Making a rural workforce: exploring the habitus of health sciences students from rural South Africa

Abstract

In South Africa, finding solutions to ensure sufficient, well-trained professionals to meet health challenges is a national imperative. The apartheid system had marked impact on schools and rural communities, influencing the abilities of students to thrive during their training and to continue to work as health professionals. Globally, a growing body of evidence attests to the benefits of recruiting students of rural origin to respond positively to human resource challenges to meet rural health needs. With a concerted effort to change the demographics of the student body in higher education institutions (HEI) in a post-apartheid era, following the Department of Education’s 1997 mandate for HEI to transform, the number of Black students who enrol to study for higher degrees has increased to reflect the demographics of South Africa’s population. Consequently, there has been an ongoing interest in exploring the habitus of students of rural origin.

Drawing on a social constructionist paradigm, using Bourdieu’s framework, I sought to understand the relationship between habitus, capital, and the field, in order to explore the factors that influence the professionalisation of health sciences students. I employed purposive sampling to recruit participants who were registered at the University of Cape Town (UCT) as students in audiology, medicine, occupational therapy, physiotherapy, and speech-language pathology. Drawing on audiorecorded in-depth interviews and journal reflections, I examined the lived experiences of final year health sciences students (n=21) from rural South Africa.

Two-thirds of my participants were female, mostly from KwaZulu-Natal Province and the majority speaking isiZulu as their first language. Only four participants lived with both parents during their schooling years. Participants revealed diverse understandings of rurality of their own communities, as heterogenous, complex, dynamic and ambiguous. They offered new descriptors that provided evidence such as “no ATM” (Automated Teller Machine); “no CBD” (Central Business District); “no computers, no library, no internet, no YouTube, no Instagram, no internet café.” The subjective and objective representations of rural spaces reflected the tensions of “living in two worlds at the same time,” as they studied and lived in the metropolitan city in Cape Town. Participants contrasted the anonymity of the city with the closeness of rural settings; in Cape Town, they explained, people do not greet and acknowledge their presence.

Through this study, I present theory of practice as a relational multiprofessional framework. Participants had access to social capital generated from multidimensional sources that included family, community, ancestors and church. The efforts of their families and teachers generated enough cultural capital to secure participants’ place at UCT through a phenomenon of school hopping for 80% of the participants. Despite acquiring an educated habitus, as high achievers in matric, in their first year participants experienced a disrupted habitus. Muted by their rural English, they were misrecognized. Some started to isolate and disengaged and as they experienced failure for the first time, they were prone to mental health challenges.

As they progressed in their studies, at times supported by classmates and clinical partners, participants employed social and cultural capital to moderate institutional hierarchies and incidents of racism. Through a generative habitus, supported by academic clinicians and supervisors they experienced transformation in clinical spaces at five levels. Scrubs translated into “professional armour” and became a marker of their professional identity. Participants reported a shift from theory to practice; from standard patient encounters to an appreciation of a holistic and biopsychosocial approach necessary for patient management; a shift from being students to becoming health professionals managing patients under supervision. Lastly, participants experienced a shift in their approach to work, as primary health centres became spaces for multidisciplinary teamwork and facilitated reciprocal learning experiences as participants transformed social attributes into professional attributes. The challenges of being different provided opportunities for their habitus to constrict and expand to different aspects of the field as they generated academic capital.

By using a Bourdieusian lens and employing habitus as a theory and a methodological tool, I have generated insights about how students of rural origin negotiate difficult university spaces. Their rural upbringing, resilience and intrinsic motivation allowed participants to generate the kinds of capital that are desirable in health care professionals and accrued benefits for patients. Through this study, it has been possible to challenge the prevailing perception of deprivation that is often associated with rural areas. I highlight the inherent values and strengths of rural communities that have often been overlooked in previous studies.