Towards a critical curriculum for mid-level community based rehabilitation training in South Africa.

Abstract

This study, conducted in Pietermaritzburg and surrounding rural and township areas, is a critical exploration of the training of mid-level Community Based Rehabilitation workers with a specific focus on the ability of course participants to understand and address the oppression and empowerment of people with disabilities. The aim of the study was to develop a conceptual framework for curriculum construction of a midlevel Community Based Rehabilitation course, through examining a Community Based Rehabilitation course and the changes that were made to it. The study was conducted within a critical theory paradigm. The social model of disability and an understanding of disability as a form of oppression were the key constructs that guided the research. Participatory action research was used in the initial phase of the research, followed by a second phase that adopted a life history approach. The initial phase of the study consisted of one cycle of action research, beginning with a reflection on the existing curriculum. The action research cycle then moved through stages of planning changes to the curriculum, implementing the changes, observing the effects of the changes and reflecting again. Data collection comprised interviews with staff members, students and community rehabilitation facilitators who had previously completed the Community Based Rehabilitation course, as well as focus groups with people with disabilities and parents of children with disabilities. Several participatory rural appraisal techniques were also used with the students. The action research cycle raised further questions about how the life experiences of the students influenced their responses to the changed curriculum. This stimulated the development of the second phase of the research which used life history methodology, comprising in-depth interviews with four students. The study found that several changes occurred in the students’ attitudes and understanding as well as in some of the activities they undertook. Some students worked with rather than for people with disabilities, indicating a change in the power relationship with their clients. The students were able to analyse their own oppression and that of people with disabilities, unlike previous students. The students also engaged in social action for the rights of people with disabilities. These findings cannot be solely attributed to the changes in curriculum. However, they raise the possibility that Community Based Rehabilitation personnel can work to address the oppression of people with disabilities rather than focusing entirely on technical rehabilitation, which is a common approach in the literature. An analysis of the life histories revealed that those students identified as ‘activists’, more willingly engaged in social action during the Community Based Rehabilitation course than other students. This challenges the dominant discourse in the literature of Community Based Rehabilitation personnel as rehabilitation workers rather than activists. One key contribution of this thesis is to research methodology through its combination of life history methodology and action research in the study. A second is its proposed framework for curriculum construction that incorporates findings from the action research and the life histories. This framework, with its macroenvironment, organisational and student influences on the curriculum, contributes to the under-theorised field of Community Based Rehabilitation training.