Charles Evans is a 2-year-old male diagnosed with Autism Spectrum Disorder (ASD). His father is a British expat who works as a management consultant. His mother is a Filipina who was a human resources (HR) officer before she became a full-time housewife. Both of them are devout Mormons. They live in Makati, Philippines. Charles doesn’t have a nanny because Mr. Evans wants Mrs. Evans to be the child’s caregiver. So Mrs. Evans quit her work to look after Charles, believing that it’s her duty to submit to her husband as commanded in the Bible.
Charles’ parents consulted an occupational therapist (OT) because of the child’s sensory modulation difficulties. He constantly roams around the church during worship services. He throws tantrums when he hears anyone speak or sing over the microphone. He would bite his parents or pull their hair when he feels distressed. In the church that they attend, the children are required to be with their parents during worship to promote family solidarity. Mr. and Mrs. Evans said that they’d like Charles to be calmer during worship gatherings. How will a culturally competent OT address these concerns?
What I like about the push towards decolonizing occupational therapy is the advocates’ emphasis on cultural competence. Being culturally competent in healthcare means having the ability to adapt to patients’ unique cultural needs (Betancourt, et al, 2003). It allows medical workers to minimize or eliminate sociocultural barriers that can hinder people, especially minorities, from accessing effective health services (ibid). Sensitivity to cultural differences can therefore reduce health inequities.
But which cultural needs should OTs meet? Do we accept or tolerate all cultural norms? Or should some be discouraged because they perpetuate unhealthy behaviors? And will discouraging certain indigenous practices be considered racist?
For example, it’s culturally acceptable in Saudi Arabia to execute homosexuals. What then should an OT who works in Saudi do with a patient who’s gay? Fully adapting to Saudi’s cultural norms might entail turning in the homosexual to the state so that capital punishment will be meted out. But adhering to North American values will compel the OT to give the gay patient the liberty to live as he pleases as long as the latter will do the same for others. Is it then considered White supremacist to let homosexuals be if the OT works in Saudi?
In Charles Evans’ case, a Filipino OT who was trained using a Westernized curriculum will address the parents’ concerns by using a combination of sensory-based approaches, reinforcements, environmental modification techniques, and parent coaching. The OT can even offer to conduct a sensitivity training class for the Mormon church so that the congregation can help Charles’ parents.
The aforementioned approaches are rooted in sensory integration theory, behaviorism, and the Ecology of Human Performance, which are Western theoretical frameworks. The Filipino OT adheres to these models regardless of their proponents’ ethnicities because they’re effective. Scientific experiments prove that they work despite their limitations. We clinicians can also attest that our patients improve when we use techniques from Western frames of reference (FORs).
Moreover, they will keep the OT focused on the goal of Charles’ parents: to participate in a worship service. The usual occupational therapy FORs don’t denounce their religious practices as dark occupations that have to be penalized for perpetuating injustices. In this case, Charles’ parents just want to exercise their freedom of religion. They’re not pushing for legislation that mandates everyone to become Mormons. So the techniques from the aforementioned theoretical frameworks will simply equip Charles and the people around him with skills that are necessary for participating in church.
On the other hand, I’ve never seen the evidence for the effectiveness of channeling spirits and drinking potions to treat a child with ASD. Even if such methods are rooted in Philippine folk medicine, I’d rather do gym ball exercises like what American OTs do because the latter produces tangible results.
From our undergraduate days, to internship, to professional practice, the great majority of Filipino OTs have never cared about the ethnicities of the people who developed our assessment and treatment techniques. We just want to do what’s effective for the patients. And we want to get paid for the value that we create. We therefore refuse to completely decolonize occupational therapy given that the best healthcare models so far are coming from the West.
However, we are very much in favor of indigenous approaches that produce good patient outcomes. Developing them further will make clinical care more effective and accessible. For example, I’d rather use pakikipagkwentuhan to elicit the concerns of Charles Evans’ Filipino mom than utilize the very tedious Canadian Occupational Performance Measure (COPM).
But I will never say that she’s oppressed because she’s a housewife. Although her British husband wanted her to resign from being an HR officer, her choice to submit to him is a result of her religious beliefs and her love for her family. It’s not because she feels inferior to a White man. Besides, being a stay-at-home mom IS a career. Hence, there’s no reason for an OT to tag her as a victim or an enabler of social injustice. Respecting Mrs. Evans’ decision to be a housewife is not racist. It’s simply cultural competence.
(Photo from Canva)
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