 2016, 958). Interestingly, Higher Education South Africa (HESA) explicates that "higher education transformation entails decolonizing, deracializing, demasculinizing and degendering South African universities, and engaging with ontological and epistemological issues in all their complexity, including their implications for research, methodology, scholarship, learning and teaching, curriculum and pedagogy" (HESA 2014, 7).

On the other end of the spectrum, there is growing frustration and impatience among black students and academics with the perpetual disenfranchisement that they feel in the academic space, which is replicated in how black people are treated within South African institutions of higher learning, as well as what they are taught (Khunou et al. 2019). This sentiment is articulated by Khoza-Shangase and Mophosho (2018), from the South African SLH professions, who posit that the commendable policies meant to drive transformation remain encapsulated at policy level, and have failed to be implemented, so that the historical legacies of apartheid and patriarchy continue to be reproduced, with the black students continuing to represent the minority in a country where black people constitute the overwhelming majority (Seabi et al. 2014).

In fact, a study exploring how equipped South Africans are to assess English additional language (EAL) speakers from indigenous linguistic and cultural backgrounds revealed that 99% of the 150 sampled SLH practitioners were from English- or Afrikaans-speaking backgrounds (Mdlalo, Flack, and Joubert 2016). These practitioners routinely assess and manage EAL speakers in English or Afrikaans, and from the cultural lens of the practitioners and not that of the client (Mdlalo, Flack, and Joubert 2019). Evidently, there continues to be a lack of appreciation of, and naive unconsciousness for, "racial whiteness", which is invisible, normal, and accepted, the "us", while those with colour are conspicuous by virtue of their "otherness" (Khoza-Shangase and Mophosho 2021; Knight 2013). Khunou et al. (2019) refer to this as the white gaze. Preis (2013) contends that within the SLH professions, this disregard for diversity may be due to the homogeneous structure of the professions, its students, and its academics. The SLH professions in South Africa were historically reserved for white therapists, and comprised almost exclusively females (Aron, Bauman, and Whiting 1967). Khoza-Shangase and Mophosho (2018, 3) continue to describe the South African SLH professions as "White, Westernized, English and mostly urban". It is certainly counterintuitive that a country such as South Africa, with a majority black population who do not speak English as their first language, should have almost no black SLH professionals who speak diverse representative South African languages (Khoza-Shangase and Mophosho 2018). Current epistemology and ontology of the South African SLH curricula have become increasingly untenable; however, the status quo is maintained by the professions claiming to be neutral in the face of ongoing inequity and the perpetuation of the single story narrative (Abrahams et al. 2019; Khoza-Shangase and Mophosho 2018, 2021). Khoza-Shangase and Mophosho (2018) lament that the majority of black African language speakers with communication disorders do not receive healthcare services in their first language. Healthcare services in general, and SLH services in particular, are provided in either English or Afrikaans, and often in the absence of trained interpreters, raising serious ethical and treatment efficacy questions about the SLH services provided in this context (Khoza-Shangase and Mophosho 2018, 2021; Mdlalo, Flack, and Joubert 2016, 2019; Moonsamy et al. 2017; Pascoe et al. 2013; Pascoe and Norman 2011; Seabi et al. 2014). Almost 30 years post-apartheid, the perceptions and lived experiences of black SLH students require investigating.

 

Primary Aim and Method

The main aim of the study was to explore undergraduate students' perceptions and experiences of transformation within South African SLH university training programmes. A cross-sectional descriptive survey design employing both quantitative and qualitative approaches was adopted. This study is part of a larger study titled "Transformation in speech-language and hearing professions in South Africa: Undergraduate students' perceptions and experiences explored". The study focused on third- and fourth-year SLH undergraduate students enrolled in SLH programmes at South African universities. A descriptive survey design, which lends itself to exploration, was selected as it allowed the researchers to delve into the history of the SLH professions in South Africa, and explore how the current cohort of undergraduate SLH students viewed and experienced transformation or the lack thereof in their training programmes (Kelley-Quon 2018).

To recruit participants, the lead researcher (FA) contacted six institutions where SLH training programmes are offered, and requested information on the total number of third- and fourth-year students to ascertain the total sample size. Only three universities responded and provided the requested information. The other institutions reported concerns of infringement of the Protection of Personal Information (POPI) Act, thus they did not provide the requested information. With only three institutions responding, it was difficult to ascertain the total sample size. Therefore, since the demographic profile of the third- and fourth-year SLH cohort across all universities was not known to the researchers beforehand, a non-probability purposive sampling method was adopted (Cozby 2009).

The lead researcher sent the questionnaire to the heads of the SLH departments at the universities, who then disseminated the anonymous online survey to their third- and fourth-year SLH students. The survey was open for a period of eight weeks, with four reminders sent to the SLH departments during the eight-week period. The total sample comprised 48 (Table 1) undergraduate students. As far as the demographic profile is concerned, the self-identified gender classification yielded 47 female students and 1 male student; the self-identified "race" category reflected 26 white, 11 Indian, 3 coloured, and 8 black African students; year of study representation indicated 22 third years and 26 fourth years, with 19 enrolled for audiology, 24 for speech therapy, and 5 for speech therapy and audiology degrees. The sample size and the response rate were influenced by a number of factors including, 1) universities declining to participate; 2) researchers not actively involved in the distribution of the survey as heads of departments were gatekeepers; 3) data collection commenced at the beginning of the global COVID-19 pandemic, and consequently, all universities were closed and students were off campus; 4) while most students had access to the internet, students in rural areas did not have access to the internet and could not participate (personal communication, 28 April 2020); lastly, 5) generally, conversation around transformation is not a comfortable topic within the South African context. Some participants may have thus chosen not to participate in the study.

 

Data Collection

A self-developed questionnaire via Google Forms was used for data collection. The questionnaire consisted of open- and closed-ended questions, developed after in-depth review of relevant literature. It was divided into six sections, with the current article focusing on one of these sections: undergraduate SLH students' perceptions and experiences of transformation. Data were collected following ethical clearance from the university's Human Research Ethics Committee (non-medical) (Protocol Number: H19/09/01), with the study adhering to the World Medical Association (WMA) Declaration of Helsinki on Research with Human Subjects of 1964 throughout. A pilot study was undertaken (Kumar 2019) with second-year students at one of the universities. The questionnaire was sent to the gatekeeper, who disseminated it to the entire second-year class. Three second-year students responded, all of whom were black African. Two of the participants indicated that although the questions were relevant and topical, the questionnaire was too long. One participant suggested a question relating to informal segregation within the classroom. The researchers effected the suggestions before the main study commenced.

 

Trustworthiness

The current study was informed by the lead researcher's personal experiences as an undergraduate SLH student who graduated from one of the South African universities offering SLH training, as a practising SLH practitioner, and as the former chairperson of the National Speech-Language Therapy and Audiology Forum in the South African public healthcare sector. As an undergraduate SLH student at a formerly Afrikaansmedium university, the lead researcher's positionality was that of a Muslim, Indian, English-speaking, middle-class female, in addition to being a minority in the SLH class as well as in the South African SLH professions. The above-mentioned factors may have potentially presented biases for this researcher. To address the biases and maintain credibility, rigour and trustworthiness, peer debriefing, bracketing, and the use of the community of practice (Babbie and Mouton 2005; Gearing 2004; Mukhalalati and Taylor 2020; Nowell et al. 2017) were applied in this study. The research supervisors (NM and KKS) played "devil's advocate" by highlighting instances where the lead researcher's subjectivity and biases threatened to cloud the research process. Since the supervisors were outsiders and not personally invested in the study, they were able to maintain an objective eye and compelled the researcher to reflect on the difference between personal experiences and the results of the study, and not allow the one to taint the other. Over and above bracketing, the researcher journaled the processing that unfolded throughout data collection and analysis as a means of examining and reflecting on the engagement with data (Cutcliffe 2003). Additionally, member checks were used with the researcher's supervisors in order to validate the participants' responses and the researchers' interpretation of the results (Fereday and Muir-Cochrane 2006).

 

Data Analysis

Once the survey was closed to participants, the data were separated into closed- and open-ended responses. Rich data were obtained from the open-ended questions. Qualitative data were grouped together based on patterns that emerged to conduct thematic analysis (Braun and Clarke 2006). Thematic analysis was used to identify, analyse, organise, describe, and report themes that emerged from the data (Braun and Clarke 2006; Nowell et al. 2017). Open-ended questions were coded in terms of the self-identified "race" category of the participant to delve into nuances that different "race" categories reported on, and to identify the presence of patterns in the responses, bearing in mind the limitation earlier acknowledged.

 

Results

The demographic profile of the sample is a very close representation of the South African SLH student and practitioner professions in terms of "race" and gender breakdown, making findings easier to generalise. Since the study was a descriptive survey, percentages are used to demonstrate the number of participants who responded or contributed to the identified themes and subthemes. In this analysis, two themes emerged: 1) progress towards attainment of transformation, and 2) visibility of transformation. Within these themes, subthemes emerged, and these are discussed below.

Theme 1: Progress towards Attainment of Transformation

As far as understanding progress towards attainment of transformation in the higher education space is concerned, three subthemes were identified, namely: 1) transformation allowing diversity through inclusivity, 2) redressing past injustices, and 3) incorporation of local knowledge into current practices. Most participants (72%), particularly speech therapy students (57.1%), believed that significant progress has been made towards transformation in their programmes.

Subtheme 1: Transformation Allowing Diversity towards "Inclusivity"

In reflecting on transformation, students provided their understanding or definition of transformation. While one participant defined transformation as "a process of changing form, nature or character" (Participant 8), most participants (58.3%) indicated that transformation meant a greater diversity of people, both in terms of student corps, and in terms of clients serviced. Diversity also included different socio-economic groups and all minority groups. Participant 3 expressed that transformation in the context of higher education entailed "moving towards greater inclusivity and equality of all cultures, ethnicities, races, socio-economic statuses, and genders, and moving away from discrimination of any sort".

While several participants mentioned inclusion of "previously disadvantaged people" in their responses, Participant 28 highlighted the concept of financial access and the importance of "creating equal opportunities for previously disadvantaged races to enter higher education institutions without any bias and irrespective of financial factors".

Participant 15 mentioned the concept of inclusion, stating that transformation and inclusivity mean "making services more inclusive for the african [sic] people". This response is an imbroglio of sorts, as the participant is an Indian person. One wonders why the participant was of the view that transformation refers exclusively to black African people, when people of Indian descent were also historically disadvantaged by apartheid policies. Historically the South African population was distinguished by "racial" classifications, which were further administered under a tricameral government and resulted in disparities in terms of service provision, education, and housing, among others. It is possible that Participant 15 sees a distinction between her experiences as an Indian person and those of black African students due to these disparities, which affected the different "race" groups' perception of each other, or that the participant understands transformation in the South African context to apply exclusively to black Africans.

Subtheme 2: Redressing Injustices of the Past

A handful (14.6%) mentioned addressing injustices of the past in South Africa and creating more opportunities for black students to access higher education. Participant 14 stated: "I think it means trying to remove racist, sexist, patriarchal-dominant, and Western-dominant repercussions of Apartheid."

Subtheme 3: Change that Acknowledges Local Knowledge

While some participants highlighted adapting international literature and practice for the South African context, the majority spoke to adapting and adjusting the curriculum to meet the realities of the country. Transformation in this theme focused on addressing both ontology as well as epistemology. Participant 28 stated: "to me it also means changing the ... syllabus to more contextual content, as opposed to the generally accepted Eurocentric content". Participant 43 appeared to draw upon theorists such as Frantz Fanon and Steve Biko, as well as the #FeesMustFall movement, to elucidate her understanding of decolonised education. In her words:

My definition of transformation is not too far from the concept of "Decolonized Education" that arose during the FMF (#FeesMustFall) movement and we engaged with theorists like Frantz Fanon and Steve Biko last year in personality psychology. In essence, what transformation or decolonized education seeks to do is to also teach students about non-Western theories, but also engage with indigenous theories or theorists because we do our population a disservice if we use Western theories or Western test approaches that have been normed on populations far different from our own.

These sentiments were shared by a handful of other participants who strongly felt that the SLH programmes' academic and clinical curriculum should transform to become contextually relevant, responsive, and responsible.

While a few participants shared their experiences of transformation, Participant 7 expressed a lack of visible and tangible evidence of transformation in SLH by stating "[t]here are attempts to bring in transformation, I am however unsure what these are".

Although 35 (72.9%) participants felt that transformation had already been achieved in undergraduate SLH training, 13 (27.1%) felt that more still needs to be done. For example, Participant 24 stated: "It has started but is nowhere near where it needs to be yet." Participant 9 reported that lecturers have "made sure that we are aware of social, cultural and racial differences and has made us aware that it is our responsibility to change".

Demographically, of the participants who felt there is still a long way to go towards transformation (n=13), five were white, and the remaining eight were black African (the entire sub-sample of black Africans in the study). Participant 47 (an Indian student) was of the view that transformation was superficial in that it focused on a specific sub-set of people instead of on appreciating diversity in general:

I feel as though the curriculum does not take into account that there is a diverse set of students. They focus on taking us to rural communities to make us more culturally aware but they have never thought of educating students on other cultures and religions.

When asked whether additional steps to achieve transformation were still required, an overwhelming majority of participants (91.7%) felt that transformation was still necessary within the South African SLH professions, while four (8.3%) felt that transformation was not necessary. Three of the four participants who did not think that transformation of the professions was necessary were white, while the fourth participant was black African.

Transformations can be observed through a curriculum that considers the culture of the undergraduate students. When participants were asked if they had learned about their own culture during their undergraduate training, more students (60.4%) reported that they had not learnt about their own culture during their undergraduate training than those who had learnt about their culture (39.6%). However, two thirds of the participants (66.7%) felt that the curriculum that they had been taught was indeed reflective of their own culture and values, while one third (33.3%) felt that the curriculum did not reflect their own culture. A consequence of majority white participants perceiving the curriculum to be reflective of their epistemology and ontology without direct instruction speaks to the presence of a dominant white culture that exists within the SLH curriculum.

Related to the above, most participants (81.3%) believe that the current undergraduate SLH curriculum is reflective of their clients' culture and values, with only nine participants (18.8%) feeling that the SLH curriculum is not reflective of their clients' cultures and values. A number of scenarios are possible in this instance, two of which are, first, that the client-base of the SLH undergraduate students is reflective of the majority culture that permeates higher education (white, English- or Afrikaans-speaking), which raises serious questions about the majority of the country's access or indeed lack thereof to SLH services, and second, that students are not reflecting on the mismatch that exists between the majority South African population and SLH services, which presents a significant concern around efficacy and ethical considerations of the SLH services provided.

Theme 2: Visibility of Transformation

As far as visibility of transformation is concerned, four subthemes emerged, and these include: 1) inclusion of South African Sign Language (SASL) and indigenous South African languages and cultures, 2) transformation in theory only and not in practice- the case of lack of appropriate tools and resources, 3) transformation as a "discussion" rather than an act, and 4) a need for diversification of the SLH professions that includes class.

Subtheme 1: Inclusion of SASL and Indigenous South African Languages and Cultures

A few participants reported that they have been encouraged to learn an indigenous South African language and/or SASL, as well as being exposed to a greater diversity of cultures. For instance, Participant 42 reported:

It is now a requirement to complete a module in SASL or an African language. Furthermore, an increasing amount of Black students account for the student population. Additionally, most of the practical sites allocated aim to serve previously disadvantaged communities.

However, Participant 47 was of the view that while students were expected to do practical sessions in rural communities, they did not truly appreciate diversity, particularly within minority communities. Her reflection was "most of the class consists of black students who do not understand Islam or how to address Muslim clients/ patients". This participant's reflection highlights that the approach to training in diversity may still be too narrow in that instead of teaching an appreciation for diversity in all its visages and forms, the curriculum may entail a tick-box approach covering discrete units of specific cultures. Alternatively, there could be poor application of theories of diversity by students across the board.

Furthermore, Participant 47 felt that while the university encouraged students to learn an indigenous language, it was only taught at a superficial level, and was not comprehensive enough to manage clients meaningfully. Participant 47 explained: "We are not taught Zulu that can be used in a health care setting. So how do they expect us to communicate if they do not educate us sufficiently on the language?"

Participant 4 recommended that indigenous languages should be offered in-depth to create competent SLH professionals who are able to communicate meaningfully with their clients:

I think that there will be great value in making at least one African language a priority in the degree programme. Even if the student chooses the language themselves. The language should then be taken to third year level to ensure competence to assess and treat.

Participant 19, on the other hand, was critical of transformation and was of the view that decolonisation of the SLH curriculum and methodologies would be deleterious to the professions, and that local knowledge would create deficiencies in the scientific base of the SLH professions. Participant 19 stated: "By removing Westernized theories we are removing half of the scientific experiments."

Subtheme 2: Transformation in Theory Only and Not in Practice

This theme addressed the lack of appropriate tools and resources, which leads to transformation being a theoretical concept rather than a practical reality.

For instance, Participant 2 reported that lecturers made concerted efforts to accommodate all students and ensure that all students were included: "Our lecturers made sure that all students understood what was going on either by doing everything in English or translating when necessary."

While it is accepted that most lectures are conducted in English, this participant's comment about lecturers translating lessons raises the question about what language lecturers are translating from. For instance, it seems the participant is highlighting that lectures are still conducted in Afrikaans, and translated into English, even though all lectures are meant to be in English, not translated into English.

Participants 31 and 34 shared the conundrum of being required to manage a diverse caseload with inappropriate tools, as well as limited real-life examples modelling cultural competence. Participant 31 reported:

The lecturers provided examples of real-life situations which made the work seem more practical. However, videos and documentations used were not SA [sic] which is difficult then to use in practicals [sic].

Participant 34 stated:

We are encouraged to be culturally diverse in our assessments yet there is [sic] restricted assessment tools that are appropriate.

Participant 34 lacerated the slow pace of transformation within the professions as well as the lack of culturally and linguistically appropriate resources. Interestingly, none of the participants appeared to be aware of the locally developed assessment and management resources that were available. Participant 34 asserted:

It's not enough to talk about transformation and encourage the use of culturally appropriate tools. What are we doing to develop these tools and protocols as a research-intensive university?

Participant 4 also highlighted that local academic resources were scant, and that these needed to be developed:

I think the profession should work on using more local textbooks and sources-this will however be very difficult as there aren't really any local textbooks or authors. We need to work on developing our own textbooks and literature and to expand the South African Speech-Language-Hearing Association (SASLHA) to match the American Speech- Language-Hearing Association (ASHA) in terms of position statements and best practice guidelines-but for the South African context.

Subtheme 3: Transformation as a "Discussion " Rather Than an Act

Several participants reported that they had been involved in discussions around transformation, either in the form of seminars, workshops, or classroom discussions. Some reported that transformation had been a part of year-long courses; others reported that they had participated in very few such sessions. Participant 1 indicated: "We had 2 sessions in 2 years where we discussed transformation very openly."

Participant 38 shared that while the session around transformation had been valuable and thought-provoking, it had not been easy to arrange. Her reflection on the transformation session was that the department lacked interest and did not prioritise transformation. She stated:

Our department attempted to implement a transformational project, with us having had one transformational session to date. While the session had its advantages and disadvantages, the effort taken to initiate such a project speaks volumes about the department valuing change, development, and evolution within its students and its staff.

Similarly, Participant 41 shared: "Our department has arranged a talk about race once, but I do not believe it was enough."

Subtheme 4: The Need for Diversification of the SLH Professions that Includes Class

Associated with lack of resources, Participant 43, a black African female, intimated issues surrounding privilege and financial resources that served to exclude certain students and perpetuate immutable conditions within the SLH professions. She said:

The issue of transport because with it comes the conversation of classism and privilege, I feel like for a long time the department didn't have to worry about transport because most students were White [sic] and could afford their own transportation so when most of us African students come in and we can't necessarily afford transport.

Her response highlights the plight of many black students entering the higher education arena without the necessary financial or material resources, such as transport to training platforms or the plethora of therapeutic equipment required, which places these students at a disadvantage when compared with their privileged peers, who do not have to agonise over fuel for practical sessions or therapy material for their clients.

Participant 7 was of the view that an increase in "racial diversity" of the student body was an indication that transformation was underway:

From my observations in my department I believe that hearing professions have been more transformed than SLTs [speech and language therapists] in terms of the racial gap. I do however also believe that this is due to a lack of applications from racially diverse students since the SLT profession is oftentimes one that not a lot of people know of. I think a possible solution to this would be to create a greater understanding in different race groups (specifically in schools) of what an SLT does as well as the need that the professionals have for a more racially diverse group.

 

Discussion and Implications

The current article explored the perceptions and experiences of third- and fourth-year SLH undergraduate students from South African universities relating to transformation of their SLH professions. The study sought to establish measures participants were aware of to transform the SLH curricula and clinical service provision.

The findings revealed that most participants believed that progress had been made towards attaining transformation; however, the overwhelming majority felt that transformation was still necessary within the SLH professions, both in knowledge and practice. The implication of these results is that while steps have been taken to transform the SLH professions to be more reflective and inclusive of the indigenous population cosmetically, a lot more meaningful work still needs to be done.

English and Afrikaans are still the most prominently spoken first and second languages of SLH students. In fact, English, and to an extent Afrikaans, is still the de facto official language and lingua franca post-apartheid (Bilchitz et al. 2016). This is despite English being spoken by only 8.2% of the South African population, making it the sixth most spoken language (Bilchitz et al. 2016). This is because the state has primarily focused on English at the expense of other South African languages. Relatedly, Afrikaans also enjoys the same status as the English language while other languages are considered or treated as minority languages. Socio-economically and post-colonially, English and Afrikaans are preferred as languages of access to the global economy by those who aspire to join the power elite, at the expense of African languages, which "relapse into carrying the small scale cultural and social heritage of the majority" (Wright 2002, 11). Thus, the marginal utility proffered by the English language continues to rise, while African languages go into decline. From this discussion, it is clear that language, particularly English and Afrikaans, transcends "race" and colour. These languages also speak to the status enjoyed by some at the expense of others, while also influencing the socio-economic status of the country. The fact that this is still the case, post-apartheid, raises questions regarding language transformation and redress in South Africa.

With regard to this study, prioritising English and Afrikaans revealed that black African students continue to form the minority within SLH classrooms. Consequently, the majority black African South African population will continue to receive SLH services in languages other than their first languages. This challenge has been documented on a number of occasions (Khoza-Shangase and Mophosho 2018, 2021; Mdlalo, Flack, and Joubert 2016; Pascoe et al. 2018; Seabi et al. 2014), and results of the current study point towards continuation of this status quo.

Understanding Progress towards Attainment of Transformation

The theme of participants viewing diversity as a vehicle towards inclusivity aligns with Seabi et al.'s (2014) finding that students were not satisfied with the pace of transformation, especially related to language of instruction, as well as lack of diversity of teaching staff.

Participants in the present study called for decolonisation of the SLH curriculum by critically evaluating the Eurocentric basis of the professions in order to incorporate indigenous knowledges, while retaining Western elements, as asserted by Fellner (2018).

Within the SLH training programmes and consequently within clinical practice, Khoza-Shangase and Mophosho (2021) call for not only reflections, but tangible and visible action as well.

A nuanced analysis of the results concerning transformation as it relates to participants' employment prospects revealed that while some students understood the concept of transformation, they were grappling with the reality of transformation and redress, and what it means for them as individuals. This shows that students are reflecting on transformation. They accept that there should be transformation; however, they are apprehensive about how it will affect their futures. For instance, results relating to employment prospects revealed that white and, in some instances, Indian participants felt that jobs that would otherwise be meant for them would be in jeopardy, particularly within the public healthcare sector.

The above finding depicts how the same participants who report that transformation is necessary and facilitates equal access feel that policies that are meant to redress past injustices will disenfranchise and disadvantage them. This view is supported by Durrheim et al. (2011), who contend that transformation policies such as affirmative action in South Africa are controversial concepts that are fraught with strong emotions, and are construed as advancing one or more social groups at the expense of others. The results of the current study indicate that participants were struggling to reconcile the implementation of transformation with the impact it may have on them. Participants may feel threatened by transformation; however, the appointment of more black SLH professionals should not be seen as occurring at the expense of job opportunities for white professionals. Indeed, the presence of more black SLH professionals in the workforce has the potential to raise the profile of the professions within communities who would otherwise not be aware of them, thus creating a greater demand for SLH services. This assertion is supported by Pillay et al. (2020), who report that the 2030 Agenda for Sustainable Development necessitates increased appointment and retention of SLH professionals within the healthcare field, in line with the South African government's National Health Insurance (NHI) Bill of 2018.

The current authors deduced from the current data that participants were supportive of transformation only if it could occur without affecting them in any way. This deduction is in line with what Durrheim et al. (2011) report when they found that opposition to affirmative action policies correlated with an increased sense of threat, marginalisation and violated entitlement among participants, while support for affirmative action was associated with the continued reality of inequitable social and material stratification that characterises South Africa.

Similarly, participants were of the view that Black Economic Empowerment (BEE) policies meant that the most qualified candidate would not necessarily be employed. This view was reported by Cornell and Kessi (2017), who found that dominant discourses on transformation portray black students as undeserving beneficiaries who are unfairly advantaged and given preference in a form of "reverse racism". While these overt assertions were not revealed in the present study, white and Indian participants' views that their "race" rather than their knowledge and skills would be the deciding factor influencing their employment prospects, and that black students were being advanced at the expense of other students, imply that these students feel unfairly treated.

A number of studies have indicated that those students who previously enjoyed institutional privilege viewed transformation as a strategy aimed at dispossessing them of opportunities that they deserve (Cornell and Kessi 2017; Dirk and Gelderblom 2017; Durrheim et al. 2011; Kohnert 2013; Robus and Macleod 2006; Thackwell et al. 2016; Traub and Swartz 2013). A study conducted by Traub and Swartz (2013) into white psychology students' perceptions on racial equity in the psychology training programme at a South African university revealed that white students experienced uncertainty, internal shame at their privilege, and assigned blame to black students for being given unfair and unearned advantages. The authors of this article believe that these assertions, such as "[white and Indian therapists] not being employed despite being the best candidate for the job" (Participants 29 and 47), are baseless and dangerous, and create and perpetuate false narratives about the professional knowledge, skill and competence of black SLH professionals. Within the SLH professions, the repercussions of these racist, meritocratic, and entitled beliefs raise ethical dilemmas about the standard of care offered by black SLH professionals.

Indeed, Reuben and Bobat (2014) report that the unfounded conviction persists that black people are incompetent and unfairly given preference for certain jobs for which they are unsuited and undeserving. In the current study, white students, while supportive of transformation and greater diversity in the SLH professions, were of the view that the perceived privileges and accommodations being made for black students should not proceed indefinitely, and that at some undefined point, the special treatment afforded by Black Economic Empowerment policies needed to come to an end. Similar findings were reported by Traub and Swartz (2013) when interviewing white psychology students, who suggested the reintroduction of community psychologists, similar to midlevel workers, to accommodate diversity instead of increasing black representation in the psychology profession-implying comfortability with black people as their assistants and helpers rather than their equals-as originally dictated by Hendrik Verwoerd's dream of black people as "hewers of wood and drawers of water" (Marumo and Sebolaaneng 2019, 13480).

Notwithstanding the BEE trope referred to by participants in the current study, participants were in fact referring to affirmative action measures introduced by the South African government in the Employment Equity Act 55 of 1998 (Reuben and Bobat 2014), while Black Economic Empowerment, or BEE that was mentioned in the study, refers to objectives set by the government for the transformation of medium and large businesses relating to black ownership and management, skills development, and the procurement of goods and services (Durrheim et al. 2011). It appears as if participants in the study confused BEE with affirmative action and this may reflect some participants' disdain for policies of redress in general, and may raise serious implications about the professional engagement with policies and the influence of this on clinical service provision to much of the South African population.

The rationale for affirmative action is to achieve a deracialised society reflected in economic, political, and social inclusion of previously disadvantaged groups (Reuben and Bobat 2014). Nonetheless, Gradín (2019) contends that merely removing discriminatory legislation is inadequate in removing racial discrimination in the workplace. While experiences in the workplace were beyond the scope of the current study, the results revealed that black (black African, coloured and Indian) SLH students had already experienced discrimination during their practical training blocks at SLH private training platforms and are anxious about their employment prospects within the private sector. It would be interesting to investigate whether the students who had experienced discrimination reported this to their lecturers and supervisors, and, if so, what the outcomes had been.

 

Conclusion

The current study highlights that while transformation of the SLH professions in South Africa has begun, it is in its infancy, and much remains to be done. Considering that South Africa is over a quarter of a century into a democratic dispensation, the urgency of transforming the professions cannot be overstated. Students have received a cursory overview of what transformation and decolonisation entail, but it appears that this knowledge remains insulated as discussions, and needs to be translated into practical outcomes in curricula, clinical service provision, as well as relationships among peers across "racial", cultural, and religious lines. Furthermore, talks on transformation need to extend beyond the pleasantries of increasing diversity to include the concept of redress and what it means for admission into the SLH degree programmes as well as employment. Additionally, the study unearthed that regardless of the "race" of the participants, SLH students were anxious about what awaits them in the professional employment sphere when considering affirmative action policies. This is an uncomfortable conversation that needs to be had in SLH classrooms, especially for those students who are accustomed to receiving first preference. This may also raise serious implications for the practical training sites where SLH students gain clinical experience, with fears of racism impacting clinical training. One way of ensuring that SLH students feel safe enough to report racism to their university departments is for the departments to have micro-aggressions reporting protocols to the SLH board of the HPCSA, and to have policies in place for how to manage these reports. Practising SLH professionals who are guilty of discriminating against students should be reported to the HPCSA. These experiences that black SLH students have endured, together with exclusive job advertisements, have made them apprehensive of seeking employment, especially within the private sector. With less than a quarter of practising SLH professionals currently employed within the public healthcare sector (Pillay et al. 2020), newly qualified professionals will most likely seek employment in the private sector.

Tangible and meaningful strides in diversifying the SLH professions begin with recruitment of students into the SLH programmes at undergraduate level. In this regard, the HPCSA SLH board should continue to engage with university departments to meet prescribed diversity targets. However, enrolment by black students in the SLH programmes alone will be insufficient if successful throughput is not ensured. The results of the current study revealed that physical resources such as transport, as well as intangible capital such as feeling comfortable within university departments and being able to identify with teaching staff, play a role in the experiences that mark students' undergraduate careers and their perception and experience of transformation.

 

Limitations

The current findings should be interpreted bearing in mind the identified limitations, which included the following: a) the study utilised a survey methodology to protect the anonymity of participants. It is believed that a mixed-method study incorporating both a survey as well as focus groups that allow for interviewing of participants would garner more in-depth results; b) the sample size and homogeneity of the participants in the pilot study is a limitation in that additional suggestions could have been obtained had the pilot sample been bigger and more diverse; c) the sample size was relatively small in relation to the total number of third- and fourth-year SLH students. The fact that two universities denied access to the researcher meant that all their students were excluded from the study; and d) due to the current make-up of the SLH profession, the sample was skewed towards white female participants. These limitations raise implications for future studies.

 

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