Occupational Therapy Student's Fieldwork Placement: Institutional and Community Based Rehabilitation Models in the Solomon Islands

Article excerpt

Occupational therapists are concerned with the health and well being of people challenged by adversity within any community. Adversity can take many forms such as: disease, disability, societal rejection due to religion, poverty, adversive governments, war, natural disasters, persistent and unyielding weather conditions and many others. Occupational therapists work with disadvantaged communities in wealthy developed nations as well as in poorly developed countries around the world (World Federation of Occupational Therapists, 2004).

Thibeault (2006) introduced the profession to the term 'majority world' referring to the nations of the world that are unable, or unwilling to adequately sustain a healthy lifestyle for all people living therein. The majority world lives with inequity and a lack of services in the field of health, education, human services and basic infrastructure. Thibeault highlighted social justice, equity of resources and individualized meaning within occupations, as core values within the profession. Such values serve occupational therapists well as they expand service provision to nontraditional settings, marginalized populations and communities in the majority world. Communication about cross cultural work experiences in disaster regions, developing and marginalized communities where people experience occupational apartheid, injustice and deprivation is growing (Kronenberg, Salvador, & Pollard, 2005).

This paper describes the first hand experience of an occupational therapy student who, with another student, completed a 10 week fieldwork placement in Honiara, Solomon Islands. The placement was the final fieldwork requirement of the four year Bachelors in Health Science in Occupational Therapy, at La Trobe University, Melbourne Australia. At the time of this placement, physiotherapy was well established within the local hospital in Honiora, and provided on site supervision for the occupational therapy students. Supervision by an occupational therapist was not an option because although the first indigenous occupational therapist had completed her training in New Zealand and returned to the region, she had to wait for an official start date from the Government before commencing paid employment. The occupational therapist started work six weeks into the student's placement following official confirmation of employment.

A faculty member at La Trobe Univeristy (second author) provided distance supervision via email. Because it was the final year of study, the student was expected to extend her knowledge and skills through preset, self directed goals in a contractual agreement with her supervisor. A description of both institutional and community based rehabilitation (IBR and CBR respectively) is given because the student contributed to provision of occupational therapy service within these two models. An overview of the differences between Australia and Solomon Islands will also be presented to contextualize the cross cultural exchange between the student and local people involved in the project.

Majority world: Health and rehabilitation strategies

The World Health Organization (WHO) estimates that less than 5% of the world's 480 million people living with a disability have access to medical and rehabilitation services (WHO, 2005b). Consequently, the WHO promotes the right to equal opportunity and the active participation of people with disabilities within their communities, and acknowledges the relationships between health, disability and poverty (WHO, 2004). Community based rehabilitation (CBR) is a WHO community development strategy that seeks to equalize opportunities for people living with a disability. The goals and philosophy of CBR are compatible with the values, goals and philosophy of the occupational therapy profession (Fransen, 2005; WFOT, 2004).

CBR seeks to provide access to community benefits such as work and education, increase availability of rehabilitation and health services, and improve the overall social inclusion of people with disabilities (WHO, 2004). …