Thursday, 26 March 2009

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."


  1. Excellent post, and should be read and considered by all therapists.

    Occupational therapy principles, at least as articulated out of the original American models, are at risk of being grossly out of step with other cultures.

    I have often considered that one of the reasons why the occupational behavior model faded away (even in the United States) is because of the inherent value propositions in social role theory that didn't resonate with all people. In other words, what worked for segments of the US population had a hard time translating to all groups and also across time. So, what made sense in one population and in one generation did not make as much sense as cultural values shifted - even within populations where the model seemed to previously 'fit.'

    Now this didn't make the model any less potentially useful, but it made its application challenging because of the shifting and different set of cultural practices - and again - this was even within the US!

    WHO-like models run toward a similar peril. Any profession that interweaves social and cultural dynamics into its fabric is at risk of fundamental inapplicability when applied across cultures. The problem is that this has never stopped proponents of globalized systems from trying. Sounds like the author ran head-first into the result of good intentions meeting people who don't want anything to do with the good intentions.

    So how do you save the world when its ideal path to salvation is different from yours? Let them follow their own ideal paths - because that is their ultimate right! If education and exposure causes them to have interest in your ideas, perhaps you will be invited to visit with them.

    Not so amazingly, they may end up teaching us some things as well.

  2. nice content...greeting from Indonesia