S t u d e n t P r o j e c t A S t r a t e g y f o r t h e R e c r u i t m e n t o f U n d e r r e p r e s e n t e d D i s a d v a n t a g e d B l a c k S t u d e n t s t o t h e D e p a r t m e n t o f P h y s i o t h e r a p y , U n i v e r s i t y o f C a p e T o w n A B S T R A C T : The lack o f B la ck p h ysio th era p ists affects the profession, the d elive ry o f quality service a n d the education o f students. This p ro je c t was c a rried out in o rd er to reach B la ck sch o la rs to inform them o f the career o p portunities f o r p h ysio th era p ists a n d that training op p o rtu n ities are a v a il­ able f o r everyone a t UCT. Thirty-one schools p re v io u sly u n d er the D E T sy s ­ tem were visited an n u a lly f o r 3 ye a rs b y sm a ll groups o f third y e a r students in o rd er to increase the p o o l o f B la ck applicants. F indings o f the scholars ’ aw areness o f p h ysio th e ra p y a n d the n u m b e r o f su b seq u e n t ap p lica tio n s are presented. P ractical p ro b lem s in carrying out the visits are d iscu ssed a n d recom m endations m ade f o r fu tu re p ro jects o f this nature. K E Y W O RD S: RE C R U ITM E N T , B L A C K D ISA D V A N TA G E D STU D E N T S, A W A R E N E S S O F P H Y S IO T H E R A P Y FLITTER MJ, Dip Physio, Dip Spec Edu, BA, M Soc Sc (Aaministration and Planning) Department of Physiotherapy, University of Cape Town INTRODUCTION “Underrepresentation o f minorities is but a subset o f our continuing inability to solve our nation’s racial and ethnic inequalities” (Nickens, 1992). The com position o f the physiotherapy student body of the University of Cape Town (UCT) has never reflected the geographical demography o f the Western Cape and even less so that o f the country. The recruitment and retention o f Black students are crucial problem s in physio­ therapy education. The deficiency not only has a direct bearing on the changes in the current health system, but also on the service and education o f the physio­ therapy profession. The lack o f Black physiotherapists will also directly affect the future of the profession, the education o f future students and the future delivery o f quality physiotherapy practice. With the present shift in focus to pri­ mary health care and the associated re­ quirem ents of services being accessible and acceptable to the clients the necessity o f having Black physiotherapists is even m ore essential and im portant to ensure that all clients receive appropriate and culturally acceptable quality m anage­ ment. Andrews (1992) found that lack of cultural diversity and sensitivity by health care providers resulted in poor quality care. Multiracial and multicultural socie­ ties need health practitioners from divers populations who are able to introduce their own talents from their varied back­ grounds (M cBride 1980). This helps the clients to experience the service as being m ore ‘user-friendly’ (Nickens 1992). Problem s o f underrepresentation o f minority groups is a universal educational problem (Andrews 1992, Kneuppel et al 1992, Lewis 1996, Lipscombe et al 1993, Nickens 1994). In the South African con­ text it is different in that there is an inverted d em o g rap h ical situation in which our “minority groups” actually form the majority o f the population. Ideally, the dem ography o f the physio­ therapy profession should m irror that o f the greater society (Nickens, 1994). Thus it is the very majority o f the population whose increasing need for education and health services requires m ost urgent attention and addressing. Several authors have found that there is a tendency for graduates in health disciplines to return to their hom e com m unities to work and in turn to prom ote their careers (Kamien and Butterfield, 1990; K nopke et al, 1996; K ruger 1991; Rabinowitz, 1998); therefore a dem ographically balanced undergraduate program m e will help to ensure that physiotherapy services reach all communities in South Africa: It would also serve to elim inate ethnic and racial barriers within the physiotherapy pro­ fession (Keith et al, 1985). T he issue o f underrepresentation o f B lack students is com plex and due to various factors. H istorically the ‘apart­ h e id ’ B antu E ducation A ct and the Extension o f University Act dictated the universities to w hich different races were permitted. This led to the creation o f the so-called Black universities, for exam ple, the M edical U niversity o f South A frica (M ED U N SA ) and Fort Hare. The historical white universities like UCT w ere not perm itted to admit Black students. The school education o f Black scholars was adm inistered by the D epartm ent o f Education and Training (DET). The education at these schools was inferior as the classes were very large; the facilities were limited and inferior; there were insufficient teachers and they frequently were not adequately CORRESPONDENCE: MJ Futter Head o f Department D epartm ent o f Physiotherapy University o f Cape Town Anzio Road OBSERVATORY 7925 South Africa Tel: (021) 406-6402 SA J o u r n a l o f Ph y sio t h e r a p y 1999 V o l 55 No 4 11 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. ) TABLE 1: APPLICATIONS AND ADMISSION FIGURES FOR PHYSIOTHERAPY 1994-1999 APPLICATIONS ADMISSIONS YEAR TOTAL 719 40 1999 Black 261 3 (7.5%) TOTAL 421 41 1998 Black 95 (22%) 2 (5%) TOTAL 534 39 1997 Black 123 (23%) 4(10% ) TOTAL 571 38 1996 Black 125 (22%) 3 (8%) TOTAL 526 42 1995 Black 119 (23%) 10 (24%) TOTAL 542 40 1994 Black 119 (23%) 4(10% ) TABLE 2: QUESTIONS ASKED PRIOR TO PRESENTATION W ho knows what physiotherapy is? W ho has been for physiotherapy before? For what? Did it help? W ho has had a family member go for physiotherapy treatment? For what? W hat sort of treatment did they receive? Did it help? How many of you are considering applying for physiotherapy? qualified. T hese schools generally have a high drop-out rate which has an effect on the pool o f physiotherapy applicants (Lee, 1992). From the tim e the apartheid system perm itted the adm ission o f black stu­ dents to LJCT in 1986, the U niversity’s revision o f its adm ission criteria for dis­ advantaged black students and the intro­ duction o f the Academ ic Developm ent Program m e in 1994 the pool o f Black applicants has been very small (Table 1). This is probably due to the general popu­ lation’s lack o f know ledge and aw are­ ness of physiotherapy as a profession as well as the lack o f contact with physio­ therapy services and the absence o f role models with whom students can identify ( Lewis, 1996). Cohen (1994) states that people are drawn to a profession by a sig n ifican t personal exp erien ce that inspires them to think of a career in health care. This is very limited in the case of physiotherapy as the services are so sparsely distributed in the disadvantaged urban com m unities and even more so in the rural areas. Thus there is a lack of role-m odels with whom scholars can identify (Lewis, 1996). Annual open-days were held in the Departm ent o f Physiotherapy, G roote Schuur Hospital to which all schools in the peninsula were invited to attend. None o f the schools previously under the DET system ever attended. Reasons given were the distance from the hospital and the costs o f transporting groups of scholars. This project was carried out in order to reach Black scholars to inform them o f the career opportunities for phy­ siotherapists and that training opportuni­ ties were available for everyone at UCT. AIMS The aims o f the study were to a )in fo rm scholars o f the adm ission requirem ents regarding their m atricu­ lation subject choice b )in crease the general p o p u la tio n ’s k n o w led g e and aw areness o f the scope o f physiotherapy and prom ote it as a career. c)increase the pool o f Black applicants TARGET POPULATION Thirty-one secondary and high schools previously under the DET system and in the Cape Town area were identified through the Schools Liaison O fficer at UCT. None of these had previously attended the open-days due to the trans­ port constraints mentioned above. Teachers, career guidance officers and scholars from grades 9 to 12 were invited to attend. This was to stim ulate an inter­ est in physiotherapy as a possible career choice for the matriculants and grade 11 scholars. It was also deem ed important to reach the grades 8, 9 and 10 scholars, not only to increase their know ledge of the scope o f physiotherapy, but also to ensure that they made the correct subject choices for m atriculation should they be interested in follow ing physiotherapy as a career. METHODOLOGY During the third year o f the undergra­ duate p ro g ram m e phy sio th erap y stu ­ dents w ere req u ired to do a project in the com m unity as a requirem ent for the C om m unity Physiotherapy course. During 1996, 1997 and 1998 these stu­ dents were placed into groups of 4 or few er and each group was allocated 3 schools to visit. The aims and the me­ thods of approaching the project were discussed with them. They were sup­ plied with the addresses and telephone numbers o f the specific schools which they were to visit. Kneuppel et al (1992) found that the most effective way o f expanding the applicant pool and recruit­ ing students is to provide personal con­ tact between scholars and young people in the profession. Students contacted the schools allo­ cated to them and made arrangem ents with the career guidance teacher or the principal regarding suitable days and times for the visits to take place. A variety o f visual displays o f the scope o f physiotherapy were made by 12 SA J o u r n a l o f Ph y s io t h er a p y 1999 V o l 55 No 4 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. ) the students. Some groups made posters, others made slides and one group made a video. The U niversity’s pam phlets on the scope o f physiotherapy, admission requirem ents, course contents, tuition fees, salaries and career opportunities were obtained from the C areer’s Office for distribution. The contents o f the ver­ bal presentation included aspects o f financial assistance that the University provides for disadvantaged students and the Academic D evelopm ent Program m e which allows the four-year course to be spread over five years. Posters advertising the visits were placed in the schools on the scholars’ n o ticeboards approxim ately a week before the meeting. At the beginning o f each presentation scholars were asked a num ber o f ques­ tions in order to establish their level o f understanding and awareness o f physio­ therapy. These are shown in Table 2. Balance balls, crutches, tripods, w ob­ ble boards, peak expiratory flow meters and stethoscopes were taken for specific dem onstrations that were to be given. Som e o f the dem onstrations were given with the scholars as models, but w here possible actual clients were used; This was follow ed by a display o f colourful photographs, posters, slides or video o f clients suffering from a variety o f medical conditions and being treated in different clinical settings in order to convey the full spectrum o f preventative, prom otive, curative and rehabilitation aspects o f physiotherapy. Detailed com ­ m entary was provided and scholars and teachers were encouraged to ask ques­ tions during the presentations. The presentations were given for 20 minutes. This was followed by 10 m in­ utes for questions and explanations. L eaflets w ere left with the career guidance teachers for distribution during the year. FINDINGS AND DISCUSSION By asking questions before the presenta­ tion it was found that the scholars knew very little about physiotherapy. The percentage o f scholars that knew som e­ thing about physiotherapy at the begin­ ning o f the presentations are reflected in Table 3. The schools where the percen­ tages were higher were the schools situ­ ated in the higher econom ic residential areas where the parents had a higher level o f education. These schools were also situated closer to health care facilities than the lower income areas. Otherwise these percentages have no significance as it appears that the schools arranged for different classes to attend the presenta­ tions each year. Hence it does not appear as though the num ber o f scholars who knew anything about physiotherapy increased from year to year. In general the teachers were unaware o f the scope o f physiotherapy. Som e o f the career guidance teachers became very keen about having som ething other than m edicine and nursing presented to the students and req u ested that the schools be visited annually. They were also pleased to know that their promising students had a choice o f careers rather than thinking o f m edicine as the only option. Scholars were less attentive when the presentations were made during their lunch breaks or after school. The best tim e for gaining their cooperation and interest was after the short tea break. G enerally the scholars w ere very interested in the presentations and parti­ cipated maximally in the demonstrations. However, in the schools w here there were scholars present from grades 8 and 9 they were less responsive and there w ere m ore disru p tio n s during the dem onstrations. It appeared as though they were not yet serious about giving much thought to their future careers. The grade 11 and 12 scholars asked m ore serious questio n s and often requested application forms which were interpreted as encouraging signs. TABLE 3: APPROXIMATE PERCENTAGE OF SCHOLARS THAT KNEW SOMETHING ABOUT PHYSIOTHERAPY SCHOOL 1 2 3 4 5 6 7 8 9 10 11 1996 10% 0% 10% 6% 16% 3% 7% 9% 13% 11% 0% 1997 9% 2% 9% 5% 18% 0% 10% 9% 10% 12% 1% 1998 11% 3% 10% 8% 15% 4% 9% 8% 12% 14% 1% SCHOOL 12 13 14 15 16 17 18 19 20 21 22 1996 0% 18% 4% 2% 3% 13% 8% 1% 3% 7% 6% 1997 1% 11% 4% 0% 1% 15% 6% 1% 2% 8% 5% 1998 0% 15% 6% 2% 0% 14% 7% 1% 2% 7% 8% SCHOOL 23 24 25 26 27 28 29 30 31 1996 3% 2% 56% 10% 21% 5% 7% 11% 10% 1997 1% 0% 53% 8% 19% 6% 8% 10% 13% 1998 2% 1% 50% 9% 20% 4% 7% 11% 9% SA J o u r n a l o f Ph y sio t h e r a p y 1999 V o l 55 No 4 13 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. ) The scholars had difficulty com pre­ hending English. The students had to speak slowly and clearly in order for them to understand the presentations. In a few groups where there were Xhosa speaking students they addressed the scholars in their home tongue and this was extrem ely well accepted. This find­ ing is supported by D ow ell’s (1996) study w here Black student recruiters were found to be more appealing com ­ pared to the white students. Dowell (1996), M cBride (1980) and Yergan et al (1988) also found the use o f Black role m odels to be advantageous in recruiting Black scholars. Some groups were obliged to use the principals or guidance teachers as inter­ preters to ensure that the scholars under­ stood what was being said. Many scholars voiced the opinion that they would not be able to study physio­ therapy as it involved science and they perceived that they simply did not have the potential to cope with it at tertiary level. O ther scholars had dropped phy­ sical science-in grade 9 or 10 as they had struggled so much with the subject. After the preliminary questions regard­ ing the scope o f physiotherapy or ques­ tions regarding the health problem s of their own family mem bers the scholars asked the following questions in the order that they are listed below: a. How much does a physiotherapist earn? b.A re there many jo b s for physiothe­ rapists? c. How long is the course? d. W hat are the tuition fees? e. At which universities can physiothe­ rapy be studied? W hen these questio n s had been answered they imm ediately asked how much doctors earn. The poor salaries o f physiotherapists and recent media coverage o f the lack o f jo b opportunities in Cape Town had an immediate dam pen­ ing effect on their original enthusiasm. They also perceived that it would be im possible to even think o f applying to UCT as they had the preconception that their marks simply would not be com ­ petitive enough for admission. They also raised the issue that UCT was the most expensive University in South Africa and totally out of reach to them. The physiotherapy students expressed the view that for the first time they had been exposed to the living environm ent o f many o f the clients with whom they had been dealing during their clinical rotations. This is understandable as the com m unity projects are done early in the year and very few o f the students would have already been exposed to a clinical rotation in the com m unity by that time. They felt that the visits had helped them to be able to relate to their clients envi­ ronm ent more easily and that this would help to make their home advice more appropriate. To date there have been no applica­ tions for physiotherapy from any o f the 31 historically Black schools visited over the 3-year period. This is in spite o f the U niversity’s vigorous efforts at transfor­ mation and increased financial aid to dis­ advantaged students in order to achieve a student body which reflects the dem o­ graphics o f the country. Although the B lack student body throughout the University has increased this has not been the case in the physiotherapy programme. PROBLEMS 1. It was often very difficult to make telephonic contact with the schools. Som etim es the telephone rang un­ answered for days at a time or it would be perm anently engaged in spite o f confirm ing with the telephone opera­ tor that the lines were functioning and the telephones were in order. In other situations the telephone calls were never returned. 2. Locating the schools was not easy as m any o f the street nam es were not listed on the city map and many streets had no name signs. 3. Lack o f sound equipm ent meant that with large groups not all the scholars could hear what was being said. 4. Some schools did not have electricity. They all had electricity laid on, but many had had the service discontinued as their bills had not been paid. Thus in spite o f being reassured that there ■were facilities for the slide or video show on arrival it was not functioning and the presentations had to be altered. 5. Schools that did have functioning electricity, screens, overhead projec­ tors and slide projectors som etim es did not have curtains to darken the room and so the visibility was again unsatisfactory. 6. Appointm ents were not kept by the school liaison person. Sometimes this was for no apparent reason, but other tim es was due to strikes when the teachers did not turn up for work and the pupils were left to their own devices. 7. The venues were inadequate. Apart from the lighting and electricity most venues were too small and cram ped m aking it difficult for the pupils to concentrate. CONCLUSION This project was set up to increase the pool o f Black physiotherapy applicants by means o f increasing the awareness o f physiotherapy as a profession and in­ forming prospective applicants timeously o f the correct subject choice for adm is­ sion to the course. Even though there have been no appli­ cations from any o f the 3 1 disadvan­ taged schools visited the project should not be seen as a once off study, but should be conducted over a period o f at least 5 years before a true reflection o f its im pact can be made. Scholars from grades 10, 11 and 12 may have become interested in follow ing physiotherapy as a career, but may not have had the cor­ rect subject choice. Scholars from the low er grades may still apply in the future as a result o f the presentations and their increased aw are­ ness o f physiotherapy as a profession. Kneuppel et al (1992) maintained that increasing the possible student pool is a long-term endeavour and that the per­ sonal contact w ith the students and professionals assists in the recruitm ent process. It is clear from this project that the majority o f pupils had not considered applying for the physiotherapy course because they were not aw are o f physio­ therapy as a career option. This is an aspect that the profession as a whole needs to address. A lthough em pirical deductions cannot be made from a sm all-scale project such as this, it may be speculated that an underlying lack o f know ledge about the profession is indeed widespread through­ out the form er DET schools. 14 SA J o u r n a l o f Ph y sio t h e r a p y 1999 V o l 55 No 4 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. ) RECOMMENDATIONS 1. A Xhosa speaking teacher should be present who will trans­ late and clarify any misunderstandings. 2. It is advisable to take one’s own audio-visual equipm ent for the presentations and to ensure that the venue has adequate facilities for making the room sufficiently dark. 3. D em onstrations that involve patients should be used when­ ever possible as they were found to be the most appealing aspect o f the presentations. W here this was not possible visual aids used like slides and photographs o f actual clients were found to be the next best way o f m aintaining the scholars’ interest. 4. More than one visit should be made to each school to make class sizes m anageable and ensure the clarity o f the content o f the presentation. Small rooms with few er than 40 pupils make the presentation more personal and give the scholars more opportunity to ask questions. 5 .Teachers should be encouraged to attend so that they can help to pass on the inform ation to future scholars. 6. Introductions by the teachers helped to stimulate an interest in the topic. In schools where this was not provided the scholars tended to be noisy and not very attentive. REFERENCES: A n d r e w s M 1 9 9 2 Cultural p ersp e ctiv es on nursing in the 2 1 st century. In: D o w e ll M . 1 9 9 6 Issu e s in R ecruitm en t and R eten tio n o f M inority N u r s in g S tu d e n ts. J o u r n a l o f N u r s in g E d u c a tio n 3 5 ( 7 ) : 2 9 3 - 2 9 7 C o h en JJ. 1994 From the President: Project 3 0 0 0 b y 2 0 0 0 and H ealth C are R eform . A c a d e m ic M e d ic in e 6 9 (9 ):7 2 8 D o w e ll M . 1 9 9 6 Issu es in R ecruitm en t and R eten tio n o f M in ority N u r sin g Students. J o u rn a l o f N u rs in g E d u c a tio n 3 5 (7 ):2 9 3 -2 9 7 K am ien M and B utterfield HI. 199 0 S o m e solu tion s to the shortage o f general practitioners in rural A ustralia. M e d ic a l J o u rn a l o f A u stra lia 15 3 :1 0 5 -1 0 7 K e it h S . 1985 E ffe c ts o f A ffirm a tiv e A c tio n in M ed ica l S c h o o ls. N e w E n g la n d J o u rn a l o f M e d ic in e 3 1 3 (2 4 ): 1 5 1 9 -1 5 2 4 K n euppel K & S z c z o tk a L. 1 9 9 2 H o w can o p tom etry b e c o m e m ore e f fe c tiv e in recruiting and retain ing appropriate num bers o f under­ represented and d isadvantaged students. J o u rn a l o f th e A m e r ic a n O p to m e tr ic A s s o c ia tio n 6 3 ( 1 1 ):8 0 2 -8 0 4 K n o p k e IH, Northrup R S and Hartman JA . 198 6 B io P re. A p rem ed i­ ca l program for rural h ig h sc h o o l stu d en ts. J o u rn a l o f th e A m e r ic a n M e d ic a l A s s o c ia tio n 2 5 6 :2 5 4 8 -2 4 5 1 K ruger FJ 1991 E d u cation and training: Career op p ortu n ities for the 1 9 9 0 ’s. E n te r p rise : N e tw o rk in g f o r A f r i c a ’s en tre p re n e u rs a n d le a d e r s 39:25 L e e M C . 1992 ‘P rogram m in g’ M in o ritie s for M e d ic in e . J o u r n a l o f the A m e r ic a n M e d ic a l A s s o c ia tio n 2 6 7 ( 1 7 ): 2 3 9 1 ,2 3 9 4 - 2 3 9 5 ► ^ L e w is C L. 199 6 A State U n iv e r s ity ’s M o d el P rogram to in c r e a s e the n u m b er o f its D isa d v a n ta g ed stu d en ts w h o m atriculate in to H ealth P r o fe ssio n s sc h o o ls . A m e r ic a n M e d ic in e 7 1 (1 0 ): 1 0 5 0 -1 0 5 7 L ip s c o m b W D , M u llan P B , Z epeda M , Price J. 199 3 E n h an cin g M in ority R ep resen tation at M e d ic a l S c h o o l. A c a d e m ic M e d ic in e 68( 10 ):5 10-512 M cB rid e ET. 1980 In creasin g M in o ritie s in the P h y sic a l T herapy P r o fe s sio n through S tudent A d m is sio n . J o u rn a l o f P h y s ic a l T h e ra p y 6 0 (1 0 ): 1 2 8 4 -1 2 8 8 N ic k e n s HW. 1992 T he ration ale fo r m inority-targeted program s in m e d ic in e in the 19 9 0 ’s. J o u r n a l o f th e A m e r ic a n M e d ic a l A s s o c ia tio n 2 6 7 ( 1 7 ):2 3 9 0 -5 N ic k e n s HW , R ea d y TP, P eter sd o rf R G . 199 4 Project 3 0 0 0 b y 2 0 0 0 and h ealthcare reform . N e w E n g la n d J o u r n a l o f M e d ic in e 331 (7 ):4 7 2 - 4 7 6 Yergan J, P h illip s TJ, S ch aad D C , M ay, A , D r ic k e y R, Yerby M S . 1988 M ed ica l E d u cation fo r M in o ritie s at a U S M ed ica l S c h o o l. J o u rn a l o f M e d ic a l E d u c a tio n 2 2 ( 4 ): 3 1 7 -3 2 4 Your Best Connection in the UK p̂ As the U K ’s second, fastest growing R ecruitm ent Agency, it is not surprising that we are able to offer long term contracts to physiotherapists in every hospital and private practice throughout the LTK. We offer... • Superb rates of pay and bonuses • CPSM membership refund • Accommodation arranged • Friendly and helpful advice • Wide range of jobs to choose from Call Johannesburg 011 881 5443 and speak to Brenda, our SA Co-ordinator. PO Box 785553 D * D , T Sandton 2146 email: bbt@mweb.com.za Medical London Leeds Bristol Birmingham SA J o u r n a l o f Physiotherapy 1999 V o l 55 No 4 15 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. ) mailto:bbt@mweb.com.za