Roslyn Cassidy Builds a Specialist Women’s Service

Pelvic floor disorders often go untreated despite their impact on quality of life. Over a series of visits, volunteer physiotherapistRoslyn Cassidy helped integrate pelvic health services through referrals, clinician training, and community outreach, creating a sustainable care model at Tintswalo Hospital. 

A Chance Encounter with Purpose 

After the COVID-19 lockdown, once we were finally able to venture out again, some of my tango dancing friends and I started camping everysecond weekend. It was during one of these trips that I met Barbara McGorian, the CEO of the Tshemba Foundation. Over time, she told me about her work with Tshemba and its support of Tintswalo District Hospital in Mpumalanga. Initially, I thought Tshemba was only for international medical volunteers and that they wouldn’t need someone like me. But as we spoke more, she mentioned that they were developing a women’s clinic focused on family planning and breast care services. That conversation planted the seed—I realized I might have something valuable to contribute.

Finding My Place at Tintswalo

In January 2023, I interviewed with the Tshemba team to assess how my skills could fit into their programs. They invited me to visit Tintswalo Hospital and Tshemba’s staff accommodation in a nearby nature conservancy six weeks later. I wanted to understand the landscape—what was being done, who was supporting the doctors, and whether there was a place for me to help.

I knew that women with pelvic floor issues were likely underserved, but I had no clear way to reach them. On my next visit, I createdposters, translated them into Tsonga and Shona, and placed them around the hospital. I also conducted Continuing Professional Development (CPD) training sessions with volunteers, consultants, and other healthcare workers, as well as community programs like GRIP (an organization supporting survivors of rape and sexual violence). This helped spread awareness about my expertise.

Building a Referral System

My first referrals came from community service doctors and Tshemba volunteers, particularly gynecologists, emergency doctors, and general practitioners working in outlying clinics. Many of these doctors were foreign-trained, especially from the Netherlands, where pelvic health physiotherapy is well established. I also received referrals from Belgian andGerman-trained doctors, while British doctors were generally less familiar with the field.

Pelvic floor physiotherapy requires an intensive first assessment, but follow-ups occur every four to six weeks. This made it feasible for me to visit Tintswalo every six to seven weeks, ensuring continuity of care for my patients. Over time, we built a referral system with the help of community service physiotherapists and the hospital’s rehabilitation department. The department head, Monika, played a crucial role in integrating pelvic health services, and together, we designed and trialed a referral pathway poster. These posters are now displayed throughout the hospital, helping both patients and providers understand the available services.

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Expanding the Service

 As my visits continued, the physiotherapy and rehabilitation department at Tshemba began referring more patients to me. After conducting CPD training there, one of the physiotherapists, Viola, started sending me referrals and even reached out between my visits for advice on certain conditions. Over time, we also saw emerging cases in men’s health, highlightingthe broader need for pelvic health services in the community.

Recognising the importance of sustainability, I focused on upskilling local physiotherapists. A Dutch physiotherapist with connections to a urogynaecology hospital in Polokwane arranged a basic women’s health training course. With funding from Tshemba, Viola attended and gained valuable skills.Later, when she encountered a child with fecal incontinence and other pelvic health concerns, I helped her find a paediatric pelvic floor course, which Tshemba also supported. Now, during my bi-monthly visits, I supervise and mentor Viola, ensuring she has the knowledge and confidence to continue providing care.

Reaching Women in the Community

Community outreach became another important avenue for referrals. Early on, a retired teacher who had fully recovered from her pelvic floor symptoms invited me to speak at her Bible group near Cottondale. I found myself discussing constipation and urinary leakage with 47 elderly women—resulting in 12 new referrals. Similarly, a community meeting at theWomen’s Skills and Permaculture Centre, facilitated by Rhian Twine, the ChiefClinical Officer at Tshemba, led to 20 more referrals. Slowly but surely, word spread that women didn’t have to simply “live with” pelvic floor issues—help was available.

A Growing Recognition of Essential Care

In my work, I have seen many common cases—conditions that men and women have long accepted as a normal part of daily life, unaware that they can be effectively treated and managed with the right care. 

At first, no one recognized this as an essential service. It wasn’t viewed as a real health need, yet it has now become vital to the community. Incontinence, for example, is a widespread but often overlooked condition that significantly impacts people’s quality of life.

Through perseverance, I have been able to reach more and more patients, helping them understand that they don’t have to simply live with these conditions. With proper treatment, their health can be restored, their dignity preserved, and their daily lives improved.

As Nicole Fiolet, our Medical Project Manager says, "It took time for our local doctors and other health professionals to trust that this is a continuous service and that it is truly beneficial for their patients. But with time, and through Ros's unwavering commitment to change and her dedication to sharing knowledge with underserved communities, her service has made a profound impact on those women in need."

Looking Ahead

What started as a chance meeting with the Tshemba CEO has grown into a comprehensive women’s pelvic health service in Tintswalo and the surrounding areas. As I reflect on the past two years, it’s clear that this wasn’t built through luck or magic—it took the compassion of a few dedicated professionals, the willingness to show up every six weeks, and a commitment to making change happen. And while there’s still much to do, I am heartened by the progress we’ve made in improving the lives of women who, for too long, have been overlooked.

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By Ros Cassidy, physiotherapist