Australian Occupational Therapy Journal (2014) 61, 6–12
doi: 10.1111/1440-1630.12104
Feature Article
Occupational performance and self-determination: The role of the occupational therapist as volunteer in two mountain communities Moira Boyle Toowoomba Refugee and Migrant Service, Toowoomba, Queensland, Australia
Background/aim: Occupational therapists involved in volunteer programmes do so as either a volunteer or as a professional working with volunteers. This study outlines two such programmes: one in regional Queensland, with refugees settling into a life in Australia, and one in Bhutan, with an organisation assisting families of children with disabilities. In both instances, the author has been involved as a volunteer, drawing on her occupational therapy skills, the Person-Environment-Occupation Model and self-determination theory as theoretical frameworks. Method: This report offers an insight into two geographically and culturally different volunteer programmes, and outlines the potential for occupational therapists to be involved in cross-cultural experiences, within Australia and abroad. In the Australian setting the author is working with newly arrived refugees from Africa, Iran and Iraq in a local community group the Toowoomba Refugee and Migrant Service. Within the Bhutanese setting the author is working with the Ability Bhutan Society, an organisation established by a group of local parents with the initial aim of sharing experiences and information relating to their children with disabilities. Results: The descriptions of each volunteering experience outline the opportunities for facilitating the development of independence, self-determination and acquisition of new roles in two cross-cultural communities by an occupational therapist working as a volunteer. Conclusion: An occupational therapist’s ability to assess the interaction between a person or organisation’s skills, the environment in which that person or organisation is functioning, and the desired occupational outcomes of that
Moira Boyle BOccThy; Occupational Therapist. Correspondence: Moira Boyle, Toowoomba Refugee and Migrant Service, C/- St Patrick’s Cathedral, 123 Neil Street, Toowoomba, Qld 4350, Australia. Email: boyletonbus@hot mail.com Accepted for publication 8 November 2013. © 2014 Occupational Therapy Australia
person or organisation, enables a unique and valuable contribution as a volunteer. KEY WORDS advocacy, African, empowerment, occupational justice.
Introduction More and more professionals are looking to ‘give back’ to a developing community, or to share their knowledge and skills in aid work (Black & Living, 2004). With their focus on enabling occupation and occupational performance, occupational therapists are ideally placed to work as, or with volunteers, in a wide range of fields, and in a wide range of establishments, including nongovernment organisations (NGOs), government supported agencies and church outreach programmes (Keane & Kunzweiler, 2007). The author is involved in two quite different programmes: one based in regional Queensland working with African refugees, the other in Bhutan working with local families of children with disabilities. These geographically and culturally diverse settings nevertheless share common goals of occupational justice, successful occupational performance and self-determination.
Toowoomba Refugee and Migrant Service In 1996, the first Sudanese family arrived in Toowoomba, Queensland. Others followed and by early 2000 people were arriving in significant numbers from Sudan, Sierra Leone, Liberia, Congo, Burundi, as well as from non-African countries such as Iran and Iraq. Some had been assessed by the United Nations (UN) as refugees and had arrived in Australia after processing by the UN Humanitarian Programme. Others were from refugee-like situations and were proposed or sponsored by family or community organisations under the Australian Government’s Special Humanitarian Programme.
OCCUPATIONAL PERFORMANCE AND SELF-DETERMINATION
Initially, refugees bound for Toowoomba were met at Brisbane airport and escorted to Toowoomba by a worker from Anglicare (now Spiritus, an NGO run by the Anglican Church). Anglican parishioners and local residents responded with donations of clothing, bedding, furniture and food. As more refugees arrived, other individuals and groups became involved in a variety of support activities such as teaching English, conducting homework classes and investigating employment opportunities. Various groups collaborated and pooled resources and in 2004 the Toowoomba Refugee and Migrant Service (TRAMS) was established. Commonwealth Government funding for TRAMS subsequently became available for management, casework, coordination of volunteers and administrative assistance. Volunteers working with refugees offer sessions to assist their transition to living and working in Australia. Examples include the establishment of driver education, youth mentoring and youth sports programmes, and the formation of a women’s support group. Inter-agency liaison and communication is maintained with other stakeholders within the Toowoomba region. The backbone of TRAMS is its volunteer community. The volunteers are as diverse as the group TRAMS supports. Students, grandparents, young parents, retirees, teachers and farmers join the volunteer group to offer support, friendship and assistance with the daily realities of resettlement. Some refugees are specifically matched with a volunteer to gain intensive assistance in meeting basic survival needs, i.e. health care, welfare options, accommodation and employment.
The refugee experience Refugees arriving in Australia have experienced trauma over time and in various settings (Schweitzer, Melville, Steel & Lacherez, 2006). Their homeland has frequently been torn apart by war and conflict, their family and community members tortured, injured or killed and their whole way of life destroyed. The refugees may also have been tortured, raped and forced to flee their home and country. They may have spent time in another country, often in a refugee camp, before being processed by the UN and eventually arriving in Australia, a country about which they generally know very little. Some are women at risk and are often accompanied by children. Many are single men. Common to all are the challenges facing all newly arrived refugees – language barriers, lack of accommodation, poor education and health care, reduced employment options and social isolation. Working within a social justice framework, staff and volunteers of TRAMS are aware of the need for a sense of belonging by the refugees, both within the wider community and within their ethnic group (Correa-Velez, Spaaij & Upham, 2012). Introducing recent arrivals to their new home is an exciting and challenging journey. New arriv-
7 als are keen to settle and integrate – to find a place to live, to obtain employment and to learn the local language. Befriending by a volunteer can significantly reduce the effects of social isolation, improve mental health and increase levels of happiness. This in turn assists refugees to engage with others, find employment, acquire English more readily and become integrated into their new community more rapidly (Andrews, Gavin, Begley & Brodie, 2003). TRAMS provides the context or environment, in which the now well-established African community can meet together to obtain both social support, and the skills and education required to help them achieve the new occupational roles they now have as residents in a different country. Volunteers working with refugee women provide opportunities for them to learn about and explore the Australian world of mothers and children, by introducing them to play groups and early literacy activities. Learning about local seasonal products and simple nutrition, preparing meals using locally available food and joining cooking and sewing classes offers the women the opportunity to develop the occupational role of homemaker in a country vastly different from the one they left. Pregnancy, breastfeeding, immunisation and simple first aid topics are also covered in formal learning settings and in one-to-one support situations. For many women, illiteracy is a major challenge and volunteers provide a valuable knowledge base. A major practical problem is providing information which can be accessed in an ongoing manner without the need for an interpreter. The author has commenced working on providing information packages with clear, simple, visual material. TRAMS volunteer support has a very strong occupational justice emphasis. The activities offered enable refugees to experience occupation as meaningful and enriching, and to participate in the social and educational life of the wider community. They come to develop their autonomy in their choice of activity and employment and to benefit from engaging in a range of community activities, e.g. sporting groups and choirs (Townsend & Wilcock, 2004). The goal is to foster autonomy and competence in living, working, studying and social integration into their new community while retaining the traditions and values they hold dear. Retaining cultural beliefs and traditions can be challenging as younger generations adopt the Australian way of life. Achieving employment, often in a role very different from their previous experiences, is important for men and women alike. Adapting to life where prior learning and experiences may not be recognised, where families have been fractured, blended or lost requires a change in perception of self and occupational roles – for example, as a provider, worker, student and parent. Supporting the refugees to blend their new roles, activities and perception of themselves is the challenge for those working with them. With our understanding of occupational performance and self-determination, occupational © 2014 Occupational Therapy Australia
8 therapists are ideally suited to facilitating such adaptations (Law et al., 1996). The African proverb ‘it takes a village to raise a child’, assumes new meaning for refugees assimilating into a foreign culture. The ‘village’ is encapsulated in the TRAMS community where recent refugees – from babies to the elderly – are supported and guided by local volunteers and refugees, who have already settled and mastered the challenges of learning to live in a new culture. They are a valuable resource for newly arrived refugees and TRAMS workers alike. Programmes are continually evaluated and modified in response to needs, suggestions and requests from the refugees and volunteers working together. TRAMS has provided the author with the opportunity to join a community network where all involved can learn of new cultures, share experiences and build friendships while facilitating the successful integration of people into their new and different culture and roles. One example of this is the work undertaken by the author with a refugee tertiary student studying for a Diploma of Counselling. This has entailed working through the external studies literature, acting as a client during supervised sessions and exploring the intersection of cultures as he strives to integrate a Western concept of psycho-social development which differs greatly from his traditional concept of roles and social norms. In addition, the author’s family has been ‘matched’ with a young couple and their children, which has involved supporting them through the arrival of the young wife, the birth of the new baby, parenting and study. Childminding, playgroups, supervision of a student project with occupational therapy students and providing workshops on parenting activities are other volunteer activities the author has undertaken. Because of a background in paediatrics, roles have emerged within TRAMS in response to specific needs, for example, assisting parents of children with developmental disabilities to recognise their children’s issues and access to support agencies. Volunteering as an occupational therapist provides an opportunity for two-way learning and cultural exchange. In doing this, it has been vitally important to consider cross-cultural experiences, beliefs and values of the refugee community in their roles as family providers, parents, students and newly arrived members of the Australian community. The use of narratives (Mattingly & Lawlor, 2000) – having the refugees tell stories illustrating their prior way of life, and the challenges they now face – has been a very significant learning tool for the author and all volunteers. Occupational therapy frames of reference are strongly Western (Chiang & Carlson, 2003) and concepts of roles, occupation, time use, health and disability are strongly defined within this framework. Learning more about the refugees’ backgrounds and experiences better enables TRAMS workers to assist them acquire the skills they need to function successfully within their new society. © 2014 Occupational Therapy Australia
M. BOYLE
Case history The following case history depicts the journey of a refugee and his family – from arrival in Australia, to independence and full inclusion into his new community. The range of support and activities provided by the TRAMS community and the involvement of the author as a volunteer occupational therapist is also described. Permission was sought from the family in the case history and informed consent obtained for their story to be told. They were given proofs of the story and their decisions on what they wished to include was final. This ensured that they retained their autonomy over what they shared, even though they were not identified. De-identifying initials have been used throughout. Permission was also sought from the Manager of Settlement Grants Programme and Volunteers TRAMS and the Executive Director of Ability Bhutan Society for inclusion in the article and again they were granted access to the proofs and were able to corroborate the information about the organisation (public record information). M and D are a young couple with one child T, a toddler of 18 months. M arrived 12 years ago as a young African refugee and D last year as his wife, sponsored under the Special Humanitarian Programme. T was born in Africa and came to Australia aged five months. M had fled his country to Egypt where he was assessed as a refugee by the UN. He is a farmer’s son and had attended primary schooling at a local village school for a few years. On arrival M originally made use of the resettlement service and the homework class as he completed high school and worked in manual seasonal jobs within the region. Besides working and studying he sponsored two family members who were at risk. M saved for and bought his own home. In 2011, he returned to Africa to be married, and on his return to Australia applied to sponsor his wife and baby. Their country of origin remains in a state of war and unrest. In 2009, M commenced tertiary studies in the area of his work within a local NGO. M has good language skills and is supported in his study by a matched partner (the author’s husband) accessed through TRAMS. Within this mentoring structure he is able to discuss the theoretical and philosophical aspects of his courses – a world view which is essentially Western – how his ethnic community values fit with them, and how his community goals and needs can be viewed within the Australian framework. D is a young woman who has never attended school and lived in a large African village prior to her arrival in Australia. She delivered their baby in a village with the support of her extended family and local women. D had no English on arrival, had never flown on a plane nor operated an electrical appliance, had always lived communally and was a new mother. M and D are matched with the author’s family. For M and D several
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varied occupational roles have emerged. Both are new parents. Both have had the experience of the African village in child rearing. The concept of play with toys and outdoor equipment and reading books is not one with which they are familiar. Although M has learnt to cook some basic foods in Australia, D had never used an electric stove or oven. She does not read numbers and is unable to tell the time. She cannot read and on arrival had only a few single English words. She was breastfeeding her toddler. With the support of the occupational therapist and TRAMS, D has been able to access English and basic literacy classes as childcare is provided. M has observed Australian fathers and their involvement with their children and minds their toddler so that D can attend English classes on Saturday. A local volunteer also assists D at home and works with her on English and literacy. D can now speak in simple sentences and understands the majority of clear, simple conversation. She has some word recognition. She can use the mobile phone and has memorised the phone contacts of important people. Pregnant with her second baby and without her ‘village’ of women, D has come to rely on her matched family and other mothers from the volunteer childminding group to share information and to support her with breastfeeding. D’s matched family prepared a simple book for her, outlining the stages of pregnancy and the development of her baby. This was an extremely positive experience for D who has shared it with the TRAMS community and both M and D plan to share it with other African village girls. Normal child development and behaviour are discussed with her matched family, where she has the opportunity to model interactions and play activities. Following the example of other women, D will take part in TRAMS workshops on topics such as breastfeeding, playing with your child, child nutrition and preparation of simple meals. D has detailed some of her longterm goals: to acquire English skills, to learn to read, to cook using local produce, to acquire a basic education, to qualify for a driver’s licence and gain employment. M has determined that he wishes to complete his qualifications, and continue working with his community, assisting youth and young men from the refugee group to gain employment. Both have family members still in Africa and are keen to share their newly acquired, culturally appropriate knowledge with their family and community there. T, the toddler, has access to organised play activity while her mother attends English classes at TRAMS. The occupational therapist is introducing D and T to playgroups and music groups as both enjoy music and D finds it assists her with language acquisition. M and D are exploring childcare options for T, including the possibility of T spending some time in their ethnic community as well as in a local childcare centre. The support that TRAMS has provided M and D has been offered within a framework of occupational justice
and self-determination. M accessed support which enabled him to study, work and eventually bring his wife and child to Australia. D has the freedom to gain an education, work outside the home and access health and welfare services. As an occupational therapist working within the organisation, I have found it is possible to work as a fellow community member while drawing on professional skills to assist refugees achieve successful autonomy and confidence as members of their ethnic support group, and as members of the wider community. Linking with families and workers of Ability Bhutan has offered a similar opportunity, but in this instance the community is far flung and communication relies on technology and telecommunications.
Ability Bhutan Society Within Western societies, the concept of giving something back to the community is a frequently identified reason for volunteering. Motivations which have been consistently identified among those who volunteer are: …the expression of altruistic and humanitarian values, understanding and learning, social relationships, career preparation and life protection and enhancement (personal development and selfesteem). (Clary et al., 1998)
In contrast, volunteering within the Buddhist society of Bhutan is rooted in traditional beliefs and practices with emphasis on principles of national self-reliance, community participation and social cohesion (Choden, 2003). The newly inaugurated Ability Bhutan Society grew from such roots. Some years ago in Bhutan, several families began to meet together as a group with the aim of sharing information and improving services for their children, all of whom had disabilities such as cerebral palsy or autism. The primary goal of all of the parents was to have access to therapy and resources, with an emphasis on in-home care, as the family was the primary unit of support. Inclusive education and development of skills and abilities that enabled their children to participate freely in their society was a group commitment. The best way for the group to achieve this was to be organised into a legal entity. In December 2007 the families joined together to outline their vision: In partnership with families, communities, governmental and non-governmental organisations, our dream is to enhance quality of life and to support individuals with inabilities to perform some or all of the activities of daily living, so they can grow in a safe, barrier free and inclusive environment, to be independent and productive members of our Bhutanese society. (Ability Bhutan Society, 2007) © 2014 Occupational Therapy Australia
10 In November 2011, the Ability Bhutan Society, under the patronage of his Majesty, The King of Bhutan, was formally registered with the Civil Society Organisation (CSO) as a Public Benefit Organisation. The Ability Bhutan Society is now able to work for its members, raise funds, apply for grants and offer services and programmes. It can also liaise with government organisations and other CSOs to provide services and benefits to its members, while training volunteers and family members as outlined in the Civil Society Organisations Act of Bhutan (2007). It has evolved into a successful advocacy group, working to disseminate information, facilitate independence and foster the integration of their children into local community and educational settings. The Ability Bhutan Society relies heavily on volunteers. The Executive Director and workers who have been involved with the setting up and commissioning of programming have all done so voluntarily. Funds have been accessed through donations and grants from groups and organisations, both within and without Bhutan. The Ability Bhutan Society conducted research about the occupations of Bhutanese, in addition to the health, education and welfare needs and goals of the country’s families and children. It became apparent as a result of this research that educating the Bhutanese community to recognise and understand disability is vitally important. To this end, a Child Development Aid programme is planned, the aim of which is ‘empowering community workers to identify children with special needs in their communities and provide basic intervention for these children’ (Ability Bhutan Society, 2011). While a small country, Bhutan is a land of towering mountains and narrow valleys. Access to transport, towns and specialised health and education facilities is challenging. Such workers would provide a valuable first step in awareness and recognition of developmental challenges faced by the children and the empowering effects of basic early intervention. A mental health training programme, covering topics such as child development, disabilities, mental health issues and parenting skills has also been designed. Provision of training for, and intensive supervision to, those working with children and families is an integral part of the programme (Ability Bhutan Society, 2011). As a parent-driven organisation, Ability Bhutan Society also offers parent support groups for parents and carers of children of different ages with attention and behavioural deficiencies. This programme is designed to offer parents knowledge and skills in managing behaviour and establishing positive interactions with their children. Training is offered in a group setting, thus providing an opportunity for families to support each other and feel less isolated. In addition, Ability Bhutan has commenced home programme assistance, in which children and families are offered in-home support about specific areas of need, for example, movement, seating, sensory aware© 2014 Occupational Therapy Australia
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ness, self-care and general management issues. The Ability Bhutan Society workers also liaise with schools as more and more children are included in regular classrooms (Ministry of Education, 2012). The home programme concept has been designed by families, for families – a ‘village’ of committed volunteers. They have been able to access the services of a volunteer Special Education Teacher from the USA during the initial stages. The Executive Director of the Ability Bhutan Society is Bhutanese, a physiotherapist with long experience in paediatrics and disability. Workers are volunteers who have a clear idea of the challenges faced in Bhutan and are actively involved in liaising with other providers from education, health and welfare sectors, be they local or international. They advocate for educational inclusion. They adapt programmes and raise community awareness of disability, the challenges inherent in caring for a child with a disability, markers of success in terms of programme outcomes and evidence of meaningful interaction of these children within the community. As an occupational therapist, volunteering for this organisation offers enormous potential to share information, learn new skills and advocate on a variety of fronts. There is a great need for therapists, psychologists and developmental paediatricians to work with the medical, educational and therapy staff in Bhutan. Currently, there is no occupational therapist in the country. Sharing knowledge and experiences, providing workshops, lectures and demonstrations on identified topics of interest to the workers, is a significant part of the author’s voluntary role, which is primarily coordinated from Australia. Liaison with AusAID programme workers and the Red Cross has naturally led to further advocacy roles for the author in investigating future possible links. Funds have been raised by the author to provide therapy resources and learning materials, as well as ongoing funding for the programmes discussed above. Parent training programmes for children with autism, and general and specific text books have been provided. These have been chosen for their clarity of presentation and adaptability for home-based programmes within the Bhutanese setting. Examples of current programmes being developed at the request of local workers are a training package on sensory issues in autism and the links to behaviour management, on CP with an emphasis on low tech equipment which could be sourced locally, and managing the child with low vision. The challenge is to develop these packages utilising the single iPad currently available for the organisation, and the basic computer also in use. Cross-cultural awareness of the availability of resources and the appropriateness of suggested interventions is vital to the successful development of the package. It is anticipated that future support will involve technology to assist Australian therapists and Bhutanese workers to develop further educational materials based on best practice. Skype, FaceTime, interactive books,
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videos and web links are all being canvassed as options by means of which questions can be posed and answered, techniques demonstrated, knowledge shared and mentoring offered. In future, it is possible that families, children and workers could participate in virtual therapy sessions with a volunteer therapist based in Queensland. Another possibility is mobilising volunteer therapists to travel to Bhutan and work alongside the Ability Bhutan workers. This could be for a short-term or longer placement and is dependent on several factors, including the community’s ability to accommodate a volunteer, matching volunteer skills and the children’s needs and the availability of funds.
Communities in common – African and Bhutanese Both communities, the refugees in Toowoomba and the families of a child with a disability in Bhutan face challenges to occupational performance and self-determination. In the Australian setting, refugees are transitioning into a very different environment from their homeland; one with very different demands in terms of occupational performance. They need to develop new skills to navigate their way into changed occupational roles. In the Bhutanese setting, the environment remains the same, but the goals of the organisation are to increase participation and occupational performance of their population of children with disabilities. This necessitates increasing the skills of those working in the organisation through training and provision of resources. Both groups have culturally defined values and beliefs. For the refugees, these may be linked with their past traumas. For the Bhutanese families – professionals, farmers and workers alike – their Buddhist faith is integral to their society and guides them in their life and approach to disability. Adequate access to health, education, welfare services and employment are constant issues in both communities. Inclusion in meaningful occupations is seen by both communities as a desirable goal and essential to living a worthwhile, dignified existence. For the refugees in Toowoomba, the provision of support was initially governed by the refugees’ needs and the knowledge of local volunteers as to how to access this assistance. As the refugee community has come to know their new country, they have been able to assess what helped most and what the ongoing needs are. They are now able to share that knowledge with the TRAMS workers, other organisations and within their communities. Accessing this knowledge has been vitally important in shaping the provision of programmes with which the author and other volunteers have been involved. Ability Bhutan consists of a group working within their environment to achieve new options and opportunities for their children. They are concerned to implement change and to work towards supporting their
children in daily life activities, education and employment. The contribution of an occupational therapist assists them to access knowledge, adapt appropriate interventions and work towards the availability of life opportunities as experienced in Bhutan. Both communities have taken ownership of the challenges they face and have a vision for the future which they now share with the wider community. In working with these communities, common themes have been recognised by the therapist – the optimism, hope and strength of the people, the need for connectedness, the need to build strong links with people and the constant evaluation of the cross-cultural experience – what are their needs as articulated by them, and how can these be addressed within the context of the Australian community. This reflects the study by Humbert, Burket, Deveney and Kennedy (2011) which outlined the challenges faced by therapists engaged in international and cross-cultural work. These two groups have a clear vision of their ultimate goals and demonstrate a strength and determination to persist to achieve these. Occupational therapy in a volunteer capacity has offered the opportunity to share professional skills and to utilise academic knowledge, but importantly it has been the ability to be a listener and observer that has served to build a strong, working relationship with members of both communities.
Conclusion Little research has been undertaken on occupational therapists working as volunteers, despite the emergence of volunteerism as an occupation applicable to a significant proportion of the community (Black & Living, 2004). There is a need to document and assess volunteer programmes and outcomes in terms of: growth of independence within the supported communities; benefits to volunteers and those with whom they work; challenges faced in the delivery of services; and the recruitment and retention of volunteers. Further review of the role of volunteering as an occupation and as an agent for the delivery of occupational justice would greatly assist programme evaluation and promotion in other communities. Working as a volunteer occupational therapist within both TRAMS and the Ability Bhutan Society has offered the author opportunities to observe the emergence of self-determination in a supported environment (refugees) and self-determination as practised by a group working for its members (Bhutan). It has involved adapting skills and knowledge to two very different groups as they move forward to embrace new and different aspects of living. Different concepts of health, wellness and disability have been canvassed. Occupational therapists with their focus on occupational performance – the ‘just right’ fit between a person’s skills, the demands of the environment and the occupational roles a person is expected to fulfil – are well placed to work with such groups. The autonomy to make choices, the inclusion within a sup© 2014 Occupational Therapy Australia
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portive community and the development of daily living competencies are the hallmarks of success for organisations that are supported by the village of volunteers (Ryan & Deci, 2000). The common desire for self-determination is expressed in a poem by a young refugee man ‘all we need is availability, accessibility, affordability, acceptability and adaptability’ (Alcock, 2011). As an occupational therapist, it is possible to support these aspirations. Having the freedom to join in all aspects of society fits with occupational therapy tenets of occupational justice, social inclusion, autonomy, occupational performance and self-determination. In his 1997 address, James D. Wolfensohn, World Bank President, outlined this desire for self-determination by refugees and marginalised people when he said: Whether they live on the plains or in the valleys, whether they live in slums or isolated villages, whether they speak Hindi, Swahili or Uzbek, they have one thing in common. They do not want charity. They want a chance. They do not want solutions imposed from without. They want the opportunity to build from within. They do not want any culture or yours. They want their own. They want a future enriched by the inheritance of their past. (Wolfensohn, 1997)
Connecting with the families, listening to their stories and discussing their beliefs and expectations is vital to the success of interaction with the refugee group as well as the families and workers based in Bhutan. The role of ‘guide on the side’ is one that the author has found most useful in these situations. Both groups have the vision of the life they wish for; the role of the occupational therapist as volunteer is often to provide information and access to options, services and support, to exchange experiences and facilitate the acquisition of skills that achieve this success.
Acknowledgements I would like to express my appreciation and thanks to the staff and communities of Toowoomba Refugee and Migrant Service, Ability Bhutan and Philippa Tolmie and Cathy McBryde for their encouragement and support in the presentation of this article.
References Ability Bhutan Society (2007). Retrieved 16 March, 2013, from http://www.absbhutan.org.bt Ability Bhutan Society (2011). Retrieved 16 March, 2013, from http://www.absbhutan.org.bt/index.php/training-a-project/mental-health-training-program?tmpl Alcock, A. (2011). One decade on—African settlement on the Downs. Toowoomba, Qld: PhotoVoice Australia. Andrews, G. J., Gavin, N., Begley, S. & Brodie, D. (2003). Assisting friendships, combating loneliness: Users’ views on a ‘befriending’ scheme. Ageing and Society, 23, 349–362. © 2014 Occupational Therapy Australia
Black, W. & Living, R. (2004). Volunteerism as an occupation and its relationship to health and wellbeing. British Journal of Occupational Therapy, 67, 526–532. Chiang, M. & Carlson, G. (2003). Occupational therapy in multicultural contexts: Issues and strategies. British Journal of Occupational Therapy, 66, 559–567. Choden, T. (2003). Traditional forms of volunteerism in Bhutan. The Centre for Bhutan Studies. Retrieved 16 March, 2013, from http://www.bhutanstudies.org.bt/wp-content/uploads/monograph/monoVolunteerism.pdf Civil Society Organisations Act of Bhutan (2007). Retrieved 16 March, 2013, from http://www.nationalcouncil.bt/ wp-content/uploads/2011/02/CivilSociety_En_07.pdf Clary, E. G., Snyder, M., Ridge, R. D., Copeland, J., Stukas, A. A., Haugen, J. et al. (1998). Understanding and assessing the motivations of volunteers: A functional approach. Journal of Personality and Social Psychology, 74, 1516–1530. Correa-Velez, I., Spaaij, R. & Upham, S. (2012). ‘We are not here to claim better services than any other’: Social exclusion among men from refugee backgrounds in urban and regional Australia. Journal of Refugee Studies, doi: 10.1093/ jrs/fes003 Humbert, T., Burket, A., Deveney, R. & Kennedy, K. (2011). Occupational therapy practitioners’ perspectives regarding international cross cultural work. Australian Occupational Therapy Journal, 58, 300–309. Keane, P. & Kunzweiler, J. (2007). Occupational justice: An effort to diminish occupational injustice. American Occupational Therapy Association National Conference 2007. Retrieved 16 March 2013, from http://www.ccels.cf. ac.uk/archives/publications/2007/keane_kunzweiler.pdf Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P. & Letts, L. (1996). The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63, 9–23. Mattingly, C. & Lawlor, M. (2000). Learning from stories: Narrative interviewing in cross-cultural research. Scandinavian Journal of Occupational Therapy, 7, 4–14. Ministry of Education (2012). National Policy on Special Education Needs. Royal Government of Bhutan. Retrieved 16 March, 2013, from http://www.gnhc.gov.bt/wp-content/ uploads/2011/05/Final-Draft-SEN-Policy-2012.pdf Ryan, R. M. & Deci, E. L. (2000). The darker and brighter sides of human existence: Basic psychological needs as a unifying concept. Psychological Enquiry, 11, 319–338. Schweitzer, R., Melville, F., Steel, Z. & Lacherez, P. (2006). Trauma, post-migration living difficulties and social support as predictors of psychological adjustment in resettled refugees. Australian and New Zealand Journal of Psychiatry, 40, 79–187. Townsend, E. & Wilcock, A. (2004). Occupational justice and client centred practice: A dialogue in progress. Canadian Journal of Occupational Therapy, 71, 75–81. Wolfensohn, J. D. (1997). The challenge of inclusion. Address to Boards of Governors of the World Bank Group at the Joint Annual Discussion. Press release no. 4 September (pp. 23–25).
doi: 10.1111/1440-1630.12104
Feature Article
Occupational performance and self-determination: The role of the occupational therapist as volunteer in two mountain communities Moira Boyle Toowoomba Refugee and Migrant Service, Toowoomba, Queensland, Australia
Background/aim: Occupational therapists involved in volunteer programmes do so as either a volunteer or as a professional working with volunteers. This study outlines two such programmes: one in regional Queensland, with refugees settling into a life in Australia, and one in Bhutan, with an organisation assisting families of children with disabilities. In both instances, the author has been involved as a volunteer, drawing on her occupational therapy skills, the Person-Environment-Occupation Model and self-determination theory as theoretical frameworks. Method: This report offers an insight into two geographically and culturally different volunteer programmes, and outlines the potential for occupational therapists to be involved in cross-cultural experiences, within Australia and abroad. In the Australian setting the author is working with newly arrived refugees from Africa, Iran and Iraq in a local community group the Toowoomba Refugee and Migrant Service. Within the Bhutanese setting the author is working with the Ability Bhutan Society, an organisation established by a group of local parents with the initial aim of sharing experiences and information relating to their children with disabilities. Results: The descriptions of each volunteering experience outline the opportunities for facilitating the development of independence, self-determination and acquisition of new roles in two cross-cultural communities by an occupational therapist working as a volunteer. Conclusion: An occupational therapist’s ability to assess the interaction between a person or organisation’s skills, the environment in which that person or organisation is functioning, and the desired occupational outcomes of that
Moira Boyle BOccThy; Occupational Therapist. Correspondence: Moira Boyle, Toowoomba Refugee and Migrant Service, C/- St Patrick’s Cathedral, 123 Neil Street, Toowoomba, Qld 4350, Australia. Email: boyletonbus@hot mail.com Accepted for publication 8 November 2013. © 2014 Occupational Therapy Australia
person or organisation, enables a unique and valuable contribution as a volunteer. KEY WORDS advocacy, African, empowerment, occupational justice.
Introduction More and more professionals are looking to ‘give back’ to a developing community, or to share their knowledge and skills in aid work (Black & Living, 2004). With their focus on enabling occupation and occupational performance, occupational therapists are ideally placed to work as, or with volunteers, in a wide range of fields, and in a wide range of establishments, including nongovernment organisations (NGOs), government supported agencies and church outreach programmes (Keane & Kunzweiler, 2007). The author is involved in two quite different programmes: one based in regional Queensland working with African refugees, the other in Bhutan working with local families of children with disabilities. These geographically and culturally diverse settings nevertheless share common goals of occupational justice, successful occupational performance and self-determination.
Toowoomba Refugee and Migrant Service In 1996, the first Sudanese family arrived in Toowoomba, Queensland. Others followed and by early 2000 people were arriving in significant numbers from Sudan, Sierra Leone, Liberia, Congo, Burundi, as well as from non-African countries such as Iran and Iraq. Some had been assessed by the United Nations (UN) as refugees and had arrived in Australia after processing by the UN Humanitarian Programme. Others were from refugee-like situations and were proposed or sponsored by family or community organisations under the Australian Government’s Special Humanitarian Programme.
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Initially, refugees bound for Toowoomba were met at Brisbane airport and escorted to Toowoomba by a worker from Anglicare (now Spiritus, an NGO run by the Anglican Church). Anglican parishioners and local residents responded with donations of clothing, bedding, furniture and food. As more refugees arrived, other individuals and groups became involved in a variety of support activities such as teaching English, conducting homework classes and investigating employment opportunities. Various groups collaborated and pooled resources and in 2004 the Toowoomba Refugee and Migrant Service (TRAMS) was established. Commonwealth Government funding for TRAMS subsequently became available for management, casework, coordination of volunteers and administrative assistance. Volunteers working with refugees offer sessions to assist their transition to living and working in Australia. Examples include the establishment of driver education, youth mentoring and youth sports programmes, and the formation of a women’s support group. Inter-agency liaison and communication is maintained with other stakeholders within the Toowoomba region. The backbone of TRAMS is its volunteer community. The volunteers are as diverse as the group TRAMS supports. Students, grandparents, young parents, retirees, teachers and farmers join the volunteer group to offer support, friendship and assistance with the daily realities of resettlement. Some refugees are specifically matched with a volunteer to gain intensive assistance in meeting basic survival needs, i.e. health care, welfare options, accommodation and employment.
The refugee experience Refugees arriving in Australia have experienced trauma over time and in various settings (Schweitzer, Melville, Steel & Lacherez, 2006). Their homeland has frequently been torn apart by war and conflict, their family and community members tortured, injured or killed and their whole way of life destroyed. The refugees may also have been tortured, raped and forced to flee their home and country. They may have spent time in another country, often in a refugee camp, before being processed by the UN and eventually arriving in Australia, a country about which they generally know very little. Some are women at risk and are often accompanied by children. Many are single men. Common to all are the challenges facing all newly arrived refugees – language barriers, lack of accommodation, poor education and health care, reduced employment options and social isolation. Working within a social justice framework, staff and volunteers of TRAMS are aware of the need for a sense of belonging by the refugees, both within the wider community and within their ethnic group (Correa-Velez, Spaaij & Upham, 2012). Introducing recent arrivals to their new home is an exciting and challenging journey. New arriv-
7 als are keen to settle and integrate – to find a place to live, to obtain employment and to learn the local language. Befriending by a volunteer can significantly reduce the effects of social isolation, improve mental health and increase levels of happiness. This in turn assists refugees to engage with others, find employment, acquire English more readily and become integrated into their new community more rapidly (Andrews, Gavin, Begley & Brodie, 2003). TRAMS provides the context or environment, in which the now well-established African community can meet together to obtain both social support, and the skills and education required to help them achieve the new occupational roles they now have as residents in a different country. Volunteers working with refugee women provide opportunities for them to learn about and explore the Australian world of mothers and children, by introducing them to play groups and early literacy activities. Learning about local seasonal products and simple nutrition, preparing meals using locally available food and joining cooking and sewing classes offers the women the opportunity to develop the occupational role of homemaker in a country vastly different from the one they left. Pregnancy, breastfeeding, immunisation and simple first aid topics are also covered in formal learning settings and in one-to-one support situations. For many women, illiteracy is a major challenge and volunteers provide a valuable knowledge base. A major practical problem is providing information which can be accessed in an ongoing manner without the need for an interpreter. The author has commenced working on providing information packages with clear, simple, visual material. TRAMS volunteer support has a very strong occupational justice emphasis. The activities offered enable refugees to experience occupation as meaningful and enriching, and to participate in the social and educational life of the wider community. They come to develop their autonomy in their choice of activity and employment and to benefit from engaging in a range of community activities, e.g. sporting groups and choirs (Townsend & Wilcock, 2004). The goal is to foster autonomy and competence in living, working, studying and social integration into their new community while retaining the traditions and values they hold dear. Retaining cultural beliefs and traditions can be challenging as younger generations adopt the Australian way of life. Achieving employment, often in a role very different from their previous experiences, is important for men and women alike. Adapting to life where prior learning and experiences may not be recognised, where families have been fractured, blended or lost requires a change in perception of self and occupational roles – for example, as a provider, worker, student and parent. Supporting the refugees to blend their new roles, activities and perception of themselves is the challenge for those working with them. With our understanding of occupational performance and self-determination, occupational © 2014 Occupational Therapy Australia
8 therapists are ideally suited to facilitating such adaptations (Law et al., 1996). The African proverb ‘it takes a village to raise a child’, assumes new meaning for refugees assimilating into a foreign culture. The ‘village’ is encapsulated in the TRAMS community where recent refugees – from babies to the elderly – are supported and guided by local volunteers and refugees, who have already settled and mastered the challenges of learning to live in a new culture. They are a valuable resource for newly arrived refugees and TRAMS workers alike. Programmes are continually evaluated and modified in response to needs, suggestions and requests from the refugees and volunteers working together. TRAMS has provided the author with the opportunity to join a community network where all involved can learn of new cultures, share experiences and build friendships while facilitating the successful integration of people into their new and different culture and roles. One example of this is the work undertaken by the author with a refugee tertiary student studying for a Diploma of Counselling. This has entailed working through the external studies literature, acting as a client during supervised sessions and exploring the intersection of cultures as he strives to integrate a Western concept of psycho-social development which differs greatly from his traditional concept of roles and social norms. In addition, the author’s family has been ‘matched’ with a young couple and their children, which has involved supporting them through the arrival of the young wife, the birth of the new baby, parenting and study. Childminding, playgroups, supervision of a student project with occupational therapy students and providing workshops on parenting activities are other volunteer activities the author has undertaken. Because of a background in paediatrics, roles have emerged within TRAMS in response to specific needs, for example, assisting parents of children with developmental disabilities to recognise their children’s issues and access to support agencies. Volunteering as an occupational therapist provides an opportunity for two-way learning and cultural exchange. In doing this, it has been vitally important to consider cross-cultural experiences, beliefs and values of the refugee community in their roles as family providers, parents, students and newly arrived members of the Australian community. The use of narratives (Mattingly & Lawlor, 2000) – having the refugees tell stories illustrating their prior way of life, and the challenges they now face – has been a very significant learning tool for the author and all volunteers. Occupational therapy frames of reference are strongly Western (Chiang & Carlson, 2003) and concepts of roles, occupation, time use, health and disability are strongly defined within this framework. Learning more about the refugees’ backgrounds and experiences better enables TRAMS workers to assist them acquire the skills they need to function successfully within their new society. © 2014 Occupational Therapy Australia
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Case history The following case history depicts the journey of a refugee and his family – from arrival in Australia, to independence and full inclusion into his new community. The range of support and activities provided by the TRAMS community and the involvement of the author as a volunteer occupational therapist is also described. Permission was sought from the family in the case history and informed consent obtained for their story to be told. They were given proofs of the story and their decisions on what they wished to include was final. This ensured that they retained their autonomy over what they shared, even though they were not identified. De-identifying initials have been used throughout. Permission was also sought from the Manager of Settlement Grants Programme and Volunteers TRAMS and the Executive Director of Ability Bhutan Society for inclusion in the article and again they were granted access to the proofs and were able to corroborate the information about the organisation (public record information). M and D are a young couple with one child T, a toddler of 18 months. M arrived 12 years ago as a young African refugee and D last year as his wife, sponsored under the Special Humanitarian Programme. T was born in Africa and came to Australia aged five months. M had fled his country to Egypt where he was assessed as a refugee by the UN. He is a farmer’s son and had attended primary schooling at a local village school for a few years. On arrival M originally made use of the resettlement service and the homework class as he completed high school and worked in manual seasonal jobs within the region. Besides working and studying he sponsored two family members who were at risk. M saved for and bought his own home. In 2011, he returned to Africa to be married, and on his return to Australia applied to sponsor his wife and baby. Their country of origin remains in a state of war and unrest. In 2009, M commenced tertiary studies in the area of his work within a local NGO. M has good language skills and is supported in his study by a matched partner (the author’s husband) accessed through TRAMS. Within this mentoring structure he is able to discuss the theoretical and philosophical aspects of his courses – a world view which is essentially Western – how his ethnic community values fit with them, and how his community goals and needs can be viewed within the Australian framework. D is a young woman who has never attended school and lived in a large African village prior to her arrival in Australia. She delivered their baby in a village with the support of her extended family and local women. D had no English on arrival, had never flown on a plane nor operated an electrical appliance, had always lived communally and was a new mother. M and D are matched with the author’s family. For M and D several
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varied occupational roles have emerged. Both are new parents. Both have had the experience of the African village in child rearing. The concept of play with toys and outdoor equipment and reading books is not one with which they are familiar. Although M has learnt to cook some basic foods in Australia, D had never used an electric stove or oven. She does not read numbers and is unable to tell the time. She cannot read and on arrival had only a few single English words. She was breastfeeding her toddler. With the support of the occupational therapist and TRAMS, D has been able to access English and basic literacy classes as childcare is provided. M has observed Australian fathers and their involvement with their children and minds their toddler so that D can attend English classes on Saturday. A local volunteer also assists D at home and works with her on English and literacy. D can now speak in simple sentences and understands the majority of clear, simple conversation. She has some word recognition. She can use the mobile phone and has memorised the phone contacts of important people. Pregnant with her second baby and without her ‘village’ of women, D has come to rely on her matched family and other mothers from the volunteer childminding group to share information and to support her with breastfeeding. D’s matched family prepared a simple book for her, outlining the stages of pregnancy and the development of her baby. This was an extremely positive experience for D who has shared it with the TRAMS community and both M and D plan to share it with other African village girls. Normal child development and behaviour are discussed with her matched family, where she has the opportunity to model interactions and play activities. Following the example of other women, D will take part in TRAMS workshops on topics such as breastfeeding, playing with your child, child nutrition and preparation of simple meals. D has detailed some of her longterm goals: to acquire English skills, to learn to read, to cook using local produce, to acquire a basic education, to qualify for a driver’s licence and gain employment. M has determined that he wishes to complete his qualifications, and continue working with his community, assisting youth and young men from the refugee group to gain employment. Both have family members still in Africa and are keen to share their newly acquired, culturally appropriate knowledge with their family and community there. T, the toddler, has access to organised play activity while her mother attends English classes at TRAMS. The occupational therapist is introducing D and T to playgroups and music groups as both enjoy music and D finds it assists her with language acquisition. M and D are exploring childcare options for T, including the possibility of T spending some time in their ethnic community as well as in a local childcare centre. The support that TRAMS has provided M and D has been offered within a framework of occupational justice
and self-determination. M accessed support which enabled him to study, work and eventually bring his wife and child to Australia. D has the freedom to gain an education, work outside the home and access health and welfare services. As an occupational therapist working within the organisation, I have found it is possible to work as a fellow community member while drawing on professional skills to assist refugees achieve successful autonomy and confidence as members of their ethnic support group, and as members of the wider community. Linking with families and workers of Ability Bhutan has offered a similar opportunity, but in this instance the community is far flung and communication relies on technology and telecommunications.
Ability Bhutan Society Within Western societies, the concept of giving something back to the community is a frequently identified reason for volunteering. Motivations which have been consistently identified among those who volunteer are: …the expression of altruistic and humanitarian values, understanding and learning, social relationships, career preparation and life protection and enhancement (personal development and selfesteem). (Clary et al., 1998)
In contrast, volunteering within the Buddhist society of Bhutan is rooted in traditional beliefs and practices with emphasis on principles of national self-reliance, community participation and social cohesion (Choden, 2003). The newly inaugurated Ability Bhutan Society grew from such roots. Some years ago in Bhutan, several families began to meet together as a group with the aim of sharing information and improving services for their children, all of whom had disabilities such as cerebral palsy or autism. The primary goal of all of the parents was to have access to therapy and resources, with an emphasis on in-home care, as the family was the primary unit of support. Inclusive education and development of skills and abilities that enabled their children to participate freely in their society was a group commitment. The best way for the group to achieve this was to be organised into a legal entity. In December 2007 the families joined together to outline their vision: In partnership with families, communities, governmental and non-governmental organisations, our dream is to enhance quality of life and to support individuals with inabilities to perform some or all of the activities of daily living, so they can grow in a safe, barrier free and inclusive environment, to be independent and productive members of our Bhutanese society. (Ability Bhutan Society, 2007) © 2014 Occupational Therapy Australia
10 In November 2011, the Ability Bhutan Society, under the patronage of his Majesty, The King of Bhutan, was formally registered with the Civil Society Organisation (CSO) as a Public Benefit Organisation. The Ability Bhutan Society is now able to work for its members, raise funds, apply for grants and offer services and programmes. It can also liaise with government organisations and other CSOs to provide services and benefits to its members, while training volunteers and family members as outlined in the Civil Society Organisations Act of Bhutan (2007). It has evolved into a successful advocacy group, working to disseminate information, facilitate independence and foster the integration of their children into local community and educational settings. The Ability Bhutan Society relies heavily on volunteers. The Executive Director and workers who have been involved with the setting up and commissioning of programming have all done so voluntarily. Funds have been accessed through donations and grants from groups and organisations, both within and without Bhutan. The Ability Bhutan Society conducted research about the occupations of Bhutanese, in addition to the health, education and welfare needs and goals of the country’s families and children. It became apparent as a result of this research that educating the Bhutanese community to recognise and understand disability is vitally important. To this end, a Child Development Aid programme is planned, the aim of which is ‘empowering community workers to identify children with special needs in their communities and provide basic intervention for these children’ (Ability Bhutan Society, 2011). While a small country, Bhutan is a land of towering mountains and narrow valleys. Access to transport, towns and specialised health and education facilities is challenging. Such workers would provide a valuable first step in awareness and recognition of developmental challenges faced by the children and the empowering effects of basic early intervention. A mental health training programme, covering topics such as child development, disabilities, mental health issues and parenting skills has also been designed. Provision of training for, and intensive supervision to, those working with children and families is an integral part of the programme (Ability Bhutan Society, 2011). As a parent-driven organisation, Ability Bhutan Society also offers parent support groups for parents and carers of children of different ages with attention and behavioural deficiencies. This programme is designed to offer parents knowledge and skills in managing behaviour and establishing positive interactions with their children. Training is offered in a group setting, thus providing an opportunity for families to support each other and feel less isolated. In addition, Ability Bhutan has commenced home programme assistance, in which children and families are offered in-home support about specific areas of need, for example, movement, seating, sensory aware© 2014 Occupational Therapy Australia
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ness, self-care and general management issues. The Ability Bhutan Society workers also liaise with schools as more and more children are included in regular classrooms (Ministry of Education, 2012). The home programme concept has been designed by families, for families – a ‘village’ of committed volunteers. They have been able to access the services of a volunteer Special Education Teacher from the USA during the initial stages. The Executive Director of the Ability Bhutan Society is Bhutanese, a physiotherapist with long experience in paediatrics and disability. Workers are volunteers who have a clear idea of the challenges faced in Bhutan and are actively involved in liaising with other providers from education, health and welfare sectors, be they local or international. They advocate for educational inclusion. They adapt programmes and raise community awareness of disability, the challenges inherent in caring for a child with a disability, markers of success in terms of programme outcomes and evidence of meaningful interaction of these children within the community. As an occupational therapist, volunteering for this organisation offers enormous potential to share information, learn new skills and advocate on a variety of fronts. There is a great need for therapists, psychologists and developmental paediatricians to work with the medical, educational and therapy staff in Bhutan. Currently, there is no occupational therapist in the country. Sharing knowledge and experiences, providing workshops, lectures and demonstrations on identified topics of interest to the workers, is a significant part of the author’s voluntary role, which is primarily coordinated from Australia. Liaison with AusAID programme workers and the Red Cross has naturally led to further advocacy roles for the author in investigating future possible links. Funds have been raised by the author to provide therapy resources and learning materials, as well as ongoing funding for the programmes discussed above. Parent training programmes for children with autism, and general and specific text books have been provided. These have been chosen for their clarity of presentation and adaptability for home-based programmes within the Bhutanese setting. Examples of current programmes being developed at the request of local workers are a training package on sensory issues in autism and the links to behaviour management, on CP with an emphasis on low tech equipment which could be sourced locally, and managing the child with low vision. The challenge is to develop these packages utilising the single iPad currently available for the organisation, and the basic computer also in use. Cross-cultural awareness of the availability of resources and the appropriateness of suggested interventions is vital to the successful development of the package. It is anticipated that future support will involve technology to assist Australian therapists and Bhutanese workers to develop further educational materials based on best practice. Skype, FaceTime, interactive books,
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videos and web links are all being canvassed as options by means of which questions can be posed and answered, techniques demonstrated, knowledge shared and mentoring offered. In future, it is possible that families, children and workers could participate in virtual therapy sessions with a volunteer therapist based in Queensland. Another possibility is mobilising volunteer therapists to travel to Bhutan and work alongside the Ability Bhutan workers. This could be for a short-term or longer placement and is dependent on several factors, including the community’s ability to accommodate a volunteer, matching volunteer skills and the children’s needs and the availability of funds.
Communities in common – African and Bhutanese Both communities, the refugees in Toowoomba and the families of a child with a disability in Bhutan face challenges to occupational performance and self-determination. In the Australian setting, refugees are transitioning into a very different environment from their homeland; one with very different demands in terms of occupational performance. They need to develop new skills to navigate their way into changed occupational roles. In the Bhutanese setting, the environment remains the same, but the goals of the organisation are to increase participation and occupational performance of their population of children with disabilities. This necessitates increasing the skills of those working in the organisation through training and provision of resources. Both groups have culturally defined values and beliefs. For the refugees, these may be linked with their past traumas. For the Bhutanese families – professionals, farmers and workers alike – their Buddhist faith is integral to their society and guides them in their life and approach to disability. Adequate access to health, education, welfare services and employment are constant issues in both communities. Inclusion in meaningful occupations is seen by both communities as a desirable goal and essential to living a worthwhile, dignified existence. For the refugees in Toowoomba, the provision of support was initially governed by the refugees’ needs and the knowledge of local volunteers as to how to access this assistance. As the refugee community has come to know their new country, they have been able to assess what helped most and what the ongoing needs are. They are now able to share that knowledge with the TRAMS workers, other organisations and within their communities. Accessing this knowledge has been vitally important in shaping the provision of programmes with which the author and other volunteers have been involved. Ability Bhutan consists of a group working within their environment to achieve new options and opportunities for their children. They are concerned to implement change and to work towards supporting their
children in daily life activities, education and employment. The contribution of an occupational therapist assists them to access knowledge, adapt appropriate interventions and work towards the availability of life opportunities as experienced in Bhutan. Both communities have taken ownership of the challenges they face and have a vision for the future which they now share with the wider community. In working with these communities, common themes have been recognised by the therapist – the optimism, hope and strength of the people, the need for connectedness, the need to build strong links with people and the constant evaluation of the cross-cultural experience – what are their needs as articulated by them, and how can these be addressed within the context of the Australian community. This reflects the study by Humbert, Burket, Deveney and Kennedy (2011) which outlined the challenges faced by therapists engaged in international and cross-cultural work. These two groups have a clear vision of their ultimate goals and demonstrate a strength and determination to persist to achieve these. Occupational therapy in a volunteer capacity has offered the opportunity to share professional skills and to utilise academic knowledge, but importantly it has been the ability to be a listener and observer that has served to build a strong, working relationship with members of both communities.
Conclusion Little research has been undertaken on occupational therapists working as volunteers, despite the emergence of volunteerism as an occupation applicable to a significant proportion of the community (Black & Living, 2004). There is a need to document and assess volunteer programmes and outcomes in terms of: growth of independence within the supported communities; benefits to volunteers and those with whom they work; challenges faced in the delivery of services; and the recruitment and retention of volunteers. Further review of the role of volunteering as an occupation and as an agent for the delivery of occupational justice would greatly assist programme evaluation and promotion in other communities. Working as a volunteer occupational therapist within both TRAMS and the Ability Bhutan Society has offered the author opportunities to observe the emergence of self-determination in a supported environment (refugees) and self-determination as practised by a group working for its members (Bhutan). It has involved adapting skills and knowledge to two very different groups as they move forward to embrace new and different aspects of living. Different concepts of health, wellness and disability have been canvassed. Occupational therapists with their focus on occupational performance – the ‘just right’ fit between a person’s skills, the demands of the environment and the occupational roles a person is expected to fulfil – are well placed to work with such groups. The autonomy to make choices, the inclusion within a sup© 2014 Occupational Therapy Australia
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portive community and the development of daily living competencies are the hallmarks of success for organisations that are supported by the village of volunteers (Ryan & Deci, 2000). The common desire for self-determination is expressed in a poem by a young refugee man ‘all we need is availability, accessibility, affordability, acceptability and adaptability’ (Alcock, 2011). As an occupational therapist, it is possible to support these aspirations. Having the freedom to join in all aspects of society fits with occupational therapy tenets of occupational justice, social inclusion, autonomy, occupational performance and self-determination. In his 1997 address, James D. Wolfensohn, World Bank President, outlined this desire for self-determination by refugees and marginalised people when he said: Whether they live on the plains or in the valleys, whether they live in slums or isolated villages, whether they speak Hindi, Swahili or Uzbek, they have one thing in common. They do not want charity. They want a chance. They do not want solutions imposed from without. They want the opportunity to build from within. They do not want any culture or yours. They want their own. They want a future enriched by the inheritance of their past. (Wolfensohn, 1997)
Connecting with the families, listening to their stories and discussing their beliefs and expectations is vital to the success of interaction with the refugee group as well as the families and workers based in Bhutan. The role of ‘guide on the side’ is one that the author has found most useful in these situations. Both groups have the vision of the life they wish for; the role of the occupational therapist as volunteer is often to provide information and access to options, services and support, to exchange experiences and facilitate the acquisition of skills that achieve this success.
Acknowledgements I would like to express my appreciation and thanks to the staff and communities of Toowoomba Refugee and Migrant Service, Ability Bhutan and Philippa Tolmie and Cathy McBryde for their encouragement and support in the presentation of this article.
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