Saturday, 27 August 2011

Affording Meaningful Occupation in India

Peoples Aid is an Organisation based across several countries,including New Zealand, that focuses on giving people in poverty the opportunity and resources to engage in meaningful work occupations.This is an area that is very relevant to Occupational Therapists as it enables people to engage in occupations which will bring them out of poverty and occupational deprivation.

“If you give a man a fish, he will eat it today and be hungry tomorrow, but if you teach a man to fish then he will not only eat today, but also tomorrow and so on.”

Rickshaws For India  is a program that busts the shackles of poverty that keep poor Indian families bound, and gives them the means to self-sufficiency and dignity.  A Rickshaw provides a poor Indian family with a debt free business, enabling them to permanently earn a good income and be self supporting. 

In India, Rickshaws are a major mode of taxi transportation for people taking short journeys. Those going to and from work and school, shoppers and business people all ride on Rickshaws. They are also used for moving goods and courier jobs. The government promotes their use as they are non-polluting.
Therefore, having a Rickshaw enables an Indian family to have a debt free, good income producing small business that permanently supports them. This provides food, housing, clothing, healthcare, and a proper education for their children.These families are just so grateful for their new Rickshaws and the better life they provide. Things that we take for granted they are now able to obtain. When being given their new Rickshaws many cry with joy. Hope floods into their lives as they are liberated.
For most of them it is the first time in their lives that they can eat every day. They can choose to live in a community with clean water and sanitation instead of in the squalid, disease-ridden slums. Rather than the children being forced to work in dangerous sweat shops, they can go to school. They are able to afford adequate clothing and buy necessities like soap and toothbrushes. For once they have the possibility of saving some money rather than merely surviving day to day.
Side Note: Children Forced Into Slave Labor
The hard-earned money that the driver is forced to hand over to the Rickshaw landlord could make a tremendous difference to the Rickshaw driver’s family, especially the children. Because their income is so substandard, they are forced to live in slums where disease runs rife. Children are not able to be educated and basic medicines are beyond their means. In India there is no social security or sickness benefits. Sadly, to make up the difference between starvation and subsistence, the children are often sent off to work. The jobs that are available to children are unimaginably horrible to Westerners. Tiny boys and girls frequently do hard labor at many dangerous slave jobs, such as digging drains, working in sweat factories, carrying heavy loads, even removing needles from used and likely contaminated syringes. Poverty is a curse for everyone in its oppressive grip, but how much more it is for the children.

The Sewing Machines For India program enables women to attend a comprehensive 3 or 6 month training course. We provide all of the materials necessary during the course. We also give assistance to enable the women to support themselves and their families during the course. They are given the same top quality model of Sewing Machine that they learn on. After being properly trained, owning a debt free Sewing Business enables the recipient to earn a good income that permanently supports them.

These Rickshaws and Sewing program are sponsered by people and churches from a number of countires. To find out more, please visit

Saturday, 20 August 2011

My Personal Reflection

Through developing this blog I have learnt more about how the other half of the world lives, and this has made me incredibly heartbroken. It has stirred in me doubly more of a passion to reach out to the poor, to enable and promote equal rights for the disabled and to empower the helpless. It has taken me on a journey of self discovery and has afforded me with the opportunity to showcase the knowledge I have gained over the last three years of my Occupational therapy training. I have founded this blog on my experiences of working with the poor in Africa and through utilising the learning gained from papers, such as Humanities. 

I have gained much insight into the Disability-Poverty Cycle and how this impacts people’s lives on a daily basis. Additionally, I’ve become more aware of Occupational Injustice and how this impacts people’s lives across the Globe. Using my example of Human Trafficking, I learnt that many traffickers acquire their victims from developing countries and move them away from everything they know; however it is largely individuals from developed countries who fuel this disgusting trade of human lives. For poverty and injustice to be eliminated, the entire world must take part. 

It is not an easy road to travel, but we who are able MUST try to make a difference. As Occupational therapists we are taught many skills which can be useful in the fight against poverty and injustice. We believe that participation in occupation is the very core of health and well-being. This gives us a very unique view on humanity. 

So, what CAN WE DO? We have the opportunity to develop and teach communities skills that can lift them out of extreme poverty. We can promote participation in livelihood activities, such as fishing and farming, which will preserve health. We can work to empower women and disabled who are marginalised. We can play a role in enabling all children, including disabled children and those considered “at-risk”, to start and progress through school. We can assist in a variety of health promotional programmes assisting in HIV prevention and Nutrition. We can network to raise awareness of occupational perspectives and their contribution to lessening the burden of disease for individuals, groups or populations. There is MUCH we can learn from people in poverty, and I believe there is also much we can do as a profession to work with them to increase their quality of life. We need to embrace the value of occupation and to face the challenge of stepping outside the boundaries and limitations set by oneself and society.

Although this blog gives a background on some of the core concepts involved in poverty and disability in third world countries, it is limited in providing resources to prepare Occupational therapists for working within poverty. 

Below are some interesting books and a blog which may be helpful;
  • Merrill, S. C. (1992). Preface. In S. C. Merrill (Ed.), Occupational therapy across cultural boundaries: Theory, practice and professional development (pp. 1-14). New York: The Haworth Press, Inc.  
  • Kronenberg, F., Simo Algado, S. S., Pollard, N. (2005). Occupational therapy without borders: Learning from the spirit of survivors. United Kingdom: ELSEVIER Churchill Livingstone. 

I hope you are inspired to make a difference in the lives of others, as I am. 


Examples of Organisations OT's could work in

There are a number of Aid organizations and NGO's currently working globally to eliminate poverty and work with people in need, assisting them in improving their quality of life. Although these organizations are not OT specific, they are very much suited to the skills and roles of the Occupational Therapist. Occupational Therapists can assist these organizations develop an occupational perspective when working with people in poverty and be valuable team members.

Examples of organizations which Occupational Therapists could work with:

  • "PATH"  is an international nonprofit organization that creates sustainable, culturally relevant solutions, enabling communities worldwide to break longstanding cycles of poor health. By collaborating with diverse public- and private-sector partners, we help provide appropriate health technologies and vital strategies that change the way people think and act. Our work improves global health and well-being.
  • The "Oaktree Foundation: Schools4Schools": A campaign in which Australian schools partner with an African school. A peer education group is formed where students have socialization, find meaning and belonging, and actively participate in.

  • “Trade Aid” is a not-for-profit organisation that supports producers with support through buying and selling their products at fair prices, sharing their stories and speaking out against injustice in the world trade markets.
  • “TearFund” and "Worldvision" are both Christian humanitarian organizations that are passionate about bringing justice and transforming lives to overcome global poverty. 
  • Grameen Foundation is a non-profit organisation that helps the world's poorest, especially women, improve their lives and escape poverty by providing them with access to small loans, essential information, and viable business opportunities. 
  • "Alliance for Youth Achievement" mission is to improve the lives of children in Africa by meeting their basic needs and providing opportunities for them to reach their fullest potential.  By working alongside African partners, AYA is able to provide food and clean water, orphan care, education, medical care (including prevention education re HIV/AIDS), and income projects to the children they serve.
  • "Alpha Communities"assists local initiatives and promotes community based responses that impact poverty through education, health care, service provision and agricultural development. Alpha presently works with communities in China and Mongolia.


Above: Powerful animation on the shortage of health workers, produced by the Global Health Workforce Alliance, UK. Although this is specifically targeted at Medical Staff, Occupational Therapists have a large part play in health promotion and providing a way for healthier living. 


The Occupational Therapy Africa Regional Group (OTARG) is in-charge of training Occupational Therapists in line with the needs of the Disabled in Africa. They are holding a OT Conference in Sept 2011 and will be discussing the following abstracts. 

Please read the abstracts below to gain an understanding of how  the Occupational Therapy profession can assist in the movement of eradicating poverty and enabling those living with disabilities in poverty to gain a better quality of life.


This goal seeks to make the right to development a reality for everyone and to free the majority of the world’s population from want. Low human development is associated with poor health and limited education, both of which lead to the loss of power to choose what is best to improve well being. What role can occupational therapy play in turning the tide?

  • Sustainable development 
  • Supports the identification of people-centred initiatives to develop a range of skills that can lift them out of extreme poverty  and promotes participation in livelihood activities
  • Practice that preserves health and well-being of families and their community. 
  • Innovative strategies for increasing sources of livelihood       

 In Sub-Saharan Africa, there are an unacceptably high number of children who do not have the opportunity to start school, or who drop out of school at some point. Occupational therapists can play a role in enabling all children including disabled children and those considered “at-risk”, to start and progress through school. The Health Promoting Schools approach is a useful framework for occupational therapists to contribute to the goal of achieving universal primary school education.
  • Occupational Therapy support to children
  • Developing healthy public policies e.g. HIV/AIDS policy
  • Creating supportive environments e.g. teacher support and wellbeing programmes
  • Developing personal skills e.g. life skills for teenagers
  • Strengthening community action e.g. involving community organisations in schools
Re-orientating school programmes and related services e.g. afterschool leisure programmes.
 Occupational therapy in Africa (and abroad) is increasingly embracing the need for a social vision of a more just society to address experiences of marginalization, deprivation and isolation in different contexts. Occupational therapy scholars and practitioners are called upon to be more politically conscious, as human rights advocates in advancing social justice.

Social change areas:
  • a commitment to eradicate the disparities based on gender equality
  • empowerment of women
  • safeguarding women’s rights
  • Support that women’s economic advancement can have on the development of communities and our society at large. 
These two goals are closely related to the health and reduction of deaths of children and their mothers.   Environments that promote early development of children are dependent on social participation and well-being. There is an important link between immunizations and disability prevention. Children at risk of impairments because of birth trauma, premature birth, infectious diseases and nervous system and sensory order impairments are also vulnerable.
  • Targeted occupational-based programmes and partnerships between government and NGOs to reduce child trauma and violence on children in families and households;
  • Access to nutritional programmes and food security;
  • Access to health care and development practice;
  • CBR and other community development strategies to improve access to services, early intervention, livelihood opportunities etc.
  • Promoting the well-being and reproductive rights of women
  • Strategies to improving access to health care for pregnant women and children in different contexts
 Sub-Saharan Africa carries the heaviest burden of disease related to HIV, TB and Malaria, compared to other developing or developed countries. Occupational perspectives of health in relation to these illnesses, beyond the views that are limited to medical perspectives, have as yet not been sufficiently explored or articulated in literature. Occupational therapy practitioners from different regions in Africa have, however, developed innovative programmes and used strategies aimed at helping those infected or affected by HIV, TB, Malaria or other diseases fulfil their occupational aspirations.
  • Links between marginalisation, occupational risk and illness
  • Networking opportunities to raise awareness about occupational perspectives and their contribution to lessening the burden of disease for individuals, groups or populations
  • Programmes to support caregivers
  • Palliative care
  • Early intervention especially also related to children with CP, developmental delay etc
Occupational Therapy has an important role to play in promoting the target of integrating principles of sustainable development into policies and programmes. The profession can ensure that such integration reduces the loss of environmental resources. We hold the potential to contribute since the occupations that people engage in are pivotal to the mitigation of climate change and food security. It is known that individuals, communities and organisations have to adapt their occupations in anticipation of, or already in response to, their changing biodiversity (i.e. the variation of life forms within a given ecosystem or on the entire Earth).
Promotion of visions of occupational justice related to:
  • Initiate or support efforts to bring drinking water and promote sanitation to underserviced communities
  • Subsistence farming and agriculture work including fishing,
  • Energy-saving devices for daily living, and
  • Adaptation of environments.
 A partnership implies inclusion, which means everyone. International cooperation (partnerships) and development programmes should be inclusive of and accessible to all marginalised groups. To achieve sustainable development the active cooperation and participation of all members of the community is needed. National and international organisations in the world community, Disabled Person’s Organisations (DPOs), and also occupational therapy associations and networks have an important role to play in promoting inclusive development. Networking is also of importance for the development of Occupational Therapy especially as in Africa where most occupational therapists work in isolation still having to convince others of the need and importance of the professions and working in under resourced settings.
Find out more @  

Above: This is a Project in Nepal which is empowering people to take care of themselves through occupations, such as agriculture.

Thursday, 11 August 2011

What do OT's have to offer?

Occupational Therapists have a range of valuable skills including;
- Group facilitation and management. 
- Teaching and Learning Skills
- Critical thinking and Problem Solving
- Organizational Skills
- Research Skills
- Occupational View
- Community development
- Knowledge about disabilities and how they impact people’s lives 
- Knowledge about the POE (Person Occupation and Environment) and how this interacts. 
- A client-centred and holistic view ( considering all aspects of the person; physical, emotion, spiritual, culture cognitive and social). 

Occupational Therapists have a wide range of roles which they can fit into;
- Therapist
- Consultant
- Mediator
- Facilitator
- Teacher
- Motivator
- Enabler
- Collaborator
- Lobbyst
- Researcher

Occupational Justice and Injustice

Occupational Therapists enable people to perform meaningful and purposeful occupations.  A core concept of our profession centers around the belief that occupation is the very essence of being human, and  occupation is known to have an influence on our health and well-being. 

We believe strongly in Occupational Justice, that is,  all individuals having the right to opportunities and resources (personal, environmental & societal) which enable them to engage in a variety of purposeful occupations that are culturally and personally meaningful. Townsend & Wilcock (2004) state that Occupational Justice complements and extends understandings of social justice. Additionally it states that as humans we have four essential rights; to experience meaning and enrichment in one's occupations; to participate in a range of occupations for health and social inclusion; to make choices and share decision-making power in daily life; and to receive equal privileges for diverse participation in occupations.

Sadly, Occupational Injustice is seen across the globe, including the Third World. Occupational Injustice occurs when people are barred, dis-empowered, segregated or restricted from participating in occupations to meet their basic needs, find satisfaction or experience well-being (Kronenberg & Pollard, 2005). 

This is a relevant issue for Occupational therapists, who are concerned with individuals or communities that are vulnerable to injustices that is causing restriction of meaningful occupation in their everyday life. Occupational Injustice may be due to unemployment, disability, incarceration, old age and forced dislocation, such as homelessness and refugeeism (Whiteford, 2004, as cited in Christiansen & Matuska, 2006 p. 56) which are prevalently seen in countries with extreme poverty.

There are five kinds of Occupational Injustice

Occupational alienation: “Prolonged experiences of disconnectedness, isolation, emptiness, lack of a sense of identity, a limited or confined expression of spirit, or a sense of meaninglessness” (Townsend & Wilcock, 2004, p. 80).

Occupational apartheid: “The segregation of groups of people through the restriction of denial of access to dignified and meaningful participation in occupations of daily life on the basis of race, color, disability, national origin, age, gender, sexual preference, religion, political beliefs, status in society, or other characteristics” (Kronenberg et al., 2005, p. 67).

Occupational deprivation: “A state of preclusion from engagement in occupations of necessity and/or meaning due to factors that stand outside the immediate control of the individual” (Whiteford, 2000, p. 201). It is due to a widespread social and economic change affecting many people globally (Gail, 2000).

Occupational Imbalance: is when people are un-occupied, under-occupied, and over-occupied (Townsend & Wilcock, 2004).

Occupational marginalization: When the “need for humans to exert micro, everyday choices about occupations” is denied by social “normative standardization of expectations about how, when, and where people ‘should’ participate” (Townsend & Wilcock, 2004, p. 81).

An example of Occupational Injustice is Human Trafficking. 

The future Group (2007) state that the international trafficking of women and  girls (and, to a lesser extent, boys) into sex slavery is the third largest criminal industry in the world, outranked only by arms and drug dealing. The United Nations estimates that trafficking in persons generates $7 to $10 billion annually for traffickers. Although Human trafficking is global in nature, traffickers acquire their victims primarily from developing countries where poverty is rampant, commonly through some means of force or deception.Victims come from virtually all developing countries and are trafficked into or through virtually all developing and developed countries.The number of people trafficked each year is estimated by most experts to be in the millions.
Link Above: This is a informative 24 minutes report with reporter Sam Kiley investigating the trafficking of underage girls into prostitution in India. It's slavery in the most disgusting form. They started in North West Bengal and ended up in the red light districts of Calcutta and Bombay.

An excellent Youtube Video on a woman's account of disability and discrimination:

Christansen, C., & Matuska, K. (2006). Life style balance: A review of concepts and research. Journal of Occupational Science, 13(1), 49-61. 

Gail, W. (2000). Occupational deprivation: Global challenge in the new millennium. The British Journal of Occupational Therapy, 63(5), 200-205.

Kronenberg, F.,  & Pollard, N. (2005). Occupational therapy without borders: Learning from the spirits of survivors . London: Elsevier Church.

The future group (2007). Human Trafficking. Retrieved August, 17, 2011, from
Townsend, E., & Wilcock, A. (2004). Occupational justice and client-centred practice: A dialogue in progress. Canadian Journal of Occupational Therapy, 71(2), 75-85.

Whiteford, G. (2004). When people can't participate: Occupational Deprivation. In C. Christansen & E. Townsend (Eds.), Introduction to occupation: The art and science of living (pp. 221-242). NJ; Prentice Hall.


Monday, 1 August 2011

Poverty-Disability cycle

When combined, Poverty and Disability forms a vicious cycle.  

Individuals with disabilities in third world countries are more likely to become disabled as a result of poor living conditions, health endangering employment, malnutrition, poor access to health care and education opportunities. This disability and the social stigma associated with it, worsen poverty through increasing an individual’s isolation from society and causing economic strain (Coleridge, 2993, as cited in Lorenzo & Duncan, 2006, p. 75). 

Chronic disability refers to those who are intergenerationally poor and also experience multi-dimensional poverty (income, education, social capital etc.).

Life-cycle of a Disabled person in Poverty:

The following is an abstract from a research paper on ‘Chronic Poverty and Disability’ produced by RebeccaYeo;

Disabled people experience discrimination from birth, or from the moment of becoming disabled, onwards. The birth of a disabled child is often considered a tragedy. The child needs more care and may not be considered to have the potential to support him or herself, let alone the older generation, in the future. In communities that are already living in chronic poverty, disabled children may be excluded even further. Where there are limited resources it may be seen as economically irresponsible to give an equal share of resources to a disabled child who is perceived as unlikely to be able to provide for the family in the future.

“Early lack of investment in disabled children is not just a reflection of ignorance. In situations of poverty this is a desperate but rational decision” (Ashton, 1999).

Disabled children often get last access to food and other basic resources. When
disabled children get ill they are often not given treatment but left to the "hand of God". They are less likely to be sent to school (even if physically possible), for fear that: they will not cope; or that their disclosure will stigmatise the family and affect the marriage prospects of siblings; or that they are not a worthwhile investment and others should get priority.

The International Disability and Development Consortium estimate that 98% of
disabled children in developing countries are denied any formal education (IDDC, 1999). Those children who do get education often get inferior treatment, have low expectations of themselves and from others and do not get the support they need in order to participate equally. Disabled children often have fewer demands placed on them, and therefore may learn less than non-disabled siblings even in an informal setting. Right from the start they are excluded from many of the day-to-day interactions that non-disabled children take for granted.

Many disabled children become street children. In some cases, impairments are
intentionally created for begging purposes. Despite the high proportion of disabled
children living on the street they are frequently excluded from programmes working with street children, as disability is seen as a specialist issue.

For all these reasons, as well as the direct result of impairment, many disabled children do not survive, particularly those born in poorer communities. Of those children that do survive, they are at a huge disadvantage as they grow-up having been excluded from formal and informal education. This has an impact not only on qualifications and experience but also on levels of confidence and self-esteem. Later in life, disabled people have restricted employment opportunities, due to discrimination, lack of education, experience and confidence.

If, during childhood, disabled children are not included in the community, then as they grow up, their non-disabled peers may not be aware of their existence, let alone their value and rights as equal citizens. In addition to this a disabled person often faces high costs directly resulting from the impairment. In a survey in India it was found that the direct cost of treatment and equipment for a disabled person varied from the equivalent of 3 days to 2 years income (Harriss-White cited in Elwan, 1999). Excluded from mainstream social, economic and political opportunities throughout their lives, disabled people frequently fall further and further into chronic poverty and have little opportunity to come out of this cycle (Yeo, 2001).


Yeo, R. (2001). Chronic poverty and disability. Somerset: Action on Disability and Development

Lorenzo, T., & Duncan, M. (2006). Practice and service learning in occupational therapy: Enhancing potential in context. New York: John Wiley & Sons.

 Youtube Clips:

This video (above) outlines how the charity Advantage Africa is helping to create new opportunities for disabled children and adults in Kenya to overcome poverty and stigma.

Above: Linda Mwaina of cbm (aid organisation) talks of the issues being faced by people with disabilities affected by the drought in the Horn of Africa

Sunday, 31 July 2011

Occupation and Occupational Need

What is Occupation and why is it important?

Occupation is the engagement in, practicing or performing of a particular action or activity (Simpson & Weiner, 1989). Meaningful occupation is an essential part of human life. It provides a means for humans to learn basic skills needed for survival, find their identity within cultural groups and as indivduals, express themselves and build a sense of community and social standing.

Unruh (2004) observed that doing something purposeful is directly associated with the meaning of one's day and that engagement in occupations that are personally meaningful contributes to a sense of purpose. One of the fundamental beliefs of Occupational Therapists is that participation in meaningful occupation encourages health and wellbeing
(Wilcock, 2006). 

However, it is important to note that not all occupations are beneficial. Participation in  negative occupations, such as crime and destructive activities, can disrupt personal and community life. Additionally, when people try to engage in occupations which are beyond their capabilities this can result in frustration, anxiety and depression (Rebeiro & Polgar, 1998, cited in Radomski & Trombly-Latham, 2008, p. 341).

What is Occupational Need?

Occupational need is when an individual encounters difficulties engaging in their occupations of daily living. Being able to engage in occupations can be influenced by environmental factors (physical, cultural, social or institutional environments), opportunity, education and resources.

Occupational Need in Third World Countries:

Occupational need is evident in Third world countries as often individuals have reduced opportunities to obtain an education and work (fair pay). This leads to lack of quality of life, as these individuals continuously struggle to meet their basic human need (food, water, shelter) in order to survive. Often harsh environmental impacts, such as droughts, floods, and political upheaval have a large impact on individuals and communities livelihoods. Individuals with disability are often the worst hit, as they lack the ability to actively contribute in making 'ends meat' and rely on others to assist with their daily needs. 

How does the Western worlds' occupations differ to developing countries?

The occupations of the western world differ to those in developing countries. The majority of the western world has the money, education, freedom and opportunities that afford participation in a variety of occupations. For example, in New Zealand we have supports put in place to help us if we have an accident which affects our ability to contribute to society through employment (i.e. sickness benefit). Additionally, we have government supports, such as student loans and allowances, which encourages citizens to further their education. 

Many people within developed countries do not have the money, resources or freedom to carry out the occupations that the western world enjoys, such as leisure and recreational activities. The main occupations of those living in extreme poverty are centred around gaining the necessities of life, such as food, clean water, shelter and safety. 

 An interesting article
gives the opinion that; 

"Poverty may be more about exclusion from the rest of society, not about material deprivation. Being vulnerable and invisible. Facing discrimination and deprivation. Lacking the ability to live as a free and dignified human being with the full potential to achieve one’s desired goals in life. Living on the margins of society, unable to participate in social and political life. Lacking capabilities. Not being “part of the system.” When living “outside” of the system, how can the impoverished expect to rise within a society when the rest of society is “part of the system?” And unfortunately, being “part of the system” is a distant dream to many of the world’s poor".

Simpson, J. A. & Weiner, E. S. C. (1989). Oxford English dictionary (2nd ed., Vols 1-12). Oxford: Clarendon Press.

Trombly Latham, C. A.(Eds.). (2008). Occupational therapy for physical dysfunction. (6th ed.). Baltimore: Lippincott Williams & Wilkins.

Unruh, A. M. (2004). Reflections on: "So...what do you do?" Occupation and construction of identity.  The Canadian Journal of Occupational Therapy [Electronic version]. 71(5), 290-295.
Wilcock, A. (2006). An occupational perspective on health. (2nd ed.). Thorofare, NJ: SLACK.