sie" | The Kawa (river) model: . culturally responsive occupational therapy without borders overview The essence of occupational therapy is simple yat potentially powertuk to enable people from all walks fife engage or participate in activities and processes thathave valu. Theforms and meanings ‘of euch activites and processee ~ or what many ‘occupational therapists situated In industrialized ‘countries rote o a ‘gocupatio’, wil vary from person to person and from context to context. Our ‘hents! oocupational narratives ~ each retlocting ‘lifferent constelation of shared experiences ‘ot in tina and space, deserve occupational {therapeutic responses that are culturally safo and honor divereity. The river metashor on which the Kawa model is based, isa promising medium for “dwvorse cients to express their dally ie naratves. Over the past few years, the Kawa model has, steadily spread wherever occupational therapists ‘seek ealutions to challenges of diversity and culture {in the broadest conse}. A series of short case Studies collected from occupational therapists in diferent parts of the wortd are presented in this ‘chapter. The cases onor tho complexities and ‘challenges of culturally responsive occupational therapy, and offer an ateratve to conventional universal epproaehes when occupational therapy is. practiced within and across cultural borders. Introduction ‘The essence of occupational therapy is simple yet potentially powerful to enable pebilefrom all walks fife engage or participate in actviseid processes ‘thathave vai (ema 2007). The forms and meanings ‘of such activities and protsses~ or what many West- fem occupitional therapists refer to as ‘occupation’, | Michael K. Iwama Hanif Farhan Erin Hanrahan Avital Kaufman Alison Nelson Neha Patel wll vary fom person to person and from context tocontext. Our cients’ occupational narratives ~each reflecting a diferent constellation of shared exper fencer set ntime and spc, deserves occupational ther peutic responses that are culturally safe (Ramsden. 1990) and honor diversity. Many occupational thers- pists may find this to be elusive if they apply theory {2 colonial manner, Faring thee preferred fame- Works and models ‘of occupational therapy onto tered cents (Iwama 2005a). Clients in such predi- ‘aments may find thee ocospatonal saratives forced ‘through universal or standardized sets of concepts and principles tht were orginally constructed on someone else's (unfamiliar cultural ray ‘Calturlly responsive (Mlance 2007) occupational therapists practicing ecross cutwtal boundaries may ‘eventually discover thet they cannct simply brig thelr ‘unuel ways of knowing and practice int ther sociocul= ‘ural contexts and assure tht these wll apply univer- sally and equitably. Despite best intentions, doing so rey disadvantage end, in some cases, be disastrous. Some may find, for example, that the largely hidden Norther end Wectem sociocultural values around individual, egocentrism, and ableism, exercised in mandates for independence, autonomy, personal causation, ete, are problematic, if not dissbling ‘And they may discover that such problems are not isolated to tome aor clients in some other places, Ducthet they can actually exist in ther own domestic ‘contents of practice. The challenges to equitable and ‘culturally responsive occupational therapy exist in our ‘very own communities (Iwama 2004) and contextsbf,.v 31 daily living as much as they do elsewhere ‘The key to culturally responsive.ond equitable cceupational therapy:prectice without borders lies ~ iPractcos Without Borders in cultivating occupational therapy theory and prac tice to meet the requirements of diverse ccntele in diverse places and time, rather than cultivating or forcing the client to meet the requirements of con- ventional occupational therapy theory end practice {(lovama 2003). In this chapter, applications of the Kawa (river) model demonstrate this therapeutic dynamic of enabling diverse occupational therspy cll- ents to cultivate a comprehensive understanding of their occupational requirements in their occupational therapists. This isachieved through a bsie metaphor ‘of nature thac uses the image of river and is pets to translate end enable cients" occupational asrative or the lif flow. Clients ae empowered toexpress their ‘occupational lives in the context of their day-to-day realities, in their own words, from their unique cul turl orientations. And just af the natural elements of acver flowing, suchas wate, wall, rocks, and drift- ‘wood, cannot be realy separated and viewed in iso lation, the client and occupational dimensions of ‘heir daly contents of living are appreciated through the Kawa model in e complex, holistic, and inte- crated way (Iwama 2006%), (Over the past few years, the Kawa model (Iwama 20058) has steadily spread wherever ceepatinnal therapists seek solutions to challenges of diversity and culture (in the broadest sense). A series of short case studies collected from occupstional thera- Pists located across five continents fellow. The cates hhonor the complexities and challenges of culturally ;ponsive occupational therapy, and offer an aterna- 0 conventional universal approaches when cca ational therapy is practiced without borders, A sungai (river) flows through rural Malaysia Hanif Farhan, occupational therapy student, National University of Mataysia (Universit Kebangsaan Malaysie), ‘Kuala Lumpur, Malaysta Ms Aini, «21-year-old Muslim woman of Malay eth act, lves in rural vilage in northern Malaysia with her older sister. She was self-admitted to a mental health insivation and fas been an inpatient for a month. Her psychiatric records revesled that she had previously been insttutionalized bver 10 times since the age of 13 years die to borderline personality disorder. During previous stays in the hospital, 258 she was observed to frequently quarrel with other patients. Furthermore, she would also act out from time to time, striking her head against the wells of hher room, In order to build therapeutic rapport with ‘Ms Ain’ and conduct further assessment, the oocypae ‘ional therapist planed to run an at activity during an established weekly group session in the ward The sessions ‘Six patients were selected for the group session, After some warming up and ‘icebreaking’ activities, the patents were asked to draw diagram of When possible, patients were encouraged to make the river symbolic far how they thought their fe was going ~ or flowing. First, exch component of the sungai (river) was briefly described using the simplest manner and language such as ayer (water), ‘bat (rock), kay hanyut(drftvrood), snd dasar su. ‘gi (siver bottom). Thea, the therapist proceeded to relate those metaphoric components with real-life situations based on the basic phenomena stressed ‘within the Kawa model (Iwas 2006a). The patients were then enrrragad to briefly talc about tele own drawing while the others were pereuaded toatk ques. tions about it. Although she did not talk rouch, Me Aint was able to complete her personal illustration ‘of her own river with some rocks embedded within to symbolize her ‘dark history” (Fg. 27.1) After the group therapy session wae finished, the ‘occupational therapist decided to carty on with an individual session with Ms Ani. Agua, each compo. nent ofthe river was briefly described, but in a mare practical approach. During the explanation, the occu petional therapist drew 2 Kawa diagram of a long, flowing river to describe the personal history of the potient ine psychodynamic way. Each sigaificant Fig. 27.1 «Ms Ari's personal tution other mir Fock yma te “dark toes) + Senaly sist + ator sie + Seat eraage mand ot cet ath tin oy + Bid and cals ‘eazy becasn ct esenaeare er eh bine + See fave 73 Fig. 27.2 © Mis Ain ite Fou. life problem Ms Aini had reported was illustrated as obstructions made up of rocks that impeded her life flow. The petiant became more talkative and used the word ‘batw’ when expressing her majo life pro- blems (Fig. 27.2). Finally, che occupational therapist Tre Kawa (iver) madet ( dew motes ernest view ofthe Ka di gram, particularly focusing on Ms Aini's present life flow (Fig, 27.3, Teble 27.1), Collaboratively, the patient and the occupational therapist proceeded to name and ascribe 2 value 10 each of the Kewa ‘components Conclusion After the nal assesment using the Kews model, the cccupationa therapist andthe patient. could snutually devtfy the actual problems end plan for further asesiment and intervention, A plan for Ms Ain to focus on here and now Gaining, peycho- educational support and realty testing wing 2 coga- tivebshavioral Famccf reference, for example was mae possible by aprecing on outcomes tsing the Kava framework Soil end interaction sk trai ing was als auggested bythe occuptional therapist ‘AS Muti, Me Ala lo sid she wanted to have Spiritual eounselng. Her cxcupational therapist hen could suggest that Ms Ail prticipate in spiral fctivites overseen and modereted by the lnttu- Son sical peychologe, "The Kaws model no oni applicable aa theores- A farework in Malay oetpainal herpy co texas by emphasing crowe-cokural sensi, but is dio ecstasy of deeming posible sin for any occupstonl condition, The Kowa Model is provingtobea lent fend femework-amodel that ke caer to achewe the therapeutic elation | posites aaon ina Fig. 278 « Crose-cecional vow of Me A's present Kawa concn. Cop thPractices Without Borders ‘able 274 Ms Aintsnaratve based onthe Kawa concepts wa concepts (Ghent centered issues (Ganasa molayu~ Engst) tyros From te eat tages of here, the nag of see tus eae te mo neste keumotne inpicatg arr aston os A’ fe fl Th, se clans had hasge hr pereptrs abou ren fe the wos. Tio crcl psu of hrm oath cian, borden paronlly dsr, pests ansher ge ack. Ti at expressed tical ns A's case a: upedcbe behav, s-seb) — hich lsu har neal, Sh lo read tt when she was wt fe sca commany, ‘ced a sg of a Tua paren’ beau of hein of runes arisen io & ‘rfl heath tation Doser sunga verbatim ard Fay ‘steal Patent win into Comma ~ ncn si ‘ay harp ation Wola to canoe ‘Atle tort an ‘Wrenn ct, easly its aecus and cores alm ten isiering osu eta easing ed “Ayer conan fo beouph the bron ng te ter. Kay ae lyre asi ‘ening th vm of ning wae. Tha aim of espera rap io fect ive efecto te au ant change aré open te beacon ina way hater Us A's 5) wl ot ae eet “ayer war ‘movies, and reading. Regarding her medial history, she reports that she has ‘general diceases ‘Tae Kaws model was used as an organizational framework of Veronica's ife and occupations. After Avital Kauffman, occupational reflecting on her ie, she made a digram of two v= therapist, Santiago, Cnto rs. The fist one was about her childhood, when she c hada happy hfe in Hungary with her family. Ie wes 2 Veronica, a Jewish woman of Hungarien heritage, quat river, where she could play apd shee. The sec cunrentl resides in Santiago, Chile, Sheisa survivor ond river wasaboute very dificalt stageat her if Ta of Auschwitz and the Holocaust, which resulted ina 1944 she and her family were deported to the con sumber of long-term lleses and daily challenges. centration camps of Nazi, Germany. She went to Her case provides a pecspective on the use of the Auschwis At this juncture her sver started to get Kawa model, which originated in East Asia is largely bigger and turbulent ~ general condition that cane tunknown fo South Americ, end its potential in cinues to this day (Table 272) cesupational therapy processes without borders. On anclying the information, we can see thit ‘The occupational therapy interview with Veronica there wes a turing point in Vertes’ Ie, marked Sek plain esha Set by the onset of the Second World War, and her su /eroniais 77 years old she is the second of four _vivel ofthe Nazi concentration camp. Another ign. ‘others ard estes Her huhend pasted away inant time that Verona repated waste sale 1999 and she les by herself, with her mid, in an hardships and traveling she had to endure ater the apartment in Santiago, She has four children, qne__war,-vthichInclydedher aval in Chile in 1946 of whom has ben living in the United States Thesneyents produced acadical change inher river, America sincej1981, Tecay,gher family consists fin herjvay of ving, and inher vision of Life: Tho 23 ‘members, She always has been dedicated to seen i the health aes, cause she considered hee het farily and the home. Herhobbiesinclude travel, disese states ike elements that impede her if low, A folyo (river) flowing through and beyond Auschwitz 260 “The Kawa (river) mods! 212 Veronica's foyo 1a awa concept ‘iont-centerod issuce (Spanish Engst) pecs ko erie dos nlf mucho the presence of sk, Se dseibes ue ver, hen er fly wast 1 Tas Pras aa ‘Sho YW, Tha soto of hr fry alr ha Seord Wer War was 2 stan | ror ecoats far. tig tip she eleone which allwed ero conmuntat.Faly 1s inporantto hes she malian oxcaert ranships wah fey manors ard decens were taken : toga ‘a= aod (C) Road paoones atts fer peomance (4) Hor copy to in er tai an to et al th eaios agus wate er ows snfr ote erain aif whan Bo Second Word War basa, wih igs and lw oer if xparorce tater ho o adap aaa toe. Ts aleve tw wth fever stale. ‘Osepatenal py canbe ied to nd a how asa ait er We + Excurgeert fhe conn of sil acts arte use a leave way of conmuicaton + coating wt spore fly stg, on pt’ dates, fxs. + Loskng erent ways to fae hea robes, he able to dongs eter depend scorn har rlrocas| + Coating to th conity oie i witout stale, end sty pazonal nes ‘Tagnas— yar bateen| esis bout she did not talk about them in this way. obstruct her life flow and which may be resolved Veronica's flowing river is representative of her We canalso think about ways and actions to improve capebilty to continue, hee religous faith, and the the free flow of her river such as strengthening fam- support of her family end friends. The mest impor- iy relations. The Kawa framework enables both ci- tant ching in her life was to be with her family 2nd to ent and therapist to explore occupational therapy see them happy. uses that aerelevat and contextually mening fal tothe client. Comment Anadi (river) flowing calmly ee " c Meet eeiectehickaceedony epee, and deeply in Mumbai seven chaged erie omsnelneetiy, tas oem gave her the impetus and strength for a better lifeand Neha Patel, senior second occupational hope down-river. She started life again inanewcoun- 7 st, Willesden Cenire for Heatth COplad sony and proceeded teehee ter, ‘Porapit, Wllescn Ca to rages OPH eon. Tes nel ang fer cen and stg car of er hands whe Tsay was once te Mamba, Indl, as 0 ted Alberner dae mans dae dasraton projec ‘Gen trast, woud Veronica need occ. "Dstt yearcldvered medal clege posonl ray neem” Tae Rowe model legurr At thderhothis fis ff Oyen (tas tenon tanto cn aie need wh sand ea er dea patito unl face” Ma In Ts second fe wa ess ear See yet ines dtnes? rr edtal cre 'm Mumbas De Shar ad life’ and sociocultural context into foctis. In Veroni- two sons and a step-daughter. His children were =>. ave morte we Sn eco cements marie ed eed oresPractices without Borders ‘Dr Sharma ha his fst stroke sx years ego followed by two strokes within a six-month ioterval. These resulted in flexion synergy pattern in his right upper limband an extension synergy paternin is ght lower limb. He was no walking with oe stick under super- vision. He had privately employed caregivers to assist him with personal and domestic activities. His wife took ‘core of his meals and his finances (paying bill etc). He has no speech problems and his cognition wae intact, In the broader study from which this ease was avn, the Kaws model (Lim & Twema 2006) was used 25a framework to assess the effects of sociocul- ‘ural factors on quality of life of elderly etcokesurvi- vors. Two semi-structured interviews were caried ‘out with 2 one-month interval in between. Perhaps having been a medical professional, Dr Sharma could articulate his health, wellbeing, and quality of life with clarity, Table 27.3 cepresents his quality of life and life flowin pat, present and future, Summary ‘The Kawa model was seen to hve an immense potential to explore Dr Sharms's own perception bout hisiliness and issues th life poststroke, Through disgraramstc illustrations, Dr Sharma's occupational status was easily under ‘ood by his family members, Moreover, Dr Sharma reported thatthe Kawa model had helped him to be more aware about viewing his life course and his ‘rehabilitation needs, In addition to physical and functional factors, the Kawe model framework used as an assesment tool helped the occupational therapist to explore socio- cultural factors suck 2s: praying to God, keeping « positive attitude towards fe, trying different things ‘of interest, friends and family, support and encour agement, and participation in making clinical decisions ‘A contributing factor toa person's health and well being according to Westeen concepts is Becoming’ through ‘Doing! (Hassekus 2002). However, ones accountability to one's social relationship is more important in the Indian culture. "Belonging! rather than ‘Doing’ becomes an important matte of iden: tigy and meaning as described in e collective frame of reference, rather than throvgh an individual introspective’ process. In Indlan society, where elderly people are not ss actively productive, dane Table 2733 Dr Sharma's occupational therapy assessment results based onthe Kawa framework Kawa concept Chant-cantared issue Pecks Dosen a is yl cts of ay hing ADL) do ose Spd inperonalreaonsip wath srs — vo are nto ting ene wi i Hs sap daagt's mal robles. fe Yost anunappy’becaao i wo was npn adhe ced 0 al is fay tes Fier sid-wals and Ws ilo was very sppaive toto ison fat n Go and rapes Hone pues cz ar wma nebo epee pon! Ronit, yer, apd ec aie sa Tooele: dee tang wh is eta peso an cher patents atone (ls nite ad ety are [-) Hs tenpuament ang because th stoke ant dependency on eveyig lef hm stated (ome wang wit sek (2) sfal’s tances; euned many poets in Jao ay neta) affected his quality of Water "ise const to ow i tanta vee as is SOK ar Tnetonl cancers rfwoed (22 abc), an his sil ys envrrment ater was ot owing but a ese ect, Ureugh he eck ard cope bund by the etches ng compen nO Sharma's er Pete ecipatona eray treater synachs and ports of iene Be gaps and are eogh wich wae ey cues me Wat to ne pee sce af he ries 202 Gast and gs {simportancbut may not mean rauch when separated from the social context in which it aceurs and from which meaning is derived. Humans ate inseparable from nature, society, and deities (lwems 2003, Lau et al 2003} Alison Nelson, cccupational th therapist ‘and doctoral candidate, University of ‘Queenstand, Brisbane, Australia Jacinta is an 1-year-ld aboriginal Australian who lives in an urban setting with her aunt and her aunt's partner. Jacinta's older and younger sisters, two younger cousins and an older cousin also live there. Jacinta uevally slept on a mattress inthe lounge-room 45 there were aot enough bedrooms for all the chil- dren. Her mother lived approximately 300 miles sway duc to er partner's living stustion. Asa baby, Jacinta was ‘given'to her other aunt who was in @ same cex relationship ond che was raised by the sunt forthe first four years of her life, Jacinta had lived with her mother previously and expected she would be living with her again in the near future. Jcint's sum and aunt were both unemployed. Jacinta wasin Year 6 st schol Application of the Kawa model River side-walls (environment) “When esked about those aspects af her environment that helped her be active and healthy, Jacinta iden- tified that she hada trampoline in her backyard and that she lived close to » pool and a park. She also noted that she was able to walk 0 school from her hovse and played soccer, cricket, and touch football a school, as well as swimming and running, Rocks (problems) sdacinga noted that her biggest problem was stress “concerning looking after her younger cousins and her younger sister, who has a tendency to get into The Kawa (river) mods ee te trouble regularly. Jacints also identified chat eating junk food made it more difficult to be healthy Logs (assets and liabilities) Jacinta generally viewed ‘logs’ as assets rather chan labiities. For instance, she recognized that having her older cousin help hercate for her younger cousins relieved her stress. She also aoted thot jumping on the trampoline was major source of stress relief ‘Another lag wa unk food’. One way to avold junk food was when her mother cooked healthy meals for the family. "Mumm when she makes our dinner; she ‘makes healthy salads and everything heathy’. Fish (relationships) and eels (bad social connections) Tk was at thi point in the conversation thet Jacinta really appeared to ‘own’ her river. She asked if she ‘could add fish to her river end identified thet these could be relationships in her life that helped her (ig 7 4) Torin vdetifiod some Ferily morhere and friends t school as fish’ who were able to sup- prt her and help her with looking ou for her youn ser sister. Jacinta next added eels to her rver stating that these were bed connection’. These inchided ‘other people at school who she fele made the situs ton with her ister more dificult. Sometimes people whom she felt were fish’ could alo be ‘el Flowers [Next Jacinta drew three flowers in er river to ‘rep sesont something that's wonderful in my life’, These appeared to be significant life events that had an overarching quality 0 her life. The first of these was when she was reunited with her mother atthe age of 4. The second ‘flower! was when Jacinta ‘was reunited with her sister Nicole, Tescomed thet despite the difficulties shehad artic lated earlier with helping Nicole a school, Jacinta ‘was eto identify the imporcance of this eationship in br life. This was also true of lcins's view of her family, that even though her life was complicate by faraily, the benefit of having family was greater. “The thing that took monof theses wy jus having a arly 2st hog ike my ster and my ema tere to fle 0 yea‘There's a park up the road svimming Walk to school Fig, 274 « Jacit’e craving of he ver Conclusions ‘Using the Kaa ede! appeared enable this you aboriginal tenes er Supine meanighl way Her eenson ofthe model sages hee tresged ready with the metaphor of the shee The tse ofthe Kove model provid Imports inkemton bern omen ander ep sions of acts. eas sont thts ont ed ratonships (sod ene bad) te cent fo hes heath and welling, ‘The finings sugested thee «> improve Jacinta helth or ince er erga tment in oespation, any fateretion wl ed {© fst focur on stenthning her reo aetied stress levels. faaee ne "The Kawa model hes potent tobe cu sfe. The cppomnty tallow ths yong pl sorry lige wether we, 8 8) cere speed tobe key In ing a true tindérstariding of her context and the way Which se ened Re fe, nS Te wa 264 Grin Hanrahan, occupational therapist, Class of 2009, Program in Dooupatonal Therpy, Univeral of Minnesota, Mimeapots, USA University of Minnesota Occupational Therapy ‘Commencement Ceremony - Excerpts from the Stuclent Address, 13 December 2008 Today i day for us all to celebrate together. And 2 ftcng tha ge arevatered today i this beautfl space o¥elooking the Great Mi River (ge Fig 275), te A [omy] In one of our courses (we) explored various theo retical models in our profesion thot. inched ‘writing, and thinking crtcaly about. the Kews Iodal, According tn the Kava model, Ife is lke a fiver, owing through time and space. Wellbeing ‘occurs when people livein harmony with the cireu- stances in ther life and their iver flows, unimpeded, ‘ven inthe face of strife Foc the past 16 months, my classmates and Ihave shared 2 journey together through this Masters in Occupational Therapy program. fa many ways our Journey can be compared to the river in the Kawa Model. The flow of the water inthe rivers affected by the river wall and floor, the rocks, and driftwood. “These are all metaphoric elements of the Kaws Model and they canbe used to ilustrats ur exper ‘nce in the oxcupational therepy proeram First there is the River Wall and Floor. In the Kawa model this represents the social and physical ‘environment. The social environment consists of people ~ and i's the relationships with classmates that have made this program memorable. Our men- ties include los of lbs and studying together, espe- tilly for practical exams. ‘Asone of my classmates shared in wiki for one of cur coures, ‘Although we allem tobe very dffer- ext people we really banded together to get to the ond’ “Thisefiect@SBF our sense of interdeper- ‘encesnd he importice of the River Wall and Floor Pour success. Fig. 275 « hail view of tho sss! rer nies, near Minesota, one day before the ‘gatluaton carerony. Px bil ‘And there wore also Roc, In he Kaw made! Rock represen prblens or dificales.. Rivers tnd peoples ves — have socks of saying ze, Shape, snd eumber. Thee have been pele ned problems ond ich ger one, Diels hove io urrounded ine raogement, nd pole have teeded to mate tough ches regain precies ter the pat four semesters. Ad thee his Been far such a before the paca exminstionean ster forme tests And some casmates have las Ioved ones before ad dsing the progam. The Rocis tave feted us jot we ae ee ete te oes reeset “Ad then theres Driftwood Inthe Kaa model duiftwood represents Asus and ble. Sily fut defewood i our personal character and the Fecal sie hat each of ue poses. There ate Meany cramples tht demenstne the character OF nda in che Ce of 2009, Ao ws have spent tre srs and ot lest 72 our each, iting iveied with communisy onieons. Tht Ince planniog and cffing Core vets, Parl sing with the Rebulng Tosther organization orig with the Kils on 2 Wheels Be Camo. Da volunteering in many other groups that sere people with dsbiites Ditovod lo represented by ou rong com anitent searing Aorene sare ins wi fo one of our courses, ‘T have so mich respect for t Jigh evel of work tat my cstates pit echPractices Without Borders class and it has been an honor to be 2 parc of his froup’. This comment speaks to our cheracter. The ‘Class of 2008 i filled with compassionate, dedi- cated, bonest, sincere, and hard working people. So it is the River Walls and Floor, Rocks, and Driftwood that give shape to our river of lif. The river runs through time end space, and there will be tines when the river has some rocks snd the eur rent i rough. And there will be ather times when the river is rushing mightily into the future ~ such fs gow, as we are ready to embark on Level Il fieldwork. T hope you have eajoyed reminiscing about our journey together in the river. Let us not forget that the Kawa model was inspired by occupational ther- apy practitioners who realized that carrenttheoreti- cal frameworss were out of eyne with their clients life experience. The Kawa model was developed ‘ut of courage and out of leadership to see new ‘connections between theory and practice, to chal- Tenge the status quo, and to create new explanations. challenge all of us to display such leadership in cour future careers, We wil leed in different ways Some will lead with their kindness and optimism, Some will lead sith their Knowledge and exper: tise, Others will led with their laughter. We need all types of leaders to address the great challenges faced in today’s world. Leadership is difficult to deseribe, yet eany to see. Leadership isnot always ‘on your résumé, but ft remains in the hearts of those you have inspired, Let us use the knowledge gained ‘uring this program, the strength from our rock, and the character of our driftwood to shape the river of cour future, Thank you and good luck! References sets B The Moai of Every ‘Geaipaon, Thora, New Jes, 2002 Sac Ine tama Mt The ve is. toward ‘ularly sleantepstemalge in ‘ccuponltheapy, Ane] Ossap ‘Fer r217-225, 2008 tama Mi Revising etre ‘czupuonal therapy reser; 2 meen endewrour, Option ‘Therapy Journal of Research 241-2, yg Me Styl meaning an sue of 7 219-227 Ce erm Iman Te Re Mode Cl See a Sa, Ramon Octo! Tarr Fay en Cha Cinco 22 ‘herapy. In KooneabergF, Algo SA, Pallrd Neato: Oxvupatonal ‘Thera With Border» Leeeing ‘Thyogh the Spit of Servier, sidurgh, 2008s, Beie/ Churchill vingstone, pp 127-139 Iams Me The Kava (ves) mode; ‘tut, fe flow & the power Feary relent ecxupationl Chery Ta KoseabeeT, Apdo SA, pp 84-53. PoleedN,eators: Occupation! ‘Therapy Who Borders — Laarng hh th Sp of Swoiors, Een, 2008, 2004" Ehevier/Chureil Legon, Conclusion Occupational therapists practicing and learning across diverse cultural spaces are finding the Kawa ‘model tobe useful in a number of way; as « mental framework to help organize the client's oaxupational jsnues in client-centered context, 28 an essessment tool, and as a modality of treatrent by itself oF combination. The client can be a single person or 2 group, or even a process. In al of the vignettes, how: eer, the occupational performance issues that the ‘model helped to illaminate transcended matters of ‘medical pathology into the dynamic realm of client daily Ife conexts. The case studies demonstrate the flexibility and ability to respond to end appreci- ate the needs and experiences of people from all ‘walks of lf, across diverse contexts. The Kawa met- sphor enables both therapist and client to examine the client's ife low retrospectively, introspectively, and prospectively. Its @ novel approach in occupa ional therapy that views the whole person(s) integrated inseparably in context and yields a wide srray of occupational therapy possibilities nd inter- ‘ventions that will potentially enable the cients’ life 1 flovr more Filly nd powerfully. This apter was devoted to briefly demonstrating Some practical sod ‘potential applications ofthe Kawa model ina variety ‘of cultural contexts. More information and literature ‘eating t0 the Kawe model's theoretical and philo- sophical underpinnings can be accessed in greater detail in growing numberof publications and inter- net resources. For further informatio, see the Kawa model website (htp://www.kawamodel.com) waa Me The Kawa ee) mode ‘Cent coved sehabitation In ‘ul eorex Te Dati 8, ‘ctor Reka The eof Tearis and Model in Pracee, Oxford, 2005 Elsevier, Iwata Mé Care and occepetonal ‘heray: meeting tho challenge of ‘slennce in bal world, crap ‘har ie 183-187, 2007. Laud, MeKensa K, Chan Commins ‘Defining eat of ite for Chinese diel ska survivors, Disabil Rehab 25656-711, 208. Lum Ki, bra M: Emerg mele ~ ‘a slon especie te Kwa er] rode tn Duncan, eer Foundation for Practice Ocsupatonl Therty, ed 4, inburgh 2006, Chisel Lingstamt Elser, pp 161-109. ‘The Kawa (iver mode! Manat: Catt respeasive caring ia Raiden I: Kass Whaararaas cecupstonl therapy. fo wane M Cau Sty in Nrsng Becton cits: Spectr on Cato aad tara Report othe Minny of Genipational Therapy: Oscsparional Esheaion Welton, 1930, ‘Therapy Intereinal, vl &,2007,,Miaty of Eau. 1p 236-280.| Human occupation as a tool for understanding and promoting social justice’ Gary Kielhofner_ Carmen Gloria de fas Heras Yolanda Suarez-Balcazar OvERVIEW ‘This chaptor discusses how the Model of Human Occupation (MOHO)} can be usedto understand and address social injustice. It highights how ‘oppression can be internalized and reflected in persons" voliion, habituation, and performance Ccpacity. The chapter presents strategies for empowering individuals and discusses how these trust be coupe wilh earloltemesserent a tnvironmental realities and possibilities. Guidelines land case examples llusirate the potential ways in which MOHO can empoxter individuals experiencing Social inustice and contribute toward structural change that begins to reverse the processes of oppression. Introduction ‘The Model of Human Occupation (MOHO) was Incroduced in 1980 by three occupational therapy practitioners to articulate concepts that guided their practice (Kiethofner et al 1980). Since then, the contributions of prectitioners and researchers throughout the world have conteibuted tothe devel- ‘opment ofthis model, which is used internationally (Bowyer et al 2008, Haghund et af 2000, Law & ‘McCall 1988). Its development, ina wide range of contexts, has contsbuted toward MOHO being a 1 Rumi field ado tagong, margin oven and opr Lael Me ge the mont of hls In hs hte, we ee tr fecal ioc eat cegpstnce whe occ preven ope ecommtnal eneeennt by nae of poverty, pale) pps nd thet scl end Cal fre. multilevel ond cross-cultural model. A number of suthors have deseribed the use of MOHO a a theo- retical framework foraddressing both individuals and sroups who were victims of social injustice. Some exaraples are: * Legally defending a family’s rights which were taken away bevause of sotal prejive ana las directed at persons with intellectual impairment. Supporting adolescents with developmental disbilities to move toward employment in 2 pest- ‘communist society with severe economic problems. Challenging and changing mental health systems, steuctures and procedures to better mect the ‘occupstional noads of parsons with severe and cronie mental illness who were marginalized by thevery systerns ostensibly designed tohelp ther. Developing interventions with homelest people inchuding those fecing prejudice because of histories of substance abuse and human immunodeficiency virus (HIV) diagnosis {Aravena &de las Heras 1999, de ls Heras 2004, 2006, Kielhofner etal 2008, Penjeam & de las Heras 2000, Porras 2002, 2008, Todorove 2008, ‘Valdés 2000), ‘As these examples illustrate, the application of MOHO to addrese iesues of social justice are varied fn their contexts, circumstances, nd methods. (Characteristics central to all these applications are ‘exemplified by 2 MOHO-based project te empower blind adultsina poor rural community in South Alice (Du Toit 2008), These adults were disadvantaged abt only by their visual impairment, but aso by poverty, soci prejudice. (even within their own families),¥ Precices Without Borders and outright dseriminauon, AS a result they were Imargialed, alienated, ard deprived of mewingfl accuptions The program supparte clients odevelop slfreapect and self-worth, to gain ner kil, eo ems. new babits and engage in new roles. Ials supported ‘hem to have more contol over their ves ad thei tervirorens. These goals were achieved though rabling cliensto engage In range of cecupations Incldingthes that geaerateincomesadcontted to the community. At the sume time the program sought to bud social support forthe participants and to increase community awareness of the partic pas and what they could contribute to society. ‘Asillusisted by this example, the use of MOHO- based services toaddresssecalljusticerequrecareul atrention t0 people's thoughts snd feelings about themselves, to ther cveryay roles and habits and ‘nuldingeria sis alles elementsareadéresed to empower individuals toward greater control over their own lives and their environments. Imparandy, MOHO-tnsed services also recognize that ise to adres berries and supports inthe environment. “This chapter examines MOHO concepts and their wulization to address peobles of individuals and niperionc tities of anal inion ning the relationship between MOH and concept of social asic, we wll discuss how MOHO is used to understand end empower people sho have been oppreseed The model of human occupation and social justice Social justice refers to politcal, scil, and economic rights of individuals ina given society (Fondacaro & ‘Weinberg 2002). At the core of social justice is the concept of human rights (Bowring 2002). According ‘to Austin (2001), ‘the centre essumption of the rights paradigm is that every person can make certain chim based solely on their humanness' (p. 184). However, individuals living tn sieuations of oppres: sionare not allowed to make such claims (Braveman & Suarez-Bleazar 2005). Socal justice has been discuss within eccups- tional therapy a5 it relates to eysternatic limitations to engage In occupation and participate in society (Abelendla et sl 2005; Keonenberg & Pollard 2008, ‘Towinsend 2003, Wiléotk 1998, Wileock & Tove send 2000). Such discussions vallerscore that soci} ties should>provide opportunities for people to engage in meaningful occupations that low thera to develop their potential end participate in ther communities (Jakobsen 2004, Wilcock 1998, Wilcock & Townsend 2000). Occupational therapy Alscourse on social justice underscores that meaning- ful employment, resources, and opportunities to us- {ein oneself and ones living environment, and access to play and leisure are among the forms of occupa tional participation that societies should provide to their members. MOHO was the fist occupational therapy model to incorporate the environments 2 MOHO, people's lives are sustained ‘and shaped by whac they do (Kielhofner 2008). What people da, in turn, can be enabled or constrained by social, political, and economic factors in the environ ment (Kielhofner 2008). form of social injustice is ecognized in cicumstances in which doing i con- frsined hy aovinamontal conditinne tn the pone that people are prevented from sustaining them- selves and realizing their potential ‘Traditionally, women, people with disabilities, indigenous people, low-income individuals, racial and ethnic minorcies, and other marginalized groupe ese likely to have the freedom #0 choose theit fccupations and/or have fewer choices avalible to them. A lerge number of individuals across the lobe ere not fre to choose their occupations. For {nstance, 30% of the working age poplation i either ‘onemployed or underemployed in ponindusteialized ‘counties (CARE2008). Thus, social njustie asi per- ‘sins to occupation affect large numbers of people in ‘wide range of contexts Using MOHO to understand the impact of social justice on occupational partici ‘According to MOHO, the individual is understood as including three components-of volition, habitua- tion, and performance capicity By inderstending how the individual may be impacted by cBhditions of socal iajutic’, we can better recopilbe how individuals and groups can be empowered. nmneneninatteveenntaeirene tin leila Vol Velition fers tthe process af ehoosingand experen- cirg cccopatons andthe thoughts and fekngs that secompany and influence this process. Acconing the concept of volition the human mative fr occupa tion begins with an inate deve to do things. Each individ, based on experience and environments influences has ongoing thoughts nd esting chat nfs encehowheor shechooses andexperiencercecupstion “These thogits and figs include values (Le, wit, ‘oneconsdersimportant and meeingfultodo) interests (Che sense ofsasfacson and enjoyment in ding), and personal ceuation (beifabout how expebe and eifec tiveonets)(Rilhofner 2008), Invi ving tions of social oppression may develop slf-constraning soltion. That, bemaed in by limite choices and innpoverished experiences of dan, they develop pat- terasof thinking and feeling tht ntemalie te oppres- Sin they experience (Freire 2000). Person who have internalized oppression may not aniipte possiblities forpositve participation aie. They may not perceive themselves asbuvingpowetoshapeteirown desis, ‘Oppression whichis imeraiaed aa volitional pat. teen thoi nl fesing may fake om any ore Consider, for example, a young sult wi fs drawn 0 and gifted atmathand whodoes nat even imagine por. ‘ing higher education ashe ees out barely s survival ‘wages street vendor. When the oppression i lly tnternalized a part of bis vltion, he hopes for n0 ‘more and sees i station simply sh plce i fe He does not recognize hs inellectoal capacity as a source of imprevinghisife circumstances is values and goals instead of cary him toward eazation of his capacities, ae focused on svi. Inthe end his choices and experiences are all within the circum: stances created by his oppcesion. While there are notable examples of people who arcable to sustain a sense of dint, power, apd con. trol despite socal injustice, many others do develop volitional thoughes and fecings tht eerve to Keep them within their unjust circumstances. For sich people, reversing the effects of oppression mast inclde bulding a sense of selfowoth, personal con- {tol and nvestonent in achieving satisfaction ion and oppression Habituation and oppression sem nee Habituation refers tothe plitem of prople’ occupe tonal lives that issustained by roles ar habits (Kiel- Ihofncr 2008). A roles a socially ascribed status thet connects people to thei larger social evironment, linking their performance to that of others. Roles provide a yeneral blueprint for action and grant a sense of identity. Habits sre patterns of action that sustain repetitive daily occupations. Individuals living under conditions of socal injus- toe are often prevented access to certain roles (ef, ‘worker or student) while being cast into or only allowed access to marginalized roler (eg. beggars, street people, squatters, or refugees). They may also find it necessary for survival and safety to engage in roles that are outside the la, subjecting themselves to the possibility of punishment. Even when ‘oppressed people manage to sustein ordinary ‘occupational roles as family members or workers, they are often forced to sustain these roles with ‘extcemely limited resources (eg, lacking adequate plumbing and sanitary conditions for casing chil- dren or ‘working in substandard conditions that constitute a health risk) and rewards (e,, earning subsistence wages). ‘The contextual support for familia and comfort able and satisfying everyday routines is often lacking for oppressed people. Those who must scramble for basic resources or wh douelap compensotary habite ‘to manage life under duress, may experience highly stressed routines of daly life. For instance, people ‘who do not have a stesdy source of food or whose access to clean water issporadic must devote temen- ddous energy to securing the basic necessities of sur- vivel, ‘hele routines become preoccupied with managing access to scarce or uncertain resources In other circumstances people may experience impoverished routines with insufficient meaningful ty because of the lack of access to resource® and opportunities for doing. ‘Consider, again, the example of the young adult ‘who is street vendor. For long days of labor he soceives at best « marginal income. Others perceive him as unslled and outside the normal workforce. Tossurvive, he may engage in practices that, iFscov- cred, could lead to imprisonment or being barred from vending. Thus, he performs on the margins of society without claiming a legitimate place and adequate reward for his lbs. His daily routines, because they area way of survival, are har to shake off even if his circumstances were to improve because they may be needed aguin when things take ‘wun for the worse. Because sufiienkentronmen- ‘tl support and resources cannot bé"irusted, He ie prone to hang on to the roles and habits that allow him to survive during the worst of times.2 Prectices Without Borders Performance capacity and oppression The sis for effectively performing occupations are developed as one uses capacity in everyday contents Oppressed people ae routinely denied opportunities to realize skills that their underlying capabilites ‘would allow (Galheigo 2005, Wileock & Townsend 2000). They are thus robbed of personal resources ‘that would allow them to control and achieve more in thee lives Consider, once more, the young stret vendor ‘who has innate capacities for learning complex math but hes barely leseed the necessary addition and subtraction for conducting his street vending busi- ness becase he had toleave school asa child inorder tocarn income for his impoverished family. Because be never develops an underlying gift, he is bound to his oppressive circumstances, The individual and oppression As the previous discussion illustrates, the conse- {quences of oppression often resonate throughout the person. Victims of oppression may develop a volitional process that internalizes thelr oppression and constrains them from wanting more of their lives, They may have impoverished or overstressed routines. They msy occupy marginal roles or struggle to fulfil traditional roles without edequate preperation or resources. They may fil to realize potentials that their underlying capacities would allow. In this way, the individual and his or hee ‘occupations become the locus of oppression. ‘At the some time, the person who lives under conditions of social injustice must do his or her bes to survive both physially and prychologically ‘The accommodations to living under oppression creep into a person's habituation and. volition: being resourceful in order to manage with meager resources, compenseting for lack of ckil by laboring +o the point of exhaustion, learning not to accept & life with limited dignity, expectations, and reward. Which such accommodations may inoculate the ‘oppressed. person against being destroyed, they result in lives which, at best, are compromised. Ironically, the resilience of many oppressed’ people can make the extent of he soc injunie they experience less apparent both to themselves and 272 MOHO as a framework for empowerment (On global level, oppression must be fought by efforts to change the social order. Such change i inherently political and ecancmic. Ie occurs in historeal time frame as social attitudes, policies, laws, and other institutional factors change. What, then, is the role of occupational therepy which deals inthe here and row with individuals or groups experiencing oppres- ‘sion? Thece fn singe of simple answer to this ques- tion. Much dependson local ctcumstances ane also.on ‘the position of the occupations therapist within the context. We propose that there are three critical and interrelated requirements forthe occupational thers: pist who wishes to address socal injustice. "The ist requirement in addressing socal injustice requires the occupational therapist to reflect on his ‘or her position in the social system. It is possible for ‘ccupstional therspy to become an extension of ‘oppression, reflecting deeply embedded institutional perspectives that can fault and penalize the recipient of occupational therapy services (Kielhofner 1993) ‘Thus, occupational therapists working within exist- ing systems must be deeply mindful of the ways that ‘oppression may have been institutionaized. When oppressive attitudes and practices are embedded into systems such as healthcare delivery, they are often dliffcul eo recognize and esay to perpetuate “The second requirement is tht the occupational ‘therapists mast work: hardtoknowtheirclientsand their situation. As we noted above, oppression found inthe ‘thoughts, feelings, behaviors, and routines of individuals and groups. Ths, one ofthe most common mistakes nade is tat of blaming the victim (Kielhofner 1993). ‘Occupational therapists mus: be astute in recognizing ‘oppression in persons as reflected in their volition (ex. sense offitalsm, thebeliefthatone isnoteffective ‘ordlle) and habituation (eq, unreasonabestressedor impoverished routines, marginalized roles), skills as affected limited education or taining. Ieisalso critical that environmental supportsand barriers are identified. The third requirement isthe occupational therapist should address oppression by seeking to empower Individuals and small groups to take charge of and change thelr own ives. Efforts toempower individuals and groups, even within oppresive environments, can “tigate to the extent to whieh those environments congirain individual lives. In some cases, it so enebles individuals to change Some of the circumstances of oppression in thei environments, Human eeoupation ae tool for understanding and promoting social ustice MOHO ig most useful 2s a tool for recognizing ceppressin, understanding clients, and. practicing empowerment (Berdichewsky & de las Heras 1995, du Toit 2008, Ziv 2004). Becoming aware of how oppression is reflected in the volition, habit- tation, snd performance sills of persons i a fist step towards a change in occupational njstice stun tions. Using our previous example, we can recognize how the street vendor makes no attempes to change his situation, beause he ses no possibility of chang- ing it and accepts it as is role, end because his hebits ‘and dlls are organized to meintaning this cole. ‘Only when he is awakened tothe possiblity cht he ‘can change is situation and given internal nd external resources to da.so, will he be able to make choices for action that may lead to change. At the same time, i is critical thatthe eccupational therapists able to assess the possible environmental reaction to efforts to throw off oppression. Social injustice does not exist by accident; rather, i exsts because certain parties benefit from the social order. These parties are typi- cally powerful and motivated to maintain the social crder. When occupational therapists support indivi- duals to change the circumstances of their oppression they may place clients in danger, For instance, the street vervlor whose action to change his circum= stances interferes with the existing social order may find his permit to vend revoked oF worse. CCounterating the forces of social injustice forindi- viduals requires thet opportunities be provided to enablevictimstodevelopasenseof their owncapaities, interests, and values. Only when they feel capable to achieve their values andinteestscanthey bepintomske change in their own lives. At the same time, realistic ppraisl of posites an of possible negative conse quences must be entered into the equation. Here, the ‘therapist mst accept responslity for assessing what theenvironment wl allow and what consequences may ‘occur along with working responsibly to make changes inthe environment wienever possible. The intervention process ‘The key elements of using MOHO in the context of social injustice are *+ Using the theoretical concepts to goncrate ‘questions that wil provide a clear understanding of indivicals and groups ‘Working cllaboratively with individuals and groups to generac a deep understanding of their situation and context, + Developing opportunities in collaboration with ‘oppressed individuals md groups, which allow ‘them to engage in occupations designed to change theie lives end crcumetances *+ Working with poweefil persons and organizations (who may be part of the oppressive system) to aadvocite for ways waddress oppressive conditions MOHO-based intervention begins with formulating theory-besed questions to guide our understanding of ‘the petsor/community. Table 28.1 hows examples ‘of questions hat canbe derived from MOHO concepts tohelp understand n individual group. These ques: tions should be generated and answered in parcnership ‘withindividealsand groups. Theoccupetional therapist takes on the rle of ebservantparticipant who seeks to ‘Toble 28:1. Examples of MOHO-based questions to guide understanding of an oppressed person or group Netion \hatare th aus and tel of his parson or group and hw do ey ait hice forse? hati Goss is porn ar gop aso te Induce cepts, and now content co ‘ey fet soit er pssbes of ug them ta rode a cane i cm cramstnces cr errant? ation ‘Where he os otis parseloup ndGo econo ccna utp? We ase tls perored tt adbquat restos? Who decides wich aes ate valle? ow dos ths parsnrgtatin oeanze daly ects? Doo is rte meet perl moos? Performance capacy What lls (eeaed and unos) des this pasaveormanty hare taceompic iste gol? ea ss Evomneat Tacs bps nc cea re ap pCa ernment Wi naw peor Iie er ocupatns? “ 5 How ax ies made, nb wor? How a esol ups rie in tr of eson maka {i ace cies a, en by wham? 273b Prootioes witout Bordore faciitarehiearher own understandingalonguithhelp- ing ndvidvals and groups to generate a deeper under standing of themselves and their own circumstances. ‘The occupational therepist, together with these he cor ahe is servicing, then generstes an understanding of the situation ofthe person or group, which is bared on theory. [tis che roe ofthe occupational therapist to teach MOHO theory in terms that sre understand able. By sharing one's conceptual tools and making them accessible, one democratizes the process end provides tools for understanding and desling with issues inthe Future. Ina final step, everyone colabo- ratively defines che goals for cooperative interaction, Setting priorities and course of action. ‘Through theirchoices for action and whet they do, people develop their own volition, habituation, and shill, and to an extent, they shape the occupational ‘world they inhabit, The role ofthe occupational ther- apis using MOHO ts to promote opportunities for ‘people to make choices and engage inaction that will sccomplish desired goals such a5: + Understanding and removing eavironmental constraints that affect occupational performance Discovering environmental factors that enable ‘occupational performance Enhancing the ability for making occupational choices consistent with values, interests, percelved potential, or available resources and goss Discovering and practicing new ways to achieve change + Increasing confidence in the ability to produce change Jn all instances, working with oppressed people requires recognizing and understanding the oppres- sing environment. Often, therapists using MOHO begin by working with persons of power within the ‘oppressing environments. MOHO has proved to be ‘helpful tool in persuading people in positions of ‘power to; it has Been used to successfully negotiste for resources to support interventions and programs sod to reverse some siwation of social injustice as will be illusteeted in the examples that follow. Examples of using MOHO to address social injustice Shee ae cee aro 278 listincly different circumstances of social injuctice as wel as quite different MOHO based:-straegies for addressing social injustice. Defending family rights ‘The first example was previously described in more etal (Abelenda et al 2005). In the province of Santa Fe, Argentioa, a Juvenile Court removed three chile dren from the custody ofan extremely impoverished couple because they had intellectual impairments Ironically, he judge removed three children who were identified as'normal' while leaving in the pventscus- tody a child identified as developmentally disabled, Tn response to the parents’ request for help, an occupational therapist working out of the Ecumenical Movement for Human Rights (EMER) evaluated the patents using the Occupational Performance Histary Interview (Kielhofner et al 1998), the Role Checklist (Oakley et al 1986), and systematic observation. She found thet the par. cents worked as traveling street vendors workiag in altemating shifts to ensure that one of them was always with the children. They took good care of the health of their children and routinely visited the local medical center for check ups. Ihe basic family needs of food and shelter were met. The cou- ple valued their role as parents and workers, and ‘heir interess revolved around the care ofthe home and the children. They hed plans fr the Fotue, such as improving thete quality of life by getting runing water and buying new beds for the children. The ‘occupational therapist concluded that their mental fnnpairments did not interfere in their performance of theirrole 2s parents, and that their habits and life- style was consistent with the cultural environment, history, and origins of the couple. Bazed on elabo- rate testimony from the therapist which referred ‘to theoretical concopts and formal assessment tool, the Court of Appeals returned the children vo the ‘custody of their parents, Importantly, because the therapist used a well-developed model with estab- lished and researched too, che war able 9 gain ce dence in the legal system. Combating social and institutional discrimination and stigmatization of jersons with schizophrenia te ‘When 1995 was declared the year for schizophrenia" In Chile, special emphasis was given to newzscence research tare this probleg. Ast was orginally Human cecupstion a¢ 2 tool for understanding and promoting sodiatjuatice envisioned the campaign would focus primarily fon researchers and. professionals who addressed schizophrenia. Within Chileon society, people with schizophrenia were highly sgmatized and misunderstood. Asaresul, people with this diagnosislived at the margins of soctesy ‘wth fev possibltis for participation and no woe in society. Occupational therapists working in Reencuen- tyos, a community occupational therapy center that served this population, discussed this special year with cents to elicit their reactions (de las Heras 2006, ‘icthofner 2002), Clients voiced chranefrastrtion in ‘eying to participate in productive roles and recounted the ativainal barriers and diserimination they faced fiom clinicians, institutions, and society. Tey also fle ‘that en emphasis on medica solutions and inclusion oF only researchers and professionals would mask the fact that people with ths disgnosis were sysvematielydis- ciminated against and disenfranchised. In their view, ‘much of the system that was designed to provide them care msialy served to keep them in their place and id nothing to allvite their marginalized status ‘The group discussions led to 2 decision to sock to play a central role in the national committee organiz- ing this campaign in order to change some of its ‘emphsts. Two members went with the occupational ‘therapist tothe organizing meetings, serving asrepre- sentatives of clients a the cormmusnity center ndalso Ininging forth ides thar ad been generated by mem bers and therapists at Reencuentros. The occups- sal therapist. presented and defended their proposals wing MOHO as a framework. Persuaded by this argument, the national organizers agreed to ‘broaden the campaign beyond trainieg for profes sonals and research in order to include formal and informal participatory educational events. Moreover, wasagreed thatthe formal educational’ events that took plce all over the country would be done with active participation of professionals, people with schizephrenia and their families. Finally, st wes agreed that the training would be not only about the illness, but also about the occupotional lives of persons with schizophrenis, and that it would ‘emphasize how to understand and facilitetepartci- pation using MOHO as a theoretical framework. Professionals, health workers, families and people with schizophrenia attended and participated in for ‘mal educational workshops together; these events included dislog between these consttutnts for the firsttime, At the end ofthe campaign a formal course, ‘with special manuals based on MOHO,. was given to families and othersto facilitate development of sel-help groups. The informal education component was organized by the community center and spon- sored by private corapanies. Ie included three national events, "Encounter with everybody’ ‘Art with every- body, and ‘Sports with everybody’. "The phrase ‘with everybody’ woderscored that these events were for all citizens; they were held in public settings in Santiago. The first event incded talks fom representatives from professional groups, government, clients; it also featured diverse classical and folk mosic and cultural performances. The second event featured diferent forms of visual and performance art, and the lst event featured a variety of sport that llowed ful perticipa- tion from everyone. The three events provided a safe settingin which famihes and people with schizophrenia ‘ould feel comfortable, share their skills, and begin Tooking to the future with « more postive, sctive, and parccipatory ettitude. They provided opportu. nities for paople to think of those with schizophrenia as individuals instead of patients by seeing them in Jnarmanizing context. ‘The occupational cherapists worked behind the scenes validating, informing, negotiating and advising clients, thei formilies, and other heal professionals (Gerdichewsky 1996, Rerdichowry le [ax Heras 1995, de las Heras 2007). The active participation of clients and thei families in the process of plesning snd implementing these events led to the founding .of25 family asociationsin the country and thecrestion of National Mental Assocation of Families. Also, the vents during thisyearledtoa numberof other ongoing initiatives. One is the development of new MOHO- based projects that empower clients and families to have active participation inthe course oftheir recovery process. Another has beenccowpational therapy patic= {pation in ongoingreform ofthe Chilean Public Mental Health System. Finally, an outgrowth ofthe efforts is formation of an ongoing consumer'scommittee, which ‘evaluates mental health services, avocates for con- sumer rights, and sponsors empowering initiatives, Empowering adolescents living in poverty ‘Tenyeors ogo, in Sanca Pe, Argentina, anindependent ‘ceupational therapist applied for government Fund- lng to implement a cornmunity project to support adolescents living in poverty and at risk for delin- ‘quency, drug abuse, and gong activity. Among other negative environmental factors, these adolescents were under pressure from femily members to steal in order to bring home food and other basic resources. The project, which was based on MOHO,Giron Practions Without Borders was designed to help 15 adolescents explore and evel their occupational ident and competence, Ie het ering wih the alc an observant participant to gan deeper insight into their occupational needs end environmental realities, She began by parslpatig in ther most meaning and enjoyable activity: plying soccer. The adaes ‘ents owed energy, pride, ane pease whe psy {ng ooccer inthe street inthe evenings with a hand sade ball of old fabrics and pieces of cat, “The occupstions therapist sed MOHO-based cbse cen ard fora comes tions with che adolescents. She Found that they dss liked their homes, in part becouse they had veay sxesful lives there and were very poor. Nonetheless they saw thei roles as thieves tobe an important con, tcbution othe emily rexources, The majority had tot attended schoo ral fle powerless in compar ison wich adolescents ‘who had been educated, Because these children ha internalized thee oppres sion in thei volition and habituation and pron: mance copsciy, the therapist realized long process of exploration would be necessary for them before they were able to develop new eccupationa iene, ‘Once the cccpational therapist had established » telationship with the adolescents, she invited them to py twice « week ata lrg natural public space instead of on the street Eventually, they idetied this place as their soccer fel Next, she invited them to form asoccer team and enabled ther to ply vith othe local soccer teats, The team identified & ‘aptain, who collaborated with the therapist to aecange for games with soccer seus from los! Schools, fostering nceraction with ether young ao- tescens. This generated curity sbou school Hay. References end Kt, Sage fe Rare he Made {ttn nce acoepd ‘llrandonaneg decane cron oes Renee Sin ls 5, Felines Ospina Tape es Boe Lang To te Soa Se cy 200, Eherer Chel _ ety tS Atha ae Hone C0: Pt, Gino te Tepace Capen de Che tof Pet de Refran Str Sere de Sed slo ike, 199; iy of Heh ‘es, Chier ngs cies en Asocton of Occ ‘Therapists! Archives. at ‘Aus W Usage mn sight enigma ce he Deklem and the pout, Eine B1e2195 200 ‘echo Fs Chao cmpain of ‘elephant pen Fart Pape rene he ing 4 rotine of games with different people wi sceapted them at socer ples and not se sce Ehidren helped them tose themselves difercrne ‘Twos liter, the therpist plied asa topo crament finds, presenting evidence of toe nda, ents progres. ‘The progim expanded snd the srouphaditownspoce for meetings, whlch eked tlitchenandareceatonl pce Panthermore se of the adolescents began to prepare for and eventually. sttended schol. Inthe coming years, thee, feapiaed the Inprtance of ving occupa therapy working wit thesechilden and gre the cccupational therapist» permanent postion in the ‘sducaonal system, She and er collegues comes prototing occupational putipeton wih oher de lescontsin the sure ststlon (Angele 1998, dels eras 2007, dels Hera t 2003) Conclusion MOKO cmb poe mle lo de ‘ending snd aren scl igus Te pose pee eae ae tected po vate, hubtanton nd pera tance cpa I prondr ance for sues Sees to empower nds The seca ples inthis pce ign diet we “hick MOHO fon empower indicus expat age nui ond contbate omer Seetl change tt bine revere he roca of ope son Utmtey cach suntan yl eal for wg Surtees ta stb nfamad by caret wer ‘de dvi eps nd teen nee Intros Cones of Pci, Lido, Venecia, Italy, 1996. a Berber CC: ‘anata traced dle Ecquofena: Una Nee ‘parted, mod de Eigen, Proc prseated he Nana Mewes Conference, Cie, oe wring We Forbin rations? The Ue dour of men ras nd ‘he seers jt Lay Human eacupation as a toal fr understanding and promoting soci! jution ‘orit hceend CloalDeeoprent Fee: Fed ofthe Opresed ‘Als, 2005, Eve Chore Smal 117, 2002 (Cvs eh, New Yor, 200, vinta, pp 38-86 weer sins A Sean Gécles _ Coan inert Bn. Lye M McCall MA Keowee ade WceCGrimarmstimlefrto, Galego SM Oxcpeorlhepy ond of tnbyaoog acpi Ertvesward donde tbemuielof ihesocal fli In Kronenberg Feats Canen sey, Can tr ocipatin, Otel Sind Alga SPllrd Ny cltare —__Ouap Ther 3698-206, 1089 MiappiitelCowZ1-24 2008, Ocepatnl Therapy With’ Oakey F, KilhoferG, Burs, et 1 rer bneae Y Socal ‘orders txtang rete Spit The le heise Deveson d We walvescucewelveton nao Stoiar, Eaabarh, 200, inp stone lait, veescnty ined eqn, am Baeve/Chercl Lipton, Scare Terps Jura of ‘Seep Ter S132. 208, parse Rear 6157-170, 186 Oy US hema Repo, ‘en Lia ,Thwl i, Pee A des Hens CG: ager de wien fesePuircors leg: cicero, ered bp fe ef oper Selh phate eects ‘Paconas de a Cal, Saris, Cole OI Medea thay Rand! Oy Ther 50 einsHc eo of Occapatonl Thespy, 707-113, 200, Pore X: Tria Opin: ST a aca de Che akobeen Kwok doesn wos howe. Tred cn Miers ova foos ble occepstionl tice Jwralel Promaton dee Patan del eesCG:Programadelnngain — OceatinelSece IEEE T34, ”— Orapcal Chie 2002, bios (Comrie Rrcucte. 20 Brean de ep, Fa yan Fania Khloe Gz Fancast: Ocypoara, Univ Ar a esc eavecebas | Towards deel view of pesoxr Belo. Fe cic Opec eornmen elton in J Cccp Ras X Terapia cyan: Tab fHomana Paper pesested sete Vit) Ter 47-28-25), 198 “on Fania de Alo Rug, Chile ‘Gilean Congreso Maral Heth, Kilofnr G: Model of Ftman tts, Archives del Deparment SR ASeerocs Sotom deChle Ocean Toy and Arplatn, Tein Ocupcena, Univer ‘oor eae baltmere, 002, Uppnete Andres Bell dala Hers CO: Romer: iis & Wis “Tob L Aes empl Progra Pri de elie Medel wee alga ates Pee Cie te Coppin. ““Seepoon They ond Apptirion, Flees nga, Resse, CRP Lands So baltmre, 2008, Lippnete— Gecpariona Therapy Healh Care dela Hert CO: Deserve Sls 8 Wis Bar, 208 Uroatonas has ora Modo de Kichafnr G Bhs), Head 1C:A ‘Townsend F Powe td jute in Gespecs Hinuons NOHO tril of aa option, "bling exuption, mJ Ocp Freese ena for Ocapaonal. Tar Asssree a iterveton, Ther 774-87, 2003, Fearn ede Cee 207, a] Onp Thor 3627-788, 18D. Vad A: Experi Sujtias de x Unewnid Andte Belo. ‘ster yan TCC, Madre de ons an iret elas Hers CO, Uere ¥, “Rakduersguidew ecciparenel aceren del Inge de Ayer {lcs 6: Renton Frcs Bfomsnc toy terse Gprtnidader Ofer, Cle FREE Tucccuiou or Peoie, TOPE) (mnton 20), Chicas, 200, Eau cogs pobre trek Ser Valiionl Cheers 1988, MOHO Cashews en Unversdad Most Finney Oscpeion Kier, SravemenB, Faz L, Wilkes AA: hs Ostia Covina, Cig 23, Leva MA conte 00 of Perper of Heath, Thoroire NI, Unvcniyo lina Chg. sees to enance procure 1866 Shick re dtu'Tol': Ung the model of aman patton among pone with Wieock A, Towasend Occupations ‘oon concept oe EEVAAIDS, acl Occ Thor evminsogy interactive dog Sccupaionl toersy pogrom for 6236-5, 208. Scepstionl jae, Jura of itd penons in South Aca, Kronenberg, Paid N: Overcoming Qecepstoua Selene 7-84-85, Occhi Therapy tn Heakh Care "occupa apathid:A preliminary 2000 si, 208. ples ope tre of ZN: Thinking wih and spine FouinearoMR, WenbergD: Conceptsof occupation they. ‘thao The mae! of aman Toci jatcem commanky Spee Sins edo, Souci evn oe Sychelogy Toward soca cslogl Pall N, etre: Onsptionl ones clinel Capen an FRutenelag, An] Commas Tovey Wow Borer: Looming acorns Irae Jura of Hl seo, 0 Toth Sof Sevun Scraper Teta 3 i = ‘HLAT-#1168, 2004.onscious Philipl youth and the elderly fan adut day care contre in March 2007, Pay iis experience was perceived by two Er ocoupationalthorapy stucints from the ‘of Gape Town. i year occupational therapy students a the cantor for community practice ‘Wo facilitated the interaction between the 19 Youth) andthe elderly. Te interactionled pglulenangeas reported by thetwro groups. inthe series of workshops we ran {Ss youn group was a strong support for the Biot oocupation 2s a synthesis of ‘Doing’, "Becoming’, and ‘Belonging’ (Hammel ieock 1998, 2008). Validation as a crtcal ing polenta! and reviving the Teflections from members ofthe Group at was the difference. .? Many people ‘be at the right place and time, but thing extra is needed Is ita kindness? PAsrespect for person? Taking time ro know ir inner spirit? (K Zane, porsna communica, 2007) DEFINITION: ‘HUMAN SPIRIT’ 7 Ete meaning and connection of ane to thelr cuter ic worl stam, whi th incl ‘Spares a sane of Dlonging and puose Mado Soran 05 Zpatricia Mary Cairns Candice Joy Mes In the beginning: ‘Stuck in Nyanga’ “This story begins when we were placed in Nyanga—a perturban setclement bout 15 km outside of Cape ‘Town. We had been placed at a community center tor the elderiy, which offered «safe space for thern togather during the day. They were given two warm ‘mes and were able to socialize with others. The cer- ‘er gave some ofthe isolated elderly» purpose forthe dy and had been identified by the university a8 a placement so as to give students an introduction into ‘working with and within communities. The resources available are vastly diferent from other contexts and therefore (is always a challenging placement. ‘We had been at the center for a week and were feeling lost and confused about our role as studente in this particular contest. The elderly appeared com- fortably eet up and wore enjoying their daly routine. “We asked ourselves: What was the purpose of the service? Who are we as occupational therapy students tostep in and just keep the elderly busy with things that don't mean anything to them?’ We experienced real feelings of wishing we had been placed at one of the more traditional sites of learning such as Groote Schuur Hospital, where our role as occupatianal therapists might have been more defined and where a clear difference could be made to the people we ‘would be working with ‘Ouse only means of trying to work out the appro- priate role of thessccupationalthorapistin chis setting ‘was through building relationships with relevant members of the organization and the community, and assessing needs an they arose. We tried to. Practices Without Borders approsch this with an open mind to create new opportunities that would impact this community band not just engage them in ‘doing’ for the sae of keeping people busy. Evidence of previous engage- ments were present in the center itself and in the community context, where students in the past right have experienced (like us) the pressure to do something perceived es productive, rather chan taking the time to seek out other creative outlets that were waiting to be explored. Posters cn chron die- ‘eases of lifesryie, exercise and stretching methods, and how to set up daily routines cuttered the walls Allthese posters were written in English, most doing ‘more by covering the chipped pit than enhancing ‘the lives of thoce around them. A change of perspective 1k was important for us to walk in the strets of [Nyanga and experience i forall it was a community where people greet anyone and everyone, where sheep's heeds were being cooked in large drums to be sold, where traditional herbs were drying in the windows of the houses, whore children played games barefoot inthe streets and the music of passing taxis created. deep resonating humm. We wanted to see the day-to-day life in this commanity £0 that we could understand the context from which the elderly peo- ple came. We didn't want to impose something from ‘outside, We wanted to help something to grow from what was already there. While iti an impoverished ‘commiinity that lacks infrastructure, there was defi. nitely something in the air that made us not want © settle on ust doing exercise routines withthe elderly ‘The thoughts of hopelessness that were felt during cous first week were radically challenged the moment wwe met 2 high schoo! student who had made an appointment to speak to us. His name was Motlati Koyo. Some of our first impressions of im, as noted incur reflective jul (20 March 207), were as He's about 17, Were surprised to se hin dened 0 ‘smerly n be blir even tough i about 30 derees ‘ute inthis Cape Town simmer: He lois rarer tha some ofthe profestomle we've wothed with And beeen tine? Hees tee aller Bg bat ene mel co confidently we en's eel ngrich, euck shocer He (has the shin ofa sgl adoestert andy his yer bra wittemething ar beyond hi ere. They re sy sad brown ‘Thats defintely nervous sl on his fae but his bunichake ie srg and sud, He ows what be want, “Te elderly re have warned ws about the teense of {he towne 0 we bter be on guard, We've been tld they jut looting fr money to sat tha ani to tele with the Mest of drag, vex, td ssl. Bue there sere to be something diferent soot hi. Daring this first encounter with Motatsi Koyo, we listened a5 he told the story of his group Ulusha ‘Oluthathalayo (The Caring Youth). The background to this setting ‘To provide some context tothe envicament in which this group was formed, here are some statistics about the youth of the Wester Cape: more than 309 of 19-year-old women in the Western Cape are reported to have given birth a least once (Kaufman de Wet & ‘Stadler 2001). HIV prevalence hasbeen noted tobedif- feu to measure in his age group, a8 the stigma sur- rounding testing i high. However, ou of those who ae tested an estimated 9.4% of gels and 3.2% of bays ae HIV postive (Averting HIV & AIDS 2007). Chil ‘dren between the ages of 13 and 18 are noted to make up the biggest drugesser group, especially with regards ‘otk (crystal methamphetamine) Tikas had aderas- tating effect on the Western Cape community, with 4 noted impect on inressng drugereated crimes ~ a shocking 159% overthe petfiveyears (Parry etal 2007), ‘Various programs are being ran by the government ‘nd nongovernmental organizations (NGOs) in these settings, They are focused on risk reduction, but often show litte success (Galvaan 2005) since the problems themselves are ssid to be multifaceted ind often not within e health professional's control. Breaking free Although the youth came from the context one in the previous section and acknowledged the tras they foe every dey, they were determined to make a difference, Motati Koyo presented «propose end told that his youth group wae interested in giving back wo the people of his commonity by runing bole iday programs a orphanages and old-age hemes ‘They wanted to run a free holiday program fe che elderly during the upcoming Easicrnaliday Os they ‘were jot stating off with cheircommunitiproject, they ncended to runthem onavolunteerbesisanddo ‘in thei spre time. They wanted to perform for ‘Aretective jouney snd exeloration ofthe humen spit _groupe who did not necessarily have money topay for the entertsinment, but who would most probably appreciate it. They were also working on a business plan to hopefully one day attain external Funding to srrange For bigger events, as thete community leaders hud tured their backs on them aleeady. Uiutsha Oluthathalayo wanted to perform various cultural ar forms as encerainment forthe elderly, nd _pend time with the goges or wise elders of thelr com ‘runity to connect with thera on a persooal level sad honor their individual end cultural heritage Building relationships and workshops ‘After reading Motlats's proposal we arranged a meeting with the main committee members of the youth group to discuss the program. We also took ‘advantage ofthis opportunity to run a workshop with the youth, focusing on the perceptions they had of the elderly end how their program could be adapted ‘tosuit the needs ofl the participant. The elderly at ‘our center had a range of needs based on their indi- ‘nal aires. Some oF them were living with hem legis and the after effects of cerebral vascular ‘accidents and would therefore be unable to be as physically active as others in the proposed group dances. There were aso two members who were viewlly impaired end so would not be able to engige fally with the youth's proposed mime performance. Connection through scaffolding ‘When we met the leaders of The Caring Youth, thece ‘was 90 denying thei strong presence. They were centhusieti and bright. Their energy was contagious. ‘The outcome of this first workshop war that the youth felts litle ‘stuck’. Their aternpts at running [programs et other organizations had been met with resistance. This was mainly informed by the preju- dlce that exists eround teenage behavior as described to us by the youth, Their surrounding, community sew them a5 disrespectful. One of the members, ‘Khanyisws Zangae, recalls thisassomethieg that frst hindered their siceess within their community Before, when meeting eter peopl, people would think wewec los supd abu abe about “The youth group was seckng ida and sapportin the process 6 planning their program so a8 not to perpetuate this prejudice. This is how we became involved in faclitative capacity. The youth knew ‘exactly what they wanted todo, For example, as part ‘oftheir holiday program, they wanted the members ofthe youth group a wells the center to introduce themselves noe only by name and surrame, but ao by clan name. The group explained this as means of ‘cannection by representing their roos and not just who they are scen atin today's society. They alo “wore traditional clothing in their drama and dances to honor their cultural and clan heritage. These actions directly showed respect nat only for their elders, but also for the journey thir spints had traveled throughow generations "This reflected a need by the youth to connect withtheeldesyehrough mesingfulengagemnent. Con- nection thit bring about a sense oF identity have been described by Max-Neef (1891) as one ofthe funda mental human needs. Similarly Wilding etal (2005) deseribe ‘connection’ as strongly asocsted with che indivdeal’s experience of spirituality. Daring ou cc end workshop dzcusion, a member fom the youth ‘troup remarked that he could connect wit the gor due to heving the ‘some spit” or ‘ollectve feeling, Shep Ue generational did Being is, itimade sense tous to suppor the youth group top ‘them sueced inthe program they had planed. Our role, then, wns ‘cfflding. We had to ge the neces say support and guidance where’t was reqired inca lorng the progrim to fic the needs ofthe edery, without tampering withthe contextual clevant cok tural ar forms. "Ar we had already assesed the needs of the elder during our first few weeks at this placement, wwe could provoke more decusson around making the youth's program accesible to all members. An tame of this was accommodating the vsully imprired members through adding song to 4 pact of the performance thet was mostly miming (Guided by adult learning theory 5 highlighted by Hope et al (1984), we probed thoughts and clarified feers and discomfort, but allowed the youth to own the decisions made during the differ: xt workshops we ran, specifically thoze on per ceptions of the elderly, handling techniques’ for the elderly group, stricturing of a program, end Teadersip within « group. This interaction was a succesfal one not just as.» peccediral therapy pro- cess, but becaize it also boosted: @HARotvatioh to ogee with the proceso noted in Belles om. 29 March 2007?Prectoss Without Borders Ian gore tay ad ely fel that we hve made a tiference Noy avinglltbe answers thy etngps trrishop with youth ov want ta semhingand rng ‘hom the space and tame etl hin cet abo ow they congo cout. They thre on ut sages, suchas dg ei ar pererance stad thea a tarscuetodscustheifelagetlurlimperencesne the respect they are Forte elder on x mare pes! Incl wth ther Lhope to hve mae moments ike thie ‘where net people rom ad fo he cna The interaction Both the elderly and youth wore filled with antcipa tion on the day of interaction, which led toa haphaz- ard start, The youth group were fecling nervous and ‘unsure of themselves which caused the leaders of the group to rally thei members around and start ‘the morning off with» prayer snd inspirational song a5 well a5 the offer of reassurance that what wat planned forthe day was appropriate. ‘During the drama preduction the eldesy listened attentively, cheered for the performers, engeged in song and were moved to teas over the realities por- rayon the dramas The youth wor all oFemotion in character, confident in hele speech and aware oF ther audience, ‘The show was short but brought across a powerful message. It began with » burst of drum beats and s reflection of che present community, with youth showing disrespect for theie social system. Thit ‘was represented by youths in drunk and promiscuous states stealing, violating the rights of others, home- less, and begging. Thenext scene focusedin on one of the veens, who was pregnant end desperste. The reon's thoughts and. emotions were expressed through a soliloquy. She then turned to those she thought could help only to be tuened away. Lastly she went home and shared her feelings with her rondmather who passes on the kaowledge she needs. The last écene showed the broader commu rity again where the enlightened teens shared the knowledge oftheir elders, The show ended on high note with all those involved in destructive occups- tions leaving them, wniting with the other youth and the elderly, and singing the national anthem sccompanied by the beating of traditional drums ‘After the drama performance, every youth group member identified ‘anselderly member who came from the same clan as they did. With our guidence the.youth then sat and shared Iife stories over refreshments which had we arranged at the center ‘This engagement opportunity was negotiated and prearranged by ws with the center management team, ‘A shared heritage created the opportuity for » ‘cultivated bond irrespective of the difference in age. Smiles and occasional tars could be seen on ‘both the youth and che eldery frces. ‘Traditional songs surg collectively, followed by prayers and blessings forthe youth, concluded she ay. A request for their return was made by the elderly which mede the youth, especially the leders, Feel greatly honored, Reflections of the process The result therefore was thatthe olidey progeara was 4 successful engagement. The youth group and the elderly and disabled members valued the experience [Narstive reasoning, a© described. by Polkinghorne (1986), was used as a vehicle to illustrate the things fone dots, has done, wants to, and could do, ‘The successful engagement between the youth, elderly, and us wos expressed through reflective ‘workshops that we held separately withthe Nysns Adult Day Care Centce members and The Caring Youth. The purpose of these workshops was for the members of boch groups to unpack what the hel ‘day program meant. One of the themes that emerged from the reflection workshop with the youth was the importance of validation, They pointed out how we ha shown abelif fa ther capac: ity by making ourselves evaable to help them plan the holiday program. The engagement brought ot only satisfaction, but a feling of meaning and put pose (Wilding tal 2005). This in turn helped them to feel validated as members oftheir community and, rmore crucially a occupational beings ‘When we met Candice nd Grace we wer not gue se aw the whole process was gong 9 So we started by having etn bout he igs we were gig to do the abl daycare cease with he sexist worked. ‘hey toned stetiely ocar oiton sd pve we when aecsary Sothat made fel rte cca (Grace sod Cand have helped we sce the pvential he rp sno onmaen200 During the reflective workshop with the eldesy, members expressed their pattude to the youth for the time and effort theyhad taken put the corcect cculeural nuances in place, for te incasion of ll members in the show and especilly forthe ime they hhad spent sharing stares together. Some elders were ‘A reftactve Journey andi exporation of te human spit sarpised bythe youth's genuine willingness to spend tin learning mace from thee elders They stated that this was 2 good example of wht youth ould belt, aluhough they sae su sadly lated case Discourse, as describ by Taipton (1995), can be cerlestood ws thevewstatsocetyseboutacertain Phenomenon, such as youth, These perceptions of Jouth ae often socal constructions perpetuated by Acminant discourses. These shape ealetve perspec tier ardinghvidval actions ath infvence what peo gle expect from individual (mn hiseae, youth) as wel 2 what the individual expects oftheir own sly Within theircommsnity and within South African society, the youth we worked with are seen a youth fick and are often associated with being both the tulnerble andthe trouble makers. Members ofthe youth group expressed thei awareness of ow they dre defined by society. Often what expected of them is that they would be drunk and ying on the axceet!| (I Ngwabeni, personal communication, 2007) and nocinvolved in projects such the onethey panned forthe centers members Being tirned avy from organizations was yet another reflection of hor lite good is expected fons he youth, This ad uch sn inpact thot the youth expraned hho, st times they fle thay were wasting ther tine doing these Kinds of projects. Same members pointed out how not even their parents supported thelr ease, Their parents hoped thet they would rather get more Structured jobs that would put food on the table, and battle to see the potenti ofthe perormances bringing in an income in the Future. One could easly be judgmental toward these parents. However, many of them are in astuation whe ther priorities center on basic needs. They are concerned with survive and ‘his flling the nee fr subsivence that Max Nest (1981) highlights as fundemental basic umn need ‘Therefore although some exernal validation Was received feom the community's encouragement, ‘ss limited due tolackof suppor from aly. Inter ral vldation was realized due to the youth's self movvation: ‘We cant ran aay, we need to be part ofthe chang’. Although the youth in his group sso acd to survive, they stem eo stave for other thing that speak ¢o community-bulding snd ‘collective story aking” (E Ramugoado, personal communica tion, 2007). ‘The youth chose both to atively break fre of perceived social consracibn an embrace a trad ‘Sion philosophy — the philosophy of Obama sonata ugunitu ngabanti, Wiening"s persan depends on ethers in odes to be" (see Chapters 1 and 21). This highlights that belonging and caring for one another is a basic valve (Shove 1983) ‘Watson & Fourie (2003) support this concept by expanding on Wileock’s (1998) theory of “doing, being and becoming’, noting how, in an African con: text, an Afro-centric view is essential, and therefore proposing that ‘Belonging’ be added to the process explained inthis theory Reflecting on the experience, Khanyiswa Zangga described to us how this journey caused a change within her, change that she cannot ignore change "hat is easing her to mature, This has conteibuted t anew outlook on her perspectives ofthe elderly nd ‘hat her rosin her community. She has gone on to ‘win few community participation awards acknowl. edged by the province, and has continued to work with other youth on similar projets, Conclusions ‘This chapter concludes wth ere hey points that, were leant through this experince: + Partnership and conncction with human beings ‘on more than one level (Le, emtional, physical, and spiritual) s needed for alistic health promotion If therapists are to work within communities, they need to be aware thatthe people they are working with may not ave Physical or mena nesses, but may be healthy indivuals who need erative direction and support with regard to ssttinable project Even though the youth group faced many

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