The health risks, psychological stress, and economic losses that COVID-19 inflicted upon Filipino occupational therapists (OTs) will most likely exacerbate attrition from the profession. Yet, COVID-19 will not destroy occupational therapy. Occupational justice will.
According to the World Federation of Occupational Therapists (WFOT), “Occupational justice is the fulfilment of the right for all people to engage in the occupations they need to survive, define as meaningful, and that contribute positively to their own well-being and the wellbeing of their communities.” An occupational justice practice model will therefore entail every OT to advocate for the redistribution of resources because doing so will allow everyone to exercise their “occupational rights” (another problematic term). And “everyone” refers to all people, not just persons with disabilities (PWDs). Occupational therapy will consequently shift its focus away from individual patients. It will become mainly about giving different populations access to privileges that will allow them to engage in their preferred occupations through transforming social and structural conditions. To do otherwise will be deemed unjust.
This kind of self-aggrandizement is dangerous on so many levels.
Reimagining Occupational Therapy Out of Existence
The WFOT does not cite any reasonable universal criteria by which we can assess if a particular occupation positively contributes to a population’s well-being. For example, there are cultures wherein it’s laudable to execute homosexuals, marry children, and subject women to male guardianship. Those are part of their social participation. Populations that embrace such practices honestly believe that they’re doing the right thing because it’s based on their religion or ideology. Are OTs then allowed to enable those populations to hang homosexuals? Or stone women to death?
But if OTs will adhere to the Western principle of letting people be as long as they’re not violating anyone’s human rights, OTs will be advocating against the indigenous practices of meting out capital punishment against gays and having sex with children. The assumption underlying that advocacy is that the Western idea of liberty is superior to non-American local customs. Isn’t that racist according to CNN?
The reason why the WFOT’s framing of occupational justice is devoid of logical consistency is because OTs lack training in addressing the social determinants of health. I’m all for improving OTs’ cultural competence and developing effective indigenous health approaches. But shifting occupational therapy’s focus away from managing individual PWDs to reforming health systems or advancing political causes will turn it into a bastardized, inferior kind of public health. Instead of using motor learning strategies or strengthening exercises to help PWDs become independent in daily activities, OTs will be mainly writing policy proposals, organizing rallies, and lecturing healthy people about how eating KitKat will cause them diabetes.
If you’re an OT who’s interested in such endeavors, you may pursue them after clinic hours. You can even take up a degree in public health. Public health is awesome when its tools are used correctly. But the aforementioned population-level interventions are not occupational therapy.
Occupational Justice Will Widen Health Inequities
When this happens, who will focus on equipping PWDs with the skills that they need to actually engage in occupations? There are already too few OTs handling patients. More of our colleagues might leave due to pandemic-related economic losses. Burdening the remaining OTs with mandates for them to advance socio-political causes will take their time away from providing occupation-based management that’s geared towards teaching independent living skills. When PWDs lack skills, how will they survive? They cannot depend on corrupt governments’ limited resources forever. Not everyone who claims to be their ally can be truly depended on.
OTs, Unite!
Besides, if you’re an OT who struggles to write reports, your life will be hell once we’re required to focus on social and structural conditions. You will not be merely documenting patient evaluation findings. You will also develop surveys, compute for indicators, stare at spreadsheets the whole day, prepare Powerpoint presentations, and write white papers that are hundreds of pages long to communicate your findings. And after all that, the policymakers might ignore you.
Finally, an occupational justice model is extremely polarizing. The lack of universal criteria for objectively assessing occupations’ impact on populations’ well-being will leave OTs in their contradicting viewpoints on reforming social structures in which people engage in those occupations. Some will continue to believe in the free market, while some will lobby for more state intervention. And based on what I’ve seen in the past months, certain OTs will even laud groups like Black Lives Matter tyrants, Antifa terrorists, or Capitol Hill rioters. OTs who will remain silent on political issues will get branded as enablers of oppressors. We might reach a point in which OTs will get penalized for not subscribing to prevailing socio-political narratives. The worst case scenario will be when OTs refuse to see patients whose views are different from their healthcare providers.
You think this is all impossible? Then take note of what’s happening in US schools because of critical race theory.
So what will sustain occupational therapy in ways that will unite OTs across the world? Well, all OTs agree that our patients need to brush their teeth. We agree that they need to take a bath. We’re united over helping them eat healthy meals, receive a formal education, and get fulfilling jobs as we keep our paperwork to reasonable volumes. And our clients agree with us because they’re paying us to train them for those tasks. Acquiring life skills will open many doors of opportunities for PWDs to participate in society as happy, productive citizens. I will gladly unite with OTs over that kind of occupation-based practice regardless of their political stripes.
REFERENCES:
Bailey, D.M. (1990). Reasons for attrition from occupational therapy. American Journal of Occupational Therapy, 44, 23-29. DOI: 10.5014/ajot.44.1.23
Hocking, C. (2018). A decade on: working together to revise the WFOT Position on Human Rights. World Federation of Occupational Therapists. https://congress2018.wfot.org/downloads/presentations/SE49/clare_hocking.pdf
Hammel, K.W. (2021). Building back better: Imagining an occupational therapy for a post-COVID-19 world. Australian Occupational Therapy Journal, 1-10. DOI: 10.1111/1440-1630.12760
Sy, M., et al. (2020). Shared voices of Filipino occupational therapists during the COVID-19 pandemic: reflections from an online forum. World Federation of Occupational Therapists Bulletin, 76(1), 60-64. DOI: 10.1080/14473828.2020.1761575
World Federation of Occupational Therapists. (2021). Public Statement - Occupational Therapy Response to the COVID-19 Pandemic. World Federation of Occupational Therapists. https://wfot.org/about/public-statement-occupational-therapy-response-to-the-covid-19-pandemic
(Photo by Clay Banks)
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