International OT Day: Occupational Therapy, a science many decades old, but still unknown in Haiti

Wood Guerlin TELLUS ;  Étudiant en 3ème année d’Ergothérapie à la FSRL

Occupational Therapy or ergotherapy  is a science in the paramedical domain that uses activities as the means of treatment for people affected by a physical, mental, and/or intellectual deficiency; or people living in a social context that does not provide a functional quality of life such as a prison or an asylum; or any other person living in a condition that excludes them from society such as drug use, or life as a refugee (immigrant).   Etymologically, the term comes from two expressions: Ergon which means activities or work (occupations) and Therapia in the sense of care or treatment.1   It is, then, a form of treatment which consists of using activities as a therapeutic tool.  Translated from Greek into English as “Occupational Therapy”, it is, in other words, a therapy provided by means of “occupation”, that is to say, by means of certain significant activities that are relevant to the patient in terms of age, pathology, and the context of the patient’s life.  Having said that, occupation, the foundational element, the cornerstone of this discipline, is considered as an ensemble of tasks, activities, and challenges that people face daily, weekly, or monthly, whether in the home, at school, at work, or within their circles of friendship,  religious life, or social life.

The origin of Occupational Therapy (OT) goes back many decades, to the beginning of the twentieth century.  In north America, in the psychiatric settings that were originally called asylums for aliens, specialists such as Adolf Meyer, inspired by a French medical doctor named Philippe Pinel, realized how important it is for people to have something to accomplish during the course of their days.  The mentally ill found that they enjoyed periods of having a break (cessation of crises) when they were mentally occupied and engaged in activities such as caning chairs and working in the fields.  In Europe, the First and Second World Wars gave a boost, with significant growth, to the domain of OT.  Again and again, in addition to physical exercises, occupation was also used with the soldiers who, after war-time, found themselves in a handicapping situation due to amputations, cognitive deficits, and mental illness.  The treatment envisioned a return to society for the soldiers, by facilitating the tasks that they could accomplish in their daily activities.   In fact, the principal mission of all Occupational Therapists today is to increase the autonomy of people affected by a physical or mental deficiency.  The outcome they look for is that the person can live his or her life fully in spite of any particular condition.  It is to help the person to stay functional by having the capacity to do all that he or she used to do before, even if in a modified way.  These activities could be as simple as taking a bath, putting ontheir clothes, going to work, or enjoying spending time with their friends.

Today, OT is practiced on almost all the surfaces on the planet, with a much higher number in Europe and north America.  At this time, in France, there are more than 23 institutions providing courses in ergotherapy ( the French term for OT) which graduate 900 professionals each year. 

Occupation, the cornerstone of the profession of Occupational Therapy…

Occupation, the keystone of Occupational Therapy, the linchpin, is made up of activities:  tasks that have a cultural and personal significance (Palatajko & Townsend 2007).  Occupation, as an object of study of occupational science that comes from OT and supports it, we will understand as a phenomenon, that is to say something that appears before us when a certain person exercises a certain activity in a specific physical, social and temporal environment, with a shape, meaning and purpose that influence each other.   Each day, we wake up with new ideas, things to accomplish, challenges to overcome, over the course of that day.  If life is a theatrical piece, we each have a role to play.  In fact, some will become doctors, lawyers, engineers, and others will become agronomists, secretaries, and so on.  That which we do every day defines, in large part, that which we are: that’s the principle of OT.

Thus, the child must play, the student must write, the secretary must type on the computer, the blacksmith must work on his metal, the elderly woman must arrange her flowers….What ARE they, if one takes all that away?  What are they if they can no longer do that which they wish to do or are able to do? What are we, if we are curled up in a wheelchair or a bed? What will we become if our days, once full, are replaced by days that all seem the same, day after day?  Should we stop living, or even existing, because of our pathology or because of any other condition at all?  The child who is autistic, doesn’t he have the right to grow up in an environment where he can develop? That is the moment for an intervention by OT.  The OT professional must ensure that the person has a certain autonomy in spite of the disability or trouble in question.  The OT profession is about health, well-being and social justice through occupation.

The Occupational Therapist believes that in spite of our losses, our limitations, our societal and cultural limitations, we are good at something; and that we can do marvels because behind each person that we call a “patient”, there is a living being, a truly human being.

Where are we with Occupational Therapy in Haiti?

The first cohort of OT professionals formed in Haiti will receive their diplomas in December, 2019. These three students – Ramona Adrien, Stephyole De S. Edmond, Marthe Gabriel, coming from FSRL (the Faculté des Sciences de Réhabilitation de Léogâne), will be the pioneers of the profession in Haiti.  Added to these, there are others who hold rehabilitation centers in the country including Autumn Marshall, originally of Myriam Center in Port-de-Paix; Dr Ivens Louius of FONHARE in Ouanaminthe; Consuelo Alzamora of FONTEN in Cayes; Ashley Kahila of Respiré in Gressier, and notably Dr Janet O’Flynn, dean of FSRL, the only school of Occupational Therapy in Haiti.  In sum, that means fewer than ten Occupational Therapists for about ten million inhabitants, where ten per cent of the population present with a mental or physical deficiency, according to a report by the United Nations.  The harvest is great but there are few harvesters.  The field is very large. Indeed, it is a compelling priority for future graduates, the Ministry of Public Health and all organizations working in the field of rehabilitation in Haiti.

The profession being little known, or poorly known, the Haitian population does not really benefit from the crumbs of treatment available from the few centers that offer an Occupational Therapy service.  In consequence, after a stroke, which is a common case in Haiti, a great number of persons will become invalids due to a lack of therapeutic care.  More than one will pass the rest of his life totally dependent, until he dies from a strangling lack of occupation. It is common to see persons with amputations wandering in the streets.  It is common that the children with special conditions do not go to school because of a lack of organizations specialized in their needs.  The few residences for very elderly persons in this country do not have any structure to offer people a way to stay functional. Doesn’t it bother any of us when there is nothing we can do?  Do not we envy those who have all their strength and enjoy life?

 Doesn’t one have the right to earn a living, despite his situation?  To re-state the idea of Socrates, “Work (occupation) keeps away three things: tedium, vice, and need.”

As Frances Leclerc once said, “There is no better way to kill a man than to pay him to do nothing.”  We are made to interact with others, to move, to accomplish things, and finally to

live, and by “to live”, we mean to be able to wash, eat, drink, dress, go to work, go to a book club or dance, come back home, and go to sleep with the feeling of having tasted happiness.  After all, are we not human beings, endowed with intelligence, with capacity, and with the determination to exist on our own? “Occupational Therapy (is) a thread which lets us sew together our life, according to Nicol Korner-Bitensky.




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