GUEST EDITORIAL

 

Occupational therapy past, present and future: Crafting our relevance with intent and foresight

 

 

Tania Rauch-Van der Merwe

Departmental Chair: Department of Occupational Therapy, School of Allied Health Professions, Faculty of Health Sciences, University of the Free State. vdMRauchT@ufs.ac.za

 

 

This year, we are celebrating the 40^th anniversary of the Occupational Therapy Department at the University of the Free State (UFS). In 1972 Lynne Visser took the intuitive leap to make a case at both the University and the Provincial Administration for the relevance and importance of the establishment of an occupational therapy department¹. This bold step toward meeting the challenge of growing public health care needs nationally, and the fact that there were only six qualified occupational therapists in the district: two in a public school for children with disabilities and three in public hospitals², may be argued as a strategic move in view of meeting the subsequent rapidly growing necessity for, and clear relevance of qualified occupational therapists. (Especially against the backdrop of it being documented in the minutes of the then South African Association of Occupational Therapists in 1949 and 1964, that some members of the public faked their occupational therapy qualifications in order to be employed³!) The department at UFS was founded in 1976, coinciding with the publication of the Scope of the Occupational Therapy Profession⁴ - a document that not only signified remarkable strategic language - in view of articulating occupational therapy's relevance and importance in the realm of health care and wellness - but also strongly denoted the then emerging discipline of occupational science.

Besides consistently seeking to meet high standards and quality assurance in its curriculum, this department's leaders and many of its lecturers have employed notable leadership and strategic decisions based on the awareness of both the immediate and environmental context at large. Space allows me to mention only a few: Mr Jock Murray was appointed as Head of Department in 1977; a position he held until 2004. Together with three other colleagues from the Faculty of Health Sciences Mr Murray submitted a project proposal in 1992 to the Kellogg's Foundation who - at the time - held a contest for the conceptualisation of the most relevant community-based project toward education, training and alleviation of poverty. Mr Murray's and his colleagues' proposal received a substantial grant over a period of five years for the Mangaung University of the Free State Community Partnership Program (MUCPP), which has subsequently become an indispensable community-based health care and skills training hub. Dr Santie van Vuuren, who started working at the department in 1979, initially as a part-time lecturer was appointed in a new position as the head of School of Allied Health Professions (SAHP) in 2001. Due to her foresight regarding the value and relevance of offering a space for interdisciplinary and simulated skills training, she started consulting locally and internationally in 2007 regarding the nature of such a facility and after obtaining the funding, the SAHP Skills Unit was completed in 2011. Dr Rita van Heerden, Mr Murray's successor, demonstrated the highest through-put of post-graduate students and, in addition to this, generated and realised together with the executive committee a well-organised administrative system in the department and facilitated the design process of a new curriculum, which thoroughly incorporates the principles of alignment and cross-alignment and that was implemented in 2012. Mrs Annamarie van Jaarsveld, in addition to her internationally recognised standing in the field of sensory integration followed as head of department in 2010 and is known for her legacy of, among other things, carefully overseeing the implementation of a new curriculum that constantly seeks the dynamic balance between theory and practice; between doing and becoming which seemingly resulted in graduandi who demonstrate a notable level of skills in synthesising theory with practice, with management and with research⁵. Finally it is no less than fitting to also mention here the remarkable stewardship of Mrs Ronette Hough with the research portfolio and who has persistently but unobtrusively steered the department as a collective toward a steady and significant research out-put rate.

Nevertheless, our current responsibility remains: to constantly interrogate our thinking and reasoning and to gain accurate and 'real-world' information⁶ in order to make the best decisions for the future. One method of gaining contextual information is to prob-lematise the 'history of the present', which in Foucauldian terms means to identify which historical patterns⁷ of inclusion and exclusion in our assumed ways of thinking, doing and being in this world, are unintendedly reproduced - a common human condition. Our student population remains homogenous in terms of race, gender and to some extent world-view and class. This status quo unabat-ingly seems to endure despite many efforts employed to recruit demographically representative applicants. It seems logical then that in order to change these exclusionary patterns with insight, deep analyses are required of deep systemic structures. Another way of gaining accurate information is to contextually interpret current national and international events in the realm of higher education. The 2015 #Fees-Must-Fall campaign ignited a new awareness of persistent threats to our not-so-new democracy: economic, social, political, and alas, epistemic inequalities. We have an emerging generation of young citizens that is reclaiming agency, who autonomously are questioning authoritarian and unilateral structures in higher education that may bare absent or, irrelevant self-criticality in a relevant context. In addition, hegemonic educational practices and mono-cultural epistemologies⁸, which may unconstitutionally serve the purpose to unfairly exclude, albeit unintendedly, are being legitimately questioned anew as such mechanisms inevitably give form to epistemic alienation⁹ - excluding many students from academic success.

However, part of accurate analyses in view of strategic decisions is also to understand and apply our strengths. If occupational therapy is viewed through the lens of complexity theory, it is clear that this profession comprehends and does by a deep understanding of the value of interaction between the large number of stakeholders and elements in the environment it forms part of; that these connexions are non-linear, rich and dynamic; and that such interconnected-ness requires constant adaptation¹⁰. World Health Organisation evidences that social determinants are most influential to human beings' health¹¹. It may be argued that Occupational Therapy is the only allied health profession that is positioned ontologically for casting a holistic view to address social health determinants in various contexts. At the UFS for example, the profession's ability to accurately assess and design community-based occupational therapy engagements are key in elucidating - via occupational science - the common grounds of institutional foci between Service Learning, Community-based Education and Inter-professional Education. The scope of contributions for our 40^th Anniversary clearly represents the complexity of the various contextual factors, environments and stakeholders that the profession artfully includes in its reasoning toward best practice. May we continue to stand on the shoulders of the giants before us, and courageously look both at the past in hindsight and at the present with insight, in order to co-create a future of a highly relevant and indispensable Occupational Therapy profession, that echoes foresight and wisdom.

 

REFERENCES

1. UFS Department of Occupational Therapy. "Arbeidsterapie, 10 Jaar, Universiteit van die Oranje Vrystaat 1976-1986:2. Booklet published by the Department of Occupational Therapy, University of the Orange Free State, 1986.         [ Links ]

2. UFS Department of Occupational Therapy. "Arbeidsterapie, 10 Jaar, Universiteit van die Oranje Vrystaat 1976-1986:6. Booklet published by the Department of Occupational Therapy, University of the Orange Free State, 1986.         [ Links ]

3. 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 ]

4. South African Government Gazette. No. R.229I, The South African Medical and Dental Council: The regulations defining the scope of occupational therapy, 3 December 1976, No. 5349.         [ Links ]

5. UFS Department of Occupational Therapy, External examination reports 2015.         [ Links ]

6. Muliro A. The importance of distinguishing the map from the territory: Interview with André Zaaiman. Development, 2014; 56(4): 440-445.         [ Links ]

7. Foucault M. See for example Discipline and Punish: The birth of the prison, 1977. New York: Patheon.         [ Links ]

8. Kronenberg FF, Pollard N. and Ramugondo E. Introduction: Courage to dance politics. In: Kronenberg FF, Pollard N. and Sakellariou D., editors. Occupational therapies without borders: Towards an ecology of occupation-based practices. London: Elsevier, 2011:1-16.         [ Links ]

9. Rauch-Van der Merwe T. The political construction of Occupational Therapy in South Africa: A critical analysis of curriculum as discourse. Doctoral thesis forthcoming. South Africa: University of the Free State 2016.         [ Links ]

10. Cilliers P Complexity and postmodernism. London: Routledge 1998:4-9.         [ Links ]

11. See for example World Health Organisation. Social determinants of health. Available at http://www.who.int/social_determinants/sdh_definition/en/. Accessed on 4 March 2015.         [ Links ]