Flowing through the Indian land- Kawa in India!
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Kawa model in the Indian context, Western and Eastern values
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Flowing through the Indian land- Kawa in India!
- 1. Flowing through the Indian land – Kawa in India - Kavitha Murthi
- 2. What I intend to do in the next 10- 15 minutes? • Gist about OT in India • Need for conceptual models • Use of models in Indian practice • Culture and conceptual models • My experience of using Kawa model in India
- 3. Indian healthcare practice (Karthik 2011, Uplekar 2000) • Privatization of healthcare in India • OT was first introduced in 1952 by Kamala V Nimkar • Growing demand helped proliferation of OT within prominent branches of allied healthcare like mental health, paediatrics, neurology, cardiology, orthopaedics etc.
- 4. Current stance of OT in Indian ethos • OT is yet to make a national mark in Indian allied health system (Karthik 2011) • 57% studies focus on interventional effectiveness (Shetty 2011) BUT • No focus on understanding underpinning rationale (Shetty 2011, Murthi 2013)
- 5. Need for conceptual models in OT practice • OT built around –’occupation’ • Professional role blurring (Wilding and Whiteford 2007) • Profession reduced to a technicality • OTs termed as ‘gap-fillers’ (Fortune 2000)
- 6. Factors involved in the choice and use of theoretical models • Education • Perceived utility in work ethos • Therapists’ perspectives regarding models
- 7. Culture • Unique and personal (Iwama 2006) • Impact of culture upon disability (AlBusaidy and Borthwick 2012)
- 8. Difference between Western and Eastern (Indian) Values (Iwama 2006, Hammell 2009, Turpin and Iwama 2011) Western Values 1. Autonomy and independence 2. Mastery over surrounding environment 3. Client – centred practice 4. Occupational engagement 5. Classification of occupation into self-care, productivity and leisure Eastern Values 1. Interdependence and harmony 2. Stable relation with the environment 3. Family and society centred practice. 4. Occupational disengagement 5. Classification of occupation into self-care, productivity and leisure is over simplistic
- 9. Influence of culture on conceptual models (Iwama 2005, Hammell 2011) • Direct transportation of western philosophies can be catastrophic • Limited adaptability of conceptual models from one culture to another • Creates confusion, disengagement, dissatisfaction, coercion, alienation
- 10. Conclusion (Turpin and Iwama 2011) • Conceptual models to guide practice • Uniqueness of the profession maintained • Realise the dangers in the ‘one size fits all’ technique • Provide service that is service user centred and something that they understand, cherish and participate in
- 11. References • AlBusaidy, N.S.M. and Borthwick, A. 2012. Occupational Therapy in Oman: The Impact of Cultural Dissonance. Occupational Therapy International. • Fortune, T. 2000. Occupational therapists: Is our therapy truly occupational or are we merely filling gaps? British Journal of Occupational Therapy, 63, 225–230. • Hammel, K.W. 2009. Sacred texts: A sceptical exploration of the assumptions underpinning theories of occupation. Canadian Journal of Occupational Therapy, 76 (1) February, pp. 6 – 13. • Hammell, K.W.2011. Resisting theoretical imperialism in the disciplines of occupational science and occupational therapy. British Journal of Occupational Therapy, 74(1), pp. 27-33.
- 12. • Iwama, M. K. 2005. Situated meaning: an issue of culture, inclusion, and occupational therapy. In: Kronenberg, F., Algado, S. S. and Pollard, N. eds. Occupational therapy without borders: learning from the spirit of survivors. Edinburgh: Elsevier Churchill Livingstone, pp.127-139. • Iwama, M. K, 2006. The Kawa Model: Culturally relevant Occupational Therapy. Churchill Livingstone. Edinburgh • Iwama, M., and Turpin, M.K 2011. Using Occupational Therapy Models in Practice: a field guide. Churchill Livingstone Elsevier. • Karthik, M. 2011. Introduction to Occupational therapy and Occupational Therapy Marketing. New Delhi: Jaypee Brothers Medical Publishers. • Murthi, K. 2013. Exploring Indian occupational therapists’ perspectives regarding use of conceptual models to guide occupational therapy practice in India. MSC thesis, Queen Margaret University.
- 13. • Shetty, R. (2011). State of the Journal: A Five year review of Indian Journal of Occupational Therapy. Indian Journal of Occupational Therapy, 43(2), pp. 10 – 15. • Uplekar, M.W. 2000. Private Health Care. Social Science and Medicine, [online] 51(6), pp. 897- 904. Available at: http://ac.els- cdn.com/S0277953600000691/1-s2.0-S0277953600000691- main.pdf?_tid=4690bba0-b105-11e2-b887- 00000aab0f6c&acdnat=1367264879_14822e91e7a7e8532ba87eb0 5c0d7bec [Accessed October 23 2012]. • Wilding C.and Whiteford G.2008. Language, identity and representation: occupation and occupational therapy in acute settings. Australian Occupational Therapy Journal, 55(3), 180-87.
Notas del editor
- Namaste, greetings of the day!!! Hello my name is Kavitha Murthi and I am an Indian Ots from Mumbai. Currently I am working as a paediatric therapist. I am extremely honoured to have gotten an opportunity to present my work before such exceptional stalwarts and I regret not being in Tokyo in person. I am going to be talking today essentially about my journey during my Masters in the UK and how I have started applying what I learnt, researched and experienced in the UK within the Indian context. I would also like to mention the special efforts of Mr. Srinivasan Iyer for his creative inputs and constant support during the making of this entire presentation.
- Hopefully in the next ten to fifteen minutes, I am aiming to give you a ...
- Introduction: Indian healthcare has both government and private components with a growth in the private health sector. Both private and govt. health care providers have different branches such as medicine, dentistry, allied health, podiatry and alternate medicine like Ayurveda, Unani , homeopathy etc. OT in the Indian context was first developed by Kamala V Nimkar [nee Elizabeth Lundy] who was a social activist. She underwent special training from Philadelphia School of OT, USA to help jumpstart OT services in Indian climate. This profession was introduced in a hospital setting in King Edward Memorial Hospital, Mumbai.
- OT is not recognised in major Indian health policies like Mental Health Act (1993), Person with Disabilities Act (1995), Rehabilitation Council of India Act (1992) and the National Trust Act (1992) that chiefly advise Indian disability management and rehabilitation (Karthik 2011). Moreover Indian healthcare still is adopting the medical model of care which is extremely reductionist and views an individual as performance deficits, available performance areas and components. (Turpin and Iwama 2011) This can be attributed to the lack of evidence scaffolding OT practice in India (OTICON 2013). Moreover, evidence presented in Indian archives and journals are extremely sporadic thus risking practice credibility. Shetty (2011) analysed five years of research studies produced in India retrospectively, and concluded that despite 57% studies focussed on interventional effectiveness, there was not even a single study highlighting the underpinning rationale/ why a particular intervention was used what was the theoretical scaffolding supporting a particular intervention. Therefore, Indian OT practice is mainly based on tacit knowledge or as Hammmell (2009), mentioned on “guesswork”.
- Egs: 1. OT professionals use prefix ‘Dr.’ to cover lack of identity – personal experiences are u a physio, nurse, doctor, arts and crafts teacher, school teacher, yoga teacher (IJOT 2014, Murthi 2013). Deciphering uniqueness of Ots is therefore even more crucial in the Indian context. 2. Borrowed concepts and influence from different world views have also resulted in creating professional role blurring (Wilding and Whiteford 2007). 3. OTs learning techniques, modalities or assessments not central to the profession which even though is a justifiable certainty, reduces the profession to a shared technicality.
- When I researched further as to why models were not used in Indian context, I found that the 1.Indian educational system and OT education curriculum is not updated according to contemporary educational standards worldwide. Also the curricula is mainly made up of modules that do not explicitly teach conceptual models but instead focus on topics that are not specific to occupational therapy (Maharastra University of Health Sciences 2003). Ashby and Chandler (2010), have in fact established a link between use of conceptual models and education. 2. Ikiugu (2010) documented that practitioners used models only when they perceived its utility in practice. however, Indian therapists are following Western values without reconceptualising or redirecting it to suit Indian needs making OT in India hegemonic (Hammell 2011). Client questioned my lecturer when I was a student – ...”why are you asking me about what I do in my free time? Free time is bad, sitting idle is bad my parents have thought me...” 3. Therapists’ perspectives while using certain models are based on direct transportation of Western values as previously discussed, due to sporadic evidence base regarding the utility of conceptual models in Indian context. Mostly are based upon senior influential therapists’ personal perspectives and experiences which in turn is transforming OT into a cult (Kelly and McFarlane 2007).
- 1. Culture is an individual and personal representation of oneself. Eg: An Indian girl wearing denim, eating burgers, listening to reggie and hip hop (Wilma 2005) Disability viewed as ‘evil eye’ or curse. Vocational opportunities and access limited for people with physical challenges in many rural Indian sectors whereas people with mental challenges are still stigmatized.
- Before deciphering how conceptual models can be incorporated in the Indian contexts it is crucial to clearly understand the differences between the Western values and Eastern/asian values Western values: personal aspirations, choices, interests and requirements to perform a particular task. MOHO describes as self-directed and independent who strive to attain mastery and independence. Separation from environment to gain Mastery over it. Models are designed around the client taking into consideration the client’s physical, social and cultural environments. Hence an individual’s relation with his/her contact environment is considered. selection, classification and implementation of occupations which have personal meaning – occupational engagement (Turpin and Iwama, 2011). Rigidity of this classification is over simplistic and culturally specific. Variety of roles adopted by one person . Teacher, carer, daughter etc. Eastern Values: Depending on others, inseparable from the envt. to maintain a harmonious relation and to co-exist with others. E.g: importance of social relations, participation in cultural events, seeking advice from elders in the family etc. “ I have always been dependent on my husband, why should I now look for a job?” Eastern values of sacrifice and the depiction of Eastern self as ‘decentralised’ (Iwama et al 2009) and the value placed to sacrifice and harmony in relationships. Decentralized self value placed on stability of an individual’s relation within the environment. Value of family and society in an individual’s care decisions. The inherent belief of this model that occupation contributes to the meaning of one’ s life is refuted by Hammell (2009), who stresses that this concept is again culture and status specific where high level employment and lifestyle provides satisfaction to individuals. This is backed up with the notion that considerable Indian population is still developing and poverty – stricken and are into occupations with low income and some more are forced into begging, prostitution, stealing etc. which may not produce positive meanings (Hammell 2009). There are many ingrained values in the Eastern cultures like meditation, prayers, rituals, caring for dependents, following family traditions which are very crucial to maintain a harmonious relation within the society and they usually fall out of the three performance areas.
- Nangaonkar’s (2002) study highlighted the direct... Square peg in a round hole phenomenon. Very diverse beliefs – both service users and therapists