Why should you travel abroad for your Fieldwork? Cultural competence.

By Jimmie Wilbourn, OTS, Florida International University

Why would I travel out of the country for my level 1 fieldwork when I can complete the requirement nearby? Wrong question. Why would I not travel out of the country if I had the opportunity? Better question. Now, I understand there are circumstances where traveling abroad is not feasible. Those notwithstanding, allow me to indulge you for a moment.

As future occupational therapists, we must find it within ourselves to strive for cultural competence on a daily basis. This term is not some esoteric concept that only those with infinite wisdom and understanding can master but rather it is a fundamental principle that we must uphold in our practice as we engage with our clients.

Interestingly, the definition of cultural competence is elusive however, according to Odawara (2005) “it is not only developing the awareness that culture is an issue in health, illness, and health care, but also learning one’s own cultural assumptions, values, and beliefs in order to interpret the therapeutic situation from multiple perspectives” (p. 326). Importantly, the AOTA Code of Ethics (2015) expresses under the principle of autonomy that when providing care we must acknowledge a person’s right to hold their own views, make choices, and make decisions based on their own values and beliefs.

If that wasn’t enough for you then allow me to trek forward with more enthralling evidence. The Occupational Therapy Practice Framework: Domain and Process, 3rd edition (2014) has an entire section devoted to the cultural context, which include: customs, beliefs, activity patterns, behavioral standards, and expectations accepted by the society of which the member belongs. To further feed the cultural competence fire, the Framework states that culture plays a pivotal role in shaping our values, roles and our choice of participation in meaningful activities (AOTA, 2014). Are you a believer yet?

In school, we are tested on cultural competence and the concept is sprinkled throughout the entire occupational therapy program to become implanted into our very being. Is that enough to make us competent and effective entry-level practitioners with the skill of cultural competence proudly displayed on our resume? I think not. To become good at anything we must practice. Which is why I went to the Bahamas for my level 1 fieldwork to immerse myself in a culture different than my own.

There is no doubt that the beginning of my occupational therapy journey will be forever impacted by my fieldwork in the Bahamas. I was welcomed by kind and affable people who represented a culture full of self-expression and hospitality. It became apparent early on that therapy was more than just a service for these clients rather it was a time to make a connection and socialise on a fundamental human level. Even within a time of need, humour and jovial conversation filled the therapy room.

During my time in the clinic I began to notice how the Bahamian culture intertwined into a therapeutic session. For instance, they showed an immense pride in their country and made sure that I was soaking in everything their island had to offer. A client would often share places to eat, sites to visit, or how to manoeuvre around the island on the local buses. The culture seemed to have an underlying tone of calmness and reassurance that time could be embraced and slowed down. Clients would sometimes miss appointments but rest assured they would come by later in the day when they were available.

Additionally, due to space constraints on the island, families would often own one vehicle so it is important as a therapist to recognise the impact this may have on making it to appointments on time. Another key point is that the clients were not passive recipients of care. They were informed consumers that wanted to know why we used a certain exercise, modality, or therapeutic activity. Overall, their attentiveness helped me hone my ability to relay the evidence behind our therapeutic process.

In essence, the power of occupational therapy lies within our compassion, creativity, ingenuity, knowledge, and desire to be a client-centred profession. It isn’t always about how many tools are in your OT toolbox but rather the quality and purpose of the tools inside. Commit to filling your toolbox with cultural competence and reap the benefits of helping your clients achieve their goals. If you need me, I’ll be eating conch fritters and dancing the night away at a Junkanoo festival.

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References

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48.

American Journal of Occupational Therapy, September 2015, Vol. 69, 6913410030p1-6913410030p8. doi:10.5014/ajot.2015.696S03

Odawara, E. (2005). Cultural competency in occupational therapy: Beyond a cross-cultural view of practice. American Journal of Occupational

Therapy, 59, 325–334.