Globally the need of rehabilitation is higher in low and middle income countries as compare to developed countries, to promote independence in function, participation in learning, productivity in terms of earning and perform roles significantly in the life. This rise in demand of rehabilitation has promoted the need of rehab professionals for health and wellbeing of an individual.
Occupational therapy falls under the umbrella of profession in rehabilitation; it promotes functionality in an individual from physical to mental, individual to social and family to community. It has emerged as profession over the span of three centuries that assist in providing rehabilitation service to individuals with physical, mental or development impairment. In 1917 St. Catherine University offered the first occupational therapy assistant (OTA) program in USA.
Occupational therapy in Pakistan started almost five decades ago, in all these years maximum 800 therapists are produced. Whereas practicing occupational therapist would be only 35 percent of the total. There are only six colleges that offer three to five year degree program. Three main institutes are in Karachi where as two in Punjab and one in KPK.
It’s been known that occupational therapy is only associated with disability which is considered as any physical impairment due to congenital, acquired or accidental factor. Whereas World Health Organization defines Disabilities as parasol term, covers impairments, activity limitations, and participation restrictions. According to international classification of functioning, disability and health; impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations.
Disability reflects the interaction between a person’s body and the society in which it lives thus justifying that health is not only the absence of any disease or disorder but mental and social wellbeing too. With such elaboration of disability, the role of occupational therapy expands beyond the management of apparent disability.
According to the Bureau of labor statistics’ occupational therapy is the fifth most demanded job in the next decades. All are developed states, where as in developing and under developing country the rate of disability is higher so as the demand of occupational therapy. The arise of value care from quantity care has significantly increase demand of occupational therapy though the service is underuse due to lack of awareness among health professionals and stereotype image of professional practice.
The national health care policy is continuously reforming in the last few years but the involvement of health professional from variety of expertise is deficient, thus the policy effective implementation remains infertile to some extent. Occupational therapy is widely used worldwide in the developmental screening of children and providing early intervention to inhibit the future disability. Occupational therapy provides proactive and preventive approach towards mental, physical, emotional or cognitive delayed in pediatric health. It involves community base rehabilitation where mothers not only informed about developmental milestone but also trained to overcome any threat that hurdles the growth and development of child globally. Secondly in case of permanent disability, family may receive early intervention approach for the child’s management and strategies to minimize the effect of disability and promote the mainstreaming learning. Since last decade, major portion of fresh graduates of occupational therapy are employed in early schooling setup promoting awareness and competing the need for better learning and inclusive education. Though majority of occupational therapist are working in pediatric setting but only with apparent disabilities rather than globally as proactive approach.
Mental health rehabilitation is the most affected area where an individual may come out the rehab center symptomatically cured but adjusting in the society to gain his previous role remains an unaccomplished task. According to WHO report, 4% 0f total health disease burden is mental health disorders with female dominance which is 24 million people. The social rehabilitation is always neglected where the occupational therapy may play significant role in psychosocial adjustment, from self to family, family to community and community to work. It requires mass contribution of the health and liberal science professional to increase.
productivity and motivation among the individuals suffering from mental health issues. The allocated resources for mental health occupational therapy is threatened since 0.013% of occupational therapist are working for 100000 mental health patients. The dilemma is that the demand and production of the professionals both is neglected thus profession is anonymous in this area of health recovery.
According to Pakistan bureau of statistic the decision to separately count the disabled was taken very late thus did not provide the headcount of disabled in the most recent population census. Globally the disability rate is 15 % of the world population; stroke is a devastating illness leading thousands disabled so as road traffic accident and many other acquired conditions. Therapist working with adult or other major disabilities can be counted on fingers of one hand, acute care occupational therapy is only provided at two major tertiary hospitals in Karachi that means the burden of disability is carried by the patient and his family from the hospitals to their home. The demand of occupational therapy after first phase of disaster management is intense for post-traumatic stress recovery along with lifestyle management and adaptation, yet the involvement of the profession is totally absent.
There is profound need of professional awareness to full fill the unmet needs or the special needs individuals for their health and wellbeing. Occupational therapy will be one of the most demanding professions in near future thus it requires incorporation at the health care holistic team work. Fortunately Pakistan occupational therapy has international standing at the World Federation of Occupational Therapy but it is struggling at national level to promote coordination among all provinces and institutions to develop the standard of processing and guidelines of therapy that is culturally intact, evidence based and as per national need.
HOD Occupational Therapy
Ziauddin College of Rehabilitation Sciences
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