Physiotherapists in under-resourced South African communities reflect on practice.

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