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The Occupational Need in Third World Countries: 

Poverty is a complex topic and there is no one solution to solve it.  However, people living in developed countries can help improve the quality of life of those living in poverty.  One group of people are occupational therapists (OTs).  Elizabeth Townsend (1945), a leading OT, decribes occupational therapy as a client-centred health profession concerned with promoting health and well being through occupation.  People living in Third World countries are disadvantage in many ways and their qaulity of life is limited because they are constantly struggling to obtain the necessarities – food, water and shelter.  Their lifestyles are opposites to those living in First and Second World countries, thus it is important for OTs from developed countries to prepare appropriately in order to practice effectively in poverty. 

There are approximately 1.2 billion individuals worldwide live in extreme poverty – less than $1 a day, and 2.7 billion live in moderate poverty – less than $2 a day (Hossain, Goyder & El Nahas, 2009).

 

 

Occupational Injustice in relation to Poverty and OT:

Occupational Justice complements and extends understandings of social justice (Townsend & Wilcock, 2004) . Occupational Injustice is the umbrella for: 

  • Occupational Alientation is the right of populations as well as individuals to experience meaningful, enriching occupations, contrasted against experiences of alientation (Townsend & Wilcock, 2004).
  •  Occupational Deprivation is a state of prolonged preclusion from engagement in occupations of necessity and/or meaning due to factors that are outside the control of individuals. It is due to a widespread social and economic chanage affecting many people globally (Gail, 2000).  
  • Occupational Marginalisation is the need for humans to exert micro, everyday chocies and decxision making power as we particpate in occupations, and macro decision like the right to vote (Townsend & Wilcock, 2004).
  • Occupational Imbalance is when people are un-occupied, under-occupied, and over-occupied (Townsend & Wilcock, 2004).

All four aspects of Occupational Injustice exist within Third World countries to a greater and lesser extent. OTs have an excellent knowledge about the importance of humans being engage in meaningful occupations.  Townsend and Wilcock (2004) also agree that OTs are excellent professionals for addressing  occupational injustice because their primary concern are those who are vulnerable to injustices because their participation in occupations is restricted to injury, chronic illness, disability of various types, mental illness, incarceration, old age, or other circumstances” (p. 83) like poverty.

Occupational Apartheid:

Occupational Apartheid is another concept under Occupational Injustice.  Kronenberg and Follard (2005) define occupational apartheid as being:  “the segregation of groups of people through the restriction or denial of access to dignified and meaningful participation in occupations of daily life on the basis of race, colour, disability, national origin, age, gender, sexual preference, religion, political beliefs, status in society, or other characteristics” (p. 67). Occasioned by political forces, its “systematic and pervasive social, cultural, and economic consequences jeopardisze health and well being as experienced by individuals, communities, and societies” (as cited in Pollard et al, 2008, p. 55).  

I have spent sometime in Malawi, Africa prior to studying OT. During my time there I witnessed a lot of bordem, begging, and standing around. People who had no jobs did not have activities to keep them occupied. This is due to a lack of resources, space, and initiation of people in authority who have the ability to run groups/activity to increases people’s sense of usefullness and skills.

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An OT’s view of Culture:

Susan Merrill (1992) discuses culture in the Preface to her book, defining it as “shared and learned assumptions, beliefs, symbols and ways of behaving which characterise a human society” (Harrison & Ritenbaugh, 1981: Hoel, 1971 cited in Merrill, 1992, pp. xiii).  She discusses further that culture is a major human adaptation (Hoebel, 1971, cited in Merrill, 1992) which helps us make sense of the physical and social environment that we inhabit.         

 A list of several well-accepted characteristics of culture which might help the OT preparing to work in poverty are:        

1.     “Culture cannot always be verbalised by the members of the group” (Hall, 1982, cited in Merrill, 1992, pp. xiv).        

2.     “Even though much of the knowledge is not conscious, the standards can be made explicit; they can be learned and studied” (Spradley & McCurdy, 1972, cited in Merrill, 1992, pp. xiv).         

3.     “The symbolic nature of objects, and therefore how they are used, is defined by an interaction between the culture and the environment” (Montagu & Matson, 1979, cited in Merrill, 1972, pp. xv).         

4.     “There are aspects of the human spirit that appear to transcend culture boundaries” (Montagu, 1950, cited in Merrill, 1972, pp. vx).         

Merrill (1972) states “experiencing other cultures creates the opportunity for personal growth” (pp. xv-xvi).   

My personal view is that understanding a person’s culture is extremely pivotal  for running an activity that is meaningful to them, as each culture has difference values on what is important to males and females, young and old, and individual, family and community.  For example, in the Fulani people’s culture cows are extremely important and there are many traditions and ceremonies that are to do with cows. If an OT is to work with the Fulani’s, these cultural aspects need to be considered when deciding on an appropriate activity, for example the activity maybe based around the occupation of farming cattle in Burkina Faso, Africa.

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Politics and OT Practice:       

Hanneke van Bruggen (2008) states that occupational therapists (OTs) have an important political role of ensuring Africans with disabilities’ human rights by implementing the African Decade of Persons with Disabilities. The main objectives of the African Decade are:        

-          “To promote the participation of persons with disabilities in the process of economic and social development” (pp. xiii).         

-          “To ensure and improve access to rehabilitation, education, training, employment, sports, the cultural and physical environment” (pp. xiii).          

-          “To prevent causes of disability” (pp. xiii).          

-          “To support the development of and strengthen disabled person’s organisations” (pp. xiii).         

-          “To advocate and raise disabilities in particular” (pp. xiii).         

To ensure these objectives are achieved in OT practice in Third World countries, OTs need to “urge governments to redirect resources away from conflict to more meaningful issues of development… During the African Decade we want to see a change of attitude at local, national and international level that will enable people with disabilities to assert their political, social and economic rights” (Phiri, 2003, cited in van, Bruggen, 2008, pp. xiii).        

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Ethics relating to OTs and Poverty:

Ethics is an extremely complex topic and initially I was going to provide government documentation on ethics. However, I have decided not to and rather look at what the OT philosphies say about ethics. Ethic is about how one should behaviour with another, it deems what is professional and proper, it focuses on providing good not harm, and is concerned with informed consent and confidentiality (Rochon & Baptiste,1998).  It is about being sensitive to the client-centered process and being in partnership with the client (Rochon & Baptiste,1998). This provides a number of challenges for those looking at working in cultures that are different to their own. Being client-centered requires the therapist to be aware of the client’s values and beliefs. It involves a level of sophistication that goes beyond the usual expectations of professional codes of conduct (Rochon & Baptiste,1998). Client-centered practice is pivotal in order for empowerment to happen. Empowerment happens when those experiencing social and occupational injustice are given the opportunity, support and encouragement to make good change in their lives. The good change in client-centered practice is client initiated and lead.  When ethics are practiced, positive change and empowerment in people are evident.

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Examples of OTs working in Third World Countries:

OTs working with Caregivers:  

Occupational therapists (OTs) need to have prior knowledge of disability, how disability affects people’s lives, culture, and the needs of carers who care for unwell people living in poverty. As people’s livelihoods are different to those in New Zealand. For example, in Thailand, strokes are the third leading cause of death (Ministry of Public Health of Thailand, 2002, cited in Jullamate, Azeredo, Paul, Subgranon, 2006).  There are more people surviving from strokes in Thailand due to the improvement in medical facilities.  A part of the Thailand culture, children are taught to look after their parents, and other relatives. In addition, in the Thai family culture the males work outside the home to support the family members and females are responsible for the household. Hence, so many caregivers are female family members. In this study the issues that arose are a need for support and assistance, more information, and social support.  An OT going into Thailand with this knowledge can prepare her/himself for such work by studying strokes and further investigating how carers and families can be supported.   

                                                                                                                                                                                                               (Photo, Retrieved 3rd September 2010, from, http://www.thaihomestays.com/about.htm)    

 

 

An OT experience in Ecuador: 

This chapter gives the reader an excellent overview of specific occupational therapy experiences obtained from Carol and Jeff Wilson-Braun, two OTs from the United States of America.  Carol and Jeff share their observations of the reality of Ecuador’s health care system, this being limited resources, poor working conditions, large caseloads, limited professional support, and limited therapists jobs resulting in intra-professional competition and isolation. The majority of their work was educating OTs and OT students. This was not their initial purpose, however it turned out to be more effective than working one on one with patients. They suggest staying six months to a year is effective. They explain the significant barriers to effective practice that they experienced are language barrier and cultural differences. They concluded that because of their experiences working in Ecuador they have gained a greater perspective and appreciation of the wealth of the USA health-care system in general, and an appreciation and respect for the people they met in Ecuador who work without these resources.  

My personal opinion: Working in another country is valuable to an OT’s professionalism, as it increases insight, knowledge, experience, perspective, and understanding. My challenge is to not let fear of the unknown, cultural differences, transportation, time, or finance prevent OTs participating in helping countries that desperately need professional workers.     

                                                                                                                                                                                                                                         (photo, Retrieved 3rd September 2010, from, http://www.kilimanjaroworld.com/Pictures%20Ecuador%20People.htm)

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Factors that influence OT Practice:

There is a list of the factors that influence practice in Third World countries:

  • Political Status of the country – war, poverty
  • Culture – values and beliefs around certain occupations
  • Gender differences – because OT is predominantly female and may prove to be difficult for those OTs working in cultures where women are second class citizens
  • Language barrier
  • Transportation
  • Resources – materials, buildings/spaces, money needed to run groups
  • Isolation – no OT association, unable to connect/network with other therapists

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Organisations that OTs can work with in Third World Countries:

There are many organisations that OTs can work with. Here are a few:

  • End poverty by 2015This is the historic promise 189 world leaders made at the United Nations Millennium Summit in 2000 when they agreed to meet the Millennium Development Goals (MDGs). The United Nations Millennium Campaign supports and inspires people from around the world to take action in support of the Millennium Development Goals.
  • TheGlobal Poverty Project is an educational and campaigning organisation that activates citizens to be a part of the global movement to end extreme poverty.
  • Trade Aid” is a not-for-profit organisation that provide the world’s most disadvantage producers with support to improve their lives, by buying and selling their products, telling their stories and speaking out for greater justic in world trade.
  • World Vision” is a Christian humanitarian organisation dedicated to working with childrn, families and communities to overcome extreme poverty and injustice.
  • TearFund” is a Christina humanitarian organisation that are passionate abou the local church bringingjustice and transforming lives to overcome global poverty. 
  • Grameen Foundation” is a non-profit organisation that works with the poor to help them eliminate poverty by providing micro-loans to help people expand their businesses.

Although these organisations are not OT specific, they are helping people globally improve their quality of life and eliminate poverty. It is with these intentions that OT services are most suited. OT’s focus on occupations involving empolyment, selfcares and leisure, both meaningful and neccessary ones. OTs can assist these organisations by providing a new perspective and way of working with people living in poverty.  OTs skills include; group faciliation, community development, knowledge about disabilities and how they impact people’s lives, problem solving, knowledge about how people, occupations and the environment interact, and views people in a holistic way by considering the physcial, social, emotion, cognitive and spiritual aspects of people.

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The current involvement OT’s have with eliminating poverty: 

OTs are currently working in:

  • Community Development Projects: Lauckner, Pentland and Paterson (2007) state that “over the past 10 years OTs have increasingly recognised the importance of working with communities as a way to enhance the health and well-being of individuals through meaningful occupational engagement” (p. 314).
  • Enabling those living with disabilities to live independent lives
  • Hospital work – acute wards, rehabilitation, inpatient wards
  • Education – educating people, families and their caregivers about their disabilities, educating students studying occupational therapy, and educating occupational therapists and other health professionals about current practice
  • Providing support for families and caregivers who look after people with disablities

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How can OTs prepare to work in poverty?

The above postings talk about an array experiences, influential factors, and issues OTs need to be aware of before working in a Third World country. This now brings me to my next point and the purpose of this blog, what do OTs need to do in order to prepare to work in poverty?

Firstly, read this blog and understand Occupational Injustice as it is a significant issue that is present in poverty.

Secondly, connect with an organisation that will support them in the work they are wanting to do.  In addtion, talk to them about accommodation and transportation for while are over there.

Thirdly, do some study around the culture, occupations people are engaged in, political situation, government strategies (health strategies), gender differences, and resources (natural and human resources).

Fourthly, find an organisation/trust/local body that will finanically support them.

Fifthly, organise flights and personal belonging. 

Preparing to work in poverty requires time and commitment in order to properly equipped.  The skills that I learnt for Fieldwork Six, organising and running a project in the community will be helpful when preparing to work in poverty. For example, gnatt charts, timetables, and checklists are effective ways to organise yourself.  The benefits for being prepared include; beginning the work in poverty feeling more equipped thus more confident with a good foundation of knowledge specific to that country/community, better supported, and will be more effective and make a greater impact.

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