Abstract
An immigrant Somalia woman with bipolar disorder leads an impoverished life with her three children in an estranged living environment. This case study report aims to illustrate how occupational therapy emphasizes cultural needs and addresses strategies to cope with occupational injustice through health literacy and intervention model enabling the client to perceive her problems and take steps to transform.
Introduction
Karly is a 30-year old woman recently emigrated from Somalia. She is able to speak and read a minimal amount of English. She works three part-time, minimum wage jobs to maintain her family. She is a timid woman, who neglects her medical checkup in order to secure her job which is the only source of livelihood to her and the children. She exploits her energy in commuting, performing chores, running errands at her workplaces and lacks sleep. She refrains to complain of unhealthy conditions to the landlord for fear of being evicted. She panics about the safety and security of her children due to scarcely inhabited living locale invaded by strangers and criminals. Her children are of course responsible, but effective parenting can rescue agony and support her in her strife.
Karly’s case reveals her underpaid assignments in all the three firms she is working with. She receives very little financial assistance from her husband. She has a history of bipolar disease and has to go for her medical checkup every 4-6 weeks, which she will sometimes forget to go to. Her medical appointments also occasionally affect her getting to work on time. Her bosses are not pleased and deduct from her pay for tardiness. Karly lack of eligibility to government assistance makes her timid to reveal her illness to her employers out of fear of being fired. Occupational justice is a term that emphasizes rights, responsibilities, and liberties that enable the individual to experience health and quality of life through engagement in occupations (Townsend & Whiteford, 2005; Wilcock and Townsend, 2000).
Analysis of occupational performance
The case of Karly shows the cultural lineage of women in Somalia. The woman’s role is very important-- and when not fulfilled, the whole family suffers. She works 5 days a week and typically gets home around 10:00 pm, depending on the bus system and takes on rotating weekends, to generate little extra money for the family. She is not taking her medications in a consistent manner as prescribed by her physician.
She rises early, completes her chores and walks the distance with her children to catch the school bus before she goes to work. Her children are responsible for each other until their mother comes home from work, which again is typically very late.
Occupational injustices and deprivation occur when people are denied the physical, social, economic, or cultural resources or opportunities to be engaged in these meaningful occupations. Conversely, the individual may be involved in too many occupations such as the case of Karly, a single parent with multiple family and work demands.
Intervention plan
Karly’s educational background and culturally dependent personality has limited her from exploring opportunities. Advocacy is a suitable intervention according to the analysis of the occupation profile. In this process the client works in collaboration with the practitioner to take every effort that directs to transformation of self and skills. Occupational therapy intervention focuses on creating or facilitating opportunities to engage in occupations that lead to participation in desired life situations (AOTA, 2008). The main objective of this intervention is to promote occupational justice and empowers to explore opportunities and resources to fully participate in daily life occupations.
Approaches to intervention
The intervention plan is suitably processed with intervention approach. In her case, Prevention (Disability Prevention) is appropriate. This intervention approach is designed to address the needs of clients, who are at the risk for occupational performance problems. This approach is designed to prevent the occurrence or evolution of barriers to performance in context. Interventions may be directed at client, context, or activity variables (adapted from Dunn et al., 1998, p.534). Hence the practitioner works with Karly’s health initiative and prevention activities, which include training, and promoting participation in after-work group activities.
Intervention Implementation
The implementation of prevention necessitates education, orientation, active participation of the client. Education or health promotion efforts designed to identify, reduce, or prevent the onset and reduce the incidence of unhealthy conditions, risk factors, diseases, or injuries (AOTA, 2013b). Practitioners use the information about clients gathered during the evaluation and theoretical principles to direct occupation-centered interventions. Intervention is then provided to assist clients in reaching a state of physical, mental, and social well-being; identifying and realizing aspirations; satisfying needs; and changing or coping with the environment.
Health promotion is “the process of enabling people to increase control over, and to improve, their health” (WHO, 1986). Karly suffers bipolar disorder, which can cause extreme mood swings that include emotional highs and depression. Being a single parent and limited employability, the occupational therapy focuses on improving her life and persona.
Review of the intervention plan and progress toward targeted outcomes
The practitioner’s knowledge of the personal context working with a client of an ethnic cultural background requires is imperative to achieve positive outcomes. Personal context refers to demographic features of the individual, such as age, gender, socio economic status, and educational level that are not part of a health condition (WHO, 2001). In addition, when patients lack the ability to understand and act upon medical information, it can put their health at risk. Training in health literacy, plain language, and culture and communication is essential for anyone working in health information and services.
Outcomes
Karly’s participation in advocacy and self-advocacy interventions not only help her improve her well-being, but also opens door for a new world of opportunities to relate to people and community, which can provide her the substantial support and prevent alienation. Occupational alienation can occur when people are required to participate in occupations they find meaningless with little recognition or reward.
Occupational marginalization, by understanding and addressing the specific justice issues within a client’s discharge environment, occupational therapy practitioners promote therapy outcomes that address empowerment and self-advocacy.
Oppression is when individual fails to exploit opportunities due to lack of skills and support. As the name implies, Karly exhibits dependency, submissive behavior, sensitive to criticism or disapproval, relying on others to make decisions. She fears rejection and expulsion, typically lacking in self-confidence. In the case of Karly, the advocacy intervention contributes to prevention of occupational problems, eliminates fear, and builds relationship, confidence and improved focus on health and family.
Conclusion
Karly’s case and intervention strategies are designed to help the family unit function in more positive and constructive ways by exploring patterns of communication to advocate health literacy and providing support and education. Application of incremental steps that are context specific works towards the larger goal of occupational justice. It is our hope that by framing the issues the clients face in occupational injustice terms, and providing a framework for addressing the injustices, we can promote further dialogue on ways we can address issues of occupational justice in our daily work lives.
References
American Occupational Therapy Association. (1989). Uniform terminology for occupational therapy (2nd ed.).
Cornett, S., (Sept. 30, 2009) "Assessing and Addressing Health Literacy" OJIN: The Online Journal of Issues in Nursing Vol. 14, No. 3, Manuscript 2.
World Health Organization. (2001). International classification of functioning, disability and health. Geneva: Author.
World Health Organization. (2006). Constitution of the World Health Organization (45th ed.). Retrieved from http://www.afro.who.int/index.php?option=com_docman&task=doc_download&gid=19&Itemid=2111WHO 2006
