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.