Occupational therapists working in Africa have developed unique skills to enable them to continue delivering services, despite having to cope with abject poverty and lack of resources.

Editors: 
V Alers (MSc OT, BA Soc Work.) Director, Acting through Ukubuyiselwa)

R Crouch (PhD OT)  Mellon Research Mentor, University of the Witwatersrand)

Book Information:
Publisher:  Sarah Shorten Publishers
Publication Date: 2010
ISBN no:  978 0 620 46486 4
Paperback
No of pages:  344 pages
Price:   R380 (OTARG Website)

This long-awaited book aims at giving a voice to occupational therapists from Africa.  It is the culmination of a dream of the members of the Occupational Therapy Africa Regional Group (OTARG) who, since its inception in 1966, visualised an “All African book on occupational therapy” (p16).

Occupational therapists working in Africa have developed unique skills to enable them to continue delivering services, despite having to cope with abject poverty and lack of resources.  The “rich diversity of cultures, traditions and spirituality” (p17) in Africa and its influence on occupational therapy have been well described in this book, showing clearly how exciting and rewarding practising in Africa can be!  Contributors include occupational therapists practising in countries such as Zambia, Malawi, Tanzania, Uganda and South Africa as well as international authors, many of whom are well-recognised locally and internationally for their contributions to occupational therapy. 

The book consists of three parts:

Part one: Introduction. 
In Chapter one, the results of a survey of therapists on OTARG’s mailing list are discussed.  This chapter provides valuable insights as to the service settings in which occupational therapists work in both rural and urban areas in Africa, as well as the diversity of roles these therapists fulfil in their daily work, truly giving a voice to the occupational therapists participating in this study.

Part two: The African Context.
Chapters two and three highlight the impact of culture on our occupations and emphasise not only the importance of cultural competence, but also the African occupational therapists’ ability to adapt to different cultures.  The impact of poverty and the African worldview on occupational therapy theory is discussed. 

Chapter four describes the importance of a multidisciplinary approach in an African context of limited resources and emphasises the importance of team members such as the family and other non-traditional partners.  Case studies illustrate how each client needed the OT to work with different “team members” in a unique way to ensure the best outcome.

Part three: Theory into practice
Chapter five describes the impact of poverty on occupational therapy services, assisting practitioners with strategies that will enable them to make a difference to service-users, as well as providing information on resources to combat the isolation that often faces therapists working in under-serviced and –resourced areas.  Case studies illustrate different strategies to prevent the harsh effects of poverty.

Chapter six provides fundamentals, illustrated by case studies, on clinical reasoning and is aptly entitled: thinking in practice.  This chapter explains the essence of clinical reasoning in simple, easily understandable language without detracting from the importance of “think[ing] carefully, evaluat[ing] the situation and decid[ing] on the most appropriate course of action” (p112).

Chapter seven provides invaluable information on the construction, production and use of low-cost assistive devices, aids and adapted equipment.  Pictures and diagrams illustrate what these low-cost devices look like.  Devices for use by adults and children are described and range from toys to adaptations to the home, devices for personal management and posture.  A section on equipment donated from overseas provides pointers for safe usage thereof.

Chapter eight contributes to the knowledge-base of occupational therapy based on experiences of therapists practising in Tanzania.  It describes a model of practice used in East Africa for mentally and physically challenged children.  Diagrams elucidate the text and provide information on posture, seating, personal management and low-cost toys.

Chapter nine provides information on forensic occupational therapy for women and children and has a strong emphasis on the human rights of the imprisoned clients.  The chapter describes the possible role of the occupational therapist working in a forensic setting, using two examples – one from Zambia, working with mentally ill prisoners and the other from Sudan, working with the children of imprisoned mothers.  This chapter provides valuable insights into the roles of the occupational therapist providing services to these very vulnerable populations.

Chapter ten describes occupational therapy with children with developmental delay.  First, an overview of the areas of development is given, after which, causes of developmental delay are discussed, followed by a discussion of occupational therapy intervention for children with physical, cognitive and social developmental difficulties.

The importance of early childhood intervention to minimise the impact of disabilities from a South African perspective, is discussed in Chapter eleven.  Various challenges in early childhood intervention are described as well as considerations for intervention.  The importance of play and providing positive experiences for children with disabilities are emphasised throughout the chapter.  Pictures and a case study are used to apply the information provided in the chapter.

Chapters twelve and thirteen provide valuable insights into the impact of HIV on human occupations and the role of the occupational therapist in palliative care settings in Africa.  The importance of both practice settings cannot be denied and case studies are used in both chapters to illustrate the role and value of the occupational therapist.

Chapter fourteen describes the role of the occupational therapist working with trauma survivors and explains the cultural aspects of trauma in an African context, with reference to aspects such as the importance of the traditional health practitioner, bewitchment and ancestral influences in the resolution of traumatic events, stigma, etc.  Different interventions are discussed, including group work and debriefing.  The chapter ends with a section in which pointers are given on sustaining community support groups.

The “vital role of occupational therapy” (p286) in psychiatry and mental health is discussed in Chapter fifteen, with reference to the prevalence of mental illness in Africa and cultural influences on mental illness, against the backdrop of poverty, lack of resources and poor service delivery (particularly in rural areas).  The impact of mental illness on occupational performance is discussed.  Case studies and pictures illustrate occupational therapy intervention with clients with mental illness, emphasising engagement in meaningful activities.

Chapters sixteen and seventeen provide invaluable information about developing services and focuses on the development of a Community Based Rehabilitation programme, whereas chapter seventeen focuses on developing occupational therapy services where previously there had been no service or infrastructure.  Both these chapters will provide essential information not only to newly qualified therapists embarking on community service, but also experienced therapists developing new services in under-resourced communities and areas.

This book is written in a comfortable, easily readable language and provides examples of the different occupations in which Africans engage, with emphasis on the diversity in each occupation because of culture, traditions and spirituality.  There are interesting reflections on occupational therapy theory in an African context characterised by a participative rather than individual culture and a worldview that considers the influence of the ancestors and witchcraft on the life journey of the individual and community.  Full colour pictures and monochrome diagrams on almost every page of this book illustrate not only the context in which we practise in Africa, but also the ingenuity and innovation of occupational therapists and clients in Africa.  Throughout the book, the impact of the culture and worldview of Africans as well as the impact of poverty not only on service-users, but also on the provision of services is highlighted, all the while celebrating the ingenuity and creativity of occupational therapists in and from Africa. 

Whilst entire chapters are dedicated to traditional practice areas of psychiatry and paediatrics, the only limitation of this book lies in the fact that there are no chapters dedicated to  neurology and biomechanical rehabilitation in Africa.  Limited information can be gleaned from the chapter on low-cost assistive devices and equipment for the rehabilitation of physical conditions in Africa.

This book provides an informative and inspiring reading experience and is bound to become a highly sought-after resource for every practitioner wanting to practise in Africa – student, occupational therapist and occupational therapy technician/assistant alike.

Royalties from the sale of Occupational Therapy: An African Perspective will accrue to OTARG to be used for bursaries for African occupational therapists to attend the OTARG Congresses.  It is available via the OTARG website, as well as from selected Van Schaik bookstores and the editors.