In Praise of 'Filling the Gaps': The Occupational Therapy Samizdat
Butler, Mary, New Zealand Journal of Occupational Therapy
Grace has been relieved of (some of) her usual responsibilities as editor in order to allow the editorial board to honour her achievement of the Frances Rutherford Award. This is the highest honour the profession in New Zealand gives and Grace is a worthy recipient. Her work speaks in a timely way to the issue of responding to threats faced by disability groups served by occupational therapists. Grace's journey points to a consistent recognition of the necessity to position herself in order to make a difference in practice: "good intentions are all very well but knowledge is power." She has come a long way from the volunteer that she once was, to a position where her voice is now listened to in practice, policy and in the media. In the beginning, her interest was in the health of older people, and as a result of her work in the community she became increasingly aware of the injustice that prevails in health services and social care systems with regards to people with dementia. The mixture of humility, social conscience and total faith in the philosophy of occupational therapy is a potent one and she epitomises the essence of good practice.
The work of visionary and leading practitioners is always one of 'filling the gaps' and responding to need in the best sense of the underground practice described originally by Mattingly and Fleming (1994). This underground practice was recently compared to the samizdat movement (G. Gillett, personal communication, February 18, 2011), which is the literature that was suppressed by the Soviet Government. This was clandestinely written, printed and distributed, using primitive methods of photocopying and typing up material. Occupational therapy methods can seem similarly primitive, but what is delivered in the process through our 'underground practice' is deeply valuable to those we serve. In the context of this samizdat analogy it may be useful to see 'filling the gaps' as less a criticism and more a way of living in an imperfect world alongside those we serve. The samizdat movement now has its legacy in the world of electronic communication, which has played a vital role in recent uprisings related to occupational and social injustice in Tunisia, Egypt and Libya.
It seems that by identifying with and fighting for particular disability groups it becomes possible to develop a finely honed perception of the systemic barriers faced by these groups in engaging in occupation. Grace was driven by her perception of the "injustice which prevails in society, and more specifically the health system, in regards to people with dementia," to shape her practice in ways that are akin to the samizdat. As she points out, "people do not need help with the small stuff" so she has constantly worked at every level to facilitate the capacity for engagement in this group. This led her to find ways of witnessing her truth to the medical community in ways that shaped their practice. Clearly the removal of a steady diet of anti psychotics from the population with dementia in rest homes is an unmitigated good that can be supported by any medical practitioner. However, it is rare and empowering to hear of an occupational therapist speaking so strongly about the value of engagement to the wider medical community, and being listened to. It was stories like this that moved some mature practitioners in the audience to unsentimental tears. The counter narrative in the audience was about the erosion of services that have been painfully built up over years. Those tears came from a place that recognised defeat in one area does not mean that failure is inevitable. We need this reminder that it is possible to muddle through with our samizdat practice and that some of us will sometimes succeed.
The other keynote papers, all of which are published verbatum, provided significant messages in support of the underground practice. …