Establishing a Health Sciences writing centre in the changing landscape of South African Higher Education

This article describes, analyses, and reflects on the conceptualisation and establishment of a Writing Lab at a South African university’s Faculty of Health Sciences. Drawing on the theoretical framework of New Literacy Studies, the academic literacies approach, and South African writing centre scholarship, the analysis revealed that the conceptualisation of the Writing Lab was primarily informed by the academic socialisation model but has since shifted to encompass a more transformative ideology; opening spaces where students’ own knowledges and literacies practices could contribute to new forms of thinking and representation in the academy. We argue that the shift was facilitated by collaboration with disciplinary lecturers, the faculty’s Primary Health Care ethos, and the Writing Lab’s engagement with a large postgraduate population, leading to the Writing Lab’s participation in new forms of knowledge-building that could contribute to the creation of decolonised spaces and shifts in institutional culture.


Introduction
Our article describes, critically analyses, and reflects on the two-year planning phase and first three years of operation of a new writing centre, located in a Faculty of Health Sciences at a historically white South African university. Named the Writing Lab, the centre opened its doors in January 2015.
Theoretical frameworks were drawn from the New Literacy Studies, which embed literacies in the context of social practices (Gee, 1990;Heath, 1983;Lea and Street, 1998;Prinsloo and Breier, 1996;Street, 1984Street, , 1995The New London Group, 1996), and makes particular use of the academic socialisation model (Lea and Street, 1998), the transformative ideology of the academic literacies approach (Lillis and Scott, 2007;Lillis et al., 2015), and research on collaboration between academic literacies practitioners and lecturers in the academic disciplines (Boughey, 2012;Butler, 2013;Clarence, 2011;Jacobs, 2007bJacobs, , 2010Jacobs, , 2013Jacobs, , 2015. Throughout, the article engages with writing centre scholarship, both in South Africa and further afield. The period of student activism during the #RhodesMustFall, #FeesMustFall, and We follow a case study approach, with the Writing Lab as single unit of analysis (Yin, 2009). Drawing on the theoretical frameworks described above, we analyse multiple data sources, comprising policy and funding documents, our own observations as participants, and data collected for the purposes of monitoring and evaluation, to describe and reflect on the evolution of the Writing Lab in its institutional context over a five year period (Yin, 2009). Our primary research question is whether the academic socialisation model that framed the project at the outset could be encompassed by a transformative approach to academic literacies (Grimm, 2009;Lea and Street, 1998;Lillis and Scott, 2007;Lillis et al., 2015). We also reflect on the nature of such transformation and the potential for writing centre work to contribute to the creation of decolonised spaces in higher education.

The Faculty of Health Sciences
The Faculty of Health Sciences has approximately 2000 staff and almost 4500 students, encompassing the disciplines of Medicine, Nursing, Health and Rehabilitation, and the Biomedical and Public Health Sciences (http://www.health.uct.ac.za/fhs/about/fhs). The faculty has a strong research culture, with networks into the rest of Africa, resulting in an unusual student demography with postgraduate students in the majority. In addition to undergraduate and postgraduate degrees, the faculty also offers more than thirty postgraduate diplomas aimed at strengthening professional and clinical capabilities, catering for postgraduate students with prior professional experience.
As part of its transition into post-Apartheid South Africa, the faculty adopted PHC as a central philosophy in 1994. This philosophy recognises that structural inequalities in access and service-delivery translate into unequal health outcomes in the population. Thus, it envisages a holistic biopsychosocial approach characterised by participation, inclusivity, and social justice (World Health Organization, 1978) which is strongly patient and community centred.

Theoretical Framework
Due to the wide range of contexts within which writing centres are located and the various theoretical approaches underpinning their practices, there is substantive diversity among them (Archer and Richards, 2011;Kinkead and Harris, 1993). Grimm (2009: 12) acknowledges the role that external factors such as 'local contexts, financial considerations, and institutional missions' play in creating variation, but argues that 'unspoken assumptions' about students, language, literacy and learning are by far more powerful in shaping the 'direction of a particular writing centre'. Grimm (2009) goes on to identify three sets of assumptions which closely aligns to distinctions made by researchers of the New Literacy Studies. The first set (Grimm, 2009: 14) points towards Street's (1984) definition of the autonomous model of literacy and Lea and Street's (1998: 157) description of a 'skills-based, deficit model of student writing'. The second, which underlies 'teaching writing as process' (Grimm, 2009: 14), comes close to Lea and Street's (1998: 158) model of 'academic socialisation' which describes literacy teaching as a process of inducting students into the main conventions of academic writing in their disciplines. Grimm's (2009: 15) third set of assumptions values the practices of multilingual and multi-dialectic speakers and recognises 'literacy learning ... as a profoundly social and transformative undertaking'. In this, she approximates Lea and Street's (1998) formulation of academic literacies as an approach which turns a critical lens on hierarchies of power in language and society (Lea and Street, 1998). Grimm (2009: 16) mines the third set of assumptions to surface three 'conscious conceptual frameworks'. She uses these to picture a writing centre that 'works within the context of global Englishes', understands literacy 'as the ability to negotiate more than one discourse system and more than one mode of representation' (Grimm, 2009: 19), and 'understands students as "the designers of social futures"' (Grimm, 2009: 21).
Grimm's conceptual frameworks owe much to the New London Group (1996) and also show affinity to Lillis and Scott's (2007) formulation of the transformative ideology of the academic literacies approach that, according to them, has the potential to empower writers to contest and change established literacies practices and academic norms. Lillis et al. (2015: 3) ascribe further epistemological reach to the academic literacies approach when they argue that researching and teaching academic literacies could transform the processes of 'individual meaning making and academic knowledge construction in higher education'.
We turn next to the task of locating South African writing centres within the complex and often contradictory environments and frameworks that contribute to the orientation of their beliefs and practices.
Academic language development in English, involving predominantly black students, was at the heart of early writing centre work in South Africa, as black students were given access to higher education in larger numbers during the country's democratic transition in the mid-1990s (Archer and Richards, 2011;Clarence and Dison, 2017). While this gave rise to widespread deficit and decontextualized skills approaches to literacy teaching, the establishment of some of the first writing centres in South Africa coincided with landmark publications in the fields of language, literacy, and education that contested these approaches (Clarence and Dison, 2017).
From early on, many South African scholars critiqued and rejected the 'autonomous' model (Street, 1984). Instead, they joined forces with researchers like Clark andIvaniç (1997), Gee (1990), and Lea and Street (1998). Many researchers influential in setting up early writing centres, for example Leibowitz et al. (1997) and Nichols (1998), viewed academic literacies as multiple, socially situated, and permeated by power relations. The vision of writing centres as a force for cultural change is prevalent from early on (Nichols, 1998).
Two edited volumes on South African writing centres (Archer and Richards, 2011;Clarence and Dison, 2017) seem to signal a shift in mission. An important theme in the 2011 volume was the exploration of the potential of writing centres to work towards change in a country trying to emerge from Apartheid's racial inequalities. Another important theme was the writing centre as a safe space, operating at a distance from formal institutional structures like assessment and the academic disciplines.
The second volume (Clarence and Dison, 2017) located its chief interest outside the walls of writing centres: inside departments and disciplines. Such a shift would seem in keeping with many institutions' decision to endorse discipline-based writing centres and interventions (Arbee and Samuel, 2015;Boughey, 2012;Kennelly et al., 2010).
It could be argued that such a shift may mitigate the problems of a marginalised identity, misconceptions about writing centre work and insecure funding expressed by many writing centres servicing the entire university (Archer, 2010;North, 1984). It could, however, also point to an increased emphasis on acculturation and inducting students into disciplinary meaningmaking (Boughey, 2012;Graves, 2016).
This raises the question whether working with and in the disciplines necessarily compromises the transformative vision expressed in some of the earlier South African writing centre scholarship cited above. Judging by the work of several South African researchers writing during and in direct response to the challenges made by the widespread student protests of the 2015 to 2017 period, the answer would be no. Several of these researchers, as shown in the examples below, argue that working in and across the disciplines could in fact expand the transformative reach of writing centres, even to the extent of starting to contribute to systemic change and opening up decolonised spaces in higher education. Authors for example reflect on writing centres' roles in capturing students' struggles and frustration with not only the norms and conventions of academic writing, but also with issues like untransformed curricula and inappropriate pedagogy. These authors believe that surfacing voices of contestation in institutional spaces could stimulate systemic change (Clarence and Dison, 2017;Esambe and Mkonto, 2017). Nichols (2017a: 35) describes the role that writing centres could play in bringing disciplinary lecturers, students and university policy makers into relationships of critical but respectful listening and acting, thereby growing the practices of 'participatory and critical citizenship' at institutions. Another example is Dison's (2018: 78) argument that the very process of inducting students into academic and disciplinary literacies could evolve into a Establishing a Health Sciences writing centre in South Africa 23 transformative process. This could be the case if the process of induction is accompanied in the long term by political ethics of care concepts and practices such as learning to listen attentively to what students bring into the academy, valuing resources brought from diverse worlds, promoting dialogue that suspends preconception, gaining understanding of others' needs and lived realities, and exploring alternative ways of making meaning, while constantly 'mobilising a critical engagement' with existing academic norms and conventions. Dison (2018) extends these practices to an institutional, systemic level by advocating for university strategies that would systematically support teaching and learning, for instance through thoughtful institution-wide processes of curriculum alignment, long term scaffolding of learning processes and development of pedagogies responsive to students' expressed needs and experiences. In these ways, Dison (2018: 80) sees institutions adopting a 'moral element' of 'attentive listening and dialogue' which could engage them in the processes of decolonising higher education.
While a full discussion of what is meant by transformation and decolonisation lies outside the scope of this article, what follows is a brief attempt to understand some of the ways in which the terms have been used in relation to recent developments in South Africa. At the same time, we wish to explain the links that we perceive between our understanding of the concepts and the transformative theoretical frameworks drawn from the New Literacy Studies and the academic literacies approach.
In their call for 'decolonisation, not transformation', Godsell and Chikane (2016: 59) present transformation as a 'functional response to a deeply ideological problem'. In their thinking this is different from 'radical transformation', which they equate with decolonisation, in that it directly targets curricula and institutional frameworks and seeks to bring about a 'radical change' in values, creating 'the space for students to critically link issues of race, intersectionality … with discussions about access and success'. Mpofu-Walsh (2016: 84) likewise explains that the #FeesMustFall movement rejected transformation as a 'failed project, content with superficial and gradual change', adopting the term decolonisation instead to refer 'to a deeper commitment to eradicating the legacies of colonialism and apartheid' and 'embracing fast and wide-ranging immediate changes to landscapes, demographics, financial models, and curricula'. Swartz et al. (2018: 10) sets up a similar relationship of critique between the terms, with decolonisation 'problematizing the transformation agenda as a liberal manifestation'.
In none of these examples are the two concepts mutually exclusive. Decolonisation emerges as the more powerful, validated concept, while transformation needs to be qualified before it 'counts as' contributing to decolonisation. Thus, providing access to higher education for black students, offering them extra support or appointing black staff may be held up as examples of 'superficial' transformation and would not 'qualify' as decolonisation (or true transformation) unless such actions were accompanied by systemic changes to institutional cultures that alienate black students and staff, obstruct their progress, and threaten their wellbeing. Unless we specify otherwise, we shall use the concept of transformation in the qualified sense, as 'real' or 'radical' transformation, that creates the possibility of systemic change and promotes decolonisation. Like Vorster and Quinn (2017: 33), we do not feel adequately prepared for confidently engaging with the thinking around decolonisation, and like them, we recognise the need to 'guard against assuming that any of our pre-existing discourses/frameworks can easily be used' in writing about this topic. We wish to propose, tentatively, that the transformative dimension of the New Literacy Studies and the academic literacies approach lies closer to forms of 'radical transformation', (i.e. supportive of decolonisation) than to forms of superficial and functional transformation. These frameworks have for some time now been highly critical of systemic forms of power and culture in higher education and have recognised the many ways in which institutional culture marginalises large groups of students, impeding their progress and threatening their well-being. Though we acknowledge that analytic applications of these frameworks may not always be in service of transformation or decolonisation, we hope that they retain their validity as tools to guide and evaluate the development of new educational ventures. In the paragraph that follows we present several examples that seem to support that hope.
Writing from their own experience as black academics in South Africa, Khunou et al. (2019: 9) describe an important aspect of decolonisation as the process of capturing narratives that illustrate 'how difficulties in the academy can lead to powerful ways of producing knowledge and of centring the student's position'. We believe that recent work undertaken by academic development and academic literacies practitioners in South Africa complements this kind of endeavour. We see Dison's (2018) exploration of attentive listening and dialogue as ways of drawing marginalised student experiences to the centre as one such an example.
Another example is Nichol's (2017b: 186-187) view that writing centres could cultivate multiple forms of connectedness: students' connection to meaning, to their own languages, to 'understanding academic English as an addition, not a replacement', to 'new knowledge', to their 'prior knowledge' and to other students and their experiences; also lecturers' connection to students, their worlds, feelings and thoughts.
We now come to the last part of this section, where we shall briefly relate the PHC philosophy to our theoretical discussion thus far. We find that the PHC emphasis on inclusivity and social justice, its commitment to patient and community-centred practice, and its recognition of structural inequalities align well with the transformative principles of the New Literacy Studies and the academic literacies approach. New Literacy Studies practitioners, and in particular many of those located in writing centres in South Africa, have long taken social justice as a point of departure and have strived towards inclusivity and equality of access, support structures, and outcomes (Nichols, 1998). Many practitioners acknowledge the importance of addressing structural and systemic problems that obstruct equality, rather than ascribing problems or deficiencies to individuals entering the system (Jacobs, 2010(Jacobs, , 2015. Like the patient and community-centred practices of the PHC approach, the student-centred practices of the academic literacies approach acknowledge the communities that students come from and value students' diverse contextual knowledges, their languages, and the importance of harnessing these to ensure inclusivity, active engagement, and student agency in educational activities (Grimm, 2009).

The Literacies Mapping Project and the National Teaching Development Grant
In this section we shall present documentary evidence that pre-dated but strongly impacted on the shape and direction that the new Writing Lab would take. These are documents related to a literacies review conducted by the faculty and a national funding opportunity that made it possible to establish the Writing Lab.
The Dean of Undergraduate Studies commissioned a Literacies Mapping Project in the Faculty of Health Sciences in 2012 (Olckers et al., 2013). The aim of the review was to make explicit the literacy competencies that were assumed to underpin the faculty's graduate attributes and to map whether, where and how these competencies were being taught in the faculty's undergraduate curricula. By interviewing course convenors, four sets of literacies were surveyed: academic, professional, information, and digital literacies (Figure 1) project.

Figure 1: The Literacies Mapping Project
Since the focus of this paper is on academic and professional literacies, we will concentrate on findings in these categories.
The theoretical underpinnings of this review strongly resemble Lea and Street's (1998) academic socialisation model, in that it envisages shaping students' literacies practices to conform to stated norms of 'graduateness' (Olckers et al., 2013). In its recognition of the importance of multilingualism, multiliteracies and multimodalities, the review nods in the direction of the New London Group (1996). Hidden in the normative language, there are hints of more transformative literacies frameworks and practices, for instance in the formulation of the 'Graduate Literacies Profile', students' ability to contribute to 'the expansion of knowledge and appropriate practice in the Health Sciences' is mentioned (Olckers et al., 2013: 127-129) and among the 'Literacies Exit Outcomes', 'critically evaluating diverse sources of information' is recognised, which includes students' own 'direct observations' of the social world as a source of information. Significantly, only staff were interviewed, which means that the student voice was not represented in the review.
Although instrumental, the review does aim at systematically improving teaching and learning, making explicit the areas where more support should be given. In particular, the review places the responsibility on lecturers to integrate the systematic development of academic literacies throughout the undergraduate curricula, which resembles Dison's (2018) application of an ethics of care to academic literacies. The review reveals the array of genres and disciplines that students are expected to negotiate in the Health Sciences. In alignment with Grimm (2009), it shows that students are expected to perform many shifts in literacies practices and modes of representation from class to class and throughout their studies: these range from ticking off Multiple Choice Questions requiring minimal writing but highly developed reading competencies, to writing short answers requiring concise control over presenting difficult knowledge in a few words; from composing reflections on prior knowledge, observations and emotions experienced during classroom activities or while visiting different types of health facilities, to constructing arguments and multimodal presentations based on a mix of biopsychosocial reading content, personal reflections, clinical observation and follow-up discussions with peers, patients and educators.
The review also draws attention to the high demands that are made of proficiency in more than one language. While many black students experience the challenges of performing their studies in English as an additional language, all students experience the frustration during clinical work of trying to communicate with patients and elicit information in multiple languages, often without knowing a patient's language or knowing only the rudiments (students in the professional undergraduate curricula are required to take courses in isiXhosa and Afrikaans).
Limited as it is in theoretical underpinnings and scope, the Literacies Mapping Project led directly to the idea of establishing a Writing Lab in the faculty. The South African national

Department of Higher Education and Training's Teaching Development Grant (TDG) was
identified as a suitable funding source, specifically because its primary purpose was the systemic development of university teaching staff as well as improving the quality and impact of teaching in order to enhance student learning and improve student success (DHET, 2013). This is in line with the Literacies Mapping Project's academic socialisation model and its emphasis on developing staff capacity to integrate academic literacies in the undergraduate curricula. The notion of changing institutional culture is not apparent in the language surrounding the TDG funding opportunity.
Like the Literacies Mapping Project report, the university's TDG funding application to establish the Writing Lab was mainly phrased in language associated with the academic socialisation model (Lea and Street, 1998). The main funding applied for was to perform three broad tasks: to build lecturers' capacity to integrate academic literacies in the curriculum; coordinate interventions that support students' acquisition of academic literacies; and manage a small satellite writing centre. The last task again hinted at more transformative theoretical underpinnings and practices: in the application, the writing centre was envisaged as 'a hub of student activity in the area of academic reading, writing and knowledge production', leaving space for student agency and recognition of prior knowledge (TDG 2014Funding Application, 2013. Funding was awarded in 2014.
The TDG funding set explicit monitoring and evaluation requirements. DHET officials guiding the development of monitoring and evaluation frameworks encouraged project teams to formulate clearly measurable outcomes, privileging quantitative data such as coverage and student performance data, although evaluation of services offered were also allowed. As we show later, these were in keeping with a normative conception of the writing centre, but in the end not the most appropriate measures for evaluating its activities.

Establishing the Writing Lab
Since the majority of the faculty's students are based in curricula that span many disciplines, working in and across the disciplines presented itself as the most obvious approach for the Writing Lab. Butler (2013) highlights that one of the challenges for staffing disciplinebased writing centres is acquiring staff with the ability to quickly immerse themselves within the discipline and become familiar with contextualised literacy practices. Jacobs (2007b: 67), however, doubts that academic literacies lecturers could sufficiently 'induct themselves into the discourses of the discipline'. Instead, she recommends (Jacobs, 2013) that there should be systematic collaboration between academic literacies and disciplinary lecturers, with the language experts asking questions to prompt disciplinary lecturers to make explicit their tacit knowledge of the conventions governing their disciplines.
The kind of academic literacies specialists envisaged for the Writing Lab required both the skills sets described by Butler and Jacobs. The advertisement for the Writing Lab coordinator targeted candidates with a PhD in Biosciences. as well as significant experience in academic literacies. This particular mix of abilities had been nurtured for a number of years in both the university's cross-faculty language development unit and the university's main writing centre by employing candidates with a background in the Sciences and training them in academic literacies theory and practice. While this requires intensive training and re-tooling, a disciplinary 'insider' who is also an academic literacies expert is both efficient and strategic, in terms of what the person can contribute to student learning, and in terms of credibility within the faculty. The advertisement for postgraduate consultants for the Writing Lab likewise specified a disciplinary background in the Health Sciences or a closely related scientific discipline, but the criteria were more flexible when it came to prior experience with academic literacies.
This type of disciplinary-literacies specialist does not negate the value of the collaborations described by Jacobs (2007aJacobs ( , 2007bJacobs ( , 2010Jacobs ( , 2013Jacobs ( , 2015. Since scientific disciplines differ markedly from one another, the need to collaborate with disciplinary experts remained important for the Writing Lab. A valuable gain is that academic literacies lecturers with a strong disciplinary background in the (Health) Sciences have during their academic literacies training gone through an internal process of making the tacit norms of their discipline explicit and are therefore in an excellent position to facilitate the process with disciplinary collaborators.
As far as finding a dedicated space for the Writing Lab, Boughey (2012) describes the benefits and challenges of finding suitable venues, especially for smaller departmental writing centres. Because of resource constraints, many discipline-based writing centres operate out of library study rooms, tutorial rooms or common spaces (Arbee and Samuels, 2015;Boughey, 2012;Nichols, 1998). This situation creates or perpetuates the perception that the work is a non-essential service. The Writing Lab experienced these challenges first-hand early in 2015, as it was temporarily located in a single office, necessitating many 'corridor' and 'stairwell' consultations. However, a permanent space was soon identified and renovated by the faculty.

The Writing Lab's activities and performance from 2015 to 2017
In this section we describe the Writing Lab's main activities during its first three years. We present and analyse mainly quantitative data that formed part of the TDG's compulsory monitoring and evaluation processes. We complement the quantitative data with our own observations and experiences. Using the university's main Writing Centre's data as a guide, coverage targets for the threeyear funding period were estimated for the Writing Lab. Table 1 below shows these targets against the actual coverage achieved.  The Literacies Mapping Project (Olckers et al., 2013) was an important initial tool to identify promising courses for academic literacies work, as was the experience gained during years of involvement by the Language Development Group in the faculty's roll out of its new PHC oriented curricula (van Pletzen, 2006). Two first-year courses, 'Becoming a Professional' and 'Becoming a Health Professional', have become fruitful sites for collaboration.
Firstly, these are core courses, taken by all first-year health professional students (+/-450 students annually), with a staff complement of up to thirty. The courses create an extensive first space for working with students, while also providing opportunities for building staff capacity.
Secondly, these courses introduce the PHC philosophy and take students into diverse and highly unequal social spaces constituting the South African public and private health systems.
Thirdly, these courses develop and explore professional competencies which are aligned to the transformative ideology of the academic literacies approach (Lillis and Scott, 2007;Nichols, 2017aNichols, , 2017b, such as non-judgemental listening, empathy, and critical thinking required by the health professions (Olckers et al., 2007). Finally, these courses encompass a wide range of academic literacies, including new modes and genres, for instance assembling online eportfolios, designing and doing team presentations, and tailoring reflective writing to academic and professional outcomes. Both courses are writing intensive and combine theoretical and practical components, from engaging with factual material, protocols, and policy documents, to capturing intense experiential learning in the classroom or during visits to different tiers of health facilities. Students are regularly required to reflect in writing on both the knowledge that they are building while working from their prior knowledge and the emotional dimensions of their learning.
While reflective writing has become the dominant genre in these courses, very few students (or teaching staff) have had prior experience of it, and the gradual process of 'growing' a new set of academic literacies practices, with student participation, has represented an exciting transformative activity. Moreover, the emphasis on interactive and experiential learning, the principle of using students' own knowledge and experience as points of departure, and the frequent debriefing and discussion sessions requiring 'attentive listening' (Dison, 2018) and empathy after visits to health facilities located in diverse social environments, have created Establishing a Health Sciences writing centre in South Africa 31 opportunities for these courses to capture 'new narratives' (Khunou et al., 2019) and new 'lived realities' (Dison, 2018) which could contribute to opening up new decolonised spaces in academic writing and the curriculum.
When the Writing Lab started in 2015, most workshops were once-off, ad hoc engagements, but these provided the foundations for cultivating relationships with staff (Jacobs, 2007a), which later enabled a shift to more sustained and strategic engagements within particular courses. The goal over the next three years is to strategically expand engagement within undergraduate courses and the curriculum, to the point that we will be providing embedded academic literacies teaching in each year of all major undergraduate degree programmes. We have already begun to do so, and the Writing Lab currently has a solid presence up to the third and fourth year of the MBChB programme and the fourth year of Physiotherapy.
As lecturers have become more convinced of the value of Writing Lab activities, requests for engagement at all levels have increased, with increases in workshops offered for postgraduates the most notable ( Figure 2). postgraduate students occupy, their struggles to have their 'existing knowledges acknowledged' (Hunma and Sibomana, 2014: 105), the challenges they encounter when constructing arguments, often in a language different from the language of instruction they experienced as undergraduates and in an academic environment or discipline different from the ones that they were in before. Hunma and Sibomana (2014) argue that these difficulties frequently impact not only on students' academic writing, but also undermine their academic identities, which could result in supervisors or lecturers' viewing them as incapable of critical thinking or not suited to postgraduate study. Our hypothesis is that aspects like these in postgraduates' experiences may further explain the high numbers accessing Writing Lab services.
The Writing Lab is in a good position to mediate between postgraduate students and their lecturers or supervisors, and has worked collaboratively in many postgraduate programmes, often in creative and innovative ways. For instance, we facilitate a space for students to work with their supervisors on the conceptual development of their literature reviews in a Pharmacology honours programme, creating opportunities for discussions that are mediated by Writing Lab staff and are therefore potentially less fraught with unequal power relations than the traditional student-supervisor relationship. In such a space, students have more opportunity to present and analyse data and build theory from their own social environments, places of work, or countries, which could result in approaches or theoretical frameworks responsive to life worlds in the global South. Establishing a Health Sciences writing centre in South Africa 33 2015 to 2017, 98% of students indicated that they would recommend the Writing Lab workshops to others and 99% said that they had learned something that they could apply to their writing.

Consultations
Individual consultations remain at the heart of the Writing Lab's work. Nichols (1998) argues that one of the strengths of a writing centre is the power it has to enable an authority shift from the educator to the student. In line with this, we think of and treat all staff and students that visit the Writing Lab as clients, a practice that affords a greater sense of agency. Clients actively choose to visit the Writing Lab and with whom to work, they set the agenda for the consultation and retain ownership over their work (Brooks, 1991). We also resist allowing lecturers to 'send' us 'problem' students, we maintain client confidentiality, and do not report on students to their lecturers or supervisors, unless requested by students themselves.
Over the past three years, there has been consistent growth in the demand for consultations ( Figure 3)  contexts (McKinney, 2017). Moreover, in environments like universities with English as the language of instruction, the assumption of monolingualism is the norm, while multilingualism ironically often translates as inadequacy or deficiency (Grimm, 2009;McKinney, 2017;Swartz et al., 2018). These are assumptions that the Writing Lab wishes to counter. While at this stage there is no guarantee that all students' language requests can be accommodated given the small staff complement, the decision to offer multilingual consultations is underpinned by a social justice goal of promoting all languages as languages of learning (McKinney, 2017), as well as implementing aspects of the University's language policy that aim at encouraging multilingual teaching and learning practices (Madiba, 2013).
Clients who have experienced consultations in their own languages comment that this improves communication and that they find it more comfortable to address their writing concerns while speaking in their home languages. Writing Lab consultants observe that they have been better able to assist their clients by rephrasing and explaining concepts that the client may find challenging to conceptualise in English. This is corroborated by Madiba's (2014) research on promoting concept literacy through use of multilingual glossaries.
The Writing Lab has also developed and curated a set of academic literacies resources specifically relevant to the Health Sciences. In some instances, these resources take the form of generalised guides that make explicit the metalanguage and conventions of disciplines within the Health Sciences. Other resources are course or assignment guides developed in conjunction with lecturers. In keeping with the Writing Lab's mission to promote languages of learning other than English, we have embarked on a process of translating resources into South African languages beyond English.
The Writing Lab achieved an important symbolic moment in 2016 when it was instrumental in coordinating the Health Sciences Language Festival, themed Health for All, Home for All (http://www.health.uct.ac.za/event/fhs-language-festival). Events celebrated the capacity of multilingualism to break down barriers and build respect among people, but also acknowledged the divisive ways in which language dominance has disempowered people in South Africa in both education and health care. The programme included poetry, music, and dance; the official launch of the Writing Lab; and a Language Seminar which acknowledged the need for multilingualism to be valued in both education and health. It also raised the problem of prioritising English over other languages in teaching and learning. The festival provided a platform to raise awareness of the social justice mission that has come to underpin the Writing Lab's vision and practices, our resistance to deficit notions so often attached to speakers of non-dominant languages in education, and our advocacy for the use of multiple languages in the fields of education and health care.

Consultant development
It has been observed that working as a consultant enables significant professional development, leading to increased employment opportunities (Grimm, 2009;Leibowitz et al., 1997;Nichols, 1998). In particular, the work prepares consultants for embarking on an academic career with a much deeper understanding of the importance, challenges, and pedagogies of academic literacy within a South African context, and better readies them for the diverse student population they will encounter as educators (Archer and Parker, 2016 Another consultant has been appointed as a medical writer at Stellenbosch University, and a third secured an industry position with a focus on communicating technical and scientific knowledge. Assessing the overall impact of the Writing Lab So far, we have attempted to capture the multiple goals, activities, and sites of practice of the Writing Lab by presenting targets and coverage data, as well as basic client evaluations of services offered. Our current evaluation practices provide only a general sense of clients' level of satisfaction with the Writing Lab's services, and do not adequately give us insight into whether or how our services contribute to the development of writing skills, impact on academic performance (Archer, 2008) or promote transformative literacies practices among staff and students that could lead to changes in institutional culture.
There is certainly a need to evolve more rigorous and multi-pronged strategies for measuring impact, preferably by combining quantitative and qualitative methodologies. Since the Writing Lab's work in the curriculum is mostly embedded and collaborative, a research methodology that quantifies changes in student writing before and after classroom interventions should be considered, in combination with interviews and focus group discussions to probe students' engagement with academic literacies (see Kelly-Laubscher et al., 2017 for an example of evaluating writing pedagogy). To prevent such an approach from becoming merely reproductive of established academic literacies conventions, space should be built into the learning and evaluation process to encourage students to 'talk back' (Nichols, 1998) to established conventions from their own knowledge and experience. Another promising approach outlined by Dison and Mendelowitz (2017) is a focus group method of evaluating writing centre practices within a context of transformation. They illustrate how this methodology enabled them to 'capture vital issues and problems around identity, voice and power that may not have emerged in other Writing Centre evaluations' (Dison and Mendelowitz, 2017: 195).

Conclusion
This article described, analysed, and reflected on the conceptualisation and first three years in the life of the Faculty of Health Sciences Writing Lab, and found it to have been a period of growth, relationship-building, and learning. The Writing Lab has been nested in established academic, ideological, and physical structures. These include relatively well-resourced interfaculty and departmental structures, the PHC philosophy of the faculty, and a purposedesigned space from which to operate. With two permanent staff members, the project has gained in sustainability and it has secured a DHET University Capacity Development Grant for another three years (2018 to 2020). From evaluations conducted so far, the Writing Lab can be deemed a successful project, with good growth in coverage and positive feedback from its different client bases.
The New Literacy Studies and the academic literacies approach had much to offer this study, in particular the critical lens that the academic literacies approach turns on hierarchies of power in language and society (Lea and Street, 1998) and the transformative ideology (Lillis and Scott, 2007) which invigorates the academic socialisation model by facilitating new forms of knowledge-making through contestation and going beyond established academic norms (Lillis et al., 2015). These made it possible to turn the 'unspoken assumptions' underlying the Writing Lab's conceptualisation and actual operations into 'conscious conceptual frameworks' (Grimm, 2009) of language and literacy. Ways of thinking about transformation and decolonisation formulated during the 2015 to 2017 period of student activism called for critical and selfreflective scrutiny of the institutional context within which the Writing Lab was coming into existence, of the ideologies and theoretical frameworks underlying institutional planning processes and state funding structures, but also the Writing Lab's own conceptual frames, forms of pedagogy and its interactions with colleagues and students.
The analysis revealed that the conceptualisation of the Writing Lab was at the outset mainly underpinned by the academic socialisation model (Lea and Street, 1998). Through various forms of practice and relationships established in disciplinary courses, curricula and with staff and students, this model evolved into a more transformative ideology, opening up spaces in which students' own knowledges and literacies practices could contribute to shaping new forms of thinking and representation in the academy.