More than 20 years ago, a young physiotherapy student sat in a lecture at the University of Pretoria watching videos of a blonde therapist treating stroke patients.
Dietlind Gretschel (now Gouws) did not know who the woman was. She only knew she needed to find her.
“I thought, if I want to learn how to treat stroke survivors, I need to get hold of this blonde therapist,” she said.
The woman was renowned Cape Town physiotherapist Dr Elsje Scheffler and connecting with her would shape Gouws’s career in ways she could never have imagined.
Today, Scheffler is more than just a mentor, friend and business partner.
She also supervised Gouws through a decade-long journey towards an international qualification that, with Scheffler, puts her among a tiny number of specialists in SA.
Gouws, 45, who lives and practises in Gqeberha, recently qualified as a Basic Bobath instructor with the International Bobath Instructors Training Association (Ibita).
She is the only one in the Eastern Cape and one of five who are active in SA.
This means she can teach the internationally accredited Basic Bobath course — an intensive programme for health professionals working in adult neurological rehabilitation — anywhere in the world.
For Gouws, however, the qualification is as much about becoming a better clinician as it is about teaching others.
“It has helped me to become a more confident therapist,” she said.
Her interest in the field began far from Gqeberha.
Born and raised in Windhoek, Namibia, she spent six months in Germany as a 14-year-old with an aunt who was a physiotherapist and used horses in therapy for adults and children with disabilities.
Gouws, then a keen rider, helped lead the horses during sessions.
A sporty upbringing — her father and brothers were football enthusiasts and she a national swimmer at age-group level — pushed her towards a career in sports physiotherapy, but that changed during a third-year clinical placement in a spinal unit.
“I realised I wanted to work in adult neurology,” Gouws said.
By her fourth year, those videos of Scheffler treating stroke patients further crystallised this ambition.
After completing her community service at Cecilia Makiwane Hospital in KuGompo City, she moved to Cape Town, determined to eventually work under the therapist she had only watched on a screen.
In 2006, she succeeded, joining the Western Cape Rehabilitation Centre (WCRC) where Scheffler was chief physiotherapist.
Under her guidance, Gouws became involved in training health professionals in wheelchair service delivery — work that inadvertently brought her to Gqeberha and introduced her to her future husband.
She volunteered to present a course in 2011 for the rather prosaic reason of wanting to furnish her new home.
“I had just bought a house in Cape Town and needed a couch, so I said I would do the training,” she said, laughing.
She took leave from her day job and travelled to the Friendly City to earn some extra money.
There she met Coetzee Gouws, who, as it happened, was Scheffler’s cousin.
Gouws moved to the city in 2013 and married Coetzee four years later. They now have a three-year-old son.
Today she owns Rehab Lab, a practice specialising in adult neuro rehabilitation as well as amputee rehab.
At the heart of her clinical work is helping people affected by life-changing neurological events such as strokes and spinal cord injuries regain function and achieve reintegration into former life roles and their community.
She also works in wheelchair service provision, assessing adults and children before prescribing appropriate postural support devices and creating customised seating solutions.
Through Rehab Skills Lab, the business she and Scheffler co-own, she trains health professionals worldwide.
Victories can appear tiny to an outsider. For a stroke patient who has been unable to move a hand, the first flicker of a finger can be cause for celebration.
For a spinal cord-injured patient, learning to transfer independently from a wheelchair to a bed, toilet or car can dramatically improve daily life.
“You have this life in your hands for a short period of time where you can make a positive impact and shape it going forward,” Gouws said.
“The purpose is for them to participate and lead a meaningful life again.”
This drive to optimise recovery underpins the Bobath concept.
Developed in the 1940s by physiotherapist Berta Bobath and her husband, Dr Karel Bobath, the approach challenged an older emphasis on teaching people with neurological impairment simply to compensate for lost movement.
In the case of a stroke patient whose left side is affected, for example, rehabilitation might once have concentrated largely on teaching the person to just manage with the unaffected right side.
“The Bobaths came along and said there is potential in this affected side,” Gouws said.
This rehab focuses on analysing a patient’s movement and helping them recover more efficient, functional movement, rather than applying an identical treatment formula to everyone.
Two people may have suffered similar strokes, Gouws points out, yet present very differently and have entirely separate goals: one may want to cycle again while the other wants to do the dishes.
For her, becoming an instructor represented the ultimate professional challenge.
After completing her own Basic Bobath course in 2006, followed by several advanced courses, she began wondering what should follow the master’s degree she finished in 2014.
“What would make me a better hands-on therapist?” she asked herself.
The answer was learning to teach the Bobath approach herself.
“If I am the one instructing, I’ve got to be super good — and this, in turn, will benefit my patients.”
And there was Scheffler.
“Although Elsje is now my friend and business partner, she will always be a physio idol to me.
“She is my mentor, the person I look up to. She is phenomenal.”
Gouws began her instructor journey in 2016, with Scheffler as her supervisor.
What followed was years of steadily increasing responsibility on the Basic Bobath courses their company presented to therapists.
It also involved developing and presenting teaching material and submitting herself to continual assessment and feedback.
She travelled to England in 2017 and Switzerland in 2018 for compulsory training modules.
Gouws built an extensive portfolio of evidence, including recordings of herself teaching, lesson plans and analyses of scientific literature.
She also undertook additional study in neurophysiology to deepen her understanding of how the brain produces and controls movement.
On several occasions, she spent a week at a time in Cape Town treating patients alongside Scheffler so that Scheffler could assess and help refine her clinical skills.
Gouws’s journey took about 10 years from start to finish, though two of those were effectively lost to the pandemic.
She never considered throwing in the towel.
“By the time we started again with the courses post-Covid, I had already invested too much to give up.”
Ironically, Gouws herself delayed the final hurdle.
Scheffler believed she was ready, but she wanted to wait before submitting herself to the formal qualification event.
“I’m glad I did because it’s only in the last two years that I felt fully confident in what I was doing.”
Her assessment, attended by two international examiners and Scheffler, finally took place in Cape Town in June.
She not only passed but scored more than 90% in both her portfolio of evidence and across her theory presentations, practical sessions and patient demonstrations.
Now the challenge shifts to sharing her knowledge with other therapists.
The Basic Bobath course combines theory, practical skills and supervised clinical work.
Participants study areas such as neurophysiology and movement before learning practical ways to help patients regain postural control and arm or leg function.
They also work with actual patients under the supervision of instructors.
Gouws believes this training is particularly relevant in a country where access to specialised neurological rehabilitation remains unequal.
The Eastern Cape, she points out, has no equivalent of the dedicated WCRC.
In the public sector, patients may be discharged once medically stable and must then rely on overstretched community services.
Private-sector rehabilitation, on the other hand, can be curtailed by medical aid funding limitations.
Her new qualification cannot solve these issues.
But it does increase SA’s capacity to train physiotherapists and occupational therapists working with people whose lives have been abruptly changed by neurological injury or disease.
“As a Bobath instructor, I fully believe in this concept,” she said.
“It is sometimes misunderstood, but you have to apply it correctly for it to work.
“The concept makes sense and I have seen just how much it benefits our patients.”