If our discipline is more engaged with occupational needs of our communities, more culturally competent and accessible, more awake and organised to building occupational just communties. . . we'll all have cause to celebrate.
At university, we'd like to see that students have the opportunity to:
"hear about it" eg curricula introduces it
"explore it" eg theory/ papers
"apply it" eg practical project assessment
"practice it" eg refugee placements
"build on it" eg research, evaluation
*Associated practice issues are knowledge, skills, attitudes enabling work with refugees & asylum seekers that are transferable to all OT practice.(eg human rights context of health, cultural and contextual competence, skills for when communities are the "client", skills for work in non-medical/disability practice contexts/teams, skills to identify and articulate occupational perspective whilst drawing on broad sources of information etc.)
Preparing students as global citizens
For example: Review the Universal Declaration of Human rights and identify each "life role" mentioned or implied (ranging from self care, to leisure!). Divide articles between student groups to re-write in plain and occupation centred language what protection is enshrined for the life roles listed earlier.
Discussion Q: When do OTs have an obligation to "use their freedom" as humans? As citizens in a free country? As professionals? As "wealthy/educated" relative to the majority of the "global village"? How can OTs support OTs working in resource poor areas?
More info: World Federation of Occupational Therapy Position Paper on Human Rights and of course the Universal Declaration of Human Rights and a UN Enable resource covering the rights of disabled refugees and PEMO for Human Rights, a human rights tool for human rights practice developed by OOFRAS member Emma Campbell.
Millenium Development Goals puts health and OT service in context
For example: Review the goals and the fact that typically refugees flee to a neighbouring country and spend decades in camps or the streets waiting for permanent re-settlement. Look at occupational implications for a refugee family "in limbo" in a neighbouring country according to whether each MDG is met or not.
Discussion Q: Where does OT presence and practice need to move to be a part of achieving these goals? If all goals were achieved what would OT presence and practice "look like"? What at the moment decides "where OT is" and "who gets access to OT"? What obligations does OT have when a government clearly can't protect its citizens or provide for their health?
More info: UN Millennium Development Goals .Also this MDG progress snapshot page 6 of "Innovating for a Brighter Future; The role of business in achieving the MDGs". Note this report encourages human service and development workers to work with the private sector to create occupational opportunities!
Poverty is not just lacking stuff; it's about occupational opportunities
For example: the hours a Lynia spends accessing water precludes her from a learning role at school. Neighbouring families are forced to adopt poor farming practices to compete in un-fair trade or starve, and the closest water now makes them sick.
Discussion Q: What in Lynia's situation is about access to "stuff" vs access to "occupational opportunities"? What alternate healthy "do more of, do less of, do differently" options are there, and who pays the cost? As it stands, who gains occupational opportunities, and who pays the costs? If Lynia ended up as a refugee re-settled, what occupational injustice would follow her and how could it affect her health?
More info: Rewriting our definition of poverty is a resource designed for critical thought in an education context. The World Bank also has excellent section on poverty reduction & equity.
This UNHCR High Commissioner's speech celebrating 2010 World Refugee Day highlights a need for more education and life skills (hear that OTs?) so that the refugee experience which took a person's home, doesn't have to take their future.
Preparing students for ethical reasoning
The implications of our code of ethics may be far reaching
For example: Ghan recently settled in a suburban unit on a "women at risk" visa, and now wants to be economically independent as her husband was lost in the conflict and she's a mother of four school aged kids. Implications of ethics can be as practical as - did the OT use qualified interpreter (national origin)? did the OT ignore or de-value her experience in the informal labour market (status in society)? did the OT assume Ghan would consent and welcome child-care help from other's "in her community"? (confidentiality)
Discussion Q: World Federation of Occupational Therapy Code of Ethics states "OTs shall not discriminate against these persons [service users] on the basis of race, colour, impairment, disability, national origin, age, gender, sexual preference, religion, political beliefs or status in society." Does OT have an obligation to ensure people with occupational needs can experience a non-discriminatory journey to access an OT service in the first place? Or does that ethic "begin" when lucky enough to access a service? What might each senario "look like" for Gahn mentioned in the example above?
More info: World Federation of Occupational Therapy Code of Ethics And of course, each OT Association typically has a refined and local version.
Preparing for diversity
Cultural competence is no longer a special interest; it's foundational to equitable service access and outcomes
For example: ANY clinical encounter involves questions like these: Do we have shared expectations for this work? How to build trust and show respect? Who is important to include? How to elicit accurate and often sensitive information? How to bridge different language, gender, cultural or life experiences? What cultural and individual assumptions might I need to check about life roles, performance contexts, the meaning and expectations of occupational performance? How do they explain their occupational dysfunction and what do they think is the remedy? Is there special meaning or stigma attached to this type of occupational dysfunction? What personal and collective resources have already been mobilised to cope with this situation? And so on.
Discussion Q: In three groups, list what you'd consider with the above reasoning questions whilst being open to the possibility of significant, small, or no difference given difficulty with the occupation of "changing the bed sheets". First group - the mainstream culture. Second group - a Lebanese Canadian in hospital after experiencing a relapse of mania who is afraid to sleep for fear of the jin at night. Third group - an Turkish grandmother who recently joined her daughter in Australia and now looks after five children during work hours despite an affected limb following a stroke 3 yrs ago.
More info: World Federation of Occupational Therapy Position Statement on Diversity & Culture
Preparing to be sensitive to trauma
Discussion Q: How can creating and enabling occupational opportunities offer healing ingredients for healing from trauma? (sense of safety, control, personal agency, predictable conenction to others)
More info: Educators can use the stories of young people from survived war and later grapple with residual trauma at school here
Preparing to work-with communities
For example: The YouTube below (a preview of a resource available to purchace) is a brief snapshot of a camp of 35 000 refugees. OTs need to reconsider who they are enabling occupational opportunities for, for example some children with developmental disabilities or all the children with no space or opportunity to play safely? OTs need to consider what occupational opportunities they create using community development practices to find and support spaces for people to identify what concerns them collectively. OTs need to consider how they enable occupational opportunities to be sustainable and build people's ability to identify and manage collective concerns. The who, what, how is different due to different context - but the why of creating and enabling occupational opportunities for health is the same.
Discussion Q: In what ways is a refugee camp a community and what ways is it not a community? After walking over mountains, waiting for days in a reception camp with no food, a 100k cattle truck journey, you arrive to meet others who have been in the camp for seventeen years - how might this change your concept of the future, and what you need? What does this way of working with communities challenge in a professional?