Abstract

PIP: Provision of occupational therapy consultant services to developing countries requires sensitivity to cultural and health conditions of the host country. There is pressure to export specialized services, but there are questions about whether the Western biomedical model is appropriate in settings where primary health care is inadequate and specialized services would only reach a privileged few. The recommendation is for consultants to first conduct a culturally sensitive assessment to provide information on the patterns of morbidity and mortality, 2) the patterns of health care service distribution, and 3) the potential to sustain occupational therapy service for a long time. As much time should be spent on familiarizing oneself with the health and health care system of the population, including regional differences, while planning what services are needed. Showpiece services should be avoided and replaced with health units in poverty areas or rural communities where need is greatest. Occupational therapy can be sustained if there is a need for services compared with other services, if there is an appropriate government infrastructure, and if there is the ability to provide real employment opportunities. In countries where there are few resources, several strategies are suggested. Rehabilitation services should be developed after identifying the extent and nature of disabilities. Another strategy is to develop a comprehensive rehabilitation plan rather than a specialized occupational therapy plan which is aware of other development links and prevention. A comprehensive plan would include identifying the cooperative roles for therapists and the potential employment in government and private practice. Suggestions might be made for developing curricula and clinical fieldwork and for developing culturally sensitive educational materials for health care professionals. A 3rd strategy is to prioritize needs, i.e., a university specializing in pediatrics and malnutrition related diseases and the special needs of the elderly. Prevention is the most effective approach to disability, and area which developed countries have paid little attention to. Dietary supplements, vaccination, and early detection and screening are examples of preventive approaches. A variety of models should be considered, i.e., the Federal University of Minas Gerais Belo Horizonte, Brazil's educational model.