I went on a hiatus from this blog for a month because so many things happened. On top of my on-site and teletherapy sessions, I gave a talk on prevocational skills, gave a lecture on sensory integration, contributed to a therapy blog, and took the Hanyu Shuiping Kaoshi. Finally, I got to moderate breakout sessions in an international occupational therapy congress for the first time. And what a great experience it was!
Being part of the Asia-Pacific Occupational Therapy Congress (APOTC) Manila was awesome for many reasons. First, we Filipino occupational therapists (OTs) got to organize a successful international conference despite all the stress that we’re facing as healthcare workers (HCWs). Second, a lot of my Filipino colleagues got to present groundbreaking research projects that are relevant to our local practice. Third, I love that many presentations promoted occupation-based approaches.
But for me, the star of the APOTC was Japan. And I mean, “WOW!!! TALK ABOUT BEING ONE HUNDRED STEPS AHEAD OF EVERYONE!”
The COVID-19 crisis has forced us to reimagine our lives, including our professions. Japan though is not merely reimagining occupational therapy. It is recreating the field! And it is doing so while staying true to occupational therapy’s ethos instead of forcing it to be a dumbed down type of public health. Based on the presentations, Japan is using public health tools to improve occupation-based practice and to prove its effectiveness in order to justify state funding. To achieve these objectives under its Universal Health Care (UHC) system, Japanese OTs have:
Developed a Japanese occupational therapy framework that reflects their local practice and communicates their interventions’ effectiveness to clients, health administrators, and policymakers.
Used public health indicators and screening tools to strengthen the evidence needed for addressing the needs of individual patients in an occupation-based manner.
Incorporated the use of Internet of Things (IoT) devices into treatment plans, which will not merely assist persons with disabilities (PWDs), but will also revolutionize the way all of us will engage in daily activities.
I’m concerned though that what OTs will take away from these is the myth that more government interference is the ultimate answer to making healthcare accessible. Well, the state is one of the building blocks of the health system so it’s definitely crucial. Unless you’re an anarchist, we agree that the government has a role not just in upholding criminal justice but also in redistributing resources to those who need it.
And that’s the keyword: redistribute. Meaning, the state does not produce the resources that are necessary for serving the masses. It only collects taxes from our incomes and then procures resources from private entities in order to implement state projects and welfare programs. This is why UHC is not free. We pay for it with our taxes as well as with our insurance contributions. So if too many people are not working, if those who are employed are earning little, and if businesses are not producing enough products and services, the resources that the state can allocate to UHC will be severely limited. We Filipinos know what results from that: lack of medical supplies, unsanitary health facilities, and poor working conditions that drive HCWs out of the country, or even out of healthcare altogether. Coverage will therefore not necessarily guarantee high-quality access to medical services.
If we want to make healthcare accessible, we've got to increase production that can be monetized. That’s where Japan excels, even in occupational therapy. Japanese OTs are developing products and services that are worth paying for because they effectively promote independence among PWDs, in light of Asians’ inclination towards interdependence. It sounds simple, but many HCWs struggle to relate that with street-level practice issues. For example, the state will not reimburse that experimental intervention that you want to try out for your patients if you can’t prove its effectiveness despite the millions of pesos that you shelled out to get certified in it. You won’t convince politicians to fund a city-wide mental health program for transgendered people who have “self-esteem” issues if you can’t compute for indicators that would point to either the improvement or regression of their self-worth. Besides, how do you compute for the prevalence of these self-esteem issues among the transgendered? How will you know the number of incidents of self-esteem problems that they experience within a certain period in a specific area? You’re not gonna get state funding if you can’t cite such reliable figures. Why? Because the government has to prioritize other more pressing concerns that are backed up by data.
But then again, who knows? Our leaders just might fund any politically correct quackery to win elections. That’s one reason why I’m not a fan of UHC. For me, UHC’s problems outweigh its benefits in countries like the Philippines where drama and maintaining the status quo are prized more than innovation...or integrity for that matter. But regardless of where one stands on UHC, any decent-minded person will want to reduce health inequities. And Japan is a benchmark of how quantitative public health tools can be used to improve occupational therapy’s service delivery among the marginalized.
(Photo by Jakub Dziubak)
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