Building relevant and current Occupational Therapy (OT) practice in India

- Kavitha Murthi (BOT, Msc OT, FHEA, OTR)

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About me...

• Pediatric Occupational Therapist (OTs) from India

• Undergraduate studies- India

• Moved to the UK to pursue Masters

• Explore international waters

• Understand therapy practices across the globe

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What I am planning to do in the next 10 minutes

• To provide a clear, current picture of the Indian Occupational Therapy practice.

• To raise awareness about the various professional challenges faced by Indian Occupational Therapists.

• To lay a foundation which can be used to build culturally relevant Occupational Therapy practice in Indian context.

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Occupational Therapy practice in India Current situation

(Acharya 2013, Karthik 2011)

• Developed in 1950 at King Edward Memorial hospital in Mumbai by Kamala V Nimkar

• OT in India has spread into various facets of the Indian allied health industry

• Despite this Occupational Therapy as a profession in India is still struggling to make a nation wide impact

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Why hasn’t Occupational Therapy made an impact in Indian healthcare

paradigm?

• Healthcare is privatised and this has increased cost of OT service delivery (OTICON 2012, Uplekar 2000)

• Service users have to pay out of their pockets (Karthik 2011)

• Increase in Evidence Based Practice due to the current fiscal climate(Copley et al 2010, Maclean et al 2012)

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• Evidence base contributed by research is very sporadic in India (Shetty 2011, Acharya 2013)

• 57% of studies explore treatment effectiveness but no study justifies underpinning therapeutic rationale (Shetty 2011, Murthi 2014)

• Huge impact of the medical model on the Indian OT educational system, research and clinical practice (Maharashtra University of Health Sciences 2003, Wells and Crabtree 2012).

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Implications of lack of Evidence base in India

• Due to the sporadic nature of research generation unique to the Indian OT context, there is direct transportation of Western ideas, values and knowledge bases within Indian service delivery. (Iwama 2006, Shetty et al 2015)

• Huge cultural dissonances between Western and Eastern values can result in confusion, dissonance, disengagement and alienation. (Iwama 2006, Hammell 2009, Shetty 2011)

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Professional challenges faced by Indian therapists

• Lack of an unique ‘occupation’ focused dialect (Supyk-melson and McKenna 2010)

• Professional ‘role blurring’ (Wilding and Whiteford 2007)

• The nature of this profession to be misunderstood leading to OT being perceived as a coercive and oppressive force that marginalises vulnerable individuals (Iwama 2006)

• Practice based on tacit (implied) knowledge or guesswork (Hammell 2009) 8

Moving ahead...

• Rebuilding culturally meaningful and relevant OT practice in India (Iwama 2006)

• To become a reflexive consumer of research and not accept literature without critically appraising their content and credibility (Hammell 2009)

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Conclusion

• Indian Occupational Therapists are now more cognizant about the gap between research and clinical practice (Acharya 2013, Swaminathan et al 2014).

• Understand the dangers of a ‘one size fits all’ technique (Turpin and Iwama 2011 Shetty et al 2015)

• This can build a practice in India that is client -centred, cherished and enjoyed by service users (Turpin and Iwama 2011, Swaminathan et al 2014).

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Reference List

• Acharaya, V.A. 2013. Psychosocial Occupational Therapy practice in India: Where is the evidence? — A Review of IJOT publications. The Indian Journal of Occupational Therapy, 45(3), September- December, pp. 8-12.

• Copley, J. A., Turpin, M. J., and King,T. L. 2010. Information used by an expert paediatric occupational therapist when making clinical decisions. Canadian Journal of Occupational Therapy, 77 (4), 249-256.

• 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.

• 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. 11

• 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.

• Maharashtra University of Health Sciences Faculty of Allied Health Sciences. [no date] Syllabus. Nashik: MUHS.

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• Maclean, F., Carin-Levy, G., Hunter, H., Malcolmson, L., and Locke, E. 2012. The usefulness of the Person-Environment- Occupation Model in an acute physical health care setting. British Journal of Occupational Therapy, 75(12), December, pp. 555-562.

• Murthi, K. 2014. Flowing through the Indian land - Kawa in India. [online] Conference Presentation. Link: https://www.youtube.com/watch?v=dQi0WvmUmWs

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• OTICON (All Indian Occupational Therapists’ Association). 2012. Research Informed Occupational Therapy in Health Care. [Online] Available at: http://www.oticon2013.com/Theme.aspx [Accessed December 29 2012].

• Shetty, R., Joshi, A., and Baldiwala, J.2015. Conversation about Mr. Bad Handwriting. Using narrative ideas within the context of occupational therapy practice. The Indian Journal of Occupational Therapy, 47(3), September- December, pp. 73-77.

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• Swaminathan, A., Jahagirdar, S., and Kulkarni, C.2014. Client-centred care:Looking through the measures of quantitative and qualitative measures - case studies. The Indian Journal of Occupational Therapy, 46(1), January- April, 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_14822e91e7a7e8532ba87eb05c0d7bec [Accessed October 23 2012].

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• Wells, J.K., Crabtree, J.L. 2012. Trends affecting Entry-level Occupational therapy education in the United States of America and their portable global impact. The Indian Journal of Occupational Therapy, 44(3), September- December, pp. 17-22.

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Questions?

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