Getting back into gear.....

I've been a bit absent from my usual web life for the past couple of weeks. Sadly my beautiful Mum has been diagnosed with breast cancer. She's going through some surgery at the moment and hoping to start chemo in the next few weeks. Being on patient and family side of the healthcare equation for a change is not really where we wanted to be but I suppose its just a case on putting one foot in front of the other for now.....

Anyway life plods on and I have some new and exciting things happening.....

I'm really looking forward to doing a session on the MSc in Assistive Technology course at Coventry university in a couple of weeks. I'm talking to the students about assessment in my area of practice and what I'm hoping they will get out of it is the importance of all the contextual factors beyond the client themselves. By that I mean the ability of the persons environment (social and physical) to support their needs, and the influence of cultural aspects. Anyway this is a very brief post and I will write more after the session and maybe post the powerpoint.

Last week I was down at UK OT HQ aka COT/BAOT offices in London. I was recently appointed to one of the professional practice seats on the Membership and External Affairs board. I've been a member of BAOT for 12 years but never really taken an active role. Following the Disability Forum networking day I attended last year I really felt motivated to get involved, so after a gentle (and much appreciated!) shove from a OT colleague I applied for the role.

I had a really interesting day learning more about the board and the work of the OTN, BJOT and the website progress. It was good to be able to comment on the excellent projects underway. I was excited to be able to offer some opinions on how the organisation could make the most of media such as blogs, twitter and facebook to promote OT and membership. I was really pleased that people were very positive about my intention to use these channels to relate my experience as a new board member. As you might have guessed I think it will be so important to BAOT to use these tools to help current and potential OTs feel connected to their professional colleagues and their professional organisation.

Are there any BAOT members out there reading the blog? Leave a comment or tweet me to let me know your thoughts about how web2.0 could help you connect.

Occupational Therapy Blog carnival call for submissions

Your Therapy Source Inc. is the host for the next Occupational Therapy Blog Carnival. A blog carnival is a collection of articles on a specific topic. There have been two previously done on occupational therapy. All you have to do is submit your favorite OT blog post to the carnival at http://blogcarnival.com/bc/submit_6317.html. You must submit your blog article by Friday, May 1st. The OT Blog Carnival #3 is set to publish on May 4th.

I don't want to make people independant: occupational heresy?

Occupational Therapists often talk a lot about independence and this often touted as being the goal of our intervention

"Occupational therapy is skilled treatment that helps individuals achieve independence" AOTA (don't get me started on how much a disagree with this statement!)

Independence is defined as "the state or quality of being independent" and independent as:

in·de·pen·dent

adj.

1. Not governed by a foreign power; self-governing.

2. Free from the influence, guidance, or control of another or others; self-reliant: an independent mind.

3. Not determined or influenced by someone or something else; not contingent: a decision independent of the outcome of the study.

If we (or more importantly our commissioners and clients) base goals on this definition I believe that occupational therapy directed at independence is both outdated and naive. In reality I dont think the occupations in which we participate are rarely, if ever, truly independent.

Rather that what matters is the extent to which we have control over interdependace we share with others. I like (part of) the current wikipedia entry:

Interdependence is a dynamic of being mutually and physically responsible to and sharing a common set of principles with others... Two states that cooperate with each other are said to be interdependent. It can also be defined as the interconnectedness and the reliance on one another socially, economically, environmentally and politically.

Whats needed, in my humble opinion, is a review of our usage of the word independance an view shared with the authors of this paper who state:

"Independence has long been a key concept. A review of the literature shows that the term's meaning has shifted throughout the past century. However, despite its significance, the word's meaning has never been deeply analysed, and it is left to the interpretation of the individual practitioner; consequently, there is a conceptual confusion surrounding the term"

Thankfully I'm not alone in this viewpoint, Rosemary Hagedorn in her student staple textbook Foundations for Practice agrees but I'm not sure most OT have really evaluated the term.
You have to ask whether semantics really matter at all but to me it is important. Surely using the right language to define what we do must be key given the eternal OT struggle to explain our profession.

In light of the reverence the profession appears to give "independence" is it not well overdue that we make sure this is what we believe our intervention is aimed at?

Guest Blogger - "How can you save the world when its ideal path to salvation is different from yours? "

Jouyin Teoh is a occupational therapy student in Malaysia and one of my Facebook friends. She is an outstanding advocate of occupational therapy: dynamic, passionate, not to mention great fun! Here is her post on the importance of evaluating the impact of cultural differences in our approach as occupational therapists:

"Recently I had the privilege of being part of a team of student occupational therapists organizing a community-based rehabilitation (CBR) programme in a predominantly Malay Muslim kampung. It was a one-day event, aiming to educate the community about the opportunities available in Malaysia for people with disabilities (PWDs), indirectly setting the local PWDs and their carers on the path to empowering themselves and leading purposeful, meaningful lives in line with World Health Organisation objectives:

“… To ensure that PWDs are empowered to maximize their physical and mental disabilities, have access to regular services and opportunities, and become active, contributing members of their communities and societies.”

Unfortunately what I saw transpiring on the day itself was a picture of pure disengagement: disappointingly low participant attendance, organizers and participants eating lunch in separate, distinct groups … What was going wrong?

It wasn’t until the post-mortem that I realized that we were actually facing blatant outright disregard and opposition from the community – My colleagues reported cases of kampung residents responding when approached on the morning of the event, “Oh yes, I know about that health rehab thing. I’m not going.” And they shut their doors on us without further explanation. To them, we were an intrusion: They knew of our existence, and we weren’t welcome. To us, this was incomprehensible: What could possibly be wrong with an activity which seeks to empower the community to empower individuals to empower themselves?

The answer came to me via discussion with Japanese occupational therapist Michael K. Iwama on cultural contexts and occupational therapy which took on a form parallel to my CBR experience. We were both of East Asian origin and shared a similar fusion of Confucian/Buddhist values together with the Westernised philosophies that defined our profession, yet we operate in vastly different environments. He talked about the difficulties of transplanting occupational therapy identity in a meaningful way to the people of his native racially/religiously/lingu

istically homogenous Japan whereas I had my own problems articulating the core construct of occupational therapy to suit the diverse cultural contexts which sum up Malaysia.

As occupational therapists, we are importing a foreign set of beliefs in the form of occupational therapy and CBR into our respective homelands. Should we be successful in deconstructing these “alien”, Western concepts and adapting them to our local realities, it would be possible to upgrade the health & wellness sectors in our respective countries to a whole new level altogether with emphasis on better quality of life which no longer discriminates and labels patients as “sick” or “disabled” but which views them as individuals with their own right to be active participants in the great circle of life. Occupational therapy does not aim to “treat the disease”. Rather, it “enables the person”.

However, the danger of this sort of intercultural exchange can best be summed up by Michael Iwama in his essay Situated Meaning: An Issue of Culture (Occupational therapy without borders, 2005). “There is always the danger of importing our own culture and thereby standards of behaviour and meanings that can disrupt people’s way of life … In this way (health & wellness interventions) can oppress rather than empower, encumber rather than emancipate, and disable rather than restore.”

How can you save the world when its ideal path to salvation is different from yours? How can you save the world when its idea of salvation differs from yours? Only by making culture a primary concern and allowing target client groups to understand and dictate the terms by which these foreign ideals should be introduced, then only will cross-cultural, international cooperation reap benefits for all."

Diffidence, geekery, occupational therapy and me

Earlier today I *almost* tweeted that I had just been reading my shiny new copy of The British Journal of Occupational Therapy in the bath and thinking how interesting the articles were this month (OK I would have to have condensed it down a bit but you get the idea!). But then I stopped. "Cant tweet that!" I thought, "I'll sound like a right geek!".

But its true I am a geek, or so I keep telling people. What is a geek anyway?

"a peculiar or otherwise odd person, especially one who is perceived to be overly obsessed with one or more things including those of intellectuality, electronics, etc."^[1]

Hmmm, not sure I like that, so my do I keep saying it?

Well I do love my job, and I'm passionate about occupational therapy, and freely admit I spend lots of my free time doing work related stuff. But given that OT is about facilitating other people to achieve optimum well being I should be proud, right?

All this got me to thinking about a presentation I went to from Jennifer Creek at the Cheshire Occupational Therapy Conference. She was talking about celebrating achievement in occupational therapy and pointing out that, on the whole, occupational therapists aren't too hot at blowing their own trumpet. She gave a great quote from Dr. Thelma Cardwell, former CAOT president, and reflected though we have made much progress, we are still a bit backward in coming forward as a profession.

dif·fi·dent

adj.

1. Lacking or marked by a lack of self-confidence; shy and timid. See Synonyms at shy¹.

2. Reserved in manner.

Now I'm not sure I'm diffident as such. I'm highly likely to be the person in the room to put my hand in the air and give and occupational therapy slant on a discussion, to volunteer for a project which I believe will further the profession, and to try my hardest to find innovative ways to develop OT services.

So why do I term myself a geek? Maybe despite all my gusto I'm still not as confident in myself as I am in my profession. Being the outwardly confident person I describe above doesn't always come easily to me, but if something scares me I'm compelled to try it. Maybe it's a grown up extension of risk taking behaviors in my earlier life? Who knows, but I think what I will take from this reflection is that its OK to be true to my Gemini starsign and be at once unconfident and self doubting if this propels me to action, but at the same time a vocal advocate of my profession.

Some people might say it's a bit of a risk posting this on a publicly accessible blog but I'm quite an open person, and fine with talking about my flaws. In fact I think some of the most interesting blog posts come when people reflect with honesty on a situation. What are your thoughts, how confident are you in promoting OT? Would you critique yourself in a similar way in a public forums?

P.S. I'll do another post about the great articles in BJOT!