R e f l e c t i v e A r t i c l e S e n s e ( S c e n t s ) o f S o u t h A f r ic a A B ST R A C T : This paper presents a brief description o f some o f the author’s p er­ ceptions o f the land, o f physiotherapy education and practice and o f the strug­ gle o f the nation o f South Africa acquired during a 4 week visit in late spring 1997. One week was spent in Capetown participating in several venues at the International Congress o f the South African Society o f Physiotherapy. Three weeks were spent at the University o f the Witswatersrand in Johannesburg presenting a course in qualitative research to health care colleagues representing the disciplines o f physical therapy, occupational therapy, speech pathology and occupational health. During the time in Johannesburg several health care facilities were visited including Baregwanath Hospital, Natal Hospital and the Wits Rural Facility and Tinswalo Hospital at Acornhoek. KATHERINE F. SHEPARD £ t was the smell o f A frica 1 m issed so I m u ch !” exclaim ed the South A frican _M -physiotherapist w ho had rec e n tly returned from the United States. W hile her colleagues com m ingling nodded their heads, 1 w ondered w hat she meant. The smell o f the sea and pines o f C ape Town? The com ingling odors o f the m agnificent trees, lush flow er beds and busy m etropo­ lis o f Johannesburg? The pungent w arm th o f the low-veld or the ozone air after thu n d ersto rm s ro lled across the plains? T h e crisp fir-scented b reezes that rise from the trout streams in the high country? South A frica was each and all o f these, as com plex and ever-changing as scents in the air. Sim ilar to a kaleidoscope, once I thought 1 had the picture/sm ell 1 turned slightly and a whole new picture/sm ell cam e into view. 1 am resolved to living with the m ultitude o f vivid short sniffs that a visitor can acquire in four weeks... and w ondering still w hat “the smell of A frica” w ould mean to som eone who was born and raised here. I am never to know. W hat a naive visitor I was! My k n ow ­ ledge o f South A frica was a superbly d is­ torted m elange o f the jun g le and anim als o f “Little Black Sam bo” , persistent televi­ sion replays o f the scenes o f poverty and brutality in Soweto, and the rem arkable N ew sw eek photos o f two courageous fo r­ mer adversaries, De K lerk and M andela shaking hands, now wise in the way elders are. A rriving at the Cape Town A irport for the 1997 In tern atio n al C o n g ress o f the South African Society o f Physiotherapy and hearing British accents everyw here in the lobby I thought, “There m ust be a big group of Brits here on holiday.” On the drive into Cape Town I noted w hat looked like many goat sheds on the hillside and thought to m yself “m m mm I never knew there w ould be goats in South A frica” . M y first evening meal at the Breakw ater L odge included pum pkin and I thought “W hat a treat to have pum pkin when it is not even T h an k sg iv in g !” To say that 1 arrived in South A frica engulfed in an ethnocentric view was an understatem ent. W ithin a day I discovered that nearly everyone 1 met in Capetow n spoke with a British tinged accent, that people, not goats, lived in the tin shacks on the hill­ side and that pum pkin was a staple food served every evening at the hotel dining room. How my perceptions and beliefs were delightfully turned upside-down over and over again in 4 weeks! A year later I was still struggling to sort out and understand the m eager bits of inform ation I had gathered and percep­ tions that enveloped me regarding the heritage, diversity, struggle and beauty of South Africa. No other country 1 have v i­ sited ev er affected me as profoundly. W ithout the stabilizing, honest and non- judgm ental responsiveness o f many p h y ­ siotherapy co lleagu es. I w ould have an even more shallow and perplexed view of South Africa. THE L A N D A N D THE C O N TEX T W hat a beautiful country! Trees shaped by winds, lush vegetation even in autumn, the unreal brilliance o f flow ers and birds, a “W yom ing” blue sky and the Southern Cross at night. D uring a short trip through a gam e park I w itnessed a huge elephant sauntering across the road chew ing vege­ tation that hung to its knees, knock-kneed baby giraffes with enorm ous brown eyes and sed u ctiv ely long ey elash es leaning against their tow ering m others, baboon bands, ever-so-busy black and w hite spot­ ted guinea hens, and hippo ears above the river surface. A t the C ape Town aquarium I w ondered how an enorm ous square fish with a tiny upright fin (sun fish) could float much less swim and along the southern rocky coast I saw wild penguins with pink eye shadow. T he author John Steinbeck once stated that we first see and try to m ake sense o f things in new lands by com paring them to w hat is fam iliar to us. As such, Walt D isney rather than Little Black Sam bo was the touchstone to my jo y and astonishm ent at this land. Perhaps it is the beauty and w onder of the co u n try sid e that m ade the co n trast with living in the city o f Johannesburg so shocking. In the m idst o f this co u n try ’s transition from apartheid to reconciliation, everyday life is saturated with concerns for personal safety. In block after block of residential areas in Johannesburg there are no lawns to be seen - only walls, some 8-10 feet high, some with barbed wire and all with locked security gates. People carry keys like jailers. Keys to hom e, to security gates, to unlock car doors and ignitions, to office doors, corridor doors, and bathroom doors in their public work places. And with good reason. N ot a sin­ gle person I met was m ore than one per­ son aw ay from som eone w hose house had been robbed or office broken into or who had been held up at gun point. A nd it was all understandable! R ecent generations of severely repressed black Africans had been raised with the slogan “R evolution before Education” . T hose tens o f thousands o f hum an beings who had been taught militia skills but no viable vocational skills live in a country where the unem ploym ent rate is 30%. The stark contrasts betw een the “haves” and “have-nots” are everyw here from modes o f transportation to food to C O RRESPO N D EN C E: K atherine F. Shepard Professor and Director, PhD Program in Physical Therapy D epartm ent o f Physical Therapy C ollege o f A llied Health Professions Tem ple U niversity Philadelphia, PA 19140 USA Phone: 215) 707-4824 Fax: 215) 707-7500 E -m ail: kshepard @ astro.tem ple.edu SA Jo u r n a l o f Ph y s io t h e r a p y 1999 V o l 55 No 1 3 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. ) t h e p h y s i c a l b o d i e s o f s m a l l c h i l d r e n . I a m a s t o n i s h e d t h a t m a s s i v e b l o o d s h e d h a s n o t b e e n a n i n h e r e n t p a r t o f t h i s r e v o ­ l u t i o n f r o m r e p r e s s i o n t o f r e e d o m . N e l s o n M a n d e l a is a p o w e r f u l , c h a r i s m a t i c l e a d e r w h o a p p e a r s to h a v e e m p a t h y w i t h all t h e S o u t h A f r i c a n p e o p l e . H o w e v e r , t h e p e o ­ p le t h e m s e l v e s h a v e to a g r e e to f o l l o w h i m in th i s r e l a t i v e l y p e a c e f u l t r a n s i t i o n o r it w o u l d n e v e r h a p p e n . W h a t r e m a r k ­ a b l e p e o p l e l i v e h e r e ! B u t n o w t h e q u e s t i o n s a p p e a r t o b e , w il l S o u t h A f r i c a s u r v i v e u n t i l t h e c u r r e n t g e n e r a t i o n o f w h i t e s k i n n e d a n d b l a c k s k i n n e d a n d b r o w n s k i n n e d c h i l d r e n a r e e d u c a t e d t o g e t h e r a n d l e a r n to t r u s t a n d r e s p e c t a n d l a u g h w i t h e a c h o t h e r a n d u s e t h e i r c o m p l e m e n t a r y i n s i g h t s a n d s k i l l s to f o r g e t h e n e w S o u t h A f r i c a ? O r w il l th e p e o p l e w h o m u s t h o l d t h e c o u n t r y t o g e ­ t h e r u n t il t h e n e x t g e n e r a t i o n is r e a d y , th e e d u c a t o r s , h e a l t h c a r e p r o v i d e r s , c i v i l s e r ­ v a n t s , b u s i n e s s m e n a n d w o m e n , c l e r g y a n d f a r m e r s h a v e t h e e m o t i o n a l s t r e n g t h a n d c o u r a g e t o s t a y a n d h o l d t h e li ne , e v e n w h e n t h e y a n d t h e i r f a m i l i e s h a v e b e e n a n d w i l l b e p u t in h a r m ’s w a y ? O r w i l l th e y , l i k e s o m a n y o f t h e i r n e i g h b o r s , f l e e t o A u s t r a l i a o r o t h e r c o u n t r i e s ? T h e w a l l s o f J o h a n n e s b u r g a f f e c t p e o ­ p l e ’s p s y c h e d e e p l y in a w a y t h a t p r o ­ m o t e s a y e a r n i n g f o r c o n n e c t i n g w i t h o t h e r s o n s u b s t a n t i a l l e v e l s . I m a r v e l a t h o w m y c o l l e a g u e s a n d t h e i r f a m i l i e s u s e d i n t e l l e c t a n d h u m o r a n d h o n e s t y , s h a r e d t h e i r f e a r s a n d p a s s i o n s , r e j o i c e d a t s m a l l v i c t o r i e s a n d s t r u g g l e d o n . W h i l e I w a s in J o h a n n e s b u r g t h e r e w a s a s t r i k i n g p o l i t i c a l c a r t o o n in t h e l o c a l n e w s p a p e r t h a t e x e m p l i f i e d m u c h o f t h i s s p i r i t . T h e s e t t i n g f o r t h e c a r ­ t o o n w a s i n s i d e a b a n k . In f r o n t o f t h e “ W i t h d r a w a l ” w i n d o w t h e r e w a s a l o n g l i n e o f p e o p l e w a v i n g g u n s . T h e s i g n a t t h e w i n d o w s a i d “ P l e a s e w a i t y o u r t u r n . ” A t t h e w i n d o w m a r k e d “ D e p o s i t s ” t h e r e w a s o n e p e r ­ s o n to w h o m t h e c a s h i e r w a s s a y i n g “ Y o u w a n t to d o w h a t ? ” A n d s o l i f e g o e s o n in J o h a n n e s b u r g . 1 w o n d e r i f t h e n e x t g e n e r a t i o n w i l l e v e r u n d e r s t a n d o r b e a b l e to e x p r e s s t h e i r g r a t i t u d e to t h i s g e n e r a t i o n w h o s t e a d ­ f a s t l y q u i e t t h e i r f e a r s a n d g o to w o r k e a c h d a y h e l p i n g to h o l d t o g e t h e r th i s n e w l y c o n c e i v e d n a t i o n . P e r h a p s s o m e d a y t h e l o n g e d f o r p e a c e f u l r a i n b o w c o a l i t i o n w i l l b e a r e a l i t y a n d w e w i l l s e e l a w n s o n c e a g a i n in J o h a n n e s b u r g . COLLEAGUES A N D CLINICAL PRACTICE H o w 1 d i d l o v e m y S o u t h A f r i c a n p h y ­ s i o t h e r a p y a n d o t h e r h e a l t h c a r e p r o f e s ­ s i o n a l c o l l e a g u e s w i t h w h o m I w o r k e d ! W h a t a p l e a s u r e to t e a c h w h e r e “ s t u d e n t s ” a r e s o h u n g r y f o r i n f o r m a t i o n ! I d o n ’t b e l i e v e t h a t 2 o r 3 o f m e w o u l d h a v e b e e n e n o u g h to a b s o r b it all o r to g i v e w h a t w a s s o e a g e r l y s o u g h t . N o c o n v e r s a t i o n w i t h t h e s e c o l l e a g u e s w a s e v e r ‘l i g h t ” . D i s c u s s i o n s w e r e d e e p a n d s e a r c h i n g - a b o u t r e s e a r c h in h e a l t h c a r e , t h e s t a t e o f p h y s i o t h e r a p y in S o u t h A f r i c a , h o w d r a ­ m a t i c a l l y t h e c o u n t r y h a s c h a n g e d s i n c e t h e 1 99 4 e l e c t i o n s a n d w h a t t h e n e x t f e w y e a r s m i g h t b r i n g . O n e e v e n i n g a t a d i n n e r w i t h m y p h y s i o c o l l e a g u e s , t h e i r s p o u s e s a n d c h i l d r e n , t h e p a r e n t s q u i e t l y g a t h e r e d at t h e d o o r w a y o f a b a c k b e d r o o m to m a r ­ v e l at t h e i r c o l l e c t i o n o f c h i l d r e n , b l a c k s k i n n e d a n d w h i t e s k i n n e d l i k e s o m a n y b l a c k a n d w h i t e p u p p i e s s p r a w l e d t o g e t h e r o n a b e d w a t c h i n g t e l e v i s i o n . T h e p a r e n t s s t a r e d f o r a l o n g w h i l e a n d s m i l e d q u i e t l y at e a c h o t h e r s e e m i n g l y b o t h a m a z e d a n d g r a t i f i e d b y th e s c e n e . T i n y c h a n g e s . E n o r ­ m o u s c h a n g e s . W h a t a t i m e in h i s t o r y to w i t n e s s ! F r o m w h a t I c a n s u r m i s e f r o m s c i e n t i f i c p a p e r s p r e s e n t e d at t h e C o n g r e s s , t h e p h y ­ s i o t h e r a p y s t u d e n t s w i t h w h o m I t a l k e d a n d f r o m r e s e a r c h b e i n g c o n d u c t e d b y p h y s i o t h e r a p y f a c u l t y a n d c l i n i c i a n s , th e s t a t e o f p h y s i o t h e r a p y in S o u t h A f r i c a s e e m s c o m f o r t a b l y s i m i l a r to E n g l a n d o r t h e U n i t e d S t a t e s . A m a j o r d i f f e r e n c e a p p e a r s in d e l i v e r y o f p r a c t i c e . T h e m a j o ­ rity o f s u p e r b l y c a p a b l e e x p e r i e n c e d S o u t h A f r i c a n c l i n i c i a n s w o r k p r e d o m i n a n t l y in p r i v a t e p r a c t i c e in u r b a n s e t t i n g s . A s s u c h , p e o p l e w h o l i v e in t h e b l a c k t o w n s h i p s a n d r u r a l a r e a s a s w e l l a s s t u d e n t s a n d n o v i c e t h e r a p i s t s h a v e v e r y l i m i t e d a c c e s s to t h i s p h y s i o t h e r a p y b r a i n tr u s t. T h e l a c k o f c l i n i c i a n m e n t o r s w a s m o s t s t r i k i n g w h e n 1 v i s i t e d T i n t s w a l o H o s p i t a l in t h e n o r t h e r n p l a i n s r e g i o n o f S o u t h A f r i c a . W h i l e P T a n d O T s t u d e n t s w h o h a d c o u r a g e o u s l y a c c e p t e d c l i n i c a l a s s i g n ­ m e n t s in th i s r u r a l h o s p i t a l w e r e p r e s e n t , t h e r e w a s little in t h e w a y o f e x p e r i e n c e d c l i n i c a l p r e c e p t o r s to t e a c h , g u i d e o r s u p ­ p o r t t h e s e s t u d e n t s in u n d e r s t a n d i n g a n d g a i n i n g c l i n i c a l s k i l l s in t h i s v a s t l y d i f ­ f e r e n t g e o g r a p h i c a l , s o c i o e c o n o m i c a n d c u l t u r a l m i l i e u . O n t h e d a y 1 v i s i t e d t h e T i n t s w a l o h o s p i t a l th e w a r d s w e r e c r o w d e d w i t h p a t i e n t s b u t t h e “ r e h a b d e p a r t m e n t ” w a s e m p t y . O n e o f t h e s t u d e n t s s a i d “ W e d o n ’t g e t r e f e r r a l s f r o m p h y s i c i a n s . T h e r e w a s a w o m a n h e r e f o r t w o w e e k s w h o h a d h a d a s t r o k e a n d w e n e v e r s a w h e r . ” O f c o u r s e , i f t h e r e is n o e x p e r i e n c e d P T m a k ­ in g w a r d r o u n d s w i t h t h e M D s a n d t e a c h ­ in g t h e m w h a t P T / O T h a s to o f f e r , t h e r e w il l b e n o r e f e r r a l s ! T r a v e l i n g w i t h P T a n d O T s t u d e n t s to m a k e h o m e v i s i t s o n e a f t e r n o o n r e v e a l e d h o w d e s p e r a t e l y e x p e r i e n c e d c l i n i c i a n s a r e n e e d e d t o e d u c a t e t h e s e s t u d e n t s f o r m e a n i n g f u l h e a l t h c a r e i n t e r v e n t i o n s in th i s m r a l a r e a . Q u i t e n a t u r a l l y , t h e s e s t u ­ d e n t s b r o u g h t t h e i r u n i v e r s i t y e d u c a t i o n a n d u r b a n h o s p i t a l c l i n i c a l t r a i n i n g to b e a r o n s o l v i n g c l i n i c a l p r o b l e m s . In a d d i t i o n , t h e i r k n o w l e d g e o f a p a t i e n t ’s p h y s i c a l a n d r e l a t e d p s y c h o e m o t i o n a l n e e d s w a s c l e a r l y l i m i t e d b y l a n g u a g e b a r ­ r i e r s . T h e i r u n d e r s t a n d i n g c o u l d o n l y c o m e f r o m t h e f i l t e r e d r e s p o n s e s o f a n a t i v e i n t e r p r e t e r . T h e c o m b i n a t i o n o f t h e i r l a c k o f k n o w l e d g e a n d e x p e r i e n c e , th e l a n g u a g e b a r r i e r a n d l a c k o f e x p e r i e n c e d r u r a l c l i n i c a l m e n ­ t o r s r e s u l t e d in a n a f t e r n o o n s t e e p e d in f r u s t r a t i o n . T h e f u s t p a t i e n t w e v i s i t e d w a s a n 8 2 y e a r o l d b l i n d w o m a n w h o h a d h a d a C V A . S h e l a y c u r l e d u p all d a y o n t h e g r o u n d o f a t w o r o o m h u t t h a t w a s s h a r e d w i t h h e r d a u g h t e r a n d t w o y o u n g c h i l d r e n . T h e p a t i e n t w a s f e a r f u l o f s i t t i n g in t h e g o v e r n m e n t i s s u e d w h e e l c h a i r b e c a u s e it m o v e d . ( T h e w h e e l c h a i r w a s a l s o t o t a l l y i m p r a c t i c a l b e c a u s e it h a d to b e f o l d e d u p to b e p u t i n s i d e t h e s m a l l h u t . O n c e t h e p a t i e n t w a s s i t t i n g in th e w h e e l c h a i r , it c o u l d n ’t b e m o v e d o u t s i d e a g a i n . I a s k e d t h e i n t e r p r e t e r a b o u t th is w h e e l c h a i r p r o b l e m in n o t a l l o w i n g th e p a t i e n t a n y o u t s i d e f r e e d o m o r i n d e p e n ­ A b ove: C hildren a n d caretaker at C roquette L a w n 4 SA J o u r n a l o f P h y s io th e ra p y 1999 V o l 55 No 1 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. ) A b ove: M o n ika P elrick, E lsa S m ith , S a n g o m a a n d Kay S h ep a rd in A co rn h o ek. d e n c e . T h e i n t e r p r e t e r r e s p o n d e d ' t h a t p e o p l e w i t h d i s a b i l i t i e s “ p r e ­ f e r r e d to s ta y a w a y f r o m c o m m u ­ n it y e y e s . ” ) T h e e n t e r p r i s i n g P T s t u d e n t s h a d p u r l o i n e d a n i m m o ­ v a b l e s t r a i g h t b a c k e d “ g o v e r n ­ m e n t c h a i r ” f o r t h e p a t i e n t . T h e s t u d e n t s p u l l e d th e p a t i e n t u p in to t h e c h a i r a n d fo r a l i g n m e n t o n e o f t h e s t u d e n t s g r a b b e d a b u n d l e o f f t h e f l o o r s a y i n g “ H e r e ’s a p i l l o w w e c a n u s e ” . T h e ‘p i l l o w ’ t h a t w a s s t u f f e d b e s i d e t h e w o ­ m a n to h e l p h o l d h e r u p r i g h t w a s a c t u a l l y a w o r n b l a n k e t t h a t h a d b e e n w r a p p e d a n d p i n n e d a r o u n d all o f h e r w o r l d l y p o s s e s s i o n s . T h e p a t i e n t h a d b e e n l y i n g o n t h e f l o o r o f t h e h u t f o r s o m e t i m e a n d h a d p a i n f u l a n d o b v i o u s l y c o n t r a c t e d l i m b s o n t h e h e m i p l e g i c s i d e . T h e s t u ­ d e n t s left w o n d e r i n g w h e t h e r o r n o t t h e p a t i e n t w o u l d u s e t h e c h a i r t h e y h a d g o n e t o s o m u c h t r o u b l e to l o c a t e a n d b r i n g to her . W h a t c o u l d y o u h a v e t a u g h t t h e s e s t u d e n t s a b o u t th i s s i t u a t i o n a n d t h e p o s ­ s i b l e c a r e o f th i s p a t i e n t ? In a n o t h e r h u t w e s a w a v e r y fr ai l m a n w i t h a t h e t o i d m o v e m e n t s a n d a le ft l o w e r e x t r e m i t y a m p u t a t i o n . T h e O T s t u d e n t s h a d m a d e s a n d b a g s to h e l p s u b d u e th e p a t i e n t ’s a t h e t o i d m o v e m e n t s , h a d b r a i d e d a l o n g r o p e t h a t t h e y ti e d to t h e e n d o f h is b e d s o t h a t he c o u l d p ul l h i m s e l f to s i t t i n g . T h e s t u d e n t s e n c o u r a g e d t h e m a n to p r a c ­ t i c e p u l l i n g h i m s e l f u p s o t h a t h e c o u l d b e c o m e s t r o n g e r , l e a r n to b a l a n c e a n d e v e n t u a l l y d o a b e d to w h e e l c h a i r t r a n s f e r . ( T h e w h e e l c h a i r , b e i n g u s e d t o h o l d c l o t h i n g a n d a b a s i n , w a s th e o n l y p i e c e o f f u r n i t u r e in t h e h u t b e s i d e s t h e b e d t h e m a n w a s l y i n g in). T h e p a t i e n t a p p e a r e d p l e a s a n t a n d p e r s o n a b l e b u t o b v i o u s l y w a n t e d n o p a r t o f t h e r o p e w h i c h he c a l l e d a s n a k e o r p e r f o r m i n g th e e x e r c i s e s t h a t w o u l d m a k e it p o s s i b l e f o r h i m to g e t o u t o f b e d . T h r o u g h a n i n t e r p r e t e r h e to ld t h e s t u d e n t s th a t h e j u s t w a n t e d to “ lie in his o w n s h i t ” . It w a s c l e a r to t h e i n t e r p r e t e r t h a t t h e m a n w a s w i l l i n g h i m s e l f to d i e . T h e s t u d e n t s r e p e a t e d l y d e m o n s t r a t e d a n d e n c o u r a g e d th e m a n to tr y a n d f i n a l l y left in te ar s. T h e s e t w o v is i ts t o g e t h e r t o o k t h r e e h o u r s o v e r l o n g b u m p y d u s t y r o a d s . H o w d e f e a t e d t h e s e s t u d e n t s fe lt! D u r i n g t h e t r ip b a c k to A c o r n h o e k t h e s e s t u d e n t t a l k e d l o n g i n g l y o f g o i n g h o m e . A n d w h o c o u l d b l a m e t h e m ? T h e y w e r e c l e a r t h e y h a d li tt l e i n t e r e s t in e v e r p r a c t i c i n g in a r u r a l h e a l t h s e t t i n g . W h a t c o u l d a n e x p e ­ r i e n c e d c l i n i c i a n , w i s e to t h e w a y s o f ru ra l h e a l t h c a r e , h a v e t a u g h t t h e s e s t u d e n t s t h a t w o u l d n o t h a v e le ft t h e m f e e l i n g s o h e l p l e s s o r h o p e l e s s ? T h e e m p t y r e h a b u n i t , t h e u n u s e d w h e e l c h a i r s in t h e h u t s , a n d r u r a l c l i n i c a l a f f i l i a t i o n s w i t h o u t c l i n i c a l e d u c a t o r s a r e s y m b o l s o f w e l l i n t e n d e d b u t m e a n i n g l e s s i n t e r v e n t i o n s . W h a t c a n o n e d o ? T h e t a s k is f o r m i d a b l e a n d t h e a n s w e r s w il l p r o ­ b a b l y c o m e o v e r m a n y y e a r s w i t h t h o u g h t ­ ful p e r s i s t e n c e a n d a g o o d b it o f tr ial a n d e r r o r . T h e e a s i e s t s o l u t i o n m i g h t a p p e a r to b e m a t e r i a l r e s o u r c e s , e . g . , e q u i p m e n t a n d t r a n s p o r t a t i o n . H o w e v e r , t h e s e e a s y o b v i ­ o u s s o l u t i o n s w o u l d p r o b a b l y s o l v e little. U r b a n a n d r u r a l h e a l t h c a r e is s e p a r a t e d b y l a n g u a g e , b e l i e f s , c u s t o m s a n d life s ty l e s . O n e a n s w e r a p p e a r s to b e t h e C o m ­ m u n i t y R e h a b i l i t a t i o n W o r k e r T r a i n i n g P r o g r a m ( C R W ) in w h i c h v i l l a g e w o r k e r s a r e t r a i n e d in " r e h a b i l i t a t i o n , c o m m u n i t y d e v e l o p m e n t a n d d i s a b i l i t y i s s u e s . ” P e r h a p s a n o t h e r a v e n u e is to f i g u r e o u t w h a t p h y s i o t h e r a p i s t s c o u l d o f f e r in th e w a y o f p a t i e n t t r e a t m e n t a n d f a m i l y e d u ­ c a t i o n a n d t r a i n i n g , e s p e c i a l l y in t h e r u r a l h o s p i t a l s e t t i n g . O n e a f t e r n o o n w e v i s i t e d w i t h a S a n g o m a ( t r a d i t i o n a l h e a l e r ) w h o w a s v e r y c l e a r r e g a r d i n g w h a t h e c o u l d o f f e r to p a t i e n t s . H e r e p o r t e d h e c o u l d tr e a t C V A , m a d n e s s , i n f e r t i l i t y a n d t u b e r ­ c u l o s i s t h a t r e s u l t e d f r o m u n f a i t h f u l n e s s o r n o t g o i n g to a f a m i l y f u n e r a l ( v e r y i m p o r t a n t in t h i s c u l t u r e . H e a l s o t o l d u s t h a t f o r t u b e r c u l o s i s f r o m d u s t o r s t o n e i n h a l a t i o n t h e p a t i e n t m u s t g o t o th e h o s ­ p it a l) . W h e n a s k e d w h a t h e d i d f o r p e o p l e w i t h C V A , t h e S a n g o m a r e p o r t e d t h a t h e w o u l d fi rs t s e n d t h e p a t i e n t to h o s p i t a l to h a v e t h e p a t i e n t ' s “ b l o o d a n d w a t e r ” c h e c k e d b e c a u s e h e c o u l d n ’t d o th a t . H e w o u l d t h e n m a k e r a z o r c u t s a n d i n s e r t h e r b s to p r e v e n t t h e p a r a l y s i s f r o m “ f l y ­ i n g ” to t h e o t h e r s i d e . T h e n h e w o u l d t r e a t t h e s i d e t h a t w a s p a r a l y z e d . T h i n k a b o u t w h a t h e a l t h c a r e p r o v i d e r s t r a i n e d in w e s t e r n m e d i c i n e c o u l d l e a r n f r o m a S a n g o m a a b o u t t h e p e r c e p t i o n s , b e l i e f s a n d n e e d s o f p e o p l e w i t h ­ in t h e S a n g o m a ’s t r i b e / c u l t u r e ! F u r t h e r m o r e , t h i n k a b o u t a p h y s i o t h e r a p i s t a n d a S a n g o m a w o r k i n g t o g e t h e r a n d r e f e r r i n g t o e a c h o t h e r . S u c h a r e l a t i o n ­ s h i p m i g h t s a v e u n t o l d h o u r s o f f u t i l e P T i n t e r v e n t i o n s . CONCLUSION H o w e a s y t h e b e e r s l o g a n m a k e s it s o u n d : “ O n e N a t i o n , O n e S o u l , O n e B e e r , O n e G o a l ” . T h e 11 ‘o f f i c i a l ’ l a n g u a g e s o f S o u t h A f r i c a a l o n e m a k e t h e o n e n a t i o n g o a l a f o i m i d a b l e q u e s t . B u t , l i k e th e p o o r e s t h u t s t h a t w e r e n e a t l y s w e p t , w i t h f l o w e r s g r o w i n g b y t h e d o o r a n d t h e s m i l e s a n d w a v e s o f p e o p l e a l o n g e v e r y r o a d s i d e ( “ W h e n y o u g r e e t s o m e o n e y o u fe el f u l f i l l e d ” s a i d o u r S o w e t o v a n d r i v e r ) a n d t h e u n f o r g e t t a b l e b a r i t o n e v o i c e s o f p a t i e n t s w i t h c e r v i c a l a n d t h o r a c i c s p i n a l c o r d i n j u r i e s s i n g i n g t h e Z u l u n a t i o n a l a n t h e m , t h e r e is a w o n d e r f u l i n n e r l i g h t a n d s e n s e o f p r i d e a n d b e l o n g i n g in th i s r a i n b o w n a t i o n . In t h e b o t t o m o f m y b r i e f c a s e [ c a r r y t h r e e s m a l l r e d r o c k s f r o m t h e l a n d t h a t is S o u t h A f r i c a . W h e n I h o l d t h e s e r o c k s in m y h a n d I a m f l o o d e d w i t h m e m o r i e s o f t h e w a r m t h , s t r e n g t h a n d c o u r a g e o f t h e w h i t e s k i n n e d a n d b l a c k s k i n n e d a n d b r o w n s k i n n e d p e o p l e , t h e c o u r a g e o u s s t r i v i n g a n d f o r t h r i g h t h o n e s t y o f m y p h y s i o t h e r a p y c o l l e a g u e s , t h e b e a u t y o f t h e c o u n t r y a n d th e d e e p c o n v e r s a t i o n s a b o u t h i s t o r i c a l p a s s a g e . P e r h a p s s o m e ­ d a y , I w il l h a v e t h e g o o d f o r t u n e to r e t u r n t h e s e r e d r o c k s t o S o u t h A f r i c a w h e r e 1 m a y o n c e a g a i n g a t h e r ‘s c e n t s ’ a n d e m e r g e w i t h a n e v e n t r u e r ' s e n s e ’ o f t h i s r e m a r k ­ a b l e l a n d a n d its p e o p l e . AC K N O W LED G M EN TS V e r y s p e c i a l t h a n k s t o t h o s e w h o m a d e th i s v i s i t h a p p e n - to P a m H a n s f o r d in C a p e T o w n , S h e e n a l r w i n - C a r r u t h e r s in T y g e r b e r g , C e l i e E a l e s a n d A i m e e S t e w a r t in J o h a n n e s b u r g , to al l t h e s t u d e n t s in t h e q u a l i t a t i v e r e s e a r c h c o u r s e , t h e f a c u l t y a t t h e U n i v e r s i t y o f t h e W i t s w a t e r s r a n d , E l s a S m i t h w h o w a s m y g u i d e to A c o r n ­ h o e k a n d t o M o n i k a P e t r i c k w h o a r r a n g e d t h e T i n t s w a l o , C r o q u e t L a w n a n d o t h e r r u r a l h e a l t h v is i t s . 1 a m s o g r a t e f u l t o e a c h o f y o u . SA Jo u r n a l o f Ph y s io t h e r a p y 1999 V o l 55 No 1 5 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. )