THE THIRD MOLLY LEVY LECTURE LOOKING TO THE FUTURE FROM THE PAST DELIVERED ON MAY 4 1993 by J C Beenhakker A n e p o n y m o u s lectu re is the high est a w a r d th e S o u th A f r i c a n S o c i e t y o f P h y sio th erap y c a n b esto w on a m em ber, for ou tstan d in g serv ice to the S ociety and to the P rofession. T he first recip ien t o f this aw ard , m ad e in 1 987, w a s M olly L ev y w h o steered o u r S ociety an d P rofession from their h um ble b egin nin gs to the stren g th in w h ich they find th em selv es today. W ith the d aw n in g o f the new South A frica, m a n y ch an g es are e xp ected inclu d­ ing reo rg an isation o f the health services an d the d eliv ery o f h ealth care. W e en ter this n ew ph ase w ith h op e an d d e term in a­ tion w ith w h ich to face the u n k n o w n chal­ lenges. Y et th ere is so m e trep id atio n and u n certain ty for w h a t this fu tu re holds. W h at equips u s for the F u tu re? It is said that trad ition s keep u s co n ­ n ected to o u r p ast b ut "The Past, seen in the Present, binds us through our Students and New Graduates to the Future, and to those who come after us."1 W e therefore need to g o b ack in tim e in o rd e r to establish o u r ro ots, b oth as reg ard s the South A frican S ociety o f P h y sio th erap y as well as o u r profession . F o r as H elen H islop said "A Society and a Profession without a sense of the Past for w hich it has Respect, lacks Identity and Respect for the Future".1 T h ere is m u ch talk, at p resen t, o f m a r­ k etin g o u rs e lv e s an d of im p ro v in g the s tatu s o f o u r profession , so th at the m ed ical fratern ity an d the lay p ublic w ill afford us the resp ect w h ich w e feel is o u r due. W e heed to look b ack h o w e v e r, an d see h ow o u r p rofession started in o rd e r to u n ­ d erstan d o u r positio n tod ay. D o cto rs w ere alw ay s ac co rd e d a high statu s together w ith the m in ister of religion, the M ay o r an d the school teacher, b e ca u se of their functional im p o rtan ce to society. N u rses, on the o th er h and , w e re seen as d o c to r's h elpers and w e re e xp ected to c a rry o u t the d o c to r's ord ers. O u r p rofession w as started in G reat Bri­ tain b y n u rses in 1895. M an y o f these Brit­ ish p h y s i o t h e r a p i s t s o p e n e d tr a in in g cen tres in a n um ber o f C o m m o n w ealth c ou ntries, in clu din g Sou th A frica, in the tw en ties and thirties. Sm all w o n d e r then tha t w e w e re also seen as the h an d m aid en s o f the d o cto rs. Y et w e can b reak o u t o f this m o u ld — L ook w h a t the Surgeon s h ave achiev ed from their hum ble b egin nin gs as Barbers! It is im p o rtan t that ed u catio n should instil a p rid e in the th e ra p ists for the k now ledge th at they h ave, m u c h o f w h ich is specific to th at profession and is theirs. T h eir d e cis io n -m a k in g skills an d th eir ability to think critically gives th em the right to q uestion an d to offer sug gestion s to oth ers, including the M ed ical and D en­ tal F r a t e r n i t y , b e c a u s e th e ir m is s io n should be to "Give good patient care Not to tip-toe around the physician's ego" Gedan 1973 2 F o rtu n a te ly , d u r in g the late sixties, th ere w a s a m o v e aw a y from p erfo rm in g treatm en t u n d e r p rescrip tio n o f the d o c ­ to rs, w h o w o u ld d e cid e u ntil then on w h ich m odalities cou ld be u se d and the req u ired d osages. Then g reater freed o m w as ob tain ed w h en patients w e re referred to the p h y siotherapists, w h o cou ld d ecid e on the treatm en t to be u sed . Finally in 1983, w e w ere allow ed to p ractice th rou gh co n ­ s u ltation an d w ere exp ected to be able to m ak e a physical d iagnosis o n w h ich to b ase o u r treatm en t plans. U nfortu n ately this fact is n ot gen erally know n and as recen tly as three w eek s ago , a d o c to r stated in a m e e t i n g o f th e S A M D C t h a t p hysio therap ists did w ork u n d er the co n ­ trol o f d o cto rs w h o d ecid ed on treatm en t plans. It even took o u r Society a lon g tim e to . b reak o u r b o n d ag e o f hand m aid enship. It w a s on ly in 1979, that w e took the q u an tu m leap o f electin g a p hy sio therap ist as P resi­ d ent o f o u r Society, rath er than a d octor. The first P residen t of the SASP w as o f co u rse M olly L e v y w h o m w e are h o n o u r­ ing this even in g. M an y o f the ch an ges in o u r p ractice w e re initiated b y o u r Society b u t it w as M olly L evy, as ch airm an o f o u r Professional B oard , w h o m an ag ed to get th em ap p ro v ed b y S A M edical an d Dental C ouncil. T h e r e is a tre n d in p h y s io th e r a p y w o rld w id e for g reater in dep end ence for p ractitio ners. N ew rules w ill soon b e p ro ­ m u lgated w h ich .w ill giv e greater au ton ­ o m y to v ario u s professions. G reater free­ d o m d oes h ow ever, b rin g g re a te r resp o n ­ sibility, and w e m u st en su re that w e are p rep ared to m eet these new challenges. F re e d o m to exercise d iscretion ary ju d g e­ m en t in patient care, results in a g reater m e a s u r e o f a c c o u n ta b ility to th e p r o ­ fession. The profession as a w h o le w ill suf­ fer if this freed o m is ab used, even if only b y the few. F o r exam p le, ov erch arg in g , ov erserv icin g and p ro v id in g false infor­ m atio n to the M ed ical A ids a re fairly co m ­ m o n com p lain ts. M an y p h y sio th erap ists b e lie v e th a t the n ew ru le s w ill a llo w g re a te r freed o m to ad v ertise th em selv es as in d iv id u als. H o w e v e r, a d v e rtis in g m ay only be u n d ertak en in a p rofessip nal m a n ­ n er an d m a y n ot be to the d e trim e n t o f oth ers. It m u st b e rem em b ered : that the ru les o f c o n d u ct p ro v id e guid elin es and directio n s for ap p ro p riate b e h av io u r by p ractitio n ers, w h ich p ro te c t the in terests of the p atien t an d en su re that their rig hts are u p h e ld . The M ission o f the S A M D C an d its v ario u s B oard s, is to p ro m o te h igh ethical s ta n d a rd s an d to e n su re train in g an d p ra c ­ tice is a p p ro p ria te an d accep table. T h e S o u t h A f r i c a n S o c i e t y o f P h y sio th erap y o n the o th e r h an d , p ro tects the in terests o f its m em b ers an d aim s to en su re that p h y sio th erap ists are n o t d is­ crim in ated again st. W e th erefo re, n eed to be a stro n g an d united S ociety in o rd e r to fulfill o u r aspiratio n s. W e n eed to im p ro v e co m m u n icatio n at all levels an d to e n co u r­ ag e o u r m em b ers to re a d their jou rn als and new sletters, w h ich aim to keep th em in­ form ed of w h a t is h ap p en in g in the Society an d w h at is b ein g d o n e o n their b ehalf th rou gh con su ltation . P h y sio th erap ists a re w o rk in g to w ard s first line p ractitio n ers, b u t still fu nction co o p erativ ely w ithin the m ed ical m odel. O u r p r o f e s s io n is h is to ric a lly b u ilt on scientific lore w h ich h as been in vestig ated an d accep ted b y d o c to rs o v e r the y ears. W e are th erefore, a m ed ically d o m in ated p ro ­ fession, and are b ou nd ' to a certain exten t b y its rules. O n the o th er h an d , c h iro p ra c ­ tors and o th ers w h o h a v e defined th em ­ selves as altern ativ e h ealers, are m ain ly ind ep end en t b u sin ess m e n w h o c a n en ­ g ag e in d irect an d su ccessfu l c o m p etitio n in m edicine. The solu tio n to this p rob lem w ill n o t be ea sy to find. W e m u s th o w e v e r, learn from the p ast in o r d e r to an ticip ate the fu tu re so that w e m a y d e term in e o u r o w n destiny. “ W e must learn to Think Pro a c tiv e ly Rather than living Reactively". W e need to b e in the fo refron t to en su re • th a to u r e d u catio n and p ra c tic e d oes reflect the ch an g es in the h ealth ca re n eed s, and n o t on ly re a c t to c h an g es o n ce they h ave occu rred . P erh ap s the p ro p o sed w ork sh op to be held on S u n d ay M ay 9th w ill give us so m e in dication to the d irectio n w e should be go in g , an d giv e us a p lan for the future. W e d o k no w that th ere will be less e m ­ p hasis on a c u te ca re in h igh tech n olo gy institutions, w h a te v e r else m a y be in store. This is n o t a n ew co n cep t an d as far back as 1 942, D r H e n ry G lu ck m an , then M inis­ ter o f H ealth , u rg ed for a u n itary health sy stem that w o u ld p ro m o te the health of the p o p u latio n rath er than to treat the dis­ eases o n ce th ey h a v e o c c u rre d . Continued on page 41... Physiotherapy, August 1993 Vol 49 No 3 Page 39 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) PHYSICAL AND OCCUPATIONAL THERAPISTS Hundreds of positions available immediately, in any state — Florida, Texas, New England •_L. UMR1 found us a wonderful job in a travel­ ing program. Our first assignment was in Las Vegas, Nevada, then we were o ff to Rhode Island. We wanted to see d/e United States and get experience. Thanks to MRI, we are doing both. Everyone has been so nice to us.” -Annalie Van Zyl and Annelu Van Wyk Medical Resources International can place you in any specialty in any part of die United States — at $35,000 to $60,000 a year. Your licensure and credendaling and visa fees are fully paid. P LU S: we provide a F R E E study course and materials to help you pass the state board exams. W e hire in all specialties,including: ■ Clinical Coordinators and staff positions ■ Outpatient orthopedics/Sports medicine ■ Rehab, including neuro, cardiac, and brain injury ■ Acute care ■ Pediatrics ■ W ork hardening ■Geriatrics See the U.S. — Apply for one of our traveling positions: ■ W ork in a variety o f locations ■ Company car ■ Housing subsidy ■ Salaries $40 to $50%000 ■ Travel to a new state every three months Other services: ■ F R E E Air fare ■ Housing assistance ■ Medical, life, and professional insurance Medical Resources International— More Jobs, Better Service Meet MRI..? Over 200 ^ health care professionals placed this past year I RI .r PRESENTATION'S ON “Living and Working in the U SA ” ■ Capetown ■ Tygerberg ■ Pretoria ■ Durban ■ Johannesburg ■ Bloemfontein Presentations to be held in late September. Please call fo r exact date and time. C a l l u s c o l l e c t 515 472 4018r . 1 0 1 N. Main St., Suite 202, Fairfield, IA f o r p r e s e n t a t i o n d a t e s a n d t i m e s l i A . _ ~ ‘ . , . j Tt c a 52556 U.S.A. ■ Fax (515) 472-1897 O f f i c e s in A u s t r a l i a , U .K ., H o ll a n d , P o l a n d , P h i l ip p i n e s , a n d U .S .A . ' ' R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) ...Continued from page 39 O u r p resen t health ad m in istrato rs are p ro m o tin g affordab le, equitable an d a vail­ able health serv ices fo r all w ith the e m ­ p hasis on p re v e n ta tiv e health - fifty-one y ears after this id ea w a s first m o o ted , and u nfortu n ately n o t a c ce p te d b y the g o v e rn ­ m en t o f the d ay. Preventive Health P ro fesso r N an cy W a tts in 1 983 told a s to r y to illu s tr a te p r e v e n tio n w h ich I w o u ld like to retell. It is a s to ry of a m an, stan d ing o n the b ank of a riv er, w h o keeps on d ivin g in to rescu e d ro w n in g m en as th ey are being sw ep t p ast. N o so o n er is one safely b ro u g h t to sh o re, w h en an o th er cry for help is h eard . W h en the rescu er is asked w h a t he is d oing, he g asp s that the d ro w n ­ ing m en are co m in g d o w n riv e r so fast, tha t h e d oes n o t h a v e a m o m e n t to ru sh u p ­ s tre a m to see w h a t is c a u s in g the m en to fall into the riv er in th e first place. W e as health ca re w o rk ers n eed to m ak e tim e to find the cau se o f health p rob lem s, an d su g ­ gest w a y s o f p rev en tin g these so that less m o n ey will n eed to be sp en t on treatm ent of d isease and m o re will b e availab le for p rev en tativ e an d p ro m o tiv e health care. O u r u n d e rg ra d u a te e d u catio n , o v e r the d ecad es, has ad a p te d to c h an g es as they o c c u r r e d , a lth o u g h m a n y o f u s w o u ld a g ree th at o u r train ing is n o t m eetin g m o st of the health c are n eed s of the cou ntry. M ost of us are a w a re th at o u r serv ices are u rgen tly n eed ed in th ose a reas w ith least a ccess to health care. It is h o w ev er, o f little v alu e a d d in g the o d d m o d u le o n c o m ­ m u n ity health an d p re v e n tiv e ca re to an a lr e a d y o v e rlo a d e d c u r ric u lu m , in the h op e that the need s will be m et. If w e e x p e ct o u r g r a d u a te s to w o rk in isolated ru ra l c o m m u n itie s, then w e m u s t give th em the m ean s to d o this, and the health services m ust su p p o rt th em o n ce th ey are there. The U n iversities do, on the w h ole, strive to giv e their s tu d en ts the tools w h ich they w ill n eed to m eet p re se n t and future d em an d s. It is h op ed that the g rad u ates will m ak e u se of the c o g n itiv e and d eci­ sion -m ak in g skills w h ich they h ave a c ­ q u ired , in o rd er to co p e w ith the reality of p ra c tic e o n ce they h a v e g ra d u a te d . N o n ew g ra d u a te can be ex p e cte d to b e co m ­ p eten t in all are a s o f clinical p ractice, as n either in d eed can an e xp erien ced p racti­ tioner lay claim to this ability. It is exp ected th at these n ew p h y sio th erap ists will im ­ p r o v e th e ir p s y c h o m o to r sk ills w h e n w o rk in g fu ll-tim e, w ith so m e clinical su p ­ p o rt, follow in g g rad u atio n . P erh ap s there is so m e m erit in an intern sh ip period d u r­ ing w h ich the recen t g ra d u a te m a y also be in stru cted in m an ag em en t an d legal m at­ ters. N o w th at sp ecialisatio n h as b eco m e a reality, w e need to con sid er a speciality in C o m m u n ity an d P rim a r y H ealth C are. This w ill req u ire a grou p of con cerned p h y sio th erap ists to un d ertak e this task, as h as been d on e b y m em b ers of Special In­ terest G ro u p s fo r th eir specialities. W e should n o t be askin g the S A Society of P h y sio th erap y to set up an o th er ad h oc c o m m i t t e e to i n v e s t ig a t e th e m a t t e r . R ather, those of u s w h o feel s tro n g ly th at this is the ro ad w e should be follow ing, should v o lu n teer to un d ertak e the task. Finally w e n eed to p reserv e the h eritage w h ich w a s h and ed d ow n to us by ou r F o u n d er M em b ers w h o se en th u siasm and d ed ication established the South A F rican Society o f P h y sio therap y . But those of us w h o received the legacy from these p ion ­ eers,. n eed to h and it d o w n to those w h o w ill follow us. A s John F K en n ed y said "It is the Task of our Times and in our Generation to hand down undiminished to those who come after us, what was handed down to us by those who went before". M an y m em b ers of the p rofession h ave s u p p o rted their Society an d h a v e giv en of their tim e a n d m o n ey to enable the SASP to g ro w in stren g th for those w h o follow. L ess th ou gh t w a s given b y these m em bers as to h ow the Society w o u ld benefit them , b ut rath er h ow th ey cou ld be of serv ice to their profession al association . F o r the so ­ ciety to be econ om ically viable an d well m an ag ed to m eet the n eed s of its m em bers, w e require the p articip ation of m a n y m o re p hysio th erapists in the affairs of the p ro ­ fession w h ich e xten d b eyon d p atient care. W e m u s t id e n tif y a n d n u r t u r e th o s e p hy sio th erapists w h o are w illing to be an activ e p a rt of the Society of p h y sio th erap y . T h ey d o n eed assistan ce and e n co u ra g e ­ m en t to ach iev e their full potential. W e all know the say in g that if y o u give a m an a fish yo u feed him for on e d ay. But if yo u teach him h ow to fish, y o u feed him for life. W e therefore n eed ,to give those w h o are w illing to serve, at B ran ch and special in­ terest gro u p level, o u r help so that they m a y b eco m e stro n g lead ers and c a rry on the go od w o rk o f the profession. Then us oldies will be h ap p y to step back and hand o v e r the reins to the fu tu re kingpins of the p rofession. In conclusion I h ave looked back at so m e of the m ile­ ston es o f o u r p a st in the h op e that they m ay lead us to the sign p o sts of the future. The reality o f the fu tu re c a n be d eterm in ed by o u r o w n foresight and vision, and should n ot d epend on w h a t o th ers think w e need to d o o r be. H ealth c are for the m ajority of the citizens o f South A frica should be ou r m ission, and u nless w e learn to think m o re global ly, there is the d an g er tha t o th ers will step in to the b reach . W e are so co n cern ed w ith p ro tectin g o u r sco pe of p ractice, that the m ean s of c h an g in g o u r th ru st to m eet ch an gin g health n eed s m a y be n eglected. I tru st th at the co m in g C o n g re s s w ill focus o n th e ch allen g es facin g u s an d give us d irectio n to p re p a re fo r the 2 1 s t C en tu ry . W e h av e ob v io u sly g ain ed a g reat deal from o u r early P ion eers, w h o s e clear vision w as their stren g th . W e h av e also learned th ro u g h trial an d e rr o r b u t should' take c a re o f n o t re-in v en tin g the w h eel, w h en w e set o u r go als for th e future. A s M r H a rry O p p en h eim er said "If we are wise, we will make, every effort to learn from other people's experience. That is a process which is much easier and very much less painful." L et us learn from this collectiv e e x p e ri­ e n ce and w isd o m an d to ch an nel o u r en ­ ergies in to stren g th en in g the S ociety and m ak in g ou r profession tru ly great. References 1. Hislop JH. The not-so-im possible dream. Physical Therapy 1975;55(10)1069-1080. 2. Gedan S. Critical Incidents in Nursing 1093; Ed. Bermosk and Corsini, Philadelphia. WB Saunders Company. 3. Watts NT. The Privilege of Choice. Physical Therapy 1983;63(11)1802-1808. ^ RESPITE CARE CENTRE ^ A new service, providing tem porary accom m o­ dation for the Physically Disabled has opened its doors to a “Half-way H ouse” in the Transvaal. Accommodation can be offered to seven dis­ abled persons, who are in reasonable health and independence for a period o f one day up to ■ three months. The centre, situated in Johannesburg, w ill cater for the following needs • the need to be attended to by an Orthotist • a student attending a short training course • discharges from hospital too early to be independent at home or with no immediate sanctuary. It is aim ed to enable these dis­ abled persons to live full, meaningful lives within the community • relief to care-givers (family or friend) by pro­ viding accomm odation for the disabled fam ­ ily mem ber allowing the care-giver to enjoy a short break or longer holiday • abandoned by the death of the care-giver or next of kin • the disabled person still needing physiother­ apy or occupational therapy between full hospital care and returning to the com ­ munity. Costs - Fees will be determined on each appli­ cant's circumstances. This non-profit making service will depend on fundraising and dona­ tions in addition to fees. For further inform ation contact Mr Paul Jackson (011) 888-6122,646-8331 Matron Lily Krause (011) 888-6122 V____________ _____________) Physiotherapy, August 1993 Vol49 No 3 Page 41 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )