By AYAD Thomas Bevitt

As an Occupational Therapist I thought I was all about inclusion, open minded, optimistic, seeing potential; even thought I was pushing potentials with the people I worked with.  I  was taught a huge lesson today, have I really been doing this or have I been creating disability.

I graduated over 5 years ago and have been working with people with disabilities for the past 3 years.  I recently took up a volunteer position in the Philippines through the AusAID funded Australia Youth Ambassador for Development program (OT Australia is a partner of this program, and it is worth looking up).  Simon of Cyrene is an Advocacy and Community Based Rehabilitation center for people with a disability. My project is to try and assist Simon with developing early intervention training packages for the staff at Simon to use in teaching the community workers how to provide “therapy” to children with developmental delay and disability within the communities.

We recently celebrated Simon’s foundation day.  Foundation day is a community awareness activity,  while acknowledging and celebrating the beginning of Simon, over 28 years ago.  This year they chose to have a sports day with the theme, “Magkarawat Kita Gabos”, “Come lets all play”.  There were over 200 participants, from 3 years old to 40 + years old.  There were labels everywhere, “that ones CP, that one is limb deficient, oh and she is deaf, that one is intellectually disabled”. Every label was represented at least once.  We played tunnel ball, hacky sack (with a bunch of loose rubber bands tied together, worked a treat as it was a slower movement compared to a ball), pin the tail on the water buffalo, sack races and a number of local games.

Interesting, the labels faded very quickly and soon were no where to to be seen.  Names, people and personalities not only emerged but were celebrated.  Everyone participated in everything; where had the disability gone?  There were tears of laughter, loads of smiles, participation, excitement and what I found most interesting, the abundance of confidence to just get in and have a go, no matter what and with absolutely no fear of failure.  I had not experienced anything really like this before in Australia, and it got me thinking, Nata?(why?)

Who, what and how is ‘disability’ created? Because from what I have just witnessed; these people may have looked different, walked different, may not have heard or saw the same as I did, but they were in no way disabled...at all! Who is creating the disability label and placing it on the person.  How did the disability just disappear like that? What were they doing that was so different?

A fellow volunteer and mentor of the program helped me to challenge these thoughts and questions.  If someone says they are not disabled - however they can't hear, then are they disabled? or just impaired.  How does this label ‘disability’ affect a person compare to impaired?

Simon works very hard on first raising the confidence of the person.  They hold workshops that highlight the persons strengths, not focus on what they can’t do.  It made me reflect on the Australian health systems and question, does our systems really create empowerment for people or does it create a dependence, and more disability, due to its focus on ‘problems’.  While I can not answer these big picture question or change thing on a large scale quickly, I surely can and have asked myself these same questions.  Am I affording empowerment or and I affording disability though my ‘therapy’.  How can I ensure that I empower and build confidence not create more disability and dependence.

With OT I especially think its about utilising the abilities of a person and thinking outside the box for 'intervention' or 'rehabilitation'.   I feel that we loose this sometimes, with pressures of wait lists, high caseloads and a mentality of right, ‘how can I help?” It is through this that we loose sight of the persons true abilities as well as their own strengths to be creative and problem solve.  Today, I saw a 7 year old boy with bilateral upper limb deficiency (above elbow), and leg length discrepancy of 20 cm, walk the full street parade of 2 km, play every game, draw an amazingly detailed picture with his toes, and eat independently with his arms; no adaptive devises, fully independent going for it.



The creative genius of the person really shone today, and focused it for me, how often in the past did I underestimated it, sometimes allowing the professional v’s client power relationship to over take.  The person is the real expert in themselves and are so cleaver in figuring out how to modify activity and environment something ever so slightly to enable participation.  It was great to see the kids with vision impairment, play ‘soccer’ with a tin can with a rock taped inside the can, so that everyone can see the ‘ball’.  It really re-enforced my role as a sounding board and creative thinker to a person, and not the ‘professional’ or ‘expert’.  How important it is to empower, not to do. Today it really emphasized to me, being an OT is not necessarily about making things easier but possible.  The young boy was putting in a massive effort but was able and passionate about doing the things the way he was.

Some of the communities we go into we get stuck on the idea of 'rehabilitation' being to make someone normal - eg if someone is an amputee we may ask them what they need and they'll say - Money, for a prosthesis.  However this person may have had no leg for 10 years and gets around fine without a leg - works in the farm, feeds his family... performs all his occupational roles, however its the community that needs the rehabilitation (to their way of thinking and limiting someone with no leg) and actually all he needs is some adaptive techniques on how he can go about his ADLs to reduce the chance of secondary impairments. We need to look at the functional level of the individual and focus on improving function within context.

As OT’s should we really be looking at changing the person, maybe the person focus should be about building confidence, and our focus should be more on community education.  This may be old news for those who have been in the industry for longer then I have, however what I really would like people to think about is, am I really being a true OT, empowering and making the disability disappear or am I adding to the disability.