Through the bus window: Initial Impressions of Community-based Rehabilitation

Week 1: 18-22 April

For the first few days of our Community block, it was overwhelming to transition from a structured Paeds context, to the dynamic nothing-goes-according-to-plan total immersion that is Community-based Rehabilitation. Greeted by a flaming pile of rubble blocking our entrance to the community on Day 1, we all suspected then, as we know now, that this block is going to shake us right out of our comfort zones.

 

Driving home after the first day in the community, on an even tarred road, watching the green trimmed lawns and large, well maintained homes flit by, I thought of other roads I had passed just a few hours ago: heavily potholed and stone-littered, marked with the black burn marks of recent protests and flanked by crumbling homes and ramshackle informal dwellings.

 

 Laptop in front of me, sitting in my comfy chair, with the breeze wafting in from the beautiful  garden outside my burglar-guarded windows  as I typed up some work that evening, I thought of another home I had been in that day. Accessible only by the narrow dirt and gravel path sloping downwards towards the battered wooden front door, the home was small, cramped and dark, the only source of light being the natural light streaming in through the holes in the roof and a small unlit candle on the surface.

 

Leaving the community on the first afternoon, and experiencing the sudden transition from the run-down, clearly poverty stricken community to the beautiful, well-fenced suburbs, I felt a huge invisible divide. Those high walls held within them not just wealth , but the promise of opportunities for improvement that many people caught in the poverty cycle would never be able to dream of achieving.

 

According to Statistics South Africa, the country's Gini coefficient (the degree of inequality between its people ranging from a 0 or total equality to 1, or total inequality) currently rests at a concerning 0,65 (Statistics South Africa, 2014).

This means that, in conjunction with, or perhaps running parallel to, the other issues plaguing the country, such as crime, corruption and drought, South Africans still face major wealth inequality. This may exacerbate tension within the country as frustration rises among those who feel short-changed by the system.

 

 

We saw a glimpse of this frustration on our first day, as we carefully drove around flaming barricades made of rocks, cans and tree branches that blocked entrance to the community. The protests had already died down by the time we arrived , but the impact of them was still visible. Taxi's and cars transporting labourers and teachers had not been allowed entrance meaning that the community lost the day's productivity. Schoolchildren milled about outside the school grounds , sent home early as the schools had decided to close for the day. The clinic waiting area was half-empty, as many people had been unable to obtain public transport from their home. And yet, despite the clear ramifications of the protests, when we decided to ask around about the reason for the strike, only one out of the five people we approached was able to explain the grievances.

 

 

It appeared that the protests we had stumbled upon centred around the housing crisis, with community residents upset at the mismanagement of the allocation of the newly built houses within the area. According to the woman we spoke to, people from outside the area were receiving houses, while people from within the area, who had been on the waiting list for years , had not been allocated homes.
The housing crisis is not a new phenomenon in South Africa. In 1994, when the new Government came into power, the urban housing backlog was already standing at 1.5 million housing units, growing at a rate of 178000 units a year (AfricaCheck, 2014). By 2011, the number of informal dwelling in the country sat at 1.9 million, making up 13% of all households in the country(AfricaCheck, 2014). According to the Financial and Fiscal Commission (FFC), it would cost R800 billion to eradicate the housing backlog by 2020 (FFC, 2013).

 

According to the South African constitution,

“Everyone has the right to have access to adequate housing" (AfricaCheck, 2014). In line with this, the Housing Act has been implemented to facilitate a sustainable housing development process.

However, according to research conducted by the Socio-economic Rights Institute of South Africa, although "politicians and officials responsible for housing policy in SA, at all levels of the state, have sought to create the impression that housing allocation is a rational process, which prioritises those in the greatest need, and those who have been waiting for a subsidised house the longest”, “there are a range of highly differentiated, and sometimes contradictory, policies and systems in place to respond to the housing need” (SERI, 2013).  The process of housing allocation lacks transparency, as there is no clearly defined process or waiting list that is followed, and sometimes allows for corrupt practices to occur.

With this sort of mismanagement evident, it is understandable why many community members have lost faith in the government's management, and are resorting to illegal protest action, even though the repercussions of these, whether in terms of the physical destruction of property, or the upheaval it causes within the community, will have a negative fallout for the community.

Within the context of these pertinent community issues, which are only the tip of the iceberg, healthcare provision occurs on an entirely different level.

Our intervention within the community setting functioned at both an individual and collective group level.

 

On the individual level, we got in contact with the community caregivers and began the process of conducting home visits with individuals within the community who required rehabilitation. This aspect forms an integral part of the community approach, as many people cannot access the clinics due to poor infrastructure or lack of mobility devices.

 

The home visits also allowed us to understand, for the first time, the context of many of the clients we work with, in terms of the physical setting, the resources available to them and the barriers to function that are often present. Although we attempted to complete as many home visits as possible, we underestimated the degree of organisation required to maximise the efficiency of our visits. We would often be sitting in the bus waiting for students to complete a home visit, or waiting in the clinic for the bus to return with the students from other disciplines.

Finally, towards the end of the week, we had a lightbulb moment and devised a plan: we mapped out the locations of all our clients and worked out the best routes, and client combinations to allow us to complete as many visits as possible, and allow members of other disciplines to accompany us as well, so that we could work together at the same time, and learn from each other in the process. In my personal capacity, I feel that I need to revisit both my isiZulu notes, as well as some of my physical textbooks, to be properly equipped for my clients, going into the next week.

On a community level, we began work at two local primary schools, beginning the screening process with a new lot of children, while carrying over intervention with the children seen by the previous lot of students. Coming from the Paediatric block, this intervention merged the two blocks together well, but after conducting in-depth 2-hour long assessments on children, completing a 10-minute screen required a bit of adaptation… (at least we provided the speech therapists with some amusement as we ran- and skipped- around with the children like headless chickens...) Out of the 44 children due for assessment, we only completed 10 within the time allocation, prompting us to sit down and brainstorm some techniques to improve our efficiency for the next round of assessments.

 

The other project that we're all particularly excited about is the project aiming to increase the engagement of individuals with disabilities within the community (we're still working on a catchy name...). This week, we met an internationally recognised Boccia player with muscular dystrophy, who is keen to start his own Boccia sports group. Having built some links with with the community Youth Centre over the past week, we hope to start our project by getting dialogue going between the relevant stakeholders, and providing the necessary support to allow this talented individual to realise his dream and spark a dream in others as well.

Over the past week, I have had the opportunity to walk into the lives of people I would likely never have interacted with otherwise. I have met healthcare workers of various disciplines, and experienced the beauty of inter-disciplinary teamwork ( we hope to soon make that 'trans-disciplinary' as we figure out how to work better together and role-release more effectively...) and how we each have a vital part to contribute to the wellbeing of an individual.

I know that as I progress on this block, I will see my perceptions of the community evolve as I realise that I have brought my own preconceived ideas & stereotypes into the block , and as I begin to understand the cultural dynamic better from my vantage point as a healthcare provider. I know that I will later read over some things I have written, or some ideas I have  formulated and pick up some superficiality in my thinking or some flawed ideas.  I look forward to experiencing a positive shift in my thinking as I grow as a person and as a therapist, all part of the learning curve of the Community block.

 

 

You made it to the end:) Here's some South African funnies for you:

 

 

 

 

 

 

Statistics South Africa (2014, April, 3). Poverty Trends in South Africa. Retrieved from

http://www.statssa.gov.za/?p=2591

 

AfricaCheck (2014). FACTSHEET: The housing situation in South Africa. Retrieved from https://africacheck.org/factsheets/factsheet-the-housing-situation-in-south-africa/

 

Financial and Fiscal Commission (2013). Exploring Alternative Finance and Policy Options for Effective and Sustainable Delivery of Housing in South Africa. Retrieved from http://www.ffc.co.za/images/Front_page_news_items/Exploring_Alternative_finance_and_Policy_Options_for_Effective_and_Sustainable_Deliver_of_housing.pdf

 

Socio-Economic Institute of South Africa (2013).

‘Jumping the Queue’,Waiting Lists and other Myths:Perceptions and Practice around Housing Demand and Allocation in South Africa. Retrieved from http://www.seri-sa.org/images/Jumping_the_Queue_MainReport_Jul13.pdf