EDITORIAL

THE ONLY WAY TO GO IS UP
Your levellers wish to level down as far as them­
selves, but they cannot bear levelling up to them­
selves.

Samuel Johnson 21 July 1763
T he them e o f “u p ” fo r an editorial suggested itself to  y our e d ito r 

as a result of a rem ark m ade by two physiotherapy students. They 
visited (with their lecturer) an institution fo r th e  profoundly mentally 
and physically handicapped. T h ere  they found the m ajority o f c e re ­
bral palsied patients being nursed in side-lying. T he walls o f their 
ward are all beautifully decorated with pictures and murals. T heir 
com m ent was “But they can ’t even see the p ictu res”. O ne hopes that 
these patients do  not spend all th eir tim e in side lying b u t...

M an is a bipedal c rea tu re  and he walks in this upright posture. 
H e needs balance to walk upright, he needs balance to  stand upright, 
he needs balance to sit upright. If he is not possessed o f the intrinsic 
balance ability, we physiotherapists can provide him with aids to

m aintain the upright posture. If one can m aintain the upright posi­
tion o ne has the ability to  see th e  w orld and deal with it on th e  sam e 
level. Being upright provides th e  vision to  look fu rth er and see the 
future.

W e as physiotherapists a re  faced with a huge dilemma in this new 
South Africa. Eighty p ercent of o u r w orkforce a re  in private practice. 
T he o th e r twenty percent provide a physiotherapy service fo r eighty 
p ercent of th e  population. T h e  H e alth Service is trying to  expand into 
prim ary health care, this to a c e r ta in , extent at th e  expense of the 
tertiary  health care system. M ost of the physiotherapists in th e  public 
se c to r w ork in the large academ ic hospitals. T h eir small n um ber 
precludes m uch involvement in delivering th eir services in the com ­
munity. A nd as a profession o u r services have a low priority in the 
H ealth Service. It is this that we m ust change.

W e need to  develop strategies th at will m ake o u r services avail­
able to the com m unity in spite of low num bers. T hese strategies m ust 
be of such a quality as to im press and involve th e  higher a u thorities 
in the H ealth Service.

W e m ust stand up and be counted. W e should not display the 
lim ited vision from  a side-lyer, n o r m ust we be levellers a nd bring 
o th ers down. T he only way to go is U P.

L M DAVIDS *

CORRESPONDENCE
To the Editor:

“A n Investigation into Post-graduate Physiotherapy E ducation, 
in South A frica” (SA Journal o f  Physiotherapy February, 1991) gave 
evidence o f the high level of training in o u r country and the direction 
in which we are planning to go.

U nfortunately while this splendid achievem ent is of interest to 
the profession here, it has little relevance to  the overwhelming num ­
b e r o f South Africans in need o f o u r professional skills.

T he m ajority o f South A fricans a re  very p o o r and live in grind- 
ingly squalid conditions which contribute directly to their ill-health 
and disability.

85%  of physiotherapists in South Africa are said to be in private 
practice. I’d like to suggest that training which is geared to  private 
practice will necessarily a ttrac t school-leavers interested in going into 
private practice.

T h ere  are physiotherapists who are filled with goodwill and ,an 
interest in working in impoverished com m unities, w hether peri­
urban o r rurally. C urrent undergraduate and post-graduate training 
simply d oes not give them  the skills they need. W ork in t h e . c om ­
m unity (especially w here th ere  a re  cultural and language barriers) 
r e q u ir e s  a h igh lev e l o f r e le v a n t clin ica l a n d  c o m m u n ity  skills. 
Physiotherapists who have to pick up these skills on the job, and 
w ithout good professional support and backup, have great difficulty 
in sustaining their com m itm ent -  and then even they end up in private 
practice o r  going overseas.

It is high time that the m ain thrust o f physiotherapy training .is 
diverted from  the universities, private practice and hospitals towards 
prim ary health rehabilitation and comm unity • skills -  with re cru it­
m ent into physiotherapy schools on that basis.

In response to the m anifest need, training o f Com munity R e h a ­
bilitation W orkers had been initiated notably at Alexandra H ealth 
Clinic and Tintswalo hospital. It may be nothing short of a disgrace 
if we accept that once qualified these comm unity w orkers should be 
deprived of professional back-up -  because we have failed to wrest 
ourselves from  the ivory-tower to  which o u r university .training, 
d o c to ra te s and professorships bind us.

It is a m a tte r of great urgency th at physiotherapy training should 
be fundam entally reoriented to the needs o f o u r country and o u r; 
continent. W e are seeing m om entous changes in many o th e r sectors 
in o rd e r to  redress the gross neglect th at ch aracterises o u r society.

T he leaders o f o u r profession m ust be heard and seen to m eet this 
challenge both by focussing conferences and congresses in searching 
fo r the way forward and by a rigorous drive to  produce the kind of 
physiotherapist who is com m itted to this country and all its people.

W ith o u r experience o f training and high professional standards, 
we have a unique opportunity to develop an excellence in com m unity 
rehabilitation which could m ake o u r profession relevant and proud.

S Kemp
G B R  P r o g ra m m e , A le x a n d ra  H e a lth  C e n tre  a n d  U n iv e rs ity  
Centre, First Avenue, Alexandra

Reply from Prof Beenhakker
I fully agree with som e of th e  sentim ents expressed in th e  le tte r 

by Stephanie Kemp, and for many years have been pleading for a 
m ore relevant curriculum  at o u r universities. I do however believe 
th at there is, at m ost M edical Schools, a swing away from  a mainly 
hospital o riented, high technology education, tow ards com m unity 
health and prim ary health care. T he wheels of change do  however 
grind far too slowly.

As regards Com munity R e h abilitation W orkers, m em bers of the 
SASP w ere involved, to g eth e r with t h e , O ccupational T herapy and 
Speech T herapy Associations, in drawing up the role, function and 
course outline for these w orkers m any years ago.

T he N ational Executive C om m ittee o f the SASP has been in­
volved in several w orkshops over the past two years, to establish the 
aim  and objectives of the Society fo r the next ten years. O n e  o f the 
areas discussed was the need to  provide continuing education p r o ­
gram m es in prim ary health care. T he first stage in the planning has 
been com pleted and we now need to  find a core o f therapists in this 
field w ho will be able to  plan relevant program m es which can be 
offered in different p arts o f the country. I would urge all concerned 
physiotherapists w ho feel that they can assist us in any way to com e 
forward. Previous calls fo r assistance yielded a null response but 
perhaps the tim e is now ripe fo r such a com m itm ent to  be m ade by 
South African physiotherapists.

T he role o f the physiotherapist in prim ary health care has also 
b e e n  d ra w n  u p  by s o m e  m e m b e r s  o f  th e  S A S P . O n c e  w e  h a v e  
established courses fo r physiotherapists in the areas o f com m unity 
a n d  p rim a ry  h e a lth  a n d  w h e n  t h e r e  a r e  s o m e  fu n c tio n in g  fa cilitie s in 
these areas, then we will be able to provide o u r stu d e n ts with the 
necessary training in o rd e r to  achieve th e  required skills.

Prof J C Beenhakker 
Chairman, SA S P A

Physiotherapy, May 1991, vol 41 no 2 Page 23

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