History of Physiotherapy Education in South Africa – the SMU & UKZN story

Physiotherapy Department at Sefako Makgatho Health Sciences University (SMU)

(Information provided by the current HOD, Prof Douglas Maleka, class of 1976 and all MEDUNSA/UL/SMU graduates, associates and friends, especially Mrs Melody Nguna (nee Mji) and Ms Shoeshoe Zulu (nee Mopeli))

Physiotherapy was one of the professions reserved exclusively for the White people in South Africa according to the apartheid Bantu Education Act of 1953. Although Physiotherapy has been a recognised profession in South Africa since 1923, the introduction of a training opportunity for Africans in Physiotherapy only took shape in earnest in the late 1960s and early 1970s.

In the Medical University of Southern Africa (MEDUNSA), the department was started by Mrs Audrey McFarlane and Dr Gilliland from the United Kingdom in 1973 under Mmadikoti College located next to Ga-Rankuwa hospital (now Dr George Mukhurai Academic Hospital) in a township called Ga-Rankuwa, 24km northwest of Pretoria the capital city of South Africa. The training offered was a three-year National Diploma in Physiotherapy. When MEDUNSA was established in the mid-1970s the department was then moved to the university.

According to the records of the institution, 400 applications were received from Southern Africa as a whole. Of those applicants, only 10 were accepted, and two from Lesotho and Botswana did not turn up to begin the training.

Only 4 graduated in 1976 from this group (see photo below).

In those days, a special license was required by Pretoria Medical Hospital to transport cadavers from the University to H.F Verwoerd Hospital to teach students dissection. This was due to black students not being allowed to enter Pretoria Medical School on the basis of the Extension of University Education Act of 1959 which prohibited black students from entering historically white universities (HWUs) without prior permission from the then minister.

The foundation courses in the curriculum, were Anatomy, Physiology, Psychology to name but a few.

Physiotherapy curriculum included the following broad areas:

1. Diagnostic
   • Sweat Test in Cystic fibrosis
   • Lung Function Tests
   • Nerve Conduction Tests and others

2. Curative
   • Focusing on cardiorespiratory: ICU and chest conditions
   • Wound healing
   • Skin conditions such as Acne Vulgaris and Psoriasis treated by Ultraviolet

3. Preventative
4. Educational
5. Rehabilitative
6. Research
7. Electrotherapy: low, medium and high-frequency currents and Faradism, used mostly for:
   • Wound healing
   • Lung function tests
   • Never Conduction Tests?

8. Orthopaedic: back and neck injuries, hip and knee pain caused by Arthritis and ankle pain, knee and hip replacements because of LLD and flat feet.
9. Paediatrics: Cerebral Palsy and other paediatric conditions
10. Neurology: spinal cord injuries and pathologies as well as stroke

Mrs Audrey McFarlane and Dr Gilliland were also the founding members of the Physiotherapy department at Ga-Rankuwa Hospital, while Ms Patricia Bowerbank was the head of the Physiotherapy Department at Kalafong Hospital. These two hospitals were the main clinical training platform for Physiotherapy students. Groothoek hospital in the former Lebowa (the former Northern Transvaal) government was also used as a clinical training platform.

The external examiners for this group of 1973-1976 were Professor Jean Blair from the University of the Witwatersrand, Mrs Reynolds from the University of Cape Town and others from University of Orange Free State (now University of the Free State) in Bloemfontein and University of South Africa (UNISA).

The diploma was discontinued in the early 1980s and a four-year BSc (Physiotherapy) degree was offered. The first intake for BSc (Physiotherapy) was in 1982. Following the discontinuation of the National Diploma, the Diplomats were given the opportunity to upgrade to BSc Physiotherapy. The curriculum was transformed to focus on the burden of diseases in South Africa, with a huge focus on the science behind the profession of Physiotherapy. Research became a huge part of the curriculum. The intake of students was increased and Physiotherapy became even more of a competitive programme to study. Clinical training platforms were expanded beyond the initial three teaching hospitals, to accommodate the increasing number of students as well as increasing students’ exposure to a variety of medical and surgical conditions, across the country. The elective clinical block was also introduced into the curriculum. Professional practice, ethics, management and administration were introduced into the curriculum. Final year Physiotherapy students began to work full days after a few weeks of preclinical teaching and in the late 1990’s the third years too.

After the first South African democratic elections in 1994, a lot of changes happened in the higher education landscape, for various reasons but the main one being financial viability and transformation of higher education institutions. To that end, in the year 2005, MEDUNSA was merged with the University of the North to form the University of Limpopo (UL) by the then Minister of Higher Education, Minister Kader Asmal. This merger did not work well, in the year 2014 the de-merging process was initiated and completed, giving birth to a new comprehensive Health Sciences University called, Sefako Makgatho Health Sciences University (SMU), in 2015.

Currently, the student body and staff members are very diverse, reflecting the demographics of the South African population. On average the department graduates 40-50 physiotherapists per year, from the four graduates in 1976. The department has also grown its postgraduate programmes, to offer MSc’s and PhDs.

The department has since produced graduates who are working in both public and private healthcare industries. Others are heading hospitals, academic institutions and the professional board of Physiotherapy, Podiatry and Biokinetics of the Health Professions Council of South Africa (HPCSA), making huge exploits and contribution to the health care system of the country and globally. We are so proud of our very own Mrs Zola Dantile (class of 1985), who was the vice president of World Confederation for Physical Therapy from 2003 to 2007.

The three academic Physiotherapy training institutions in Gauteng province are headed by MEDUNSA graduates, namely; Associate Professor Joyce Mothabeng of the University of Pretoria, Associate Professor Veronica Ntsiea of the University of the Witwatersrand and Associate Professor Douglas Maleka of MEDUNSA/SMU. Indeed, we are looking back in amazement, at the small beginnings of Mrs Audrey MacFarlane and her other colleagues. In the honour of Mrs MacFarlane, the department is awarding a prize to the most outstanding, excellent and performing student in the four years of study.

Since the inception of the department, the HODs were female, namely Mrs A. McFarlane, Ms L. Puckree (now Professor), Mrs N. Themba, Mrs K. Mokwena (now Full Professor of Public Health), Ms NP Mbambo (now Associate Professor) and Mrs N Taukobong (Associate Professor). In 2017, the very first male HOD was appointed, Associate Professor Douglas Maleka (from the class of 1995).

In 2023, the department will be commemorating and celebrating 50^thanniversary of producing physiotherapists, dare I say, mostly Black South African physiotherapists, from poor rural areas and provinces of South Africa.

UKZN Department of Physiotherapy

(Information provided by HOD Prof Saul Cobbingand former HOD, Dr Thaya Nadasan)

The Department of Physiotherapy at the University of KwaZulu-Natal (UKZN) is the only training centre for physiotherapists in the province of KwaZulu-Natal (KZN). The Department of Physiotherapy was established in 1964 at King Edward VIII (KEH) hospital between the old Natal Provincial Administration (NPA) and the University of Durban Westville (UDW), under the leadership of Prof Schultze, who was a Physical Medicine Specialist. He questioned the absence of non-white physiotherapists in the apartheid era and he proposed that KEH become the training centre for non-white physiotherapists. All non-white students were recruited from the four old South African provinces. They were to study for a National Diploma in physiotherapy and serve the whole country during this time. There were also students from Swaziland and Lesotho. Prof Schultze, a medical doctor, was the National Head of Department of Rehabilitation Medicine and Remedial Services in South Africa, based at KEH in charge of Training and ALL rehabilitation services (OT, PT Speech and Hearing etc). Miss Gwen Jones from England was the first head of department (HOD) of the school of physiotherapy and, of course, all lecturers were white at that time. Shiela Blackwood and Charles Liggins joined the school in 1968. Between 1964 and 1973, a Diploma in Physiotherapy was offered. Student intake was small at this time, with about 12 students entering the programme each year.

In 1974, the first batch of BSc Physiotherapy students was enrolled for a degree programme. Mrs Margaret Rhode (an ex UKZN lecturer) was in the second batch of 12 students who were assisted by Prof Schultze in obtaining the NPA bursary. Only four of these students graduated in 1979. Miss Jones was HOD, followed by Mr Liggins interchangeably as he used to travel to the UK often. There were six Joint Health Establishment Posts between NPA and UDW.  The other lecturers were Professor Gounden, Miss Marilyn Ashby, Miss Anne Bandle and Mrs Gumede, who made headlines as the first Black lecturer to be appointed at UDW. This degree programme continued up until 1980. Anatomy, physiology and clinical sciences lecturers were done together with medical school students. In 1981, Thaya Nadasan (current UKZN senior lecturer) was in the first batch for the BPhysio degree (15 students), which is still continuing to date. Only four of these 15 students graduated in 1985. Anatomy, done together with the first batch of occupational therapy students, and physiology was done on Westville campus along with biology, physics, chemistry and psychology. All physiotherapy lectures, at that time, were still done in KEH. Miss Nadasan was appointed in the Joint Health Establishment post in 1988 to date. Clinical training started in the second year, taking place mainly at KEH, which had 2500 beds, with all clinical areas/blocks such as general surgery, medicine, ICU, respiratory unit run, outpatients and O&G. In addition, cardiology, neurology ICU and rehabilitation, paediatric neurology, hydrotherapy/outpatients were implemented at Wentworth hospital, Spes Nova and Workman’s Accident and Rehabilitation Centre (at St Augustine’s Hospital) respectively.

Profesor Gounden was made HOD in 1994 (when Charles Liggins retired) up until his own retirement in 2004. In 1998 BPhysio year-long courses were changed to the modular system and more UDW lecturer posts were created as the intake was increased to 40 students inclusive of those from disadvantaged backgrounds to increase health services to those really in need. Academic Development Programmes and Recognition of Prior Learning were also introduced. Mrs Gumede used to also relieve Prof Gounden as HOD at this time. In 1996 the physiotherapy department moved to Westville campus (E block), the year Professor Puckree was appointed. In 2004 the University of Durban Westville and the University of Natal merged to form the University of KwaZulu-Natal. Disciplines were also arranged into schools and the department was initially included in the School of Physiotherapy, Sports Science and Optometry. Professor Puckree was made HOD in 2004 and the Head of School between 2005 and 2007. Dr Nadasan was nominated as HOD from 2005-2006, Dr Serela Ramklass was HOD in 2007 and Professor Sonill Maharaj was HOD from 2008-2015. In 2012, UKZN changed to a College Structure and the Department of Physiotherapy was then included as one of the eight disciplines in the School of Health Sciences, which in turn is one of the four Schools in the wider College of Health Sciences. In 2016, under the leadership of the current Dean of the School of Health Sciences, Profesor Mahmoud Soliman, Dr Nadasan was appointed as HOD, overseeing the initial preparation and implementation of the Decentralised Clinical Training Programme (DCTP). In 2018, Saul Cobbing, who joined the department in 2010, was appointed as HOD/Academic Leader. In 2020, physiotherapy in KZN will be celebrating 56 years in existence!

Over the past five years, the Department of Physiotherapy at UKZN has made significant progress in the areas of teaching, research and community engagement. In this time, four staff members have obtained PhD degrees with four other staff members currently completing their PhDs. Five members have also completed their Masters degrees in this period, while three of our staff have been promoted to the level of Associate Professor (Professor Verusia Chetty, Professor Sonill Maharaj and Professor Saul Cobbing). Professor Chetty served as Academic Leader for Teaching and Learning for the School of Health Sciences between 2017 and 2020. Rogier van Bever Donker, who joined the department in 2012, was appointed to the position of President of the South African Society of Physiotherapy in 2019. In addition to these achievements, more than 60 peer-reviewed articles have been written by our staff in the past five years, demonstrating expertise in a wide range of teaching and research areas. It should also be noted that our departmental technician, Mr Levin Chetty, who has been with the department for twenty years, is also currently completing his PhD and has a growing research output himself.

This excellence in research is mirrored by the improvements we have made in the undergraduate curriculum, which reflects the department’s commitment to extensive community engagement and societal impact. This can most clearly be seen in the successful transition of the department’s clinical training from primarily urban institutions to the innovative and contextually-relevant DCTP. This programme involves our fourth (final) year physiotherapy students completing four six-week clinical blocks at rural hospitals throughout KwaZulu-Natal.  In 2018, the department received full accreditation from the Health Professionals Council of South Africa for the next five years.

The Department of Physiotherapy at UKZN is committed to advancing relevant health research and redressing the scarcity of healthcare professionals in the academic and healthcare sectors in the country, congruent with the imperatives of the National Departments of Education and Health. Of UKZN’s seven key goals, the two goals that are most applicable to our department are Goal 2, namely Responsible Community Engagement – through which we aim to contribute to the prosperity and sustainability of our province, and to nation-building, by connecting with and committing ourselves to the communities we serve in a manner that adds value and earns their respect, admiration and trust – as well as Goal 4, namely Excellence in Teaching and Learning, in which we aim to promote excellence in teaching and learning through creative and innovative curriculum design and development, pedagogical strategies, and assessment practices in accordance with the highest quality management principles. We aim to produce physiotherapists, who are reflective of the country’s demographic profile, and who are equipped with the knowledge, skills, professional ethics and attitudes to assist in achieving optimal health for all. We further aim to inspire our physiotherapy students to become expert practitioners throughout the whole continuum of health promotion, prevention, screening, diagnosis and treatment in the spirit of Ubuntu and in alignment with the Batho Pele (People First) principles.