Learning about OT in the Philippines

Today in my introduction to OT class, our professor talked to us (or rather we did a quick report) on the code of ethics and the standards of practice. She claimed it was kind of a boring topic but honestly the whole thing was just kind of interesting for me (more importantly: the standards of practice). Code of ethics kind of just dictate principles every occupational therapist should follow as it is in the rules and regulations.

Standards of practice is the step by step methodology typically followed in terms of treating someone. It starts with the practicing license (that’s a given), the referral (you need a doctor’s referral as a requirement for starting OT), the screening (wherein the doctor evaluates whether or not you actually need OT), the assessment (the OT is in charge of this one, they evaluate the ADL or Activities of Daily Living. This can take up to two sessions as you try to be as holistic as possible), and then the Intervention Plan.

The intervention is then implemented, the community transitional services are offered (integration with the community), followed by discontinuation, continuation quality index, and then the discharge and management. Pretty simple stuff.

OT is a very westernized medical model. All of the key concepts and methods OTs use are actually all from the westernized world. The short history of OT in the Philippines includes propagating it, brain drain, issues with the law as being confused for PT (people assume that OTs massage people, and no, that is not part of our job) as well as still learning to have a foothold in society and be recognized as a need for people with special needs.

In comparison to psychology, wherein Virgilio Enriquez stood up for Sikolohiyang Pilipino, there is barely a trace of Filipino influence on OT.

Our professor pointed out that since OT is basically a very contextualized therapy and client centered service, it doesn’t really matter whether or not we have our own specialized form of methodology in terms of cultural sensitivity or not, during the intervention phase of the standards of practice, we create an individualized intervention plan for the patient, so it’s more focused on being aware of the cultural context rather than integrating it into therapy.

Maybe it’s because of my psych training, or maybe it’s the Filipino in me that wants recognition, but I do hope that Filipinos are able to provide a contribution to the world of OT soon. Our professor talked about a research paper in the works with regards to the “occupation” of Filipinos but not necessarily as a framework of reference (FOR) since OT is still considerably young as a field here in the Philippines.

In my mind, I had visualized a lot of ideas for studies that could be possible in OT. Here are just some of them.

  1. Learning the social norms when riding a jeep
  2. Learning to adapt to Filipino traditions when you don’t like being so touchy
  3. How to talk to people about sex here in the Philippines (in a public and educating manner)
  4. How to approach indigenous cultures with regards to application of OT
  5. A larger presence of OT in the government system for influential decisions that accommodate people with special needs

There are a lot of improvements to be done for Occupational Therapy in the Philippines. The Philippines isn’t aware of what OT can do for it. There are thousands of kids with neurodevelopmental disorders, adults facing newly acquired disabilities whose functions are limited but can be improved, and an entire population wherein psychosocial well being is not a need but a want that can be ignored until it’s too late.

Therapy isn’t considered affordable or even necessary in the Philippines. People think therapy is expensive. It’s a luxury. Only those with money can actually afford to have therapy. Even though OT is part of the PhilHealth card discount, it only accounts for 10-12 sessions. Two of those sessions are for assessment. What can you do within ten sessions? Especially with kids who have neurodevelopmental issues who need highly intensive therapy for rehabilitation, ten sessions isn’t usually enough.

My professor talked about home plans. These are basically intervention plans patients can do at home. But what if the person is not motivated or if it’s a kid, what if the parents are busy working all day and can’t afford someone to watch over the kid and actually implement the program?

The Philippine population is a very young one, yet the government’s educational plan barely spends 2% of its budget on education. It’s tiring, difficult, and all I see is an uphill climb for occupational therapists.

OTs leave the Philippines often. After fulfilling the two year return service agreement, people often find jobs in other countries due to lack of opportunities here in the Philippines. It’s a tiring process. Brain drain is a real issue and there’s not a lot we can do to stop it.

It’s tiring to look at. The uphill climb has barely started. I feel like I’ve taken on this huge responsibility, something a whole lot bigger than me.

But I remember my internship. I remember the kids whose lives were changed because they went through therapy, they went through early intervention programs. I saw how neurodevelopmental disorders could be circumvented. I may not be here to see the future of that kid who will go on to do great things in the future, but I’ll be happy to know that in the future, I’ll be able to change someone’s life drastically, just because I spent an hour of therapy with them every week, teaching them eye contact, social skills, and ADLs.

It’s tiring to think about but I’m pushing through. This is the path I chose.