Maximizing Independence: Occupational Therapy in Tamil Nadu, India

Nathan Menezes

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In January 2019, I travelled to Tamil Nadu, India to complete a fieldwork placement (in Occupational Therapy). I have always wanted to travel abroad and work in a low-resource setting. After much exposure in a North American setting, I thought it was time to challenge myself in a country such as India. To be exposed to a whole new way of life, religion, political climate, culture, and inequities, is something in itself and a humbling experience to say the least.

I spent two months at Amar Seva Sangam (ASSA), an organization dedicated to serving those with disabilities. At ASSA, I worked in the special school (pediatric population with physical and mental disabilities) as well as the spinal cord unit (adults with SCI injury). I would see these clients daily to work on goals to achieve maximum independence with daily living. Therapy sessions would include transfer training, wheelchair training, fine motor exercise and activities, upper extremity strengthening, edema control, and adaptive tool training.

The experience was totally different from that of Canada which took some getting used to. For one, getting things done in India is extremely slow. I requested wheelchair modifications to be done for my client, but the process took well over two weeks. During this time I visited the labouring units frequently to check on my requests and push to get things underway. From this experience I learned to do things on my own if I wanted them done in time for my clients. From this I learned to be creative and work on my design/build OT enablement skills. In addition, working with translators was challenging, especially when the translator was a patient and a friend to the rest of the patients in the unit. I questioned if I should probe into personal items/mental health during my assessments with clients as patient confidentiality was compromised because of this. I realized I was not there to impose my western views and went with the flow.

Going into an international fieldwork placement I always wondered whether I was doing more harm than good, and if what I was doing was sustainable. To my surprise, a patient shared that they “are excited to have us providing therapy because for once they are now hopeful that things may get better.” This stuck with me throughout my fieldwork placement, because I felt the clients were appreciative and grateful for the therapy I was providing. In addition, since arriving back home, I have been receiving positive follow-up messages from local staff about the progress of my previous clients. This is truly humbling. I made efforts to ensure my therapies were sustainable and will be carried out once I departed from ASSA. They have continued as planned and my clients have benefited from them.

Here’s a little bit of advice for those interested in participating in international fieldwork:

  1. A lot of your practices in a low-resource/non-western setting may not exactly be evidence based, but that is okay. Using your clinical expertise in combination with evidence based therapy is useful here.

  2. Don’t impose your western views. We cannot assume that what we do here in Canada is best practice. There is more than one way of doing things, so go in with a open mind and experience it all!

  3. Go for fieldwork, but don’t do just that! Experience the culture, food, travel, do like the locals. It becomes a truly enriching experience when you are able to soak it all in.

  4. Acknowledge your privilege and power as a Canadian student. I was reminded of this during fieldwork often - to use my power as a Canadian student to get things done my way etc. But I did not want to exercise this, instead I worked to dismantle it.

  5. A lot of standardized assessments were developed in North America, and thus are not suitable to use/appropriate in this setting. It is okay to adapt your own version of this to collect and document pertinent client information.



Nathan Menezes is a masters student in Occupational Therapy at McGill University. He holds a bachelors degree in Kinesiology from Western University. His ultimate goal is to become an occupational therapist and pursue further studies in global health epidemiology with a focus on disability, rehabilitation, and disaster management