How I Failed a Lab Exam Because of Colonial Occupational Therapy

It’s official: I’m going to Canada this year! And it looks like I might be able to go to Ontario! I’ll finally see my family again in Winnipeg. I’m excited to see Ontario too because it’s one of the world’s greatest technology hubs. I’ve always wanted to go there because of my interest in health technology. Plus, I really loved Canada when I was there. I pray that it will really be God’s will for these trips to push through.

My upcoming vacation got me thinking about what could’ve been if I worked as an occupational therapist (OT) in Canada. I probably would’ve frequently used the Canadian Occupational Performance Measure (COPM), which we studied intensely in undergrad. In fact, the COPM is why I failed my first lab exam in OT 179 (yes, ganyan na ako katanda!).

My Perspectives on the COPM

The COPM is an individualized outcome measure that helps patients and their families identify problems in the performance of daily living activities. Although it was developed in Canada, its underlying theory stems from American ideals about personal autonomy and Western countries’ proclivity towards individualism.

We occupational therapy undergrads at the UP College of Allied Medical Professions (CAMP) were tested using the Tagalog version of the COPM, which was non-standardized at that time. The way we utilized the COPM was super structured and formal. And the whole interview process was incredibly long! Our professors deducted a point each time we forgot to deliver a line for eliciting the patient’s responses. It turns out that the original English version can be candidly delivered in a manner that was a lot less structured.

Consequently, I failed the exam. I just couldn’t memorize all those Tagalog lines on top of the other stuff that I had to study. Not to mention that I was dangerously close to being clinically depressed when I was in third year - college.

Did I use the COPM in the Philippines as a licensed OT? I did, a few times. But I did not use the Tagalog version that we had at the UP CAMP. I used my version of it, in English and in

Taglish. I found my version of the COPM useful when helping Filipino clients prioritize goals when they’re getting confused as to which one should be targeted first. The COPM was also good for helping clients to go over each area of occupation at a time to make sure that they’re getting all the bases covered. These are quite important because here in the Philippines, we need to raise more awareness about the different developmental milestones across the lifespan.

Most of the time though, I used a more conversational approach when interviewing, which is proven to be more effective for Filipino clients given our Eastern cultural mindset. While the COPM has its place, it can make Filipinos feel like they’re being tested. It can also subconsciously reinforce the notion that the OT is the outsider expert, instead of an insider in the Filipino client’s life.

The possible outcome could be that Filipinos might attempt to give the impression that they’re complying with the clinician’s recommendations to help everyone save face when in fact they’re doing the opposite. That’s because the clinician didn’t properly frame the problems in the occupational areas the way that their clients would. Hence the OT suggested approaches that the client deemed irrelevant to his problems.

Unity in Diversity

I can think of many other instances wherein I experienced a mismatch between the Canadianized/Americanized occupational therapy that I studied with what was actually happening in the lives of my Filipino clients.

As a junior clinician then, I felt like I was cheated. First, my grades in my OT subjects weren’t stellar because I had to memorize a bunch of North American-related stuff that I wasn’t going to use in clinical practice. Second, being hyper-Westernized almost cost me my professional license. When I was taking the boards, almost every page on the OT Applications part of the exam had questions about administrative duties that OTs were supposed to fulfill — in North America! I passed the exams the first time that I took them. But the score that I got was bordering on failure.

Most importantly, I felt like I was being an ineffective clinician because my way of thinking seemed to be disconnected from my clients’ daily realities. Yet we were charging them hefty fees by the hour!

Without a doubt, some Asian OTs are going to use this issue to turn occupational therapy into a dumbed down type of public health in the name of “decolonization”. Ironically, they’ll be doing the bidding of a few liberal North American OTs.

Departing from occupational therapy’s ethos of equipping individuals with independent living skills to focus on addressing the social determinants of health will have dire consequences on both patients and therapists. Not to mention all the university resources that will be wasted on the occupational justice model! Hence, OTs all over the world must retain their profession’s primary purpose of promoting individual participation in the different areas of occupation. So what if that’s a Western idea? What’s important is that we OTs are able to fulfill our patients’ needs in ways that are distinct from other health professionals.

We OTs don’t need to turn occupational therapy into a dumbed down public health to contextualize our clinical practice in the Philippines, or in any country for that matter. There is a way for Eastern and Western OTs to find common ground about what our scope of practice should be while accommodating the cultural sensitivities of the populations that we serve. For me, it starts with a common understanding of what “occupation” is. But that’s for the next article.

(Photo by Ryan Fields)