NATIONAL CONGRESS & COUNCIL Pretoria, 22 to 24 April 1991 THE ROAD TO 2000 Molly Levy Lecture delivered by S Irwin-Carruthers Minister Venter, Madam President, Madam Chairman, Ladies and Gentlemen - In 1987 the Council of the South African Society of Physiother­ apy bestowed upon Mrs Molly Levy its highest award - that of an eponymous lecture. This was only fitting, because the name of Molly Levy has been synonymous with that of the SASP over several decades during which Molly earned the respect and love of her colleagues both in South Africa and Internationally. It is therefore a great honour for me to stand here today to deliver the second Molly Levy lecture. I would like to thank not only those physiotherapists who nominated me, but also those colleagues and friends at work and at home who have ensured that I have been allowed time to work on SASP projects, I’d like to thank our Chairman - Professor Jo Beenhakker - for her constant support and, last but not least, Molly h erself w ho, in my m o re yo u th fu l days, channelled w hat I had thought to be rightful indignation into more constructive courses of action. It is hard to believe that we are in the last decade of the 20th Centuiy. As we look backwards towards the early days of physiother­ apy and forwards towards the year 2000 we can see that we are at a watershed in the history of physiotherapy in South Africa. This watershed did not occur mid-centuiy - it was a long, slow haul up to the point at which we find ourselves now, but now we are poised on the verge of a new South Africa with its complex and challenging health needs. Are we top-heavy with our expertise, technology and professional image and liable to fall headlong through the last few years of the centuiy? O r do we have a firm foundation upon which to analyse and solve problems so that, in the year 2000, we can look back and say that we, as a profession, truly have contributed to the quality o f life of our fellow countrymen? The priorities of the profession over the last decade have been many and varied. They include: • our first Mission Statement, in 1987 • a strong stance taken against apartheid and all discriminatory practices • the planned establishment of Divisions for CPE, Research and Publications • the envisaged Education Foundation and Back Pain Founda­ tion • and finally, in 1991, the acquisition of our own property. There is a strong lobby within the SASP which stresses the Society’s obligation to meet the needs of its members. This is good, but let us now forget the words of Ruth Wood, currently 2nd Vice-President of the World Confederation for Physical Therapy, when she delivered the 23rd Mary McMillan lecture to the American Physical Association in 1989: “Physical Therapy is a service profession and as such has no acceptable reason for being except to affect individual needs by the treatment or prevention of disease and disability. Patients are our focus! Without them we are nothing! They are our reason for being!” 1 What has the Society achieved in terms of patient care during these last few years? Most important, I think, was our Mission Statement of 1987, in which we unequivocally accepted responsibility to strive to ensure quality physiotherapy services to all people of South Africa, to es­ Miss S H Irwin-Carruthers, University of Stellenbosch chew all forms of discrimination, and to support integration in health care and the provision of a unitary health service. In the same year we conducted a survey into the physiotherapy needs of detainees and published a code of conduct for physiotherapists involved in treating detainees. Perhaps more obvious to the man in the street in Physiotherapy Back Week - initiated by the Action Committee and now conducted annually at both National and Branch level.More recently the Society adopted a long-overdue policy statem ent on community physiother­ apy. This, and other matters related to the health needs of the land will be debated at the forthcoming Council Meeting. Whatever the motive for specialisation, standards of patient care will be influenced by the specialisation process which will be initiated at the Inaugural Meeting of the College of Physiotherapists of South Africa, to be held later this week. Malcolm Peat commented in 1983 that it was generally recog­ nised that it was no longer possible for all physiotherapists to be equally competent in all aspects of clinical practice2. D oreen Moore, as early as 1978, went as far as suggesting that specialisation might begin in the latter part of undergraduate training, since it was not possible to provide undergraduate students with clinical experience in all facets of physiotherapy3. Inasmuch as the accent in specialisation is on clinical com­ petence, its advent is to be welcomed. The establishment of a spe­ cialisation procedure gives formal recognition to the process and provides motivation for physiotherapists to improve their expertise in certain areas of patient care. The granting of specialist status enables the public and other health professionals to identify clinical experts, thereby making their skills available to more patients in the surrounding community and even further afield. Identification of areas appropriate for specialisation may identify priority areas in health care and lead to appropriate changes in undergraduate edu­ cation 4, but this is not always the case; it may in fact lead to bias in undergraduate and graduate education as well as in the priorities determined by the SASP. We have to ask ourselves whether speciali­ sation and the areas so far identified for specialisation are in harmony with the country’s needs for primary health care services and for example, whether they make provision for the projected increase in the number of elderly people by the year 2000. A re members’ special interests perhaps in conflict with the perceived health needs of the majority of the people? It has been observed that increasing speciali­ sation may result in very specific small group interests which may hamper the profession in its working towards overall goals3. It is strange and maybe a sad reflection on our priorities and motives that it has proved more difficult to get a quality assurance programme off the ground than it has been to establish a specialisa­ tion process. Nevertheless, we can look back on two years of hard work and enthusiastic participation by so many people from so many parts of the country - two years which have culminated in the beginnings of a national programme. To me this is even more exciting than achieving the reality of specialisation, because quality assurance can only be to the benefit or our patients. It represents the willingness of physiotherapists to evaluate their own performance critically, to acknowledge shortcomings in their service to patients and to seek remedies for these shortcomings in a quest for excellence. Let us never cease to pursue excellence in the performance of our profes­ sional acts. I am convinced that the advent of primary contact has in ­ creased our role in health care and has improved our service to the patient. This is only so, however, if we accept our full responsibilities towards the patient. Today’s undergraduate students are trained to Physiotherapy, August 1991 Vol 41 no 3 Page 45 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. ) I f Schwab Rehabilitation Center, a 77-bed teach in g reh ab ilitatio n h o sp ita l w ith a n a tio n a l r e p u ta tio n fo r p ro v id in g o u ts ta n d in g an d in n o v a tiv e p a tie n t care, h as professional opportunities for P h y sio th erap ists. O ur rap id ly expanding P hy sio th erap y D e p a r tm e n t n e e d s m o tiv a te d a n d d e d ic a te d p ro fessio n als. O u r n eed s offer you the opportunity to work w ithin th e a r e a s of P e d i a t r i c s , A d u l t N e u ro lo g y , O r th o p a ed ic s a n d T ra u ­ m a tic B ra in I n ju r ie s a s w e ll a s th e o p p o rtu n ity to w ork in an a cu te ca re d e p a r tm e n t m a n a g e d b y S c h w a b Rehabilitation Center. We invite you to explore the possibility of jo in in g o u r d e p a rtm e n t w hich is rep resen ted by highly skilled th e ra p ists from m any area s of the world. C h ic a g o o ffe rs w o rld re n o w n e d o p p o r tu n itie s fo r e d u c a tio n a l a n d professional affiliations, m any of them which are w ith in a sh o rt d istan ce of o ur h o sp ital, as well as a sign ifican t a r r a y of c u ltu ra l, re c re a tio n a l a n d civic program s and in stitu tio n s. If you m eet our qualifications and are in t e r e s te d in w o rk in g a t S chw ab R eh ab ilitatio n C enter, w e w ill a s s is t y o u w it h t h e V isa , li c e n s in g a n d relocation processes. SCHW\B A We invite you to contact Mr. P er Backstrom , D irector of Physi­ cal Therapy, (who soon w ill be visiting your area) via telephone or in writing. You may call c o lle c t at (312) 522 - 2010, extension 5120, or w rite to: Mr. P er Backstrom P.T., Schwab Re-' habilitation Center, 1401 South C a lifo rn ia B o u lev a r d , C h ica g o , I lli­ n o i s , 6 0 6 0 8 U .S .A . An E q u a l O p­ p o rtu n ity Em ployer M/F/H/V. CAMBRIDGE COLLOCATION: EUROPEAN MEDICAL AND PROFESSIONAL RECRUITMENT Physiotherapy vacancies in the UK: we have vacancies for physiotherapists in the private health sector in the UK. Excellent salaries and working conditions. Please contact: Maureen Johnston Brown or Margaret Lamb, Cambridge Collocation, 191 Huntingdon Road, Cambridge CB3 0DL, England. Telephone: (0)223 276891 Fax: (0) 223 276871 Em ploym ent Agencies Act 1973 Licence No SE 118181 VAT N o 538357911 Bladsy 46 Fisioterapie, Augustus 1991, dee! 47 no 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. ) NATIONAL CONGRESS & COUNCIL Pretoria, 22 to 24 April 1991 diagnose, to accept those patients who can respond to physiotherapy treatment and to refer to other health professionals those who either cannot benefit or who need additional treatment outside the scope of physiotherapy. Most physiotherapists have proven themselves willing and capable of accepting this responsibility - but why is it so often taken to apply only to private practice? Consider the needs of the country! Why are we not offering our services at primary contact level in local authority clinics and polyclinics? Why are we not looking a t com m unity diagnosis in ru ral and p eri-u rb an areas? I am saddened that, at an international level, WCPT-Africa has so far not proved equal to the task of combining its resources to the benefit of patients in Africa. The encouraging progress made in Bulawayo in September last year, when so many common problems were identified and when consensus was reached on a C harter for the Region, has been blocked by the inability of two member-organi- sations to take part in the activities of the Region. To quote again from Ruth Wood1 “Before making any decision we must first ask ‘What benefits or detriments will the patient derive from this deci­ sion?’ We must subscribe to the theory that what is good for the patient is good for the physical therapist is good for the Association, and thus is good for the profession. To rearrange that series in a way that puts the physical therapist o r the Association before the patient can only invite disaster”. Sadly, this appears to be the case. In conclusion, I am proud and honoured to have been involved in many of the Society’s activities over the last decade - in the d e v e lo p m e n t o f th e s p e c ia lisa tio n an d q u a lity a s s u ra n c e p r o ­ grammes, in political statem ents made in the interests o f our patients and colleagues, in the beginnings (however tentative) of WCPT-Af­ rica. I would have been still more proud had we been able to formulate and present to this Congress a long-term physiotherapy health care plan in answer to our country’s needs. This is the chal­ lenge facing the incoming National Executive Committee. The chal­ lenge facing Council this coming weekend is to make quite sure that we, as a professional association, associate ourselves with the em er­ gent new South Africa and with the needs and aspirations of its people. REFER ENC ES 1. Wood R. Twenty-Third Mary McMillan Lecture: Footprints. Phys Ther 1989;69:975-980. 2. Peat M. President’s Address, CPA Congress, Winnipeg, Manitoba. Physiother Canada 1983;35:262-264. 3. Moore DM. Specialisation - professional growth o r fragmentation? Physiother Canada 1978;30:249-252. 4. Moore DM. Founders Address, Australian College o f Physiotherapists: Fifth Presentation of Fellows, Perth, W. Australia. Austral Jnl Physiother 1985;31:57-60.* SUMMARY OF CONGRESS PROCEEDINGS Three days of often stimulating and thought provoking papers and workshops were presented to the participants at this congress. A wide variety of workshops were provided by a number of overseas speakers and local physiotherapists. Key-note addresses were d e­ livered by specialists from abroad and thirty-nine papers were given by physiotherapists, one by a chiropractor and one by a homeopath. A special poster session was provided which demonstrated that these poster presentations are considered as important as the d e­ livery of papers. The Poster Session • J Doubell a private practitioner urged all physiotherapists, whether in private o r hospital practice, to make more use of hydrotherapy. • J A C Gilder demonstrated the cardboard seat insets which were developed and manufactured at Lentegeur Hospital. It has been shown that these insets enable handicapped persons to sit up and thus improve their level of functional ability. • S Irwin-Carruthers of the University of Stellenbosch depicted a process of clinical specialisation as an alternative to academic post-graduate degrees. The steps involved in the design o f the process and the functions o f the College Council and Specialty Boards were shown. • R Henn, M Tout and J van de Merwe of the Rand Mutual Hospital demonstrated the range o f adaptations that injured miners made to their homes and environment to ensure inde­ pendence. • R Vos of the Karl B rem er Hospital presented an economical wheelchair and explained the development of this very useful chair. • A Wenham, a private practitioner demonstrated through a series of photographs how care of posture in babies can be included in post-natal classes. • M Wilson, a private practitioner had a video which dem on­ strated the use of martial arts as a therapeutic modality in the rehabilitation of brain injured persons. ABSTRACTS PLANNING OF CEREBRAL PALSY MANAGEMENT BASED ON LOCOMOTOR PROGNOSIS by F M Bischof, United Cerebral Patsy Association, Johannesburg AIM: To establish the locomotor prognosis of the cerebral palsied child in order to set guidelines for physical management METHOD; Certain predictive measures have been documented in the literature, which can be applied in the assessment of the young cerebral palsied child to prognosticate whether he will be able to walk or not. Three case studies will be presented describing the use o f these measures, and the subsequent implications to treatm ent of children assessed at the Townsview Cerebral Palsy Clinic. RESULTS: Realistic long- and short-term goals o f treatm ent could be defined The type of orthopaedic intervention and the objectives thereof Physiotherapy, August 1991 Vol 41 no 3 could be clarified The parents could be counselled early about a predictable future for their child CONCLUSION: Planning of the treatm ent of the cerebral palsied individual is optimised when based on the locomotor prognosis. A MODEL FOR THE PHYSIOTHERAPEUTIC MANAGEMENT OF PATIENTS WITH SPINAL DYSFUNCTION by R G Botha H F Verwoerd Hospital, University o f Pretoria The confines of the field within which the Physiotherapist is working is given. This is defined as that area o f function which concerns itself with the usability of an intact morphological structure. In order to evaluate this entity a holistic approach is necessary. This entails an evaluation of Mobility, Pain and Muscle Integrity. These Continued on page 55... Page 47 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. )