GUEST EDITORIAL Shula Werner* I feel privileged to talk to you tonight, after having been in South Africa for slightly over a m onth, visiting the tertiary care hospitals, the special schools, the universities and some private prac­ tices. I was impressed by the exceptionally high professional stand­ ards in the various areas, by the dedication o f the teachers, by the personal involvement o f the clinicians. But what struck m e most was the fact that although the problems o f this country are unique, the dilemmas o u r profession is faced with here, are similar to those all over the world, only perhaps m ore so. H ere, like in many countries o f the world, the health needs exceed the resources by far, the pay in the public service is so poor that good experienced practitioners are obliged to leave, the patients who could benefit most from our services are referred least and the few existing services are not accessible. B ut what worries m e most is that with all these insur­ m ountable problems we, as a profession, have not yet decided where we are going and what we want for ourselves. Many o f us, because o f o u r education and o u r traditional way o f thinking have still not m ade the transition from technician to academician. We still focus more on the techniques o f the profession than on the theoretical concepts. W e still define ourselves by m eans o f what we do rather than who we are; and so do others - the health professions and the rest o f society. W e are directed by an external locus o f control rather than an internal one, focussing on all the num erous factors we cannot change instead o f concentrating on the few that we can! We should begin by asking ourselves those crucial questions o f the 5W H Model I have used so often in my workshops. • W ho are we? • Why are we here? • W hat are we doing? • W here should we be? • W hen should we be intervening? • How are we performing? At the end o f the 20th century o u r whole outlook on health is different to what it was at the beginning o f the century. H ealth is no longer defined as a state o f absence o f disease, o r a state o f complete wellbeing, physically, emotionally and socially, but as the ability to adapt to life’s changes, as the need to acquire quality o f life. If this is health, and the current slogan is “H ealth for All” - Who are we? T he answer is simple - o f all the helping professions we are the experts in the domain o f physical function - in all ages, in all states o f health! What should we be doing? Can we confine ourselves to the narrow limits o f curative treatm ent - the clearing o f infected chests, the strapping o f sprained ankles on the rugby field, the treatm ent o f an acute back, o r should we expand o u r role to include preventive care, health prom otion and health education, for all the healthy and the disabled. W e should be going into the areas o f rehabilitation in addition to cure, rehabilitation o f the CO PD patient, rehabilitation o f the head-injured child. W e should be practising what o u r profession was intended to be - a long term care profession, comprehensive, continuous, co-ordinated - caring. If this is what, where should we be? N ot only in the hospitals, where we have always been, bu t w here o u r clients live, love, learn and work. In rehabilitation centres, in clubs, in old age homes, in regular and special schools, in primary care clinics, in work places, in people’s homes. Those o f us who have visited people in their natural environ - m ent w onder how we could have functioned effectively without actually seeing how a person lived. I know there are all kinds o f rules and regulations regarding home visits - but they are not gospel - they can be changed if we make a convincing effort. W hen should o u r intervention occur - as soon as possible. Because ju st like in the acute stage when the patient is in hospital - the right intervention should begin as early as possible - w hether it is preventive, curative o f rehabilitative. Why should we be there? B ecause we are needed, because no profession bu t o urs can supply this unique service - the prom otion o f physical function, so essential to hum an life, to quality o f life. We are the professionals, we possess the expert knowledge, the necessary skills, to assess the needs, to plan and implement the intervention in that particular field! A nd finally, how should we be doing it! How will we be able to reach m ore people, to enable many different kinds o f clients to avail themselves o f o u r diverse knowledge and o u r varied skills? Can the present structure o f the profession answer to the needs o f the future? T h e medical profession all over the world has already taken a hard look at itself as a profession m ade up o f specialities in all fields, where each specialist knows m ore and m ore about less and less until they know almost everything about almost nothing. Many medical schools have changed their training, focussing on the training o f a family physician, a medical man whose speciality is to be a generalist - a man who focusses on the family in health and disease as a viable unit, who has a broad base o f knowledge and can deal effectively with most o f the problem s with which families are faced. This specialist in family medicine is trained with the biopsychosocial model in mind, rath er th at the medical model. His target populations are individuals, families and whole communities; their needs are o f a physical, social and psychological kind - com bined needs, the way hum an health needs usually are, and he is skilled in providing preventive, curative and rehabilitative care. This is the specialist in family medicine - a grand, broadly educated generalist, who can solve most hum an problem s in health and disease. This is the model som e o f us should adopt - a broadly educated physiotherapist with many diverse skills - in com munication, in interviewing, in problem solving, in teaching and instruction in addi­ tion to having a good foundation in m ost technical skills. This gener­ alist will be able to deal with m ost problem s in o u r profession, to perform a comprehensive assessment o f clients’ needs, to set objec­ tives for intervention in most areas o f the profession, to plan and implement his intervention, and perform a detailed and com prehens­ ive evaluation. This generalist will have access to oth er professions in the health team and, m ost im portant o f all, to the various physiotherapy specialists. She will be aware o f her capabilities but also o f her limitations, and will refer those people whose problem she cannot solve. N ot every single patient with a backache has to be treated by a Manipulative T herapist with special qualifications. Most o f o u r patients never need m anipulations, and most physiotherapists today have the basic mobilisation techniques to help most patients - they learn them in school! T h e specialists should be highly trained in their specific areas, and their tim e should not be wasted on general problems - but only on very special ones. W e need only a few specialists, b u t we need many many g en er­ alists who will possess the general hum an skills I have described who will deal with the general problem s o f most people - it is strange, but com m on conditions tend to be com m on and unusual conditions tend to be rare. We need m ore physiotherapists who will care for the com mon afflictions like CO PD , the O A knee, the LBP, the stroke, the CP in this country, than we need physiotherapists in the heart * Speech delivered at the Annual General Meeting of the Western Province Branch of the SASP 22 August 1990 Bladsy 2 Fisioterapie, November 1990, dee! 46 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. ) transplant unit, in the extrem e sport injuries. O ur generalist will be focussing on teaching rather than treating, teaching patients, family members, other professionals and healthy people to take care of themselves - and not to be dependent on the very specialized services o f a specialist. Go to the people Start with what they know Build on what they have Only the best leaders When their task is accomplished When their work is done Will the people all remark ‘W e have done it ourselves’’ Lao Tsu 500 BC Report of the 16th Meeting of the National Committee of Representatives held on 28 April 1990 in the Physiotherapy Department of the Johannesburg Hospital T h e N ational C hairm an o f the South African Society o f Physiotherapy (P ro f J Beenhakker) welcomed all those present and o pened the meeting. Present w ere all the office bearers o f the Society, Chairman o f the Professional B oard for Physiotherapy, and rep re­ sentatives o f the Branches, G roups and Com m ittees o f the Society. T he meeting observed a short silence in tribute to the late P rof J Blair w ho had been the first H onorary Life Vice President o f the Society. P rof Beenhakker’s report elaborated on the work done by the National Executive Com m ittee in the past year. A m ajor problem is the deterioration o f health services in the public sector. Tlie Society has been urging a unitary health service for all the people o f South Africa. O ther supplementary health professional groups have been approached in order to have a stronger voice. T he improvement in black education is also being addressed. This involves a realistic approach to encouraging physiotherapy as a career in black schools. T he provision o f bursaries, bridging courses and hostel facilities is also being investigated. T he N E C is also trying to involve all the different race groups in the affairs o f the Society at branch level. Working closely with the special interest groups, the N E C is trying to avert threats from other groups such as chiropractors and biokineticians. P ro f Beenhakker also explained that physiotherapists fall under the Medical and D ental Act which allows only the treatm ent o f man. T hus physiotherapists who are not registered with the V eterinary Council, may not treat animals. M rs Elena Stock has been appointed P R O for the Society. She is a co-opted m em ber o f the executive com m ittee and works through the Action Committee. T he members o f the N E C attended several workshops on strategic planning. T he goals and objectives agreed upon in 1985 have largely been achieved and new objectives will have to be set to take the Society to the year 2000. Generally the N E C with its various portfolios has been ex­ tremely busy and many o f the tasks undertaken after the last Council M eeting have been completed. Miss P Blake then presented the report o f th e A ppointm ents Inform ation Secretary. Since the secretariat o f the Society deals with most overseas enquiries, this post will be abolished at the next Council Meeting. Mrs M Beattie read the rep o rt from the Professional B oard for Physiotherapy. As at February 1990, 2784 physiotherapists were registered with the South African Medical and D ental Council. A great many o f these had not yet paid their annual fees. T here are 94 physiotherapy assistants registered. T he process o f limited registra­ tion has been shortened thus condensing the tim e taken for this type o f registration. Training facilities are regularly inspected and inspection o f training institutions for assistants has also been instituted. Regulation regarding the length o f laser beam s used in physiotherapy apparatus has been referred to the Radiation Control Board. All apparatus sold must be licenced and the premises used m ust also be licenced by the Radiation Control Board. T he Physiotherapy B oard also deals with disciplinary matters. T h e num ber o f complaints is steadily increasing - a reflection largely on the ignorance o f th e rules and regulations governing private practice. Miss K Coleskfc read the rep o rt for the 19th N ational Congress to be held in pretoria from 22 to 24 April 1991. T he them e is “Physiotherapy in Perspective”. T h e congress will be held at the CSIR Conference Centre. Some lectures and workshops on the third day will be held in collaboration with the SA Sports Medicine Association. T hree overseas speakers have been invited to address the congress. D r Rina V enter, Minister o f National H ealth and Population Devel­ opm ent has agreed to open the congress. T he N ational Council M eeting will be held on 26 and 27 April a t the Pretoria Holiday Inn. P rof SA Strauss will be asked to open the meeting. T he report o f the E d ito rial B oard was read by Miss L Davids. A t the next Council M eeting it will be proposed to renam e the B oard - the Publications Division. As reported a t the last Council Meeting, the Medical Associ­ ation o f South Africa has ceased publication o f the Journal. In order to accom m odate financial and logistical problems, it was decided to com bine the publication o f the Journal and F orum - producing 4 Journals and 8 F orum s annually. T h e B oard will also be responsible for scrutinizing all Society publications and eventually be responsible for the printing o f pamphlets, brochures, etc. This decision has been implem ented since the beginning o f 1990 and so far is working extremely well. T he rep o rt o f the E ducation Com m ittee was read by M rs J A C Gilder. Since the competency profile o f the graduate physiothera­ pist was com pleted in 1986/87, this com m ittee has concentrated on specialisation and research. T he PAS o f Physiotherapy Assistants was com m ented on by Miss E Smith explaining th at no training posts existed so that the PAS was not applicable. T h ere are also no prom o­ tion posts and different educational prerequisites obtain for different authorities. Miss S Irw in-Carruthers read the report on Specialisation. Interim Specialty Boards have been appointed, eg Manipulative Therapy, Paediatrics. T he th ree docum ents relating to the College (Articles o f Association, the Bye-laws and the M em orandum ) have been edited. Discussion is necessary on the appointm ent o f F ounders and Fellows o f the College and an official seal will have to be designed. A separate physical location will also be needed. T he final docum ents will be prepared by the attorneys for implementation after the 1991 Council Meeting. M rs R Bernstein delivered the rep o rt o f the Finance Com m it­ tee. Both the income and expenditure o f the Society rose in the last year. T h e investments are doing very well: far above the inflation rate. A com m ittee has been convened to look for a property to house the Society. It is hoped to buy a house which will have business rights o r consent use for residential properties. A new Canon photocopier was purchased by the Southern Transvaal Branch for the Society. A facsimile machine was also acquired. T he subscriptions for 1990/91 have been increased as well as the malpractice insurance which will now provide cover o f R 100 000. Continued on page 12... Physiotherapy, November 1990, vol 46 no 4 Page 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. )