EDITORIAL COMMENT

 

Occupational therapy at the University of the Witwatersrand - The past, the present and the future

 

 

Marjorie Concha

Editor SAJOT

 

 

Welcome to this special edition of the South African Journal of Occupational Therapy which celebrates the 70^th anniversary of the Occupational Therapy (OT) Department at the University of the Witwatersrand (Wits). This is a notable milestone and it deserves a look at some of the history of a Department which has been an integral part of the history of the profession in South Africa as it was the first training centre for occupational therapists. The OT course started in 1943 whereas the Occupational Therapy Association only came into being in Aug 1945¹.

Occupational Therapy at Wits was initiated through the work of two enterprising medical students - Sarah Klempman and Pat Hingle. Pat had been "pained by the spectacle" of two old African men with TB lying in the, what was then, the Non-European hospital (NEH) in Johannesburg, just waiting to die. She had enlivened their day by showing them how to knit². The positive effects of this activity resulted in a group of women medical students teaching many of the patients at the hospital to knit. This knitting project was extended to a nursery for ambulant children at the same hospital by these two students as well as some others who had been recruited through the knitting project. Later these same medical students "commandeered" a stall used in the celebratory events held at the Zoo Lake at the end of the World War II, which was then re-erected with the help of male medical students in the grounds of NEH hospital and equipped with toys for the children top play with. Prof Raymond Dart was the person to whom these Medical Students turned and through his assistance attention was drawn to the work that had been done at NEH. Prof Dart became a very influential champion of OT along with his wife Marjorie. Later the prestigious award given to the best student in occupational therapy over all the years of study was named after this couple. The inauguration of the post graduate course in Physical Medicine at Wits was used to draw attention to these humble beginnings of occupational therapy and Dr Humphrey Raikes, then Principal of Wits University took up the challenge of inaugurating the Diploma in Occupational Therapy in 1943.

As there were really no OTS in SA, two occupational therapists were recruited from the UK to start the training - Miss M Crousaz and Miss J McArthur. Their journey to SA in the midst of war is part of the folklore of South African OT, their boat having been torpedoed off the coast of Africa. They landed in Freetown with little except some clothes and a fur coat! They eventually arrived in SA having lost all their text books and other resources which they were bringing to assist with the training. This inauspicious start with no resources for OT training facilitated inventiveness and an inner resourcefulness of the students which has endured to this day and has led to the Wits OT Department being the first to initiate many activities and types of training.

This very first training for occupational therapists was started with 4 students who became very well known in OT circles i.e. B Nurik, Simme Cynkin, H van Staden (Vona du Toit) and J H Serebro (Hilda Sidelsky).

In 1969 Wits was the first University to offer a BSc Degree in OT, the 3½ year diploma changing to a 4 year course with the first students qualifying in 1971. In 1993 the courses within this undergraduate programme were restructured and Wits became the first SA University to offer The 'Science of Occupation' as a major thus emphasising the more scientific direction that OT was taking in its use of 'activities as treatment'.

The undergraduate degree was soon followed in 1972 by the first master's degree (by research) in occupational therapy with Pam McLaren being the first occupational therapist to obtain a Master's degree in 1978. Not only was she the first OT to obtain a master's degree but she was the first student in the Allied Medical Disciplines (i.e. OT, Physiotherapy and Speech Therapy) to receive this post graduate degree through Wits.

In 1972 the Wits OT Department started a "clinic" for treating children with learning and associated problems, the first University to do so. This was to provide learning opportunities for the undergraduate students and was stimulated by the ground breaking work done by Freda Muller in this field. Freda was a graduate of Wits and she inaugurated the very first school for children with learning problems.

Leading on from this Wits initiated the training in Sensory Integration in this country by bringing Pat Wilbarger to the country to run the first SI theory and assessment course. The course culminated in the formation of the SA Institute for Sensory Integration and the first SAISI board was formed with Wits staff forming the backbone.

These initiatives in the field of learning problems led to the research masters being augmented by a Master's degree by course work in 1982. Two streams were offered i.e. Perception and Neurosciences. Simultaneously an alternative to the masters was offered i.e. an Advanced Diploma in the same two subjects for those students who did not wish to pursue the research requirement of the master's degree. In 2000 these courses were offered on a block release basis with much of the theoretic work being delivered through distance learning modules. This was done to attract students who reside outside Johannesburg.

At the same time that Wits was offering this formal training in a specialist area of OT the department recognised that it needed to prepare students for meeting the needs of what was then the majority of the population i.e. rural based people. So in 1986 the OT dept. inaugurated a compulsory rural block in the 4^th year of study to replace the elective, much to the disappointment of some of the students at the time. However most of them came to see the relevance of this initiative. The programme had many spinoffs for the Department not least of all were the learning opportunities for staff and students alike. The rural block also led to the OT department being the first to invest in the training of Community Rehabiliation Workers (CRWs) located at Tintswalo Hospital, Acornhoek with Theresa Lorenzo being the first course co-ordinator. This cadre of personnel received multidisciplinary training (i.e. it covered aspects of OT, Physiotherapy and Speech and Hearing Therapy) in rehabilitation to enable those trained to work in communities and at peoples' homes and culminated in a certificate offered by the University. The Unit was known as the Community Rehabiliation Research and Education programme (CORRE) and led the field in this type of work along with the training that took place at Alexander Health Centre. CORRE was an outside - funded Unit within the Department. The unit was also a founding programme of the Wits Rural facility a facility that provided the base for many of the Wits rural programmes of which there were several. The Wits certificated programme was converted to a two year undergraduate diploma offered formally by the University in 1998. It was then the intention to make this diploma part of a laddering process into the degree course. At the same time training for occupational therapy assistants was offered, also as part of this laddering proposal. These two initiatives led to the development of a course work master's degree in Community Rehabiliation offered together with the School of Public Health.

Unfortunately two events led to the demise of these two under-graduate diploma initiatives. The first was the change in regulations whereby Universities were no longer able to offer undergraduate diploma courses. The negotiations for these courses to move to the Technicon were curtailed due to the increasing reluctance of the Physiotherapy Board as well as the Dept. of Health to support the training and work of multidisciplinary personnel. Reluctantly Wits was forced to abandon the training of CRWS thus forfeiting many years of effort put into developing services for rural areas. However the Wits OT department built on these efforts to offer services and to train students to work in under resourced and underserved areas. A service at Zola Clinic in SOWETO was started along with the OT Dept. at Baragwaneth Hospital on the 20^th Aug 1990³. Those who set out with the students to open up the practice on that first day will never forget it as there had been riots in SOWETO the day before and the Provincial kombi carrying the students and staff had to negotiate road blocks, burnt tyres etc. The students were wondering what on earth this mad lot in the OT Dept. had now got them into! The service was intended to be a true CBR programme however the very uncertain political situation at the time prevented this from happening³. Another development followed on from this when a service was started at Deiplsoot informal settlement by Alison Leishman and Marj Concha in 1998 and operated, at first from a container made available by JAFTA. In 1999 the project became the Bona Lesedi (meaning "See the Light") project when it moved to its own premises - a set of containers on land that had been allocated by the community. The name was chosen at a workshop of parents of children receiving intervention, members and facilitators.

Another first in the field of teaching occupational therapists in SA was the introduction of Problem Based Learning within the occupational therapy course in 1993. Unfortunately the other courses that the students had to attend as part of the degree were still offered through the conventional method of lectures. This is sometimes inclined to make the students feel hard done by when they are required to put in the extra hours of self-study. Two articles published in this edition describe an evaluation of the students' perceptions of problem based learning^4,5. An addition to this programme was a joint venture with People for Awareness of Disability Issues (PADI) started in 1995 whereby the students were paired with a disabled person and spent time with them experiencing the day to day highs and lows of their lives. This was not therapy but a unique experiential learning opportunity. Due to its success the programme was expanded to include the Physiotherapy and the Speech Pathology and Audiology departments.

Another first was the introduction of an e-platform and a fully-fledged e-learning programme as part of the problem based curriculum in 2008. An article in this journal describes the programme and part of its evaluation⁶.

Along with all the other firsts for the OT Dept. at Wits was the fact that it was a Wits graduate - Pam McLaren who was the first OT in the country to obtain a PhD. Another landmark for the Department was when Marj Concha became the first OT to be appointed an associate professor as well as the first woman to become deputy Dean of the then Faculty of Medicine in 1982, this was a major breakthrough in a very traditional medically orientated faculty. The faculty has now become much more inclusive of all the programmes offered and has changed to a Faculty of Health Sciences. Since then several woman have held a deputy deanship as well as becoming Dean of the Faculty.

Many graduates from of the Wits OT programme are household names within the profession due to the enormous contribution that they made to the growth of the profession. To name but a few from the early days of Wits: Vona Du Toit (the VdTMoCA which is further developed in this edition⁷), Else Eggers (initiator of the Pretoria Multi-motivational Therapeutic Apparatus - MMTA), Simme Cynkins (first SA head of the OT Dept. at Wits and author of OT text book), Joan Davy (OT historian), Pam McClaren (well known for her ground breaking work in the field of community and rural based OT), Ruth Watson (past head of School of Occupational Therapy at the University of Cape Town and author of a textbook), Zelia Kotkin (member of Wits OT staff for many years and initiator of the writing assessment programme described in this Journal⁸, Treasurer and President of OTASA, SAISI), Rose Crouch (past member of Wits OT staff and author of a well know OT Text book), Barbara Stewart Lord (past member of Wits OT Staff and SAISI). Unfortunately space does not allow for a full exposée of their achievements nor does it allow for a full list of all the graduates who have made unique contributions to the growth and development of the profession over the 70 years of which there are many.

Now that we have examined some of the past, what are the plans for the future? The departmental mission statement defines two areas of focus and is described by Pat de Witt the current head of the OT department as follows.

The first is to be recognised nationally and internationally as a centre of excellence in research in occupational therapy and rehabilitation which is also in line with the University's 2022 strategic plan. To achieve this the department aims to:

• Increase the research expertise of all staff, increase the number of staff with PhDs and who have established research niches and a publishing portfolio so as to be able to apply for NRF rating. Judging by the number of articles published in this special edition it seems that the department is on its way to meeting this objective. In addition there is a wide scope of the research such as the management of clinical education⁹ to identifying occupational performance factors that influence the readmission of mental health users diagnosed with schizophrenia¹⁰.
• Increase the number of PhD and masters students with a consistent throughput rate. The department has already increased its number of post graduate students substantially over the years from an initial one - two post graduate students to the current number of 50 completing the Masters' degree through course work, 22, the Masters' degree through research and 10 a PhD.
• Increase the annual departmental publication output especially in ISI approved journals.
• Provide opportunities for all staff to present their research locally and internationally.
• Establish some international collaborations around research.

The second is to be recognised nationally and internationally as a centre of educational excellence for occupational therapy. To achieve this the department aims to:

• Be the educational centre of choice for all students, both under- and post-graduate, wishing to study occupational therapy so that it is able to select and graduate students of quality with at least 80% of the class passing. It is interesting to note that the first year intake has grown from the initial 4 students to 68.
• To develop dynamic and relevant curricula which will enable students to be excellent clinicians who are able to develop and deliver appropriate occupational therapy services that take cognisance of research that measures treatment outcomes that are cost effective. It is hoped that the research profile of the staff in the department will reflect and contribute to outcome measures in OT.
• To continue to develop leaders in the profession.
• To provide educational research which will support the educational content and teaching techniques.

With these focus areas in mind it is hoped that the Department will continue to be the "first" to offer many innovative programmes that will contribute to the growth of the profession of occupational therapy both in SA and internationally.

The editorial committee of the South African Journal of Occupational Therapy takes this opportunity to congratulate the Occupational Therapy Department at the University of the Witwatersrand on their 70^th Anniversary, and on the many achievements of its staff and students.

 

REFERENCES

1. Davy J "The first 30 years" A short history of the growth of the SA Association of Occupational Therapists 1945 - 1975. Booklet published by the Association of Occupational therapists.         [ Links ]

2. Dart R. The Initiation of Occupational Therapy in South Africa. The South African Journal of Occupational Therapy, 1963; Voll:Noll:4-6.         [ Links ]

3. Farmer H. Zola Clinic: A Stepping stone for training therapists for work in community based Rehabiliation. The South African Journal of Occupational Therapy, 1992; 22(2): 12-14.         [ Links ]

4. Jay J. Problem based Learning - a review of students' perceptions on an occupational therapy Undergraduate curriculum. The South African Journal of Occupational Therapy, 2014; 44(1):56-61. In this edition.         [ Links ]

5. Jacobs L. The other side of the coin: OT students' perceptions of problem based learning. The South African Journal of Occupational Therapy, 2014; 44(1): 62- 67. In this edition.         [ Links ]

6. P Barnard Ashton. The influence of blended learning on student performance in an undergraduate occupational therapy curriculum. SAJOT, 2014; 44(1) in this Journal.         [ Links ]

7. Casteleijn, D. Using measurement principles to confirm the levels of creative ability as described in the Vona du Toit Model of creative ability. The South African Journal of Occupational Therapy, 2014; 44(1): 14-19. In this edition.         [ Links ]

8. Franzsen D, Stewart A. identifying factors that contribute to hand writing problems experienced by students at a higher education institution in South Africa. The South African Journal of Occupational Therapy, 2014; 44(1): 3-8. In this edition.         [ Links ]

9. De Witt P Rothberg A, Bruce J. Occupational therapy managers' role and perceptions of clinical education. The South African Journal of Occupational Therapy, 2014; 44(1): 9-14. In this edition.         [ Links ]

10. R Smith, Occupational performance factors perceived to influence the readmission of mental health care users diagnosed with schizophrenia. The South African Journal of Occupational Therapy, 2014; 44(1): 51-56. In this edition.         [ Links ]