Occupational therapy: A big step forward

Occupational therapy: A big step forward

By Martina Tobing

JAKARTA (JP): Daily tasks, such as making a cup of coffee, are
simple processes which we take for granted.

That is until a trauma to the head shakes the brain enough to
scramble the messages and foul up the ability to sequence the
activity properly. We forget to boil the water before pouring it
into the cup, spoon the coffee onto a plate, or pour sugar in the
pan. In other words, we make a mess.

None of us wishes to experience that kind of trouble, but if
we do, we hope to have the skilled services of an occupational
therapist at hand to help us re-learn these skills.

In Indonesia today, the need for occupational therapy may not
yet seem urgent - after all the norm is for servants or relatives
to take care of those who are helpless.

Take Rina (not her real name) for example. The 26-year-old
woman lies passively at Dharmais Cancer hospital in West Jakarta
with a form of skin cancer. Rina is a mother of two small
children, and has been bedridden for over two months. Family
members take turns washing and feeding her.

When I ask her if she is able to feed herself, she responds
with a look which seems to say, "How could you ask such a
question?"

The nurses do not encourage her to participate in her self
care by allowing her to wash her own face or feed herself.

The role of the physical therapist is to prepare Rina to walk
again by limbering up her ankles and knees which have become
stiff - a condition which could have been prevented if therapy
had started earlier in her hospitalization.

At this stage, it will be hard for Rina to begin with
occupational therapy and learn to bathe and feed herself again.
Having been served from head to toe for more than two months,
Rina has lost much of her will to be independent.

In Western society, where patients like Rina are expected to
eventually go home to lead a busy life with small children and
minimal help, physical and occupational therapists are an
essential part of the hospitalization process.

The occupational therapist would have assessed Rina's muscular
strength and the range of motion of her arms, both prerequisites
for dressing herself.

If she also lacked coordination in her fingers, needed to
button a blouse, the occupational therapist would design a piece
of adaptive equipment such as a button hook, which is a metal
loop attached to a wooden handle, that she would be better able
to grasp.

Urgent

Success in these types of activities would give Rina a
positive boost and encourage her to participate actively in the
total rehabilitation process, putting her on the road to
recovery.

But even in Indonesia, with an abundance of servants and
relatives at hand, the need to develop the profession of
occupational therapy has become quite urgent.

With increases in industrial accidents and injuries, coupled
with advances in medicine, more people are surviving, but are
left with disabled bodies which requires more than the standard
prescription of physical therapy.

One step towards answering the need for occupational therapy
in Indonesia was the establishment on April 23 of the Indonesian
Occupational Therapy Association (Ikatan Okupasiterapi
Indonesia,IOTI) in Surakarta, Central Java, by nine occupational
therapists.

The word "occupation" on this professional title has caused
much confusion, wrongly linking occupational therapists to job
trainers, work, leisure and recreational therapy.

However, the word is meant to identify how people occupy our
daily lives, and how our time is spent, instead of referring to
job-related injuries or ailments.

American occupational therapist Gary Kielhofner divides daily
activities into daily care (bathing, dressing, eating),
productivity (working, studying or playing), and leisure time.

To live successfully within our environment doing those daily
activities, we use our senses, muscles, nerves, knowledge and
interpersonal skills.

If any of these learned abilities fails us through illness,
injury, slowed development or aging, we become unable to perform
our daily activities, and become disabled.

But the lack of need for self care among many Indonesians has
also forced professionals to change course.

Since almost two decades ago, when Djoko Soesetyo, the first
foreign-trained Indonesian occupational therapist, opened up shop
in the rehabilitation center in Surakarta, named after its
founder, Prof. Dr. Soeharso, he has faced difficulties getting
the profession off the ground.

Djoko, soon to be followed by Harry Siahaan and Trisnawati
Tanumihardjo, were pioneers in the profession and experienced how
difficult it was to get the medical society, let alone the wider
public, to understand the focus of occupational therapy.

Soldiers

The profession of occupational therapy was born in l917 in the
United States, during World War I when many injured American
soldiers in European hospitals were getting depressed and losing
their ability to function.

As a result, hastily-trained so-called reconstruction aides
were send to France to provide therapy. This consisted of
activities that occupied the patients' time and minds, and at the
same time strengthened their muscles and limbered up their
joints.

Soon the therapists realized that the activities did wonders
for the soldiers' physiques and minds, and further training
programs were designed.

Eventually the American Occupational Therapy Association was
established.

The development of the profession in Indonesia is more recent.

In l990 the University of Alberta in Canada, together with the
Canadian International Development Aid, offered a training
program in occupational therapy to four physical therapists from
Surakarta.

These young men have recently graduated and are now in the
process of developing an academic program, to be opened this
September in Surakarta.

While their former professional colleagues, physical
therapists, take a critical look at how this new profession is
going to effect their business, the new occupational therapists
are full of enthusiasm and positive ideas.

"Our main goal is to first get healthcare professionals to
understand the role of occupational therapists," commented one of
the graduates, Tri Budi Santoso.

"An occupational therapist is still the missing link in the
rehabilitation team here," he added. All four emphasized the
importance of working as a team with physical therapists since
each profession offers a different service to the patient.

Harry Siahaan, the new president of the Association, defines a
broader aim.

"We hope to be able to reach our goal of helping disabled
Indonesians," he said. "We want to improve the quality of life of
the handicapped, and help them become productive members of
society, rather than being helpless burdens, as is the case now,"
he added.