Book Review: Occupational Therapy Disruptors

This is a unique and fascinating book that takes a tour around the world to explore the lives and practices of international Occupational Therapists. Each chapter is based on a conversation that the author had with an OT, from countries as diverse as Iceland, Ghana and New Zealand. The book opens up the many ways in which Occupational Therapy is taught and practiced around the world, dependant on local cultures, traditions and resources. It reminds us of how diverse occupations are, the different ways that people perform daily routines such as personal care, dressing and eating, and that the western notion of independence isn’t applicable to all settings.

Many of the featured OTs had to move abroad in order to study, due to not having programmes in their home countries. This highlights the resources such as textbooks and assessments that they learnt about that aren’t applicable in their home countries, due to different cultures and languages. These are case studies of trailblazers who returned to their home countries, set up OT programmes and adapted what they had learnt abroad to their communities.

The OTs in some countries, notably Palestine and Haiti, spoke about the impact of political instability and violence in their countries, and how if affects their ability to safely engage in daily occupations. People have to constantly change their occupations and roles to adapt. Natural disasters, for example the 2010 Haiti earthquake, also meant that “people lost limbs, jobs, function, and mobility”, changing the occupations of many residents, and also the workload of the OTs.

For many of the books participants, the occupation of studying OT is a way for them to do, be and become. For Milena in Brasil, this was a way for her to “break away from prior expectations of herself” in a culture where women staying at home for domestic occupations is the norm. Much of her work includes educating young girls and nurturing their dreams.

There are wonderful examples of creative adaptations used by OTs with limited resources. Victor in Uganda has cut holes in plastic garden chairs for toileting over latrines in refugee camps. Tunchanok in Thailand hangs tyres to trees to make sensory swings for children. These are inspiring examples that make me both grateful for the resources I have as an OT in the UK, yet also envious of the ability to work more freely in this way. Being able to order custom made equipment for clients is a luxury, but I feel also takes away possibilities for creative problem solving.

The case studies caused me to reflect on the access to everyday necessities and utilities that I often take for granted. Several of the OTs in the book had limited and unpredictable access to electricity, which affects occupations in their countries such as cooking and studying. Others had limited access to clean water or sanitation.

The subject of politics came up frequently, from the impact of politics on occupations to the political roles that some OTs had taken up as healthcare professionals. Adam, an OT in the USA, has entered this world in order to learn the language of the powerful people, to aid in fundraising for community projects.

Some accounts highlighted the education that OTs are providing in cultures where seeking help or admitting illness is seen as a weakness. Ann in Ghana works with families where children with mental health problems are hidden away from society, educating people about health and disability.

The challenge of explaining OT was a constant theme throughout many countries, and practitioners had found varying ways to explain it. For some, such as Razia in Bangladesh, the difficulties of explaining the benefits of therapy is compounded by a culture that only sees worth in activity that has monetary gain.

The ingrained racism within Western countries is also explored, including how this has trickled down through generations to create current health inequalities. Musharrat explains the difficulties with studying and working within a predominantly white UK workforce, and the systemic racism that limits access to occupations and affects health outcomes.

The range of roles covered within the book is inspiring, covering physical and mental health specialities but also including work with the homeless, sex education (such as Sakshi in India, who works with sex workers to help adapt for disabled clients), and helping people budget for drugs, respecting their right to this occupation and promoting safer ways to engage with ‘illicit’ occupations.

After reading this book I have emerged a different OT than the one who began it. It has served as a reminder of how holistic and open minded we should be, but also an insight into how OT is practiced in different countries. I welcome more opportunities to learn and network with OTs around the world.