PART TWO: WORKING WITH THE DATA
6.3 Systemic and social issues
Although not all participants mentioned this category overtly, it was inherent in the sentiments expressed. These were extracted, and include the sub-categories of service delivery, language of service provision, and the healthcare system.
6.3.1 Service delivery
Effective service delivery was the main goal for all participants. It was interesting to pursue what effective service delivery meant for the participants. In Lynn’s narrative,
Communication strategies of speech- language therapists during clinical engagement Systemic and social issues Student training and continued learning World of work context Communicating and accommodating families and clients Practitioner’s experience of speech- language therapy Cross linguistic– cross-cultural communication
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she expressed concern over effective service delivery when providing therapy to clients who speak languages in which she was not proficient:
Most of the interpreters can help with the Zulu–English language barrier. Even then I am not always able to guarantee that I am providing a 100% service delivery. But then what do I do in situations where clients and their families speak Swahili, Amharic, French or Lingala?
(Extract from Lynn’s narrative, section 4.5) From Lynn’s concerns, it was evident that she saw that her competence in the language of the client was imperative for effective service delivery, and she became doubtful when she encountered clients from varied linguistic backgrounds.
Amelia expressed concerns about effective service delivery because of systemic changes that took place within the Department of Education, which did not always filter through to therapists at the school. These changes impacted on her service delivery to the learners at the school. She felt that a remediation to this would be to speak to the teachers more regularly in order to find out about activities in the classroom:
There have been many changes in the education system in the country that impacts on us as therapists working in schools. We must become more aware of these. I needed to liaise more with the teachers and find what goes on in their everyday classrooms.
(Extract from Amelia’s narrative, section 5.3) The preoccupation with effective service delivery was clear from the participants’ responses. Systemic changes, a lack of interpreters and the varied linguistic repertoire of clients were factors affecting their services about which SLTs were concerned. Perhaps a more introspective approach needs to be encouraged so that the professionals may look to themselves as an active resource with the capacity to deal with challenges rather than be passive victims of systemic and social change. The ‘professionalisation’ of an individual should imply that this individual has equipped him- or herself with basic competencies to function in the world of work.
6.3.2 Language of service provision
Amelia experienced policy constraints in her school context based on the medium of language instruction at the school and during therapy:
106 Most of the children were first-language isiZulu speakers. The remedial school was mandated, as per Department of Education policy, to engage these learners to access the English language. This meant that there had to be a double-learning: learning to learn English, in order to learn in general.
(Extract from Amelia’s narrative, section 5.3) Amelia’s understanding of the aforementioned policy is at the centre of this discussion. The policy that she was possibly alluding to was the Language of Teaching and Learning Policy, section 29(2) of the Constitution of South Africa (Republic of South Africa, 1996), which states that every learner has the right to receive basic education in the language of his or her choice, where this is reasonably practicable. The latter part of this statement is of concern. Amelia had interpreted this statement to mean that it was not practicable to conduct therapy in the client’s language of choice, as she was a monolingual English speaker and it was considered ‘practicable’ to target English as the language of medium of teaching and learning since the staff themselves were not sufficiently multilingual in African languages. Amelia was cognisant of the fact that the clients had an extra burden of double learning as they had to learn English first in order to access the content taught. There was however, a lack of recognition that she was complicit to this burden on the client because of her misinterpretation of policy.
6.3.3 The healthcare and basic education systems
Sharon related experiencing problems within the referral system in her context. She followed the correct channels of communication in making the referral; however, the client was not helped. This caused much frustration for her:
I referred Mbongeni and his mum to the educational psychologist for school placement and other issues and the psychologist for counselling. Unfortunately, I have not heard back from the psychologists and they have not acknowledged my referral. I just feel this is a system that’s failed. While I was a student a qualified therapist told me that working for the government can make a person lazy. You don’t need to show progress with your clients and you will still get paid at the end of each month. So why bother? I have a problem with this thinking.
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As a novice professional, Sharon would have learnt about the importance of timeous referrals during her undergraduate education. An integrated approach of different therapies are often required for the holistic management of a client. The lack of following up referrals from other professionals was frustrating for Sharon because she was concerned about the rehabilitation process and the well-being of the client. She became despondent when she realised the non-committal behaviour of other professionals in the healthcare system. She justified these behaviours with what she had learnt about working in the government sector. Although she still strongly opposed these behaviours, she understood that this was a systemic issue rather than a personal one.
Similarly, in the basic educator sector, Halima encountered difficulties when working with teachers and parents:
I had to routinely consult with the teachers on how the learners were doing. I also consulted with the teachers and assistants on how they could better communicate with the learners. I used these consultations to also find out what themes they worked on in the classroom according to themes in the CAPS curriculum34 from the Department of Education. My therapy had to be relevant because at the end of the day when the client went back into the classroom, it had to be functional for him or her. Sadly, therapy was still a challenge, because the teachers, parents and I were not on the same page. There was very little carry-over taking place from therapy to classroom or to the home … Between the teachers and the parents it felt like no one really seemed to care or acknowledge what the speech therapist had to say. I have been here for a few years and I do not know whether it is time for a change. How will I survive with the lack of reciprocity between the teachers and me? Perhaps I needed to go where my voice will be heard because the frustration was mounting and I did not want to just be another PERSAL number.35
(Extract from Halima’s narrative, section 5.5). Halima made a strong point about not wanting to be lost in the system when she said that she did not want to be another PERSAL number. She pointed out that the efforts
34 ‘CAPS’ is an acronym for Curriculum Assessment Policy Statement, which is an SA education policy, i.e. a policy statement for learning and teaching in SA schools (Department of Education, 2011).
35 PERSAL is a unique system, which generates an 8-digit number assigned to each employee who is appointed on the personal database system in public service in South Africa.
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that she has made to communicate with the teachers and parents were not reciprocated, which left her feeling frustrated. She rationalised this as being undervalued as the (sole) SLT in a school context and that her voice was not loud enough to hear.
On systemic and social issues
The participants often found that systemic and social issues were constraining and affecting their practice, such as updates and changes in policies and guidelines from the Department of Education. However, their line mangers did not pass these updates or changes on to them. It appeared that the participants did not see it as their responsibility to enquire about policy changes and guidelines. This has the potential to constrain their ability to serve as professionals. Not knowing about the broader systemic policy regulations affecting the specific work context is problematic. Further, the professionals within this study expected that they would be informed about what these framing regulations enabled or restricted within the work practice context. However, problematically, they did not believe that they were obliged to take responsibility of sourcing information. This could relate to a lack of adequate guidance provision to participants about the system-wide policies that influence varied work contexts during their initial professional education. They also did not seem to understand professionalism as an exercising of active, independent, autonomous agency to interpret and engage with their specific context. It is to be questioned whether their professional education produced ‘passive professionals’ instead. Such passivity relies merely on outside sources to activate their personal development. According to the critical outcomes adopted by SAQA (2000), the National Qualifications Framework
(
NQF) level 8 graduates (as are speech-language therapy graduates) are expected, as a outcome of the declared curriculum design of their formal education, to “collect, analyse, organise and critically evaluate information” (Nkomo, 2000, p. 18). However, the participants appeared to be unable to assess the challenges that they experience adequately. In the process of ‘professionalisation’ of healthcare professionals, the analytical engagement of policy ought to be an integral part of the undergraduate curriculum. One needs to question why these systemic considerations are not infused into the operational curricula foci of professional education, especially since the varied contextual spaces and their ambient regulatory109
policy frames within which the practitioner is likely to practice, are usually well defined by course designers. The participants’ main preoccupation was effectively an abstract form of ‘service delivery’ disconnected from the operational systemic world with both its constraints and enabling lived worlds. The practitioners in this study seemed to negotiate their professional role in order to maintain an apparently neutral form of professional practice sanitised from the ‘messiness’ of the real contextual spaces. This fostered their own incapacity to interpret what the likely sources for change were. This inhibited their potential deliberative search for solutions that could be activated to realise their deeper professionalism. Instead, the naïve professionals chose to locate the source of the problems primarily within the systemic context and capitulated, arguing that they themselves were unable to effect any meaningful change. Hence, their preoccupation with a ‘neutralised effective service delivery’ inhibited their critical thinking about the reasons why these challenges exist. They were also unable to seek their own involvement in contributing to the contextual problems. It is no small wonder that they actively chose to seek out spaces where dissonance with their worldviews was less likely.